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Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. J Orthop Res 2024; 42:578-587. [PMID: 37814893 DOI: 10.1002/jor.25699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.
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Affiliation(s)
- Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Steven B Soliman
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Annett Dalbøge
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
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Lawrence RL, Richardson LB, Bilodeau HL, Bonath DJ, Dahn DJ, Em MA, Sarkar S, Braman JP, Ludewig PM. Effects of Scapular Angular Deviations on Potential for Rotator Cuff Tendon Mechanical Compression. Orthop J Sports Med 2024; 12:23259671231219023. [PMID: 38435717 PMCID: PMC10906059 DOI: 10.1177/23259671231219023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/14/2023] [Indexed: 03/05/2024] Open
Abstract
Background One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration. Purpose To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction. Study Design Descriptive laboratory study. Methods Three-dimensional bone models were reconstructed from computed tomography scans obtained from 10 asymptomatic subjects and 9 symptomatic subjects with a clinical presentation of impingement syndrome. Models were rotated to average scapular orientations from a healthy dataset at higher (120°) and lower (subject-specific) humeral elevation angles to investigate internal and subacromial impingement risks, respectively. Incremental deviations in scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt were imposed on the models to simulate scapular movement impairments. The minimum distance between the rotator cuff insertions and potential impinging structures (eg, glenoid, acromion) was calculated. Two-way mixed-model analyses of variance assessed for effects of scapular deviation and group. Results At 120° of humerothoracic elevation, minimum distances from the supraspinatus and infraspinatus insertions to the glenoid increased with ≥5° changes in upward rotation (1.6-9.8 mm, P < .001) or external rotation (0.9-5.0 mm, P≤ .048), or with ≥10° changes in anterior tilt (1.1-3.2 mm, P < .001). At lower angles, ≥20° changes in most scapular orientations significantly increased the distance between the supraspinatus and infraspinatus insertions and the acromion or coracoacromial ligament. Conclusion A reduction in scapular upward rotation decreases the distance between the rotator cuff tendon insertions and glenoid at 120° humerothoracic elevation. Interpretation is complicated for lower angles because the humeral elevation angle was defined by the minimum distance. Clinical Relevance These results may assist clinical decision making regarding the effects of scapular movement deviations in patients with rotator cuff pathology and scapular dyskinesia and may help inform the selection of clinical interventions.
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Affiliation(s)
- Rebekah L. Lawrence
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura B. Richardson
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hannah L. Bilodeau
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dane J. Bonath
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel J. Dahn
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary-Ann Em
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanjay Sarkar
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P. Braman
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit Michigan
| | - Paula M. Ludewig
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
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Imai T, Nagamatsu T, Kawakami J, Karasuyama M, Harada N, Kudo Y, Madokoro K. Effects of elevation on shoulder joint motion: comparison of dynamic and static conditions. Clin Shoulder Elb 2023; 26:148-155. [PMID: 37316175 DOI: 10.5397/cise.2022.01319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. METHODS The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. RESULTS At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°- 120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. CONCLUSIONS Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions. Level of evidence: Level III, diagnostic cross-sectional study.
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Affiliation(s)
- Takaki Imai
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare, Kumamoto, Japan
| | - Takashi Nagamatsu
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare, Kumamoto, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Masaki Karasuyama
- Department of Rehabilitation, Minamikawa Orthopedic Hospital, Fukuoka, Japan
| | - Nobuya Harada
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Yu Kudo
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Kazuya Madokoro
- Department of Physical Therapy, Technical School of Medical and Welfare Ryokuseikan, Saga, Japan
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Lawrence RL, Saini G, Staker JL, Ludewig PM. Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification. Braz J Phys Ther 2023; 27:100505. [PMID: 37167904 DOI: 10.1016/j.bjpt.2023.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Recent evidence suggests that internal impingement, or rotator cuff tendon deformation against the glenoid, occurs during overhead motions and may therefore be a mechanism of pathology even in non-athletes. Clinically, knowing how movement impacts potential injury mechanisms would be useful to guide movement-based treatment strategies. OBJECTIVE To compare the distance between the glenoid and rotator cuff footprint between two groups classified based on scapulothoracic upward rotation (UR) magnitude (i.e., low, high) at 90° humerothoracic elevation. METHODS Shoulder kinematics were quantified during scapular plane abduction in 60 participants using single-plane fluoroscopy. Of these, 40 were subsequently classified as having high or low scapulothoracic UR based on the sample's distribution. The minimum distance between the glenoid and rotator cuff footprint was calculated along with the locations of closest proximity (i.e., proximity centers). Minimum distances and proximity center locations were compared between groups using 2-factor mixed-model ANOVAs. The prevalence of glenoid-to-footprint contact was also compared. RESULTS Glenoid-to-footprint distances consistently decreased as humerothoracic elevation angle increased, and the anterior aspect of the footprint was closest to the posterosuperior glenoid. Minimum distances were not significantly different between UR groups (p≥0.16). However, group differences existed in proximity center locations (p<0.01). Glenoid-to-footprint contact was identified in 75.0% of participants at an average (SD) of 133.6° (3.2°) humerothoracic elevation. CONCLUSION The results of this study suggest that decreased UR as classified and assessed in this study does not significantly impact glenoid-to-footprint distances but does alter the location of the contact, which occurred in most participants.
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Affiliation(s)
- Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, MSC 8502-66-1101, St. Louis, MO 63108, USA; Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA.
| | - Gaura Saini
- Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
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Lawrence R, Soliman SB, Roseni K, Zauel R, Bey MJ. In vivo evaluation of rotator cuff internal impingement during scapular plane abduction in asymptomatic individuals. J Orthop Res 2023; 41:718-726. [PMID: 35880416 PMCID: PMC9877247 DOI: 10.1002/jor.25423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Internal impingement-or entrapment of the undersurface of the rotator cuff tendon against the glenoid during overhead activities-is believed to contribute to articular-sided tears. However, little is known about internal impingement outside athletic populations. Therefore, the objectives of this study were to (1) describe glenoid-to-footprint distances and proximity centers during dynamic, in vivo motion in asymptomatic individuals, and (2) determine the extent to which these measures differed between individuals with and without a rotator cuff tear. Shoulder kinematics were assessed in 37 asymptomatic individuals during scapular plane abduction using a high-speed biplane radiographic system. Glenoid-to-footprint distances and proximity center locations were calculated by combining the kinematics with computerized tomography-derived bone models. Glenoid-to-footprint contact was presumed to occur when the minimum distance was less than the estimated labral thickness. The condition of the supraspinatus tendon (intact, torn) was assessed using ultrasound. Minimum distances and proximity centers were compared over humerothoracic elevation angles (90°, 110°, 130°, 150°) and between supraspinatus pathology groups using two-factor mixed model analysis of variances. Glenoid-to-footprint minimum distances decreased consistently across elevation angles (p < 0.01) without a significant difference between groups. Contact was estimated to occur in all participants. Proximity centers were generally located on the anterior half of the rotator cuff footprint and on the posterosuperior glenoid. Statement of Clinical Significance: Internal impingement during overhead motions may be a prevalent mechanism of rotator cuff pathology as contact appears to be common and involves the region of the rotator cuff footprint where degenerative rotator cuff tears are thought to originate.
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Affiliation(s)
| | | | - Kevin Roseni
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
| | - Roger Zauel
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
| | - Michael J Bey
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
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Kuniki M, Iwamoto Y, Kito N. Effects of core stability on shoulder and spine kinematics during upper limb elevation: A sex-specific analysis. Musculoskelet Sci Pract 2022; 62:102621. [PMID: 35926474 DOI: 10.1016/j.msksp.2022.102621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Upper limb elevation begins with core stabilization, but the effects of core stability on shoulder and spine kinematics are unknown. Sex differences also exist in shoulder kinematics and core stability. OBJECTIVE To clarify the effects of core stability on shoulder and spine kinematics during upper limb elevation by taking sex into account. DESIGN Cross-sectional. METHODS The Sahrmann Core Stability Test, lumbar spine motor control test battery, and Y Balance Test (lower and upper quarters) were performed in 50 healthy young adults. For each test, a principal component (PC) analysis was conducted according to sex; the overall core stability score was calculated. The top and bottom third of the PC scores were defined as high and low score groups, respectively (each group: nine males and eight females). Shoulder and spine kinematics during upper limb elevation were compared separately for males and females. RESULTS Spinal extension was greater in the low score group by a maximum of 1.9° in males (P < .001; η2 = 0.068) and 1.6° in females (P < .001; η2 = 0.141). In the low score group of females, the scapular posterior tilt was a maximum of 5.6° smaller (P < .001; η2 = 0.221) and glenohumeral elevation was a maximum of 4.5° larger (P < .001; η2 = 0.113) than the high score group of females. CONCLUSION Core stability affected spine and female scapular and glenohumeral kinematics during upper limb elevation. Core stability may be one of the potential contributors to shoulder kinematics, particularly in females.
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Affiliation(s)
- Masahiro Kuniki
- Graduate School of Medical Welfare Sciences, Medical Engineering, Hiroshima International University, 555-36, Kurose-gakuendai, Higashi-hiroshima, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3 Kasumi 1-chome, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, 555-36, Kurose-gakuendai, Higashi-hiroshima, Hiroshima, Japan.
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Peeters I, Braeckevelt T, Palmans T, Van Tongel A, De Wilde L. Kinematic analysis of scapulothoracic movements in the shoulder girdle: a whole cadaver study. JSES Int 2022; 7:147-152. [PMID: 36820418 PMCID: PMC9937811 DOI: 10.1016/j.jseint.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Existing kinematic studies of the shoulder girdle focus on humerothoracic movements. Isolated scapulothoracic movements are also performed during daily activities and rehabilitation but kinematic values are lacking. Methods A kinematic analysis was performed in 14 cadaveric shoulders during protraction, retraction, and shrug. An optical navigation system was used to analyze sternoclavicular, scapulothoracic, and acromioclavicular motions. Results In the sternoclavicular joint, shrug and retraction caused a posterior clavicular rotation of 5° (standard deviation [SD] 6°) and 3° (SD 2°), while protraction induced an anterior rotation of 3° (SD 2°). Shrug caused a large clavicular elevation of 25° (SD 5°). Shrug and retraction caused an increase in retraction of 17° (SD 5°) and 9° (SD 2°). Protraction induced an increase of 10° (SD 2°) toward protraction. In the scapulothoracic joint, shrug induced an increase of 3° (SD 2°) in anterior scapular tilt, and a lateral rotation of 26° (SD 4°). Retraction caused a lateral rotation of 4° (SD 3°). Protraction caused an increase of 7° (SD 2°) in the scapular protraction position, while shrug and retraction demonstrated a decrease of 9° (SD 2°) and 6° (SD 5°). In the acromioclavicular joint, posterior tilting of the scapula compared to the clavicle increased 23° (SD 6°) during shrug, while during protraction an increase of only 4° (SD 3°) was seen. During shrug, relative lateral rotation increased 13° (SD 4°). The protraction movement decreased the relative protraction position with 3° (SD 2°). Conclusion This study provided normative kinematic values of scapulothoracic movements in the shoulder girdle.
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Affiliation(s)
- Ian Peeters
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
- Corresponding author: Ian Peeters, MD, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - Thomas Braeckevelt
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Tanneke Palmans
- Faculty of Medicine and Health Sciences, Department of Rehabilitation sciences, Ghent University, Ghent, Belgium
| | - Alexander Van Tongel
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
| | - Lieven De Wilde
- Faculty of Medicine and Health Sciences, Department of Orthopaedic Surgery and Traumatology, Ghent University, Ghent, Belgium
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Mozingo JD, Akbari-Shandiz M, Van Straaten MG, Murthy NS, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study. J Electromyogr Kinesiol 2022; 62:102350. [PMID: 31481296 PMCID: PMC7036020 DOI: 10.1016/j.jelekin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023] Open
Abstract
Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, -49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1-1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.
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Affiliation(s)
- Joseph D. Mozingo
- Biomedical Engineering and Physiology Graduate Program,
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN,
USA,Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | | | - David R. Holmes
- Department of Physiology and Biomedical Engineering, Mayo
Clinic, Rochester, MN, USA
| | | | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
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Croteau F, Paradelo D, Pearsall D, Robbins S. Risk Factors for Shoulder Injuries in Water Polo: a Cohort Study. Int J Sports Phys Ther 2021; 16:1135-1144. [PMID: 34386291 PMCID: PMC8329310 DOI: 10.26603/001c.25432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Very limited investigations have been conducted exploring risk factors for injury in water polo players. A gap remains in the literature regarding identification of variables that should be considered as part of player screening evaluations. PURPOSE To estimate whether previous injury, changes in strength, range of motion (ROM) or upward scapular rotation (UR) are related to shoulder injuries in water polo players. STUDY DESIGN Descriptive cohort study. METHODS Thirty-nine international-level players participated (19 males). Shoulder internal (IR) and external rotation (ER) peak torque was measured using an isokinetic device (CONtrex MJ). Shoulder ROM was measured passively using standard goniometry. Scapular UR was measured using a laser digital inclinometer. At baseline players were divided into groups: those with and without previous shoulder injuries. Independent t-tests and Mann-Whitney U tests were used to compare the study variables between groups. After nine months, a second analysis compared the same athletes, who were then grouped by those who had or had not sustained new injuries. Effect sizes were calculated with a Hedge's g. Chi squared analysis compared proportion of injured players with and without previous injury. RESULTS Eighteen participants (46%) had previous injuries at baseline. Players with a previous injury showed higher peak torques for IR (0.62±0.15 vs 0.54±0.13N/kg, p=0.04, g=0.60); larger loss of IR ROM (9.9±9.1 vs 4.1±7.5°, p=0.04, g=0.68), but no statistical difference in UR (p=0.70). After nine months, there were no statistical strength differences between groups. Loss of IR ROM was significantly higher in the injured group (9.8±9.8 vs 4.0±6.7°, p=0.04, g=0.68), as well as UR (13.0±3.0 vs 10.4±3.3°, p=0.01, g=0.81). History of previous injury was significantly related to developing a new injury (OR 6.5, p=0.02). Logistic regression found previous injury and UR most important contributors to injury risk. CONCLUSIONS Previous injury, changes in IR ROM and UR are related to new shoulder injuries in water polo, but further variables such as rest, training load, or psychosocial factors may explain the incidence of new injuries. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Félix Croteau
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Institut National du Sport du Québec, Montreal, Quebec, Canada
| | | | | | - Shawn Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Layton-Lethbridge-MacKay Rehabilitation Centre
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Lawrence RL, Zauel R, Bey MJ. Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography. J Vis Exp 2021. [PMID: 33779606 DOI: 10.3791/62210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The shoulder is one of the human body's most complex joint systems, with motion occurring through the coordinated actions of four individual joints, multiple ligaments, and approximately 20 muscles. Unfortunately, shoulder pathologies (e.g., rotator cuff tears, joint dislocations, arthritis) are common, resulting in substantial pain, disability, and decreased quality of life. The specific etiology for many of these pathologic conditions is not fully understood, but it is generally accepted that shoulder pathology is often associated with altered joint motion. Unfortunately, measuring shoulder motion with the necessary level of accuracy to investigate motion-based hypotheses is not trivial. However, radiographic-based motion measurement techniques have provided the advancement necessary to investigate motion-based hypotheses and provide a mechanistic understanding of shoulder function. Thus, the purpose of this article is to describe the approaches for measuring shoulder motion using a custom biplanar videoradiography system. The specific objectives of this article are to describe the protocols to acquire biplanar videoradiographic images of the shoulder complex, acquire CT scans, develop 3D bone models, locate anatomical landmarks, track the position and orientation of the humerus, scapula, and torso from the biplanar radiographic images, and calculate the kinematic outcome measures. In addition, the article will describe special considerations unique to the shoulder when measuring joint kinematics using this approach.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System
| | - Roger Zauel
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System;
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Zago M, Kawczyński A, Klich S, Pietraszewski B, Galli M, Lovecchio N. Fatigue-Induced Scapular Dyskinesis in Healthy Overhead Athletes. Front Bioeng Biotechnol 2020; 8:302. [PMID: 32373599 PMCID: PMC7186350 DOI: 10.3389/fbioe.2020.00302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/20/2020] [Indexed: 11/13/2022] Open
Abstract
Alterations of scapular kinematics affect the whole kinematic chain, potentially leading to the impingement syndrome. This is crucial in overhead sports, where athletes perform frequent and quick upper limb actions. In this manuscript, we aimed to assess the extent to which fatigue alters scapulo-thoracic and scapulo-humeral ranges of motion (RoM), as well as scapulo-humeral movement onset during different upper limb actions. Twenty-four young healthy males aged 22 ± 2 years (height: 1.82 ± 0.06 m, body mass: 78.0 ± 7.8 kg) performed three movements (upper limb elevation, scapular-plane abduction, and intra-extra rotation) before and after an isokinetic fatigue protocol (upper limb intra/extra rotation, 32 repetitions at 120 degrees/s). Pre vs. post fatigue RoM of humeral elevation and rotation, scapular retraction/protraction, and rotation and tilt were computed. Humerus-scapula movement delay was also determined. Humerus elevation range reduced during intra/extra humerus rotation in fatigued conditions (p = 0.006). Scapular tilt RoM increased after the fatigue protocol (p = 0.063, large effect). Humerus-scapular movement onset delay reduced in fatigued conditions of about 80 ms (p < 0.001, large effect). In sum, fatigued intra/extra upper limb rotators altered the scapulohumeral rhythm, and joints RoM in movements outside the scapular plane. Rather, movements close to the scapular plane were less prone to fatigue-induced alterations.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy.,e4Sport Laboratory, Politecnico di Milano, Italy
| | - Adam Kawczyński
- Faculty of Sport Science, University School of Physical Education, Wrocław, Poland
| | - Sebastian Klich
- Faculty of Sport Science, University School of Physical Education, Wrocław, Poland
| | - Bogdan Pietraszewski
- Faculty of Physical Education, University School of Physical Education, Wrocław, Poland
| | - Manuela Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy.,e4Sport Laboratory, Politecnico di Milano, Italy
| | - Nicola Lovecchio
- Department of Public Health, Experimental and Forensic Medicine, The University of Pavia, Pavia, Italy
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Lang AE, Dickerson CR, Kim SY, Stobart J, Milosavljevic S. Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks. Clin Biomech (Bristol, Avon) 2019; 70:223-230. [PMID: 31669920 DOI: 10.1016/j.clinbiomech.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Breast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group. METHODS Fifty women (aged 35-65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05). FINDINGS Breast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80-1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54-0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development. INTERPRETATION Impingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.
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Affiliation(s)
- Angelica E Lang
- Department of Health Sciences, College of Medicine, University of Saskatchewan, Canada
| | - Clark R Dickerson
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Canada
| | - Soo Y Kim
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada
| | - Jamie Stobart
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada
| | - Stephan Milosavljevic
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada.
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Lawrence RL, Braman JP, Keefe DF, Ludewig PM. The Coupled Kinematics of Scapulothoracic Upward Rotation. Phys Ther 2019; 100:283-294. [PMID: 31696926 PMCID: PMC8204887 DOI: 10.1093/ptj/pzz165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/01/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Scapulothoracic upward rotation (UR) is an important shoulder complex motion allowing for a larger functional work space and improved glenohumeral muscle function. However, the kinematic mechanisms producing scapulothoracic UR remain unclear, limiting the understanding of normal and abnormal shoulder movements. OBJECTIVE The objective of this study was to identify the coupling relationships through which sternoclavicular and acromioclavicular joint motions contribute to scapulothoracic UR. DESIGN This was a cross-sectional observational study. METHODS Sixty participants were enrolled in this study; 30 had current shoulder pain, and 30 had no history of shoulder symptoms. Shoulder complex kinematics were quantified using single-plane fluoroscopy and 2D/3D shape matching and were described as finite helical displacements for 30-degree phases of humerothoracic elevation (30 degrees-60 degrees, 60 degrees-90 degrees, and 90 degrees-120 degrees). A coupling function was derived to estimate scapulothoracic UR from its component motions of acromioclavicular UR, sternoclavicular posterior rotation, and sternoclavicular elevation as a function of acromioclavicular internal rotation. The proportional contributions of each of the component motions were also calculated and compared between phases of humerothoracic elevation and groups. RESULTS Scapulothoracic UR displacement could be effectively predicted using the derived coupling function. During the 30- to 60-degree humerothoracic elevation phase, acromioclavicular UR accounted for 84.2% of scapulothoracic UR, whereas sternoclavicular posterior rotation and elevation each accounted for < 10%. During later phases, acromioclavicular UR and sternoclavicular posterior rotation each accounted for 32% to 42%, whereas sternoclavicular elevation accounted for < 11%. LIMITATIONS Error due to the tracking of sternoclavicular posterior rotation may have resulted in an underprediction of its proportional contribution and an overprediction of the proportional contribution of acromioclavicular UR. CONCLUSIONS Acromioclavicular UR and sternoclavicular posterior rotation are the predominant component motions of scapulothoracic UR. More research is needed to investigate how these coupling relationships are affected by muscle function and influenced by scapular dyskinesis.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, and Bone and Joint Center, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202 (USA),R.L. Lawrence, PT, PhD, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, and Bone and Joint Center, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202 (USA). Address all correspondence to Dr Lawrence at:
| | | | - Daniel F Keefe
- Department of Computer Science and Engineering, University of Minnesota
| | - Paula M Ludewig
- PhD, Department of Rehabilitation Medicine, University of Minnesota
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Shoulder kinematics impact subacromial proximities: a review of the literature. Braz J Phys Ther 2019; 24:219-230. [PMID: 31377124 DOI: 10.1016/j.bjpt.2019.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/23/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space. OBJECTIVE The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities. CONCLUSIONS A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.
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