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Klich S, Kristiansen M, Wang HK, Kawczyński A, Larsen RG, Madeleine P. Dependence of Rotator Cuff Muscle Thickness and Stiffness on Low-Level Contractions: Metrology of the Contraction Level Using Shear-Wave Imaging. J Sport Rehabil 2024; 33:542-548. [PMID: 39089674 DOI: 10.1123/jsr.2023-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/22/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The study aimed to investigate the effects of the level of contraction during isometric shoulder abduction at different abduction angles on muscle thickness and stiffness of the shoulder girdle in asymptomatic individuals. DESIGN Measurement properties study. SETTING Biomechanics and motion analysis lab. PARTICIPANTS Twenty individuals volunteered to participate in this study. MAIN OUTCOME MEASURE The subjects were tested for morphological and mechanical properties, expressed by thickness and stiffness of the supraspinatus tendon and muscle, and upper trapezius muscle. Moreover, acromiohumeral distance was also evaluated using B-mode ultrasound and shear-wave elastography. INTERVENTION The thickness and stiffness of the supraspinatus and upper trapezius muscle were assessed at 3 angles of abduction (0°, 60°, and 90°) and 3 levels of contraction (0%, 10%, and 20% of the maximal voluntary isometric contraction) using ultrasonography with shear-wave imaging. Moreover, the acromiohumeral distance was measured to establish the occupation ratio during passive movement. RESULTS The supraspinatus and upper trapezius muscle thickness and stiffness were significantly greater at 60° shoulder abduction compared with 0°, and 90° compared with 60°, as well as significantly greater at 20% maximal voluntary isometric contraction compared with 0% and 10% maximal voluntary isometric contraction. Thickness and stiffness were significantly greater in the supraspinatus compared with the upper trapezius muscle at all 3 angles of shoulder abduction for all 3 level of contractions. The acromiohumeral distance decreased significantly from 0° to 60° and from 60° to 90°. CONCLUSION Morphological and mechanical properties of the supraspinatus and upper trapezius muscles depended on the relative level of muscle contraction and the angle of shoulder abduction.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
| | - Mathias Kristiansen
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Adam Kawczyński
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Ryan Godsk Larsen
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Department of Health Science and Technology, ExerciseTech, Aalborg University, Aalborg, Denmark
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Umehara J, Yagi M, Ueda Y, Nojiri S, Kobayashi K, Tachibana T, Nobuhara K, Ichihashi N. Compensation strategy of shoulder synergist muscles is not stereotypical in patients with rotator cuff repair. J Orthop Res 2024; 42:21-31. [PMID: 37292048 DOI: 10.1002/jor.25641] [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: 11/14/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
Rotator cuff tear is a common shoulder injury that causes shoulder dysfunction and pain. Although surgical repair is the primary treatment for rotator cuff tear, it is well recognized that impaired force exertion of muscles connecting to the involved tendon and subsequent complemental change in the force exertion of synergist muscles persist even after repair. This study aimed to identify the compensation strategy of shoulder abductors by examining how synergist muscles respond to supraspinatus (SSP) muscle force deficit in patients with rotator cuff repair. Muscle shear modulus, an index of muscle force, was assessed for SSP, infraspinatus, upper trapezius, and middle deltoid muscles in repaired and contralateral control shoulders of 15 patients with unilateral tendon repair of the SSP muscle using ultrasound shear wave elastography while the patients passively or actively held their arm in shoulder abduction. In the repaired shoulder, the shear modulus of the SSP muscle declined, whereas that of other synergist muscles did not differ relative to that of the control. To find the association between the affected SSP and each of the synergist muscles, a regression analysis was used to assess the shear moduli at the population level. However, no association was observed between them. At the individual level, there was a tendency of variation among patients with regard to a specific muscle whose shear modulus complementarily increased. These results suggest that the compensation strategy for SSP muscle force deficit varies among individuals, being nonstereotypical in patients with rotator cuff injury.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Ueda
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Faculty of Health Science, Takarazuka University of Medical and Healthcare, Takarazuka, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kotono Kobayashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hoshikawa K, Yuri T, Oishi R, Uno T, Nagai J, Giambini H, Mura N. Muscle belly ratio is the most suitable estimate of the activity of the torn supraspinatus muscle. JSES Int 2023; 7:2373-2378. [PMID: 37969501 PMCID: PMC10638582 DOI: 10.1016/j.jseint.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background A torn rotator cuff muscle deteriorates over time leading with an increase in muscle atrophy and fatty infiltration. There are several clinical assessments for evaluating the atrophy of the torn supraspinatus muscle. However, it is unclear which approach can more accurately estimate the activity of the torn supraspinatus muscle. The purpose of this study was to determine which magnetic resonance imaging-based muscle atrophy imaging assessment currently implemented in the clinical setting accurately estimates the activity of the torn supraspinatus muscle. Methods Forty patients who were diagnosed with a rotator cuff tear and were candidates for repairs were selected for this study. Cross-sectional area, occupation ratio, and tangent sign were analyzed on T1-weighted oblique sagittal plane magnetic resonance images in which the scapular spine leads to the Y-section. Muscle belly ratio of the supraspinatus muscle was analyzed by calculating the ratio of the width of the muscle belly to the distance from the greater tubercle to the proximal end of the muscle on T1-weighted coronal plane magnetic resonance imaging images. Fatty infiltration was evaluated using the Goutallier classification system. Tear size was obtained intraoperatively by measuring the width and length of the tear and classified based on the Cofield's classification. To assess activity of the torn supraspinatus muscle, participants were first instructed to sit on a chair with the affected arm resting on a table and the shoulder abducted to 60° in the scapular plane with neutral rotation. Elasticity of the supraspinatus muscle belly was then obtained at rest and during isometric contraction using with real-time tissue elastography. Muscle activity, a surrogate for contractility, was defined as the difference between the elasticities measured at rest and during isometric contraction. A stepwise multiple regression analysis was used to investigate independent factors, such as sex, tear width, cross-sectional area, occupation ratio, tangent sign, and muscle belly ratio, related to muscle activity. Results Stepwise multiple regression analysis (R2 = 0.522, P < .001) revealed that supraspinatus muscle activity was significantly correlated with muscle belly ratio (β = 0.306, P = .044) and Goutallier stage (β = -0.490, P = .002). Conclusion Estimations of muscle belly ratio are most suitable for assessing the activity of a torn supraspinatus muscle compared to other clinical measurements.
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Affiliation(s)
- Kyosuke Hoshikawa
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan
| | - Takuma Yuri
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Ryuta Oishi
- Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomohiro Uno
- Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jun Nagai
- Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Nariyuki Mura
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Department of Orthopedic Surgery, Yoshioka Hospital, Yamagata, Japan
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Yuri T, Trevino JH, Hoshikawa K, Hooke A, Giambini H. Moment arms of the anatomical subregions of the rotator cuff muscles during shoulder rotation. Clin Biomech (Bristol, Avon) 2023; 107:106040. [PMID: 37429101 DOI: 10.1016/j.clinbiomech.2023.106040] [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: 03/21/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Rotator cuff muscles are responsible for humeral rotation. Moment arms of different regions of these muscles during humeral rotation were analyzed in neutral and abducted positions. METHODS In eight cadaveric shoulders, subregions of the rotator cuff muscles were identified and their excursion during humeral rotation was measured in neutral and abducted positions from an internal rotation of 30° to an external rotation of 45°, with 15° increments, using a 3-D digitizing system. Statistical tests were used to assess differences between subregions within a single muscle. FINDINGS The posterior-deep subregion of the supraspinatus muscle had greater moment arms compared to the anterior-superficial and anterior-middle subregions in both positions (p < 0.001). The middle and inferior subregions of the infraspinatus muscle and the teres minor muscle showed differences in moment arms compared to the superior region in an abducted position (p < 0.042). The superior subregion of the subscapularis muscle showed differences in moment arms compared to the middle and inferior subregions in an abducted position (p < 0.001). INTERPRETATION The posterior-deep subregion of the supraspinatus muscle behaved similar to the infraspinatus muscle, as an external rotator. The anterior-superficial and anterior-middle subregions of the supraspinatus muscle showed a biphasic behavior during rotation at a neutral position, but acted as pure external rotators during rotation at an abducted position. Inferior subregions of the infraspinatus and subscapularis muscles showed the largest moment arms compared to superior subregions. These findings support distinct functional roles of the rotator cuff muscle subregions.
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Affiliation(s)
- Takuma Yuri
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Jose H Trevino
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Kyosuke Hoshikawa
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA.
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Yuri T, Trevino JH, Hooke A, Giambini H. Moment arms from the anatomical subregions of the rotator cuff muscles during flexion. J Biomech 2022; 144:111340. [DOI: 10.1016/j.jbiomech.2022.111340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/18/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
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Hoshikawa K, Yuri T, Giambini H, Mura N, Kiyoshige Y. The functional role of the supraspinatus and infraspinatus muscle subregions during forward flexion: a shear wave elastography study. JSES Int 2022; 6:849-854. [PMID: 36081699 PMCID: PMC9446250 DOI: 10.1016/j.jseint.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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