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Khandare S, Jalics A, Lawrence RL, Zauel R, Klochko C, Bey MJ. A novel 3D MRI-based approach for assessing supraspinatus muscle length. J Biomech 2024; 168:112110. [PMID: 38677025 DOI: 10.1016/j.jbiomech.2024.112110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/22/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
Rotator cuff (RC) tears are a common source of pain and decreased shoulder strength. Muscle length is known to affect muscle strength, and therefore evaluating changes in supraspinatus muscle length associated with RC pathology, surgical repair, and post-operative recovery may provide insights into functional deficits. Our objective was to develop a reliable MRI-based approach for assessing supraspinatus muscle length. Using a new semi-automated approach for identifying 3D location of the muscle-tendon junction (MTJ), supraspinatus muscle length was calculated as the sum of MTJ distance (distance between 3D MTJ position and glenoid plane) and supraspinatus fossa length (distance between root of the scapular spine and glenoid plane). Inter- and intra-operator reliability of this technique were assessed with intraclass correlation coefficient (ICC) and found to be excellent (ICCs > 0.96). Muscle lengths of 6 patients were determined before RC repair surgery and at 3- and 12-months post-surgery. Changes in normalized muscle length (muscle length as a percentage of pre-surgical muscle length) at 3 months post-surgery varied considerably across patients (16.1 % increase to 7.0 % decrease) but decreased in all patients from 3- to 12-months post-surgery (0.3 % to 17.2 %). This study developed a novel and reliable approach for quantifying supraspinatus muscle length and provided preliminary demonstration of its utility by assessing muscle length changes associated with RC pathology and surgical repair. Future studies can use this technique to evaluate changes over time in supraspinatus muscle length in response to clinical intervention, and associations between muscle length and shoulder function.
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Affiliation(s)
- Sujata Khandare
- Bone & Joint Center, Henry Ford Health, Detroit, MI, USA; University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA.
| | - Alena Jalics
- Bone & Joint Center, Henry Ford Health, Detroit, MI, USA.
| | - Rebekah L Lawrence
- Bone & Joint Center, Henry Ford Health, Detroit, MI, USA; Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Roger Zauel
- Bone & Joint Center, Henry Ford Health, Detroit, MI, USA.
| | - Chad Klochko
- Department of Radiology, Henry Ford Health, Detroit, MI, USA.
| | - Michael J Bey
- Bone & Joint Center, Henry Ford Health, Detroit, MI, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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 RL, Veluswamy B, Dobben EA, Klochko CL, Soliman SB. Predictors of infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear. Skeletal Radiol 2023; 52:695-703. [PMID: 36195776 PMCID: PMC10332804 DOI: 10.1007/s00256-022-04201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine the demographic and clinical factors that predict infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear. MATERIALS AND METHODS A retrospective analysis was performed using the medical records of patients who had a shoulder MRI interpreted by 1 of 3 fellowship-trained musculoskeletal radiologists since the implementation of a standardized MRI 3 T protocol within our healthcare system. Demographic (e.g., age, sex) and clinical data (e.g., tear size, muscle degeneration, co-morbidities) were collected. Patients with an isolated supraspinatus tendon tear (n = 121) were assigned to one of two groups based on whether any infraspinatus muscle degeneration was present. Logistic regression was used to assess the univariate relationships between infraspinatus muscle degeneration and patient and clinical data, while least absolute shrinkage and selector operator (LASSO) logistic regression was used to assess the multivariable relationship. RESULTS Of the patients with an isolated supraspinatus tendon tear, 16.5% had evidence of infraspinatus muscle degeneration. The presence of infraspinatus muscle degeneration was independently associated with cardiovascular disease (P = 0.01), supraspinatus muscle degeneration (P < 0.01), and subscapularis muscle degeneration (P = 0.01). When the multivariable relationship is assessed, supraspinatus muscle degeneration emerged as the only variable of significant importance for detecting infraspinatus muscle degeneration (specificity: 87.1%, sensitivity: 80.0%). CONCLUSION Infraspinatus muscle degeneration is not uncommon in individuals with an isolated supraspinatus tear and is most associated with concomitant supraspinatus muscle degeneration. These findings highlight the need for clinicians to specifically assess the status of each rotator cuff muscle, even when the tendon itself is intact.
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Affiliation(s)
- Rebekah L Lawrence
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, Detroit, MI, USA
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Balaji Veluswamy
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Elizabeth A Dobben
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Chad L Klochko
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
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Braudy R, Atoms B, Coghlan J, Staples M, Moga D, Tollefsrud R, Lawrence RL, Ludewig P, Koehler L. Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer. Arch Phys Med Rehabil 2023; 104:403-409. [PMID: 36202228 DOI: 10.1016/j.apmr.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics. DESIGN Nested case control study. SETTING University Academic Breast Center. PARTICIPANTS Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation. RESULTS Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle. CONCLUSIONS Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.
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Affiliation(s)
- Renata Braudy
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN.
| | - Brittany Atoms
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Jenna Coghlan
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Meaghan Staples
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - David Moga
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Ryan Tollefsrud
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Paula Ludewig
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Linda Koehler
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
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Lawrence RL, Roseni K, Bey MJ. Correspondence between scapular anatomical coordinate systems and the 3D axis of motion: A new perspective on an old challenge. J Biomech 2022; 145:111385. [PMID: 36403529 PMCID: PMC10321460 DOI: 10.1016/j.jbiomech.2022.111385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Several scapular anatomical coordinate systems have been reported in the literature to describe shoulder kinematics. Unfortunately, the use of different conventions hinders comparison across studies. Further, inconsistencies between a coordinate system and the scapula's 3D axis of motion means that scapular motion will be incorrectly attributed to axes about which it did not rotate. The objectives of this study were to: 1) determine the extent to which the axes of four common scapular coordinate system conventions correspond to the 3D axis of scapular motion (i.e., instantaneous helical axis, IHA), and 2) report the prevalence of scapulothoracic gimbal lock for each convention. Shoulder kinematics were tracked during scapular plane abduction in 45 participants using biplane videoradiography. Scapulothoracic kinematics were described using the original convention proposed by van der Helm, the convention recommended by the International Society of Biomechanics (ISB), a glenoid-based coordinate system, and a glenoid-oriented coordinate system. The 3D angle was calculated between the IHA and each axis of the four conventions (IHA-axis angular deviations). A repeated measures ANOVA was used to compare IHA-axis angular deviations between conventions. The glenoid-oriented and ISB conventions resulted in the smallest and largest IHA-axis angular deviations, respectively (21.7°±3.6° vs. 30.5°±5.2°, p < 0.01). Gimbal lock was approached in 17.8% of participants when using the original convention, 2.2% when using the ISB convention, and 0% when using the glenoid-based or -oriented conventions. These findings suggest the glenoid-oriented coordinate system may be worthy of further consideration when investigating shoulder kinematics during scapular plane abduction.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA; Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Kevin Roseni
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Dept. of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
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Lawrence RL, Ruder MC, Zauel R, Jalics A, Olszewski AM, Diefenbach BJ, Moutzouros V, Makhni EC, Muh S, Bey MJ. In Vivo Static Retraction and Dynamic Elongation of Rotator Cuff Repair Tissue After Surgical Repair: A Preliminary Analysis at 3 Months. Orthop J Sports Med 2022; 10:23259671221084294. [PMID: 35387360 PMCID: PMC8978322 DOI: 10.1177/23259671221084294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Rotator cuff repair is a common orthopaedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions. Purpose: To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon’s insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests. Results: At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P = .01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P < .01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion. Conclusion: Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function.
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Affiliation(s)
| | - Matthew C Ruder
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Roger Zauel
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Alena Jalics
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam M Olszewski
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael J Bey
- Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
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Aliaj K, Lawrence RL, Bo Foreman K, Chalmers PN, Henninger HB. Kinematic coupling of the glenohumeral and scapulothoracic joints generates humeral axial rotation. J Biomech 2022; 136:111059. [PMID: 35367838 PMCID: PMC9081276 DOI: 10.1016/j.jbiomech.2022.111059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/22/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Glenohumeral and scapulothoracic motion combine to generate humerothoracic motion, but their discrete contributions towards humerothoracic axial rotation have not been investigated. Understanding their contributions to axial rotation is important to judge the effects of pathology, surgical intervention, and physiotherapy. Therefore, the purpose of this study was to investigate the kinematic coupling between glenohumeral and scapulothoracic motion and determine their relative contributions towards axial rotation. Twenty healthy subjects (10 M/10F, ages 22-66) were previously recorded using biplane fluoroscopy while performing arm elevation in the coronal, scapular, and sagittal planes, and external rotation in 0° and 90° of abduction. Glenohumeral and scapulothoracic contributions towards axial rotation were computed by integrating the projection of glenohumeral and scapulothoracic angular velocity onto the humeral longitudinal axis, and analyzed using one dimensional statistical parametric mapping and linear regression. During arm elevation, scapulothoracic motion supplied 13-20° (76-94%) of axial rotation, mainly via scapulothoracic upward rotation. The contribution of scapulothoracic motion towards axial rotation was strongly correlated with glenohumeral plane of elevation during arm elevation. During external rotation, scapulothoracic motion contributed 10° (8%) towards axial rotation in 0° of abduction and 15° (15%) in 90° of abduction. The contribution of scapulothoracic motion towards humerothoracic axial rotation could explain the simultaneous changes in glenohumeral plane of elevation and axial rotation associated with some pathologies and surgeries. Understanding how humerothoracic motion results from the functional coupling of scapulothoracic and glenohumeral motions may inform diagnostic and treatment strategies by targeting the source of movement impairments in clinical populations.
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Lawrence RL, Ward K, Wall CR, Bloomfield FH. New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study. BMC Pregnancy Childbirth 2021; 21:819. [PMID: 34886814 PMCID: PMC8662890 DOI: 10.1186/s12884-021-04297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04297-0.
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Affiliation(s)
- R L Lawrence
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - K Ward
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C R Wall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F H Bloomfield
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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11
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Saini G, Lawrence RL, Staker JL, Braman JP, Ludewig PM. Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion. Orthop J Sports Med 2021; 9:23259671211036908. [PMID: 34646898 PMCID: PMC8504240 DOI: 10.1177/23259671211036908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles (r = –0.76; R2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.
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Affiliation(s)
- Gaura Saini
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebekah L Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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12
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Ruder MC, Lawrence RL, Soliman SB, Bey MJ. Presurgical tear characteristics and estimated shear modulus as predictors of repair integrity and shoulder function one year after rotator cuff repair. JSES Int 2021; 6:62-69. [PMID: 35141678 PMCID: PMC8811389 DOI: 10.1016/j.jseint.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Rotator cuff repair provides pain relief for many patients; however, retears are relatively common and affect approximately 20%-70% of patients after repair. Although magnetic resonance imaging (MRI) offers the ability to assess tissue characteristics such as tear size, retraction, and fatty infiltration, it provides little insight into the quality of the musculotendinous tissues the surgeon will encounter during surgery. However, shear wave elastography (SWE) could provide an indirect assessment of quality (ie, stiffness) by measuring the speed of shear waves propagating through tissue. The objective of this study was to determine the extent to which estimated shear modulus predicts repair integrity and functional outcomes 1 year after rotator cuff repair. Methods Thirty-three individuals scheduled to undergo arthroscopic rotator cuff repair were enrolled in this study. Before surgery, shear modulus of the supraspinatus tendon and muscle was estimated using ultrasound SWE. MRIs were obtained before and 1 year after surgery to assess tear characteristics and repair integrity, respectively. Shoulder strength, range of motion, and patient-reported pain and function were assessed before and after surgery. Functional outcomes were compared between groups and across time using a two-factor mixed model analysis of variance. Stepwise regression with model comparison was used to investigate the extent to which MRI and shear modulus predicted repair integrity and function at 1 year after surgery. Results At 1 year after surgery, 56.5% of patients had an intact repair. No significant differences were found in any demographic variable, presurgical tear characteristic, or shear modulus between patients with an intact repair and those with a recurrent tear. Compared with presurgical measures, patients in both groups demonstrated significant improvements at 1 year after surgery in pain (P < .01), self-reported function (P < .01), range of motion (P < .01), and shoulder strength (P < .01). In addition, neither presurgical MRI variables (P > .16) nor shear modulus (P > .52) was significantly different between groups at 1 year after surgery. Finally, presurgical shear modulus generally did not improve the prediction of functional outcomes above and beyond that provided by MRI variables alone (P > .22). Conclusion Although SWE remains a promising modality for many clinical applications, this study found that SWE-estimated shear modulus did not predict repair integrity or functional outcomes at 1 year after surgery, nor did it add to the prediction of outcomes above and beyond that provided by traditional presurgical MRI measures of tear characteristics. Therefore, it appears that further research is needed to fully understand the clinical utility of SWE for musculoskeletal tissue and its potential use for predicting outcomes after surgical rotator cuff repair.
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Affiliation(s)
| | | | | | - Michael J. Bey
- Bone & Joint Center, Henry Ford Health System, Detroit, MI, USA
- Corresponding author: Michael J. Bey, PhD, 6135 Woodward Avenue, Detroit, MI 48202, USA.
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13
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Lawrence RL, Ludewig PM, Ward SR. An Integrated Approach to Musculoskeletal Performance, Disease, and Recovery. Phys Ther 2021; 101:6374810. [PMID: 34636897 PMCID: PMC8651066 DOI: 10.1093/ptj/pzab225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA,Address all correspondence to Dr Lawrence at:
| | - Paula M Ludewig
- Divisions of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel R Ward
- Departments of Radiology, Orthopaedic Surgery, and Bioengineering, University of California San Diego, San Diego, California, USA
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14
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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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15
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Lawrence RL, Ruder MC, Moutzouros V, Makhni EC, Muh SJ, Siegal D, Soliman SB, van Holsbeeck M, Bey MJ. Ultrasound shear wave elastography and its association with rotator cuff tear characteristics. JSES Int 2021; 5:500-506. [PMID: 34136861 PMCID: PMC8178591 DOI: 10.1016/j.jseint.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Approximately 20-60% of rotator cuff repairs fail with higher failure rates in patients with larger or more chronic tears. Although MRI provides an objective estimate of tear size, it can only provide qualitative descriptions of tear chronicity. By contrast, ultrasound shear wave elastography (SWE) may assess tear chronicity by estimating tissue mechanical properties (ie, shear modulus). Furthermore, SWE imaging does not share many of the challenges associated with MRI (eg, high cost, risk of claustrophobia). Therefore, the objective of this study was to determine the extent to which estimated supraspinatus shear modulus is associated with conventional MRI-based measures of rotator cuff tear size and chronicity. Methods Shear modulus was estimated using ultrasound SWE in two regions of the supraspinatus (intramuscular tendon, muscle belly) under two contractile conditions (passive, active) in 22 participants with full-thickness rotator cuff tears. The extent to which estimated supraspinatus shear modulus is associated with conventional MRI measures of tear size and chronicity was assessed using correlation coefficients and Kruskal-Wallis tests, as appropriate. Results Estimated shear modulus was not significantly associated with anterior/posterior tear size (P > .09), tear retraction (P > .20), occupation ratio (P > .11), or fatty infiltration (P > .30) under any testing condition. Discussion Although ultrasound SWE measurements have been shown to be altered in the presence of various tendinopathies, the findings of this study suggest the utility of ultrasound SWE in this population (ie, patients with a small to medium supraspinatus rotator cuff tear) before surgical rotator cuff repair remains unclear.
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Affiliation(s)
| | - Matthew C Ruder
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Daniel Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - Steven B Soliman
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Michael J Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
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16
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Lawrence RL, Ruder MC, Zauel R, Bey MJ. Instantaneous helical axis estimation of glenohumeral kinematics: The impact of rotator cuff pathology. J Biomech 2020; 109:109924. [PMID: 32807327 PMCID: PMC7443981 DOI: 10.1016/j.jbiomech.2020.109924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022]
Abstract
The rotator cuff is theorized to contribute to force couples required to produce glenohumeral kinematics. Impairment in these force couples would theoretically result in impaired ball-and-socket kinematics. Although less frequently used than traditional kinematic descriptors (e.g., Euler angles, joint translations), helical axes are capable of identifying alterations in ball-and-socket kinematics by quantifying the variability (i.e., dispersion) in axis orientation and position during motion. Consequently, assessing glenohumeral helical dispersion may provide indirect evidence of rotator cuff function. The purpose of this exploratory study was to determine the extent to which rotator cuff pathology is associated with alterations in ball-and-socket kinematics. Fifty-one participants were classified into one of five groups based on an assessment of the supraspinatus using diagnostic imaging: asymptomatic healthy, asymptomatic tendinosis, asymptomatic partial-thickness tear, asymptomatic full-thickness tear, symptomatic full-thickness tear. Glenohumeral kinematics were quantified during coronal plane abduction using a biplane x-ray system and described using instantaneous helical axes. The degree to which glenohumeral motion coincided with ball-and-socket kinematics was described using the angular and positional dispersion about the optimal helical axis and pivot, respectively. No statistically significant difference was observed between groups in angular dispersion. However, symptomatic individuals with a full-thickness supraspinatus tear had significantly more positional dispersion than asymptomatic individuals with a healthy supraspinatus or tendinosis. These findings suggest that symptomatic individuals with a full-thickness supraspinatus tear exhibit impaired ball-and-socket kinematics, which is believed to be associated with a disruption of the glenohumeral force couples.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA.
| | - Matthew C Ruder
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
| | - Roger Zauel
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
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17
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Kage CC, Akbari-Shandiz M, Foltz MH, Lawrence RL, Brandon TL, Helwig NE, Ellingson AM. Validation of an automated shape-matching algorithm for biplane radiographic spine osteokinematics and radiostereometric analysis error quantification. PLoS One 2020; 15:e0228594. [PMID: 32059007 PMCID: PMC7021291 DOI: 10.1371/journal.pone.0228594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/18/2020] [Indexed: 11/19/2022] Open
Abstract
Biplane radiography and associated shape-matching provides non-invasive, dynamic, 3D osteo- and arthrokinematic analysis. Due to the complexity of data acquisition, each system should be validated for the anatomy of interest. The purpose of this study was to assess our system’s acquisition methods and validate a custom, automated 2D/3D shape-matching algorithm relative to radiostereometric analysis (RSA) for the cervical and lumbar spine. Additionally, two sources of RSA error were examined via a Monte Carlo simulation: 1) static bead centroid identification and 2) dynamic bead tracking error. Tantalum beads were implanted into a cadaver for RSA and cervical and lumbar spine flexion and lateral bending were passively simulated. A bead centroid identification reliability analysis was performed and a vertebral validation block was used to determine bead tracking accuracy. Our system’s overall root mean square error (RMSE) for the cervical spine ranged between 0.21–0.49mm and 0.42–1.80° and the lumbar spine ranged between 0.35–1.17mm and 0.49–1.06°. The RMSE associated with RSA ranged between 0.14–0.69mm and 0.96–2.33° for bead centroid identification and 0.25–1.19mm and 1.69–4.06° for dynamic bead tracking. The results of this study demonstrate our system’s ability to accurately quantify segmental spine motion. Additionally, RSA errors should be considered when interpreting biplane validation results.
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Affiliation(s)
- Craig C. Kage
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Mohsen Akbari-Shandiz
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mary H. Foltz
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rebekah L. Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Taycia L. Brandon
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nathaniel E. Helwig
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
- School of Statistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arin M. Ellingson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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20
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Akbari-Shandiz M, Lawrence RL, Ellingson AM, Johnson CP, Zhao KD, Ludewig PM. MRI vs CT-based 2D-3D auto-registration accuracy for quantifying shoulder motion using biplane video-radiography. J Biomech 2018; 82:375-380. [PMID: 30385001 DOI: 10.1016/j.jbiomech.2018.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models. However, the accuracy of MRI-based 2D-3D registration for quantifying glenohumeral kinematics is unknown. We developed an automatic 2D-3D registration program that works with both CT- and MRI-based image volumes for quantifying joint motions. The purpose of this study was to use the proposed 2D-3D auto-registration algorithm to describe the humerus and scapula tracking accuracy of CT- and MRI-based registration relative to radiostereometric analysis (RSA) during dynamic biplanar video-radiography. The GH kinematic accuracy (RMS error) was 0.6-1.0 mm and 0.6-2.2° for the CT-based registration and 1.4-2.2 mm and 1.2-2.6° for MRI-based registration. Higher kinematic accuracy of CT-based registration was expected as MRI provides lower spatial resolution and bone contrast as compared to CT and suffers from spatial distortions. However, the MRI-based registration is within an acceptable accuracy for many clinical research questions.
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Affiliation(s)
- Mohsen Akbari-Shandiz
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Rebekah L Lawrence
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Arin M Ellingson
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Paula M Ludewig
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA.
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21
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Lawrence RL, Sessions WC, Jensen MC, Staker JL, Eid A, Breighner R, Helwig NE, Braman JP, Ludewig PM. The effect of glenohumeral plane of elevation on supraspinatus subacromial proximity. J Biomech 2018; 79:147-154. [PMID: 30172354 DOI: 10.1016/j.jbiomech.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/12/2018] [Accepted: 08/10/2018] [Indexed: 01/03/2023]
Abstract
Shoulder pain is a common clinical problem affecting most individuals in their lifetime. Despite the high prevalence of rotator cuff pathology in these individuals, the pathogenesis of rotator cuff disease remains unclear. Position and motion related mechanisms of rotator cuff disease are often proposed, but poorly understood. The purpose of this study was to determine the impact of systematically altering glenohumeral plane on subacromial proximities across arm elevation as measures of tendon compression risk. Three-dimensional models of the humerus, scapula, coracoacromial ligament, and supraspinatus were reconstructed from MRIs in 20 subjects. Glenohumeral elevation was imposed on the humeral and supraspinatus tendon models for three glenohumeral planes, which were chosen to represent flexion, scapular plane abduction, and abduction based on average values from a previous study of asymptomatic individuals. Subacromial proximity was quantified as the minimum distance between the supraspinatus tendon and coracoacromial arch (acromion and coracoacromial ligament), the surface area of the supraspinatus tendon within 2 mm proximity to the coracoacromial arch, and the volume of intersection between the supraspinatus tendon and coracoacromial arch. The lowest modeled subacromial supraspinatus compression measures occurred during flexion at lower angles of elevation. This finding was consistent across all three measures of subacromial proximity. Knowledge of this range of reduced risk may be useful to inform future studies related to patient education and ergonomic design to prevent the development of shoulder pain and dysfunction.
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Affiliation(s)
- Rebekah L Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota; 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - William C Sessions
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454, USA
| | - Megan C Jensen
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota; 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota; 420 Delaware St. SE, Minneapolis, MN 55455, USA; Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Aya Eid
- Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - Ryan Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Nathaniel E Helwig
- Department of Psychology and School of Statistics, College of Liberal Arts, University of Minnesota, 375 Ford Hall, 224 Church Street SE, Minneapolis, MN 55455, USA
| | - Jonathan P Braman
- Department of Orthopaedic Surgery, Medical School, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota; 420 Delaware St. SE, Minneapolis, MN 55455, USA; Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
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22
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Lawrence RL, Ellingson AM, Ludewig PM. Validation of single-plane fluoroscopy and 2D/3D shape-matching for quantifying shoulder complex kinematics. Med Eng Phys 2017; 52:69-75. [PMID: 29229406 DOI: 10.1016/j.medengphy.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
Fluoroscopy and 2D/3D shape-matching has emerged as the standard for non-invasively quantifying kinematics. However, its accuracy has not been well established for the shoulder complex when using single-plane fluoroscopy. The purpose of this study was to determine the accuracy of single-plane fluoroscopy and 2D/3D shape-matching for quantifying full shoulder complex kinematics. Tantalum markers were implanted into the clavicle, humerus, and scapula of four cadaveric shoulders. Biplane radiographs were obtained with the shoulder in five humerothoracic elevation positions (arm at the side, 30°, 60°, 90°, maximum). Images from both systems were used to perform marker tracking, while only those images acquired with the primary fluoroscopy system were used to perform 2D/3D shape-matching. Kinematics errors due to shape-matching were calculated as the difference between marker tracking and 2D/3D shape-matching and expressed as root mean square (RMS) error, bias, and precision. Overall RMS errors for the glenohumeral joint ranged from 0.7 to 3.3° and 1.2 to 4.2 mm, while errors for the acromioclavicular joint ranged from 1.7 to 3.4°. Errors associated with shape-matching individual bones ranged from 1.2 to 3.2° for the humerus, 0.5 to 1.6° for the scapula, and 0.4 to 3.7° for the clavicle. The results of the study demonstrate that single-plane fluoroscopy and 2D/3D shape-matching can accurately quantify full shoulder complex kinematics in static positions.
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Affiliation(s)
- Rebekah L Lawrence
- Division of Rehabilitation Science, University of Minnesota, 420 Delaware Street SE MMC 388, Minneapolis, MN 55455, USA .
| | - Arin M Ellingson
- Divisions of Physical Therapy and Rehabilitation Science, University of Minnesota, 420 Delaware Street SE MMC 388, Minneapolis, MN 55455, USA
| | - Paula M Ludewig
- Divisions of Physical Therapy and Rehabilitation Science, University of Minnesota, 420 Delaware Street SE MMC 388, Minneapolis, MN 55455, USA
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23
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Ludewig PM, Kamonseki DH, Staker JL, Lawrence RL, Camargo PR, Braman JP. CHANGING OUR DIAGNOSTIC PARADIGM: MOVEMENT SYSTEM DIAGNOSTIC CLASSIFICATION. Int J Sports Phys Ther 2017; 12:884-893. [PMID: 29158950 PMCID: PMC5675364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Proper diagnosis is a first step in applying best available treatments, and prognosticating outcomes for clients. Currently, the majority of musculoskeletal diagnoses are classified according to pathoanatomy. However, the majority of physical therapy treatments are applied toward movement system impairments or pain. While advocated within the physical therapy profession for over thirty years, diagnostic classification within a movement system framework has not been uniformly developed or adopted. We propose a basic framework and rationale for application of a movement system diagnostic classification for atraumatic shoulder pain conditions, as a case for the broader development of movement system diagnostic labels. Shifting our diagnostic paradigm has potential to enhance communication, improve educational efficiency, facilitate research, directly link to function, improve clinical care, and accelerate preventive interventions.
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Affiliation(s)
- Paula M. Ludewig
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, The University of Minnesota, Minneapolis, MN, USA
| | - Danilo H. Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Justin L. Staker
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, The University of Minnesota, Minneapolis, MN, USA
| | - Rebekah L. Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, The University of Minnesota, Minneapolis, MN, USA
| | - Paula R. Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Jonathan P. Braman
- Department of Orthopaedic Surgery, Medical School, The University of Minnesota, Minneapolis, MN, USA
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24
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Lawrence RL, Schlangen DM, Schneider KA, Schoenecker J, Senger AL, Starr WC, Staker JL, Ellermann JM, Braman JP, Ludewig PM. Effect of glenohumeral elevation on subacromial supraspinatus compression risk during simulated reaching. J Orthop Res 2017; 35:2329-2337. [PMID: 28071815 PMCID: PMC5503805 DOI: 10.1002/jor.23515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
Mechanical subacromial rotator cuff compression is one theoretical mechanism in the pathogenesis of rotator cuff disease. However, the relationship between shoulder kinematics and mechanical subacromial rotator cuff compression across the range of humeral elevation motion is not well understood. The purpose of this study was to investigate the effect of humeral elevation on subacromial compression risk of the supraspinatus during a simulated functional reaching task. Three-dimensional anatomical models were reconstructed from shoulder magnetic resonance images acquired from 20 subjects (10 asymptomatic, 10 symptomatic). Standardized glenohumeral kinematics from a simulated reaching task were imposed on the anatomic models and analyzed at 0, 30, 60, and 90° humerothoracic elevation. Five magnitudes of humeral retroversion were also imposed on the models at each angle of humerothoracic elevation to investigate the impact of retroversion on subacromial proximities. The minimum distance between the coracoacromial arch and supraspinatus tendon and footprint were quantified. When contact occurred, the magnitude of the intersecting volume between the supraspinatus tendon and coracoacromial arch was also quantified. The smallest minimum distance from the coracoacromial arch to the supraspinatus footprint occurred between 30 and 90°, while the smallest minimum distance to the supraspinatus tendon occurred between 0 and 60°. The magnitude of humeral retroversion did not significantly affect minimum distance to the supraspinatus tendon except at 60 or 90° humerothoracic elevation. The results of this study provide support for mechanical rotator cuff compression as a potential mechanism for the development of rotator cuff disease. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2329-2337, 2017.
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25
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Sessions WC, Lawrence RL, Steubs JT, Ludewig PM, Braman JP. Thickness of the Rotator Cuff Tendons at the Articular Margin: An Anatomic Cadaveric Study. Iowa Orthop J 2017; 37:85-89. [PMID: 28852340 PMCID: PMC5508269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND With a substantial portion of the population experiencing rotator cuff pathology, the importance of understanding mechanisms of rotator cuff disease remains critical. Current research aimed at understanding relationships between shoulder movement and cuff injuries has been hindered by our limited knowledge of the thickness of soft tissue structures within the shoulder. Therefore, the purpose of this study is to measure the thicknesses of all four rotator cuff tendons at the articular margin. METHODS An anatomic study of 21 cadaveric shoulders was conducted. The thicknesses of the four rotator cuff tendon insertions were measured by caliper at the articular margin. RESULTS The mean thickness of the supraspinatus at the articular margin was 4.9 mm ± 2.1 (median: 4.2 mm, range: 2.9-12.7 mm). The mean thickness of the infraspinatus tendon was 4.9 mm ± 1.3 (median: 4.8 mm, range: 3.0-7.2 mm). The mean thickness of the teres minor tendon was 3.20 mm ± 1.14 (median: 2.9 mm, range: 1.7-5.7 mm). Finally, the mean thickness of the subscapularis tendon at the articular margin was 5.5 mm ± 1.3 (median: 5.5 mm, range: 3.5-9.3 mm). CONCLUSIONS This current study provides needed objective data about the thickness of the rotator cuff tendons at the articular margin. Data regarding the infraspinatus, teres minor and teres major, which have been largely understudied, are particularly important. In addition, the current study demonstrates that rotator cuff thicknesses can vary substantially between individuals. There are likely natural age related changes as well as changes from etiologies that are not yet elucidated. Clinical Relevance: Data from this study will allow for improved modelling accuracy of soft tissue structures specific to the shoulder. Eventually knowledge gained through study of shoulder mechanics can be used to pursue prevention of rotator cuff tears and improve targeted treatment planning.
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Affiliation(s)
| | - Rebekah L Lawrence
- Department of Rehabilitation Medicine Divisions of Physical Therapy & Rehabilitation Science University of MinnesotaMinneapolis, MN
| | - J Tyler Steubs
- Department of Emergency Medicine Summa Akron City HospitalAkron, OK
| | - Paula M Ludewig
- Department of Rehabilitation Medicine Divisions of Physical Therapy & Rehabilitation Science University of MinnesotaMinneapolis, MN
- Department of Orthopedics University of MinnesotaMinneapolis, MN
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26
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Abstract
The case of 17-year-old boy with thalassemia major who contracted the human immunodeficiency virus (HIV) through multiple transfusions is described. Eight years after the onset of generalized lymphadenopathy, and 5 years after the documentation of HIV infection on serologic grounds, he developed the first of multiple, painful, subcutaneous nodules, which proved to be leiomyosarcomas of vascular origin. The histopathology and possible pathogenesis of these unusual tumors are discussed.
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Affiliation(s)
- S J Orlow
- Department of Dermatology, New York University School of Medicine, New York
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27
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Abstract
Pulsatile blood flow within the normal carotid sinus involves at least two distinct components. That near the flow divider is laminar and antegrade, whereas a boundary layer separation zone in the posterolateral aspect exhibits transient blood flow reversal. It is now possible to document these flow velocity components using pulsed Doppler ultrasound methods. When atherosclerosis develops, it preferentially involves the posterolateral bulb region, obliterating the normal configuration of the sinus with consequent loss of the flow separation zone. It was therefore hypothesized that if flow separation could be detected, it should be predictive of a normal angiogram. To assess this, we evaluated 20 symptomatic patients and two with only bruits found by duplex scanning to have flow separation in either one or both carotid bulbs and who also underwent cerebral angiography. Initial diagnoses were stroke in seven, reversible ischemic neurologic deficit in one, transient ischemic attack in 12, and bruit in two. Flow separation was bilateral in 13 patients (59%). There were 15 patients with symptoms in the territory of a carotid bulb exhibiting flow separation. By angiography, of the 35 bulbs with boundary layer separation, 27 (77%) were normal, with the remainder showing lesions that reduced the diameter of the vessel by 20% or less. Final diagnoses of the 15 patients with symptoms ipsilateral to a carotid sinus exhibiting flow separation were fibromuscular disease in two, lacunar stroke in three, dissection in two, subclavian steal in one, cardiogenic embolus in three, migraine in one, hyperventilation syndrome in one, kink of the mid-internal carotid artery in one, and no diagnosis in one.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S C Nicholls
- Department of Surgery, University of Washington School of Medicine, Seattle
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Nicholls SC, Kohler TR, Bergelin RO, Primozich JF, Lawrence RL, Strandness DE. Carotid artery occlusion: natural history. J Vasc Surg 1986; 4:479-85. [PMID: 3773131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During a 5-year period, 212 patients (170 men and 42 women, median age 65 and 64 years, respectively) were diagnosed as having internal carotid artery occlusion. Mean follow-up was 24.9 months. Five-year cumulative survival and stroke-free rates by life-table analysis were 62% and 75%, respectively. Deaths were due to stroke in 7 of 40 patients (17%) and were of cardiac origin in 22 of 40 patients (55%). The strokes were ipsilateral in 20 of 31 patients (65%). No statistically significant difference between the sexes could be demonstrated for either death or stroke, nor was age correlated with stroke during follow-up. Diabetes and hypertension increased the risk of stroke, whereas gender and aspirin consumption had no discernible effect. Endarterectomy of the opposite carotid artery did not significantly affect the natural history but did reduce the stroke rate in the territory of the operated artery. Presenting symptoms were useful for estimating prognosis. Twenty-two of 111 patients referred for stroke (20%) suffered a further stroke and 21 of 111 patients (19%) died (three were stroke-related), whereas of those patients referred for transient ischemic attack (TIA), only 2 of 42 patients (5%) suffered a stroke and none died. TIAs occurred in 23 patients (11%) during follow-up, and these were premonitory for stroke in three cases (13%). The limited value of TIA in predicting stroke and the high mortality rate unrelated to stroke in this group are important considerations when therapy is considered for these patients.
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