Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

BACKGROUND: There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. METHODS: Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. RESULTS: There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). CONCLUSIONS: The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Movimento escapular: padrão de normalidade e suas alterações na disfunção / Scapular motion: standard of normality and your alterations in the disfunction

O conhecimento do exato papel da escápula em relação à função do membro superior é de extrema importância para compreensão do movimento humano, assim como, para entendermos as conseqüências e os motivos das alterações em seu padrão de normalidade. Neste sentido, muitos trabalhos vêm sendo realizados visando esclarecer o padrão de movimento normal, as estruturas que estão relacionadas a este padrão e as possíveis causas das disfunções, além de investigar as implicações causadas por tais disfunções em outras estruturas; entretanto, tais idéias são apresentadas de maneira fragmentada. Assim, a proposta do presente estudo é realizar uma revisão da literatura sobre a função da escápula e suas alterações na disfunção. Para isso, foi realizada uma busca na base de dados da PubMed por “scapulohumeral rhythm”, “scapular motion” e “scapular disfunction”, onde foram selecionados artigos entre 2000 e 2006. Os artigos selecionados foram analisados a fim de relacionar as evidências encontradas em uma idéia global. Nota-se que uma série de estruturas necessita estar em pleno equilíbrio para manter o padrão cinético e cinemático normal. Uma alteração cinética geralmente acaba promovendo uma alteração cinemática, da mesma forma que a alteração cinemática impõe grande influência para promover uma alteração cinética. Desta forma, deve-se realizar uma avaliação minuciosa levando em consideração tanto os aspectos cinéticos quanto cinemáticos, porque só assim se consegue o equilíbrio necessário para a função normal do membro superior.

The knowledge of the accurate paper of the scapula in relation to the function of the upper member is of extreme importance for understanding of the human movement, as well as, to understand the consequences and the reasons of the alterations in its standard of normality. In this direction, many works come being carried through aiming at to clarify the standard of normal movement, the structures that are related to this standard and the possible causes of the dysfunctions, besides investigating the implications caused for such dysfunctions in other structures; however, such ideas are presented in fragmented way. Thus, the proposal of the present study is to carry through a revision of literature on the function of the scapula and its alterations in the dysfunction. For this, was made a search in the database of the PubMed for “scapulohumeral rhythm”, “scapular motion” e “scapular dysfunction”, where articles between 2000 and 2006 had been selected. The selected articles had been analyzed in order to relate the evidences found in a global idea. It is observed that a series of structures needs to be in full balance to keep normal the kinetic and kinematics standard. A kinetic alteration generally finishes promoting an alteration kinematics, in the same way that the alteration kinematics imposes great influence to promote an alteration kinetic. Of this form, they must be carried through a minute evaluation in such a way taking in consideration how much kinematics and kinetic aspects, because only thus the necessary balance for the normal function of the upper member is obtained.

Correlação entre posicionamento escapular, análise postural funcional e grau de incapacidade dos membros superiores (DASH Brasil) em médicos ultrassonografistas / Correlation among scapular positioning, functional postural analysis and upper extremities disability degree in sonographers (DASH Brazil)

OBJETIVO: Avaliar e mensurar o posicionamento escapular e correlacioná-lo com o grau de incapacidade e avaliação funcional de ultrassonografistas. MATERIAIS E MÉTODOS: Dezoito médicos, divididos em grupos sintomático e assintomático em relação à presença de dor por mais de seis meses, responderam a uma entrevista e foram submetidos a avaliação física e aplicação do DASH Brasil. Foi realizada a medida do ângulo de inclinação escapular e avaliação do posicionamento dos membros superiores durante a ultrassonografia. Foram utilizados testes U Mann-Whitney para avaliação do questionário de incapacidade, t de Student para posicionamento do membro superior, ANOVA para inclinação escapular e coeficiente de Spearman para correlação do posicionamento funcional de membros superiores e grau de incapacidade. RESULTADOS: Nas 30 primeiras questões do DASH Brasil houve diferença significativa entre os grupos sintomático e assintomático. No módulo opcional, relacionado ao trabalho, houve diferença significativa entre os grupos. As medidas do inclinômetro apresentaram diferenças significativas entre os grupos no plano frontal em 90° e 120°. Para o ângulo funcional dos membros superiores não houve diferença significativa entre os grupos. CONCLUSÃO: Alterações no ângulo de inclinação escapular podem levar à disfunção dos membros superiores e a aplicação do DASH Brasil pode indicar o grau de dor e incapacidade do indivíduo.

OBJECTIVE: To evaluate and measure the scapular positioning, and establishing its correlation with functional postural analysis and degree of upper extremities disability in sonographers. MATERIALS AND METHODS: Eighteen physicians divided into two groups - symptomatic individuals with pain for more than six months, and asymptomatic individuals - were interviewed and submitted to physical assessment with application of the Brazilian version of the DASH questionnaire. Functional measurements of scapular inclination angles and upper limbs positioning were obtained during the ultrasound scanning. The Mann-Whitney U test was utilized for analyzing the disability questionnaires; the t-Student test, for upper limbs positioning; ANOVA, for scapular inclination angles, and the Spearman's test for correlation between the functional upper limbs positioning and disability degree. RESULTS: A significant difference between symptomatic and asymptomatic groups was observed in the first 30 items of the DASH questionnaire as well as in the four study-related questions. Measurements of scapular positioning presented significant differences between the groups in the frontal plane at 90° and 120°. No significant difference was found for the analysis of functional upper limbs positioning. CONCLUSION: Changes in the scapular positioning may result in upper limbs dysfunction, and the application of the DASH questionnaire can indicate the level of pain and disability of an individual.

THE RELATIONSHIPS BETWEEN SHOULDER'S FUNCTION AND DAMAGE FOR HANDBALL PLAYERS / 体力科学

[Objective] The purpose of this study is to examine the relationships between shoulder's function and damage for handball players. Subjects were nine female handball players with dominant shoulder pain.[Methods] Clinical diagnosis was done from the medical doctor's opinion and MRI. Then, the shoulder joint movement was measured with X rays.[Results] Most of them had admitted a lot the impingement syndrome and the subacromial bursitis. The trunk rotation angle at zero-positions was significantly larger in the symptomatic shoulder (dominant shoulder) than in the asymptomatic shoulder (nondominant shoulder). That is, it was obvious that the damage of the shoulder changed tilting angle of scapula medially.[Conclusion] It is reported that the damage of the shoulder causes abnormality to the “scapulohumeral rhythm” by the previous research. But, these results, suggested to need to understand not only “scapulohumeral rhythm” but also movement to the position of the scapula, when the shoulder joint function was observed for the handball player mainly composed of throwing motion.

Scapulohumeral Rhythm of Hemiplegic Patients by Plain X-ray Examination

OBJECTIVE: 1. To determine the difference of scapulohumeral rhythm (SHR) between the affected and unaffected side in hemiplegic patients. 2. To discover the influencing factors on altered scapulohumeral rhythm of affected side in hemiplegic patients. METHOD: Fifteen hemiplegic subjects, 18 to 54 years of age, participated in this study. Subjects were divided into two groups according to muscle tone on the basis of modified Ashworth scale (MAS). Plain X-ray of the shoulders were taken in neutral, 90 degree abduction, and full elevation of the arm in both affected and unaffected side. The arm angle, scapula angle, and glenohumeral angle were recorded for each individual in each of the three positions. RESULT: In the unaffected shoulders of hemiplegic patients, the mean values of SHRs from neutral to the 90o and from neutral to the 180o were 1 : 1.82 and 1 : 2.12, respectively. In the affected shoulders, the mean values of SHRs between 0~90o abduction and 0 to full abduction were 1 : 2.35 and 1 : 2.25, respectively. The mean value of SHRs from neutral to 90 degree of affected side was significantly decreased than unaffected side in the low tone group and increased in the high tone group (p<0.05). In addition, the SHRs of hemiplegic shoulders were significantly increased in the high tone group than the low tone group (p<0.05). CONCLUSION: Spasticity tends to result in decreased motion of scapula, which alters the SHR. A glenohumeral-to-scapulothoracic ratio of hemiplegic shoulder could be affected by spasticity and presence of subluxation.

Observation of Treatment Outcome with Radiography in Adhesive Capsulitis of Shoulder

OBJECTIVE: In adhesive capsulitis, assessment of the mobility of the shoulder are likely to have intrinsic error because of the altering scapulohumeral rhythm and extrinsic error. For more objective and the precise assessment of shoulder mobility in adhesive capsulitis, we observed proper glenohumeral movement, the change of scapulohumeral angle, the scapulohumeral rhythm were evaluated with radiography and compared with clinical measurement of shoulder range of motion (ROM). METHOD: The subjects were 19 patients (21 shoulder) with adhesive capsulitis of the shoulder and undertook combination treatment of distention arthrography, per os medication of non-steroid anti- inflammatory drug, stellate ganglion block, physical therapy including exercise. We assessed change in visual analogue scale (VAS), joint space capacity, shoulder mobility by measurement of ROM, and scapulohumeral angle in active shoulder abduction under the fluroscopy. RESULTS: All the subjects experienced pain relief, increased shoulder mobility and restoration of scapulohumeral rhythm. The improvement of the shoulder extension and scapulohumeral angle is well correlated with the change of VAS and joint capacity. However, the improvement of the shoulder flexion, abduction, external rotation and internal rotation were poor correlated with them. CONCLUSION: We propose the measurement of scapulohumeral angle with active shoulder abduction in shoulder AP view as an assessment method for shoulder mobility in adhesive capsulitis.