No abstract

Abnormal scapular movement is widely believed to be an important factor in clinical pathology of the shoulder joint complex. Validated non-invasive techniques for measuring scapular movement have been developed, but the effect of marker placement on accuracy is unknown. The objective of this study was to determine the accuracy and reliability of different groupings of markers to achieve the best accuracy and reliability for measuring scapular kinematics. Eight healthy young adult subjects were recruited. An optoelectronic marker grid was applied to the skin overlying the scapula. Two bone pins with optoelectronic marker carriers were inserted into the scapula. The accuracy of six surface marker configurations was determined by comparing the measured kinematics with scapular bone pins (the gold standard). Four humeral movements were tested: glenohumeral abduction, glenohumeral horizontal adduction, hand behind back, and forward reaching. All three rotations had a significant difference in the accuracy of the patches (p = 0.04 to p < 0.0001). For posterior tipping there was a significant effect of movement (p = 0.003) and a significant interaction (p < 0.0001). There was also a significant interaction for external rotation (p = 0.001). The marker grouping with the largest cranio-caudal spread had the highest accuracy for measuring posterior tilting (RMS 1.9°). Markers closer to the scapular spine were more accurate for tracking external rotation (RMS 2.0°) while an intermediate grouping of markers were most accurate for quantifying upward rotation (RMS 1.9°). The reliability between days ranged between 3.8° and 7.5° (based on RMS difference between trials) and there was a significant interaction between patch and movement (p < 0.0001). Intraclass correlation coefficients show moderate to good agreement for most arm movements and scapular rotations. Thus, there exists distinct optimal configurations of non-invasive marker locations for accurately measuring scapular kinematics.

Noninvasive measurement of scapular kinematics using skin surface markers presents technical challenges due to the relative movement between the scapula and the overlying skin. The objectives of this study were to develop a noninvasive subject-specific skin correction factor that would enable a more accurate measurement of scapular kinematics and evaluate this new technique via comparison with a gold standard for scapular movement. Scapular kinematics were directly measured using bone pins instrumented with optoelectronic marker carriers in eight healthy volunteers while skin motion was measured simultaneously with optoelectronic markers attached to the skin surface overlying the scapula. The relative motion between the skin markers and the underlying scapula was estimated over a range of humeral orientations by palpating and digitizing bony landmarks on the scapula and then used to calculate correction factors that were weighted by humeral orientation. The scapular kinematics using these correction factors were compared with the kinematics measured via the bone pins during four arm movements in the volunteers: abduction, forward reaching, hand behind back, and horizontal adduction. The root-mean-square (rms) errors for the kinematics determined from skin markers without the skin correction factors ranged from 5.1 deg to 9.5 deg while the rms errors with the skin correction factors ranged from 1.4 deg to 3.0 deg. This technique appeared to perform well for different movements and could possibly be extended to other applications.