Evaluation of shoulder balance in the normal adolescent population and its correlation with radiological parameters

Abstract

A descriptive clinical study in healthy adolescents was done to evaluate the clinical shoulder balance and analyze the correlation between clinical and radiological parameters which are currently used to evaluate shoulder balance. In addition to trunk shift and rib hump, shoulder balance is one of the criteria that are used to evaluate the outcomes in spinal deformity surgery. Several methods have been proposed to evaluate the shoulder balance in scoliotic patients; however, there is no uniformity to these methods in the current literature. Patients who applied to pediatric clinic without musculoskeletal pathology formed the patient population. Volunteers were asked to fill out a questionnaire assessing shoulder balance perception and had their clinical photograph taken simultaneously with a P-A chest X-ray. The clinical shoulder balance was evaluated through analysis of the clinical photograph. The X-rays were used to evaluate the radiological shoulder balance. The evaluated parameters included coracoid height difference (CHD), clavicular angle (CA), the clavicle-rib cage intersection difference (CRID), clavicular tilt angle difference (CTAD), and T1-tilt. The study group was composed of 48 male and 43 female patients with an average age of 13.6 +/- 2.1 (10-18) years. In the questionnaire, all patients stated that their shoulders were level. The digital photographs revealed that only 17(18.7%) adolescents had absolutely level shoulders. The average height difference between shoulders was 7.5 +/- 5.8 mm. The average CHD was 6.9 +/- 5.8 mm, average CA was 2.2 +/- 1.7 degrees , average CRID was 4.8 +/- 3.6 mm, average CTAD was 4 +/- 3.2 degrees , and average T1-tilt was 1.3 +/- 1.4 degrees . CHD, CA, and CRID demonstrated high correlation with clinical pictures, whereas CTAD demonstrated moderate and T1-tilt demonstrated only mild correlation. The radiological parameters used to evaluate the shoulder balance correlate with the clinical appearance. Contrary to popular belief, shoulder balance in healthy adolescents often does not exist.

The effect of a vertical expandable prosthetic titanium rib on shoulder balance in patients with congenital scoliosis

“…It is the method of choice for assessing radiological shoulder balance; differences of more than 9 mm correlate with shoulder imbalances of [10 mm [7]. In our study, all of the patients had preoperative a CHD of [9 mm; postoperatively there was significant improvement in CHD, but most of the patients still had CHD [9 mm.…”

“…It has the additional advantage of being the method of choice when the shoulders are not included in the X-ray [7]. CTAD [ 4.5°i ndicates a clinical shoulder imbalance of [10 mm [7].…”

Comparative Analysis of Shoulder Balance through Growth Guidance Techniques in the Surgical Treatment of Early-onset Scoliosis

“…Clavicle-rib cage intersection difference (CRID) is known as the distance between the horizontal lines drawn through the intersecting points of the superior aspects of each clavicle with the outer edge of the second rib's insertio ( Figure 4) [3][4][5]. The clavicular tilt angle difference (CTAD) is the difference between the angles formed by the bisection of the lines of the proximal portions of the clavicle with the horizontal (Figure 4) [4].…”

“…The aim of this retrospective study was to evaluate the effects of the three distinct growth guidance techniques on shoulder balance in the coronal-plane, by measuring the following radiographical parameters of shoulder balance (difference of coracoid process height-CHD, clavicula-tilt angle-CTAD and clavicula-rib cage intersection point-CRID) [3][4][5] that were obtained in the preoperative, postoperative and final follow-up period which underwent statistical analysis in comparison with each other.…”

Does anterior shoulder balance in adolescent idiopathic scoliosis correlate with posterior shoulder balance clinically and radiographically?

“…Previous studies [5,6] have shown that there is weak correlation between radiographic parameters and posterior clinical shoulder balance (Sh.B), and the principles of deformity correction involve consideration of not only the correction of radiographic measures but also that of clinical appearance. As an example, correction of only radiographic parameters in Lenke 2 curves may lead to a decompensated shoulder imbalance if the clinical appearance is not considered in surgical planning [7][8][9].…”