Measuring dynamic in-vivo glenohumeral joint kinematics: Technique and preliminary results

Abstract

Rotator cuff tears are a common injury that affect a significant percentage of the population over age 60. Although it is widely believed that the rotator cuff's primary function is to stabilize the humerus against the glenoid during shoulder motion, accurately measuring the three-dimensional (3D) motion of the shoulder's glenohumeral joint under in-vivo conditions has been a challenging endeavor. In particular, conventional motion measurement techniques have frequently been limited to static or two-dimensional (2D) analyses, and have suffered from limited or unknown in-vivo accuracy. We have recently developed and validated a new model-based tracking technique that is capable of accurately measuring the 3D position and orientation of the scapula and humerus from biplane x-ray images. Herein we demonstrate the in-vivo application of this technique for accurately measuring glenohumeral joint translations during shoulder motion in the repaired and contralateral shoulders of patients following rotator cuff repair. Five male subjects were tested at 3−4 months following arthroscopic rotator cuff repair. Superior-inferior humeral translation was measured during elevation, and anterior-posterior humeral translation was measured during external rotation in both the repaired and contralateral shoulders. The data failed to detect statistically significant differences between the repaired and contralateral shoulders in superior-inferior translation (p=0.74) or anterior-posterior translation (p=0.77). The measurement technique overcomes the limitations of conventional motion measurement techniques by providing accurate, 3D, in-vivo measures of glenohumeral joint motion during dynamic activities. On-going research is using this technique to assess the effects of conservative and surgical treatment of rotator cuff tears.

Investigation of 3D glenohumeral displacements from 3D reconstruction using biplane X-ray images: Accuracy and reproducibility of the technique and preliminary analysis in rotator cuff tear patients

“…However, the amplitude observed in asymptomatic volonteers in the superoinferior direction (4.1 mm) was higher than that was previously reported in the literature where it was less than 2 mm (Bey et al, 2008;Graichen et al, 2005Graichen et al, , 2000 or 2.5 mm (Massimini et al, 2011) in healthy subjects. However, the amplitude of anteroposterior displacements were lower than results in the literature for both groups (less than 4.8 mm versus 6 mm) (Massimini et al, 2011).…”

“…However, in term of the complexity of methods, the fluoroscopy based techniques require additional model segmentations from the CT scan (Bey et al, 2008(Bey et al, , 2006Nishinaka et al, 2008) or MRI (Boyer et al, 2008;Massimini et al, 2012;Zhu et al, 2012) that risk increased radiation or cost, whereas the present method was based on a priori geometry knowledge from a relatively large cadaveric database and did not require additional image acquisition for shape reconstruction. Besides, compared to conventional motion capture techniques based on skin markers (Ludewig and Cook, 2002), the accuracy of the present method was substantially improved, as the scalupa and humerus were tracked directly on X-ray images that avoided errors from skin motion relative to the bony structures.…”

The Effect of the Remplissage Procedure on Shoulder Stability and Range of Motion

“…Further biomechanical studies are needed to more definitively assess the remplissage procedure. Employing advanced techniques such as in vivo kinematic tracking 39 , robotic devices 40,41 and finite element analysis 42 may be useful. Specifically, in vivo studies would provide better direct evidence regarding the advantages and adverse effects of surgical procedures.…”

Electromyographic assessment of muscle fatigue in massive rotator cuff tear

“…Coordinated synchronous activity of shoulder girdle muscles is required to limit translation of the humeral head on the shallow glenoid fossa [Bey et al, 2008;Poppen et al, 1978]. Rotator cuff muscle activity plays a fundamental role in maintaining glenohumeral joint (GHJ) stability [Burkhart, 1991;Inman et al, 1996;Yanagawa et al, 2008], 'stiffening' the GHJ to establish a stable fulcrum [David et al, 2000].…”