Differences in 3-Dimensional Shoulder Kinematics between Persons with Multidirectional Instability and Asymptomatic Controls

Background Evidence that persons with multidirectional instability (MDI) of the shoulder have abnormal shoulder kinematics is limited. A kinematic description of scapulothoracic and glenohumeral motion can assist both conservative and surgical rehabilitative programs. Hypothesis Persons with MDI of the shoulder demonstrate increased anterior and inferior glenohumeral translation and decreased scapular upward rotation and increased scapular internal rotation compared with age-matched and gender-matched asymptomatic controls. Study Design Controlled laboratory study. Methods Sixty-two subjects were recruited from an outpatient orthopaedic clinic. Subjects with MDI were matched according to age, gender, and hand dominance to asymptomatic controls. An electromagnetic motion capture system evaluated the 3-dimensional position of the trunk, scapula, and humerus during frontal and scapular plane elevation. A repeated measures analysis of variance evaluated joint positions and glenohumeral translations during 4 phases of elevation (0°-30°, 31°-60°, 61°-90°, and 91°-120°). Results When averaged across the 4 phases of elevation, persons with MDI demonstrated a significant decrease in scapular upward rotation in scapular plane abduction (8°, P = .006) and abduction (5.8°, P = .016) and increased internal rotation during scapular plane abduction (12.2°, P = .03). Alterations in glenohumeral translations in the MDI group did not reach statistical significance (P = .54-.71). Conclusion Abnormal scapular kinematics are seen in the MDI shoulder, highlighting the importance of incorporating scapular positioning and stability exercises during rehabilitation. Additional study is warranted concerning the efficacy of various rehabilitation programs, and also both surgical and nonsurgical interventions in this population.

[1]  R. Guldberg,et al.  Anterior shoulder stability: Contributions of rotator cuff forces and the capsular ligaments in a cadaver model. , 1992, Journal of shoulder and elbow surgery.

[2]  C. Gerber,et al.  Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. , 1984, The Journal of bone and joint surgery. British volume.

[3]  L J Micheli,et al.  Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis. , 1992, Clinical orthopaedics and related research.

[4]  F Matsen,et al.  Mechanisms of glenohumeral joint stability. , 1993, Clinical orthopaedics and related research.

[5]  Frederick Albert Matsen IV,et al.  Mechanics of glenohumeral instability. , 1991, Clinics in sports medicine.

[6]  Andrew R Karduna,et al.  Three-dimensional scapulothoracic motion during active and passive arm elevation. , 2005, Clinical biomechanics.

[7]  B F Morrey,et al.  Scapular inclination and inferior stability of the shoulder. , 1992, Journal of shoulder and elbow surgery.

[8]  C A Rockwood,et al.  Treatment of instability of the shoulder with an exercise program. , 1992, The Journal of bone and joint surgery. American volume.

[9]  B Sennett,et al.  Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. , 1999, The Journal of orthopaedic and sports physical therapy.

[10]  Heiko Graichen,et al.  Relevance of Arm Position and Muscle Activity on Three-Dimensional Glenohumeral Translation in Patients with Traumatic and Atraumatic Shoulder Instability * , 2002, The American journal of sports medicine.

[11]  W Ben Kibler,et al.  The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  J. Basmajian,et al.  Factors preventing downward dislocation of the adducted shoulder joint. An electromyographic and morphological study. , 1959, The Journal of bone and joint surgery. American volume.

[13]  L. Neumann,et al.  Non-operative treatment of multidirectional shoulder instability , 2000, International Orthopaedics.

[14]  P Van Roy,et al.  Glenohumeral joint kinematics related to minor anterior instability of the shoulder at the end of the late preparatory phase of throwing. , 2001, Clinical biomechanics.

[15]  W. Mallon,et al.  Multidirectional instability: current concepts. , 1995, Journal of shoulder and elbow surgery.

[16]  Paula M Ludewig,et al.  Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane. , 2002, Clinical biomechanics.

[17]  A. Bulbena,et al.  Clinical assessment of hypermobility of joints: assembling criteria. , 1992, The Journal of rheumatology.

[18]  R. Richards.  The diagnostic definition of multidirectional instability of the shoulder: searching for direction. , 2003, The Journal of bone and joint surgery. American volume.

[19]  K. An,et al.  Influence of rotator cuff tearing on glenohumeral stability. , 1997, Journal of shoulder and elbow surgery.

[20]  C. Neer.  Impingement lesions. , 1983, Clinical orthopaedics and related research.

[21]  A R Karduna,et al.  Dynamic measurements of three-dimensional scapular kinematics: a validation study. , 2001, Journal of biomechanical engineering.

[22]  K. Speer,et al.  Anatomy and pathomechanics of shoulder instability. , 1995, Clinics in sports medicine.

[23]  J. Brems,et al.  Multidirectional Instability of the Shoulder: Pathophysiology, Diagnosis, and Management , 1998, The Journal of the American Academy of Orthopaedic Surgeons.

[24]  B. Torpey,et al.  Evaluation of Shoulder Laxity , 1996, Sports medicine.

[25]  K. Speer,et al.  Intra- and Interobserver Reproducibility of the Shoulder Laxity Examination , 1999, The American journal of sports medicine.

[26]  K N An,et al.  Kinematic and kinetic analysis of push-up exercise. , 1990, Biomedical sciences instrumentation.

[27]  G. Murrell,et al.  The Unstable Shoulder in the Adolescent Athlete , 2002, The American journal of sports medicine.

[28]  J. Kennedy,et al.  Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement , 1990, The American journal of sports medicine.

[29]  G. Murrell,et al.  Clinical Examination of the Unstable Shoulder , 2002, Sports medicine.

[30]  R. Hawkins,et al.  Classification and physical diagnosis of instability of the shoulder. , 1993, Clinical orthopaedics and related research.

[31]  P J McMahon,et al.  Effects of Simulated Scapular Protraction on Anterior Glenohumeral Stability , 1999, The American journal of sports medicine.

[32]  Frank W. Jobe,et al.  EMG analysis of the scapular muscles during a shoulder rehabilitation program , 1992, The American journal of sports medicine.

[33]  Bryan Buchholz,et al.  ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand. , 2005, Journal of biomechanics.

[34]  R. Friedman,et al.  Multidirectional instability of the glenohumeral joint. , 2000, The Orthopedic clinics of North America.

[35]  A. Karduna,et al.  Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. , 2001, Journal of shoulder and elbow surgery.

[36]  Foster Cr.  Multidirectional instability of the shoulder in the athlete. , 1983, Clinics in sports medicine.

[37]  Klipple Feil,et al.  The shoulder , 2000 .

[38]  Thomas M. Cook,et al.  Comparison of Surface Sensor and Bone-Fixed Measurement of Humeral Motion , 2002 .

[39]  C. Neer,et al.  Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. , 1980, The Journal of bone and joint surgery. American volume.

[40]  G L Smidt,et al.  Dynamic scapulohumeral rhythm: the effects of external resistance during elevation of the arm in the scapular plane. , 1998, The Journal of orthopaedic and sports physical therapy.

[41]  T. Cook,et al.  Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. , 2000, Physical therapy.

[42]  E. K. Alpar,et al.  Joint structure and function. A comprehensive analysis , 1984 .

[43]  C. H. Wang,et al.  Stretching and strengthening exercises: their effect on three-dimensional scapular kinematics. , 1999, Archives of physical medicine and rehabilitation.

[44]  S S Burkhart,et al.  Shoulder injuries in overhead athletes. The "dead arm" revisited. , 2000, Clinics in sports medicine.

[45]  W. Kibler,et al.  The role of the scapula in athletic shoulder function. , 1998, The American journal of sports medicine.

[46]  S M Howell,et al.  Normal and abnormal mechanics of the glenohumeral joint in the horizontal plane. , 1988, The Journal of bone and joint surgery. American volume.

[47]  R. Paine,et al.  The role of the scapula. , 1993, The Journal of orthopaedic and sports physical therapy.

[48]  J Ozaki,et al.  Glenohumeral movements of the involuntary inferior and multidirectional instability. , 1989, Clinical orthopaedics and related research.

[49]  Orit Shechtman,et al.  Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60 , 2001 .

[50]  R. Warren,et al.  Effect of joint compression on inferior stability of the glenohumeral joint. , 1999, Journal of shoulder and elbow surgery.

[51]  Cs Neer,et al.  2nd. Impingement lesions. , 1983 .

[52]  J G Andrews.  On the specification of joint configurations and motions. , 1984, Journal of biomechanics.

[53]  A. Carr,et al.  The assessment of shoulder instability. The development and validation of a questionnaire. , 1999, The Journal of bone and joint surgery. British volume.

[54]  Thomas M Cook,et al.  Translations of the humerus in persons with shoulder impingement symptoms. , 2002, The Journal of orthopaedic and sports physical therapy.

[55]  Paula M. Ludewig,et al.  Relative Balance of Serratus Anterior and Upper Trapezius Muscle Activity during Push-Up Exercises , 2004, The American journal of sports medicine.