Arjen Kolk1, Jan Ferdinand Henseler2, Pieter Bas de Witte3, Erik W van Zwet4, Peer van der Zwaal5, Cornelis P J Visser6, Jochem Nagels7, Rob G H H Nelissen8, Jurriaan H de Groot9. 1. Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: a.kolk@lumc.nl. 2. Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: J.F.Henseler@lumc.nl. 3. Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: P.B.de_Witte@lumc.nl. 4. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Postzone S5-P, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: E.W.van_Zwet@lumc.nl. 5. Department of Orthopaedic Surgery, Medical Center Haaglanden-Bronovo, Bronovolaan 5, 2597AX The Hague, the Netherlands. Electronic address: p.van.der.zwaal@mchaaglanden.nl. 6. Department of Orthopaedics, Alrijne Hospital, Postzone RZL-22, Simon Smitweg 1, 2353GA Leiderdorp, the Netherlands. Electronic address: C.Visser@rijnland.nl. 7. Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: J.Nagels@lumc.nl. 8. Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: R.G.H.H.Nelissen@lumc.nl. 9. Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, the Netherlands. Electronic address: J.H.de_Groot@lumc.nl.
Abstract
BACKGROUND: Rotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo. METHODS: In this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n=34), 2) an isolated supraspinatus tear (n=21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n=54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion. FINDINGS: In the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p<0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p=0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p<0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p=0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation. INTERPRETATION: The massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.
BACKGROUND: Rotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo. METHODS: In this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n=34), 2) an isolated supraspinatus tear (n=21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n=54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion. FINDINGS: In the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p<0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p=0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p<0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p=0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation. INTERPRETATION: The massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.
Authors: Nicole G Lemaster; Carolyn M Hettrich; Cale A Jacobs; Nick Heebner; Philip M Westgate; Scott Mair; Justin R Montgomery; Tim L Uhl Journal: Clin Orthop Relat Res Date: 2021-09-01 Impact factor: 4.755