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Moment arms of the deltoid, infraspinatus and teres minor muscles for movements with high range of motion: A cadaveric study

      Highlights

      • High moment arms are observed on a plane which is not the one from the movement.
      • Position of the glenohumeral joint induces changes in the muscular moment arms.
      • Deltoid is the main elevator.
      • Deltoid act either as an elevator or depressor, while moving the elevation plane.
      • Infraspinatus and teres minor moment arms (sign) changes after 45° of elevation.

      Abstract

      Background

      Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation.

      Methods

      The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane).

      Findings

      We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane).

      Interpretation

      The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

      Keywords

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      References

        • Ackland D.C.
        • Pak P.
        • Richardson M.
        • Pandy M.G.
        Moment arms of the muscles crossing the anatomical shoulder.
        J. Anat. 2008; 213: 383-390https://doi.org/10.1111/j.1469-7580.2008.00965.x
        • Ackland D.C.
        • Roshan-Zamir S.
        • Richardson M.
        • Pandy M.G.
        Moment arms of the shoulder musculature after reverse total shoulder arthroplasty.
        JBJS. 2010; 92: 1221-1230https://doi.org/10.2106/JBJS.I.00001
        • Carter A.B.
        • Kaminski T.W.
        • Douex Jr., A.T.
        • Knight C.A.
        • Richards J.G.
        Effects of high volume upper extremity plyometric training on throwing velocity and functional strength ratios of the shoulder rotators in collegiate baseball players.
        J. Strength Cond. Res. 2007; 21: 208-215
        • Ebaugh D.D.
        • McClure P.W.
        • Karduna A.R.J.C.B.
        Three-dimensional scapulothoracic motion during active and passive arm elevation.
        Clin. Biomech. 2005; 20: 700-709
        • Eno J.J.T.
        • Kontaxis A.
        • Novoa-Boldo A.
        • Windsor E.
        • Chen X.
        • Erickson B.J.
        • et al.
        The biomechanics of subscapularis repair in reverse shoulder arthroplasty: the effect of lateralization and insertion site.
        J. Orthop. Res. 2020; 38: 888-894https://doi.org/10.1002/jor.24531
        • Favre P.
        • Gerber C.
        • Snedeker J.G.
        Automated muscle wrapping using finite element contact detection.
        J. Biomech. 2010; 43: 1931-1940https://doi.org/10.1016/j.jbiomech.2010.03.018
        • Garner B.A.
        • Pandy M.G.
        Musculoskeletal model of the upper limb based on the visible human male dataset.
        Comput. Methods Biomech. Biomed. Eng. 2001; 4: 93-126https://doi.org/10.1080/10255840008908000
        • Graichen H.
        • Englmeier K.
        • Reiser M.
        • Eckstein F.
        An in vivo technique for determining 3D muscular moment arms in different joint positions and during muscular activation–application to the supraspinatus.
        Clin. Biomech. 2001; 16: 389-394https://doi.org/10.1016/S0268-0033(01)00027-4
        • Greiner S.
        • Schmidt C.
        • König C.
        • Perka C.
        • Herrmann S.
        Lateralized reverse shoulder arthroplasty maintains rotational function of the remaining rotator cuff.
        Clin. Orthop. Relat. Res. 2013; 471: 940-946https://doi.org/10.1007/s11999-012-2692-x
        • Haering D.
        • Raison M.
        • Begon M.
        Measurement and description of three-dimensional shoulder range of motion with degrees of freedom interactions.
        J. Biomech. Eng. 2014; 136084502https://doi.org/10.1115/1.4027665
        • Hamilton M.A.
        • Roche C.P.
        • Diep P.
        • Flurin P.-H.
        • Routman H.D.
        Effect of prosthesis design on muscle length and moment arms in reverse total shoulder arthroplasty.
        Bull. Hosp. Jt Dis. 2013; 71: S31-S35
        • Hik F.
        • Ackland D.C.
        The moment arms of the muscles spanning the glenohumeral joint: a systematic review.
        J. Anat. 2019; 234: 1-15https://doi.org/10.1111/joa.12903
        • Hoffmann M.
        • Haering D.
        • Begon M.
        Comparison between line and surface mesh models to represent the rotator cuff muscle geometry in musculoskeletal models.
        Comput. Methods Biomech. Biomed. Eng. 2017; 20: 1175-1181https://doi.org/10.1080/10255842.2017.1340463
        • Hoffmann M.
        • Begon M.
        • Lafon Y.
        • Duprey S.
        Influence of glenohumeral joint muscle insertion on moment arms using a finite element model.
        Comput. Methods Biomech. Biomed. Eng. 2020; : 1-10https://doi.org/10.1080/10255842.2020.1789606
        • Hughes R.E.
        • Niebur G.
        • Liu J.
        • An K.-N.
        Comparison of two methods for computing abduction moment arms of the rotator cuff.
        J. Biomech. 1997; 31: 157-160https://doi.org/10.1016/S0021-9290(97)00113-9
        • Ingram D.
        Musculoskeletal Model of the Human Shoulder for Joint Force Estimation.
        2015
        • Kedgley A.E.
        • Mackenzie G.A.
        • Ferreira L.M.
        • Drosdowech D.S.
        • King G.J.
        • Faber K.J.
        • et al.
        The effect of muscle loading on the kinematics of in vitro glenohumeral abduction.
        J. Biomech. 2007; 40: 2953-2960https://doi.org/10.1016/j.jbiomech.2007.02.008
        • Khadilkar L.
        • MacDermid J.C.
        • Sinden K.E.
        • Jenkyn T.R.
        • Birmingham T.B.
        • Athwal G.S.
        An analysis of functional shoulder movements during task performance using dartfish movement analysis software.
        Int. J. Shoulder Surg. 2014; 8: 1https://doi.org/10.4103/0973-6042.131847
        • Kuechle D.K.
        • Newman S.R.
        • Itoi E.
        • Morrey B.F.
        • An K.-N.
        Shoulder muscle moment arms during horizontal flexion and elevation.
        J. Shoulder Elb. Surg. 1997; 6: 429-439https://doi.org/10.1016/S1058-2746(97)70049-1
        • Kuechle D.K.
        • Newman S.R.
        • Itoi E.
        • Niebur G.L.
        • Morrey B.F.
        • An K.-N.
        The relevance of the moment arm of shoulder muscles with respect to axial rotation of the glenohumeral joint in four positions.
        Clin. Biomech. 2000; 15: 322-329https://doi.org/10.1016/S0268-0033(99)00081-9
        • Langenderfer J.
        • Jerabek S.A.
        • Thangamani V.B.
        • Kuhn J.E.
        • Hughes R.E.
        Musculoskeletal parameters of muscles crossing the shoulder and elbow and the effect of sarcomere length sample size on estimation of optimal muscle length.
        Clin. Biomech. 2004; 19: 664-670https://doi.org/10.1016/j.clinbiomech.2004.04.009
        • Leschinger T.
        • Birgel S.
        • Hackl M.
        • Staat M.
        • Müller L.P.
        • Wegmann K.
        A musculoskeletal shoulder simulation of moment arms and joint reaction forces after medialization of the supraspinatus footprint in rotator cuff repair.
        Comput. Methods Biomech. Biomed. Eng. 2019; : 1-10https://doi.org/10.1080/10255842.2019.1572749
        • Magermans D.
        • Chadwick E.
        • Veeger H.
        • Rozing P.
        • Van der Helm F.
        Effectiveness of tendon transfers for massive rotator cuff tears: a simulation study.
        Clin. Biomech. 2004; 19: 116-122https://doi.org/10.1016/j.clinbiomech.2003.09.008
        • McDonald A.C.
        • Calvin T.
        • Keir P.J.
        Adaptations to isolated shoulder fatigue during simulated repetitive work. Part II: recovery.
        J. Electromyogr. Kinesiol. 2016; 29: 42-49https://doi.org/10.1016/j.jelekin.2015.05.005
        • Meskers C.
        • Van der Helm F.C.
        • Rozendaal L.
        • Rozing P.
        In vivo estimation of the glenohumeral joint rotation center from scapular bony landmarks by linear regression.
        J. Biomech. 1997; 31: 93-96https://doi.org/10.1016/S0021-9290(97)00101-2
        • Mulla D.M.
        • Hodder J.N.
        • Maly M.R.
        • Lyons J.L.
        • Keir P.J.
        Modeling the effects of musculoskeletal geometry on scapulohumeral muscle moment arms and lines of action.
        Comput. Methods Biomech. Biomed. Eng. 2019; 22: 1311-1322https://doi.org/10.1080/10255842.2019.1661392
        • O’Connell N.E.
        • Cowan J.
        • Christopher T.
        An investigation into EMG activity in the upper and lower portions of the subscapularis muscle during normal shoulder motion.
        Physiother. Res. Int. 2006; 11: 148-151https://doi.org/10.1002/pri.336
        • Otis J.C.
        • Jiang C.-C.
        • Wickiewicz T.L.
        • Peterson M.
        • Warren R.F.
        • Santner T.J.
        Changes in the moment arms of the rotator cuff and deltoid muscles with abduction and rotation.
        JBJS. 1994; 76: 667-676https://doi.org/10.2106/00004623-199405000-00007
        • Quental C.
        • Folgado J.
        • Ambrósio J.
        • Monteiro J.
        Critical analysis of musculoskeletal modelling complexity in multibody biomechanical models of the upper limb.
        Comput. Methods Biomech. Biomed. Eng. 2015; 18: 749-759https://doi.org/10.1080/10255842.2013.845879
        • Ratanapinunchai J.
        • Mathiyakom W.
        • SJAorm Sungkarat
        Scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke.
        Ann. Rehabil. Med. 2019; 43: 178
        • Schwartz D.G.
        • Kang S.H.
        • Lynch T.S.
        • Edwards S.
        • Nuber G.
        • Zhang L.-Q.
        • et al.
        The anterior deltoid’s importance in reverse shoulder arthroplasty: a cadaveric biomechanical study.
        J. Shoulder Elb. Surg. 2013; 22: 357-364https://doi.org/10.1016/j.jse.2012.02.002
        • Sobczak S.
        • Dugailly P.-M.
        • Feipel V.
        • Baillon B.
        • Rooze M.
        • Salvia P.
        • et al.
        In vitro biomechanical study of femoral torsion disorders: effect on moment arms of thigh muscles.
        Clin. Biomech. 2013; 28: 187-192https://doi.org/10.1016/j.clinbiomech.2012.12.008
        • Webb J.D.
        • Blemker S.S.
        • Delp S.L.
        3D finite element models of shoulder muscles for computing lines of actions and moment arms.
        Comput. Methods Biomech. Biomed. Eng. 2014; 17: 829-837https://doi.org/10.1080/10255842.2012.719605
        • de Witte P.B.
        • van der Zwaal P.
        • van Arkel E.
        • Nelissen R.G.
        • De Groot J.H.
        Pathologic deltoid activation in rotator cuff tear patients: normalization after cuff repair?.
        Med. Biol. Eng. Comput. 2014; 52: 241-249https://doi.org/10.1007/s11517-013-1095-9
        • Wolin P.M.
        • Tarbet J.A.
        Rotator cuff injury: addressing overhead overuse.
        Phys. Sportsmed. 1997; 25: 54-74https://doi.org/10.1080/00913847.1997.11440259
        • Wu G.
        • Van der Helm F.C.
        • Veeger H.D.
        • Makhsous M.
        • Van Roy P.
        • Anglin C.
        • 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.
        J. Biomech. 2005; 38: 981-992https://doi.org/10.1016/j.jbiomech.2004.05.042