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Patients with recurrent anterior shoulder instability exhibit altered glenohumeral and scapulothoracic joint kinematics during upper limb movement: A prospective comparative study

  • Lukas Ernstbrunner
    Correspondence
    Corresponding author at: Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, 3050 Parkville, Victoria, Australia.
    Affiliations
    Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia

    Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
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  • Author Footnotes
    1 Co first-author: Investigation performed at the Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia and at the Balgrist University Hospital, Zurich, Switzerland.
    Fraser W. Francis-Pester
    Footnotes
    1 Co first-author: Investigation performed at the Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia and at the Balgrist University Hospital, Zurich, Switzerland.
    Affiliations
    Australian National University Medical School, Acton, Canberra, Australia
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  • Aaron Fox
    Affiliations
    Centre for Sport Research, Deakin University, Waurn Ponds, Geelong, Australia
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  • Karl Wieser
    Affiliations
    Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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  • David C. Ackland
    Affiliations
    Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
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  • Author Footnotes
    1 Co first-author: Investigation performed at the Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia and at the Balgrist University Hospital, Zurich, Switzerland.

      Highlights

      • Scapulothoracic kinematics are significantly altered in anterior instability vs. controls.
      • In abduction reduced glenohumeral motion is compensated by increased scapular rotation.
      • In apprehension position greater glenohumeral joint angles, but normal humeral translation.
      • This suggests altered neuromuscular control of the unstable shoulder.
      • The observed differences in shoulder kinematics may be used for targeted rehabilitation.

      Abstract

      Background

      Altered shoulder kinematics in patients with recurrent anterior shoulder instability remains poorly understood. This prospective study aimed to quantify in vivo glenohumeral and scapulothoracic joint kinematics and joint-contact positions in patients with shoulder instability and healthy controls.

      Methods

      Twenty patients with recurrent anterior shoulder instability (mean 28 years) and five patients without shoulder pathology (mean 39 years) were scanned using open CT in six static upper limb positions including 90° of abduction, combined abduction and external rotation, 90° of flexion, lift-off position (i.e. reaching behind the back) and the neutral shoulder with external rotation. Image datasets were digitally reconstructed to quantify shoulder joint kinematics and glenohumeral translation.

      Findings

      At 90° of abduction, instability patients demonstrated significantly less glenohumeral abduction and a reciprocal increase in upward scapulothoracic rotation compared to controls (mean difference: 13.3°, p = 0.038). With the shoulder in combined abduction and external rotation, instability patients showed a significant increase in glenohumeral rotation and a reciprocal decrease in scapulothoracic rotation compared to controls (mean difference: 5.0°, p = 0.042). There were no significant differences in humeral head translation in the sagittal plane (anterior-posterior axis) for all motions tested (p > 0.05).

      Interpretation

      Scapulothoracic and glenohumeral kinematics are significantly different between patients with recurrent anterior shoulder instability and those with a healthy shoulder. Instability patients compensate for reduced glenohumeral function during abduction by increasing scapular rotation. With the shoulder in combined abduction and external rotation position, greater glenohumeral joint angles without significantly increased humeral head translation suggest altered neuromuscular control in the unstable shoulder.

      Keywords

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