Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Dynamic three-dimensional shoulder kinematics in patients with massive rotator cuff tears: a comparison of patients with and without subscapularis tears

  • Yuji Yamada (Graduate School of Health Science, Kyoto Tachibana University) ;
  • Yoshihiro Kai (Graduate School of Health Science, Kyoto Tachibana University) ;
  • Noriyuki Kida (Faculty of Arts and Sciences, Kyoto Institute of Technology University) ;
  • Hitoshi Koda (Department of Rehabilitation, Faculty of Health Science, Kansai Welfare Science University) ;
  • Minoru Takeshima (Department of Orthopedics, Tanabe Central Hospital) ;
  • Kenji Hoshi (Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University) ;
  • Kazuyoshi Gamada (Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University) ;
  • Toru Morihara (Department of Orthopedics, Marutamachi Rehabilitation Clinic)
  • Received : 2022.02.03
  • Accepted : 2022.02.22
  • Published : 2022.12.01
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Abstract

Background: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. Methods: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. Results: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. -1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. Conclusions: In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.

Keywords

Acknowledgement

The authors would like to thank H. Itou for providing technical assistance with the experiments. We also thank Y. Miura and H. Fukushima for their expertise on shoulder rehabilitation.

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