Clin Orthop Surg.  2016 Sep;8(3):316-324. 10.4055/cios.2016.8.3.316.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

• Lee KW
• Kim YI
• Kim HY
• Yang DS
• Lee GS
• Choy WS

• KMID: 2374279
• DOI: http://doi.org/10.4055/cios.2016.8.3.316

Abstract

BACKGROUND
There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion.
METHODS
Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation.
RESULTS
There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction).
CONCLUSIONS
The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Keyword

Shoulder; Reverse total shoulder arthroplasty; 3D scapular motions; Scapulohumeral rhythm; Optical tracking system

MeSH Terms

Aged
Arm/physiology
Arthroplasty, Replacement, Shoulder/*methods
Biomechanical Phenomena
Cohort Studies
Female
Fiducial Markers
Humans
Imaging, Three-Dimensional/*methods
Male
Range of Motion, Articular/*physiology
Scapula/*physiology
Shoulder Joint/*physiology

Figure

• 

  Fig. 1 Gross photographs showing reflective markers on bony landmarks and synchronized infrared cameras. (A) The photograph shows reflective markers on the anterior aspect of the chest wall and upper extremities. a: jugular notch of the sternum, b: xiphoid process of the sternum, c: medial epicondyle of the humerus, d: lateral epicondyle of the humerus, e: nail of the thumb. (B) The photograph shows reflective markers on the posterior aspect of the chest wall and upper extremities. f: spinous process of the seventh cervical vertebra, g: spinous process of the eighth thoracic vertebra, h: base of the scapular spine, i: inferior angle of the scapula, j: midpoint between the most anterosuperior aspect of the acromioclavicular joint and the angle of the acromion, k: the angle of the acromion. The scapular segment was created using "h," "j," and "k" markers.

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  Fig. 2 To guide the motion on the intended plane, lines were drawn with attached reflective markers on the floor. (A) The photograph shows the subject performing sagittal plane flexion. (B) The photograph shows the subject performing scapular plane abduction.

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  Fig. 3 The illustrations show the definition of right scapular motion with respect to the trunk. (A) Upward rotation. (B) Internal rotation. (C) Posterior tilting. Ant.: anterior, Post.: posterior.

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  Fig. 4 Graphs showing the measured angle of the scapular motion of the reverse total shoulder arthroplasty and contralateral shoulders during sagittal plane flexion. (A) Upward rotation of the scapular motion was significantly different between both shoulders. However, there was no significant difference in internal rotation (B) and posterior tilting (C) of the scapular motion between both shoulders. RTSA: reverse total shoulder arthroplasty.

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  Fig. 5 Graphs showing the measured angle of the scapular motion of reverse total shoulder arthroplasty and contralateral shoulders during scapular plane abduction. (A) There was significant difference in the upward rotation of the scapular motion between both shoulders. However, internal rotation (B) and posterior tilting (C) of the scapular motion were not significantly different between both shoulders. RTSA: reverse total shoulder arthroplasty.

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  Fig. 6 Graphs showing the scapulohumeral rhythm (SHR) of the reverse total shoulder arthroplasty and contralateral shoulders during sagittal plane flexion (A) and scapular plane abduction (B). There was significant difference in the SHR during sagittal plane flexion and scapular plane abduction between both shoulders. RTSA: reverse total shoulder arthroplasty.

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