Effects of Scapular Angular Deviations on Potential for Rotator Cuff Tendon Mechanical Compression

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2024 Mar 4

PMID 38435717

Authors

Rebekah L Lawrence

Laura B Richardson

Hannah L Bilodeau

Dane J Bonath

Daniel J Dahn

Mary-Ann Em

Sanjay Sarkar

Jonathan P Braman

Paula M Ludewig

Affiliations

Soon will be listed here.

Abstract

Background: One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration.

Purpose: To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction.

Study Design: Descriptive laboratory study.

Methods: Three-dimensional bone models were reconstructed from computed tomography scans obtained from 10 asymptomatic subjects and 9 symptomatic subjects with a clinical presentation of impingement syndrome. Models were rotated to average scapular orientations from a healthy dataset at higher (120°) and lower (subject-specific) humeral elevation angles to investigate internal and subacromial impingement risks, respectively. Incremental deviations in scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt were imposed on the models to simulate scapular movement impairments. The minimum distance between the rotator cuff insertions and potential impinging structures (eg, glenoid, acromion) was calculated. Two-way mixed-model analyses of variance assessed for effects of scapular deviation and group.

Results: At 120° of humerothoracic elevation, minimum distances from the supraspinatus and infraspinatus insertions to the glenoid increased with ≥5° changes in upward rotation (1.6-9.8 mm, < .001) or external rotation (0.9-5.0 mm, ≤ .048), or with ≥10° changes in anterior tilt (1.1-3.2 mm, < .001). At lower angles, ≥20° changes in most scapular orientations significantly increased the distance between the supraspinatus and infraspinatus insertions and the acromion or coracoacromial ligament.

Conclusion: A reduction in scapular upward rotation decreases the distance between the rotator cuff tendon insertions and glenoid at 120° humerothoracic elevation. Interpretation is complicated for lower angles because the humeral elevation angle was defined by the minimum distance.

Clinical Relevance: These results may assist clinical decision making regarding the effects of scapular movement deviations in patients with rotator cuff pathology and scapular dyskinesia and may help inform the selection of clinical interventions.

Citing Articles

In vivo shoulder kinematic changes and rotator cuff healing after surgical repair of large-to-massive rotator cuff tears.

Tashiro E, Kozono N, Higaki H, Shimoto T, Nakashima Y J Orthop Surg Res. 2024; 19(1):801.

PMID: 39604958 PMC: 11603637. DOI: 10.1186/s13018-024-05292-9.

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