Older Age is Associated with Decreased Overall Shoulder Strength but Not Direction-specific Differences in the Three-dimensional Feasible Torque Space

Shoulder strength is reduced in older adults but has only been assessed in planar motions that do not reflect the diverse requirements of daily tasks. We quantified the impact of age on strength spanning the three degrees of freedom relevant to shoulder function, referred to as the feasible torque space. We hypothesized that the feasible torque space would differ with age and expected this age-effect to reflect direction-specific deficits. We measured strength in 32 directions to characterize the feasible torque space of the shoulder in participants without shoulder pain or tendinous pathology (n = 39, 19-86 years). We modeled the feasible torque space for each participant as an ellipsoid, computed the ellipsoid size and direction-specific metrics (ellipsoid position, orientation, and shape), and then tested the effect of age on each metric. Age was negatively associated with ellipsoid size (a measure of overall strength magnitude; -0.0033 ± 0.0007 (Nm/kg)/year, p < 0.0001). Contrary to our expectation, the effect of age on the direction-specific metrics did not reach statistical significance. The effect of age did not differ significantly between male and female participants. Three-dimensional strength measurements allowed us to constrain the direction of participants' maximum torque production and characterize the entire feasible torque space. Our findings support a generalized shoulder strengthening program to address age-related shoulder weakness in those without pain or pathology. Clinical exam findings of imbalanced weakness may suggest underlying pathology beyond an effect of age. Longitudinal studies are needed to determine the positive or negative impact of our results.