Effect of axis alignment on in vivo shoulder kinematics

Background. To describe 3D shoulder joint movements, the International Society of Biomechanics (ISB) recommends using segment coordinate systems (SCSs) on the humerus, scapula and thorax, and joint coordinate systems (JCSs) on the shoulder. However, one of the remaining problems is how to define the zero angles when the arm is in an initial reference position. The aim of this paper is to compare various methods of determining the JCSs of the shoulder that make it possible to define the zero angles of the arm in the resting position.

Methods. Able-bodied subjects performed elevation movements in the scapular plane, specifically neutral, internal and external rotations of the humerus. The initial humerus position (at the beginning of the arm movement) and range of motion were analysed for the purpose of clinical interpretation of arm attitude and movement. The following four different JCSs were explored: (1) the standard JCS, defined as recommended by the ISB, (2) a first aligned JCS, where the humerus SCS is initially aligned with the scapula SCS, (3) a second aligned JCS, where the opposite operation is performed and 4) a third aligned JCS, where both the humerus and the scapular SCS are initially aligned with the thorax SCS.

Findings. The second aligned JCS was the only method that did not produce any exaggerated range of movement in either anatomical plane.

Interpretation. Mathematical JCS alignment allows clearer clinical interpretation of arm attitude and movement.     

Shoulder joint kinematics during elevation measured by ultrasound-based measuring system.

In order to analyze shoulder joint movements, the authors use a ZEBRIS CMS-HS ultrasound-based movement analysis system. In essence, the measurement involves the determination of the spatial position of the 16 anatomical points, which are specified on the basis of the coordinates of ultrasound-based triplets positioned on the upper limb, the scapula, and the thorax; their spatial position is measured in the course of motion. Kinematic characteristics of 74 shoulder joints of 50 healthy persons were identified during elevation in the plane of the scapula. Kinematic characteristics of motion were identified by scapulothoracic, glenohumeral, and humeral elevation angles; range of angles; scapulothoracis and glenohumeral rhythm; scapulothoracic, glenohumeral, and scapuloglenoid ratios; and the relative displacement between the rotation centers of the humerus and the scapula. Motion of the humerus and the scapula relative to each other was characterized by their rotation as well as the relative displacement between the rotation centers of scapula and humerus. The biomechanical model of the shoulder joint during elevation can be described by analyzing the results of the measurements performed.     

Evaluation of regression-based 3-D shoulder rhythms

The movements of the humerus, the clavicle, and the scapula are not completely independent. The coupled pattern of movement of these bones is called the shoulder rhythm. To date, multiple studies have focused on providing regression-based 3-D shoulder rhythms, in which the orientations of the clavicle and the scapula are estimated by the orientation of the humerus. In this study, six existing regression-based shoulder rhythms were evaluated by an independent dataset in terms of their predictability. The datasets include the measured orientations of the humerus, the clavicle, and the scapula of 14 participants over 118 different upper arm postures. The predicted orientations of the clavicle and the scapula were derived from applying those regression-based shoulder rhythms to the humerus orientation. The results indicated that none of those regression-based shoulder rhythms provides consistently more accurate results than the others. For all the joint angles and all the shoulder rhythms, the RMSE are all greater than 5°. Among those shoulder rhythms, the scapula lateral/medial rotation has the strongest correlation between the predicted and the measured angles, while the other thoracoclavicular and thoracoscapular bone orientation angles only showed a weak to moderate correlation. Since the regression-based shoulder rhythm has been adopted for shoulder biomechanical models to estimate shoulder muscle activities and structure loads, there needs to be further investigation on how the predicted error from the shoulder rhythm affects the output of the biomechanical model.     

Difference between palpation and optoelectronics recording of scapular motion

The aim of this study is to determine the errors of scapular localisation due to skin relative to bone motion with an optoelectronic tracking system. We compared three-dimensional (3D) scapular positions obtained with skin markers to those obtained through palpation of three scapular anatomical landmarks. The scapular kinematics of nine subjects were collected. Static positions of the scapula were recorded with the right arm elevated at 0°, 40°, 80°, 120° and 160° in the sagittal plane. Palpation and subsequent digitisation of anatomical landmarks on scapula and thorax were done at the same positions. Scapular 3D orientation was also computed during 10 repeated movements of arm elevation between 0° and 180°. Significant differences in scapular kinematics were seen between static positions and palpation when considering anterior/posterior tilt and upward/downward rotation at angles over 120° of humeral elevation and only at 120° for internal/external rotation. There was no significant difference between positions computed during static positions and during the movement for the three scapular orientations. A rotation correction model is presented in order to reduce the errors between static position and palpation measurement.     

Scapular taping alters kinematics in asymptomatic subjects

BackgroundScapular taping is frequently used in the management of shoulder pain and as a part of injury prevention strategies in sports. It is believed to alter scapular kinematics and restore normal motion. However, there is little evidence to support its use. The aim of the study was to investigate the effect of shoulder taping on the scapular kinematics of asymptomatic subjects.MethodThirteen asymptomatic subjects performed elevations in the sagittal and scapular planes with no tape and after the application of tape. A motion tracking system and a scapula locator method were used to measure the shoulder movement. Co-ordinate frames were defined for the thorax, humerus and scapula and Euler angles were used to calculate joints rotations.ResultsScapular taping increased the scapular external and upward rotations and posterior tilt in elevations in the sagittal plane (p < 0.001). In the scapular plane, taping increased scapular external rotation (p < 0.05).ConclusionsTaping affects scapulothoracic kinematics in asymptomatic subjects. The effect may be different for different planes of movement. The findings have implications on the use of taping as a preventive measure in high-risk groups. Further work is needed to assess the effect of taping on symptomatic populations.     

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual’s anthropometry. We compared the model to “gold standard” bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models.     

Shoulder movements during quadrupedal locomotion in arboreal primates

The kinematics of scapula and shoulder joint movements were analyzed in three species of arboreal quadrupedal primates using cineradiography. Our findings indicate that scapular movement is highly important for forelimb movement in primates with this ancestral mode of locomotion. Retroversion of the scapula (syn. caudal rotation or extension) during the stance phase contributes more than 40% to the stride length of the forelimb. Lateral forelimb excursions, a general feature for arboreal primates, are based on complex three-dimensional scapular movements guided by the clavicle. Humeral abduction is achieved by scapular abduction and transversal rotation of the scapula about its longitudinal axis, and is therefore strikingly different from humeral abduction in humans. At the same time, the movements of the shoulder joint are limited to flexion and extension only.     

Scapular kinematics during unloaded and maximal loaded isokinetic concentric and eccentric shoulder flexion and extension movements

Characterization of scapular kinematics under demanding load conditions might aid to distinguish between physiological and clinically relevant alterations. Previous investigations focused only on submaximal external load situations. How scapular movement changes with maximal load remains unclear. Therefore, the present study aimed to evaluate 3D scapular kinematics during unloaded and maximal loaded shoulder flexion and extension. Twelve asymptomatic individuals performed shoulder flexion and extension movements under unloaded and maximal concentric and eccentric loaded isokinetic conditions. 3D scapular kinematics assessed with a motion capture system was analyzed for 20° intervals of humeral positions from 20° to 120° flexion. Repeated measures ANOVAs were used to evaluate kinematic differences between load conditions for scapular position angles, scapulohumeral rhythm and scapular motion extent. Increased scapular upward rotation was seen during shoulder flexion and extension as well as decreased posterior tilt and external rotation during eccentric and concentric arm descents of maximal loaded compared to unloaded conditions. Load effects were further seen for the scapulohumeral rhythm with greater scapular involvement at lower humeral positions and increased scapular motion extent under maximal loaded shoulder movements. With maximal load applied to the arm physiological scapular movement pattern are induced that may imply both impingement sparing and causing mechanisms.     

Subscapularis function in gibbons and chimpanzees: Implications for interpretation of humeral head torsion in hominoids

Chimpanzees and gibbons, along with other hominoids, share a number of features in the morphology of their shoulders that have generally been associated with use of the upper limb in overhead postural and locomotor activities. These include the position and shape of the scapula, as well as the morphology of the proximal end of the humerus. Results of an electromyographic (EMG) analysis of shoulder muscle activity patterns indicate that these two species of hominoids also share broad similarities in shoulder muscle function during locomotion and voluntary movements. Differences do exist, however, in the activity patterns of subscapularis, a medial rotator of the arm. These differences mainly involve a greater participation by the gibbon subscapularis in free arm movements. This greater participation is characterized by earlier onset of muscle activity, higher amplitude of recruitment, and involvement of more of the total mass of the muscle. These differences in muscle recruitment suggest that the shoulder of gibbons differs from that of chimpanzees in some manner that necessitates the greater contribution of a medial rotator to the production of motion in the upper limb. I suggest that the low degree of humeral head torsion in gibbons, compared to that of other hominoids, gives their elbow a “lateral set” that must be overcome by the action of subscapularis during free arm movements. I propose that this modest degree of humeral head torsion in gibbons reflects a compromise between necessary changes caused by the repositioning of the scapula onto the dorsum of the thorax and the demands for extreme positioning of the elbow during brachiation. In addition, I suggest that the greater amount of torsion in the chimpanzee humerus is an accommodation to quadrupedal habits, and finally, that the high degree of torsion in human humeri is an independently acquired trait related to use of the upper limb as a manipulatory organ.     

An alternative definition of the scapular coordinate system for use with RSA

When performing radiostereometric analysis (RSA), computed tomography scans are often taken to obtain the landmarks used to create anatomical coordinate systems (CSs) for quantifying joint kinematics. Different conventions for defining CSs lead to an inability to compare results among studies. The International Society of Biomechanics (ISB) has proposed a set of CSs; however, the landmarks needed to create the recommended scapular CS require the entire scapula to be scanned, thereby also exposing breast and other tissues to radiation. The main purpose of this work was to investigate an alternate definition of the CS that has repeatably attainable landmarks and axes as close as possible to those recommended by the ISB, while limiting the portion of the scapula requiring scanning. Intra- and inter-investigator variabilities of landmark digitization were quantified in one model of a scapula and one cadaveric specimen. Based on the variability of the digitizations, an alternative CS was defined. The differences between the ISB and alternative CSs were evaluated on 11 cadaveric specimens. Beaded biplanar RSA was performed on the glenohumeral joint model in 15 different configurations and the resulting kinematics were calculated for each set of landmark digitizations using both sets of coordinate systems. While the kinematic angles obtained using the alternative CS were statistically different from those obtained using the ISB standard, these differences were small (on the order of 5°) and therefore considered to be of little clinical significance. In all likelihood, the benefits of decreasing radiation exposure outweigh these differences in angles.     

Rotation sequence is an important factor in shoulder kinematics. Application to the elite players’ flat serves

The aim of this study was to test three different rotation sequences (YXY, ZXY, and XZY) on the shoulder kinematics (rotations of the humerus relative to the thorax) during an original movement such as the tennis flat serve (FS). Nine elite male and female players performed a minimum of five flat serves. An optoelectronic motion analysis system was used to record the movements. Segment kinematics during each FS was reconstructed from the spatial trajectories of the markers according to ISB recommendations. For each rotation sequence, three angles were reported for the shoulder joint, each corresponding to a rotation component around a defined axis. The occurrence of gimbal lock (GL) and angle amplitude coherences were examined. From these three rotation sequences tested, it appears that the XZY sequence was the only decomposition not to suffer from GL. Moreover, the rotation sequence XZY was found to be coherent for all rotation components. Thus, these results show that the best rotation sequence, from both GL and amplitude coherence points of view, is XZY to describe the shoulder kinematics during the tennis serve.     

A new method for motion capture of the scapula using an optoelectronic tracking device: a feasibility study

Optoelectronic tracking systems are rarely used in 3D studies examining shoulder movements including the scapula. Among the reasons is the important slippage of skin markers with respect to scapula. Methods using electromagnetic tracking devices are validated and frequently applied. Thus, the aim of this study was to develop a new method for in vivo optoelectronic scapular capture dealing with the accepted accuracy issues of validated methods.

Eleven arm positions in three anatomical planes were examined using five subjects in static mode. The method was based on local optimisation, and recalculation procedures were made using a set of five scapular surface markers.

The scapular rotations derived from the recalculation-based method yielded RMS errors comparable with the frequently used electromagnetic scapular methods (RMS up to 12.6° for 150° arm elevation). The results indicate that the present method can be used under careful considerations for 3D kinematical studies examining different shoulder movements.     

Double calibration: an accurate, reliable and easy-to-use method for 3D scapular motion analysis

The most recent non-invasive methods for the recording of scapular motion are based on an acromion marker (AM) set and a single calibration (SC) of the scapula in a resting position. However, this method fails to accurately measure scapular kinematics above 90° of arm elevation, due to soft tissue artifacts of the skin and muscles covering the acromion. The aim of this study was to evaluate the accuracy, and inter-trial and inter-session repeatability of a double calibration method (DC) in comparison with SC. The SC and DC data were measured with an optoelectronic system during arm flexion and abduction at different angles of elevation (0-180°). They were compared with palpation of the scapula using a scapula locator. DC data was not significantly different from palpation for 5/6 axes of rotation tested (Y, X, and Z in abduction and flexion), where as SC showed significant differences for 5/6 axes. The root mean square errors ranged from 2.96° to 4.48° for DC and from 6° to 9.19° for SC. The inter-trial repeatability was good to excellent for SC and DC. The inter-session repeatability was moderate to excellent for SC and moderate to good for DC. Coupling AM and DC is an easy-to-use method, which yields accurate and reliable measurements of scapular kinematics for the complete range of arm motion. It can be applied to the measurement of shoulder motion in many fields (sports, orthopaedics, and rehabilitation), especially when large ranges of arm motion are required.     

Contributions of the individual muscles of the shoulder to glenohumeral joint stability during abduction

The aim of this study was to determine the relative contributions of the deltoid and rotator cuff muscles to glenohumeral joint stability during arm abduction. A three-dimensional model of the upper limb was used to calculate the muscle and joint-contact forces at the shoulder for abduction in the scapular plane. The joints of the shoulder girdle-sternoclavicular joint, acromioclavicular joint, and glenohumeral joint-were each represented as an ideal three degree-of-freedom ball-and-socket joint. The articulation between the scapula and thorax was modeled using two kinematic constraints. Eighteen muscle bundles were used to represent the lines of action of 11 muscle groups spanning the glenohumeral joint. The three-dimensional positions of the clavicle, scapula, and humerus during abduction were measured using intracortical bone pins implanted into one subject. The measured bone positions were inputted into the model, and an optimization problem was solved to calculate the forces developed by the shoulder muscles for abduction in the scapular plane. The model calculations showed that the rotator cuff muscles (specifically, supraspinatus, subscapularis, and infraspinatus) by virtue of their lines of action are perfectly positioned to apply compressive load across the glenohumeral joint, and that these muscles contribute most significantly to shoulder joint stability during abduction. The middle deltoid provides most of the compressive force acting between the humeral head and the glenoid, but this muscle also creates most of the shear, and so its contribution to joint stability is less than that of any of the rotator cuff muscles.     

Scapular position in primates

Scapular position affects shoulder mobility, which plays an important role in the upper limb adaptations in primates. However, currently available data on scapular position are unsatisfactory because of the failure to simultaneously consider the relative dimensions of all the three skeletal elements of the shoulder girdle, i.e. the clavicle, the scapula and the thorax. In the present study, the clavicular length and the scapular spine length were measured on preserved cadavers, and the dorsoventral thoracic diameter was measured on scaled radiographs of a wide range of primates, permitting a quantitative comparison of scapular position among primates. It was found that arboreal monkeys have a more dorsally situated scapula than terrestrial ones, but the same difference was not found between terrestrial and arboreal prosimians. Hominoids were found to have the most dorsally situated scapula. Contrary to the slow climbing theory of hominoid evolution, which tries to explain most postcranial specializations of hominoids as adaptations for slow climbing, the scapulae of slow-climbing lorines and Alouatta are much less dorsal than those of the hominoids.     

Cineradiographic study of forelimb movements during quadrupedal walking in the brown lemur (Eulemur fulvus, Primates: Lemuridae)

Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.     

Effects of attachment position and shoulder orientation during calibration on the accuracy of the acromial tracker

The acromial tracker is used to measure scapular rotations during dynamic movements. The method has low accuracy in high elevations and is sensitive to its attachment location on the acromion. The aim of this study was to investigate the effect of the attachment position and shoulder orientation during calibration on the tracker accuracy. The tracker was attached to one of three positions: near the anterior edge of the acromion process, just above the acromial angle and the meeting point between the acromion and the scapular spine. The scapula locator was used to track the scapula during bilateral abduction simultaneously. The locator was used to calibrate the tracker at: no abduction, 30°, 60°, 90° and 120° humerothoracic abduction. ANOVA tests compared RMS errors for different attachment positions and calibration angles. The results showed that attaching the device at the meeting point between the acromion and the scapular spine gave the smallest errors and it was best to calibrate the device at 60° for elevations ≤90°, at 120° for elevations >90° and at 90°or 120° for the full range of abduction. The accuracy of the tracker is significantly improved if attached appropriately and calibrated for the range of movement being measured.     

Method for determining the spatial position of the shoulder with ultrasound-based motion analyzer.

Several methods have been developed recently for the analysis of the spatial motion of the scapula and the arm, whereby the spatial position of shoulder bones is determined in static conditions by interrupting motion. The authors have developed a 3D motion analysis method recording scapular motion in progress with appropriate accuracy in the course of arm movements of various degrees. The objective of this study is to explore the applicability of the method developed, as well as to compare it with and verify it by other methods developed earlier. The position and displacements of shoulder bones were determined on 30 shoulders of 15 healthy people. The newly developed measurement method is based on the mechanical basic principle stating that the position and motion of a rigid body -- in this case, the bones (segments) forming the shoulder joint -- can be calculated at any moment from the spatial coordinates of three points of a segment and any changes thereof in the course of motion. Ultrasound-based triplets providing the three points (fundamental points) by a segment as required for measurement were fixed on the sternum (modeling the trunk), the clavicle, the acromion (modeling the scapula), the upper arm, and the lower arm. The position of the sixteen anatomical points involved in the study were determined by an ultrasound-based pointer in the local coordinate system specified by the fundamental points before starting measurements. The ZEBRIS ultrasound-based motion analysis system was used for measuring the spatial coordinates of triplets in the course of continuous motion. The spatial coordinates of the designated anatomical points can be calculated by the method of triangulation. The method was calibrated by a ZEBRIS mapping (3DCAD) software commercially available, and the measurement error rate of the method was determined by statistical calculations. On the basis of calibration and error calculations it could be established that the accuracy and the reproducibility of the method were appropriate, in accordance with the limit values to be found in the literature.