Abstract
Analyzing shoulder kinematics is challenging as the shoulder is comprised of a complex group of multiple highly mobile joints. Unlike at the elbow or knee which has a primary flexion/extension axis, both primary shoulder joints (glenohumeral and scapulothoracic) have a large range of motion (ROM) in all three directions. As such, there are six degrees of freedom (DoF) in the shoulder joints (three translations and three rotations), and all these parameters need to be defined to fully describe shoulder motion. Despite the importance of glenohumeral and scapulothoracic coordination, it's the glenohumeral joint that is most studied in the shoulder. Additionally, the limited research on the scapulothoracic primarily focuses on planar motion such as abduction or flexion. However, more complex motions, such as internally rotating to the back, are rarely studied despite the importance for activities of daily living. A technique for analyzing shoulder kinematics which uses 4DCT has been developed and validated and will be used to conduct analysis. The objective of this study is to characterize glenohumeral and scapulothoracic motion during active internal rotation to the back, in a healthy young population, using a novel 4DCT approach.
Eight male participants over 18 with a healthy shoulder ROM were recruited. For the dynamic scan, participants performed internal rotation to the back. For this motion, the hand starts on the abdomen and is moved around the torso up the back as far as possible, unconstrained to examine variability in motion pathway. Bone models were made from the dynamic scans and registered to neutral models, from a static scan, to calculate six DoF kinematics. The resultant kinematic pathways measured over the entire motion were used to calculate the ROM for each DoF.
Results indicate that anterior tilting is the most important DoF of the scapula, the participants all followed similar paths with low variation. Conversely, it appears that protraction/retraction of the scapula is not as important for internally rotating to the back; not only was the ROM the lowest, but the pathways had the highest variation between participants. Regarding glenohumeral motion, internal rotation was by far the DoF with the highest ROM, but there was also high variation in the pathways. Summation of ROM values revealed an average glenohumeral to scapulothoracic ratio of 1.8:1, closely matching the common 2:1 ratio other studies have measured during abduction.
Due to the unconstrained nature of the motion, the complex relationship between the glenohumeral and scapulothoracic joints leads to high variation in kinematic pathways. The shoulder has redundant degrees of freedom, the same end position can result from different joint angles and positions. Therefore, some individuals might rely more on scapular motion while others might utilize primarily humeral motion to achieve a specific movement. More analysis needs to be done to identify if any direct correlations can be drawn between scapulothoracic and glenohumeral DoF. Analyzing the kinematics of the glenohumeral and scapulothoracic joint throughout motion will further improve understanding of shoulder mechanics and future work plans to examine differences with age.
