Does the osteoarthritic shoulder have altered rotator cuff vectors with increasing glenoid deformity? An in silico analysis.

Humans Rotator Cuff / diagnostic imaging Shoulder / physiology Shoulder Joint / diagnostic imaging Scapula / diagnostic imaging Tomography, X-Ray Computed / methods Glenoid Cavity / diagnostic imaging
CT images Shoulder osteoarthritis glenoid retroversion humeral torsion muscle volume rotator cuff shoulder arthroplasty transverse force couple

Journal

Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499

Informations de publication

Date de publication:
Dec 2022
Historique:
received: 25 02 2022
revised: 26 05 2022
accepted: 05 06 2022
pubmed: 26 7 2022
medline: 18 11 2022
entrez: 25 7 2022
Statut: ppublish

Résumé

A transverse force couple (TFC) functional imbalance has been demonstrated in osteoarthritic shoulders by recent 3-dimensional (3D) muscle volumetric studies. Altered rotator cuff vectors may be an additional factor contributing to a muscle imbalance and the propagation of glenoid deformity. Computed tomography images of 33 Walch type A and 60 Walch type B shoulders were evaluated. The 3D volumes of the entire subscapularis, supraspinatus, and infraspinatus-teres minor (ISP-Tm) and scapula were manually segmented. The volume masks and scapular landmarks were imported into MATLAB to create a coordinate system, enabling calculation of muscle force vectors. The direction of each muscle force vector was described in the transverse and vertical plane, calculated with respect to the glenoid. Each muscle vector was then resolved into compression and shear force across the glenoid face. The relationship between muscle force vectors, glenoid retroversion or inclination, compression/shear forces on the glenoid, and Walch type was determined using linear regression. In the transverse plane with all rotator cuff muscles combined, increasing retroversion was significantly associated with increasing posterior drag (P < .001). Type B glenoids had significantly more posterior drag than type A (P < .001). In the vertical plane for each individual muscle group and in combination, superior drag increases as superior inclination increases (P < .001). Analysis of individual muscle groups showed that the anterior thrust of ISP-Tm and supraspinatus switched to a posterior drag at 8° and 10° of retroversion respectively. The compression force on the glenoid face by ISP-Tm and supraspinatus did not change with increasing retroversion for type A shoulders (P = .592 and P = .715, respectively), but they did for type B shoulders (P < .001 for both). The glenoid shear force ratio in the transverse plane for the ISP-Tm and supraspinatus moved from anterior to posterior shear with increasing glenoid retroversion, crossing zero at 8° and 10° of retroversion, whereas the subscapularis exerted a posterior shear force for every retroversion angle. Increased glenoid retroversion is associated with increased posterior shear and decreased compression forces on the glenoid face, explaining some of the pathognomonic bone morphometrics that characterize the osteoarthritic shoulder. Although the subscapularis always maintains a posterior thrust, the ISP-Tm and supraspinatus together showed an inflection at 8° and 10° of retroversion, changing from an anterior thrust to a posterior drag. This finding highlights the importance that in anatomic TSA the rotator cuff functional balance might be better restored by correcting glenoid retroversion to less than 8°.

Sections du résumé

BACKGROUND BACKGROUND
A transverse force couple (TFC) functional imbalance has been demonstrated in osteoarthritic shoulders by recent 3-dimensional (3D) muscle volumetric studies. Altered rotator cuff vectors may be an additional factor contributing to a muscle imbalance and the propagation of glenoid deformity.
METHODS METHODS
Computed tomography images of 33 Walch type A and 60 Walch type B shoulders were evaluated. The 3D volumes of the entire subscapularis, supraspinatus, and infraspinatus-teres minor (ISP-Tm) and scapula were manually segmented. The volume masks and scapular landmarks were imported into MATLAB to create a coordinate system, enabling calculation of muscle force vectors. The direction of each muscle force vector was described in the transverse and vertical plane, calculated with respect to the glenoid. Each muscle vector was then resolved into compression and shear force across the glenoid face. The relationship between muscle force vectors, glenoid retroversion or inclination, compression/shear forces on the glenoid, and Walch type was determined using linear regression.
RESULTS RESULTS
In the transverse plane with all rotator cuff muscles combined, increasing retroversion was significantly associated with increasing posterior drag (P < .001). Type B glenoids had significantly more posterior drag than type A (P < .001). In the vertical plane for each individual muscle group and in combination, superior drag increases as superior inclination increases (P < .001). Analysis of individual muscle groups showed that the anterior thrust of ISP-Tm and supraspinatus switched to a posterior drag at 8° and 10° of retroversion respectively. The compression force on the glenoid face by ISP-Tm and supraspinatus did not change with increasing retroversion for type A shoulders (P = .592 and P = .715, respectively), but they did for type B shoulders (P < .001 for both). The glenoid shear force ratio in the transverse plane for the ISP-Tm and supraspinatus moved from anterior to posterior shear with increasing glenoid retroversion, crossing zero at 8° and 10° of retroversion, whereas the subscapularis exerted a posterior shear force for every retroversion angle.
CONCLUSION CONCLUSIONS
Increased glenoid retroversion is associated with increased posterior shear and decreased compression forces on the glenoid face, explaining some of the pathognomonic bone morphometrics that characterize the osteoarthritic shoulder. Although the subscapularis always maintains a posterior thrust, the ISP-Tm and supraspinatus together showed an inflection at 8° and 10° of retroversion, changing from an anterior thrust to a posterior drag. This finding highlights the importance that in anatomic TSA the rotator cuff functional balance might be better restored by correcting glenoid retroversion to less than 8°.

Identifiants

DOI: 10.1016/j.jse.2022.06.008 PMID: 35872168
pubmed: 35872168
pii: S1058-2746(22)00571-7
doi: 10.1016/j.jse.2022.06.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e575-e585

Informations de copyright

Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Auteurs

Desmond J Bokor (DJ)

MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia.

Antonio Arenas-Miquelez (A)

MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia. Electronic address: antarenas1987@gmail.com.

David Axford (D)

Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada.

Petra L Graham (PL)

School of Mathematical and Physical Sciences, Macquarie University, Sydney, NSW, Australia.

Louis M Ferreira (LM)

Department of Biomedical Engineering, The University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada; Collaborative Training Program in Musculoskeletal Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.

George S Athwal (GS)

Roth|McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada; Collaborative Training Program in Musculoskeletal Health Research, and Bone and Joint Institute, The University of Western Ontario, London, ON, Canada.

Sumit Raniga (S)

MQ Health Translational Shoulder Research Program, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Appareil locomoteur › Tendons › Coiffe des rotateurs › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Régions du corps › Membres › Membre supérieur › Épaule › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Appareil locomoteur › Squelette › Articulations › Articulation glénohumérale › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Appareil locomoteur › Squelette › Os du membre supérieur › Scapula › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Does the osteoarthritic shoulder have altered...
questionsmedicales.fr › Appareil locomoteur › Squelette › Os du membre supérieur › Scapula › Cavité glénoïde › Does the osteoarthritic shoulder have altered...