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Background: Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs., Materials and Methods: All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation., Results: Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group., Conclusion: Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Noninvasive methods enabling measurement of shoulder bone positions are paramount in clinical and ergonomics applications. In this study, the acromion marker cluster (AMC) method is assessed in comparison with a model-based approach allowing scapula tracking from low-dose biplanar radiograph images. Six healthy male subjects participated in this study. Data acquisition was performed for 6 arm abduction positions (0°, 45°, 90°, 120°, 150°, 180°). Scapula rotations were calculated using the coordinate systems and angle sequence was defined by the ISB. The comparison analysis was based on root mean square error (RMSE) calculation and nonparametric statistical tests. RMSE remained under 8° for 0° to 90° arm abduction and under 13.5° for 0° to 180° abduction; no significant differences were found between the 2 methods. Compared with previous works, an improved accuracy of the AMC approach at high arm abduction positions was obtained. This could be explained by the different sources of data used as the "gold standard."

Background: Accurate knowledge of the scapular anatomy is fundamental for the preoperative evaluation but some bony landmarks are difficult to identify. Statistical approaches based on subject-specific parametric models could be used to overcome this difficulty. The aim of this study was to propose a quantitative parametric model of the scapula and to analyze correlations between descriptive morphologic parameters., Materials and Methods: Forty-three scapulae were scanned and reconstructed. Each 3D scapula was regionalized and a simple geometric element was best fitted on each region using least square method. Descriptive parameters of each region were obtained. Correlation and linear regression analyses were performed between all measurements in order to assess parameters that can be used as predictors of the other descriptive parameters., Results: Morphometric scapular measurements from 3D reconstructions were obtained. Correlation and linear regression analyses assessed correlations between the glenoid width and both the glenoid height and the acromial width. Also, we obtained correlation between the orientation of the inferior part of the acromion on the A-P view and on the axillary view., Discussion: Parametric models are widely used in biomechanics for identifying anatomical landmarks or rotations centers of these structures. For the scapula, no such model is available. We elaborated a first parametric model of scapula based on a large database of 43 scapulae. Our morphometric measurements are very close to others founded in literature. Correlations obtained should help to progress toward relevant subject-specific models of the scapula based on reduced information.

A robust and reproducible scapular coordinate system is necessary to study scapulothoracic kinematics. The coordinate system recommended by the ISB (International Society of Biomechanics) is difficult to apply in studies using medical imaging, which mostly use a glenoid-centered coordinate system. The aim of this study was to assess the robustness of a glenoid-centered coordinate system compared with the ISB coordinate system, and to study the reproducibility of this coordinate system measure during abduction. A Monte-Carlo analysis was performed to test the robustness of the two coordinate systems. This method enabled the variability of the orientation of the coordinate system to be assessed in a laboratory setting. A reproducibility study of the glenoid-centered coordinate system in the thorax reference frame was performed during abduction in the scapular plane using a low-dose stereoradiography system. We showed that the glenoid-centered coordinate system was slightly more robust than the ISB-recommended coordinate system. Most reproducible rotation was upward/downward rotation (x axis) and most reproducible translation was along the Y axis (superior-inferior translation). In conclusion, the glenoid-centered coordinate system can be used with confidence for scapular kinematics analysis. The uncertainty of the measures derived from our technique is acceptable compared with that reported in the literature. Functional quantitative analysis of the scapulothoracic joint is possible with this method. [ABSTRACT FROM AUTHOR]

Objective: Optimal position and fixation of the baseplate is essential for the longevity of the reverse shoulder arthroplasty (RSA) and the patient-specific instrumentation (PSI) can help the surgeon to achieve that purpose. The aim of this study was to assess the reliability of the PSI guides for the positioning of the baseplate and the fixation's screws.Method: Prospective study involving 35 patients operated for RSA. The PSI guides were planned and used by the senior surgeon in all cases. We compared the planned orientation (frontal and axial) of the baseplate and the screws with the post-operative CT scan.Results: The mean difference between the planned measures and the post-op measures was inferior to 2.5°. The screw's length corresponded with the pre-op plan in 70% of the cases.Conclusion: The use of a PSI guide to position the glenoid implant in total reverse shoulder arthroplasty is reliable, reduces the risk of positioning errors and improves the quality of fixation with the screws. [ABSTRACT FROM AUTHOR]

To investigate the reproducibility of shoulder bony landmarks location using the EOS® low-dose stereoradiography system, in order to validate this new tool for the study of gleno-humeral pseudo-kinematics. An inter and intraobserver reproducibility study of shoulder bony landmarks location concerning 22 healthy volunteers. This study concerned the neutral position, arm at rest. Humerus and scapula were modeled with simple geometric shapes using specific software. Those shapes were positioned on A-P and lateral x-rays views. Images analysis of the 22 subjects was carried out three times ( nr = 3), by two observers ( no = 2), for a total of ntot = 132 analyses. We obtained a very good reproducibility for the humeral head center and the diaphysis axis with 95% confidence interval (IC95%) inferior to 1.09 mm and 0.41°, respectively. The uncertainty was higher for the lateral and medial epicondyles. Regarding the scapular bony landmarks, we observed a good reproducibility for the tip of the coracoid process, the inferior glenoid rim, and the axillar border with a 95% confidence interval lower than 2.13, 2.91 mm, and 3.67°, respectively. The uncertainty was higher for the most postero-lateral point of the acromion and the superior glenoid rim. Our analysis of the x-rays obtained with the EOS® low-dose stereoradiography system assessed the location reliability and reproducibility of specific scapular and humeral bony landmarks. This work opens the way to gleno-humeral pseudo-kinematics analysis using EOS® imaging system. [ABSTRACT FROM AUTHOR]

Rotator cuff (RC) tears may be associated with increased glenohumeral instability; however, this instability is difficult to quantify using currently available diagnostic tools. Recently, the three-dimensional (3D) reconstruction and registration method of the scapula and humeral head, based on sequences of low-dose biplane X-ray images, has been proposed for glenohumeral displacement assessment. This research aimed to evaluate the accuracy and reproducibility of this technique and to investigate its potential with a preliminary application comparing RC tear patients and asymptomatic volunteers. Accuracy was assessed using CT scan model registration on biplane X-ray images for five cadaveric shoulder specimens and showed differences ranging from 0.6 to 1.4mm depending on the direction of interest. Intra- and interobserver reproducibility was assessed through two operators who repeated the reconstruction of five subjects three times, allowing defining 95% confidence interval ranging from ±1.8 to ±3.6mm. Intraclass correlation coefficient varied between 0.84 and 0.98. Comparison between RC tear patients and asymptomatic volunteers showed differences of glenohumeral displacements, especially in the superoinferior direction when shoulder was abducted at 20° and 45°. This study thus assessed the accuracy of the low-dose 3D biplane X-ray reconstruction technique for glenohumeral displacement assessment and showed potential in biomechanical and clinical research. [ABSTRACT FROM AUTHOR]