Fluoroscopic assessment of rotator cuff fatigue on glenohumeral arthrokinematics in shoulder impingement syndrome.
BACKGROUND
Although prior researchers have assessed glenohumeral arthrokinematics using isometrically held arm postures with standard radiographs, dynamic assessment of glenohumeral arthrokinematics has been limited. This study utilized video fluoroscopy to analyze superior inferior glenohumeral migration during dynamic arm elevation in individuals with outlet impingement syndrome, before and after fatigue of the rotator cuff.


OBJECTIVE
Prior to the study, it was hypothesized that during the pre-fatigue state, glenohumeral migration would be in the superior direction, and that post-fatigue there would be a significant increase in superior migration.


METHODS
Digital fluoroscopic videos (30 Hz) were used to analyze 20 male volunteers (27.7 +/- 7.3 years) with right shoulder outlet impingement syndrome during concentric elevation of the arm in the plane of the scapula, both before and after fatigue of the rotator cuff.


RESULTS
During concentric arm elevation, there was superior glenohumeral migration (1.6 mm) between 45 degrees and 90 degrees of arm elevation, regardless of fatigue-state (P = .02). After rotator cuff fatigue, the humeral head was positioned more superiorly on the glenoid fossa (P = .03). The position of the humeral head was 0.4 mm more superior than that reported in a previous study on healthy individuals.


CONCLUSIONS
These results support prior findings that suggest superior glenohumeral migration during arm elevation is influenced both by shoulder pathology and the state of fatigue of the rotator cuff musculature. Future research should examine the effects of physical therapy and surgical interventions on glenohumeral arthrokinematics to better determine the most effective treatment methods for outlet impingement.


METHODS
Controlled laboratory study.
Physical Therapy Department, United States Army Health Clinic, Vicenza, Italy. phil.royer@us.army.mil
Philip J
PJ
Royer
Edward J
EJ
Kane
Kyle E
KE
Parks
Jacob C
JC
Morrow
Richard R
RR
Moravec
Douglas S
DS
Christie
Deydre S
DS
Teyhen
D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D018763:Muscle Fatigue; D017006:Rotator Cuff / Q000503:physiopathology*; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D055815:Young Adult