title: The effect of posterior capsular tightening on peak subacromial contact pressure during simulated active abduction in the scapular plane.
abstract: OBJECTIVE
  Our hypothesis was that tightening of the posterior capsule would lead to increased subacromial pressure and increased superior translation during active abduction in the scapular plane.
  
  
  BACKGROUND
  Subacromial impingement syndrome is a painful condition that occurs during overhead activities as the rotator cuff is compressed in the subacromial space. Unrecognized secondary causes of subacromial impingement may lead to treatment failure. Posterior capsular tightness, believed to alter glenohumeral joint kinematics, is often cited as a secondary cause of SI; however, scientific evidence is lacking. The primary objective of this study was to evaluate the effect of posterior capsular tightening on peak subacromial pressure during abduction in the scapular plane.
  
  
  METHODS
  Ten fresh frozen shoulder specimens from deceased donors were mounted on a custom shoulder simulator. With the scapula fixed, the deltoid and rotator cuff muscles were loaded in discrete static steps with a constant ratio to elevate the humerus in the scapular plane. The treatment order (no tightening, 1-cm, and 2-cm tightening of the posterior capsule) was randomly assigned to each specimen. Peak subacromial contact pressure and glenohumeral kinematics at the peak pressure position were compared using a repeated measures analysis of variance.
  
  
  RESULTS
  Peak subacromial pressures (mean +/- standard deviation) were similar between treatment groups: 345 +/- 152, 410 +/- 213, and 330 +/- 164 kPa for no tightening, 1-cm, and 2-cm tightening of the posterior capsule respectively (P > .05). No significant differences were found for superior or anterior translations at the peak pressure position (P > .05).
  
  
  CONCLUSIONS
  Posterior capsular tightening, as a sole variable, did not contribute to a significant increase in peak subacromial pressure during abduction in the scapular plane. A similar study simulating active forward flexion is necessary to fully characterize the contribution of posterior capsular tightness to subacromial impingement.
  
  
  CONCLUSIONS
  Tightening of the posterior capsule did not increase subacromial pressure, or increase superior or anterior translation during abduction in the scapular plane.
authors.affiliation: Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Poitras
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Kingwell
authors.forename: Othman
authors.initials: O
authors.lastname: Ramadan
authors.forename: Donald L
authors.initials: DL
authors.lastname: Russell
authors.forename: Hans K
authors.initials: HK
authors.lastname: Uhthoff
authors.forename: Peter
authors.initials: P
authors.lastname: Lapner
mesh_terms: D000174:Acromion / Q000502:physiology; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016059:Range of Motion, Articular / Q000502:physiology; D012540:Scapula / Q000502:physiology*; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology*; D012785:Shoulder Joint / Q000502:physiology