The effect of clavicle malunion on shoulder biomechanics; a computational study.
BACKGROUND
Clavicle malunion affects the biomechanics of the shoulder joint. The purpose of this study is to establish the abduction, flexion, and internal (medial) rotation biomechanics of the shoulder after clavicle malunion.


METHODS
A computational study was performed utilizing a three-dimensional, validated computational model of the upper extremity. Sequential shortening of the clavicle up to 20% was simulated. Muscle forces, moment arms, and moments were calculated for the surrounding musculature through a range of flexion, abduction, and internal rotation during the simulated shortening.


RESULTS
Shortening of the clavicle decreases the shoulder elevation moments of the upper extremity muscles during abduction. Internal rotation moments are also decreased with shortening. Flexion moments were affected less through physiologic range of motion. The observed effects are due to a combination of changes in moment arms of the individual muscles as well as a decrease in the force generating capacity of the muscles. Additionally, shortening of the clavicle increases coronal angulation of the clavicle at the sternoclavicular joint.


CONCLUSIONS
Shortening causes a decrease in the moment generating capacity as well as the total force generating capacity of the shoulder girdle muscles. The clinical significance of these computational results, which are consistent with recent clinical studies, is validation of the proposed functional deficit caused by clavicle malunion.
Department of Mechanical and Aeronautical Engineering, Western Michigan University, Kalamazoo, Michigan 49008, USA.
Bipin
B
Patel
Peter A
PA
Gustafson
James
J
Jastifer
D000328:Adult; D002968:Clavicle / Q000293:injuries* / Q000503:physiopathology*; D003198:Computer Simulation; D017759:Fractures, Malunited / Q000503:physiopathology*; D006801:Humans; D008954:Models, Biological; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology*