Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy

Authors:

Peter J Millett, J Erik Giphart, Katharine J Wilson, Kine Kagnes, Joshua A Greenspoon

Abstract:

Rotator cuff tears are a common cause of shoulder pain, weakness, and decreased range of motion. One of the primary functions of the rotator cuff is stabilization of the shoulder joint by compressing the humeral head into the glenoid cavity and allowing concentric rotation of the joint. This dynamic stabilization relies on balanced muscle force couples around the joint in the transverse and coronal planes. In the transverse plane, this balance is maintained by the subscapularis muscle anteriorly and the infraspinatus and teres minor muscles posteriorly. In the coronal plane, the force couple is the balance among the deltoid muscle, the rotator cuff, and the weight of the arm.

While it is theorized that a tear in the rotator cuff could disrupt the balanced muscle forces, how it alters glenohumeral kinematics remains to be defined. A variety of methods have been used in the literature to statically measure translation of the humeral head relative to the glenoid during shoulder elevation. Previous methods of measuring glenohumeral joint motion with a torn rotator cuff have relied on cadaveric simulations, 2-dimensional (2D) radiographs, and static 3-dimensional (3D) radiographs. It has been reported that proximal migration of the humeral head occurs during elevation, and this has become clinically accepted. However, each of these static measurement techniques is associated with limitations, and the results have not been validated by an in vivo dynamic 3D joint motion study.

This study used a dynamic 3D method of analyzing glenohumeral kinematics following rotator cuff teardbiplane fluoroscopy with computed tomography (CT). Biplane fluoroscopy is a recently emerging, highly accurate way to measure the in vivo 3D kinematics of the bony structures of a joint. It has had some use on the shoulder joint but limited work on the kinematic effects of rotator cuff tears. Bey studied patients postoperatively to determine how well surgical repair of the rotator cuff returned glenohumeral kinematics compared with asymptomatic controls.

The purpose of this study was to quantitatively mea- sure the 3D glenohumeral translations during dynamic shoulder abduction in the scapular plane, using a biplane fluoroscopy system, in patients with supraspinatus rotator cuff tears. It was hypothesized that during shoulder abduction in the scapular plane (scaption), subjects with rotator cuff tears would demonstrate dynamic superior migration of the humeral head relative to subjects with asymptomatic shoulders.

For the complete study: Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy

Authors:

Abstract:

About the Author: Peter Millett, MD