Abstract
Frozen shoulder is a common condition characterized by a stiff shoulder. Thickening of an axillary pouch and a coracohumeral ligament, which are the passive stabilizers of the shoulder joint, is widely known as a manifestation of frozen shoulder. In this study, the effect of frozen shoulder on the shoulder behavior was investigated by using five finite element shoulder models. Finite element analysis was performed for the shoulder motions. The rotational angle, strain distribution, and the stress distribution were assessed relatively. The mean rotational angle was 54.9 ± 4.5° in external rotation, 35.9 ± 2.8° in internal rotation, 21.2 ± 6.0° in adduction, and 28.2 ± 2.1° in abduction. The resultant angle was decreased 4.1° in external rotation, 4.6° in internal rotation, 1.5° in adduction, and 2.3° in abduction from the normal shoulder to frozen shoulder respectively. The thickening of the AP had more effect on the rotational motions and abduction, on the other hand, the thickening of the CHL had more effect on adduction. The overall strain distribution was similar between the normal and frozen shoulder, however, the high-strain area and the strain value were reduced in frozen shoulder.
Similar content being viewed by others
References
Binder, A., Bulgen, D., Hazleman, B. L., and Roberts, S., “Frozen Shoulder: A Long-Term Prospective Study,” Annals of the Rheumatic Diseases, Vol. 43, No. 3, pp. 361–364, 1984.
Lloyd-Roberts, G. C. and French, P. R., “Periarthritis of the Shoulder: A Study of the Disease and Its Treatment,” British Medical Journal, Vol. 1, No. 5137, pp. 1569–1571, 1959.
Terry, G. C. and Chopp, T. M., “Functional Anatomy of the Shoulder,” Journal of Athletic Training, Vol. 35, No. 3, pp. 248–255, 2000.
Culham, E. and Peat, M., “Functional Anatomy of the Shoulder Complex,” Journal of Orthopaedic & Sports Physical Therapy, Vol. 18, No. 1, pp. 342–350, 1993.
Ishihara, Y., Mihata, T., Tamboli, M., Nguyen, L., Park, K. J., et al., “Role of the Superior Shoulder Capsule in Passive Stability of the Glenohumeral Joint,” Journal of Shoulder and Elbow Surgery, Vol. 23, No. 5, pp. 642–648, 2014.
Lee, M. H., Ahn, J. M., Muhle, C., Kim, S. H., Park, J. S., et al., “Adhesive Capsulitis of the Shoulder: Diagnosis Using Magnetic Resonance Arthrography, with Arthroscopic Findings as the Standard,” Journal of Computer Assisted Tomography, Vol. 27, No. 6, pp. 901–906, 2003.
Emig, E. W., Schweitzer, M. E., Karasick, D., and Lubowitz, J., “Adhesive Capsulitis of the Shoulder: MR Diagnosis,” American Journal of Roentgenology, Vol. 164, No. 6, pp. 1457–1459, 1995.
Mengiardi, B., Pfirrmann, C. W., Gerber, C., Hodler, J., and Zanetti, M., “Frozen Shoulder: MR Arthrographic Findings 1,” Radiology, Vol. 233, No. 2, pp. 486–492, 2004.
Sofka, C. M., Ciavarra, G. A., Hannafin, J. A., Cordasco, F. A., and Potter, H. G., “Magnetic Resonance Imaging of Adhesive Capsulitis: Correlation with Clinical Staging,” HSS Journal, Vol. 4, No. 2, pp. 164–169, 2008.
Lefevre-Colau, M.-M., Drapé, J.-L., Fayad, F., Rannou, F., Diche, T. et al., “Magnetic Resonance Imaging of Shoulders with Idiopathic Adhesive Capsulitis: Reliability of Measures,” European Radiology, Vol. 15, No. 12, pp. 2415–2422, 2005.
Homsi, C., Bordalo-Rodrigues, M., Da Silva, J. J., and Stump, X. M., “Ultrasound in Adhesive Capsulitis of the Shoulder: Is Assessment of the Coracohumeral Ligament A Valuable Diagnostic Tool?” Skeletal Radiology, Vol. 35, No. 9, pp. 673–678, 2006.
Li, J.-Q., Tang, K.-L., Wang, J., Li, Q.-Y., Xu, H.-T., et al., “MRI Findings for Frozen Shoulder Evaluation: Is the Thickness of the Coracohumeral Ligament a Valuable Diagnostic Tool?” PLoS One, Vol. 6, No. 12, Paper No. e28704, 2011.
Ogilvie-Harris, D., Biggs, D., Fitsialos, D., and MacKay, M., “The Resistant Frozen Shoulder: Manipulation Versus Arthroscopic Release,” Clinical Orthopaedics and Related Research, Vol. 319, pp. 238–248, 1995.
Snow, M., Boutros, I., and Funk, L., “Posterior Arthroscopic Capsular Release in Frozen Shoulder,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 25, No. 1, pp. 19–23, 2009.
Holloway, G. B., Schenk, T., Williams, G. R., Ramsey, M. L., and Iannotti, J. P., “Arthroscopic Capsular Release for the Treatment of Refractory Postoperative or Post-Fracture Shoulder Stiffness,” Journal of Bone & Joint Surgery, Vol. 83, No. 11, pp. 1682–1687, 2001.
Zanotti, R. M. and Kuhn, J. E., “Arthroscopic Capsular Release for the Stiff Shoulder: Description of Technique and Anatomic Considerations,” The American Journal of Sports Medicine, Vol. 25, No. 3, pp. 294–298, 1997.
Nicholson, G. P., “Arthroscopic Capsular Release for Stiff Shoulders,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 19, No. 1, pp. 40–49, 2003.
Tetro, A. M., Bauer, G., Hollstien, S. B., and Yamaguchi, K., “Arthroscopic Release of the Rotator Interval and Coracohumeral Ligament: An Anatomic Study in Cadavers,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 18, No. 2, pp. 145–150, 2002.
Hatakeyama, Y., Itoi, E., Urayama, M., Pradhan, R. L., and Sato, K., “Effect of Superior Capsule and Coracohumeral Ligament Release on Strain in the Repaired Rotator Cuff Tendon a Cadaveric Study,” The American Journal of Sports Medicine, Vol. 29, No. 5, pp. 633–640, 2001.
Eid, A., “Miniopen Coracohumeral Ligament Release and Manipulation for Idiopathic Frozen Shoulder,” International Journal of Shoulder Surgery, Vol. 6, No. 3, pp. 90–96, 2012.
Omari, A. and Bunker, T. D., “Open Surgical Release for Frozen Shoulder: Surgical Findings and Results of the Release,” Journal of Shoulder and Elbow Surgery, Vol. 10, No. 4, pp. 353–357, 2001.
Itoi, E., Berglund, L. J., Grabowski, J. J., Naggar, L., Morrey, B. F., and An, K.-N., “Superior-Inferior Stability of the Shoulder: Role of the Coracohumeral Ligament and the Rotator Interval Capsule,” Mayo Clinic Proceedings, pp. 508–515, 1998.
Neer, C. S., Satterlee, C. C., Dalsey, R. M., and Flatow, E.L., “The Anatomy and Potential Effects of Contracture of the Coracohumeral Ligament,” Clinical Orthopaedics and Related Research, Vol. 280, pp. 182–185, 1992.
Kang, K.-T., Kim, S.-H., Son, J., Lee, Y. H., and Chun, H.-J., “In Vivo Evaluation of the Subject-Specific Finite Element Model for Knee Joint Cartilage Contact Area,” Int. J. Precis. Eng. Manuf., Vol. 16, No. 6, pp. 1171–1177, 2015.
Lee, K.-J., Park, S.-J., Lee, S.-J., Naito, M., and Kwon, S.-Y., “Biomechanical Study on the Efficacy of the Periacetabular Osteotomy Using Patient-Specific Finite Element Analysis,” Int. J. Precis. Eng. Manuf., Vol. 16, No. 4, pp. 823–829, 2015.
Han, I. S. and Kim, Y. E., “Development of a New Head/Brain Model for the Prediction of Subdural Hemorrhage,” Int. J. Precis. Eng. Manuf., Vol. 15, No. 11, pp. 2405–2411, 2014.
O'Brien, S. J., Neves, M. C., Arnoczky, S. P., Rozbruck, S. R., Dicarlo, E. F., et al., “The Anatomy and Histology of the Inferior Glenohumeral Ligament Complex of the Shoulder,” The American Journal of Sports Medicine, Vol. 18, No. 5, pp. 449–456, 1990.
Drury, N. J., Ellis, B. J., Weiss, J. A., McMahon, P. J., and Debski, R. E., “The Impact of Glenoid Labrum Thickness and Modulus on Labrum and Glenohumeral Capsule Function,” Journal of Biomechanical Engineering, Vol. 132, No. 12, Paper No. 121003, 2010.
Sugalski, M. T., Wiater, J. M., Levine, W. N., and Bigliani, L. U., “An Anatomic Study of the Humeral Insertion of the Inferior Glenohumeral Capsule,” Journal of Shoulder and Elbow Surgery, Vol. 14, No. 1, pp. 91–95, 2005.
Ellis, B. J., Debski, R. E., Moore, S. M., McMahon, P. J., and Weiss, J. A., “Methodology and Sensitivity Studies for Finite Element Modeling of the Inferior Glenohumeral Ligament Complex,” Journal of Biomechanics, Vol. 40, No. 3, pp. 603–612, 2007.
Moore, S. M., Stehle, J. H., Rainis, E. J., McMahon, P. J., and Debski, R. E., “The Current Anatomical Description of the Inferior Glenohumeral Ligament Does Not Correlate with Its Functional Role in Positions of External Rotation,” Journal of Orthopaedic Research, Vol. 26, No. 12, pp. 1598–1604, 2008.
Moore, S. M., Ellis, B., Weiss, J. A., McMahon, P. J., and Debski, R. E., “The Glenohumeral Capsule Should be Evaluated as a Sheet of Fibrous Tissue: A Validated Finite Element Model,” Annals of Biomedical Engineering, Vol. 38, No. 1, pp. 66–76, 2010.
Ellis, B. J., Drury, N. J., Moore, S. M., McMahon, P. J., Weiss, J. A., and Debski, R. E., “Finite Element Modelling of the Glenohumeral Capsule Can Help Assess the Tested Region during a Clinical Exam,” Computer Methods in Biomechanics and Biomedical Engineering, Vol. 13, No. 3, pp. 413–418, 2010.
Drury, N. J., “Evaluating the Anterior Stability Provided by the Glenohumeral Capsule: A Finite Element Approach,” M.Sc. Thesis, University of Pittsburgh, 2008.
Hwang, E., Carpenter, J. E., Hughes, R. E., and Palmer, M. L., “Shoulder Labral Pathomechanics with Rotator Cuff Tears,” Journal of Biomechanics, Vol. 47, No. 7, pp. 1733–1738, 2014.
Jang, S. W., Yoo, Y.-S., Lee, H.-Y., Kim, Y. S., Srivastava, P. K., and Nair, A.V., “Stress Distribution in Superior Labral Complex and Rotator Cuff during in vivo Shoulder Motion: A Finite Element Analysis,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 31, No. 11, pp. 2073–2081, 2015.
Boardman, N. D., Debski, R. E., Warner, J. J., Taskiran, E., Maddox, L., et al., “Tensile Properties of the Superior Glenohumeral and Coracohumeral Ligaments,” Journal of Shoulder and Elbow Surgery, Vol. 5, No. 4, pp. 249–254, 1996.
Ciccone, W. J., Hunt, T. J., Lieber, R., Pedowitz, R., Esch, J., and Tasto, J. P., “Multiquadrant Digital Analysis of Shoulder Capsular Thickness,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 16, No. 5, pp. 457–461, 2000.
Drury, N. J., Ellis, B. J., Weiss, J. A., McMahon, P. J., and Debski, R. E., “Finding Consistent Strain Distributions in the Glenohumeral Capsule between Two Subjects: Implications for Development of Physical Examinations,” Journal of Biomechanics, Vol. 44, No. 4, pp. 607–613, 2011.
Poppen, N. K. and Walker, P. S., “Normal and Abnormal Motion of the Shoulder,” Journal of Bone & Joing Surgery, Vol. 58, No. 2, pp. 195–201, 1976.
Frankle, M. A., Teramoto, A., Luo, Z.-P., Levy, J. C., and Pupello, D., “Glenoid Morphology in Reverse Shoulder Arthroplasty: Classification and Surgical Implications,” Journal of Shoulder and Elbow Surgery, Vol. 18, No. 6, pp. 874–885, 2009.
Jeong, J., Bryan, J., and Iannotti, J. P., “Effect of a Variable Prosthetic Neck-Shaft Angle and the Surgical Technique on Replication of Normal Humeral Anatomy,” Journal of Bone & Joint Surgery, Vol. 91, No. 8, pp. 1932–1941, 2009.
Harryman, D. T., 2nd, Sidles, J. A., Harris, S. L., and Matsen, F. A., 3rd, “The Role of the Rotator Interval Capsule in Passive Motion and Stability of the Shoulder,” Journal of Bone & Joint Surgery, Vol. 74, No. 1, pp. 53–66, 1992.
Kumar, V. P. and Balasubramaniam, P., “The Role of Atmospheric Pressure in Stabilising the Shoulder. An Experimental Study,” Bone & Joint Journal, Vol. 67, No. 5, pp. 719–721, 1985.
Boone, D. C. and Azen, S. P., “Normal Range of Motion of Joints in Male Subjects,” Journal of Bone & Joint Surgery, Vol. 61, No. 5, pp. 756–759, 1979.
Gerber, C., Werner, C. M. L., Macy, J. C., Jacob, H. A. C., and Nyffeler, R. W., “Effect of Selective Capsulorrhaphy on the Passive Range of Motion of the Glenohumeral Joint,” Journal of Bone & Joint Surgery, Vol. 85, No. 1, pp. 48–55, 2003.
Harryman, D. T., Sidles, J. A., Clark, J. M., McQuade, K. J., Gibb, T. D., and Matsen, F. A., “Translation of the Humeral Head on the Glenoid with Passive Glenohumeral Motion,” Journal of Bone & Joint Surgery, Vol. 72, No. 9, pp. 1334–1343, 1990.
Kibler, W. B., “Specificity and Sensitivity of the Anterior Slide Test in Throwing Athletes with Superior Glenoid Labral Tears,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 11, No. 3, pp. 296–300, 1995.
McQuade, K. J. and Smidt, G. L., “Dynamic Scapulohumeral Rhythm: The Effects of External Resistance during Elevation of the Arm in the Scapular Plane,” Journal of Orthopaedic & Sports Physical Therapy, Vol. 27, No. 2, pp. 125–133, 1998.
Lee, T. Q., Dettling, J., Sandusky, M. D., and McMahon, P. J., “Age Related Biomechanical Properties of the Glenoid-Anterior Band of the Inferior Glenohumeral Ligament-Humerus Complex,” Clinical Biomechanics, Vol. 14, No. 7, pp. 471–476, 1999.
Itoi, E., Hsu, H.-C., and An, K.-N., “Biomechanical Investigation of the Glenohumeral Joint,” Journal of Shoulder and Elbow Surgery, Vol. 5, No. 5, pp. 407–424, 1996.
Michelin, P., Delarue, Y., Duparc, F., and Dacher, J. N., “Thickening of the Inferior Glenohumeral Capsule: An Ultrasound Sign for Shoulder Capsular Contracture,” European Radiology, Vol. 23, No. 10, pp. 2802–2806, 2013.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, H., Kim, SY. & Chae, SW. A comparative study of the behaviors of normal and frozen shoulder: A finite element study. Int. J. Precis. Eng. Manuf. 18, 545–553 (2017). https://doi.org/10.1007/s12541-017-0065-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12541-017-0065-9