Summary
Previous studies have shown that abnormal rotation of the scapula is associated with shoulder pathology. Among the methods which have been proposed, planar x-ray measurements are probably the only methods, which enable clinicians to assess accurately and objectively the scapulohumeral functionin vivo. The aim of this study was to develop a method for the assessment of scapulohumeral kinematics using digital fluoroscopy. Anteroposterior images of the right glenohumeral joint were taken, in thirty-four healthy males, with the arm at rest, 30°, 60°, 90°, 120°, 150° and maximum abduction, in the scapular plane. High inter- and intra-examiner reliability was observed regarding the arm and scapular angle measurements (ICC=0.92–0.99). The positioning of the arm at the proposed angles was also highly accurate (<2.3° misplacement) and reproducible (CV%<5.3%). The mean radiation dose was 0.075 mSv (±0.027 mSv). At the resting position the scapula was in slight downward rotation (−2.4°±4.3°) and the arm in slight abduction (1.5°±6.6°). The mean maximum scapular rotation and the mean maximum arm abduction was 61.4° (±5.2°) and 162.4° (±6.6°) respectively. A curvilinear relationship was found between the arm angle (AA) and the scapular angle (SA) (p<0.0001). The AA:SA ratio for the entire range of abduction was 2.5:1. The greatest contribution of the scapula (1.7:1) achieved at 30°–60° of arm. The high accuracy and reliability of our method and the low radiation recordings suggests that digital fluoroscopy may be considered for further investigation of the scapulohumeral kinematics in both healthy and pathological shoulders.
Résumé
Des études précédentes ont montré qu'une rotation anormale de la scapula était observée dans certaines pathologies de l'épaule. Parmi les méthodes qui ont été proposées, les mesures sur des radiographies planes sont probablement les seules méthodes qui permettent aux cliniciens d'appréhender fidèlement et objectivement la fonction scapulo-humérale in vivo. Le but de cette étude était de développer une méthode pour appréhender la cinématique scapulo-humérale à l'aide de la radioscopie digitalisée. Des images antéro-postérieures de l'art. gléno-humérale droite ont été prises chez 34 hommes sains, le bras au repos, puis à 30°, 60°, 90°, 120°, 150° d'abduction et en abduction maximum, dans le plan de la scapula. Une haute précision inter et intra-observateur a été obtenue en ce qui concerne les mesures des angles du bras et de la scapula (ICC=0,92 – 0,99). Le positionnement du bras aux angles choisis était également très précis (<2,3° d'erreur) et reproductible (CV%<5,3 %). La dose moyenne d'irradiation était de 0,075 mSv (±0,027 mSv). Au repos, la scapula était en légère rotation vers le bas (−2,4°±4,3°) et le bras en légère abduction (1,5°±6,6°). La rotation maximum moyenne de la scapula et l'abduction maximum moyenne du bras étaient respectivement de 61,4° (±5,2°) et 162,4° (±6,6°). Une relation curviligne a été trouvée entre l'angle du bras (AA) et l'angle de la scapula (SA) (p<0,0001). Le rapport AA/SA pour le mouvement total d'abduction était de 2,5 / 1. La participation la plus importante de la scapula (1,7 / 1) survenait entre 30 et 60° d'abduction. La haute précision et la fiabilité de notre méthode, et l'acquisition des données au prix d'une faible irradiation, suggèrent que la radioscopie digitalisée pourrait être utilisée pour des investigations ultérieures sur la cinématique scapulo-humérale, à la fois sur des épaules saines et des épaules pathologiques.
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Mandalidis, D.G., Mc Glone, B.S., Quigley, R.F. et al. Digital fluoroscopic assessment of the scapulohumeral rhythm. Surg Radiol Anat 21 (Suppl 4), 241–246 (1999). https://doi.org/10.1007/BF01631393
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DOI: https://doi.org/10.1007/BF01631393