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Coracohumeral Distances and Correlation to Arm Rotation: An In Vivo 3-Dimensional Biplane Fluoroscopy Study.

Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ - Orthop J Sports Med (2013)

Bottom Line: This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%).Coracohumeral distance was reduced during internal rotation.Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

View Article: PubMed Central - PubMed

Affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA.

ABSTRACT

Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.

Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.

Study design: Descriptive laboratory study.

Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board-approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.

Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = -0.75) existed between the coracohumeral distance and coracoid index.

Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.

Clinical relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

No MeSH data available.


Related in: MedlinePlus

Superior view of the shoulder illustrating internal-external glenohumeral rotation calculated based on the bicipital groove and a line passing through the angulus acromialis and trigonum spinae. Coracohumeral distance and coracoid index are also visualized.
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fig4-2325967113496059: Superior view of the shoulder illustrating internal-external glenohumeral rotation calculated based on the bicipital groove and a line passing through the angulus acromialis and trigonum spinae. Coracohumeral distance and coracoid index are also visualized.

Mentions: Coordinate systems and 3D glenohumeral rotations were determined following the International Society of Biomechanics standards39 as closely as possible. The lateral-medial axis for the scapula was determined by a line drawn between the trigonum spinae (root of the spine of the scapula) and the angulus acromialis (junction of the posterior and lateral borders of the acromion) (Figure 4). The lateral-medial axis of the humerus was directed parallel to a line connecting the medial and lateral humeral epicondyles, which was estimated based on the bicipital groove,33,34 with the superior-inferior axis along the central canal of the shaft.3,23 Internal-external glenohumeral joint rotation was described through the use of Euler angles as the rotation of the humerus about its superior axis.39 A position of 0° of glenohumeral internal-external rotation was defined as the glenohumeral rotation found with the arm in the neutral position, as described above.


Coracohumeral Distances and Correlation to Arm Rotation: An In Vivo 3-Dimensional Biplane Fluoroscopy Study.

Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ - Orthop J Sports Med (2013)

Superior view of the shoulder illustrating internal-external glenohumeral rotation calculated based on the bicipital groove and a line passing through the angulus acromialis and trigonum spinae. Coracohumeral distance and coracoid index are also visualized.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4555485&req=5

fig4-2325967113496059: Superior view of the shoulder illustrating internal-external glenohumeral rotation calculated based on the bicipital groove and a line passing through the angulus acromialis and trigonum spinae. Coracohumeral distance and coracoid index are also visualized.
Mentions: Coordinate systems and 3D glenohumeral rotations were determined following the International Society of Biomechanics standards39 as closely as possible. The lateral-medial axis for the scapula was determined by a line drawn between the trigonum spinae (root of the spine of the scapula) and the angulus acromialis (junction of the posterior and lateral borders of the acromion) (Figure 4). The lateral-medial axis of the humerus was directed parallel to a line connecting the medial and lateral humeral epicondyles, which was estimated based on the bicipital groove,33,34 with the superior-inferior axis along the central canal of the shaft.3,23 Internal-external glenohumeral joint rotation was described through the use of Euler angles as the rotation of the humerus about its superior axis.39 A position of 0° of glenohumeral internal-external rotation was defined as the glenohumeral rotation found with the arm in the neutral position, as described above.

Bottom Line: This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%).Coracohumeral distance was reduced during internal rotation.Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

View Article: PubMed Central - PubMed

Affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA.

ABSTRACT

Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.

Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.

Study design: Descriptive laboratory study.

Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board-approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.

Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = -0.75) existed between the coracohumeral distance and coracoid index.

Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.

Clinical relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

No MeSH data available.


Related in: MedlinePlus