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Journal of Shoulder and Elbow Surgery

Upper limb kinematics after arthroscopic and open shoulder stabilization

Published:October 21, 2014DOI:https://doi.org/10.1016/j.jse.2014.08.006

      Background

      Shoulder joint stability mediated by proprioception is often quantified by arm repositioning tests (i.e., static end-position accuracy), overlooking ongoing movement quality. This study assessed movement quality by adopting smoothness-related kinematic descriptors. We compared performance of healthy controls with that of patients in arthroscopic shoulder stabilization and open shoulder stabilization groups. We hypothesized that arm kinematics after arthroscopic intervention would more closely resemble healthy movements compared with patients after open shoulder stabilization surgery.

      Methods

      Healthy controls (N = 14) were compared with patients after arthroscopic shoulder stabilization (N = 10) and open shoulder stabilization (N = 12). Right-hand dominant subjects (the affected side in patients) performed 135 unconstrained 3-dimensional pointing movements toward visual targets (seen through pinhole goggles; i.e., no arm vision). Arm kinematic data were recorded and offline analyzed to obtain hand tangential velocity profiles further used to compute the acceleration-to-movement time ratio, peak-to-mean velocity ratio, and number of velocity peaks (“symmetry,” “proportion,” and “fragmentation” features, respectively). Parametric and nonparametric statistics were used for comparisons (P ≤ .05).

      Results

      Control and arthroscopic shoulder stabilization groups presented similar acceleration-to-movement time ratio and peak-to-mean velocity ratio. Both groups differed from the open shoulder stabilization group (P = .001). Distributions of velocity peaks for control and arthroscopic shoulder stabilization groups were similar, whereas open shoulder stabilization and control subjects differed significantly (P = .028).

      Conclusions

      Movement quality mediated by proprioception in arthroscopic shoulder stabilization patients matches that of healthy controls, whereas performance in open shoulder stabilization patients seems inferior compared with that in healthy controls, as assessed by smoothness-related measures (less symmetrical, more fragmented movements).

      Level of evidence

      Keywords

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      References

        • Abend W.
        • Bizzi E.
        • Morasso P.
        Human arm trajectory formation.
        Brain. 1982; 105: 331-348
        • Arzi H.
        • Krasovsky T.
        • Pritsch M.
        • Liebermann D.G.
        Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients.
        J Shoulder Elbow Surg. 2014; 23: 982-992https://doi.org/10.1016/j.jse.2013.09.021
        • Bagesteiro L.B.
        • Sainburg R.L.
        Handedness: dominant arm advantages in control of limb dynamics.
        J Neurophysiol. 2002; 88: 2408-2421https://doi.org/10.1152/jn.00901.2001
        • Balke M.
        • Liem D.
        • Dedy N.
        • Thorwesten L.
        • Balke M.
        • Poetzl W.
        • et al
        The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability.
        Arch Orthop Trauma Surg. 2011; 131: 1077-1084https://doi.org/10.1007/s00402-011-1285-6
        • Barden J.M.
        • Balyk R.R.
        • Raso V.J.
        • Moreau M.
        • Bagnall K.
        Dynamic upper limb proprioception in multidirectional shoulder instability.
        Clin Orthop Relat Res. 2004; 420: 181-189https://doi.org/10.1097/00003086-200403000-00025
        • Biess A.
        • Liebermann D.G.
        • Flash T.
        A computational model for redundant human 3D pointing movements: integration of independent spatial and temporal motor plans simplifies movement dynamics.
        J Neurosci. 2007; 27: 13045-13064https://doi.org/10.1523/JNEUROSCI.4334-06.2007
        • Biess A.
        • Flash T.
        • Liebermann D.G.
        Riemannian geometric approach to human arm dynamics, movement optimization, and invariance.
        Phys Rev E Stat Nonlin Soft Matter Phys. 2011; 83: 031927https://doi.org/10.1103/PhysRevE.83.031927
        • Bottoni C.R.
        • Smith E.L.
        • Berkowitz M.J.
        • Towle R.B.
        • Moore J.H.
        Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial.
        Am J Sports Med. 2006; 34: 1730-1737https://doi.org/10.1177/0363546506288239
        • Cole B.J.
        • L'Insalata J.
        • Irrgang J.
        • Warner J.J.
        Comparison of arthroscopic and open anterior shoulder stabilization.
        J Bone Joint Surg Am. 2000; 82: 1108-1114
        • Edmonds G.
        • Kirkley A.
        • Birmingham T.B.
        • Fowler P.J.
        The effect of early arthroscopic stabilization compared to nonsurgical treatment on proprioception after primary traumatic anterior dislocation of the shoulder.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 116-121https://doi.org/10.1007/s00167-003-0346-y
        • Flash T.
        • Hogan N.
        The coordination of arm movements: an experimentally confirmed mathematical model.
        J Neurosci. 1985; 5: 1688-1703
        • Gaskill T.R.
        • Taylor D.C.
        • Millett P.J.
        Management of multidirectional instability of the shoulder.
        J Am Acad Orthop Surg. 2011; 19 (PMID: 22134208): 758-767
        • Hore J.
        • O'Brien M.
        • Watts S.
        Control of joint rotations in overarm throws of different speeds made by dominant and nondominant arms.
        J Neurophysiol. 2005; 94: 3975-3986https://doi.org/10.1152/jn.00327.2005
        • Janwantanakul P.
        • Magarey M.E.
        • Jones M.A.
        • Dansie B.R.
        Variation in shoulder position sense at mid and extreme range of motion.
        Arch Phys Med Rehabil. 2001; 82: 840-844
        • Jerosch J.
        • Thorwesten L.
        • Steinbeck J.
        • Reer R.
        Proprioceptive function of the shoulder girdle in healthy volunteers.
        Knee Surg Sports Traumatol Arthrosc. 1996; 3: 219-225
        • Khiami F.
        • Sariali E.
        • Rosenheim M.
        • Hardy P.
        Anterior shoulder instability arthroscopic treatment outcomes measures: the WOSI correlates with the Walch-Duplay score.
        Orthop Traumatol Surg Res. 2012; 98: 48-53https://doi.org/10.1016/j.otsr.2011.09.013
        • Kirkley A.
        • Griffin S.
        • Dainty K.
        Scoring systems for the functional assessment of the shoulder.
        Arthroscopy. 2003; 19: 1109-1120https://doi.org/10.1016/j.arthro.2003.10.030
        • Lephart S.M.
        • Warner J.
        • Borsa P.
        Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders.
        J Shoulder Elbow Surg. 1994; 3: 371-380
        • Liebermann D.G.
        • Krasovsky T.
        • Berman S.
        Planning maximally smooth hand movements constrained to nonplanar workspaces.
        J Mot Behav. 2008; 40: 516-531https://doi.org/10.3200/JMBR.40.6.516-531
        • Liebermann D.G.
        • Levin M.F.
        • McIntyre J.
        • Weiss P.L.
        • Berman S.
        Arm path fragmentation and spatiotemporal features of hand reaching in healthy subjects and stroke patients.
        Conf Proc IEEE Eng Med Biol Soc. 2010; 2010: 5242-5245https://doi.org/10.1109/IEMBS.2010.5626297
        • Murray I.R.
        • Goudie E.B.
        • Petrigliano F.A.
        • Robinson C.M.
        Functional anatomy and biomechanics of shoulder stability in the athlete.
        Clin Sports Med. 2013; 32: 607-624https://doi.org/10.1016/j.csm.2013.07.001
        • Myers J.B.
        • Lephart S.M.
        Sensorimotor deficits contributing to glenohumeral instability.
        Clin Orthop Relat Res. 2002; 400 (PMID: 12072751): 98-104
        • Pötzl W.
        • Thorwesten L.
        • Götze C.
        • Garmann S.
        • Steinbeck J.
        Proprioception of the shoulder joint after surgical repair for instability.
        Am J Sports Med. 2004; 32: 425-430https://doi.org/10.1177/0363546503261719
        • Richardson M.J.
        • Flash T.
        Comparing smooth arm movements with the two-thirds power law and the related segmented-control hypothesis.
        J Neurosci. 2002; 22: 8201-8211
        • Rokito A.S.
        • Birdzell M.G.
        • Cuomo F.
        • Di Paola M.J.
        • Zuckerman J.D.
        Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques.
        J Shoulder Elbow Surg. 2010; 19: 564-569https://doi.org/10.1016/j.jse.2009.09.010
        • Sullivan J.A.
        • Hoffman M.A.
        • Harter R.A.
        Shoulder joint position sense after thermal, open, and arthroscopic capsulorrhaphy for recurrent anterior instability.
        J Shoulder Elbow Surg. 2008; 17: 389-394https://doi.org/10.1016/j.jse.2007.11.015
        • Veeger H.E.
        • van der Helm F.C.
        Shoulder function: the perfect compromise between mobility and stability.
        J Biomech. 2007; 40: 2119-2129https://doi.org/10.1016/j.jbiomech.2006.10.016
        • Wann J.P.
        • Ibrahim S.F.
        Does limb proprioception drift?.
        Exp Brain Res. 1992; 91: 162-166
        • Zuckerman J.D.
        • Gallagher M.A.
        • Cuomo F.
        • Rokito A.
        The effect of instability and subsequent anterior shoulder repair on proprioceptive ability.
        J Shoulder Elbow Surg. 2003; 12: 105-109https://doi.org/10.1067/mse.2003.4