Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression. 2018

Felix Dyrna, and Neil S Kumar, and Elifho Obopilwe, and Bastian Scheiderer, and Brendan Comer, and Michael Nowak, and Anthony A Romeo, and Augustus D Mazzocca, and Knut Beitzel
Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany.

Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. Controlled laboratory study. Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (-27.2%; 95% CI, -43.3% to -11.1%, P = .04), anterosuperior (-51.5%; 95% CI, -70.2% to -32.8%, P < .01), and massive (-48.4%; 95% CI, -65.2% to -31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = -0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070636 Rotator Cuff Injuries Injuries to the ROTATOR CUFF of the shoulder joint. Glenoid Labral Tears,Rotator Cuff Tears,Rotator Cuff Tendinitis,Rotator Cuff Tendinosis,Cuff Injury, Rotator,Glenoid Labral Tear,Injury, Rotator Cuff,Labral Tear, Glenoid,Labral Tears, Glenoid,Rotator Cuff Injury,Rotator Cuff Tear,Rotator Cuff Tendinitides,Rotator Cuff Tendinoses,Tear, Glenoid Labral,Tear, Rotator Cuff,Tears, Rotator Cuff,Tendinitis, Rotator Cuff,Tendinoses, Rotator Cuff,Tendinosis, Rotator Cuff
D000174 Acromion The lateral extension of the spine of the SCAPULA and the highest point of the SHOULDER. Acromion Process,Acromion Processes,Acromions
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D012540 Scapula Also called the shoulder blade, it is a flat triangular bone, a pair of which form the back part of the shoulder girdle. Scapulae,Shoulder Blade,Shoulder Blades
D012782 Shoulder Part of the body in humans and primates where the arms connect to the trunk. The shoulder has five joints; ACROMIOCLAVICULAR joint, CORACOCLAVICULAR joint, GLENOHUMERAL joint, scapulathoracic joint, and STERNOCLAVICULAR joint. Shoulders
D012785 Shoulder Joint The articulation between the head of the HUMERUS and the glenoid cavity of the SCAPULA. Glenohumeral Joint,Glenoid Labrum,Glenohumeral Joints,Joint, Glenohumeral,Joint, Shoulder,Joints, Glenohumeral,Joints, Shoulder,Labrum, Glenoid,Shoulder Joints

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