Abduction Motion Analysis of Hemiplegic Shoulders with a Fluoroscopic Guide

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Abstract

Purpose

We investigated the usefulness of video based, fluoroscopically guided abduction motion analysis of hemiplegic shoulders.

Patients and Methods

Twenty-two stroke patients with Brunnstrom stages 3-4 (Group 1) or 5-6 (Group 2) were enrolled in this study. Patients with shoulder pain and significant spasticity (MAS 2) were excluded. We recorded motion pictures of the abductions of affected and unaffected shoulder joints under an AP fluoroscopic guide. Lateral scapular slide distances (D1: T2-superior angle, D2: T3-scapular spine, D3: T7-inferior angle) were measured at 30°, 60°, 90° during glenohumeral abduction in a captured photographic image. The angles of scapular rotation and trajectory (stromotion) of the humeral head center, relative to the 3rd thoracic spine in the abduction motion were analyzed.

Results

In Group 1, a significant difference was found in the lateral scapular slide distance between the affected and sound sides. However, no significant side to side difference was found in Group 2. Scapular angles in abduction were also increased in Group 1. Patients with a more synergistic movement pattern showed less scapular stabilizing muscle activity and, instead, exhibited a compensatory "shrugging" like motion accomplished by spinal tilting.

Conclusion

The present findings support the notion that the above parameters of fluoroscopically guided shoulder abduction motion analysis correlate well with clinical findings. These parameters should be useful for evaluations of hemiplegic shoulder biomechanics.

Related collections

Most cited references 19

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The role of the scapula in athletic shoulder function.

W Kibler (2015)

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This "Current Concepts" review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.

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Normal and abnormal motion of the shoulder.

Susan P. Walker, N K Poppen (1976)

The roentgenographic parameters of motion in normal and abnormal shoulders, including the movement of the scapula, arm angle, glenohumeral angle, scapulothoracic angle, excursion of the humeral head, and instant center of motion for abduction in the plane of the scapula, were determined in twelve normal subjects and fifteen patients. The scapula rotated externally with abduction. The ratio of glenohumeral to scapulothoracic movement was 5:4 after about 30 degrees of abduction. The center of rotation of the glenohumeral joint for abduction in the plane of the scapula was located within six millimeters of the geometric center of the humeral ball. The average excursion of the humeral ball on the face of the glenoid in the superoinferior plane between each 30-degree arc of motion was less than 1.5 millimeters in normal subjects. Significant previous injury resulting in abnormal mechanics of the shoulder joint was associated with abnormal values for excursion of the instant center and of the humeral head. An abnormal glenohumeral-to-scapulothoracic ratio was associated with significant pain in the shoulder. The fact that these various parameters were sensitive indicators of normal and abnormal motion raises the possibility of diagnostic clinical application.

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Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway.

Lynne Turner-Stokes, Diana Jackson (2002)

Shoulder pain is a common complication of stroke. It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay. This systematic review was undertaken to inform the development of an evidence-based integrated care pathway (ICP) for the management of hemiplegic shoulder pain (HSP). 1) To provide a background understanding of the functional anatomy of the shoulder and its changes following stroke. 2) To review the literature describing incidence and causation of HSP and the evidence for factors contributing to its development. 3) To appraise the evidence for effectiveness of different interventions for HSP. Data sources comprised a computer-aided search of published studies on shoulder pain in stroke or hemiplegia and references to literature used in reviews (total references = 121). Although a complex variety of physical changes are associated with HSP, these broadly divide into 'flaccid' and 'spastic' presentations. Management should vary accordingly; each presentation requiring different approaches to handling, support and intervention. (1) In the flaccid stage, the shoulder is prone to inferior subluxation and vulnerable to soft-tissue damage. The arm should be supported at all times and functional electrical stimulation may reduce subluxation and enhance return of muscle activity. (2) In the spastic stage, movement is often severely limited. Relieving spasticity and maintaining range requires expert handling; overhead exercise pulleys should never be used. Local steroid injections should be avoided unless there is clear evidence of an inflammatory lesion. HSP requires co-ordinated multidisciplinary management to minimize interference with rehabilitation and optimize outcome. Further research is needed to determine effective prophylaxis and document the therapeutic effect of different modalities in the various presentations. Development of an integrated care pathway provides a reasoned approach to management of this complex condition, thus providing a sound basis for prospective evaluation of different interventions in the future.

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Author and article information

Journal

Journal ID (nlm-ta): Yonsei Med J

Journal ID (publisher-id): YMJ

Title: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

ISSN (Print): 0513-5796

ISSN (Electronic): 1976-2437

Publication date (Print): 30 April 2007

Publication date (Electronic): 30 April 2007

Volume: 48

Issue: 2

Pages: 247-254

Affiliations

[1 ]Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

[2 ]Department of Rehabilitation Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.

Author notes

Reprint address: requests to Dr. Sang-Jee Lee, Department of Rehabilitation Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, 520-2 Daeheung-dong, Jung-gu, Daejeon 301-723, Korea. Tel: 82-42-220-9819, Fax: 82-42-252-5158, upperlimb@ 123456hanmail.net

Article

DOI: 10.3349/ymj.2007.48.2.247

PMC ID: 2628121

PubMed ID: 17461523

SO-VID: 4fd6ff04-9839-412f-8e21-25884f1878d4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 08 May 2006

Date accepted : 22 September 2006

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