Full length articleReliability of scapular kinematics estimated with three-dimensional motion analysis during shoulder elevation and flexion
Introduction
In clinical settings, upper limb range of motion is usually measured using a goniometer that does not enable the examiner to describe the motion continuously in the three planes exactly at any point in time during various movements. Furthermore, scapular kinematics during movements cannot be easily quantified clinically. The three-dimensional (3D) analysis of the shoulder movement is important since two-dimensional methods fail to account for “out-of-plane” motions, which can produce significant errors and may also fail to capture the complexity of the shoulder movement [1]. In previous studies, 3D movements of the shoulder including the glenohumeral and scapulothoracic motion have been measured using invasive methods with bone pins [[2], [3], [4]] and non-invasive methods including 3D radiographic [5], 3D marker based motion analysis [6,7] and electromagnetic-based systems [8]. Chu et al. [6], comparing scapular kinematics measured with 3D marker based motion analysis and dynamic stereo X-ray, stated that 3D marker based motion analysis is a valid method to quantify scapular kinematics while acknowledging the limitations. Several studies have reported reduced accuracy of scapular kinematics above 90° of humeral elevation with the acromion marker cluster (AMC) method [[9], [10], [11], [12]] and above 120° with skin-fixed scapular receivers [2]. Marker based 3D motion capture data can provide more detailed information on upper limb movement in children and adults. Furthermore, quantifying upper limb function allows the detection of shoulder pathologies and could possibly objectify pre- and post-treatment monitoring. Motion analysis of the upper limb has become increasingly interesting and is a rapidly growing field in movement research [[13], [14], [15], [16]].
Besides the lack of standardized descriptions of upper limb motion, results from different motion laboratories can often not be compared directly because of methodologic differences in experimental set-ups. The need for standardized protocols for upper limb motion analysis, for instance, involving the construction and use of a proper biomechanical model, has been previously emphasized [[16], [17], [18]]. Jaspers et al. [19,20] established the reliability of a measurement procedure incorporating recommendations published by the International Society of Biomechanics (ISB) defining joint coordinate systems and rotation sequences [18] for normally developing children and children with hemiplegic cerebral palsy. In normally developing children, within session intraclass correlation coefficients (ICCs) were generally high for all joint angles at the point of task achievement for different tasks, indicating good endpoint reliability; reliability between sessions was highest for scapula, shoulder and elbow kinematics. The careful selection of a set of relevant tasks was previously stated to be important for standardised upper limb protocols [17]. Most studies have analysed daily activities [15,[19], [20], [21]], which involve shoulder movements in all planes. In contrast, in clinical examinations main movements trying to restrict the shoulder kinematics to one plane (e.g. shoulder flexion in the sagittal plane) are frequently evaluated. Moreover, since disadvantages of using extracted scalers or specific points of waveforms have become apparent [22], this study aims to analyse scapular kinematics in relation to humeral elevation continuously during the movements. The reliability of using 3D motion analysis and a model based on the ISB recommendations to evaluate scapular kinematics during continuous shoulder elevation in scapular plane and shoulder flexion, however, has not yet been tested at each degree of humeral elevation. When analysing patients (e.g. with scapula dyskinesia), changes over time are often being analysed. In this context it is essential to know the reliability of scapular kinematics during continuous humeral elevation to interpret which differences might be due different assessors or measurement points and which differences or changes over time actually can be interpreted as such.
Therefore, the aim of this study was to assess the intra-subject as well as intra- and interrater reliability of scapulothoracic joint angles as measured by three-dimensional motion analysis continuously during shoulder elevation in the scapular plane and during shoulder flexion.
Section snippets
Methods
Twenty healthy subjects (13 men, 7 women) with a mean age of 26.6 years (±3.5 years) ranging from 21 to 33 years were recruited for this study. Participants were included if they were between 20 and 35 years old, and excluded if they had any shoulder problems, previous upper limb fractures, injuries, surgical procedures or muscle strains. The research ethics board of the Cantonal Hospital St. Gallen (Switzerland) approved the study, and all participants provided written informed consent prior
Results
Shoulder elevation in scapular plane as well as scapula rotation, tilting and pro-retraction angles at each degree of shoulder elevation from 0° to 150° are shown in Fig. 1. Intra-subject reliability was found to be very high (>0.90) for all scapulothoracic joint angles during shoulder elevation (Fig. 2) above 15°. Furthermore, scapula tilting and scapula pro-retraction angles show decreasing intra-subject reliability at shoulder elevations above 140°. Intra- and interrater reliability of
Discussion
The purpose of this study was to assess intra-subject as well as intra- and interrater reliability of scapular kinematics measured using 3D motion analysis in relation to humeral elevation in healthy adults. Reliability was tested during shoulder elevation in scapular plane and shoulder flexion in sagittal plane, which are tasks often used in clinical examination.
In agreement with scapulothoracic joint angles measured with bone pins [3], the current study (Figs. 1 & 3) also showed greatest
Acknowledgement
This research was supported by the Clinical Trials Unit of the Cantonal Hospital St. Gallen (CTU-Kommision Nr. 14/03).
References (33)
The scapulo-humeral rhythm: effects of 2-D roentgen projection
Clin. Biomech. (Bristol, Avon)
(1999)- et al.
Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo
J. Shoulder Elbow Surg.
(2001) - et al.
Validation of a video-based motion analysis technique in 3-D dynamic scapular kinematic measurements
J. Biomech.
(2012) - et al.
Validity and reliability of 3D marker based scapular motion analysis: a systematic review
J. Biomech.
(2014) - et al.
Kinematic and clinical evaluation of shoulder function after primary and revision reverse shoulder prostheses
J. Shoulder Elbow Surg.
(2011) - et al.
Double calibration: an accurate, reliable and easy-to-use method for 3D scapular motion analysis
J. Biomech.
(2011) - et al.
Comparison between tripod and skin-fixed recording of scapular motion
J. Biomech.
(2007) - et al.
Effects of attachment position and shoulder orientation during calibration on the accuracy of the acromial tracker
J. Biomech.
(2011) - et al.
Recording scapular motion using an acromion marker cluster
Gait Posture
(2009) - et al.
The active and passive kinematic difference between primary reverse and total shoulder prostheses
J. Shoulder Elbow Surg.
(2014)
Three-dimensional kinematics of the scapula and trunk, and associated scapular muscle timing in individuals with stroke
Hum. Mov. Sci.
Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy
Gait Posture
A framework for the definition of standardized protocols for measuring upper-extremity kinematics
Clin. Biomech. (Bristol, Avon)
ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion – part II: shoulder, elbow, wrist and hand
J. Biomech.
The reliability of upper limb kinematics in children with hemiplegic cerebral palsy
Gait Posture
Upper limb kinematics: development and reliability of a clinical protocol for children
Gait Posture
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