Reliability of the Fluoroscopic Assessment of Load-Induced Glenohumeral Translation during a 30° Shoulder Abduction Test

Croci, Eleonora; Künzler, Marina; Börlin, Sean; Eckers, Franziska; Nüesch, Corina; Baumgartner, Daniel; Müller, A

doi:10.3390/biomechanics2020020

Cited by 3 publications

(7 citation statements)

References 30 publications

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“…However, load-bearing extravasation causes stress on shoulder tissues and may cause shoulder tissue damage. Through biomechanical analysis of the change in glenohumeral joint translation caused by load bearing abduction, Eleonora Croci et al 28 found that load bearing increased the risk of rotator cuff tissue injury. The most common type of rotator cuff tear is a supraspinatus tendon injury, which usually occurs in the critical zone, where the tendon, synovial membrane, and bone tissue are connected, resulting in a concentration of stress and making recovery difficult because of the relatively low blood supply 29 .…”

Section: Discussionmentioning

confidence: 99%

Effect of different loads on the shoulder in abduction postures: a finite element analysis

Zhou

Yang

et al. 2023

Sci Rep

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Load can change the mechanical environment of dynamic and static stable structures of the shoulder joint, increase the risk of tissue damage and affect the stability of the shoulder joint, but its biomechanical mechanism is still unclear. Therefore, a finite element model of the shoulder joint was constructed to analyze the mechanical index changes of shoulder joint abduction under different loads. The stress of the articular side on the supraspinatus tendon was higher than that of the capsular side, with a maximum difference of 43% due to the increased load. For the deltoid muscle and glenohumeral ligaments, increases in stress and strain were obvious in the middle and posterior deltoid muscles and inferior glenohumeral ligaments. The above results indicate that load increases the stress difference between the articular side and the capsular side on the supraspinatus tendon and increases the mechanical indices of the middle and posterior deltoid muscles, as well as the inferior glenohumeral ligament. The increased stress and strain in these specific sites can lead to tissue injury and affect the stability of the shoulder joint.

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Section: Discussionmentioning

confidence: 99%

Effect of different loads on the shoulder in abduction postures: a finite element analysis

Zhou

Yang

et al. 2023

Sci Rep

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“…Single-plane fluoroscopy images (Multitom Rax, Siemens Healthineers) were acquired for all shoulders during a 30° loaded and unloaded shoulder abduction test in the scapular plane. Testing procedures were performed as described in the study of Croci et al [ 28 ]. Participants abducted both arms simultaneously in the scapular plane up to 30°, first without handheld weight and then with 2-kg and 4-kg additional handheld weight in a randomised order.…”

Section: Methodsmentioning

confidence: 99%

“…To analyse shoulder kinematics (i.e. scapular rotation, glenohumeral translation or abduction angle) throughout the entire 30° abduction and adduction tasks, five anatomic landmarks must be detected in each fluoroscopic image: the glenohumeral joint centre (defined as the centre of a best-fit circle on the humeral head [ 1 ]), the most inferior and superior points on the edge of the glenoid and the most lateral point on the acromion [ 28 ] as well as a point on the humeral shaft axis. For calibration purposes, it is also necessary to determine the size of the reference sphere.…”

Section: Methodsmentioning

confidence: 99%

“…While this method has high accuracy, it requires computed tomography (CT) images, hence exposing patients to high ionising radiation [ 27 ]. More recently, another method for estimating glenohumeral translation with single-plane fluoroscopy, requiring the labelling of five landmarks [ 28 ], has been suggested, but measurements of scapular rotation or critical shoulder angle [ 29 ] should also be possible. This method is associated with low radiation exposure and has good reliability with manual labelling [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, another method for estimating glenohumeral translation with single-plane fluoroscopy, requiring the labelling of five landmarks [ 28 ], has been suggested, but measurements of scapular rotation or critical shoulder angle [ 29 ] should also be possible. This method is associated with low radiation exposure and has good reliability with manual labelling [ 28 ]. However, because this process is time consuming, its applicability is limited on a large scale.…”

Section: Introductionmentioning

confidence: 99%

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Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence

Croci,

Hess,

Warmuth

et al. 2023

Eur Radiol

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Objective Patients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head. Materials and methods Fluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere. Results The nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°. Conclusion The proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane. Clinical relevance statement This nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders. Key Points • Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears. • Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements. • The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.

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New methods for the in vivo diagnostics of shoulder kinematics

2023

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Zusammenfassung Hintergrund Die Erfassung der In-vivo-Schulterkinematik gewinnt zunehmend an Bedeutung. Fragestellung Welche neuen Methoden stehen für die In-vivo-Diagnostik der Schulterkinematik zur Verfügung? Material und Methode Es wird eine Übersicht über aktuelle Literatur und Technologien gegeben. Ergebnisse Neben der etablierten markerbasierten Bewegungsanalyse können markerlose Bewegungsanalyse, elektromagnetische Systeme, ultraschallbasierte Bewegungsanalyse, tragbare Sensoren und medizinische Bildgebung zur In-vivo-Diagnostik der Schulterkinematik verwendet werden. Jedes dieser Systeme birgt Chancen, muss aber im Kontext der jeweiligen (technischen) Vor- und Nachteile beurteilt werden. Schlussfolgerung Neue Methoden zur In-vivo-Diagnostik der Schulterkinematik erlauben die Erfassung komplexer Bewegungsmuster sowie Alltagsbewegungen und können einen direkten Bezug zur Anatomie und jeweiligen Pathologie herstellen.

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Reliability of the Fluoroscopic Assessment of Load-Induced Glenohumeral Translation during a 30° Shoulder Abduction Test

Cited by 3 publications

References 30 publications

Effect of different loads on the shoulder in abduction postures: a finite element analysis

Effect of different loads on the shoulder in abduction postures: a finite element analysis

Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence

New methods for the in vivo diagnostics of shoulder kinematics

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