Comparison of Two Methods for In Vivo Estimation of the Glenohumeral Joint Rotation Center (GH-JRC) of the Patients with Shoulder Hemiarthroplasty

Determination of an accurate glenohumeral-joint rotation center (GH-JRC) from marker data is essential for kinematic and dynamic analysis of shoulder motions. Previous studies have focused on the evaluation of the different functional methods for the estimation of the GH-JRC for healthy subjects. The goal of this paper is to compare two widely used functional methods, namely the instantaneous helical axis (IHA) and symmetrical center of rotation (SCoRE) methods, for estimating the GH-JRC in vivo for patients with implanted shoulder hemiarthroplasty. The motion data of five patients were recorded while performing three different dynamic motions (circumduction, abduction, and forward flexion). The GH-JRC was determined using the CT-images of the subjects (geometric GH-JRC) and was also estimated using the two IHA and SCoRE methods. The rotation centers determined using the IHA and SCoRE methods were on average 1.47±0.62 cm and 2.07±0.55 cm away from geometric GH-JRC, respectively. The two methods differed significantly (two-tailed p-value from paired t-Test ∼0.02, post-hoc power ∼0.30). The SCoRE method showed a significant lower (two-tailed p-value from paired t-Test ∼0.03, post-hoc power ∼0.68) repeatability error calculated between the different trials of each motion and each subject and averaged across all measured subjects (0.62±0.10 cm for IHA vs. 0.43±0.12 cm for SCoRE). It is concluded that the SCoRE appeared to be a more repeatable method whereas the IHA method resulted in a more accurate estimation of the GH-JRC for patients with endoprostheses

External rotation during elevation of the arm

Background Knowledge about the pattern of rotation during arm elevation is necessary for a full understanding of shoulder function, and it is also useful for planning of rehabilitation protocols to restore range of motion in shoulders in disorder. However, there are insufficient in vivo data available

Determination of the optimal elbow axis for evaluation of placement of prostheses

Objective. To present a method to determine the position and orientation of the mean optimal flexion axis of the elbow in vivo to be used in clinical research. Design. Registering the movements of the forearm with respect to the upper arm during five cycles of flexion and extension of the elbow using a 6 degrees-of-freedom electromagnetic tracking device. Background. Lessening of elbow endoprostheses could be caused by not placing the prostheses in a biomechanically optimal way. To evaluate the placement of endoprostheses with regard to loosening, a method to determine the elbow axis is needed. Methods. The movements of the right forearm with respect to the upper arm during flexion and extension were registered with a 6 degrees-of-freedom electromagnetic tracking device. A mean optimal instantaneous helical axis of 10 elbows was calculated in a coordinate system related to the humerus. Results. The average position of the flexion/extension axis was 0.81 cm (SD 0.66 cm) cranially and 1.86 cm (SD 0.72 cm) ventrally of the epicondylus lateralis. The average angle with the frontal plane was 15.3°(SD 2°). Conclusions. A useful estimation of the position and orientation of a mean optimal flexion axis can be obtained in vivo

Measurement of three dimensional shoulder movement patterns with an electromagnetic tracking device in patients with a frozen shoulder

Objective: To compare three dimensional movement patterns of the affected and non-affected shoulder in patients with a frozen shoulder before and after physical therapy. Methods: Patients with a unilateral frozen shoulder were assessed before and after three months of treatment. Three dimensional movement analysis was performed with the "Flock of Birds" electromagnetic tracking device while the patient raised their arms in three directions. Slopes of the regression lines of glenohumeral joint rotation versus scapular rotation, reflecting the scapulohumeral rhythm, were calculated. All assessments were made for both the affected and the unaffected side. Additional assessments included conventional range of motion (ROM) measurements and visual analogue scales (VAS) (0–100 mm) for shoulder pain at rest, during movement, and at night. Results: Ten patients with a unilateral frozen shoulder were included. The slopes of the curves of the forward flexion, scapular abduction, and abduction in the frontal plane of the affected and the unaffected side were significantly different in all three movement directions. Mean differences were 0.267, 0.215, and 0.464 (all p values <0.005), respectively. Mean changes of the slopes of the affected side after treatment were 0.063 (p=0.202), 0.048 (p=0.169), and 0.264 (p=0.008) in forward flexion, scapular abduction, and abduction in the frontal plane, respectively. All patients showed significant improvement in active ROM (all p<0.005), and the VAS for pain during movement and pain at night (p<0.05). Conclusions: With a three dimensional electromagnetic tracking system the abnormal movement pattern of a frozen shoulder, characterised by the relatively early laterorotation of the scapula in relation to glenohumeral rotation during shoulder elevation, can be described and quantified. Moreover, the system is sufficiently sensitive to detect clinical improvements. Its value in other shoulder disorders remains to be established

Determining the optimal flexion-extension axis of the elbow in vivo - a study of interobserver and intraobserver reliability

In the current study the interobserver and intraobserver reliability of a recently developed method to obtain the position and orientation vectors of the flexion-extension axis of the elbow in vivo is determined. The method uses the Flock of Birds(TM) six degrees-of-freedom electromagnetic tracking device. Ten subjects performed three trials comprising five flexion and extension cycles. The movements of the forearm with respect to the upper arm were recorded. Observer A measured two trials and observer B measured one trial. Optimal instantaneous helical axes were calculated in a humeral coordinate system for each trial. Intraclass correlation coefficients and 99% confidence intervals were computed to compare the three measurements. Zero was in the range of all the narrow confidence intervals, which is strong indication for resemblence. Interobserver intraclass correlation coefficients values for orientation vectors were good to excellent and intraobserver values were fair to good. The intraclass correlation coefficients values for position vectors were lower, probably due to the lack of variance between subjects. It is concluded that the method is reliable and can be used in certain clinical settings. Copyright (C) 2000 Elsevier Science Ltd