scholarly journals Three-dimensional Alignment of the Upper Extremity in the Standing Neutral Position in Healthy Subjects

Author(s):  
Yuki Yoshida ◽  
Noboru Matsumura ◽  
Yoshitake Yamada ◽  
Satoshi Hiraga ◽  
Kazunori Ishii ◽  
...  

Abstract Background: Though alignment of the spine and lower extremities in the standing neutral position has been evaluated, a few studies evaluating the alignment of the upper extremities have also been made. This study assessed the normal alignment of the upper extremities in the standing neutral position and clarified the three-dimensional angular rotations of the upper extremity joints.Methods: Computed tomography (CT) images of 158 upper extremities from 79 healthy volunteers were prospectively acquired in the standing neutral position using an upright CT scanner. Three-dimensional coordinate systems of the thorax, scapula, humerus, and forearm were designated, and three-dimensional angular rotations of the scapulothoracic, glenohumeral, and elbow joints were calculated.Results: The mean angle of the scapulothoracic joint was 8.5° ± 5.9° of upward rotation, 28.7° ± 5.9° of internal rotation, and 7.9° ± 5.2° of anterior inclination. The mean angle of the glenohumeral joint was 4.4° ± 5.9° of abduction, 9.4° ± 12.3° of internal rotation, and 0.3° ± 4.4° of extension. The mean angle of the elbow joint was 9.6° ± 3.7° of valgus, 88.8° ± 14.3° of pronation, and 15.4° ± 4.2° of flexion. Correlations in angular rotation values were found, and interactions for keeping the upper extremities in a neutral position were observed.Conclusions: This study clarified the three-dimensional angular rotation of upper extremity joints in the standing neutral position using an upright CT scanner. Our results may provide important insights for the functional evaluation of upper extremity alignment.

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuki Yoshida ◽  
Noboru Matsumura ◽  
Yoshitake Yamada ◽  
Minoru Yamada ◽  
Yoichi Yokoyama ◽  
...  

Abstract Background Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. Methods Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30–49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. Results The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9–15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3–14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7–14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4–13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.


2008 ◽  
Vol 24 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Kristin E. Meyer ◽  
Erin E. Saether ◽  
Emily K. Soiney ◽  
Meegan S. Shebeck ◽  
Keith L. Paddock ◽  
...  

Proper scapular motion is crucial for normal shoulder mechanics. Scapular motion affects glenohumeral joint function during throwing, yet little is known about this dynamic activity. Asymptomatic subjects (10 male and 10 female), ages 21 to 45, were analyzed. Electromagnetic surface sensors on the sternum, acromion, and humerus were used to collect 3-D motion data during three trials of low-velocity throwing. Scapular angular position data were described for five predetermined events throughout the throw corresponding with classic descriptions of throwing phases, and trial-to-trial reliability was determined. ANOVA compared scapular angles across events. Subjects demonstrated good to excellent reliability between trials of the throw (ICC 0.74–0.98). The scapula demonstrated a pattern of external rotation, upward rotation (peak of approx. 40°), and posterior tilting during the initial phases of the throw, progressing into internal rotation after maximum humeral horizontal abduction. During the arm acceleration phase, the scapula moved toward greater internal rotation and began anteriorly tilting. At maximum humeral internal rotation, the scapula ended in internal rotation (55°), upward rotation (20°), and anterior tilting (3°).


Author(s):  
Yujin Kwon ◽  
Gwanseob Shin

The muscular loads of the upper extremity and chest muscles were assessed during floor vacuuming with stick vacuum cleaners. Ten participants conducted vacuuming with two stick cleaners (weight: 3.03 kg, 3.56 kg) on tiled and carpeted floors while the myoelectric activity of the upper extremity and chest muscles were collected. The mean muscle activation levels ranged from 15.5% to 45.7% of the maximum voluntary capacity. Greater muscular loads were observed on the forearm and shoulder muscles when vacuuming with repeated curved strokes (vs. straight storkes), and on the chest muscle when vacuuming the carpeted floor. The range of muscular loads were higher than that of occupational tasks such as house painting and dental drilling, which have been known as intensive activities for upper extremities. The results suggest that floor vacuuming with stick vacuum cleaners is physically demanding for household consumers. Ergonomic interventions such as more user-friendly design should be considered.


2020 ◽  
Author(s):  
Yuki Yoshida ◽  
Noboru Matsumura ◽  
Yoshitake Yamada ◽  
Minoru Yamada ◽  
Yoichi Yokoyama ◽  
...  

Abstract Background: Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods.Methods: Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30–49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements.Results: The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9–15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3–14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7–14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4–13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions: This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.


2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Da-Hang Zhao ◽  
Di-Chao Huang ◽  
Gong-Hao Zhang ◽  
Yun-Ping Fan ◽  
Jian Yu ◽  
...  

Ankle joint kinematics is mainly stabilized by the morphology of the talar dome and the articular surface of tibiofibular mortise as well as the medial and lateral ligament complexes. Because of this the bicondylar geometry of talus dome is believed to be crucial for ankle implant design. However, little data exist describing the precise anatomy of the talar dome and the talocrural joint axis. The aim of this study is to document the anatomy of the talar dome and the axis of the talocrural joint using three-dimensional (3D) computed tomographic (CT) modeling. Seventy-one participants enrolled for CT scanning and 3D talar model reconstruction. All the ankles were held in a neutral position during the CT scanning. Six points on the lateral and medial crest of the talar dome were defined. The coordinate of the six points; radii of lateral-anterior (R-LA), lateral-posterior (R-LP), medial-anterior (R-MA), and medial-posterior (R-MP) sections; and inclination angle of the talar dome were measured, and the inclination and deviation angles of the talocrural joint axis were determined. The mean values of R-LA, R-LP, R-MA, and R-MP were 19.23 ± 2.47 mm, 18.76 ± 2.90 mm, 17.02 ± 3.49 mm, and 22.75 ± 3.04 mm. The mean inclination angle of the talar dome was 9.86 ± 3.30 degrees. Gender variation was found in this parameter. The mean inclination and deviation angles were 8.60 ± 0.07 and 0.76 ± 0.69 degrees for the dorsiflexion axis and −7.34 ± 0.07 and 0.09 ± 0.18 degrees for the plantarflexion axis. Bilateral asymmetries between the medial and lateral crest of the talar dome were found, which resulted in different dorsiflexion and plantarflexion axes of the talocrural joint. Currently, no ankle implants replicate this talar anatomy, and these findings should be considered in future implant designs.


PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3976 ◽  
Author(s):  
Alejandro Otero ◽  
Vivian Allen ◽  
Diego Pol ◽  
John R. Hutchinson

Many of the major locomotor transitions during the evolution of Archosauria, the lineage including crocodiles and birds as well as extinct Dinosauria, were shifts from quadrupedalism to bipedalism (and vice versa). Those occurred within a continuum between more sprawling and erect modes of locomotion and involved drastic changes of limb anatomy and function in several lineages, including sauropodomorph dinosaurs. We present biomechanical computer models of two locomotor extremes within Archosauria in an analysis of joint ranges of motion and the moment arms of the major forelimb muscles in order to quantify biomechanical differences between more sprawling, pseudosuchian (represented the crocodile Crocodylus johnstoni) and more erect, dinosaurian (represented by the sauropodomorph Mussaurus patagonicus) modes of forelimb function. We compare these two locomotor extremes in terms of the reconstructed musculoskeletal anatomy, ranges of motion of the forelimb joints and the moment arm patterns of muscles across those ranges of joint motion. We reconstructed the three-dimensional paths of 30 muscles acting around the shoulder, elbow and wrist joints. We explicitly evaluate how forelimb joint mobility and muscle actions may have changed with postural and anatomical alterations from basal archosaurs to early sauropodomorphs. We thus evaluate in which ways forelimb posture was correlated with muscle leverage, and how such differences fit into a broader evolutionary context (i.e. transition from sprawling quadrupedalism to erect bipedalism and then shifting to graviportal quadrupedalism). Our analysis reveals major differences of muscle actions between the more sprawling and erect models at the shoulder joint. These differences are related not only to the articular surfaces but also to the orientation of the scapula, in which extension/flexion movements in Crocodylus (e.g. protraction of the humerus) correspond to elevation/depression in Mussaurus. Muscle action is highly influenced by limb posture, more so than morphology. Habitual quadrupedalism in Mussaurus is not supported by our analysis of joint range of motion, which indicates that glenohumeral protraction was severely restricted. Additionally, some active pronation of the manus may have been possible in Mussaurus, allowing semi-pronation by a rearranging of the whole antebrachium (not the radius against the ulna, as previously thought) via long-axis rotation at the elbow joint. However, the muscles acting around this joint to actively pronate it may have been too weak to drive or maintain such orientations as opposed to a neutral position in between pronation and supination. Regardless, the origin of quadrupedalism in Sauropoda is not only linked to manus pronation but also to multiple shifts of forelimb morphology, allowing greater flexion movements of the glenohumeral joint and a more columnar forelimb posture.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Tomonori Kenmoku ◽  
Keisuke Matsuki ◽  
Nobuyasu Ochiai ◽  
Masaru Sonoda ◽  
Takumi Ishida ◽  
...  

Abstract Background The purpose of this study to compare glenohumeral joint motion during active shoulder axial rotation between subacromial impingement syndrome (SIS) shoulders and asymptomatic shoulders using cine-magnetic resonance imaging (cine-MRI). Measurement of glenohumeral joint motion via manual intervention does not assess the usual glenohumeral joint motion, and the glenoid surface cannot be confirmed manually. However, cine-MRI can produce clear images of glenohumeral joint rotation. Therefore, we sought to measure the active ROM of the glenohumeral rotation using cine-MRI. Methods Seventy-three shoulders in 42 asymptomatic volunteers and 110 SIS shoulders in 103 consecutive patients were included in this study. We evaluated 36 matched pairs (72 shoulders in total) adjusting for baseline characteristics with propensity score matching method. The patients underwent cine-MRI during axial rotation of the adducted arm. During imaging, participants rotated their shoulder from the maximum internal rotation to the maximum external rotation over the first 10 s and then back to the maximum internal rotation over the subsequent 10 s. We assessed internal/external rotation, and compared the asymptomatic and SIS shoulders in this regard. Evaluation of rotation angles was performed on a series of axial images through the humeral head center. Results The mean internal rotation angles of the asymptomatic and patient groups were 55° ± 10° and 41° ± 23°, respectively, (P = .002; 95% Confidence Interval [CI], 51–58 vs 33–49); the mean external rotation angles were 47° ± 15° and 21° ± 25°, respectively, (P < .001; CI, 42–52 vs 13–29). Conclusions Compared to asymptomatic shoulders, SIS shoulders showed significantly restricted glenohumeral rotation as determined by cine-MRI. Our results suggested that the significant limitation of active glenohumeral rotation might be associated with rotator cuff dysfunction.


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0010
Author(s):  
Alessio Bernasconi ◽  
Lucy Cooper ◽  
Shirley Lyle ◽  
Shelain Patel ◽  
Nicholas Cullen ◽  
...  

Category: Ankle, Hindfoot Introduction/Purpose: Charcot-Marie-Tooth disease (CMT) is an inherited sensory motor peripheral neuropathy progressively leading to cavovarus deformity of the foot. Conversely, the idiopathic cavovarus foot represents a non-neurological condition, with a spectrum from subtle to markedly deformed. Our aim was to investigate morphological differences between CMT pes cavovarus (CMT-PC), idiopathic pes cavovarus (I-PC) and normally aligned feet using three-dimensional (3D) cone beam weightbearing computed tomography (WBCT) measurements. We hypothesised that the hindfoot alignment was significantly different between the three groups. Methods: Retrospectively, we compared 17 CMT-PC (15 patients) with 24 I-PC and 24 clinically normally aligned feet. Patients were comparable by age, sex and body mass index. All WBCTs were performed during routine investigation. Exclusion criteria included previous ipsilateral foot/ankle surgery and inability to heel weightbear. Three measurements were made by one orthopaedic surgeon: foot and ankle offset (FAO), a three-dimensional calculation describing the relationship between the centre of gravity of the tripod of the foot and the centre of the ankle; calcaneal offset (CO), measuring the distance between a theoretically neutral position of the calcaneus and its true position; and hindfoot angle (HA), an estimative of coronal angular hindfoot alignment. These measurements were all repeated twice for intraobsever reliability calculation (Pearson correlation). The mean values were compared using one-way ANOVA (values normally distributed after Shapiro-Wilk test) with the Bonferroni test. Results: Intraobserver reliability was excellent for all the three measurements (r=0.98 for FAO, CO and HA). Mean FAO value ± standard deviation in CMT-PC group (-14.1% ± 7.2) and in I-PC group (-9.6% ± 5.2) both differed from normal feet (1.6% ± 3.3) (p< .001). Of note, a difference was found between mean FAO in CMT-PC and I-PC feet (p .025). Furthermore, the mean CO (- 23.6 mm ± 11.3 in CMT-PC, -16.7 mm ± 8.2 in I-PC and 3.1 mm ± 6 in normal feet) and the mean HA (-44.9° ± 21.7 in CMT-PC; - 30.3° ± 16.9 in I-PC; 5.1° ± 10.1 in normal feet) significantly differed in three groups (p< .001) and specifically between CMT-PC and I-PC feet (p .032 and p .02 for CO and HA, respectively). Conclusion: This study confirms our hypothesis. Hindfoot alignment in patients diagnosed with CMT cavovarus and idiopathic cavovarus feet significantly differed between them and from normal controls, with a more accentuated varus deformity in CMT patients. This probably reflects the presence of a known neuromuscular imbalance driving the deformity over time in CMT feet. We therefore propose using a reliable method of quantifying heel varus and seeking a potential neurological diagnosis in the more severe.


1999 ◽  
Vol 24 (6) ◽  
pp. 719-723 ◽  
Author(s):  
G. NYLANDER ◽  
C. CARLSTRÖM ◽  
L. ADOLFSSON

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.


Sign in / Sign up

Export Citation Format

Share Document