Consequences of deltoid muscle elongation on deltoid muscle performance: a computerised study

The deltoid muscle plays an important role in normal shoulder function. Knowledge of the position of the glenohumeral rotational centre and of the deltoid muscle length is essential to understand optimal placement of a total shoulder prosthesis.

This study is designed to analyse the effect of deltoid muscle elongation on shoulder joint function.

A three-dimensional model of the glenohumeral joint with deltoid muscle analysis in the scapular plane.

A geometrical three-dimensional ball-and-socket model of the shoulder joint was developed. From dry bones, the position of the origins and insertions of the three parts of the deltoid muscle relative to the calculated centre of rotation of the humeral head was defined. The position and the direction of the muscle force working lines relative to this humeral centre were calculated using former measurements and CT-data of the deltoid. Muscle length-tension data were applied to obtain angle-force relationships. The model was used to calculate the angle-force relationships, the moment arm and the moment of the deltoid muscle components for successive arm elevation angles in the scapular plane. These data were compared to those of a theoretical situation assuming a 10% elongation of the muscle.

Muscle angle-force curves show a more favourable slope after moderate (10%) deltoid muscle elongation. Elongating the muscle by changing the distance between the humeral rotation point and the deltoid insertion along the humeral axis does not affect moment arms. The moments of the deltoid muscle forces themselves, however, seem more adapted to elevation in the scapular plane. The deltoid maximal moment exceeds the arm-weight moment by about 40% instead of being approximately equal, and that the maximum is situated around 100 degrees of elevation.

From a biomechanical point of view, stretching the deltoid muscle by 10% seems to result in a significantly more favourable position in case of shoulder elevation at 90 degrees of abduction in the scapular plane in a centred glenohumeral joint.

This model suggests that a 10% elongation of the deltoid muscle, the most important shoulder abductor, improves its ability to elevate the arm. If properly implemented, this observation can be very important in the treatment and early rehabilitation of rotator-cuff-insufficient shoulders treated by a specific total shoulder replacement design.