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Three-dimensional scapular dyskinesis in hook-plated acromioclavicular dislocation including hook motion.

Eugene Kim1, Seunghee Lee1, Hwa-Jae Jeong1

  • 1Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Journal of Shoulder and Elbow Surgery
|February 17, 2018
PubMed
Summary

Hook plate fixation for acromioclavicular dislocation can cause scapular dyskinesis and subacromial erosion due to plate movement. The hook itself does not appear to directly impinge on the humeral head.

Keywords:
3-dimensional analysisAcromioclavicular dislocationhook plateimpingementin vivokinematicsscapular dyskinesissubacromial erosion

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Shoulder joint imaging

Background:

  • Acromioclavicular dislocation is often treated with hook plate fixation.
  • Complications include subacromial erosion and impingement.
  • Limited data exists on 3D scapular and hook plate kinematics post-surgery.

Purpose of the Study:

  • To analyze 3D scapular dyskinesis after hook plate fixation for acromioclavicular dislocation.
  • To evaluate hook plate kinematics relative to the acromion in vivo.
  • To investigate potential causes of subacromial erosion and impingement.

Main Methods:

  • Computed tomography (CT) scans of 15 affected and 15 contralateral shoulders.
  • Analysis of scapular 3D motion relative to the thorax during arm elevation via computer simulation.
  • Measurement of hook plate-acromion distance and angular motion, and hook-to-humeral head distance.

Main Results:

  • Affected shoulders showed decreased posterior tilting and increased external rotation.
  • Mean hook plate translation was 4.0 ± 1.6 mm, with mean angular motion of 15° ± 8° against the acromion.
  • Minimum distance between hook plate and humeral head was 6.9 mm during arm elevation.

Conclusions:

  • Hook plate fixation for acromioclavicular dislocation may induce scapular dyskinesis.
  • Hook plate motion against the acromion may cause subacromial erosion.
  • Direct impingement of the hook on the humeral head appears unlikely.