The Effect of Scapular Orientation on Measures of Rotator Cuff Tendon Impingement: A Simulation Study

Mechanical impingement of the rotator cuff tendons against the acromion (subacromial) and glenoid (internal) during shoulder motions has long been thought to contribute to tears. Clinically, the risk for impingement is thought to be influenced by scapular movement impairments. Therefore, our purpose was to determine the extent to which simulated changes in scapular orientation impact the proximity between the rotator cuff tendon footprint and the acromion and glenoid during scapular plane abduction. Specifically, shoulder kinematics were tracked in 25 participants using a high-speed biplane videoradiography system. Scapular movement impairments were simulated by rotating each participant's scapula from their in vivo orientation about the scapular axes (±2°, ±5°, and ±10°). Subacromial and internal proximities were described using minimum distances, proximity center locations, and prevalence of contact. Statistical parametric mapping was used to investigate the extent to which these measures were impacted by simulated changes in scapular orientation. Simulated changes in scapular orientation significantly altered proximity patterns in a complex manner that depended on the impingement mechanism, humerothoracic elevation angle, and magnitude of the simulated change. Clinicians should be mindful of these factors when interpreting the potential effects during a clinical examination.