Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing

The goals of this study were to define biplanar glenohumeral kinematics and glenohumeral-scapulothoracic motion relationships in normal patients with a two-plane radiograph series and then in patients with anterior shoulder instability or rotator cuff tear both before surgery and after surgical repair and postoperative rehabilitation. A two-plane radiographic series of x-ray films in the scapular and horizontal (axillary) planes was performed. With these films, measurements of the relationship between the centers of the humeral head and glenoid and measurements of the component contributions of glenohumeral and scapulothoracic motion to total arm abduction were made. Six normal adults underwent x-ray evaluation to establish normal control values. Kappa analysis was used to determine reliability of technique. Eighteen patients with confirmed anterior shoulder instability (group A) and 15 with confirmed rotator cuff tears (group B) were studied before surgery. Seven (39%) of 18 of the patients in group A and all 15 (100%) of the patients in group B demonstrated superior translation of the humeral head during scapular plane abduction. In the horizontal plane 14 (78%) of 18 patients in group A (instability) and none in group B (rotator cuff tear) demonstrated abnormal anterior translation of the humeral head on the glenoid. Both groups demonstrated altered glenohumeral-scapulothoracic motion relationships compared with the normal control group. Two years after surgery 12 patients from group A and 14 patients from group B were restudied. All of these patients had demonstrated abnormalities of humeral head translation before surgery. For group A 12 (100%) of 12 patients demonstrated normal glenohumeral kinematics in both planes after open anterior stabilization. For group B 12 (86%) of 14 patients demonstrated normal glenohumeral kinematics in both planes after open rotator cuff repair. In group A the altered glenohumeral-scapulothoracic motion relationships persisted, whereas in group B these relationships became normal.