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. 2022 May 19;2(2):255-263.
doi: 10.3390/biomechanics2020020.

Reliability of the Fluoroscopic Assessment of Load-Induced Glenohumeral Translation during a 30° Shoulder Abduction Test

Eleonora Croci  1   2 , Marina Künzler  1   2 , Sean Börlin  2 , Franziska Eckers  2 , Corina Nüesch  1   2   3   4 , Daniel Baumgartner  5 , Andreas Marc Müller  2 , Annegret Mündermann  1   2   3   4
Affiliations

Reliability of the Fluoroscopic Assessment of Load-Induced Glenohumeral Translation during a 30° Shoulder Abduction Test

Eleonora Croci et al. Biomechanics (Basel). .

Abstract

Rotator cuff tears are often linked to superior translational instability, but a thorough understanding of glenohumeral motion is lacking. This study aimed to assess the reliability of fluoroscopically measured glenohumeral translation during a shoulder abduction test. Ten patients with rotator cuff tears participated in this study. Fluoroscopic images were acquired during 30° abduction and adduction in the scapular plane with and without handheld weights of 2 kg and 4 kg. Images were labelled by two raters, and inferior-superior glenohumeral translation was calculated. During abduction, glenohumeral translation (mean (standard deviation)) ranged from 3.3 (2.2) mm for 0 kg to 4.1 (1.8) mm for 4 kg, and from 2.3 (1.5) mm for 0 kg to 3.8 (2.2) mm for 4 kg for the asymptomatic and symptomatic sides, respectively. For the translation range, moderate to good interrater (intra-class correlation coefficient ICC [95% confidence interval (CI)]; abduction: 0.803 [0.691; 0.877]; adduction: 0.705 [0.551; 0.813]) and intrarater reliabilities (ICC [95% CI]; abduction: 0.817 [0.712; 0.887]; adduction: 0.688 [0.529; 0.801]) were found. Differences in the translation range between the repeated measurements were not statistically significant (mean difference, interrater: abduction, -0.1 mm, p = 0.686; adduction, -0.1 mm, p = 0.466; intrarater: abduction 0.0 mm, p = 0.888; adduction, 0.2 mm, p = 0.275). This method is suitable for measuring inferior-superior glenohumeral translation in the scapular plane.

Keywords: abduction; fluoroscopy; glenohumeral instability; humeral head migration; rotator cuff; shoulder.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Patient with the arm at maximal amplitude. The patient is positioned against the fluoroscopic device for the acquisition of images in the scapular plane. The string attached to the lower arm controls the maximal arm amplitude during the abduction test.
Figure 2
Figure 2
Example of a labelled image at the initial position with the glenoid coordinate system. The glenohumeral head joint centre (GH-1) is defined as the centre of a best-fit circle on the humeral head. The axis GH-1-H-1 Is used to measure the arm abduction angle (θ). H1 is the centre of a circle fitted to the humeral shaft (set as distally as possible). The critical shoulder angle (CSA) points are used as a reference for the translation measurements [23].
Figure 3
Figure 3
Example of tracked glenohumeral translations during arm abduction for all raters. ‘x’ indicates the initial position of the movement. Positive translation values represent a superior translation of the glenohumeral joint centre.
Figure 4
Figure 4
Bland-Altman plots showing the limits of agreements of the translation range for abduction and adduction for the interrater and intrarater reliability. ABD.—Abduction; ADD.—Adduction; Diff.—Difference; Avg.—Average; Transl.—Translation.
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