Are glenoid retroversion, humeral subluxation and Walch classification associated with a muscle imbalance

Abstract

Introduction: The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior to posterior rotator cuff muscle and deltoid volumes as a function of humeral subluxation and glenoid morphology when analyzed as continuous variable in arthritic shoulders.

Methods: Three hundred and thirty-three (273 arthritic and 60 healthy controls) CT scans of shoulders were included in this study and were segmented automatically. For each muscle, the volume of muscle fibers without intra-muscular fat was then measured. The ratio between the volume of the subscapularis and the volume of the infraspinatus + teres minor (AP ratio) and the ratio between the anterior and posterior deltoid (AP_deltoid) were calculated. Statistical analyses were performed to determine whether a correlation could be found between these ratios and glenoid version/ humeral subluxation/glenoid type in the Walch classification.

Results: Within the arthritic cohort, no statistically significant difference was found between the AP ratio between A and type B glenoids (1.09 ± 0.22 versus 1.03 ± 0.16 p=0.09), between A and D type glenoids (1.09 ± 0.22 versus 1.12 ± 0.27, p=0.77) nor between the A and C type glenoids (1.09 ± 0.22 versus 1.10 ± 0.19, p=1). No correlation was found between AP ratio and glenoid version/humeral subluxation (rho =-0.0360, p=0.55; rho = 0.076; p=0.21). The AP_deltoid ratio of type A glenoids was significantly greater than that of type B glenoids (0.48 ± 0.15 versus 0.35 ± 0.16, p< 0.01), and type C glenoids (0.48 ± 0.15 versus 0.21±0.10, p < 0.01) but not significantly different from the AP_deltoid ratio of type D glenoids (0.48 ± 0.15 versus 0.64 ± 0.34, p=1). When evaluating both healthy control and arthritic shoulders, moderate correlations were found between AP_deltoid ratio and glenoid version/humeral subluxation (rho=0.55, p<0.01; rho=-0.61, p<0.01).

Conclusion: As opposed to previous two-dimensional CT scan studies, we did not find any correlation between AP muscle volume ratio and glenoid parameters in arthritic shoulders. Therefore, rotator cuff muscle imbalance does not seem to be associated with posterior humeral subluxation leading to posterior glenoid erosion and subsequent retroversion characteristic of Walch B glenoids. However, our results could suggest that a larger posterior deltoid pulls the humerus posteriorly into posterior subluxation, but this requires further evaluation as the deltoid follows the humerus possibly leading to secondary asymmetry between the anterior and the posterior deltoid.

Keywords: 3D reconstruction; automated segmentation; deltoid; muscle volume; posterior subluxation; rotator cuff.