Rapp van Roden Elizabeth A, Richardson Robert Tyler, Russo Stephanie A, Rose William C, Chafetz Ross S, Gabos Peter G, Shah Suken A, Samdani Amer F, Richards James G
Biomechanics and Movement Science Program, University of Delaware, Newark.
Kinesiology Program, School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown.
J Pediatr Orthop. 2018 Sep;38(8):e446-e454. doi: 10.1097/BPO.0000000000001207.
Proper contribution of the scapulothoracic joint is necessary for adequate shoulder complex function. Associations between trunk shape and abnormal scapular kinematics and subsequent shoulder dysfunction have been established; however, the extent of shoulder dysfunction in adolescent idiopathic scoliosis (AIS) is still poorly understood. The purpose of this study was to perform a comprehensive analysis of scapular kinematics during multiplanar arm motion in patients with AIS and compare kinematics and patient-reported function with that of a typically developing cohort.
Typically developing adolescents (n=33) and patients with AIS (n=26) with no history of spine or shoulder surgery were recruited for this study. A 3-dimensional optoelectronic motion capture system was used to analyze scapular kinematics in 4 positions: rest, full abduction, forward reach, and hand to spine. Subjects in each group also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a measure of patient-reported function.
The convex shoulders of the patients with AIS exhibited deficits in scapular upward rotation and posterior tilt in all positions and reduced protraction range of motion during reaching. The AIS group also reported worse patient-perceived shoulder function than the typically developing group; however, this dysfunction was not related to specific scapular kinematic patterns.
Patients with AIS show alterations in scapular kinematics that are associated with shoulder pathology. Despite displaying an unaffected ability to place the hand in space, the underlying joint mechanics place these adolescents at risk for future pathology. Accordingly, consideration of scapulothoracic and glenohumeral joint function is warranted in the treatment of AIS.
Level III-cross-sectional comparison.
肩胛胸壁关节的正常功能对于肩部复合体的充分功能是必要的。躯干形状与异常肩胛运动学及随后的肩部功能障碍之间的关联已得到证实；然而，青少年特发性脊柱侧凸（AIS）中肩部功能障碍的程度仍知之甚少。本研究的目的是对AIS患者在多平面手臂运动期间的肩胛运动学进行全面分析，并将运动学和患者报告的功能与典型发育队列进行比较。
本研究招募了无脊柱或肩部手术史的典型发育青少年（n = 33）和AIS患者（n = 26）。使用三维光电运动捕捉系统分析肩胛在4个位置的运动学：休息位、完全外展位、前伸位和手触脊柱位。每组受试者还完成了手臂、肩部和手部功能障碍（DASH）问卷，作为患者报告功能的一项指标。
AIS患者的凸肩在所有位置均表现出肩胛上旋和后倾不足，以及前伸时前屈运动范围减小。AIS组报告的患者感知肩部功能也比典型发育组差；然而，这种功能障碍与特定的肩胛运动学模式无关。
AIS患者表现出与肩部病变相关的肩胛运动学改变。尽管他们将手放置在空间中的能力未受影响，但潜在的关节力学使这些青少年面临未来病变的风险。因此，在AIS的治疗中，有必要考虑肩胛胸壁关节和盂肱关节的功能。
III级——横断面比较。
