Mattar Luke T, Johnson Camille C, Gale Tom H, Popchak Adam J, Anderst William J, Musahl Volker, Irrgang James J, Debski Richard E
Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States.
Clin Biomech (Bristol). 2024 Feb;112:106184. doi: 10.1016/j.clinbiomech.2024.106184. Epub 2024 Jan 12.
Reaching behind the back is painful for individuals with rotator cuff tears. The objectives of the study were to determine changes in glenohumeral kinematics when reaching behind the back, passive range of motion (RoM), patient reported outcomes and the relationships between kinematics and patient reported outcomes following exercise therapy.
Eighty-four individuals with symptomatic isolated supraspinatus tears were recruited for this prospective observational study. Glenohumeral kinematics were measured using biplane radiography during a reaching behind the back movement. Passive glenohumeral internal rotation and patient reported outcome measures were collected. Depending on data normality, appropriate tests were utilized to determine changes in variables. Spearman's correlations were utilized for associations, and Stuart-Maxwell tests for changes in distributions.
Maximum active glenohumeral internal rotation increased by 3.2° (P = 0.001), contact path length decreased by 5.5% glenoid size (P = 0.022), passive glenohumeral internal rotation RoM increased by 4.9° (P = 0.001), and Western Ontario Rotator Cuff Index and American Shoulder and Elbow Surgeons scores increased by 29.8 and 21.1 (P = 0.001), respectively. Changes in Western Ontario Rotator Cuff Index scores positively associated with changes in maximum active glenohumeral internal rotation and negatively associated with changes in contact path lengths (P = 0.008 and P = 0.006, respectively).
The reaching behind the back movement was useful in elucidating in-vivo mechanistic changes associated with patient reported outcomes. Glenohumeral joint function and patient reported outcomes improved, where changes in Western Ontario Rotator Cuff Index scores were associated with kinematics. These findings inform clinicians of functional changes following exercise therapy and new targetable treatment factors.
对于患有肩袖撕裂的个体来说，伸手到背后会很疼。本研究的目的是确定伸手到背后时盂肱关节运动学的变化、被动活动范围（RoM）、患者报告的结果以及运动疗法后运动学与患者报告结果之间的关系。
招募了84名有症状的孤立性冈上肌撕裂患者进行这项前瞻性观察研究。在伸手到背后的动作过程中，使用双平面X线摄影测量盂肱关节运动学。收集被动盂肱关节内旋和患者报告的结果测量值。根据数据正态性，使用适当的测试来确定变量的变化。使用Spearman相关性分析关联，使用Stuart-Maxwell检验分析分布变化。
最大主动盂肱关节内旋增加了3.2°（P = 0.001），接触路径长度减少了5.5%的关节盂大小（P = 0.022），被动盂肱关节内旋RoM增加了4.9°（P = 0.001），西安大略肩袖指数和美国肩肘外科医生评分分别增加了29.8和21.1（P = 0.001）。西安大略肩袖指数评分的变化与最大主动盂肱关节内旋的变化呈正相关，与接触路径长度的变化呈负相关（分别为P = 0.008和P = 0.006）。
伸手到背后的动作有助于阐明与患者报告结果相关的体内机制变化。盂肱关节功能和患者报告的结果得到改善，其中西安大略肩袖指数评分的变化与运动学相关。这些发现为临床医生提供了运动疗法后功能变化及新的可靶向治疗因素的信息。
