Shoulder muscle forces and tendon

excursions during glenohumeral

abduction in the scapular plane
Patrick J. McMahon, MD, Richard E. Debski, BS, William O. Thompson, MD,
Jon J. P. Warner, MD, Freddie H. Fu, and Savio L-Y. Woo, PhD, Pittsburgh, Pa.

Muscle force values and tendon excursions across the glenohumeral joint during
unconstrained glenohumeral abduction in the scapular plane were evaluated with a
dynamic shoulder testing apparatus. This evaluation was achieved by simulated rotator
cuff and middle deltoid activity applied in four plausible muscle force ratios: (1) equal
force to each tendon, (2) 2:3 ratio of force applied to the middle
deltoid/supraspinatus tendons, (3) 3:2 ratio of force applied to the middle
deltoid/supraspinatus tendons, and (4) zero force applied to the supraspinatus tendon
to simulate supraspinatus paralysis. The glenohumeral joint was then moved to 5 ~
15 ~ 30~ 45~ 60~ and maximum glenohumeral abduction while muscle forces,
tendon excursions, and glenohumeral joint kinematics were monitored. Furl
glenohumeral abduction was achieved in aft four test conditions. When the muscle
force combination favored the middle deltoid, the smallest supraspinatus force was
required from 30 ~ to maximum glenohumeral abduction; however, when the
supraspinatus was favored, the largest supraspinatus force was necessary to achieve
maximum glenohumeral abduction. With simulated supraspinatus paralysis the middle
deltoid required the greatest increase in force from 15 ~ through 45 ~ of glenohumeral
abduction. These results indicate that muscle efficiency during glenohumeral abduction
is highly dependent on the ratio of applied force between the middle deltoid and
supraspinatus. A larger contribution of force from the supraspinatus was required near
the beginning of motion, whereas the middle deltoid was more important near the
end of glenohumeral abduction in the scapular plane. Tendon excursion for the middle
deltoid (6.4 +_0.2 cm) and supraspinatus (3.8 +_0.2 cm) were proportionately larger
than those for the subscapularis and infraspinatus. Humeral head translations on the
glenoid were less than 2 mm in all four conditions evaluated; therefore the
glenohumeral joint behaves kinematically as a "ball-and-socket" articulation during
glenohumeral abduction. Simulated supraspinatus paralysis does not change normal
joint kinematics and does not prevent furl glenohumeral abduction. (J SHOULDERELBOW
SURG 1995;4:199-208.)

,ALrticular surface conformity offers little inherent
stabilitylO, 19, 3o to the glenohumeral joint; hence
joint stability is primarily achieved through soft-
tissue restraint. 3z Although the joint capsule and
From the Musculoskeletal Research Center, Department of Ortho-
paedic Surgery, University of Pittsburgh.
Supported by Blue Cross/Blue Shield of Western Pennsylvania,
the Whitaker Foundation, and the Universityof PittsburghMedi-
cal Centen
Reprint requests: Savio L-Y. Woo, PhD, Department of Ortho-
p aedic Surgery, 1010 Kaufman Building, University of Pitts-
urgh, Pittsburgh, PA 15213.
Copyright 9 1995 by Journal of Shoulder and Elbow Surgery
Board of Trustees.
1058-2746/95/$3.00 + 0 3211159199
ligaments have been shown to provide static limi-
tation to glenohumeral translations, these structures
are lax throughout most of glenohumeral rota-
tional, 3o, 3~, 39; therefore large excursions of the
humeral head on the glenoid are possible in the
absence of active muscle contraction across the
joint.
Because the shoulder is a complex arrangement
of many muscles and intercalated joints, little infor-
mation on individual muscle force values exists.
Previous studies have attempted to determine the
maximum force in muscles by measuring cross-
sectional area. 4" 9, 12, 1~, 31.32 Electromyography
has been used to measure individual shoulder
199
200 McMahon et al. J. ShoulderElbow Surg.
May/June 1995

RotationSequence
TestingApparatus
1)Internal/Externa
~" Rotation

~ ~
x• 2)Scapulaplane
(SPA)
r
Abduction

3)Horizontal
Abduction/
Adduction

Figure 1 Pittsburghdynamic shouldertestingapparatus. A, Scapular mount; B,

magnetic tracking device platform; C, load cell (n-6); D, hydraulic cylinder
(n = 6); E, linear variable differential transducers (n = 6). Insert depicts rotation
sequence used to describe humeral orientation.

muscle activity, 2~ 2r 35 and electromyography-to- MATERIAL AND METHODS

force conversion has been applied to a limited
number of muscle groups. TM Selective paralysis of
individual nerves has allowed analysis of the re-
sultant changes in shoulder strength during abduc-
tion.~, lZ Several recent experimental models have
provided information on glenohumeral kinematics
during abduction in the scapular plane73' 3s Fi-
nally, dynamic analysis models have also permit-
ted determination of muscle forces necessary to
perform certain complex shoulder motions. ~5" 22
None of these studies, however, has determined
the optimum combination of muscle forces in the
supraspinatus and deltoid to achieve full gleno-
humeral abduction (GHA) in the scapular plane.
The purpose of this study was to determine the
effect of different combinations of muscle forces in
the middle deltoid and supraspinatus on joint kine-
matics and the efficiency of GHA. A dynamic
shoulder testing apparatus (DSTA) previously de-
veloped in our laboratory was used for the deter-
mination of joint kinematics and tendon excursions
in full upper extremities when forces were applied
to individual rotator cuff muscles and the deltoid7 z
Dynamic shoulder testing apparatus.
This model attempts to simulate in vivo gleno-
humeral motion by satisfying three criteria: (1) joint
compression occurs through the application of
forces to the muscles that are normally active dur-
ing GHA, 3" ~' 12, ~z, 2,, 35 (2) whole human upper
extremities are used for accurate simulation of the
mass distribution along the length of the extremity,
and (3) glenohumeral joint kinematics are moni-
tored to ensure that movement approximates in
vivo motions.
The DSTA uses six servoactuated hydraulic cyl-
inders (independently controlled) to apply forces
and displacements to each of the rotator cuff ten-
dons and the middle deltoid through a tendon
clamp-cable-pulley system (Figure 1). 42 The force
in each cable is measured by a load cell mounted
on top of the piston of each hydraulic cylinder.
Linear variable differential transducers attached to
each cylinder measure the linear displacement of
each cable. A computer with customized software
controls the hydraulic cylinders and allows acqui-
sition of force (muscle force) and displacement
J. Shoulder Elbow Surg.
Volume 4, Number 3
(tendon excursion) data for each cable. The DSTA
approximates the in vivo position of the scapula
relative to the thorax by means of a scapular
mount with six degrees of freedom. The cable-and-
pulley systems are used to achieve the anatomic
force vector of each muscle being simulated, and
the smooth, sinusoidal gripping mechanism of
each clamp allows for high-force transmission with-
out tendon slippage within the clamp.
Glenohumeral joint motion is measured with a
six degrees-of-freedom magnetic tracking device
(The Bird, Ascension Technologies, Inc., Colchester,
Vt.) with an accuracy within 0.8 mm of translation
and 0.8 ~ of rotation, as previously determined in
our laboratory, z The transmitter is mounted on a
Plexiglas (Rohm and Haas Company, Philadelphia,
Pa.) frame (magnetic tracking device platform),
and the stylus attaches the sensor to the humerus at
the insertion of the latissimus dorsi muscle.
Specimen preparation. Eight fresh-frozen
full upper extremities were obtained from human
cadavers (age range at death 49 to 78 years) and
were kept frozen at-20 ~C. Entire upper extremities
were used for this study, because we wanted the
exact weight of the entire upper extremity at its cen-
ter of mass. Because the mass moment of the upper
extremity is a measure of the weight distribution
along the length of the arm, small perturbations of
the center of mass of the arm would result in large
errors in the determined muscle forces during GHA.
The cadaver specimens used were similar in weight
and length to those reported previously. 5" 31
The specimens were thawed at room tempera-
ture for 24 hours before dissection, and then the
soft tissue proximal to the glenohumeral joint was
removed except for the tendons of the rotator cuff
and the joint capsule. The tendon of the middle
deltoid was also stripped of all muscle tissue. The
coracohumeral, coracoclavicular, and acromio-
clavicular ligaments, anterior and posterior por-
tions of the deltoid, long head of the biceps, and
triceps were left intact. The glenohumeral joint was
vented to atmosphere by this dissection; thus sta-
bility through negative intraarticular pressure was
eliminated. 3~ All joints distal to the glenohumeral
joint were pinned in extension, and the scapula
was then fixed in an epoxy-putty block with the
scapula aligned with the vertical plane of the block
so that the specimen could be mounted on the
DSTA.
McMahon et al. 201
Each specimen was then attached to the DSTA,
and the tendon clamp-cable-pulley systems were
configured to simulate the action of each muscle.
The scapula was oriented such that the glenoid
was between 5 ~ to 15 ~ cephalad to the vertical
plane (verified with radiographs) and remained
fixed in that position during motion simulation. The
rotator cuff muscle force vectors, defined as the
lines of action from the muscle insertions through
the centroids of the muscle tissue, had b~en previ-
ously determined with magnetic resonance imag-
ing data75 The middle deltoid vector was defined
by its sites of origin and insertion.
Motion simulation.~Because both clin-
ical studies3' 6~ 17. ?o. 32. 35 and experimental
work22. 20, 31.~3.~have demonstrated that the rotator
cuff (sup~spinatus, infraspinatus, teres minor, and
subscapularis) and the deltoid work together to
achieve full GHA, these were the muscles whose
actions we chose to simulate with the DSTA. The
subscapularis and infraspinatus-teres minor were
included for joint stability, and forces in these were
kept equal to balance the anterior-posterior force
couple.l~. 21, 23.25,28, 3, Because the supraspinatus
and middle deltoid are the primary abductors of
the glenohumeral joint, these muscles were the
focus of this study.3' 17
Supraspinatus tendon tears have been associ-
ated with both shoulder pain and abnormal shoul-
der motion. TM lZ. 31.33 Moreover, injury to the del-
toid can also lead to shoulder dysfunction. r 17, 31
Therefore this study examined four different force
ratios between these two important shoulder
muscles: equal force applied to the tendon of each
muscle (equal force); less force applied to the
middle deltoid tendon relative to the supraspinatus
tendon in a 2 : 3 ratio (supradominant); more force
applied to the middle deltoid tendon relative to the
supraspinatus tendon in a 3 : 2 ratio (delt dominant);
no force applied to the supraspinatus tendon, with
all force to achieve GHA applied through the
middle deltoid (supraparalyzed). This condition
simulated a supraspinatus paralysis. For all four
conditions the force applied to the tendons of the
subscapularis and infraspinatus-teres minor re-
mained constant at each abduction angle to elimi-
nate the effect that each of these muscles would
have on GHA.
The glenohumeral joint was cycled 25 times
between the neutral position (0~ abduction and no
202 McMahon et al.
force applied to four tendons) and maximum GHA
to minimize the effect of viscoelasticity of the soft
tissues.4~ Sufficient tension was applied to the ten-
don of each simulated muscle to achieve the ap-
propriate GHA positions for this study. Each
muscle force was applied linearly over time to
achieve GHA angles of 5 ~ 15 ~ 30 ~ 45 ~ 60 ~
and maximum abduction. If the desired GHA
angle was not achieved, the shoulder was brought
to the neutral position, the force values were
changed, and this procedure was repeated until
the desired angle was obtained. At each GHA
angle muscle forces, tendon excursions, and hu-
meral position were recorded, and the shoulder
was then returned to the neutral position before
moving to the next GHA angle. The muscle forces
for maximum GHA were applied over 2 seconds.
Each test condition was repeated three times to
confirm reproducibility. 29
The description of glenohumeral joint motion was
based on a reference coordinate system that was
fixed with respect to the scapula. The x-axis was
defined as perpendicular to the scapular plane, the
z-axis as parallel but directed superiorly, and the
y-axis as perpendicular to both the x-axis and z-axis
and therefore directed laterally in the scapular
plane (Figure 1). ~' 7 To describe motion of the hu-
merus relative to the scapula, the following system
was used: internal/external rotation, which was ro-
tation about the z-axis; GHA in the scapular plane,
which was rotation about the x-axis; and horizontal
abduction/adduction, which was rotation about
the z-axis. Internal/external rotation was rotation
about the z-axis when the arm was at the side,
whereas horizontal abduction/adduction was rota-
tion about the z-axis when the arm was abducted
90 ~ With the scapula fixed, translations during gle-
nohumeral motion were defined as (1) anterior-
posterior movement along the x-axis, (2) superior-
inferior movement along the z-axis, and (3) me-
diolateral movement along the y-axis. With a
computer program the humeral rotations and trans-
lations were calculated from the position, and orien-
tation data were collected with the magnetic track-
ing device. ~"is. 34 40
After motion simulation was completed, each
glenohumeral joint was dissected to verify that no
intraarticular bony or soft-tissue pathologic fea-
tures were present. The articular surface of the
humeral head was then digitized with the mag-
J. Shoulder Elbow Surg.
May/June 1995
netic tracking device and was fitted to a sphere to
determine the center of curvature.
Finally, all tissue distal to the glenohumeral joint
was weighed. A metallic pin was placed at the
center of mass during a balance test of the upper
extremity, and a radiograph of the arm was taken
to allow the distance from the center of curvature
of the humeral head to the center of mass (moment
arm of upper extremity) to be measured. The
muscle forces were then normalized to the weight
and the moment arm of the center of mass of each
upper extremity to minimize differences resulting
from cadaver size. The mass of each upper extrem-
ity distal to the glenohumeral joint was 2.8 _ 0.2
kg. The center of mass for each upper extremity
was 0.29 + 0.02 meters from the center of the
humeral head. The mass moment was
6.98 _+0.59 N 9 m. The normalized muscle forces
were compared at each angle of GHA with a
one-way analysis of variance. Three vdlues of su-
praspinatus muscle force and four values of middle
deltoid muscle force were available at each angle
of GHA.
RESULTS
In all four testing conditions the maximum GHA
averaged 82.5 ~ _+ 1.7 ~ and no significant differ-
ence for this value was seen in all four conditions.
Joint motion was smooth and had no abrupt starts
and stops, and the path of motion of the upper
extremity was repeatable. With the scapula fixed,
motion at the glenohumeral joint was approxi-
mately in the plane of the scapula. When the joint
was abducted to the maximum position a mean of
10.0 ~ internal rotation and 15.0 ~ horizontal ad-
duction was seen.
Muscle forces. Figure 2 shows the su-
praspinatus force necessary to achieve the six
positions of GHA for equal force, supradominant,
and delt dominant conditions. A nonlinear region
was present from 0 ~ to 15 ~ of GHA, because
larger rates of increase in the supraspinatus muscle
were required to initiate GHA, whereas thereafter
a linear increase was observed over the remaining
GHA. When the ratio of force applied to the
selected muscles favored the supraspinatus (supra-
dominant), larger supraspinatus force and rate of
force increase were required from 30 ~ to maxi-
mum GHA when compared with equal force
(p < 0.05). On the other hand, when the ratio of
J. Shoulder Elbow Surg. McMahon et al. 203
Volume 4, Number 3

~ 30
~-. 9 EQUAL FORCE
z 25
uJ ......9 ...... SUPRA DOMINANT ......
us
o ---*-- DELT DOMINANT ...............
20 ....................
iio

-- 15 ................. . .....
oOr) 15
,,.....," ...
:~
:S 10 .....~ ......... ,..~[. .......
.,......"" =~176176
~J
5 ........!;= ,,..,"'
....... o -i ~ -. - -

O 0
z 0 10 20 30 40 50 60 70 80 90
GLENOHUMERAL ABDUCTION ANGLE (degrees)
Figure 2 Supraspinatusmuscleforces during glenohumeral abduction in scapu-
lar plane for equal force, supradominant, and delt dominant conditions.

.~ 20 ".L
z 9 EQUAL FORCE ..~
zv
u)
us
u
15
.-:
n,
O
U. .'"5""~
u

us 5
.J
<

0
z 0 10 20 30. 40 50 60 70 80 90
G L E N O H U M E R A L ABDUCTION ANGLE (degrees)
Figure 3 Middle deltoid muscle force during glenohumeral abduction. Three
conditions are identical to those in Figure 2.

force favored the deltoid (delt dominant), signifi- 3). After a nonlinear region at the beginning of
cantly smaller supraspinatus muscle force and rate motion a linear relation was seen from 15 ~ to
of force increase were required relative to equal maximum GHA. However, no significant differ-
force and supradominant conditions (p < 0.05). ence was seen between conditions one to three
Interestingly, between 0 ~ to 30 ~ of GHA, no statis- throughout the range of GHA (p > 0.05).
tically significant difference in supraspinatus In the case of a simulated supraspinatus paraly-
muscle force was seen for all three conditions in sis we found significant increases in the middle
which force was applied to the supraspinatus. deltoid muscle force when compared with condi-
For the middle deltoid muscle force a similar tion one. This percent increase was statistically
trend to that of the supraspinatus was seen (Figure significant from 0 ~ to 45 ~ of GHA (p < 0.05);
204 McMahon et al.
however, at greater than 60 ~ of GHA no signifi-
cant difference was demonstrated (Figure 4).
Tendon excursions. Tendon excursions from
15 ~ to maximum GHA are graphically represented
in Figure 5. The largest tendon excursions were in
the middle deltoid (6.5 + 0.2 cm) and the su-
praspinatus (3.8 + 0.2 cm), whereas the shortest
excursions were in the infraspinatus/teres minor
(3.5 _+0.2 cm) and subscapularis (0.4 +_0.2 cm).
No significant difference was seen in these values
among all four test conditions (p > 0.05).
Glenohumeral joint kinematics. The hu-
meral head started from a neutral position that
corresponded to the inferior rim of the glenoid and
moved to a centered position over the first 15 ~ of
GHA. A translation always occurred at the ini-
tiation of abduction because of the initial inferior
subluxation of the humeral head that was pre-
sumably caused by loss of negative intraarticular
pressure.39
Translations of the humeral head on the glenoid
were not significantly different among the first
three test conditions (Figure 6). From 15 ~ to maxi-
mum GHA the humeral head translations were less
than or equal to 1 mm for each specimen along all
three axes. The standard deviation of the humeral
head translation along all three axes increased as
the GHA angle increased, indicating more vari-
ability at the extremes of motion. In the suprapara-
lyzed condition translations of the humeral head
on the glenoid were not statistically different com-
pared with those in the first three conditions.
DISCUSSION
We believe that the DSTA is a good model for in
vitro study of shoulder motion when full cadaveric
upper extremities are used. As a result the data
obtained may be more relevant than data ac-
quired with isolated glenohumeral joints. No asso-
ciated scapulothoracic motion was seen in our
model. Nevertheless it has been shown that scapu-
Iothoracic motion is minimal in the first 30 ~ to 45 ~
of scapular plane abduction 8" 3T; therefore this
model may be relevant to in viva glenohumeral
motion in that range. During in viva shoulder ab-
duction the mass moment arm for the upper extrem-
ity increases and peaks at approximately 90 ~ of
humerothoracic motion (GHA approximately 60 ~
and scapular rotation approximately 30o). 8, 3o
Thus during scapular plane abduction muscle
J. Shoulder Elbow Surg.
May/June 1995
forces peak at the mid range of shoulder abduc-
tion (approximately 60 ~ of GHA). As shoulder
abduction continues, the mass moment arm for the
upper extremity decreases so that the muscle
forces decrease to minimal values as the arm
reaches a near vertical position.
No difference was seen in the maximum GHA
achieved with all four test conditions; therefore it
can be assumed that the supraspinatus and deltoid
muscles can substitute for each other in clinical
situations where one of them is not functioning
normally. Although past investigators 3' 2o. 22. 33
have stressed the importance of each of these
muscles for shoulder abduction, we have demon-
strated that no single ratio of force exists between
them that is necessary for full GHA. Even with
complete loss of supraspinatus function, as mod-
eled in the supraparalyzed condition, the middle
deltoid was able to fully abduct the glenohumeral
joint with normal kinematics. This occurrence is
consistent with the observations by Colachis and
Strohm,6 which showed that individuals with a
selective suprascapular nerve palsy were still able
to achieve full shoulder abduction.
Although different muscle force combinations
were used to achieve maximum GHA, the magni-
tude of these forces depended on the ratio of middle
deltoid to supraspinatus. In the supradominant con-
dition, where the muscle force ratio was 2:3 for
middle deltoid/supraspinatus, larger increments of
supraspinatus force were necessary to achieve
each GHA position; however, when the ratio fa-
vored the middle deltoid as in the delt dominant
condition, proportionately smaller increases were
seen in the supraspinatus muscle force necessary to
achieve each target GHA position. These different
muscle force requirements for GHA may be ex-
plained by differences in the moment arms of these
two muscles. Because the supraspinatus tendon in-
serts close to the axis of rotation of the glenohumeral
joint, its moment arm changes little over the range of
GHA22.25, 27, sl; however, because the insertion of
the middle deltoid is farther from the axis of rotation,
its moment arm changes significantly, because it is
short atthe initiation of motion but long atthe end of
GHA. Thus when GHA is beginning, increases in
force lead to small increases in torque about the
joint, but as GHA increases the moment arm in-
creases, and thus the torque of the deltoid in-
creases, whereas that of the supraspinatus changes
J. Shoulder Elbow Surg. McMahon et al. 205
Volume 4, Number 3

~ 25
z 9 EQUALFORCE
m 20
w.I
0
0
,, 15
w
_1
0
m 10

Ill
__. 5
_1

o 0
z 0 10 20 30 40 50 60 70 80 90
GLENOHUMERAL ABDUCTION ANGLE ( d e g r e e s )
Figure 4 Middle deltoid muscleforcesduring glenohumeralabduction in equal
force and supraparalyzedconditions.

7
DELT
A
SUPRA
E6
(3 [~ INFRA
Z 5 SUBS
O

0
X 3
w
Z 2
0
a
z 1
ul
I--
0
EQUAL SUPRA DELT
FORCE DOMINANT DOMINANT

Figure 5 Tendonexcursions for middle deltoid (DELT),supraspinatus (SUPRA),

infraspinatus (INFRA), and subscapularis (SUBS)during glenohumeral abduction
from 15~ to maximum.

little. Only in the supraparalyzed condition was a
significant increase in the middle deltoid force nec-
essary to achieve all target GHA positions, because
the moment arm of the supraspinatus, which is larg-
est in the first 30 ~ of GHA is lost, and the deltoid,
which has a shorter moment arm in this range of
GHA, must compensate through increased force.
Because the deltoid's moment arm is larger and that
of the supraspinatus is relatively smaller toward the
end of GHA, loss of the supraspinatus function here
does not appear to have a significant impact on
function.
We found tendon excursions to be largest for the
middle deltoid and supraspinatus, both of which
function as a primary mover for GHA. By contrast,
those for the subscapularis and infraspinatus/teres
minor were small. This difference is explained by
the anatomic arrangement that places the insertion
of the middle deltoid and supraspinatus further
from the axis of rotation than those of the other
rotator cuff muscles. Knowledge of these tendon
excursions is clinically relevant, because the suc-
cess of surgery for repair of rotator cuff tendon
tearing depends on a restoration of normal excur-
206 McMahon et al.
--m-.- EQUAL FORCE
9 SUPRA DOMINANT
2
PARALYZED
~,~
...A... DELT DOMINANT
--o-- SUPRA
;o'
t- -1
-2
10 20 30 40
GLENOHUMERAL ABDUCTION ANGLE (degrees)
Figure 6 Humeraltranslationwith respectto scapula along superior-inferior axis
during glenohumeralabduction for all testing conditions (sameas those in Figures
2 and 4).
sion. A surgical procedure that transfers tendons to
reconstruct a rotator cuff defect might limit excur-
sion and consequently lead to loss of motion.
Moreover, iatrogenic injury to the deltoid may
significantly affect the efficiency of shoulder ab-
duction through loss of this important source of
torque.2, 24
We observed, as have others, 1r 23, 31 that small
translations of the humeral head on the glenoid are
along all three axes. This confirms that the gleno-
humeral joint behaves kinematically like a "ball-
and-socket" during GHA. Moreover, even with a
simulated supraspinatus paralysis, the "ball-and-
socket" kinematics were not disrupted. Howell et
al. 17 observed similar findings in individuals with
selective paralysis of the suprascapular nerve, and
they suggested that joint compression through re-
maining rotator cuff action was sufficient to pro-
vide a fixed fulcrum for concentric rotation of the
glenohumeral joint during abduction. Lippett et
al. 2~ have termed this the "concavity-compres-
sion" effect and have experimentally showed that
it is a major stabilizing mechanism. This concept
has clinical relevance for rotator cuff tears, be-
cause individuals with tears of the supraspinatus
would be expected to have normal glenohumeral
kinematics and the ability to achieve full abduction
through the remaining rotator cuff muscles and
deltoid.
J. Shoulder Elbow Surg.
May~June 1995
SUPERIOR
T
/
INFERIOR
50 60 70 80 90
SUMMARY
We have developed a dynamic shoulder testing
apparatus that offers a unique in vitro method to
simulate active shoulder GHA. The apparatus also
permits us to model several different ratios of force
between the middle deltoid and supraspinatus.
We have shown that full GHA is possible through
several different combinations of force in these
muscles and that neither shoulder motion nor gle-
nohumeral kinematics are significantly affected by
a simulated supraspinatus paralysis. Moreover,
tendon excursions for the middle deltoid, su-
praspinatus, subscapularis, and infraspina-
tus/teres minor have been quantitated for GHA
while glenohumeral joint kinematics are recorded.
These observations provide the basis for under-
standing why patients with rotator cuff tears or
deltoid dysfunction can still achieve full shoulder
abduction. Future studies will address the effect of
different size rotator cuff tears on overall shoulder
GHA and glenohumeral kinematics.
Technical assistance from Mr. Warren Thompson is
gratefully acknowledged.
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Volume 4, Number 3
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