A comparison of two non-invasive methods for measuring scapular orientation in functional positions.

Identification of scapular dyskinesis and evaluation of interventions depend on the ability to properly measure scapulothoracic (ST) motion. The most widely used measurement approach is the acromion marker cluster (AMC), which can yield large errors in extreme humeral elevation and can be inaccurate in children and patient populations. Recently, an individualized regression approach has been proposed as an alternative to the AMC. This technique utilizes the relationship between ST orientation, humerothoracic orientation and acromion process position derived from calibration positions to predict dynamic ST orientations from humerothoracic and acromion process measures during motion. These individualized regressions demonstrated promising results for healthy adults; however, this method had not yet been compared to the more conventional AMC. This study compared ST orientation estimates by the AMC and regression approaches to static ST angles determined by surface markers placed on palpated landmarks in typically developing adolescents performing functional tasks. Both approaches produced errors within the range reported in the literature for skin-based scapular measurement techniques. The performance of the regression approach suffered when applied to positions outside of the range of motion in the set of calibration positions. The AMC significantly underestimated ST internal rotation across all positions and overestimated posterior tilt in some positions. Overall, root mean square errors for the regression approach were smaller than the AMC for every position across all axes of ST motion. Accordingly, we recommend the regression approach as a suitable technique for measuring ST kinematics in functional motion.

Errors Associated With Utilizing Prescribed Scapular Kinematics to Estimate Unconstrained, Natural Upper Extremity Motion in Musculoskeletal Modeling.

Musculoskeletal modeling is capable of estimating physiological parameters that cannot be directly measured, however, the validity of the results must be assessed. Several models utilize a scapular rhythm to prescribe kinematics, yet it is unknown how well they replicate natural scapular motion. This study evaluated kinematic errors associated with a model that employs a scapular rhythm using 2 shoulder movements: abduction and forward reach. Two versions of the model were tested: the original MoBL ARMS model that utilizes a scapular rhythm, and a modified MoBL ARMS model that permits unconstrained scapular motion. Model estimates were compared against scapulothoracic kinematics directly measured from motion capture. Three-dimensional scapulothoracic resultant angle errors associated with the rhythm model were greater than 10° for abduction (mean: 16.4°, max: 22.4°) and forward reach (mean: 11.1°, max: 16.5°). Errors generally increased with humerothoracic elevation with all subjects reporting greater than 10° differences at elevations greater than 45°. Errors associated with the unconstrained model were less than 10°. Consequently, use of the original MoBL ARMS model is cautioned for applications requiring precise scapulothoracic kinematics. These findings can help determine which research questions are suitable for investigation with these models and assist in contextualizing model results.

Validation of a mathematical approach to estimate dynamic scapular orientation.

The goal of this study was to develop and validate a non-invasive approach to estimate scapular kinematics in individual patients. We hypothesized that individualized mathematical algorithms can be developed using motion capture data to accurately estimate dynamic scapula orientation based on measured humeral orientations and acromion process positions. The accuracy of the mathematical algorithms was evaluated against a gold standard of biplane fluoroscopy using a 2D to 3D fluoroscopy/model matching process. Individualized linear models were developed for nine healthy adult shoulders. These models were used to predict scapulothoracic kinematics, and the predicted kinematics were compared to kinematics obtained using biplane fluoroscopy to determine the accuracy of the algorithms. Results showed strong correlations between mathematically predicted kinematics and validation kinematics. Estimated kinematics were within 8° of validation kinematics. We concluded that individualized linear models show promise for providing accurate, non-invasive measurements of scapulothoracic kinematics in a clinical environment.

A comparison of acromion marker cluster calibration methods for estimating scapular kinematics during upper extremity ergometry.

Accurate measurement of joint kinematics is required to understand the musculoskeletal effects of a therapeutic intervention such as upper extremity (UE) ergometry. Traditional surface-based motion capture is effective for quantifying humerothoracic motion, but scapular kinematics are challenging to obtain. Methods for estimating scapular kinematics include the widely-reported acromion marker cluster (AMC) which utilizes a static calibration between the scapula and the AMC to estimate the orientation of the scapula during motion. Previous literature demonstrates that including additional calibration positions throughout the motion improves AMC accuracy for single plane motions; however this approach has not been assessed for the non-planar shoulder complex motion occurring during UE ergometry. The purpose of this study was to evaluate the accuracy of single, dual, and multiple AMC calibration methods during UE ergometry. The orientations of the UE segments of 13 healthy subjects were recorded with motion capture. Scapular landmarks were palpated at eight evenly-spaced static positions around the 360° cycle. The single AMC method utilized one static calibration position to estimate scapular kinematics for the entire cycle, while the dual and multiple AMC methods used two and four static calibration positions, respectively. Scapulothoracic angles estimated by the three AMC methods were compared with scapulothoracic angles determined by palpation. The multiple AMC method produced the smallest RMS errors and was not significantly different from palpation about any axis. We recommend the multiple AMC method as a practical and accurate way to estimate scapular kinematics during UE ergometry.