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Path of Glenohumeral Articulation Throughout the Rotational Range of Motion in a Thrower’s Shoulder Model

G. Russell Huffman, MD, MPH^*,, James E. Tibone, MD^*,, Michelle H. McGarry, MS^*, Brinceton M. Phipps, MD^*,, Yeon Soo Lee, PhD^*, and Thay Q. Lee, PhD^*,,||

From the ^* Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, and the University of California, Irvine, California

^|| Address correspondence to Thay Q. Lee, PhD, Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th Street, Long Beach, CA 90822 (e-mail: tqlee{at}med.va.gov; tqlee{at}uci.edu).

Background: Overhead-throwing athletes have increased external and diminished internal glenohumeral rotation that may alter glenohumeral kinematics.

Purpose: To quantify the kinematic changes present in a cadaveric model of a thrower’s shoulder.

Study Design: Controlled laboratory study.

Methods: In 8 fresh-frozen cadaveric shoulders, the rotator cuff and overlying muscles were removed, and the glenohumeral capsule, coracoacromial ligament, and coracohumeral ligament were left intact. The scapula was fixed, and the humerus was placed in 90° of shoulder abduction in a 6 degrees of freedom testing device. A compressive force of 44 N was applied. A thrower’s shoulder model was created, and sequential conditions were examined: intact, after anterior stretching, and after the addition of posterior-inferior capsular plication. Kinematic measurements were obtained through a complete range of glenohumeral rotation.

Results: Glenohumeral external rotation increased 16%, from 149° to 173° (P < .001), after stretching in external rotation and remained increased by 11% to 166° (P < .001) after posterior-inferior capsular plication. With the addition of the posterior-inferior capsular plication, internal rotation averaged 7° , which was not significantly different from the intact state (11° , P = .55) or the stretched state (16° , P = .07). The total glenohumeral rotation after stretching followed by posterior-inferior capsular plication did not differ significantly from intact state (P = .25). At maximum external rotation, the humeral head apex was shifted posteriorly in the stretched (P = .003) and plicated (P < .001) states compared with the intact state. The humeral head apex was posteriorly displaced at 135° and 150° of external rotation compared with the intact condition (P = .039 and .049, respectively). In maximum internal rotation, anterior stretching had no significant effect on the humeral head apex position. However, after posterior-inferior capsular plication, the humeral head apex was significantly shifted inferiorly (P = .005) and anteriorly (P = .03) in maximum internal rotation compared with the intact state.

Conclusion: Significant changes in glenohumeral motion occur in this model during the simulated late-cocking and follow-through phases of throwing. In this model, posterior capsular tightness alters the humeral head position most profoundly during the deceleration and follow-through phases of throwing.

Key Words: thrower’s shoulder • biomechanics • glenohumeral contracture • cadaveric study

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