The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores

Document Type : RESEARCH PAPER

Authors
Eric J. West
Derek T. Dixon
Thomas W. Throckmorton
David L. Bernholt
Frederick M. Azar
Tyler J. Brolin
Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
10.22038/abjs.2024.77880.3588
Abstract
Objectives: Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the “gold standard” between vertebral level and goniometer-based measurements.
Methods: Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright.
Results: Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = - 0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = - 0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%).
Conclusion: A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.
        Level of evidence: III
Keywords
Internal rotation
Range of motion
Rotator cuff
Shoulder arthroplasty
Shoulder pain
Subjects
  1. Best MJ, Aziz KT, Wilckens JH, McFarland EG, Srikumaran U. Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg. 2021; 30(5):1159-1166. doi:10.1016/j.jse.2020.08.010.
  2. Hochreiter B, Hasler A, Hasler J, Kriechling P, Borbas P, Gerber C. Factors influencing functional internal rotation after reverse total shoulder arthroplasty. JSES Int. 2021; 5(4):679-687. doi:10.1016/j.jseint.2021.03.005.
  3. Kiet TK, Feeley BT, Naimark M, et al. Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2015; 24(2):179-185. doi:10.1016/j.jse.2014.06.039.
  4. Southard EJ, Ode G, Simon P, et al. Comparing patient-reported outcome measures and physical examination for internal rotation in patients undergoing reverse shoulder arthroplasty: does surgery alter patients' perception of function? J Shoulder Elbow Surg. 2021; 30(7S):S100-S108. doi:10.1016/j.jse.2021.01.020.
  5. Kim MS, Jeong HY, Kim JD, Ro KH, Rhee SM, Rhee YG. Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2020; 29(1):86-94. doi:10.1016/j.jse.2019.05.031.
  6. Baek CH, Kim JG, Baek GR. Restoration of active internal rotation following reverse shoulder arthroplasty: anterior latissimus dorsi and teres major combined transfer. J Shoulder Elbow Surg. 2022; 31(6):1154-1165. doi:10.1016/j.jse.2021.11.008.
  7. Wirth B, Kolling C, Schwyzer HK, Flury M, Audigé L. Risk of insufficient internal rotation after bilateral reverse shoulder arthroplasty: clinical and patient-reported outcome in 57 patients. J Shoulder Elbow Surg. 2016;25(7):1146-1154. doi:10.1016/j.jse.2015.11.010.
  8. Rojas J, Joseph J, Srikumaran U, McFarland EG. How internal rotation is measured in reverse total shoulder arthroplasty: a systematic review of the literature. JSES Int. 2019;4(1):182-188. doi:10.1016/j.jses.2019.10.109.
  9. Triplet JJ, Everding NG, Levy JC, Moor MA. Functional internal rotation after shoulder arthroplasty: a comparison of anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2015; 24(6):867-874. doi:10.1016/j.jse.2014.10.002.
  10. Hochreiter B, Wyss S, Gerber C. Extension of the shoulder is essential for functional internal rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2022; 31(6):1166-1174. doi:10.1016/j.jse.2021.11.006.
  11. Ginn KA, Cohen ML, Herbert RD. Does hand-behind-back range of motion accurately reflect shoulder internal rotation? J Shoulder Elbow Surg. 2006; 15: 311e4. https://doi.org/10.1016/j.jse.2005.08.005.
  12. Edwards TB, Bostick RD, Greene CC, Baratta RV, Drez D. Interobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level. J Shoulder Elbow Surg. 2002;11(1):40-42. doi:10.1067/mse.2002.119853.
  13. Gruber MD, Kirloskar KM, Werner BC, Lädermann A, Denard PJ. Factors associated with internal rotation following reverse shoulder arthroplasty: a narrative review. JSES Rev Rep Tech. 2022; 2(2):117-124. doi: 10.1016/j.xrrt.2021.12.007.
  14. Rol M, Favard L, Berhouet J. Factors associated with internal rotation outcomes after reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2019; 105(8):1515-1519. doi:10.1016/j.otsr.2019.07.024.
  15. Aleem AW, Chamberlain AM, Keener JD. The functional internal rotation scale: a novel shoulder arthroplasty outcome measure. JSES Int. 2019; 4(1):202-206. doi:10.1016/j.jses.2019.10.002.
  16. Coscia AC, Matar RN, Espinal EE, Shah NS, Grawe BM. Does preoperative diagnosis impact patient outcomes following reverse total shoulder arthroplasty? A systematic review. J Shoulder Elbow Surg. 2021; 30(6):1458-1470. doi:10.1016/j.jse.2020.10.003.
  17. Monir JG, Abeyewardene D, King JJ, Wright TW, Schoch BS. Reverse shoulder arthroplasty in patients younger than 65 years, minimum 5-year follow-up. J Shoulder Elbow Surg. 2020; 29(6):e215-e221. doi:10.1016/j.jse.2019.10.028.
  18. Collin P, Rol M, Muniandy M, Gain S, Lädermann A, Ode G. Relationship between postoperative integrity of subscapularis tendon and functional outcome in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2022; 31(1):63-71. doi:10.1016/j.jse.2021.05.024.
  19. Eichinger JK, Rao MV, Lin JJ, et al. The effect of body mass index on internal rotation and function following anatomic and reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2021; 30(2):265-272. doi:10.1016/j.jse.2020.06.008.
  20. Friedman RJ, Flurin PH, Wright TW, Zuckerman JD, Roche CP. Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. J Shoulder Elbow Surg. 2017; 26(4):662-668. doi:10.1016/j.jse.2016.09.027.
  21. Liu B, Kim JU, Kim YK, Jeong HJ, Oh JH. Clinical outcomes of reverse shoulder arthroplasty and rotator cuff repair in patients with massive rotator cuff tears without osteoarthritis: comparison using propensity score matching. J Shoulder Elbow Surg. 2022; 31(10):2096-2105. doi:10.1016/j.jse.2022.02.040.
  22. Monir JG, Tams C, Wright TW, Parsons M, King JJ, Schoch BS. Preoperative factors associated with loss of range of motion after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021; 30(10):e621-e628. doi:10.1016/j.jse.2021.02.010.
  23. Gill TK, Shanahan EM, Tucker GR, Buchbinder R, Hill CL. Shoulder range of movement in the general population: age and gender stratified normative data using a community-based cohort. BMC Musculoskelet Disord. 2020; 21(1):676. doi:10.1186/s12891-020-03665-9.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 8
August 2024
Pages 558-566

  • Receive Date 05 February 2024
  • Revise Date 20 May 2024
  • Accept Date 23 May 2024