DOCSLIB.ORG

Supraspinatus Musculotendinous Architecture: a Cadaveric and in Vivo Ultrasound Investigation of the Normal and Pathological Muscle

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Supraspinatus Musculotendinous Architecture: a Cadaveric and in Vivo Ultrasound Investigation of the Normal and Pathological Muscle SUPRASPINATUS MUSCULOTENDINOUS ARCHITECTURE: A CADAVERIC AND IN VIVO ULTRASOUND INVESTIGATION OF THE NORMAL AND PATHOLOGICAL MUSCLE by Soo Young Kim A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Graduate Department of Rehabilitation Science University of Toronto © Copyright by Soo Young Kim 2009 Supraspinatus musculotendinous architecture: a cadaveric and in vivo ultrasound investigation of the normal and pathological muscle Soo Young Kim Doctor of Philosophy, Graduate Department of Rehabilitation Science Faculty of Medicine, University of Toronto, 2009 Abstract The purpose of the study was to investigate the static and dynamic architecture of supraspinatus throughout its volume in the normal and pathological state. The architecture was first investigated in cadaveric specimens free of any tendon pathology. Using a serial dissection and digitization method tailored for supraspinatus, the musculotendinous architecture was modeled in situ. The 3D model reconstructed in Autodesk MayaTM allowed for visualization and quantification of the fiber bundle architecture i.e. fiber bundle length (FBL), pennation angle (PA), muscle volume (MV) and tendon dimensions. Based on attachment sites and architectural parameters, the supraspinatus was found to have two architecturally distinct regions, anterior and posterior, each with three subdivisions. The findings from the cadaveric investigation served as a map and platform for the development of an ultrasound (US) protocol that allowed for the dynamic fiber bundle architecture to be quantified in vivo in normal subjects and subjects with a full-thickness supraspinatus tendon tear. The architecture was studied in the relaxed state and in three contracted states (60º abduction with either neutral rotation, 80º external rotation, or 80º internal rotation). The dynamic changes in the architecture within the distinct regions of the muscle were not uniform and varied as a function of joint position. Mean FBL in the anterior region shortened significantly with contraction (p<0.05) but not in the posterior. In the anterior region, mean PA was significantly smaller in the middle part compared to the deep (p<0.05). Comparison of the normal and pathological muscle found large differences in the percentage change of FBL and PA with contraction. The architectural parameter that showed the largest changes with tendon pathology was PA. In sum, the results showed that the static and dynamic fiber bundle architecture of supraspinatus is heterogeneous throughout the muscle volume and may influence tendon stresses. The architectural data collected in this study and the 3D muscle model can be used to develop future contractile models. The US protocol may serve as an assessment tool to predict the functional outcome of rehabilitative exercises and surgery. ii Acknowledgements I would first like to give great thanks to my supervisor, mentor, and friend, Dr. Anne Agur, for providing a wonderful opportunity to learn and grow. I am so grateful for the positive and rich learning environment that Dr. Agur has provided. I’d also like to extend a sincere thanks to my committee members Drs Erin Boynton, Robert Bleakney, Tim Rindlisbacher, and Denyse Richardson for their expertise and advice. In particular, thank you Dr. Boynton for your enthusiasm and passion, Dr. Bleakney for your dedication and all the hours of scanning, Dr. Rindlishbacher and Richardson for your encouragement and referrals for the study. To my mother and father, I thank you for all your years of hard work to provide your two daughters with the best. Your love and support have allowed me to be who I am and be where I am today. To my sister Hyon and brother-in-law Peter, I truly could not have done it without your help, encouragement, humor, and prayers. Thank you so very much for bearing some of my burdens with me in the past four years. Most importantly, I give my loving husband, Jae Young, my deepest thanks. Without you, I would have never discovered my passion for teaching, and without your immense sacrifice this dream of becoming a professor could not have come true. Thank you for your love, patience, gentleness, and support. Also, to my precious Noah—you are a true gift from God. To my father-in-law and mother-in-law in Korea, thank you for your constant support from afar. Acknowledgement is made to the Canadian Orthopaedic Foundation, the Division of Anatomy, Faculty of Medicine, University of Toronto for financial support. iii Table of Contents Page Abstract ii Acknowledgements iii Table of Contents iv List of Figures x List of Tables xii List of Abbreviations xvi Chapter 1: Introduction 1 1.1 Contents of thesis 2 Chapter 2: Literature Survey 4 2.1 Structure of human skeletal muscle 5 2.1.1 Organization of contractile and connective tissue elements 5 2.1.2 Contractile mechanism 7 2.2 Muscle architecture 9 2.2.1 Overview 9 2.2.2 Architectural parameters and importance to function 11 2.2.2.1 Muscle 11 2.2.2.2 Tendon 15 2.2.3 Methods used to study muscle architecture 16 2.2.3.1 Cadaveric dissection 16 2.2.3.2 Ultrasound 17 2.2.3.3 Magnetic resonance imaging 18 iv 2.3 Muscle architecture of normal supraspinatus 19 2.3.1 Morphology of supraspinatus 19 2.3.2 Cadaveric investigation of normal supraspinatus 21 2.3.2.1 Overview 21 2.3.2.2 Comparison of methodologies 24 2.3.2.2.1 Fiber bundle length 24 2.3.2.2.2 Pennation angle 25 2.3.2.2.3 Muscle volume 25 2.3.2.2.4. Muscle length 26 2.3.2.2.5 Physiological cross sectional area 26 2.3.2.2.6 Tendon dimensions 26 2.3.2.3 Comparison of results 31 2.3.2.3.1 Fiber bundle length 31 2.3.2.3.2 Pennation angle 31 2.3.2.3.3 Muscle volume 32 2.3.2.3.4 Muscle length 32 2.3.2.3.5 Physiological cross sectional area 32 2.3.2.3.6 Tendon dimensions 32 2.3.3 Ultrasound investigation of normal supraspinatus 35 2.3.3.1 Overview 35 2.3.3.2 Comparison of methodologies 36 2.3.3.3 Comparison of results 37 2.3.4 Magnetic resonance imaging of normal supraspinatus 38 2.4 Muscle architecture of pathological supraspinatus 39 2.4.1 Overview 39 2.4.2 Cadaveric investigation of pathological supraspinatus 40 2.4.3 Imaging investigation of pathological supraspinatus 42 2.5 Modeling of skeletal muscles 43 2.5.1 Overview 43 2.5.2 Type of models 44 2.5.2.1 Phenomenological models 44 2.5.2.2 Structural models 45 v 2.5.2.3 Use of architectural parameters in muscle 45 models 2.5.3 Models of shoulder region: sources of architectural data 46 2.5.4 Use of digitized data for muscle modeling 47 2.6 Role of supraspinatus in abduction and glenohumeral stabilization 47 2.7 Summary 51 Chapter 3: Hypotheses and Objectives 52 3.1 Hypotheses 52 3.2 Objectives 53 3.3 Significance 54 Chapter 4: Methods 55 4.1 Cadaveric investigation of normal supraspinatus 55 4.1.1 Specimens 55 4.1.2 Dissection and digitization 55 4.1.3 MicroscribeTM G2 Digitizer 56 4.1.4 Modeling 57 4.1.5 Data analysis 58 4.2 Ultrasound investigation of normal supraspinatus 59 4.2.1 Subjects 59 4.2.2 Equipment 60 4.2.3 Positioning and screening of subjects 60 4.2.4 Protocol 60 4.2.4.1 Protocol development 62 4.2.4.2 Development of acromion correction factor 63 4.2.4.2.1 Dissection and digitization 63 4.2.4.3 Ultrasound investigation 64 4.2.5 Measurement of architectural parameters from US scans 65 4.2.6 Data analysis 68 vi 4.3 Ultrasound investigation of pathological supraspinatus 69 4.3.1 Subjects 69 4.3.2 Protocol 69 4.3.3 Measurement of architectural parameters from 70 US scans 4.3.4. Data analysis 70 4.4 Reliability and validity of measurements 71 4.4.1 Intra-rater reliability 71 4.4.2 Inter-rater reliability 71 4.4.3 Validity 72 Chapter 5: Results 73 5.1 Introduction 73 5.2 Cadaveric investigation of normal supraspinatus 73 5.2.1 Tendon architecture 73 5.2.2 Muscle architecture 74 5.2.2.1 Anterior region 75 5.2.2.2 Posterior region 76 5.2.2.3 Fiber bundle length 79 5.2.2.4 Pennation angle 79 5.3 Ultrasound investigation of normal supraspinatus 81 5.3.1 Pre-scanning 81 5.3.2 Intramuscular tendon 82 5.3.3 Muscle architecture 83 5.3.3.1 Muscle thickness 83 5.3.3.2 Anterior region 84 5.3.3.3 Posterior region 85 5.4 Ultrasound investigation of pathological supraspinatus 89 5.4.1 Pre-scanning 89 5.4.2 Intramuscular tendon 90 5.4.3 Muscle architecture 91 vii 5.4.3.1 Muscle thickness 92 5.4.3.2 Anterior region 93 5.4.3.3 Posterior region 96 5.5 Comparison of pathological and normal data 98 5.5.1 Pre-scanning 98 5.5.2 Intramuscular tendon 99 5.5.3 Muscle architecture 100 5.5.3.1 Muscle thickness 100 5.5.3.2 Anterior region 101 5.5.3.3 Posterior region 104 5.6 Reliability and validity of measurements 104 5.6.1 Intra-rater reliability 104 5.6.2 Inter-rater reliability 105 5.6.3 Validity 105 5.7 Summary of main results 106 Chapter 6: Discussion 109 6.1 Cadaveric investigation of normal supraspinatus 109 6.1.1 Three-dimensional modeling 109 6.1.2 Measurement of architectural parameters 110 6.1.3 Comparison of architectural parameters 111 6.1.3.1 Fiber bundle length 111 6.1.3.2 Pennation angle 112 6.1.3.3 Muscle volume 113 6.1.3.4 Tendon architecture 113 6.2 Ultrasound investigation of normal supraspinatus 114 6.2.1 Measurement of architectural parameters 116 6.2.2 Muscle architecture 117 viii 6.3 Functional implications of cadaveric and in vivo findings 118 of normal subjects 6.4 Ultrasound investigation of pathological supraspinatus 123 6.5 Functional implications of in vivo findings of pathological 125 subjects 6.6 Clinical implications 126 6.7 Summary 128 Chapter 7: Conclusions 130 Chapter 8: Future Directions 133 References 135 Appendix A: Sample size calculation 145 Appendix B: Ethics approval 146 ix List of Figures Chapter 2: Page Figure 2.1 Organization of skeletal muscle.
Load more

Recommended publications
  • M1 – Muscled Arm
    M1 – Muscled Arm See diagram on next page 1. tendinous junction 38. brachial artery 2. dorsal interosseous muscles of hand 39. humerus 3. radial nerve 40. lateral epicondyle of humerus 4. radial artery 41. tendon of flexor carpi radialis muscle 5. extensor retinaculum 42. median nerve 6. abductor pollicis brevis muscle 43. flexor retinaculum 7. extensor carpi radialis brevis muscle 44. tendon of palmaris longus muscle 8. extensor carpi radialis longus muscle 45. common palmar digital nerves of 9. brachioradialis muscle median nerve 10. brachialis muscle 46. flexor pollicis brevis muscle 11. deltoid muscle 47. adductor pollicis muscle 12. supraspinatus muscle 48. lumbrical muscles of hand 13. scapular spine 49. tendon of flexor digitorium 14. trapezius muscle superficialis muscle 15. infraspinatus muscle 50. superficial transverse metacarpal 16. latissimus dorsi muscle ligament 17. teres major muscle 51. common palmar digital arteries 18. teres minor muscle 52. digital synovial sheath 19. triangular space 53. tendon of flexor digitorum profundus 20. long head of triceps brachii muscle muscle 21. lateral head of triceps brachii muscle 54. annular part of fibrous tendon 22. tendon of triceps brachii muscle sheaths 23. ulnar nerve 55. proper palmar digital nerves of ulnar 24. anconeus muscle nerve 25. medial epicondyle of humerus 56. cruciform part of fibrous tendon 26. olecranon process of ulna sheaths 27. flexor carpi ulnaris muscle 57. superficial palmar arch 28. extensor digitorum muscle of hand 58. abductor digiti minimi muscle of hand 29. extensor carpi ulnaris muscle 59. opponens digiti minimi muscle of 30. tendon of extensor digitorium muscle hand of hand 60. superficial branch of ulnar nerve 31.
    [Show full text]
  • Anatomy, Shoulder and Upper Limb, Shoulder Muscles
    Eovaldi BJ, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder Muscles. [Updated 2018 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534836/ Anatomy, Shoulder and Upper Limb, Shoulder Muscles Authors Benjamin J. Eovaldi1; Matthew Varacallo2. Affilations 1 University of Tennessee HSC 2 Department of Orthopaedic Surgery, University of Kentucky School of Medicine Last Update: December 3, 2018. Introduction The shoulder joint (glenohumeral joint) is a ball and socket joint with the most extensive range of motion in the human body. The muscles of the shoulder dynamically function in performing a wide range of motion, specifically the rotator cuff muscles which function to move the shoulder and arm as well as provide structural integrity to the shoulder joint. The different movements of the shoulder are: abduction, adduction, flexion, extension, internal rotation, and external rotation.[1] The central bony structure of the shoulder is the scapula. All the muscles of the shoulder joint interact with the scapula. At the lateral aspect of the scapula is the articular surface of the glenohumeral joint, the glenoid cavity. The glenoid cavity is peripherally surrounded and reinforced by the glenoid labrum, shoulder joint capsule, supporting ligaments, and the myotendinous attachments of the rotator cuff muscles. The muscles of the shoulder play a critical role in providing stability to the shoulder joint. The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The four rotator cuff muscles include:[2] • Supraspinatus • Infraspinatus • Teres minor • Subscapularis. Structure and Function The upper extremity is attached to the appendicular skeleton by way of the sternoclavicular joint.
    [Show full text]
  • Arthroscopic Biceps Tenodesis to Supraspinatus Tendon: Technical Note
    Arthroscopic Biceps Tenodesis to Supraspinatus Tendon: Technical Note Laurent Lafosse, MD, Anup A. Shah, MD, Robert B. Butler, MD, and Rachel L. Fowler, BA echniques T & pen or arthroscopic biceps tenodesis is per- In addition, the subscapularis is always thoroughly formed when the proximal biceps tendon is examined. thought to be a pain generator. The biceps Once the decision is made to perform a biceps teno- Otendon generates pain, it is believed, in desis, an additional portal is made through the rotator partial-thickness tears of the biceps, in biceps instability, interval just anterior to the long head of the biceps and in biceps tendinopathy, often occurring with rotator tendon or the supraspinatus (“d” portal in Figure 1B). cuff pathology and affecting shoulder biomechanics. In cases of anterosuperior cuff tears, this area can be echnologies Management of biceps tendon pathology has been a accessed easily from the subacromial space and is often T subject of much interest among shoulder surgeons. used to prepare the tuberosity for cuff repairs. We obtain Several techniques for tenodesis of the biceps tendon this portal with needle localization and use a blunt trocar have been described, but few incorporate the biceps to create a path for instruments and the scope. If no cuff into the rotator cuff tendon. These studies have involved tear is evident, the portal can still be used, but care must techniques that provide a secure tenodesis and fewer be taken not to damage the intact cuff. The lateral portal incisions with good results.1-7 rthopedic A new technique developed by the senior author (L.L.) “Our indications for biceps O incorporates the long head of the biceps tendon with the supraspinatus in patients with anterosuperior rotator cuff tenodesis include biceps tendonitis tears.
    [Show full text]
  • Arterial Supply to the Rotator Cuff Muscles
    Int. J. Morphol., 32(1):136-140, 2014. Arterial Supply to the Rotator Cuff Muscles Suministro Arterial de los Músculos del Manguito Rotador N. Naidoo*; L. Lazarus*; B. Z. De Gama*; N. O. Ajayi* & K. S. Satyapal* NAIDOO, N.; LAZARUS, L.; DE GAMA, B. Z.; AJAYI, N. O. & SATYAPAL, K. S. Arterial supply to the rotator cuff muscles.Int. J. Morphol., 32(1):136-140, 2014. SUMMARY: The arterial supply to the rotator cuff muscles is generally provided by the subscapular, circumflex scapular, posterior circumflex humeral and suprascapular arteries. This study involved the bilateral dissection of the scapulohumeral region of 31 adult and 19 fetal cadaveric specimens. The subscapularis muscle was supplied by the subscapular, suprascapular and circumflex scapular arteries. The supraspinatus and infraspinatus muscles were supplied by the suprascapular artery. The infraspinatus and teres minor muscles were found to be supplied by the circumflex scapular artery. In addition to the branches of these parent arteries, the rotator cuff muscles were found to be supplied by the dorsal scapular, lateral thoracic, thoracodorsal and posterior circumflex humeral arteries. The variations in the arterial supply to the rotator cuff muscles recorded in this study are unique and were not described in the literature reviewed. Due to the increased frequency of operative procedures in the scapulohumeral region, the knowledge of variations in the arterial supply to the rotator cuff muscles may be of practical importance to surgeons and radiologists. KEY WORDS: Arterial supply; Variations; Rotator cuff muscles; Parent arteries. INTRODUCTION (Abrassart et al.). In addition, the muscular parts of infraspinatus and teres minor muscles were supplied by the circumflex scapular artery while the tendinous parts of these The rotator cuff is a musculotendionous cuff formed muscles received branches from the posterior circumflex by the fusion of the tendons of four muscles – viz.
    [Show full text]
  • Dynamic Contributions to Superior Shoulder Stability A.M
    Journal of Ort hopaed ic Research ELSEVIER Journal of Orthopaedic Research 19 (1001) 206-212 www.elsevier.nl/locate/orthres Dynamic contributions to superior shoulder stability A.M. Halder, K.D. Zhao, S.W. O'Driscoll, B.F. Morrey, K.N. An * hfajo Clinic, Orthopedic Biamechanic~Lahouatory, ,700 First Street S U', Rochrster, hfN 5590.5, LISA Received 1 November 1999; accepted 24 April 2000 Abstract It has been suggested that superior decentralization of the humeral head is a mechanical factor in the etiology of degenerative rotator cuff tears. This superior decentralization may be caused by muscular imbalance. The objective of this study was to investigate the contribution of individual shoulder muscles to superior stability of the glenohumeral joint. In 10 fresh frozen cadaver shoulders the tendons of the rotator cuff, teres major, latissimus, pectoralis major, deltoid and biceps were prepared. The shoulders were tested in a shoulder-loading device in O", 30°, 60" and 90" of glenohumeral abduction. A constant superior force of 20 N was applied to the humerus. Tensile loads were applied sequentially to the tendons in proportion to their cross-sectional areas and translations of the humeral head relative to the glenoid were recorded with a 3Space'" Fastrak system. Depression of the humeral head was most effectively achieved by the latissimus (5.6 f 2.2 mm) and the teres major (5.1 k 2.0 mm). Further studies should elucidate their possible in vivo role in the frontal plane force couple to counter balance the deltoid. The infraspinatus (4.6 i2.0 mm) and sub- scapularis (4.7 i 1.9 mm) showed similar effects while the supraspinatus (2.0& 1.4 mm) was less effective in depression.
    [Show full text]
  • The Most Effective Exercise for Strengthening the Supraspinatus
    0363-5465/102/3030-0374$02.00/0 THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 30, No. 3 © 2002 American Orthopaedic Society for Sports Medicine The Most Effective Exercise for Strengthening the Supraspinatus Muscle Evaluation by Magnetic Resonance Imaging* Yoshitsugu Takeda,†‡ MD, PhD, Shinji Kashiwaguchi,§ MD, PhD, Kenji Endo,§ MD, Tetsuya Matsuura,§ MD, and Takahiro Sasa,§ MD From the †Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, and the §Department of Orthopedic Surgery, The University of Tokushima School of Medicine, Tokushima, Japan ABSTRACT Strengthening of the rotator cuff muscles, especially the supraspinatus muscle, is one of the most integral parts of Background: Electromyography has been used to de- a rehabilitation program for athletes with shoulder prob- termine the best exercise for strengthening the supraspi- lems who are involved in overhead throwing sports. Jobe natus muscle, but conflicting results have been reported. and Moynes19 suggested that abduction in the scapular Magnetic resonance imaging T2 relaxation time appears plane with internal rotation, the so-called empty can ex- to be more accurate in determining muscle activation. ercise, is the optimal position for isolating the supraspi- Purpose: To determine the best exercises for strength- natus muscle for strengthening and manual muscle test- ening the supraspinatus muscle. ing. However, Blackburn et al.5 reported that the prone Study design: Criterion standard. position with the elbow extended and the shoulder ab- Methods: Six male volunteers performed three exer- ducted to 100° and externally rotated produced the great- cises: the empty can, the full can, and horizontal abduc- est amount of EMG activity in the supraspinatus muscle.
    [Show full text]
  • Chapter 5 the Shoulder Joint
    The Shoulder Joint • Shoulder joint is attached to axial skeleton via the clavicle at SC joint • Scapula movement usually occurs with movement of humerus Chapter 5 – Humeral flexion & abduction require scapula The Shoulder Joint elevation, rotation upward, & abduction – Humeral adduction & extension results in scapula depression, rotation downward, & adduction Manual of Structural Kinesiology – Scapula abduction occurs with humeral internal R.T. Floyd, EdD, ATC, CSCS rotation & horizontal adduction – Scapula adduction occurs with humeral external rotation & horizontal abduction © McGraw-Hill Higher Education. All rights reserved. 5-1 © McGraw-Hill Higher Education. All rights reserved. 5-2 The Shoulder Joint Bones • Wide range of motion of the shoulder joint in • Scapula, clavicle, & humerus serve as many different planes requires a significant attachments for shoulder joint muscles amount of laxity – Scapular landmarks • Common to have instability problems • supraspinatus fossa – Rotator cuff impingement • infraspinatus fossa – Subluxations & dislocations • subscapular fossa • spine of the scapula • The price of mobility is reduced stability • glenoid cavity • The more mobile a joint is, the less stable it • coracoid process is & the more stable it is, the less mobile • acromion process • inferior angle © McGraw-Hill Higher Education. All rights reserved. 5-3 © McGraw-Hill Higher Education. All rights reserved. From Seeley RR, Stephens TD, Tate P: Anatomy and physiology , ed 7, 5-4 New York, 2006, McGraw-Hill Bones Bones • Scapula, clavicle, & humerus serve as • Key bony landmarks attachments for shoulder joint muscles – Acromion process – Humeral landmarks – Glenoid fossa • Head – Lateral border • Greater tubercle – Inferior angle • Lesser tubercle – Medial border • Intertubercular groove • Deltoid tuberosity – Superior angle – Spine of the scapula © McGraw-Hill Higher Education.
    [Show full text]
  • University of California, Irvine
    UNIVERSITY OF CALIFORNIA, IRVINE Propensity for Acute Supraspinatus Injury in Low-Speed Rear-End Automobile Collisions: A Biomechanical Perspective THESIS submitted in partial satisfaction of the requirements for the degree of MASTER OF SCIENCE in Biomedical Engineering by Ross Craig Hunter Thesis Committee: Professor Thay Q. Lee, Chair Professor David J. Reinkensmeyer Professor Ranjan Gupta 2017 © 2017 Ross Craig Hunter DEDICATION I dedicate this thesis to my beloved wife, Miyu, without her help and great patience this research could not have been completed. ii TABLE OF CONTENTS LIST OF FIGURES iv LIST OF TABLES v ACKNOWLEDGMENTS vi ABSTRACT OF THE THESIS vii INTRODUCTION 1 CHAPTER 1: Methods 8 1.A.1 Scapula and Humerus Orientation of Volunteers in the Driving Position 8 1.A.2 Glenohumeral Joint Alignment in the Driving Position 12 1.B.1 Change in Supraspinatus Muscle and Tendon Length 17 1.B.2 Passive Tightness of the Supraspinatus Muscle 19 1.B.3 Supraspinatus Tendon Impingement 20 1.B.4 Supraspinatus Tendon Loading to Failure 21 CHAPTER 2: Results 24 2.A.1 Scapula and Humerus Orientation of Volunteers in the Driving Position 24 2.A.2 Glenohumeral Joint Alignment in the Driving Position 25 2.B.1 Change in Supraspinatus Muscle and Tendon Length 28 2.B.2 Passive Tightness of the Supraspinatus Muscle 28 2.B.3 Supraspinatus Tendon Impingement 29 2.B.4 Supraspinatus Tendon Loading to Failure 31 CHAPTER 3: Discussion 32 3.A.1 Scapula and Humerus Orientation of Volunteers in the Driving Position 32 3.A.2 Glenohumeral Joint Alignment in the Driving Position 33 3.B.1 Change in Supraspinatus Muscle and Tendon Length 34 3.B.2 Passive Tightness of the Supraspinatus Muscle 35 3.B.3 Supraspinatus Tendon Impingement 37 3.B.4 Supraspinatus Tendon Loading to Failure 37 CONCLUSION 35 REFERENCES 42 APPENDIX A: Driver Motion During a Low-Speed Rear-End Collision 51 APPENDIX B: Alternative Sequences for Scapula Euler Rotations 53 iii LIST OF FIGURES Figure 1 Illustration of the upper extremity bones and rotator cuff muscles.
    [Show full text]
  • Human Anatomy & Physiology I Lab 9 the Skeletal Muscles of the Limbs
    Human Anatomy & Physiology I Lab 9 The skeletal muscles of the limbs Learning Outcomes • Visually locate and identify the muscles of the rotator cuff. Assessment: Exercises 9.1 • Visually locate and identify the muscles of the upper arm and forearm. Assessments: Exercise 9.2, 9.3 • Visually located and identify selected muscles of the upper leg and lower leg. Assessment: Exercise 9.4, 9.5 Muscles of the rotator cuff Information The rotator cuff is the name given to the group of four muscles that are largely responsible for the ability to rotate the arm. Three of the four rotator cuff muscles are deep to the deltoid and trapezius muscles and cannot be seen unless those muscles are first removed and one is on the anterior side of the scapula bone and cannot be seen from the surface. On the anterior side of scapula bone is a single muscle, the subscapularis. It is triangular in shape and covers the entire bone. Its origin is along the fossa that makes up most of the “wing” of the scapula and it inserts on the lesser tubercle of the humerus bone. The subscapularis muscle is shown in Figure 9-1. Figure 9-1. The subscapularis muscle of the rotator cuff, in red, anterior view. On the posterior side of the scapula bone are the other three muscles of the rotator cuff. All three insert on the greater tubercle of the humerus, allowing them, in combination with the subscapularis, to control rotation of the arm. The supraspinatus muscle is above the spine of the scapula.
    [Show full text]
  • Relationship Between Supraspinatus Strength and Throwing Velocity and Accuracy of Minor League Professional Baseball Players
    University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 1990 Relationship between supraspinatus strength and throwing velocity and accuracy of minor league professional baseball players David Wallwork The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Wallwork, David, "Relationship between supraspinatus strength and throwing velocity and accuracy of minor league professional baseball players" (1990). Graduate Student Theses, Dissertations, & Professional Papers. 7247. https://scholarworks.umt.edu/etd/7247 This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. 1 Mike and Maureen MANSFIELD LIBRARY Copying allowed as provided under provisions of the Fair Use Section of the U.S. COPYRIGHT LAW, 1976. Any copying for commercial purposes or financial gain may be undertaken only with the author’s written consent. MontanaUniversity of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. relationship b e t w e e n supraspinatus s t r e n g t h AND THROWING VELOCITY AND ACCURACY OF MINOR LEAGUE PROFESSIONAL BASEBALL PLAYERS By David Wallwork B.S., Concordia University, Montreal, Quebec, Canada Presented in partial fulfillment of the requirements for the degree of M.S., Health and Physical Education UNIVERSITY OF MONTANA 1990 Approved by; Board of Examiners D#^Sn, Graduate Schoo Date Reproduced with permission of the copyright owner.
    [Show full text]
  • Upper Extremity Counterstrain Counterstrain Counterstrain
    1 Upper Extremity Counterstrain Dan Williams, D.O. Board Certified Neuromusculoskeletal Medicine And Osteopathic Manipulation 2 Counterstrain • Osteopathic manipulation technique developed by Larry Jones, D.O. • Discovered by accident • Based upon finding tender points and then passive patient positioning to treat the tender point 3 Counterstrain Advantages • Easy to teach – Little need for biomechanics – Find tender point - Fold and hold • Easy to implement at the bedside • Great gateway technique for further study in osteopathic manipulation • Safe for most patients • Requires minimal patient cooperation 4 Counterstrain Advantages • Great for acute pain • Great for headaches • Great for sports injuries • Great for patients with soft tissue pain 5 Counterstrain Points • Have tissue texture change • Are tender to palpation • Frequently located in relationship to soft tissue structures • Can be used as a standalone technique • Frequently combined with other manipulative modalities 6 Principles of Counterstrain • Identify the tender point – May be based on pain pattern, regional scan, observation, etc. • Establish a pain scale (1-10) and stay on the tender point • Bring patient to text book treatment position • Patient is completely passive! 7 Principles of Counterstrain • Recheck tenderness of tender point – Want at least a 70% reduction • Continue to monitor the tender point • Hold with patient completely relaxed for 90 seconds 1 • Occasionally recheck that point is no longer tender 8 Principles of Counterstrain • While continuously monitoring
    [Show full text]
  • Immediate Changes and Recovery of the Supraspinatus, Long Head
    Original Article Clinics in Orthopedic Surgery 2021;13:385-394 • https://doi.org/10.4055/cios20187 Immediate Changes and Recovery of the Supraspinatus, Long Head Biceps Tendon, and Range of Motion after Pitching in Youth Baseball Players: How Much Rest Is Needed after Pitching? Sonoelastography on the Supraspinatus Muscle- Tendon and Biceps Long Head Tendon Joo Han Oh, MD, Joon Yub Kim, MD*,#, Kyoung Pyo Nam, MD*, Heum Duck Kang, MA†,#, Ji Hyun Yeo, MD‡ Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, *Department of Orthopedic Surgery, Yeson Hospital, Bucheon, †Baseball Academy, Seongnam, ‡Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea Background: Baseball players are subjected to repeated loads on the supraspinatus and long head biceps tendon from youth, and repetitive pitching motions can cause shoulder injuries. The purpose of this study was to evaluate the immediate changes caused by pitching in the supraspinatus muscle-tendon, long head of the bicep tendon (LHBT), and shoulder range of motion (ROM) and to verify their recovery over time in youth baseball players. Methods: Fifteen youth baseball players (mean age, 11.5 ± 1.3 years) were enrolled. The thicknesses of the supraspinatus tendon and LHBT and the strain ratios (SRs) of supraspinatus muscle and tendon were measured by sonoelastography. ROMs of shoulder joints (abduction, external rotation at 90° of abduction [ABER], and internal rotations at 90° of abduction [ABIR]) and horizontal adduction (HA) were measured using a goniometer. All measurements were performed on the throwing shoulders before and im- mediately after pitching (mean pitch count, 78.3 ± 13.3) and at 30 minutes, 24 hours, and 72 hours after pitching.
    [Show full text]