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Capturing Three-Dimensional Clavicle Kinematics

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Capturing Three-Dimensional Clavicle Kinematics Capturing Three-Dimensional Clavicle Kinematics During Arm Elevation: Describing the Contribution of Clavicle Motion and Associated Scapulothoracic Muscle Activation to Total Shoulder Complex Motion DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Kimberly A. Szucs, M.S., OTR/L Graduate Program in Allied Medical Professions The Ohio State University 2010 Dissertation Committee: John D. Borstad, advisor John Bolte John Buford Jane Case-Smith Mark Merrick Copyright by Kimberly A. Szucs 2010 Abstract Shoulder pathologies are common musculoskeletal disorders, affecting up to 31% of the general population. Conservative management aims to restore normal motion patterns and strength of the scapulothoracic musculature to the shoulder complex; however many people continue to experience symptoms. To improve treatment outcomes, interventions need to be developed based on the biomechanics of the total shoulder complex. To accomplish this, the normal kinematics of all the components of the shoulder complex, including the clavicle, need to be described. Therefore, the goals of this dissertation included: explore the relationship of clavicle rotations at the sternoclavicular joint to scapula motion, establish the validity of a non-invasive measurement tool for capturing dynamic clavicle motion, and describe the contribution of clavicle rotations to shoulder complex motion using this validated surface sensor in vivo. To describe how the clavicle contributes to total shoulder motion, it was necessary to first explore how the stabilizing structures of the sternoclavicular joint affect clavicle motion. Manipulating the stabilizing ligaments of the sternoclavicular joint resulted in altered clavicle and scapula rotations. The changes in scapula motion were consistent with kinematic alterations reported in subjects with subacromial impingement syndrome. These results demonstrate that altered sternoclavicular stability affects clavicle motion and influences both acromioclavicular joint and scapula rotations and suggests altered clavicle motion may be a mechanism for developing shoulder pathology. ii In order to include clavicle motion in future shoulder studies, a non-invasive measure of dynamic clavicle motion was validated against bone pin measurements. Based on this analysis, it was determined that the surface sensor accurately tracks retraction and elevation, but underestimates posterior rotation. A mathematical equation was developed to improve the fit of surface sensor values for posterior rotation. To assess the plausibility of the surface sensor for capturing clavicle motion, active clavicle rotations were captured in vivo in healthy subjects. Active clavicle retraction captured with the surface sensor was below previously reported values. However, this rotation did have the highest ICC values in the validation study so it is possible that the sensor was able to track this motion and these healthy subjects truly had a lower amount of retraction. Also, clavicle elevation and posterior rotation captured with the surface sensor in vivo are consistent with previous in vivo studies and support the validity of the surface sensor for collection of active 3D clavicle rotations. Finally, the contribution of clavicle rotations and associated muscle activation to total shoulder motion were explored using this validated surface sensor in healthy subjects. This investigation identified normal variations in the clavicle and scapula kinematics and muscle activation patterns between phases of elevation and the dominant and non-dominant extremity. Collectively, the studies in this dissertation demonstrate a mechanical link between clavicle and scapula rotations and provide a validated non-invasive measurement tool for capturing active clavicle rotations in future studies. These findings are notable as clavicle motion patterns are generally not studied when exploring mechanisms for shoulder pathology. iii Acknowledgments Acknowledgments and recognition are due to a number of people, for without their guidance, assistance, and support, these projects would not have been successful. I would like to express my gratitude to my advisor, John Borstad, PhD, PT, for his excellent guidance and commitment during this process. His support, encouragement, and expertise have contributed to make these projects successful. Also, I am very appreciative of his patience, his challenging and thought-provoking questions, and the many opportunities for doing research in his lab, all of which have prepared me to be an independent researcher. To my committee members, John Bolte IV, PhD John Buford, PhD, PT Jane Case-Smith, EdD, OTR/L Mark Merrick, PhD, ATC They contributed valuable suggestions for developing my projects and sage advice that guided me through this entire process. Their commitment to these projects was evident, and they have been instrumental to the success of my work and my growth as a researcher and person. iv To my lab mates – Anand Navalgund, Amit Dashottar, and Matt Briggs. Some of our conversations were in-depth and thought-provoking, but most were just silly. Those were the moments that helped me through long days of data reduction and analysis. Anand, special thanks to you for all of the tutoring over the years – you were invaluable when it came to learning MatLab! Amit, you are now the senior student, enjoy! And thank you for the anatomical drawings, they add so much to the final project. To my dear friends, who have helped me maintain my sanity along the way. Wendy Herbert, I‘m so glad we have gone through this program together – it‘s been wonderful sharing these experiences with you! And to the friends who helped remind me there is life outside of the lab – Heather Watson, Andrea Cozza-Lawless, Stephanie Heuker, and Kendra Dehm. Thanks for the dinners, nights out, shopping trips, and all of the other excuses to clear my mind and relax! To my family, especially my parents, for continuing to support me through these many years of ―college‖. Your pride and support were unwavering and a constant source of encouragement for me. Also, thank you for all of the ―little‖ things that helped my life run smoothly while I focused on completing this project – keeping the refrigerator stocked, mowing the lawn - all of the things you didn‘t have to do, but did anyway. v And finally, to Nick. It has been a long journey and I could not have made it without your support, sense of humor, and encouragement. Thank you for everything you have done over the past several years to make my life easier and to make me smile. You have brought a sense of calm to my life, and I am profoundly grateful. vi Vita June 2003 .......................................................B.S. Occupational Therapy, The Ohio State University June 2005 .......................................................M.S. Anatomy, The Ohio State University August 2005 to present .................................Graduate Associate, School of Allied Medical Professions, The Ohio State University Publications Borstad JD, Szucs K, Navalgund A. Scapula kinematic alterations following a modified push-up plus task. Human Movement Science, 2009; 28:738-751. Szucs K, Navalgund A, Borstad JD. Scapular muscle activation following a task to fatigue serratus anterior. Medical & Biological Engineering & Computing, 2009; 47(5):487-95. Flinn S, Kloos A, Teaford M, Clark K, Szucs K. Helping hands for healthy living: A collaborative service learning project with occupational and physical therapy students. Occupational Therapy in Health Care, 2009; 23(2):146-167. vii Fields of Study Major Field: Allied Medical Professions viii Table of Contents Abstract ............................................................................................................................... ii Acknowledgments.............................................................................................................. iv Vita .................................................................................................................................... vii List of Tables ................................................................................................................... xiv List of Figures ................................................................................................................ xviii Chapter 1: General Introduction ........................................................................................ 1 1. Sternoclaviculoscapular Link................................................................................... 2 2. Current Methods for Capturing Three-Dimensional Shoulder Kinematics ............. 5 2.1. Validation of Surface Sensor Measurements .................................................... 6 3. Muscular Control of the Total Shoulder Complex .................................................. 8 4. Studies of Shoulder Pathology ............................................................................... 12 5. Hypothesis.............................................................................................................. 16 Chapter 2: Manipulating the Stability of the Sternoclavicular Joint and the Resulting Changes of Clavicle and Scapula Rotations ..................................................................... 17 1. Introduction ............................................................................................................ 17 2. Methods.................................................................................................................
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