Effect of critical shoulder angle on deltoid muscle strength reduction in patients with rotator cuff tears_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhiling , CUI Dedong , LONG Yi , MENG Ke , ZHENG Zhenze , LI Cheng ,  YANG Rui ,  HOU Jingyi

Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

YANG Rui, Email: yangr@mail.sysu.edu.cn; HOU Jingyi, Email: houjy7@mail.sysu.edu.cn

Keywords：

Rotator cuff tear; handheld dynamometer; critical shoulder angle; deltoid muscle; shoulder

DOI：

10.7507/1002-1892.202303064

Video：

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Objective To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength. Methods A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores. Results Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side (P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients (P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides (P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score (P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid (P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA (P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B (P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B (P>0.05). Conclusion Patients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.

Citation： WANG Zhiling, CUI Dedong, LONG Yi, MENG Ke, ZHENG Zhenze, LI Cheng, YANG Rui, HOU Jingyi. Effect of critical shoulder angle on deltoid muscle strength reduction in patients with rotator cuff tears. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 827-832. doi: 10.7507/1002-1892.202303064 Copy

1.	Doiron-Cadrin P, Lafrance S, Saulnier M, et al. Shoulder rotator cuff disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations. Arch Phys Med Rehabil, 2020, 101(7): 1233-1242.
2.	Liu T, Zhang M, Yang Z, et al. Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis. Arch Orthop Trauma Surg, 2023, 143(5): 2653-2663.
3.	Chamorro C, Arancibia M, Trigo B, et al. Absolute reliability and concurrent validity of hand-held dynamometry in shoulder rotator strength assessment: systematic review and meta-analysis. Int J Environ Res Public Health, 2021, 18(17): 9293. doi: 10.3390/ijerph18179293.
4.	Moor BK, Bouaicha S, Rothenfluh DA, et al. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J, 2013, 95-B(7): 935-941.
5.	Croisier JL, Ganteaume S, Binet J, et al. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med, 2008, 36(8): 1469-1475.
6.	Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther, 1996, 76(3): 248-259.
7.	Boileau P, Watkinson DJ, Hatzidakis AM, et al. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg, 2005, 14(1 Suppl S): 147S-161S.
8.	Villatte G, van der Kruk E, Bhuta AI, et al. A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading. J Shoulder Elbow Surg, 2020, 29(10): 1967-1973.
9.	Rai MF, Cai L, Tycksen ED, et al. RNA-Seq reveals distinct transcriptomic differences in rotator cuff tendon based on tear etiology and patient sex. J Orthop Res, 2022, 40(12): 2728-2742.
10.	Longo UG, Berton A, Papapietro N, et al. Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci, 2012, 57: 1-9.
11.	Wagner KC, Byrd GD. Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature. J Med Libr Assoc 92(1) January 2004. J Med Libr Assoc, 2012, 100(4 Suppl): J.
12.	Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg, 2010, 19(1): 116-120.
13.	Powell JK, Lewis JS. Rotator cuff-related shoulder pain: Is it time to reframe the advice, “you need to strengthen your shoulder”? J Orthop Sports Phys Ther, 2021, 51(4): 156-158.
14.	Hecker A, Aguirre J, Eichenberger U, et al. Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach. J Shoulder Elbow Surg, 2021, 30(2): e60-e68.
15.	Schmalzl J, Fenwick A, Boehm D, et al. The application of ultrasound elastography in the shoulder. J Shoulder Elbow Surg, 2017, 26(12): 2236-2246.
16.	Cools AM, Vanderstukken F, Vereecken F, et al. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3838-3847.
17.	Suter T, Gerber Popp A, Zhang Y, et al. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg, 2015, 24(6): e149-e158.
18.	Olmos MI, Boutsiadis A, Swan J, et al. Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40 degrees. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 240-249.

1. Doiron-Cadrin P, Lafrance S, Saulnier M, et al. Shoulder rotator cuff disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations. Arch Phys Med Rehabil, 2020, 101(7): 1233-1242.
2. Liu T, Zhang M, Yang Z, et al. Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis. Arch Orthop Trauma Surg, 2023, 143(5): 2653-2663.
3. Chamorro C, Arancibia M, Trigo B, et al. Absolute reliability and concurrent validity of hand-held dynamometry in shoulder rotator strength assessment: systematic review and meta-analysis. Int J Environ Res Public Health, 2021, 18(17): 9293. doi: 10.3390/ijerph18179293.
4. Moor BK, Bouaicha S, Rothenfluh DA, et al. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J, 2013, 95-B(7): 935-941.
5. Croisier JL, Ganteaume S, Binet J, et al. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med, 2008, 36(8): 1469-1475.
6. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther, 1996, 76(3): 248-259.
7. Boileau P, Watkinson DJ, Hatzidakis AM, et al. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg, 2005, 14(1 Suppl S): 147S-161S.
8. Villatte G, van der Kruk E, Bhuta AI, et al. A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading. J Shoulder Elbow Surg, 2020, 29(10): 1967-1973.
9. Rai MF, Cai L, Tycksen ED, et al. RNA-Seq reveals distinct transcriptomic differences in rotator cuff tendon based on tear etiology and patient sex. J Orthop Res, 2022, 40(12): 2728-2742.
10. Longo UG, Berton A, Papapietro N, et al. Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci, 2012, 57: 1-9.
11. Wagner KC, Byrd GD. Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature. J Med Libr Assoc 92(1) January 2004. J Med Libr Assoc, 2012, 100(4 Suppl): J.
12. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg, 2010, 19(1): 116-120.
13. Powell JK, Lewis JS. Rotator cuff-related shoulder pain: Is it time to reframe the advice, “you need to strengthen your shoulder”? J Orthop Sports Phys Ther, 2021, 51(4): 156-158.
14. Hecker A, Aguirre J, Eichenberger U, et al. Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach. J Shoulder Elbow Surg, 2021, 30(2): e60-e68.
15. Schmalzl J, Fenwick A, Boehm D, et al. The application of ultrasound elastography in the shoulder. J Shoulder Elbow Surg, 2017, 26(12): 2236-2246.
16. Cools AM, Vanderstukken F, Vereecken F, et al. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3838-3847.
17. Suter T, Gerber Popp A, Zhang Y, et al. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg, 2015, 24(6): e149-e158.
18. Olmos MI, Boutsiadis A, Swan J, et al. Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40 degrees. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 240-249.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of critical shoulder angle on deltoid muscle strength reduction in patients with rotator cuff tears

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