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Kinematic Alterations in Reverse Total Shoulders In Vivo and Method to Simulate Them In Vitro.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Kinematic Alterations in Reverse Total Shoulders In Vivo and Method to Simulate Them In Vitro./
Author:	Sulkar, Hema Jay.
Description:	1 online resource (106 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 85-09, Section: B.
Contained By:	Dissertations Abstracts International85-09B.
Subject:	Biomechanics. -
Online resource:	click for full text (PQDT)
ISBN:	9798381960761

Kinematic Alterations in Reverse Total Shoulders In Vivo and Method to Simulate Them In Vitro.
Sulkar, Hema Jay.

Kinematic Alterations in Reverse Total Shoulders In Vivo and Method to Simulate Them In Vitro. - 1 online resource (106 pages)

Source: Dissertations Abstracts International, Volume: 85-09, Section: B.

Thesis (Ph.D.)--The University of Utah, 2023.

Includes bibliographical references

The reverse total shoulder arthroplasty (rTSA) is a joint replacement procedure for shoulder pathology upon unsatisfactory conservative treatments. It reverses the joint anatomy, replacing the humeral head with a cup and scapula glenoid with a hemispherical implant component. While pain relief and improvement in function are common after rTSA, the range of motion (ROM) outcomes can vary considerably across patients. The overall aims of this dissertation were to investigate alterations in joint kinematics that cause ROM limitations after rTSA, and develop biomechanics tools.Shoulder joints were analyzed in two markedly limited, yet kinematically under-studied, activities used in daily shoulder function. Notable observations were: 1) patients unable to reach behind the back not only produced less axial internal rotation, but also had a more externally rotated proximal humerus anatomy and less scapular mobility compared to others and healthy controls, 2) peak humerothoracic elevation with a handheld weight varied considerably, with 40% of participants reaching below 90°, compared to without handheld weight where all elevated >90°, 3) scapulothoracic contributions increased considerably with concurrent decrease in glenohumeral contributions to humerothoracic elevation with handheld weight. Together, these findings indicate that altered scapulothoracic and glenohumeral kinematic orientations and anatomical biases, such as proximal humerus external rotation, present in patients may need to be considered for addressing ROM limitations. Consequently, physical therapy protocols emphasizing scapular stability/mobility and surgical/implant factors considering anatomical variance may benefit rTSA patients.Iterative testing of surgical and implant factors can aid biomechanics study. Current laboratory simulation models using generic healthy kinematics to study patient population limit clinical translation of study results. The developed simulation tool produced kinematic accuracy with <5°error and physiologically relevant muscle forces for subject-specific 3D humerus and scapula simulation. Pilot test cases of changing input kinematics (generic, and healthy and rTSA subject-specific) varied in outcomes. Thus, potentially affecting study conclusions and clinical recommendations.Overall, this dissertation used motion capture and quantified scapulothoracic and glenohumeral origins of limited ROM post-rTSA, and produced tools for study of kinematics in rTSA. Dissemination of the proximal humerus coordinate system prediction capability, a valuable tool for shoulder biomechanics researchers, aimed to aid research reproducibility.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798381960761Subjects--Topical Terms:

565307
Biomechanics.
Subjects--Index Terms:

Clinical decision makingIndex Terms--Genre/Form:

554714
Electronic books.

Kinematic Alterations in Reverse Total Shoulders In Vivo and Method to Simulate Them In Vitro.
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520 $a The reverse total shoulder arthroplasty (rTSA) is a joint replacement procedure for shoulder pathology upon unsatisfactory conservative treatments. It reverses the joint anatomy, replacing the humeral head with a cup and scapula glenoid with a hemispherical implant component. While pain relief and improvement in function are common after rTSA, the range of motion (ROM) outcomes can vary considerably across patients. The overall aims of this dissertation were to investigate alterations in joint kinematics that cause ROM limitations after rTSA, and develop biomechanics tools.Shoulder joints were analyzed in two markedly limited, yet kinematically under-studied, activities used in daily shoulder function. Notable observations were: 1) patients unable to reach behind the back not only produced less axial internal rotation, but also had a more externally rotated proximal humerus anatomy and less scapular mobility compared to others and healthy controls, 2) peak humerothoracic elevation with a handheld weight varied considerably, with 40% of participants reaching below 90°, compared to without handheld weight where all elevated >90°, 3) scapulothoracic contributions increased considerably with concurrent decrease in glenohumeral contributions to humerothoracic elevation with handheld weight. Together, these findings indicate that altered scapulothoracic and glenohumeral kinematic orientations and anatomical biases, such as proximal humerus external rotation, present in patients may need to be considered for addressing ROM limitations. Consequently, physical therapy protocols emphasizing scapular stability/mobility and surgical/implant factors considering anatomical variance may benefit rTSA patients.Iterative testing of surgical and implant factors can aid biomechanics study. Current laboratory simulation models using generic healthy kinematics to study patient population limit clinical translation of study results. The developed simulation tool produced kinematic accuracy with <5°error and physiologically relevant muscle forces for subject-specific 3D humerus and scapula simulation. Pilot test cases of changing input kinematics (generic, and healthy and rTSA subject-specific) varied in outcomes. Thus, potentially affecting study conclusions and clinical recommendations.Overall, this dissertation used motion capture and quantified scapulothoracic and glenohumeral origins of limited ROM post-rTSA, and produced tools for study of kinematics in rTSA. Dissemination of the proximal humerus coordinate system prediction capability, a valuable tool for shoulder biomechanics researchers, aimed to aid research reproducibility.
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