TY - JOUR
T1 - Does the Walch type B shoulder have a transverse force couple imbalance? A volumetric analysis of segmented rotator cuff muscles in osteoarthritic shoulders
AU - Arenas-Miquelez, Antonio
AU - Liu, Victor K.
AU - Cavanagh, Joseph
AU - Graham, Petra L.
AU - Ferreira, Louis M.
AU - Bokor, Desmond J.
AU - Athwal, George S.
AU - Raniga, Sumit
N1 - Publisher Copyright:
© 2021 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2021/10
Y1 - 2021/10
N2 - Background: The etiology of the Walch type B shoulder remains unclear. We hypothesized that a scapulohumeral muscle imbalance, due to a disturbed transverse force couple (TFC) between the anterior and posterior rotator cuff muscles, may have a role in the pathogenesis of the type B morphology. The purpose of this study was to determine whether there is a TFC imbalance in the Walch type B shoulder using an imaging-based 3-dimensional (3D) volumetric and fatty infiltration assessment of segmented rotator cuff muscles. Methods: Computed tomography images of 33 Walch type A and 60 Walch type B shoulders with the complete scapula and humerus including the distal humeral epicondyles were evaluated. The 3D volumes of the entire subscapularis, supraspinatus, and infraspinatus–teres minor (Infra-Tm) were manually segmented and analyzed. Additionally, anthropometric parameters including glenoid version, glenoid inclination, posterior humeral head subluxation, and humeral torsion were measured. The 3D muscle analysis was then compared with the anthropometric parameters using the Wilcoxon rank sum and Kruskal-Wallis tests. Results: There were no significant differences (P >.200) in muscle volume ratios between the Infra-Tm and the subscapularis in Walch type A (0.93) and type B (0.96) shoulders. The fatty infiltration percentage ratio, however, was significantly greater in type B shoulders (0.94 vs. 0.75, P <.001). The Infra-Tm to subscapularis fatty infiltration percentage ratio was significantly larger in patients with >75% humeral head subluxation than in those with 60%-75% head subluxation (0.97 vs. 0.74, P <.001) and significantly larger in patients with >25° of retroversion than in those with <15° of retroversion (1.10 vs. 0.75, P =.004). The supraspinatus fatty infiltration percentage was significantly lower in Walch type B shoulders than type A shoulders (P =.004). Walch type A shoulders had mean humeral retrotorsion of 22° ± 10° whereas Walch type B shoulders had humeral retrotorsion of only 14° ± 9° relative to the epicondylar axis (P <.001). Conclusion: The TFC is in balance in the Walch type B shoulder in terms of 3D volumetric rotator cuff muscle analysis; however, the posterior rotator cuff does demonstrate increased fatty infiltration. Posterior humeral head subluxation and glenoid retroversion, which are pathognomonic of the Walch type B shoulder, may lead to a disturbance in the length-tension relationship of the posterior rotator cuff, causing fatty infiltration.
AB - Background: The etiology of the Walch type B shoulder remains unclear. We hypothesized that a scapulohumeral muscle imbalance, due to a disturbed transverse force couple (TFC) between the anterior and posterior rotator cuff muscles, may have a role in the pathogenesis of the type B morphology. The purpose of this study was to determine whether there is a TFC imbalance in the Walch type B shoulder using an imaging-based 3-dimensional (3D) volumetric and fatty infiltration assessment of segmented rotator cuff muscles. Methods: Computed tomography images of 33 Walch type A and 60 Walch type B shoulders with the complete scapula and humerus including the distal humeral epicondyles were evaluated. The 3D volumes of the entire subscapularis, supraspinatus, and infraspinatus–teres minor (Infra-Tm) were manually segmented and analyzed. Additionally, anthropometric parameters including glenoid version, glenoid inclination, posterior humeral head subluxation, and humeral torsion were measured. The 3D muscle analysis was then compared with the anthropometric parameters using the Wilcoxon rank sum and Kruskal-Wallis tests. Results: There were no significant differences (P >.200) in muscle volume ratios between the Infra-Tm and the subscapularis in Walch type A (0.93) and type B (0.96) shoulders. The fatty infiltration percentage ratio, however, was significantly greater in type B shoulders (0.94 vs. 0.75, P <.001). The Infra-Tm to subscapularis fatty infiltration percentage ratio was significantly larger in patients with >75% humeral head subluxation than in those with 60%-75% head subluxation (0.97 vs. 0.74, P <.001) and significantly larger in patients with >25° of retroversion than in those with <15° of retroversion (1.10 vs. 0.75, P =.004). The supraspinatus fatty infiltration percentage was significantly lower in Walch type B shoulders than type A shoulders (P =.004). Walch type A shoulders had mean humeral retrotorsion of 22° ± 10° whereas Walch type B shoulders had humeral retrotorsion of only 14° ± 9° relative to the epicondylar axis (P <.001). Conclusion: The TFC is in balance in the Walch type B shoulder in terms of 3D volumetric rotator cuff muscle analysis; however, the posterior rotator cuff does demonstrate increased fatty infiltration. Posterior humeral head subluxation and glenoid retroversion, which are pathognomonic of the Walch type B shoulder, may lead to a disturbance in the length-tension relationship of the posterior rotator cuff, causing fatty infiltration.
KW - Anatomy Study
KW - CT images
KW - fatty infiltration
KW - humeral torsion
KW - Imaging
KW - muscle volume
KW - rotator cuff
KW - Shoulder osteoarthritis
KW - transverse force couple
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U2 - 10.1016/j.jse.2021.02.005
DO - 10.1016/j.jse.2021.02.005
M3 - Article
C2 - 33675976
AN - SCOPUS:85106919704
SN - 1058-2746
VL - 30
SP - 2344
EP - 2354
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 10
ER -