Keywords
rotator cuff
shoulder girdle
How to Cite
Abstract
Relevance. The presence of calcium deposits in the rotator cuff tendons usually leads to a restriction of the biomechanics of the shoulder joint and, in particular, to a failure of the scapulohumeral rhythm. The question of the compensatory participation of the muscles of the shoulder girdle in ensuring the stability of the shoulder joint in conditions of partial-thickness damage to the tendon of the supraspinatus muscle caused by calcific tendinitis remains interesting and understudied.
Objective: to carry out skeletal and muscular modeling with the study of the compensatory participation of the rotator cuff muscles in ensuring the stability of the shoulder joint during the elementary movement of elevation of the upper limb in conditions of partial-thickness damage to the supraspinatus tendon caused by the presence of calcification in it.
Materials and Methods. For the analysis we used simulation modeling in the software package AnyBody Modeling System™ (AnyBody Technology A / S, Denmark) for Windows. The calculation was carried out using the software component Mannequin, selected from the AnyBody Managed Model Repository™ model collection. The parameters of joint forces acting in the direction of three axes – X, Y, Z – were calculated, where the X axis corresponded to the anterior-posterior force direction (antero-posterior force), the Y axis – to the inferior-superior force direction, the Z axis – compression-distraction force direction (medio-lateral force) on the shoulder joint. The object of the study was muscle activity (Activity) and muscle strength (Fm) of m. deltiodus clavicular, m. deltiodus scapularis, m. infrapsinatus, m. subscapularis, m. teres major, and m. teres minor while simulating a decrease in the strength of m. supraspinatus by 50% caused by the presence of calcification in the thickness of its tendon.
Results. With complex movement of the upper limb, associated with the elevation of the upper limb, in conditions of partial-thickness tear to the m. supraspinatus, with a decrease in its strength by 50%, there is a compensatory increase in the strength of the muscles of the shoulder joint – the posterior portion of the m. deltoidus scapularis, m. infraspinatus and m. subscapularis, to ensure the stability of the shoulder joint. Taking into account minor changes in joint reactions along three axes, with a decrease in the strength of m. supraspinatus caused by the presence of calcification in its thickness, the compensatory mechanism of including additional muscle activity and muscle efforts of other muscles of the shoulder girdle provides the necessary stability of the shoulder joint in these conditions.
Conclusions. The study confirms the possibility of successful application of programs of conservative treatment of calcifications of the m. supraspinatus tendon, aimed at developing the compensatory capabilities of the muscles of the shoulder girdle.
References
Plenk HP. Calcifying tendinitis of the shoulder. Radiology. 1952; 59:384–389.
Mohr W, Bilger S. Basic morphologic structures of calcified tendinopathy and their significance for pathogenesis. Z Rheumatol. 1990;49:346–355.
Jim YF, Hsu HC, Chang CY, Wu JJ, Chang T. Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study. Skeletal Radiol. 1993;22:183–185. DOI: 10.1007/BF00206150
Wolfgang GL. Surgical repair of tears of the rotator cuff of the shoulder: factors influencing the result. J Bone Joint Surg Am. 1974;56:14–26.
Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. J Am Med Assoc. 1941;116:2477–2482.
Uhthoff, & Loehr. Calcific Tendinopathy of the Rotator Cuff: Pathogenesis, Diagnosis, and Management. The Journal of the American Academy of Orthopaedic Surgeons, 1997; 5(4), 183–191. DOI: 10.5435/00124635-199707000-00001
Draghi F, Scudeller L, Guja A, Chandra D. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound. 2015:151-158. DOI: 10.1007/s40477-015-0167-0
Elshewy MT. Calcific tendinitis of the rotator cuff. World J Orthop. 2016;7(1):55. DOI: 10.5312/wjo.v7.i1.55
Clavert P, Sirveaux F. Société française d’arthroscopie: Les tendinopathies calcifiantes de l’épaule [Shoulder calcifying tendinitis]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(8):S336–S355. DOI: 10.1016/j.rco.2008.09.010
Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulopoulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis. 1989;48(3):211–214. DOI: 10.1136/ ard.48.3.211
McKendry PJ, Uhthoff HK, Sarkar K, Hyslop PS. Calcifying tendonitis of the shoulder: prognostic value of clinical, histologic, and radiologic features in 57 surgically treated cases. J Rheumatol. 1982;9(1):75–90.
DePalma AF, Kruper JS. Long-term study of shoulder joints affected with and treated for calcific tendinitis. Clin Orthop. 1961;20:61–72
Bureau NJ. Calcific Tendinopathy of the Shoulder. 2013;1(212):80-84. DOI: 10.1055/s-0033-1333941
Becciolini M, Bonacchi G, Galletti S. Intramuscular migration of calcific tendinopathy in the rotator cuff: ultrasound appearance and a review of the literature. J Ultrasound. 2016;19(3):175-181. DOI: 10.1007/s40477-016-0202-9
Strafun O.S. Treatment of calcific tendinitis of rotator cuff muscles. Journal “Trauma” Vol 18, №1, 2017. DOI: 10.22141/1608-1706.1.18.2017.95586
Hurt G, Baker CL Jr. Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34(4):567–575. DOI: 10.1016/ s0030-5898(03)00089-0
Porcellini G, Paladini P, Campi F, Paganelli M. Arthroscopic treatment of calcifying tendinitis of the shoulder: clinical and ultrasonographic follow-up findings at two to five years. J Shoulder Elbow Surg. 2004;13(5): 503–508. DOI: 10.1016/ S1058274604000904
Rizzello G, Franceschi F, Longo UG, et al. Arthroscopic management of calcific tendinopathy of the shoulder: do we need to remove all the deposit? Bull NYU Hosp Jt Dis. 2009;67:330–333.
This work is licensed under a Creative Commons Attribution 4.0 International License.