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  • TRACKING THE GLENOHUMERAL JOINT: SUMMARY OF REPLIES

    Dear Biomch-L subscribers,

    I apologise for my delayed presentation of the summary of replies, as I
    have been overseas for the last month. I thank everyone for taking the time
    to help with this problem, especially Daniel Magnusson from the Department
    of Biomedical Engineering at the Lerner Research Institute.
    It is evident that the kinematic/kinetic modelling of shoulder motion is a
    complex problem that still needs much attention.

    If anyone has more ideas on the subject, then your comments would be most
    welcome. I am particularly interested in methods that determine the centre
    of rotation of the glenohumeral joint. Presently, I am aware of two such
    methods.

    The other problem is how to account for shoulder retraction/protraction and
    shoulder elevation/depression in a rigid-body kinetic model (inverse &
    forward solution) of the trunk-arm-hand complex. Any ideas how this can be
    done?

    Thank you.

    Rene Ferdinands
    University of Waikato
    Dept of Physics & Electronic Engineering
    Private Bag 3105
    Hamilton 2001
    New Zealand

    Phone: (+64 7) 838 4026
    Fax: (+64 7) 838 4219
    email: redf1@waikato.ac.nz
    --------------------------------------


    ORIGINAL MESSAGE
    **********************
    Rene Ferdinands wrote:
    >
    > Hello,
    >
    > I am performing a 3D motion analysis of bowling in cricket. I am having
    > difficulty in deciding how to place markers around the shoulder to estimate
    > the 3D position of the glenohumeral joint.
    >
    > I know there are methods that specify various bony landmarks on the
    > scapula. However, in a dynamic activity such as bowling the scapula moves
    > significantly under the skin. Instead, I need to develop a skin-based
    > method to do this job. Any information on this subject would be greatly
    > appreciated.
    >
    > Regards
    >
    > Rene Ferdinands
    > University of Waikato
    > Dept of Physics & Electronic Engineering
    > Private Bag 3105
    > Hamilton 2001
    > New Zealand
    >
    > Phone: (+64 7) 838 4026
    > Fax: (+64 7) 838 4219
    > email: redf1@waikato.ac.nz
    > --------------------------------------



    Hi Rene,

    I have also looked at measuring the motions of the shoulder (was working on a
    method to describe just what you are trying to figure out, had limited
    success). As you can imagine that is not an easy task. The shoulder defies
    standard motion analysis techniques for exactly the reason that you mention,
    the great movement of the scapula under the surface of the skin. The only way
    that anyone has "accurately" measured the shoulder is by either:

    (a) doing a series of static positions along the path of action (ie. the
    various positions that the thrower/bowler would be going through) see numerous
    articles by Veeger, van der Helm, Pronk, and others in the Dutch shoulder
    group, or
    (b) actually drilling in bone pins into the acromial process of the scapula.
    See articles by Koh and Grabiner (1998?) and recent work done by Karduna et
    al.

    (If you want the exact references for all of the above people please let me
    know, they are too many to list at the moment.)

    As you can imagine both of these methods have their detractors. The ideal way
    would be to look at the position of the scapula as if it were in an MR
    scanner.
    However, here again you are limitied to static positions (Look at Graichen et
    al, 2000; Journal of Biomechanics, 33, pgs 609-613).

    Personally, I have experimented with using a motion analysis system to detect
    the surface deformation of the skin over the scapula, with limited success
    (was
    only a semester long directed study course, so the project has been on hold
    for
    a while now, as I focus on my thesis research (also on the shoulder)). If you
    are curious about exactly what I did, please contact me.

    Since it is difficult to do this there are several approaches that you could
    possibly take, in addition to the ones mentioned above:

    1) Consider looking at the shoulder joint like a ball and socket joint that
    has
    a stationary position on the torso (Problem: Is the motion you measure
    going to
    be sufficiently accurate?)

    2) Consider doing a series of static positions that could be strung together
    "cinematically" to show the relative positions the shoulder through the range
    of motion. (Problem: Static position of the scapula may be different than what
    actually occurs in real life since the shoulder is required to stabilize the
    arm in the stationary position until that position is quantified. Also
    consider
    the difficulty of keeping the arm/shoulder stationary while in an awkward
    position without external stabilization. (Very difficult!) )

    3) Consider finding a willing subject to have pins drilled into the acromial
    process. (Problem: Pins may interefere with the range of motion of the
    subject,
    and may not accurately reflect the movement of the "whole" scapula, just the
    movement at the acromial process. ie. Can't see how much the inferior angle of
    the scapula moves from just the acromial process movement.)

    4) Consider using fluoroscopy to measure the movement (cine-fluoroscopy)
    (Problems: Inherently inaccurate since you are looking at a 2-D image of a 3-d
    object. Also consider the amount of radiation exposure)

    5) Consider creating a cadaveric model that can be used to mimic the movement
    of the bowler/pitcher (Problems: Difficulty in determining the exact forces
    that all of the individual muscles use when actually doing the task. More
    problems are present but are not important to discuss unless you are
    interested
    in doing this.)

    6) Utilize a computer model. The shoulder model constructed by van der Helm is
    one of the most complete, and accurate ones available. Also some modelling of
    the shoulder has been done by a graduate student of Marcus Pandy. Also see the
    work of Udupa's group who have done MRI reconstructed cinematic sequences
    (series of static positions strung together.) Again, I don't have the
    references immediately handy, but if you want I will dig them up.

    I wish you good luck in your efforts and am very curious to see the responses
    that you get to your question. Please email me a summary when you can.

    Please feel free to contact me at the following:

    Daniel Magnusson B.Sc.
    Research Assistant
    Department of Biomedical Engineering (ND-20)
    Lerner Research Institute
    Cleveland Clinic Foundation
    9620 Carnegie Avenue
    Cleveland, Ohio
    44195
    USA

    Telephone: (216) 445-0747
    Fax: (216) 444-9198
    email: magnusd@bme.ri.ccf.org

    Good luck!
    -Dan

    ************************************************** ****************************
    Rene,

    If you are using a magnetic tracking device, such as those by Ascension
    Technologies (e.g. Flock of Birds), you may want to look at a
    dissertation by Kevin McQuade at the University of Iowa in the USA. The
    title is "The scapulohumeral rhythm: a three-dimensional kinematic
    analysis of the effects of load and fatigue during evaluation of the arm
    in the scapular plane".

    There is also a thesis at the University of Iowa by PM Ludewig titled
    "The effect of head position on scapular rotation and muscle activity
    during humeral elevation"

    You can also want to get in touch with Andrew Kardua, Ph.D. at Hannaman
    University in Philadelphia, Pennsylvania in the USA. I believe this
    hospital has merged with Drexel University, also in Philadelphia. You
    may have to search under both to find out how to contact him. He has a
    method for measuring scapular position, also with magnetic tracking
    devices.

    I hope this is some help,

    Timothy Lutz
    North Carolina State University

    ************************************************** **************************
    Hi Rene,

    I have been watching your cricket progress with interest, especially
    as I see you are one of the very few NZers on the membership list of
    ISBS

    Your latest question, shoulder markers, got a wry smile from me in
    the first instance. In the second I wonder whether you might:

    1 set up a group of markers and compute a position

    2.set up a triangulation method using say C3 and L1 and head of
    humerus. or maybe even four positions with iliac crest added to the
    other three.

    Why don't you ask Jim Hay at Unisport?

    In the meantime I'll continue to think on it.

    From: "Doug McClymont"
    Organization: Christchurch Collge of Education
    ************************************************** **********
    Hi Rene,

    We did some 3D motion capture on bowling in cricket last year. At the
    time we were not concerned with the shoulder and therefore only used
    one marker on the acromion process. However the marker was often
    occluded on the bowling arm side as the arm came over prior to
    ball release.This occlusion may be another concern when specifying a
    marker placement to find the 3D position of the glenohumeral joint.

    I am sorry I could not assist with any ideas. I would be interested
    in the answers to this question.

    Regards

    Dudley Tabakin
    University of Cape Town
    Motion analysis Laboratory
    Sports Science Institute of South Africa
    Boundary Rd
    Newlands
    Cape Town
    South Africa

    Tel: +27 21 686-7330 ext.257
    email: dudley@sports.uct.ac.za
    ************************************************** ***********
    Hi Rene,

    I read your message on Biomch-l.
    Doorenbosch et al., 1999
    Gait and Posture 1999 Vol. 10, No 1, pp54-55.

    This is an abstract presented at ESMAC'99. They work out the centre of
    rotation of the glenohumeral joint.

    I hope this helps.

    Gabor
    ************************************************** ********************
    Hello Rene,

    I am actually in the process of completing my Masters thesis. My research
    examines the amount of glenohumeral translation present in the shoulder in
    vivo using MRI, specifically in a paraplegic population.

    For your interest, there is a meeting of the International Shoulder Group in
    Newcastle(-upon-Tyne), England in September 4 - 5 2000.

    The kinematic analyses that look at javelin and baseball pitching tend to
    use fine wire and surface EMG (and examine the muscle activation patterns)
    as their main focus (Pink; Perry; Jobe, to name a few authors). Those that
    do use motion analysis (can't think of who might have done these offhand)
    tend to use the assumption that the shoulder joint is a ball and socket in a
    stationary position on the torso.

    The most "successful" technique to date is the use of the bone pins, but
    like I mentioned in the previous email, there are problems with this
    technique as well, especially if you want to look at bowling/pitching.

    Here are a list of the references that I have. It is not a complete list but
    should give you a good start. Should give you some other authors to start
    from if you want to look at the fuction of the glenohumeral joint. The
    authors I would recommend for you are references #
    11,13,14,16,19,22,24,25,26,28,30,36-41.

    For the work from Karduna you will have to contact him directly since I do
    not have any of his papers handy (saw his work at some conferences).

    Hopefully this helps you.

    Curious to hear what other responses you have gotten.

    Best of luck.

    -Dan

    Daniel Magnusson B.Sc.
    Research Assistant
    Department of Biomedical Engineering
    Lerner Research Institute
    9620 Carnegie Avenue (ND-20)
    Cleveland Clinic Foundation
    Cleveland, Ohio, USA 44195

    Tel216)445-0747
    Fax216)444-9198
    Email: magnusd@bme.ri.ccf.org



    References
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    mechanics in a position of shoulder instability. Journal of Biomechanics
    23(5): 405-415, 1990.

    2. Bayley JC, Cochran TP, Sledge CB: The weight bearing shoulder: The
    impingement syndrome in paraplegics. Journal of Bone and Joint Surgery
    69-a:676-678, 1987

    3. Burnham RS, May L, Nelson E, Steadward RD, Reid DC: Shoulder pain in
    wheelchair athletes: The role of muscle imbalance. American Journal of
    Sports Medicine 21: 238-242, 1993

    4. Burnham RS, Steadward RD: Upper extremity peripheral nerve entrapments:
    Prevalence, location and risk factors. Archives of Physical Medicine and
    Rehabilitation 75:519-524, 1994

    5. Codman, EA. The shoulder: rupture of the supraspinatus tendon and other
    lesions in or about the subacromial bursa, special ed. New York: Classics
    of Surgery Library, repr.1991, c. 1934.

    6. Enoka, RM. Simple joint system operation in: Neuromechanical basis of
    kinesiology. Champaign: Human Kinetics Books. p. 133, 1988.

    7. Flatow EL, Soslowsky LJ, Ticker JB, Pawluk RJ, Hepler M, Ark J, Mow VC,
    Bigliani LU: Excursion of the rotator cuff under the acromion: Patterns of
    subacromial contact. American Journal of Sports Medicine 22:779-788, 1994

    8. Frank, C.B. and Shrive, N.B. Ligament in: Biomechanics of the
    musculoskeletal system: Nigg and Herzog (Eds.), John Wiley and Sons: New
    York. P.109, 1994.

    9. Gellman H, Waters RL, Sie IH: Late complications of the weight-bearing
    upper extremity in the paraplegic patient. Clinical Orthopaedics and Related
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    10. Gibb, TD, Sidles, JA, Harryman, DT, McQuade, KJ and Masten III, FA. The
    effect of capsular venting on glenohumeral laxity. Clinical Orthopaedics and
    Related Research 268: 120-127, 1991.

    11. Happee, R and Van der Helm, FCT. The control of shoulder muscles during
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    12. Harryman DT, Sidles JA, Harris SL, Matsen FA: Laxity of the normal
    glenohumeral joint: A qualitative in-vivo assessment. Journal of Shoulder
    and Elbow Surgery 1: 66-76, 1992.

    13. Högfors C, Peterson B, Sigholm G and Herberts P: Biomechanical model of
    the human shoulder joint - II. The shoulder rhythm. Journal of Biomechanics
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    14. Inman VT, Saunders M, Abbot LC: Observations on the function of the
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    15. Itoi E, Motzkin NE, Morrey BF, An KN: Contribution of axial arm rotation
    to humeral head translation. American Journal of Sports Medicine 22:499-503,
    1994

    16. Kronberg M, Broström LA, Németh G: Differences in shoulder muscle
    activity between patients with generealized joint laxity and normal
    controls. Clinical Orthopaedics and Related Research 269:181-192, 1991.

    17. Kronberg M, Larsson P, Broström LA: Characterisation of Human deltoid
    muscle in patients with impingement syndrome. Orthopaedic Research
    15:727-733, 1997

    18. Lippit S, Matsen F: Mechanisms of glenohumeral stability. Clinical
    Orthopaedics and Related Research 291:20-28, 1993.

    19. Maffet, MW, Jobe, FW, Pink, MM, Brault, J and Mathiyakom, W. Shoulder
    muscle firing patterns during the windmill softball pitch. American Journal
    of Sports Medicine 25: 369-374, 1997.

    20. Neer CS II: Impingement lesions. Clinical Orthopaedics and Related
    Research 173:70-77, 1983

    21. Nigg BM: Inertial properties of the human or animal body In:
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    22. Otis, JC, Jiang, CC, Wickiewicz, TL, Peterson, MGE, Warren, RF and
    Santner, TJ. Changes in the moment arms of the rotator cuff and deltoid
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    23. Payne LZ, Deng X, Craig EV, Torzilli PA, Warren RF: The combined dynamic
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    24. Pearl ML, Perry J, Torbum L, Gordon LH: An electromyographic analysis of
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    25. Pink, M, Perry, J, Browne, A, Scovazzo, ML and Kerrigan, J. The normal
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    26. Poppen NK, Walker PS: Forces at the glenohumeral joint in abduction.
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    27. Powers, CM, Newsam, CJ, Gronley, JK, Fontaine, CA, Perry, J. Isometric
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    28. Reyes, ML, Gronley, JK, Newsam, CJ, Mulroy, SJ, Perry, J.
    Electromyographic analysis of shoulder muscles of men with low-level
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    29. Rodgers MM, Gayle GW, Figoni SF, Kobayashi M, Lieh J and Glaser RM:
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    30. Ruwe PA, Pink M, Jobe FW, Perry J, Scovazzo ML: The normal and painful
    shoulders during the breaststroke: Electromyographic and cinematographic
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    32. Silfverskiold J & Waters RL: Shoulder pain and functional disability in
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    ************************************************** *************************
    Hello Rene,

    I must apologize for the long delay in this reply but I have just been
    extreamly busy with a new baby and all.

    Anyways, in response to your question:

    First, you say you want to track the "glenohumeral joint". This means you
    want to know the position of BOTH the scapula and the humerus. Is this
    correct? Or, are you only interested in the position of the humeral head?

    If it is the first, then this is a difficult problem which I have not found
    an adaquate solution in the literature. The bigger problem is tracking the
    motion of the scapula. As you say, there are a number of techniques which
    use palpation of bony landmarks.
    e.g.
    Barnett et al. 1999, The measurement of three dimensional scapulohumeral
    kinematics - a study of reliability
    Lukasiewicz et al. 1999, Comparison of 3-dimensional scapular position and
    orientation between subjects with and without shoulder impingement.

    In terms of a a dynamic method, there are few studies using a dynamic
    approach. McQuade in 1998 (J Orthop Sports Phys Ther 1998 Aug;28(2):74-80)
    use skin markers so you may want to check this reference. In the 1999
    meeting of the ORS, Karduna has an article using skin markers compared to
    bone pins directly inserted into the scapula. Unfortunatly, I have not seen
    Karduna publish the study yet so...Karduna also has a website I've seen
    before so you may want to do a search for it.

    My study into using skin markers to track scapula motion is not yet
    complete. However, it appears that the region around the scapular spine is
    the best place to start (perhaps this is obvious but...)

    If you are just interested in the humerus, then I think it is a much simpler
    problem since it becomes similar to a gait analysis problem.

    hope this helps a bit
    good luck
    anthony

    Orthopaedic Engineering Research
    The University of British Columbia & Vancouver Hospital



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    Rene Ferdinands
    University of Waikato
    Dept of Physics & Electronic Engineering
    Private Bag 3105
    Hamilton 2001
    New Zealand

    Phone: (+64 7) 838 4026
    Fax: (+64 7) 838 4219
    email: redf1@waikato.ac.nz
    --------------------------------------

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