Three-dimensional in vivo comparative analysis of the kinematics of normal shoulders and shoulders with massive rotator cuff tears with successful conservative treatment

Background: This study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders. Methods: Ten patients (age, 67.4 +/- 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders. Findings: There was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p < .05). This difference disappeared in the range from 40 degrees to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9 degrees at rest (p < .05) and by 11.6 degrees at terminal elevation (p < .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups. Interpretation: Kinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.