Shoulder Bone Geometry Affects the Active and Passive Axial Rotational Range of the Glenohumeral Joint

Abstract

Background: The range of motion of the glenohumeral joint varies substantially among individuals and is dependent on humeral position. How variation in shape of the humerus and scapula affects shoulder axial range of motion at various positions has not been established. Purpose: To quantify variation in the shape of the glenohumeral joint and investigate whether the scapula and humerus geometries affect the axial rotational range of the glenohumeral joint. Study Design: Descriptive laboratory study. Methods: The range of active and passive internal-external rotation of the glenohumeral joint was quantified for 10 asymptomatic participants with optical motion tracking at 60º, 90º, and 120º humeral elevations in the coronal, scapular, and sagittal planes. Bone geometrical parameters were acquired from shoulder magnetic resonance image scans, and correlations between geometrical parameters and maximum internal and external rotations were investigated. Three-dimensional participant-specific models of the humerus and scapula were used to identify collisions between bones at the end of range. Results: Maximum internal and external rotations of the glenohumeral joint were correlated to geometric parameters and were limited by bony collisions. Generally, the active axial rotational range was greater with increased articular cartilage and glenoid curvature, while a shorter acromion resulted in greater passive range. Greater internal rotation was correlated with a greater glenoid depth and curvature in the scapular plane (r = 0.76, P < .01, at 60° of elevation), a greater subacromial depth in the coronal plane (r = 0.74, P < .01, at 90° of elevation), and a greater articular cartilage curvature in the sagittal plane (r = 0.75, P < .01, at 90° of elevation). At higher humeral elevations, a greater subacromial depth and shorter acromion allowed a greater range of motion. Conclusion: The study strongly suggests that specific bony constraints restrict the maximum internal and external rotations achieved in active and passive glenohumeral movement. Clinical Relevance: This study identifies bony constraints that limit the range of motion of the glenohumeral joint. This information can be used to predict full range of motion and set patient-specific rehabilitation targets for those recovering from shoulder disorders. It can improve positioning and choice of shoulder implants during preoperative planning by considering points of collision that could limit range of motion.