Electromagnetic Tracking Device Research Articles

Hip Kinematics During a Stop-Jump Task in Patients With Chronic Ankle Instability

Chronic ankle instability (CAI) commonly develops after lateral ankle sprain. Movement pattern differences at proximal joints may play a role in instability. To determine whether people with mechanical ankle instability (MAI) or functional ankle instability (FAI) exhibited different hip kinematics and kinetics during a stop-jump task compared with "copers." Cross-sectional study. Sports medicine research laboratory. Sixty-three recreational athletes, 21 (11 men, 10 women) per group, matched for sex, age, height, mass, and limb dominance. All participants reported a history of a moderate to severe ankle sprain. The participants with MAI and FAI reported 2 or more episodes of giving way at the ankle in the last year and decreased functional ability; copers did not. The MAI group demonstrated clinically positive anterior drawer and talar tilt tests, whereas the FAI group and copers did not. Participants performed a maximum-speed approach run and a 2-legged stop jump followed by a maximum vertical jump. An electromagnetic tracking device synchronized with a force plate collected data during the stance phase of a 2-legged stop jump. Hip motion was measured from initial contact to takeoff into the vertical jump. Group differences in hip kinematics and kinetics were assessed. The MAI group demonstrated greater hip flexion at initial contact and at maximum (P = .029 and P = .017, respectively) and greater hip external rotation at maximum (P = .035) than the coper group. The MAI group also demonstrated greater hip flexion displacement than both the FAI (P = .050) and coper groups (P = .006). No differences were noted between the FAI and coper groups in hip kinematic variables or among any of the groups in ground reaction force variables. The MAI group demonstrated different hip kinematics than the FAI and coper groups. Proximal joint motion may be affected by ankle joint function and laxity, and clinicians may need to assess proximal joints after repeated ankle sprains.

Design of the Image-Guided Biopsy Marking System for Gastroscopy

Endoscopists currently rely on an invasive biopsy tattooing method to identify previously biopsied sites. In order to better guide endoscopists to find the biopsy positions in follow-ups, we proposed a non-invasive image guided biopsy marking system for gastroscopy. Using an electromagnetic tracking device, the position of the gastroscope relative to the stomach was acquired and displayed in the guidance interface. The biopsy positions were recorded in computer for the use of guidance in follow-ups. The accuracy of the system was evaluated by both phantom experiments and in vivo experiments. The average target registration errors on the test animal and the volunteer are 13.4mm and 11.2mm respectively. Although the positioning error is slightly larger than current biopsy tattooing method, it satisfies the need for guidance. In the near future, we will validate the system by measuring how much it saves examination time.

In vitro validation and reliability study of electromagnetic skin sensors for evaluation of end range of motion positions of the hip

There is growing evidence that femoroacetabular impingement (FAI) is a probable risk factor for the development of early osteoarthritis in the nondysplastic hip. As FAI arises with end range of motion activities, measurement errors related to skin movement might be higher than anticipated when using previously reported methods for kinematic evaluation of the hip. We performed an in vitro validation and reliability study of a noninvasive method to define pelvic and femur positions in end range of motion activities of the hip using an electromagnetic tracking device. Motion data, collected from sensors attached to the bone and skin of 11 cadaver hips, were simultaneously obtained and compared in a global reference frame. Motion data were then transposed in the hip joint local coordinate systems. Observer-related variability in locating the anatomical landmarks required to define the local coordinate system and variability of determining the hip joint center was evaluated. Angular root mean square (RMS) differences between the bony and skin sensors averaged 3.2° (SD 3.5°) and 1.8° (SD 2.3°) in the global reference frame for the femur and pelvic sensors, respectively. Angular RMS differences between the bony and skin sensors in the hip joint local coordinate systems ranged at end range of motion and dependent on the motion under investigation from 1.91 to 5.81°. The presented protocol for evaluation of hip motion seems to be suited for the 3-D description of motion relevant to the experimental and clinical evaluation of femoroacetabular impingement.

Scapulohumeral kinematic assessment of the forward kayak stroke in experienced whitewater kayakers

By understanding the normal humeral and scapular kinematics during the kayak stroke, inferences about the relationship of kayaking technique and shoulder injury may be established. The purpose of this study was to describe scapular and humeral kinematics and to compare dominant versus non-dominant symmetry in healthy whitewater kayakers performing the forward stroke. Twenty-five competent whitewater kayakers (mean age: 34.1 ± 9.4 years, mean height: 1.768 ± 0.093 m, mean mass: 78.2 ± 13.0 kg) underwent humeral and scapular kinematic assessment, using an electromagnetic tracking device, while kayaking on a kayak ergometer. Paired t-tests were used to determine symmetry. Scapular and humeral kinematic means and standard deviations at six time points during the kayak stroke were described. Scapular and humeral kinematics were shown to be similar upon bilateral comparison. The greatest potential for injury during the forward stroke may be at thrust paddle shaft vertical when the humerus is maximally elevated in internal rotation and adduction as subacromial structures may be mechanically impinged. The relationship between scapulohumeral kinematics related to injury at other time points are also described.

Effects of forearm muscles on carpal stability

Thirty cadaveric forearms were tested using a wrist testing apparatus specifically designed to investigate the mechanisms of muscle stabilization of the wrist. The specimens were set in a jig allowing the distal row to migrate proximally and to rotate around the pronosupination forearm axis. Five wrist motor tendons (FCR, FCU, ECU, ECRL and APL) were loaded with specific weights. Reactive rotations of the scaphoid, triquetrum and capitate were measured by an electromagnetic motion tracking device. When all five tendons were loaded simultaneously, the capitate supinated and the proximal row predominantly supinated and flexed. By contrast, when the ECU was loaded in isolation, it caused pronation to both proximal and distal rows. The FCR exhibited a mixed effect pronating the capitate and triquetrum, whilst supinating the scaphoid. Based on this, a hypothesis is proposed linking wrist stability to the balance of wrist pronators (ECU and FCR) and supinators (FCU, ECRL and APL).

Accuracy assessment for navigated maxillo-facial surgery using an electromagnetic tracking device

Purpose To evaluate the accuracy and the usability of an electromagnetic tracking device in maxillo-facial surgery through testing on a phantom skull under operating room (OR) conditions. Material and methods A standard plastic skull phantom was equipped with a custom made model of the maxilla and with target markers and dental brackets. Imaging was performed with a computed tomography (CT) scanner. The extent and robustness of the electromagnetic tracking system’s target registration error (TRE) was evaluated under various conditions. Results For each measurement a total of 243 registrations were performed with 5 point registration and 4374 registrations with 6 point registration. The average target registration error for the 5 point registration under OR conditions was 2.1 mm (SD 0.86) and 1.03 (SD 0.53) for the 6 point registration. Metallic instruments applied to the skull increased the TRE significantly in both registration methods. Conclusion The electromagnetic tracking device showed a high accuracy and performed stable in both registration methods. Electromagnetic interference due to metallic instruments was significant but the extent of TRE was still acceptable in comparison to optical navigation devices. A benefit of EM tracking is the absence of line-of-sight hindrance. The test setting simulating OR conditions has proven suitable for further studies.

Changes in Bending Stiffness and Lumbar Spine Range of Movement Following Lumbar Mobilization and Manipulation

Objective The purpose of this study was to investigate the effects of lumbar rotational manipulation and lumbar central posteroanterior mobilization on lumbar bending stiffness and flexion and extension range of motion (ROM). Methods A same-subject, repeated-measures, crossover design was used using 32 asymptomatic subjects (16 female and 16 male; mean [SD] age, 25.5 [4.5] years; weight, 65.7 [11.8] kg; and height, 1.70 [0.08] m). Each subject received mobilization or manipulation on 2 different occasions. Bending stiffness was calculated using a 3-point bending model using an electromagnetic tracking device and a force platform; lumbar flexion and extension ROM was measured using an electromagnetic tracking device. All variables were measured pre- and postintervention. Their effect was compared using paired t tests. Results Manipulation and mobilization did not significantly alter either bending stiffness or lumbar flexion and extension ROM (mobilization: P = .175, P = .613, and P = .535; manipulation: P = .973, P = .323, and P = .439). Bending stiffness changes were not correlated to changes in ROM (Pearson r for stiffness-flexion = −0.102, P = .586; Pearson r for stiffness-extension = 0.014, P = .941). Conclusions Manipulation and mobilization had no significant effect on bending stiffness or flexion and extension ROM for this group of subjects. Some individual variations in effect were observed.

A28 野球のフリーバッティングにおける左右上肢セグメントの連動運動(打撃動作II)

The purpose of this study was to investigate the relationship between angular velocity of the bat and movements of upper limbs. Nine hitters performed free-batting practice. An electromagnetic tracking device was used to record three dimensional kinematic data of the thorax, the humerus and the forearm of the both side and the bat. The results showed that sequential rotation, in order of the thorax, the shoulder, the elbow and forearm, was observed on the lead arm for all subjects. All joint range of motion on the push arm were larger than that on the lead arm. There was a significant correlation between swing angular velocity and shoulder range of motion for horizontal abduction on the lead arm. No correlation was founded between the rolling angular velocity and body movements, indicating that the magunitude of the rolling angular velocity is not associated with the range of each joint motion and the timing of sequential action.

Non-invasive Error-assessment of the Acromial-Sensor-Tracking Protocol for the Measurement of Scapular Orientation

The acromial-sensor-tracking protocol with an electromagnetic tracking device is a non-invasive measurement protocol for recording the three-dimensional scapular movement continuously. In the present study, the orientations of motionless scapula were determined with the acromial-sensor-tracking protocol and the magnitude of the measurement error attributable to the skin-movement was assessed non-invasively by the landmark-digitizing protocol with the digitizer. Three sensors of the electromagnetic tracking device were attached to the skin overlaying the sternum, acromion and humerus, and three or more bony landmarks for each segment were manually digitized with the stylus to define the anatomical meaningful orientation. After the initial digitizing, the subject was asked to maintain the arm at five positions. While the subject was maintaining the arm, the orientation of the scapula was determined simultaneously by the attached sensors and by the directly digitizing of the scapular bony landmarks (the landmark-digitizing protocol). The mean values for the root mean square (RMS) errors representing the differences in the measured scapular orientation between the acromial-sensor-tracking protocol and the landmark-digitizing protocol across the five humeral abduction angles were found to be <5.2°. The magnitude of the measurement error exhibited in acromial-sensor-tracking protocol was substantially smaller than the range of the scapular movement exhibited during the humeral abduction. The results demonstrate that the acromial-sensor-tracking protocol is a valid measurement protocol to describe the three-dimensional continuous scapular movement with sufficient accuracy.

Three-Dimensional Morphologic Nasal Surface Characteristics that Predict the Extremes of Esthetics in Patients with Repaired Cleft Lip and Palate

The purposes of this study were (1) to develop imaging methods and objective numeric parameters to describe nose morphology, and (2) to correlate those parameters with nasal esthetics for patients with clefts. A total of 28 patients with repaired complete unilateral cleft lip and palate (CUCLP) and 20 age- and gender-matched individuals without clefts were identified. A panel of orthodontists rated and ranked nasal esthetics from nose casts for the cleft group. Best and worst esthetic cleft groups were established from the cast assessments. Three-dimensional surface coordinates of the casts were digitally mapped with an electromagnetic tracking device. Digitized nasal images were oriented, voxelated, sliced, and mathematically curve-fitted. Maximum difference, percent area difference, and maximum and minimum derivative differences between cleft and noncleft and between right and left nose sides were calculated. Differences in parameters between groups were assessed with the use of analysis of variance (ANOVA) and t tests, and correlations with esthetics were assessed with the Spearman rank correlation test. Differences were seen between cleft and noncleft and best and worst esthetic groups for all four parameters (p < .05). The best esthetic cleft group had (1) lower percent area difference (p < .0001), (2) lower maximum difference (p < .001), and (3) smaller differences in slope of the nose in the coronal plane (p < .0001) than the worst esthetic cleft group. Maximum difference and maximum derivative difference and, to a lesser degree, percent area difference can be used to identify differences between cleft and noncleft nasal morphology and to assess levels of nasal esthetics for patients with CUCLP.

A Robot Arm for Assisting Liver Surgery

AbstractLiver surgery is a complex operation. During the operation, even with the help of realtime CT imaging, doctors often struggle in finding the exact tumor positions. This paper introduces a robot arm specially designed for assisting liver surgery. It includes a 5 DOF (Degree-of-Freedom) robot arm and a computer software system. The position resolution of the robot arm is 0.1mm and the software system is developed using Visual C++. The robot arm can hold an endoscope. With the help of electromagnetic position tracking device, the robot arm can also show the path of the endoscope during the surgery. To test the accuracy of the robot arm, a prototype is designed and built. The experiment results show that the position accuracy of the robot arm is 0.3mm, sufficient for assisting liver surgery. In addition, the cost of this system is only about US$10, 000, much lower than thesurgical robot systems in the market.

Kinematic and clinical evaluation of shoulder function after primary and revision reverse shoulder prostheses

Results of the reverse shoulder prosthesis on pain are generally satisfying; however, active range of motion (ROM) is often not optimal, especially after revision. A kinematic and clinical analysis of the reverse prosthesis was performed to provide more precise information on its glenohumeral motion pattern. We hypothesized that the difference in the primary and revision cases is due to differences in the motion in the glenohumeral joint. The motion pattern of 31 patients with a reverse prosthesis (35 shoulders, 19 primary and 16 revisions) was measured during 3 active ROM tasks-forward flexion, abduction, and axial rotation. Average age was 71 ± 8 years (range, 58-85 years). Average follow-up was 23 ± 14 months (range, 4-63 months). Kinematic measurements were performed with a 3-dimensional electromagnetic tracking device. Clinical evaluation was performed by obtaining Constant score, Disabilities of Arm, Shoulder and Hand (DASH) score, and the Simple Shoulder Test (SST). Acromial-prosthetic distance was measured on anteroposterior radiographs. Primary placed prostheses showed significantly better active glenohumeral motion than revisions for forward flexion (71° ± 18° vs 53° ± 26°, P < .05), abduction (64° ± 15° vs 46° ± 24°, P < .05), and active external rotation (31° ± 25° vs 13° ± 16°, P < .05). Constant score improved for the whole group from 24 (range, 5-47) to 50 (range, 8-87; P < .001), for the primary group from 28 (range, 13-47) to 60 (range, 8-87; P < .001) and for revisions from 20 (range, 5-47) to 38 (range, 11-73; P < .001). Acromial-prosthetic distance showed no significant correlation for active glenohumeral motion. Five shoulders with a deficient teres minor muscle showed no significant decrease of external rotation. Active ROM is better in primary placed prosthesis, and this difference takes place mainly in the glenohumeral joint. In all our patients, Constant scores improved significantly postoperatively. However, we could not find any clinical correlating parameters to explain this difference.

Scapular Rotation to Attain the Peak Shoulder External Rotation in Tennis Serve

The purposes of this study were (a) to describe the detailed movements of the shoulder complex during the cocking phase in tennis serve and (b) to determine the contribution of the scapular rotation to the peak shoulder external rotation attained at the end of the cocking phase. Twenty tennis players performed flat tennis serves with the maximum effort, and three-dimensional kinematic data of the thorax, scapula, and humerus of the dominant side were recorded by an electromagnetic tracking device (Liberty; Polhemus) at 240 Hz. The humeral rotation with respect to the thorax (named as the resultant shoulder rotation) was decomposed into the scapular rotation with respect to the thorax and the humeral rotation with respect to the scapula (named as the glenohumeral rotation). The scapular rotation that contributed to attain the peak resultant shoulder external rotation was quantitatively determined, and the ratio of the glenohumeral external rotation to the scapular rotation that contributed to attain the peak resultant shoulder external rotation was computed to represent the scapulohumeral rhythm for shoulder external rotation. Of the three components of scapular rotations, the scapular posterior tilt was the primary component that contributed to the attainment of the peak resultant shoulder external rotation. The scapulohumeral rhythm for shoulder external rotation (scapular posterior tilt-glenohumeral external rotation) exhibited during the backswing phase was 1:2.3. The peak resultant shoulder external rotation was generated by a synchronized combination of the scapular posterior tilt and glenohumeral external rotation. A consistent pattern of three phases of the scapular posterior tilt and the glenohumeral external rotation that could be accurately modeled by three linear regressions was observed in preparation for the peak shoulder external rotation in tennis serve.

Alteration of Scapula Lateral Rotation for Subjects with the Reversed Anatomy Shoulder Replacement and its Influence on Glenohumeral Joint Contact Force

It has previously been reported that motion of the scapula varies for subjects with shoulder joint pathologies and is different from that of normal subjects. In this study, an electromagnetic tracking device was used to measure the three-dimensional scapula motion of nine patients with Bayley-Walker (B-W) reverse anatomy joint replacements. The data were then compared to scapula kinematics of 12 normal subjects with no known shoulder pathology. The scapula kinematics for each subject was determined and a regression analysis to find the mean scapula lateral rotation (SLR) for B-W and normal subjects was performed. The regression model which showed the highest change compared to normal was identified and was used in the biomechanical shoulder model to predict the glenohumeral joint contact force. A high variability of the scapula kinematics was observed, with some subjects having a maximum SLR smaller than that of the normal subjects and some similar to the normal subjects. It was found that scapula may move in such a way to keep the deltoid length at its optimum. The change in the scapula kinematics affected the predicted joint force and its point of application. Hence, knowledge of scapular kinematics is essential for realistic modelling of implanted shoulders.

Augmented reality haptic (ARH): an approach of electromagnetic tracking in minimally invasive surgery

Minimally Invasive Surgery (MIS) is a widely used surgical technique that requires a long training process due to its difficulty and complexity. We developed an Augmented Reality Haptic (ARH) System based on electromagnetic tracking devices for use in creation training models (computer-enhanced trainers), in computer-assisted surgery or telemanipulation applications. The ARH system consists currently in a Linux driver and a calibration protocol to acquire the tooltip position of conventional laparoscopic tools in real time. A Polhemus Isotrack(®) II was used to track surgical endoscopic tooltip movements. The receiver was mounted on the tool handle in order to measure laparoscopic tools positions without complex modifications. Two validation tests were done to guarantee the proper functioning of the ARH system in a MIS environment. The first one checks the driver operation and the second measures the accuracy and reliability of the tooltip pose estimation process. Jitter and orientation errors for the first test were 2.00±0.10 and 2.00±0.09mm, respectively. Relative position error of 0.25±0.06cm for a distance of 5cm was found. Jitter error for the second test was 127 ± 60, 117 ± 40 and 122 ± 39mm in Z, Y and X rotations, respectively. Results obtained with the ARH system are sufficiently accurate for use in MIS training. A supplementary correction procedure would be necessary to use this ARH system in computer-assisted surgery or telemanipulation.

A proto-type design of a real-tissue phantom for the validation of deformation algorithms and 4D dose calculations

The purpose of this study is to design a real-tissue phantom for use in the validation of deformation algorithms. A phantom motion controller that runs sinusoidal and non-regular patient-based breathing pattern, via a piston, was applied to porcine liver tissue. It was regulated to simulate movement ranges similar to recorded implanted liver markers from patients. 4D CT was applied to analyze deformation. The suitability of various markers in the liver and the position reproducibility of markers and of reference points were studied. The similarity of marker motion pattern in the liver phantom and in real patients was evaluated. The viability of the phantom over time and its use with electro-magnetic tracking devices were also assessed. High contrast markers, such as carbon markers, implanted in the porcine liver produced less image artifacts on CT and were well visualized compared to metallic ones. The repositionability of markers was within a measurement accuracy of ±2 mm. Similar anatomical patient motions were reproducible up to elongations of 3 cm for a time period of at least 90 min. The phantom is compatible with electro-magnetic tracking devices and 4D CT. The phantom motion is reproducible and simulates realistic patient motion and deformation. The ability to carry out voxel-based tracking allows for the evaluation of deformation algorithms in a controlled environment with recorded patient traces. The phantom is compatible with all therapy devices clinically encountered in our department.

A new method for motion capture of the scapula using an optoelectronic tracking device: a feasibility study

Optoelectronic tracking systems are rarely used in 3D studies examining shoulder movements including the scapula. Among the reasons is the important slippage of skin markers with respect to scapula. Methods using electromagnetic tracking devices are validated and frequently applied. Thus, the aim of this study was to develop a new method for in vivo optoelectronic scapular capture dealing with the accepted accuracy issues of validated methods. Eleven arm positions in three anatomical planes were examined using five subjects in static mode. The method was based on local optimisation, and recalculation procedures were made using a set of five scapular surface markers. The scapular rotations derived from the recalculation-based method yielded RMS errors comparable with the frequently used electromagnetic scapular methods (RMS up to 12.6° for 150° arm elevation). The results indicate that the present method can be used under careful considerations for 3D kinematical studies examining different shoulder movements.

Alteration in Shoulder Kinematics and Associated Muscle Activity in People With Idiopathic Scoliosis

A cross-sectional control-matched study in adolescents with idiopathic scoliosis (IS). To evaluate whether subjects with IS had shoulder dysfunction and associated impairment in shoulder kinematics and muscular activation. Evidence indicates that shoulder kinematics are related to shoulder pain and dysfunction. Despite the degree of morbidity associated with altered shoulder kinematics likely to occur in subjects with IS, no report has been published to address this hypothesis. In this investigation, shoulder kinematics (scapular tipping, scapular upward rotation, and scapulohumeral rhythm) and associated muscular activities [upper trapezius (UT), lower trapezius (LT), serrantus anterior (SA), and middle deltoid (MD)] were evaluated with a 3-dimensional electromagnetic tracking device and electromyography during arm elevations in 13 female subjects with IS and 13 age-gender-dominant hand-matched controls. Additionally, self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) was evaluated between the 2 groups. Subjects with IS demonstrated lower FLEX-SF scores than the controls (P = 0.01). For the convex side, more anterior tilt of the scapula in resting position was identified (P = 0.006). For the concave side, more scapular upward rotation in resting position was identified (P = 0.01). For the EMG amplitude, higher LT contraction activity on the convex side and lower LT and SA contraction activity on the concave side were established (P = 0.007 and less than 0.01, respectively). A moderate positive association was found between scapular posterior tipping during movement and FLEX-SF functional score (R = 0.51). A moderate negative association was found between LT muscular activity and FLEX-SF functional score (R = -0.54). Given the progressive nature of IS and kinematic linkage among the thoracic spine, scapula, and arm, inadequate posterior tipping movement and high LT muscular activity on the convex side of IS are important to consider in rehabilitation programs for subjects with IS.

Quantitative evidence of kinematics and functional differences in different graded trigger fingers

Background Clinical diagnosis and classification of trigger fingers is traditionally based on physical examinations and certain obvious symptoms . However, it might lack quantitative evidence to describe the different graded trigger digits. This study provides quantitative evidence of kinematics and functional differences among different graded trigger fingers based on Froimson's classification. Methods Forty-seven patients with fifty-five trigger fingers and graded twenty-three, eleven, and twenty-one fingers as grades II, III, and IV, respectively. The QuickDASH questionnaire evaluated the subject's self-perception of hand symptoms and functions. The study measured maximal workspace of the fingertip motion and range of motion of the finger joints during an assigned tendon-gliding task using an electromagnetic tracking device. In addition, R α, defined as the ratio range of angular acceleration during finger extension to the range during finger flexion of each joint, quantified the triggering effect. Findings The QuickDASH score results show that functional performances have significant differences among three grades ( P < 0.05). Workspace, range of motion of proximal interphalangeal joint and R α of proximal interphalangeal and distal interphalangeal joint of trigger fingers also significantly differ among three grades ( P < 0.05). These findings quantitatively show that trigger fingers in different impairment levels have different kinematics and functional performances. Interpretation The results serve as evidence-based knowledge for clinics. The more practical and immediate application of this study would be to facilitate the assessment, design and execution of rehabilitation for patients with trigger fingers.

Effect of Shortening Deformity of the Clavicle on Scapular Kinematics

Background In some short malunion cases, midshaft clavicular fractures are reported to result in unsatisfactory clinical outcomes. Shortening deformity of the clavicle could change the anatomical alignment of the shoulder girdle and is surmised to affect shoulder kinematics on arm movements. Nevertheless, no report has ever referred to documented changes. Hypothesis Scapular motion will change with clavicular shortening in cadaveric models. Study Design Controlled laboratory study. Methods Twelve cadaveric shoulders were used, and sequential clavicular shortening by 0%, 5%, 10%, 15%, and 20% from the original length was simulated in this study. The scapulothoracic motion during passive arm elevation in 3 planes was monitored using an electromagnetic tracking device. Differences in kinematics of the scapula between the 0% shortening models and the other 4 experimental groups were analyzed. Results During arm elevation, posterior tilting and external rotation of the scapula significantly decreased with ≥10% shortening of the clavicle. Decreased posterior tilting was found with a shorter clavicle and at higher positions of arm elevation in all planes and became obvious during coronal plane elevation. Upward rotation of the scapula did not change with shortening at any elevated arm positions. Conclusion The findings of this study clearly indicated that shortening of the clavicle affects the kinematics in the shoulder girdle. Clinical Relevance The results of this cadaveric study suggest that clavicular shortening of ≥10% affects scapular kinematics and might produce clinical symptoms.