Electromagnetic Tracking System Research Articles

Noctopus: a novel device and method for patient registration and navigation in image-guided cranial surgery.

A patient registration and real-time surgical navigation system and a novel device and method (Noctopus) is presented. With any tracking system technology and a patient/target-specific registration marker configuration, submillimetric target registration error (TRE), high-precise application accuracy for single or multiple anatomical targets in image-guided neurosurgery or ENT surgery is realized. The system utilizes the advantages of marker-based registration technique and allows to perform automatized patient registration using on the device attached and with patient scanned four fiducial markers. The best possible sensor/marker positions around the patient's head are determined for single or multiple region(s) of interest (target/s) in the anatomy. Once brought at the predetermined positions the device can be operated with any tracking system for registration purposes. Targeting accuracy was evaluated quantitatively at various target positions on a phantom skull. The target registration error (TRE) was measured on individual targets using an electromagnetic tracking system. The overall averaged TRE was 0.22 ± 0.08 mm for intraoperative measurements. An automatized patient registration system using optimized patient-/target-specific marker configurations is proposed. High-precision and user-error-free intraoperative surgical navigation with minimum number of registration markers and sensors is realized. The targeting accuracy is significantly improved in minimally invasive neurosurgical and ENT interventions.

Implementing an electromagnetic tracking navigation system improves the precision of endoscopic transgastric necrosectomy in an ex vivo model

Endoscopic transgastric necrosectomy is crucial in the management of complications resulting from necrotizing pancreatitis. However, both real-time and visual-spatial information is lacking during the procedure, thereby jeopardizing a precise positioning of the endoscope. We conducted a proof-of-concept study with the aim of overcoming these technical difficulties. For this purpose, a three-dimensional (3D) phantom of a stomach and pancreatic necroses was 3D-printed based on spatial information from individual patient CT scans and subsequently integrated into a silicone torso. An electromagnetic (EM) sensor was adjusted inside the endoscope´s working channel. A software interface enabled real time visualization. The accuracy of this novel assistant system was tested ex vivo by four experienced interventional endoscopists who were supposed to reach seven targets inside the phantom in six different experimental runs of simulated endoscopic transgastric necrosectomy. Supported by endoscopic camera view combined with real-time 3D visualization, all endoscopists reached the targets with a targeting error ranging between 2.6 and 6.5 mm in a maximum of eight minutes. In summary, the EM tracking system might increase efficacy and safety of endoscopic transgastric necrosectomy at the experimental level by enhancing visualization. Yet, a broader feasibility study and further technical improvements are mandatory before aiming at implementation into clinical setting.

Accurate digitization of EEG electrode locations by electromagnetic tracking system: The proposed head rotation method and comparison against optical system

Electroencephalogram (EEG) electrode digitization is crucial for accurate EEG source estimation, and several commercial systems are available for this purpose. The present study aimed to evaluate the digitizing accuracy of electromagnetic and optical systems. Additionally, we introduced a novel rotation method for the electromagnetic system and compared its accuracy with the conventional method of electromagnetic and optical systems. In the conventional method, the operator moves around a stationary participant to digitize, while the participant does not move their head or body. In contrast, in our proposed rotation method with an electromagnetic system, the operator rotates the participant sitting on a swivel chair to digitize in a consistent position. We showed high localization accuracy in both the optical and electromagnetic systems, with an average localization error of less than 3.6 mm. Comparisons of the digitization methods revealed that the electromagnetic system demonstrates superior digitizing accuracy compared to the optical system. Notably, the proposed rotational method is the most accurate among the three methods, which can be attributed to the consistent positioning of EEG electrode digitization within the electromagnetic field. Considering the affordability of the electromagnetic system, our findings provide valuable insights for researchers aiming for precise EEG source estimation.•The study compares the accuracy of electromagnetic and optical systems for EEG electrode digitization, introducing a novel rotation method for improved consistency and precision.•The electromagnetic system, especially with the proposed rotation method, achieves superior digitizing accuracy over the optical system.•Highlighting the cost-effectiveness and precision of the electromagnetic system with the rotation method, this research offers significant insights for achieving precise EEG source estimation.

A comprehensive quality assurance protocol for electromagnetic tracking in brachytherapy.

Electromagnetic tracking (EMT) systems have proven to be a valuable source of information regarding the location and geometry of applicators in patients undergoing brachytherapy (BT). As an important element of an enhanced and individualized pre-treatment verification, EMT can play a pivotal role in detecting treatment errors and uncertainties to increase patient safety. The purpose of this study is two-fold: to design, develop and test a dedicated measurement protocol for the use of EMT-enabled afterloaders in BT and to collect and compare the data acquired from three different radiation oncology centers in different clinical environments. A novel quality assurance (QA) phantom composed of a scaffold with supports to fix the field generator, different BT applicators, and reference sensors (sensor verification tools) was used to assess the precision (jitter error) and accuracy (relative distance errors and target registration error) of the EMT sensor integrated into an afterloader prototype. Measurements were repeated in different environments where EMT measurements are likely to be performed, namely an electromagnetically clean laboratory, a BT suite, an operating room, and, if available, a CT suite and an MRI suite dedicated to BT. The mean positional jitter was consistently under 0.1mm across all measurement points, with a slight trend of increased jitter at greater distances from the field generator. The mean variability of sensor positioning in the tested tandem and ring gynecological applicator was also below 0.1mm. The tracking accuracy close to the center of the measurement volume was higher than at its edges. The relative distance error at the center was 0.2-0.3mm with maximum values reaching 1.2-1.8mm, but up to 5.5mm for measurement points close to the edges. In general, similar accuracy results were obtained in the clinical environments and in all investigated institutions (median distance error 0.1-0.4mm, maximum error 1.0-2.0mm), however, errors were found to be larger in the CT suite (median distance error up to 1.0mm, maximum error up to 3.6mm). The presented quality assessment protocol for EMT systems in BT has demonstrated that EMT offers a high-accuracy determination of the applicator/implant geometry even in clinical environments. In addition to that, it has provided valuable insights into the performance of EMT-enabled afterloaders across different radiation oncology centers.

Automatic Diagnosis of Carotid Atherosclerosis Using a Portable Freehand 3-D Ultrasound Imaging System.

The objective of this study is to develop a deep-learning-based detection and diagnosis technique for carotid atherosclerosis (CA) using a portable freehand 3-D ultrasound (US) imaging system. A total of 127 3-D carotid artery scans were acquired using a portable 3-D US system, which consisted of a handheld US scanner and an electromagnetic (EM) tracking system. A U-Net segmentation network was first applied to extract the carotid artery on 2-D transverse frame, and then, a novel 3-D reconstruction algorithm using fast dot projection (FDP) method with position regularization was proposed to reconstruct the carotid artery volume. Furthermore, a convolutional neural network (CNN) was used to classify healthy and diseased cases qualitatively. Three-dimensional volume analysis methods, including longitudinal image acquisition and stenosis grade measurement, were developed to obtain the clinical metrics quantitatively. The proposed system achieved a sensitivity of 0.71, a specificity of 0.85, and an accuracy of 0.80 for diagnosis of CA. The automatically measured stenosis grade illustrated a good correlation ( r = 0.76) with the experienced expert measurement. The developed technique based on 3-D US imaging can be applied to the automatic diagnosis of CA. The proposed deep-learning-based technique was specially designed for a portable 3-D freehand US system, which can provide a more convenient CA examination and decrease the dependence on the clinician's experience.

Efficacy of navigation system-assisted distraction osteogenesis for hemifacial microsomia based on artificial intelligence for 3 to 18 years old: study protocol for a randomized controlled single-blind trial

BackgroundMandibular distraction osteogenesis (MDO) is a major part of the treatment for hemifacial microsomia patients. Due to the narrow surgical field of the intraoral approach, osteotomy accuracy is highly dependent on the surgeons’ experience. Electromagnetic (EM) tracking systems can achieve satisfying accuracy to provide helpful real-time surgical navigation. Our research team developed an EM navigation system based on artificial intelligence, which has been justified in improving the accuracy of osteotomy in the MDO in animal experiments. This study aims to clarify the effect of the EM navigation system in improving the MDO accuracy for hemifacial microsomia patients.MethodsThis study is designed as a single-centered and randomized controlled trial. Altogether, 22 hemifacial microsomia patients are randomly assigned to the experiment and control groups. All patients receive three-dimensional CT scans and preoperative surgical plans. The EM navigation system will be set up for those in the experiment group, and the control group will undergo traditional surgery. The primary outcome is the surgical precision by comparing the osteotomy position of pre- and postoperative CT scan images through the Geomagic Control software. The secondary outcomes include mandibular symmetry (occlusal plane deviation angle, mandibular ramus height, and body length), pain scale, and complications. Other indications, such as the adverse events of the system and the satisfactory score from patients and their families, will be recorded.DiscussionThis small sample randomized controlled trial intends to explore the application of an EM navigation system in MDO for patients, which has been adopted in other surgeries such as orthognathic procedures. Because of the delicate structures of children and the narrow surgical view, accurate osteotomy and protection of nearby tissue from injury are essential for successful treatment. The EM navigation system based on artificial intelligence adopted in this trial is hypothesized to provide precise real-time navigation for surgeons and optimally improve patient outcomes, including function and aesthetic results. The results of this trial will extend the application of new navigation technology in pediatric plastic surgery.Trial registrationChinese Clinical Trial Registry ChiCTR2200061565. Registered on 29 June 2022.

A magnetic resonance conditional robot for lumbar spinal injection: Development and preliminary validation.

This work presents the design and preliminary validation of a Magnetic Resonance (MR) conditional robot for lumbar injection for the treatment of lower back pain. This is a 4-degree-of-freedom (DOF) robot that is 200×230×130mm3 in volume and has a mass of 0.8kg. Its lightweight and compact features allow it to be directly affixed to patient's back, establishing a rigid connection, thus reducing positional errors caused by patient movements during treatment. To validate the positioning accuracy of the needle by the robot, an electromagnetic (EM) tracking system and a needle with an EM sensor embedded in the tip were used for the free space evaluation with position accuracy of 0.88±0.46mm and phantom mock insertions using the Loop-X CBCT scanner with target position accuracy of 3.62±0.92mm. Preliminary experiments demonstrated that the proposed robot showed improvements and benefits in its rotation range, flexible needle adjustment, and sensor protection compared with previous and existing systems, offering broader clinical applications.

Accuracy of an electromagnetic tracking enabled afterloader based on the automated registration with CT phantom images.

Electromagnetic tracking (EMT) has been researched for brachytherapy applications, showing a great potential for automating implant reconstruction, and overcoming image-based limitations such as contrast and spatial resolution. One of the challenges of this technology is that it does not intrinsically share the same reference frame as the patient's medical imaging. To present a novel phantom that can be used for a comprehensive quality assurance (QA) program of brachytherapy EMT systems and use this phantom to validate a novel applicator-based registration method of EMT and image reference frames for gynecological (GYN) interstitial brachytherapy. Eleven 6F-catheters (20cm long), one 6F round tip catheter (29.4cm long) and a tandem and ring gynecological applicator (Elekta, CT/MR 60°, 40mm long tandem, 30mm diameter ring) were placed in a rigid custom-made phantom (Elekta Brachytherapy, Veenendaal, The Netherlands) to reconstruct their geometry using a five-degree of freedom EMT sensor attached to an afterloader's check cable. All EMT reconstructions were done in three different environments: disturbance free (no metal nearby), computed tomography (CT)-on-rails brachytherapy suite and magnetic resonance imaging (MRI) brachytherapy suite. Implants were placed parallel to a magnetic field generatorand were reconstructed using two different acquisition methods: step-and-record and continuous motion. In all cases, the acquisition is performed at a rate of approximately 40Hz. A CT scan of the phantom inside a water cube was obtained. In the treatment planning system (TPS), all catheters in the CT images were manually reconstructed and the applicator reconstruction was achieved by manually placing its solid 3D model, found in the applicator library of the TPS. The Iterative Closest Point and the Coherent Point Drift algorithms were used, initialized with four known points, to register both EMT and CT scan reference frames using corresponding points from the EMT and CT based reconstructions of the phantom, following three approaches: one gynecological applicator, four interstitial catheters inside four calibration plates having an S-shaped path, and four 5mm diameter ceramic marbles found in each of the four calibration plates. Once registered, the registration error (perpendicular distance) was computed. The absolute median deviation from the expected value for EMT measurements in the disturbance free environment, CT-on-rails brachytherapy suite, and MRI-brachytherapy suite are 0.41, 0.23, and 0.31mm, respectively, while for the CT scan it is 0.18mm. These values significantly lie below the sensor's expected accuracy of 0.70mm (p<0.001), suggesting that the environment did not have a significant impact on the measurements, given that care is taken in the immediate surroundings. In all three environments, the two acquisitions and three registration approaches have mean and median registration errors that lie at or below 1mm, which is lower than the clinical acceptable threshold of 2mm. The novel phantom allowed to successfully evaluate the accuracy of EMT-based reconstructions of catheters and a GYN tandem and ring applicator in different clinical environments. A registration method based only on the applicator geometry, reconstructed withan EMT sensor and the TPS solid applicator library, was validated and shows clinically acceptable accuracy, comparable to CT-based reconstruction but within a few minutes. Since the applicator is also visible in MRI, this method could potentially be used in clinics in an EMT-MR interstitial GYN brachytherapy workflow.

A Passive Model-Based Error Compensation Approach for Bevel Tip Needle Deflection

The interaction between an asymmetric (bevel) tipped needle and the surrounding tissue in image-guided percutaneous interventions, such as in prostate needle biopsy, can result in the deflection of the needle tip and cause significant targeting error. Researchers have extensively investigated different aspects of the needle-tissue interaction and proposed various solutions to mitigate this issue. While there are several promising approaches, most require complex software or hardware which makes them difficult to be deployed for clinical use. In this paper, we present a predictive model-based approach to passively compensate for undesired deflection of the needle tip prior to the initial insertion into the tissue. In this approach, an approximation of the initial deflection angle of the needle tip and the natural curvature of the needle path are utilized to simulate the insertion and predict the tip deflection prior to insertion. The model then calculates a modified needle entry point which accounts for the predicted tip deflection during the insertion. To create the model, we first collected a set of needle insertion data utilizing nonhomogeneous gelatin phantoms and ex vivo bovine tissue, using an electromagnetic (EM) tracking system and a needle with an EM sensor embedded at its tip. The collected data were then used to find the model parameters, namely, the initial deflection angle and the needle path curvature. After creating the model, a validation study consisting of two sets of insertions, one with and another without compensation, was carried out to evaluate the performance of our proposed model in compensating for the tip deflection error. The results demonstrate an average of 77% targeting accuracy improvement for insertions with modified entry points based on our model’s prediction compared with the uncompensated insertions.

Comparison of synergy patterns between the right and left hand while performing postures and object grasps

The human hand, with many degrees of freedom, serves as an excellent tool for dexterous manipulation. Previous research has demonstrated that there exists a lower-dimensional subspace that synergistically controls the full hand kinematics. The elements of this subspace, also called synergies, have been viewed as the strategy developed by the CNS in the control of finger movements. Considering that the control of fingers is lateralized to the contralateral hemisphere, how the synergies differ for the control of the dominant and the non-dominant hand has not been widely addressed. In this paper, hand kinematics was recorded using electromagnetic tracking system sensors as participants made various postures and object grasps with their dominant hand and non-dominant hand separately. Synergies that explain 90% of variance in data of both hands were analyzed for similarity at the individual level as well as at the population level. The results showed no differences in synergies between the hands at both these levels. PC scores and cross-reconstruction errors were analyzed to further support the prevalence of similarity between the synergies of the hands. Future work is proposed, and implications of the results to the treatment and diagnosis of neuromotor disorders are discussed.

The effect of lateral collateral ligament repair tension on elbow stability: An in vitro biomechanical study

BackgroundThe aim of this study was to determine the optimal repair tension of the lateral collateral ligament of the elbow by performing simulated active flexion with the arm in the varus gravity loaded position using an in vitro elbow simulator. MethodsEight cadaveric specimens were mounted in the varus gravity loaded orientation onto an elbow motion simulator. Four states were studied (intact, lateral collateral ligament injured, and 15 N and 20 N lateral collateral ligament repairs) with the forearm in supination and pronation. An electromagnetic tracking system was used to measure joint kinematics during active elbow flexion. FindingsThere was no difference in ulnohumeral rotation between the intact state and the 15 N repair (P = .150 for pronation; P = 1.0 for supination) or the 20 N repair (P = 1.0 for pronation; P = .568 for supination). For varus-valgus angulation, the 20 N repair was not statistically different from the intact state (P = .059 in pronation; P = 1.0 in supination). InterpretationRepair of the lateral collateral ligament following injury can restore joint kinematics with the arm in the varus position. A repair tension of 20 N was successful in restoring joint stability for simulated active motion with the forearm in pronation and supination. This study shows that when the lateral collateral ligament is repaired with adequate tension, avoidance of the varus position may not be as crucial during early motion.

A Systematic Review of the Biomechanical Studies on Shoulder Kinematics in Overhead Sporting Motions: Types of Analysis and Approaches

The shoulder is a unique and complex joint in the human body with three bones and four joints, which makes it the most unstable joint in the body due to the amount of motion. To improve approaches toward understanding the performance of overhead throwing movements, this systematic review summarizes the type of analysis related to shoulder biomechanics involving overhead sporting motions. A search of seven databases identified 33 eligible studies, which were subsequently scored using the Modified Coleman Methodology Score scale. A total of nine articles from badminton, seven from baseball, five from volleyball, five from tennis, three from cricket, and one from softball were reviewed. All 33 studies evaluated shoulder kinematics and 12 of them also investigated the forces and torques (kinetics). The most common methods used were 3D motion analysis (76%), digital video cameras (15%), electromagnetic tracking system (6%), and finally 3% used IMU sensors. Overall, shoulder external rotation during the back swing, internal rotation, and elbow extension during the forward acceleration phase were the strongest predictors of high velocity overhead throwing movement. The findings provide some useful insights and guidance to researchers in their future contribution to the existing body of literature on shoulder overhead throwing movement biomechanics.

Endoscopic measurement of the size of gastrointestinal polyps using an electromagnetic tracking system and computer vision-based algorithm

PurposePolyp size is an important factor that may influence diagnosis and clinical management decision, but estimation by visual inspection during endoscopy is often difficult and subject to error. The purpose of this study is to develop a quantitative approach that enables an accurate and objective measurement of polyp size and to study the feasibility of the method.MethodsWe attempted to estimate polyp size and location relative to the gastro-oesophageal junction by integrating data from an electromagnetic tracking sensor and endoscopic images. This method is based on estimation of the three-dimensional coordinates of the borders of the polyp by combining the endoscope camera position and the corresponding points along the polyp border in endoscopic images using a computer vision-based algorithm. We evaluated the proposed method using a simulated upper gastrointestinal endoscopy model.ResultsThe difference between the mean of ten measurements of one artificial polyp and its actual size (10 mm in diameter) was 0.86 mm. Similarly, the difference between the mean of ten measurements of the polyp distance from the gastroesophageal junction and its actual distance (~ 22 cm) was 1.28 mm. Our results show that the changes in camera positions in which the images were taken and the quality of the polyp segmentation have the most impact on the accuracy of polyp size estimation.ConclusionThis study demonstrated an innovative approach to endoscopic measurements using motion tracking technologies and computer vision and demonstrated its accuracy in determining the size and location of the polyp. The observed magnitude of error is clinically acceptable, and the measurements are available immediately after the images captured. To enhance accuracy, it is recommended to avoid identical images and instead utilise control wheels on the endoscope for capturing different views. Future work should further evaluate this innovative method during clinical endoscopic procedures.

The role of an active muscular subsystem in prone instability test during rest and leg raise conditions.

Clinicians commonly used prone instability test (PIT) by assessing the posterior-to-anterior (PA) displacement to identify lumbar instability. Most studies focusing on passive subsystem found greater mobility in lower lumbar (L4-L5) than upper lumbar (L1-L3) spine. However, there is still a lack of evidence to demonstrate the role of active subsystem. Additionally, it is unclear whether sex affects PA displacements. To determine differences in displacement among five lumbar segments, between two testing positions (rest and leg raise), and between male and female during PIT in individuals with chronic non-specific low back pain (CNLBP). A cross-sectional study design. Spine biomechanics laboratory. Individuals with CNLBP. An electromagnetic tracking system was used to measure PA displacement with sensors attached at T12, S2 and a hand-held dynamometer. Participants were asked to perform PIT, while a 100N force was applied to each lumbar segment during resting and leg raise positions. Significantly less PA displacement (P<0.05) was seen in lower compared to upper lumbar spine and in leg raise compared to rest at L1 to L4. No significant interaction of sex with different lumbar levels and conditions (P>0.05) during PIT was found. Although previous studies have reported that the lower lumbar spine had greater mobility, the lower amount of displacement during the rest position suggests the role of an active subsystem contributing to lumbar stability regardless of sex. A reduction in displacement during the leg raise position across L1 to L4 suggesting an interaction of stabilizing subsystems of the spine to provide lumbar stability.

Magnetic Model Calibration and Distortion Compensation for Electromagnetic Tracking in a Clinical Environment

Electromagnetic tracking (EMT) of surgical tools is used for image-guided navigation in minimally invasive interventions. Calibration of the tracker position and orientation is a fundamental task to correct systematic errors. This article explores the effect of metallic distortion on the open hardware Anser EMT system and describes a newly developed approach for volume calibration of the magnetic field model. The technique is also applied to effectively map the field in the presence of magnetic shields that can be used to reduce electromagnetic distortions passively. Unlike calibration techniques commonly found in literature, which aim to correct the tracking position error, our method can reconstruct an analytical magnetic field model starting from a reduced amount of scattered data. This way, a faster convergence of the solver algorithm is obtained, and EMT position and orientation errors are inherently corrected. The new modelling technique was applied to generate a new, undistorted magnetic field model for Anser EMT, to demonstrate the effectiveness of passive shielding, and to compensate for the distortion introduced by a commercial fluoroscopy C-arm. Furthermore, the concept of a real-time distortion compensation technique is expressed based on the modelling method presented in this article. For all the experiments, sub-millimeter errors were obtained after calibration, which may meet the needs of most endoscopic and surgical navigation tasks.

Analysis and optimization of surgical electromagnetic tracking systems by using magnetic field gradients

Background: Electromagnetic tracking systems (EMTSs) are widely used in surgical navigation, allowing to improve the outcome of diagnosis and surgical interventions, by providing the surgeon with real-time position of surgical instruments during medical procedures. Objective: the main goal is to improve the limited range of current commercial systems, which strongly affects the freedom of movement of the medical team. Studies are currently being conducted to optimize the magnetic field generator (FG) configuration (both geometrical arrangements and electrical properties) since it affects tracking accuracy. Methods: In this paper, we discuss experimental data from an EMTS based on a developed 5-coils FG prototype, and we show the correlation between position tracking accuracy and the gradients of the magnetic field. Therefore, we optimize the configuration of the FG by employing two different metrics based on i) the maximization of the amplitude of the magnetic field as reported in literature, and ii) the maximization of its gradients. Results: The two optimized configurations are compared in terms of position tracking accuracy, showing that choosing the magnetic field gradients as objective function for optimization leads to higher position tracking accuracy than maximizing the magnetic field amplitude.

The effect of joint orientation on passive movement of the dog's stifle.

The cranial cruciate ligament (CCL) is one of numerous structures which determine the path of the tibia relative to the femur when passively flexing/extending the stifle of the dog. The effect of cutting the CCL on passive motion with the hind limb in different orientations, is unknown. The aim of this study was to describe passive movement of the tibia relative to the femur in dogs, with the hind limb in three different orientations, and with CCL intact and cut. Ten cadaveric hind limbs were obtained from dogs weighing between 20 kg and 25 kg and prepared for testing in a custom-built joint testing machine. Each hind limb was tested in three different orientations with data collected, using an electromagnetic tracking system, during 2 cycles of flexion/extension with the CCL intact and cut. Each cycle was initiated with the stifle in full extension (0°) and data was collected at 0°, 20°, 30°, 40°, 45°, and 55° of stifle flexion/extension. Flexion of the stifle resulted in caudal translation and internal rotation of the tibia relative to the femur, with cranial translation and external rotation occurring during extension along the identical path. Cutting the cranial cruciate ligament did not result in significant differences in translation or rotation when the stifle was orientated to approximated the standing position of a dog. Isometric points at the origin and insertion of the CCL can potentially be identified in CCL deficient stifles using a technique based on passive motion of an intact stifle.

Scapular Resting Posture and Scapulohumeral Rhythm Adaptations in Volleyball Players: Implications for Clinical Shoulder Assessment in Athletes.

Volleyball players develop shoulder sports-related adaptations due to repetitive overhead motions. It is essential to differentiate between these sports-related adaptations and pathological patterns in clinical assessments, particularly on scapular resting posture and scapulohumeral rhythm. Using an electromagnetic tracking system, the 3D shoulder kinematics of 30 male elite asymptomatic volleyball players and a matching control group were recorded at rest and in eight humeral elevation positions, in 15-degree increments from 15 to 120 degrees. The results indicated that the dominant scapular resting posture of the volleyball group was more anteriorly tilted than the control group (Volleyball: mean = -12.02°, STD = 4.16°; Control: mean = -7.45°, STD = 5.42°; Mean difference = 4.57°; STD = 6.85°; CI95% = 2.1° to 7.1°). The scapulohumeral rhythm in the volleyball group showed greater scapular internal rotation (Volleyball: mean = 41.60°, STD = 9.14°; Control: mean = 35.60°, STD = 6.03°; mean difference = 6.02°, STD = 1.47°; CI95% = 4.80° to 7.25°) and anterior tilt (Volleyball: mean = -9.10°, STD = 5.87°; mean = -2.3°, STD = 9.18°; mean difference = 6.88°, STD = 0.66°; CI95% = 6.34° to 7.43°). These findings suggest that volleyball players have developed a sports-related scapular adaptive pattern. This information may be valuable for clinical assessment and rehabilitation planning in injured volleyball players and may aid in the decision-making process for determining a safe return-to-play after a shoulder injury.

Comparison of Peak Shoulder Distraction Forces Between Pain and Pain-Free Youth Baseball Pitchers.

Increased shoulder distraction force during a baseball pitch may make a pitcher susceptible to rotator cuff or glenohumeral labral injuries. A precursor to a pitching injury may be pain experienced in the throwing arm. To (1) compare peak shoulder distraction (PSD) forces in youth baseball pitchers with and without upper extremity pain when throwing a fastball and (2) assess if PSD forces across trials differ between pain and pain-free groups. Controlled laboratory study. A total of 38 male baseball pitchers aged 11 to 18 years were separated into a pain-free group (n = 19; mean age, 13.2 ± 1.7 years; mean height, 163.9 ± 13.5 cm; mean weight, 57.4 ± 13.5 kg) and a pain group (n = 19; mean age, 13.3 ± 1.8 years; mean height, 164.9 ± 12.5 cm; mean weight, 56.7 ± 14.0 kg). Pitchers in the pain group indicated that they experienced pain in their upper extremity while throwing a baseball. Pitching mechanical data from 3 fastballs per pitcher were recorded with an electromagnetic tracking system and motion capture software. The mean PSD (mPSD) was calculated as the mean PSD of 3 pitches per pitcher, the trial with the highest recorded PSD was determined as the maximum-effort PSD (PSDmax), and the PSD range (rPSD) was defined as the difference of the PSD force of the trial with the highest PSD and the lowest PSD for each pitcher. The PSD force was normalized to the pitcher's body weight (%BW). Pitch velocity was also recorded. The mPSD force was 114%BW ± 36%BW for the pain group and 89%BW ± 21%BW for the pain-free group. Pitchers in the pain group exhibited a significantly higher PSDmax force (t30.548 = 2.894; P = .007) and mPSD force (t29.231 = 2.709; P = .009) compared with those in the pain-free group. There were no significant between-group differences in the rPSD force or pitch velocity. The normalized PSDmax force was higher in pitchers who experienced pain while throwing fastballs compared with pitchers who were pain-free while throwing. Baseball pitchers who experience pain in their throwing arm are likely to have higher shoulder distraction forces. Improvement in pitching biomechanics and corrective exercises may assist in the mitigation of pain while pitching.

Recovery of the shoulder kinematics after reverse shoulder arthroplasty

BackgroundThere is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure. MethodsNineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months. FindingsMaximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05). InterpretationShoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.