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Motion of the Shoulder Complex During Multiplanar Humeral Elevation
Paula M. Ludewig, PT, PhD1; Vandana Phadke, BPT1; Jonathan P. Braman, MD2; Daniel R. Hassett, PT1; Cort J. Cieminski, PT, PhD, ATC, CSCS1; Robert F. LaPrade, MD, PhD2
1 Department of Physical Medicine and Rehabilitation, University of Minnesota, MMC 388, 420 Delaware Street S.E., Minneapolis, MN 55455. E-mail address for P.M. Ludewig: ludew001@umn.edu
2 Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institute of Child Health and Human Development (NIH grant #K01HD042491). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institute of Child Health and Human Development or the National Institutes of Health.
Investigation performed at the Orthopaedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Feb 01;91(2):378-389. doi: 10.2106/JBJS.G.01483
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Background: Many prior studies have evaluated shoulder motion, yet no three-dimensional analysis comparing the combined clavicular, scapular, and humeral motion during arm elevation has been done. We aimed to describe and compare dynamic three-dimensional motion of the shoulder complex during raising and lowering the arm across three distinct elevation planes (flexion, scapular plane abduction, and coronal plane abduction).

Methods: Twelve subjects without a shoulder abnormality were enrolled. Transcortical pin placement into the clavicle, scapula, and humerus allowed electromagnetic motion sensors to be rigidly fixed. The subjects completed two repetitions of raising and lowering the arm in flexion, scapular, and abduction planes. Three-dimensional angles were calculated for sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joint motions. Joint angles between humeral elevation planes and between raising and lowering of the arm were compared.

Results: General patterns of shoulder motion observed during humeral elevation were clavicular elevation, retraction, and posterior axial rotation; scapular internal rotation, upward rotation, and posterior tilting relative to the clavicle; and glenohumeral elevation and external rotation. Clavicular posterior rotation predominated at the sternoclavicular joint (average, 31°). Scapular posterior tilting predominated at the acromioclavicular joint (average, 19°). Differences between flexion and abduction planes of humerothoracic elevation were largest for the glenohumeral joint plane of elevation (average, 46°).

Conclusions: Overall shoulder motion consists of substantial angular rotations at each of the four shoulder joints, enabling the multiple-joint interaction required to elevate the arm overhead.

Clinical Relevance: Improved knowledge of the normal motion of the shoulder during humeral elevation will improve the assessment of patients with shoulder motion abnormalities, planning for rehabilitation programs, and performance of stabilization procedures.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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