Three-dimensional evaluation of the transverse rotator cuff muscle's resultant force angle in relation to scapulohumeral subluxation and glenoid vault morphology in nonpathological shoulders.

BACKGROUND: Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling.

METHODS: Computed tomography scans of 55 trauma patients (age 31±13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3D. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector (RFV) direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The RFV was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated.

RESULTS: The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4±4.5°, 54.3±4.8%, -4.1±4.4°, 5.1±10.8°, 3.3±0.6 mm, 20±2 mm, and 33.6±4.6 mm, respectively. The TRFA correlated strongly with SHSI (R=0.731, p<0.001) and GVA (R=0.716, p<0.001) and moderately with GOA (R=0.663, p<0.001). The SHSI was strongly negatively correlated with GVA (R=-0.813, p<0.001) and moderately with GOA (R=-0.552, p<0.001). The GVA correlated strongly with GOA (R=0.768, p<0.001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius.

CONCLUSION: Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset.