A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading

Abstract

Background: The Critical Shoulder Angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA. Methods: An inverse dynamics three-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane, and slow and fast forward flexion measured by a 3D motion capture system were used to quantify joint reaction shear and compressive forces. Results: Increasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; p<0.05). Reducing CSA results in increased latero-medial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion; p<0.01). Discussion/Conclusion: Changes in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that would contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces which contribute to joint wear.