• Biomechanical evaluation of ph...

Treffer: Biomechanical evaluation of physical examination tests for rotator cuff tears: a computer simulation study.

Title:
Biomechanical evaluation of physical examination tests for rotator cuff tears: a computer simulation study.
Authors:
Menze J; Faculty of Medicine, School of Precision and Biomedical Engineering, University of Bern, Bern, Switzerland; Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland., Rojas JT; Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile., Zumstein MA; Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia. Electronic address: matthiaszumstein@sonnenhof.ch., Ferguson SJ; Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland., De Pieri E; Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland., Gerber K; Faculty of Medicine, School of Precision and Biomedical Engineering, University of Bern, Bern, Switzerland.
Source:
Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2025 Jun; Vol. 34 (6), pp. 1574-1582. Date of Electronic Publication: 2024 Dec 14.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Mosby Country of Publication: United States NLM ID: 9206499 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-6500 (Electronic) Linking ISSN: 10582746 NLM ISO Abbreviation: J Shoulder Elbow Surg Subsets: MEDLINE
Imprint Name(s):
Publication: St. Louis, MO : Mosby
Original Publication: St. Louis, MO : Mosby Yearbook, Inc., c1992-
MeSH Terms:
Rotator Cuff Injuries* , Physical Examination*/methods , Computer Simulation* , Tendon Injuries*/diagnosis , Tendon Injuries*/physiopathology, Humans ; Biomechanical Phenomena ; Rotator Cuff/physiopathology ; Male ; Female
Contributed Indexing:
Keywords: Shoulder; computational biomechanics; diagnosis; musculoskeletal modeling; physical examination; rotator cuff tear
Entry Date(s):
Date Created: 20241215 Date Completed: 20250512 Latest Revision: 20250512
Update Code:
20250512
DOI:
10.1016/j.jse.2024.09.050
PMID:
39675660
Database:
MEDLINE

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Background: Numerous physical diagnostic shoulder tests have been established to determine the presence of rotator cuff tears and to identify the affected muscles. However, reported sensitivities and specificities of these tests vary strongly. The aim of this study was to identify diagnostic postures that are biomechanically most sensitive in identifying rotator cuff lesions and compensation mechanisms.
Methods: A musculoskeletal modeling study investigating muscle activity in healthy shoulders as well as in shoulders with anterior, superior, and posterosuperior rotator cuff tear patterns, was conducted. Muscle moment arms and muscle synergism for the Lift-off and Bear Hug tests, Jobe and Full-can tests, and Infraspinatus and Hornblower tests were compared for healthy and pathological models.
Results: In a healthy model the Lift-off test showed significantly higher subscapularis activity compared to the Bear Hug test (P < .001). Teres minor and infraspinatus activity were threefold and twofold higher, in the Hornblower than the Infraspinatus test, respectively. In superior tests, supraspinatus activity was more than twofold lower than lateral deltoid activity and synergistic activity increase was smallest (Δ 1%-3% in deltoid). Activity increase was highest in posterosuperior tests for the teres minor with 66.4% activity increase in the Infraspinatus test (P < .001) and 81.3% increase in the Hornblower test (P < .001).
Conclusions: The Lift-off test was significantly more sensitive in detecting subscapularis tears and the Hornblower test was more effective in assessing teres minor integrity in posterosuperior tears. Both, Jobe and Full-can tests demonstrated low biomechanical sensitivity in the detection of superior rotator cuff tears.
(Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)