Stiffness Regulation and Muscle-Recruitment Strategies of the Shoulder in Response to External Rotation Perturbations

Huxel, Kellie C.; Swanik, C. Buz; Swanik, Kathleen A.; Bartolozzi, Arthur R.; Hillstrom, Howard J.; Sitler, Michael R.; Moffit, Dani M.
January 2008
Journal of Bone & Joint Surgery, American Volume;Jan2008, Vol. 90-A Issue 1, p154
Academic Journal
Background: The complex interactions between capsuloligamentous structures and muscle-recruitment strategies that maintain glenohumeral stability remain unclear. The purposes of the present study were to determine whether stiffness regulation and muscle-activation strategies differed under varying joint positions and levels of contraction in the shoulder and to determine the relationship between generalized joint laxity, glenohumeral joint laxity, and joint stiffness. Methods: Forty healthy, physically active subjects with a mean age (and standard deviation) of 25.2 ± 4.6 years, a mean height of 174.7 ± 6.7 cm, and a mean mass of 73.1 ± 13.8 kg were tested. Shoulder stiffness and the activation of muscles (including the rotator cuff and the anterior deltoid) were measured at two levels of internal rotation torque (0% and 50% of maximum) and two joint positions (0° and 90% of maximum external rotation) before and after a 5° external rotation perturbation. Generalized laxity and glenohumeral joint laxity (in the anterior, posterior, and inferior directions) were also assessed. Results: Stiffness was 77% greater at 50% of maximum internal rotation torque than at 0% of maximum internal rotation torque (p < 0.001) but was not significantly different between joint positions (p = 0.73). From 0% to 50% of maximum internal rotation torque, preparatory and reactive recruitment of the subscapularis increased significantly more (p < 0.05) than those of the other muscles. Also, subscapularis preparatory activity was 36% greater in 0° of external rotation than in 90% of maximum external rotation (p < 0.01). Generalized joint laxity (as indicated by a score of ≥4) was present in 20% of the subjects. Glenohumeral joint laxity (as indicated by a grade of ≥2) was present in the anterior, posterior, and inferior directions in 13%, 15%, and 15% of the subjects, respectively. No correlation existed between passive stiffness and generalized or glenohumeral laxity (r = -0.12 to 0.29; p = 0.08 to 0.48). Conclusions: Moderate levels of muscle contraction can significantly increase glenohumeral joint stiffness and stability. Preactivation of the subscapularis appears to be the primary dynamic stabilizer with the arm in 0° of external rotation. However, with the arm in 90% of maximum external rotation (the apprehension position), less subscapularis activity is observed and the maintenance of stability may shift toward other musculoskeletal structures because joint stiffness does not change. A relationship between generalized joint laxity, glenohumeral laxity, and stiffness was not observed in healthy subjects. Clinical Relevance: Clinically, healthy populations have comparable levels of stiffness, or joint stability, in 0° of external rotation and in 90% of maximum external rotation (the apprehension position).


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