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Excursion of the Rotator Cuff Under the Acromion

Patterns of Subacromial Contact

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Louis J. Soslowsky, PhD

Orthopaedic Research Laboratories, the University of Michigan, Ann Arbor, Michigan

Jonathan B. Ticker, MD

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Robert J. Pawluk, MS

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Matthew Hepler, MD

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Jon Ark, MD

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Van C. Mow, PhD

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Louis U. Bigliani, MD

Orthopaedic Research Laboratory, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Nine fresh-frozen, human cadaveric shoulders were el evated in the scapular plane in two different humeral rotations by applying forces along action lines of rotator cuff and deltoid muscles. Stereophotogrammetry deter mined possible regions of subacromial contact using a proximity criterion; radiographs measured acromio humeral interval and position of greater tuberosity. Con tact starts at the anterolateral edge of the acromion at 0° of elevation; it shifts medially with arm elevation. On the humeral surface, contact shifts from proximal to dis tal on the supraspinatus tendon with arm elevation. When external rotation is decreased, distal and poste rior shift in contact is noted. Acromial undersurface and rotator cuff tendons are in closest proximity between 60° and 120° of elevation; contact was consistently more pronounced for Type III acromions. Mean acro miohumeral interval was 11.1 mm at 0° of elevation and decreased to 5.7 mm at 90°, when greater tuberosity was closest to the acromion. Radiographs show bone- to-bone relationship; stereophotogrammetry assesses contact on soft tissues of the subacromial space. Con tact centers on the supraspinatus insertion, suggesting altered excursion of the greater tuberosity may initially damage this rotator cuff region. Conditions limiting ex ternal rotation or elevation may also increase rotator cuff compression. Marked increase in contact with Type III acromions supports the role of anterior acromioplasty when clinically indicated, usually in older patients with primary impingement.

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