Considering the lack of consensus, we feel these mechanisms merit additional focus and research. LD transfer changes shoulder anatomy and thus affects the complex interplay in the glenohumeral and scapulothoracic joints. So far, no study has been…
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Source
Brief title
Condition
- Tendon, ligament and cartilage disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The following primary study endpoints will be obtained for both the patient
group and the control group.
With the use of the Flock-of Birds method at the READE Centre, we will measure
3 actively performed ROM tasks: (1) elevation in the sagittal plane (forward
flexion), (2) abduction in the scapular plane (elevation), and (3) internal and
external rotation of the arm with 90° of abduction in scapular plane (axial
rotation). Patients will be instructed to reach a maximal joint angle in each
active ROM task.
In addition, patients will perform several ADL tasks, such as grasping a cup,
combing their hair, and scratching their back. All ROM and ADL tasks will be
performed twice, and at the subject*s own pace.
For each active ROM task, we will calculate 3 different motions: (1) the motion
of the scapula relative to the thorax (ie, scapulothoracic motion), (2) the
motion of the humerus relative to the thorax (ie, thoracohumeral motion), and
(3) the motion of the humerus to the scapula (ie, glenohumeral motion).
All motions are expressed in joint angles defined using the International
Society of Biomechanics standardization proposal of the International Shoulder
Group. The difference between the thoracohumeral and glenohumeral angles
reflects the contribution of scapular motion to the movement of the arm.
Secondary outcome
The following secondary study endpoints will be obtained for both the patient
group and the control group:
(1) Muscle activity of a selection of shoulder muscles will be recorded with
the use of surface EMG (Delsys Trigno Wireless, Delsys Inc., Boston, USA).
Muscle activation patterns will be quantified by EMG amplitudes (normalized by
1 kg isometric contractions) and relative timing of different muscles.
(2) Abduction and external rotation strength quantified in Newton will be
measured with a hand-held dynamometer.
The following secondary study endpoints will be obtained for only the patient
group:
(1) Amount of pain in the shoulder during the 3 actively performed ROM tasks
will be noted and quantified according to VAS.
(2) All transfers, subscapularis and teres minor muscles will be visualized by
MRI imaging. A musculoskeletal radiologist at the OLVG will evaluate these
images and assess the degree of atrophy and fatty infiltration according the
classification of Goutallier.
(3) Ultrasound will be used to (a) assess actual movement of the LD transfer
before and after the muscular interval through which the transfer is being
pulled, namely between the teres major muscle and the long head muscle of the
triceps, and (b) visualize the LD and the subcapularis tendon and assess its
integrity and possible ruptures. These observations and classifications will be
done by a musculoskeletal radiologist at the OLVG.
(4) A standardized X-ray of the operated shoulder will be made at the OLVG and
will be classified according the Hamada classification for cuff tear
arthropathy by the coordinating and principal investigator.
(5) Different shoulder scores and PROMS will be obtained: Constant Scores,
Simple Shoulder Test scores, Oxford Shoulder Scores and the DASH.
Background summary
Transfer of the latissimus dorsi (LD) is gaining popularity as a treatment of
patients with irreparable postero-superior rotator cuff tears without
degeneration of the glenohumeral joint. LD transfer provides overall functional
improvement and pain relief, but some patients do better than others. The
working mechanisms to success or failure are not well understood yet. It is
suggested that the LD after transfer primarily acts as a new external rotator
and as a suppressor of the humeral head. Others claim that the transfer
primarily provides a tenodesis effect, resulting in a more sufficient balancing
of the glenohumeral joint while enabling other shoulder muscles to replace the
dysfunctioning rotator cuff. Despite encouraging results, a return to full
normal active function or strength cannot be expected and some patients have
poor results. Which ones do well and which ones do not, we do not know and both
the mechanisms to success or failure are not fully understood.
Study objective
Considering the lack of consensus, we feel these mechanisms merit additional
focus and research. LD transfer changes shoulder anatomy and thus affects the
complex interplay in the glenohumeral and scapulothoracic joints. So far, no
study has been performed to evaluate the kinematic pattern after LD transfer.
Therefore, we propose this study that aims to gain insight in 3D kinematics and
muscle activation patterns after LD transfer, that may explain its clinical
improvements in patients >1 year after LD transfer. In addition, we aim to
identify which anatomical and patient characteristics may contribute to the
functional and clinical outcome of the LD transfer.
Study design
The study will be designed as an observational case-control study.
Study burden and risks
Risks and Burden
The burden for participants is to visit 2 different centres for non-invasive
kinematic analysis (READE) and physical and radiological examination (OLVG).
The control group will only visit the READE institution for Flock-of-Bird
measurements. The additional radiation dose per shoulder X-ray (10µSV), that is
to be made for inclusion purposes, is comparable to the background radiation
that an average person receives on one normal day. Furthermore, as a result of
the EMG measurements which are being applied to the patients shoulder regios
with sticky patches, patients will be informed on possible skin irritation and
muscle aches after the various measurements.
Our research objectives cannot be achieved without this specific group of
patients who have undergone LD transfer.
Oosterpark 9
Amsterdam 1091 AC
NL
Oosterpark 9
Amsterdam 1091 AC
NL
Listed location countries
Age
Inclusion criteria
Patients can be included if they underwent a LD transfer after massive postero-superior rotator cuff tears (ruptured infra- and supraspinatus) with no osteoarthritis with a minimal follow-up of 1 year.
Exclusion criteria
Patients are excluded from this study in case of severe osteoarthritis of the shoulder or if they underwent any shoulder surgery before the LD transfer in the past.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL50263.100.16 |