Coordination in the Arm after a Rotator Cuff Tear in the Elderly

Introduction: Individuals with rotator cuff tears have been found to compensate in their movement patterns by using lower thoracohumeral elevation angles during certain tasks, as well as increased internal rotation of the shoulder (Vidt et al., 2016). Leading joint hypothesis suggests there is one leading joint that creates the foundation for the entire limb motion, and there are other subordinate joints which monitor the passive interaction torque and create a net torque aiding to limb motions required for the task. This experiment seeks to establish a better understanding of joint control strategies during a wide range of arm movements. Based on the leading joint hypothesis, we hypothesize that when a subject has a rotator cuff tear, their performance of planar and three-dimensional motions should be altered not only at the shoulder, which is often the leading joint, but also at other joints on the arm, such as the elbow and wrist. This paper will focus on the effect of normal aging on the control of the joints of the arm.
Methods: There were 4 groups of participants: healthy younger adults (n=14)(21.74 ± 1.97), healthy older adults (n=12)(55-75), older adults (n=4)(55-75) with a partial-thickness rotator cuff tear, and older adults (n=4)(55-75) with a full-thickness rotator cuff tear (RCT). All four groups completed strength testing, horizontal drawing and pointing tasks, and three dimensional (3D) activities of daily living. Kinematic and kinetic variables of the arm were obtained during horizontal and 3D tasks using data from 12 reflective markers placed on the arm, 8 motion capture cameras, and Cortex motion capture software (Motion Analysis Corp., Santa Rosa, CA). Strength testing tasks were measured using a dynamometer. All strength testing and 3D tasks were completed for three trials and horizontal tasks were completed for two trials.
Results: Results of the younger adult participants showed that during the forward portion of seven 3D tasks, there were four phases of different joint control mechanics seen in a majority of the movements. These phases included active rotation of both the shoulder and the elbow joint, active rotation of the shoulder with passive rotation of the elbow, passive rotation of the shoulder with active rotation of the elbow, and passive rotation of both the shoulder and the elbow. Passive rotation during movements was a result of gravitational torque on the different segments of the arm and interaction torque caused as a result of the multi-joint structure of human limbs. The number of tested participants for the minor RCT, and RCT older adults groups is not yet high enough to produce significant results and because of this their results are not reported in this article. Between the older adult control group and the young adult control group in the tasks upward reach to eye height and hair comb there were significant differences found between the groups. The differences were found in shorter overall time and distance between the two groups in the upward eye task.
Discussion: Through the available results, multiple phases were found where one or both of the joints of the arm moved passively which further supports the LJH and extends it to include 3D movements. With available data, it can be concluded that healthy older adults use movement control strategies, such as shortening distance covered, decreasing time percentage in active joint phases, and increasing time percentage in passive joint phases, to account for atrophy along with other age-related declines in performance, such as a decrease in range of motion. This article is a part of a bigger project which aims to better understand how older adults with RCTs compensate for the decreased strength, the decreased range of motion, and the pain that accompany this type of injury. It is anticipated that the results of this experiment will lead to more research toward better understanding how to treat patients with RCTs.