1. Suprascapular Nerve Block Disrupts The Normal Pattern Of Scapular Kinematics Sean McCully David Suprak Peter Kosek Andrew Karduna

2. Rotator Cuff Tears Incidence as high as 40% for people 40 years and older Disruption of motion between the scapula and humerus, may result in alterations in: - muscle moment arms - compression of cuff tendons - joint stability

3. Pathology of Cuff Tears Majority start with supraspinatus tendon Next most commonly involved is the infraspinatus tendon supraspinatus infraspinatus

4. Models of Cuff Tear or Dysfunction Animal models injection of collagenase (Soslowsky et al, 2002) injection of carrageenan (Tillander et al, 2001) Cadaver models surgical simulation of tears (Parsons et al., 2002) simulated paralysis (Sharkey et al., 1994) In-vivo models muscle fatigue (Ebaugh et al., 2005)

5. Suprascapular Nerve superior trunk of brachial plexus passes through suprascapular notch innervates supraspinatus and infraspinatus

6. Suprascapular Nerve Block Performed clinically for pain relief due to arthritis, frozen shoulder and operations Used in biomechanical studies of: Strength Colachis and Strohm, 1971; Howell et al, 1986; Kuhlman et al, 1992 Glenohumeral Kinematics Howell et al, 1991

8. Purpose Investigate the use a suprascapular nerve block as an model of dysfunction of the supraspinatus and infraspinatus.

9. Protocol 15 healthy subjects (mean age 26 years) Baseline kinematics and force Suprascapular nerve block Repeat kinematics and force

10. KINEMATICS ISB recommendation (Wu et al, 2005)

11. Polhemus 3Space Fastrak electronics unit digitizer sensors transmitter

12. Scapular Tracker sensor

13. Method Validation bone sensor skin sensor

14. Sensor Placement humerus scapula thorax transmitter

15. Scapular Rotations Retraction/Protraction Anterior/Posterior Tilting Lateral/Medial Rotation

16. Clavicular Rotations Retraction/ProtractionElevation/Depression

17. ISOMETRIC FORCE External rotation with arm at the side Data recorded with a load cell At this position, 75% of external rotation torque comes from infraspinatus and supraspinatus (Kuechle et al, 2000)

18. NERVE BLOCK 100 mg of lidocaine Injected into the suprascapular notch Nerve stimulator to confirm needle placement Data collection 10 minutes after injection

20. scapular tracker needle stimulation wire lidocaine injection

21. Subject Inclusion Threshold of 50% reduction in external rotation force (Colachis and Strohm, 1971) 4 subjects did not meet criterion Additional subject excluded due to inability to lift arm n=10 for statistical analysis

22. Results No effect on clavicular rotation No effect on scapular posterior tilting Significant effect for scapular internal rotation and upward rotation

23. Internal Rotation

24. Upward Rotation

26. Nerve Block Cuff TearsFatigue

27. Discussion Results support use of model Although the supraspinatus and infraspinatus do not directly control the movement of the scapula, they appear to indirectly affect the scapulothoracic rhythm.

28. Limitations Assessment of successful block Proprioception Young subjects

29. What does this mean? A)Results similar to cuff tears Scapular changes due to tears are compensatory and represent an alternative method for arm elevation

30. What does this mean? B)Results similar to fatigue Scapular changes during to repetitive motion are due to fatigue of the rotator cuff muscles and may lead to cuff tears

31. What does this mean? C)What is going on in the subacromial space? increase upward rotation