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Biomechanics & Motion

Elbow biomechanics: UCL function under valgus stress, rotational axis, and instability patterns relevant to sports injuries.

Overview

Elbow lateral collateral ligament injuries benefit from active motion over passive motion during rehabilitation to reduce instability [1]. For symptomatic rotator cuff tears, improvement in kinematic changes is a key determinant of successful conservative treatment [2]. In contrast, patient-estimated range of motion is not a reliable tool for assessing outcomes due to significant differences from measured values [4].

Three-dimensional analysis of elbow soft tissue footprints and anatomy provides information that may aid in restoring elbow biomechanics and preserving range of motion [8]. Significant kinematic differences exist between fastball, changeup, curveball, and dropball pitch types in collegiate softball pitchers, which may be necessary to execute desired pitch outcomes [19]. Further research is needed to define a precise motion analysis protocol for multi-segmental kinematics of the thoracolumbar spine in terms of segment definition and clinical relevance [20].

Available biomechanical evidence regarding subscapularis repair in reverse total shoulder arthroplasty is limited, and further studies are needed [5]. All movement planes show significant differences in simulated range of motion when comparing preoperative planning protocols with and without adjustment for posture in reverse total shoulder arthroplasty [12]. Implant designs that create a more lateralized center of rotation are associated with increased total range-of-motion in reverse shoulder arthroplasty [64].

Clinical and biomechanical studies suggest minimal changes in glenohumeral range of motion following arthroscopic remplissage for anterior shoulder instability, though strong conclusions are limited by heterogeneity in reporting and lack of comparative studies [47]. Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty [63]. Understanding the consequences of implant head shape in total shoulder arthroplasty may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes [63].

Anatomy & Pathophysiology

Kinematics

Scapular kinematics in symptomatic subjects are multifactorial [3]. In the elbow, sagittal and rotational motions exhibit a weak relationship yet both significantly influence upper limb function [7]. The carrying angle of the forearm remains constant as the elbow flexes [52]. Elbow and shoulder kinetics increase with time, particularly after age 13 [22]. Small but significant asymmetries exist between the dominant and nondominant shoulders in terms of kinematics [50].

Elbow position affects distal radioulnar joint kinematics, which are primarily affected by forearm rotation and secondarily by elbow flexion [32]. Alterations in elbow kinematics deviate increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius [16]. Placement of a distal humeral hemiarthroplasty implant causes a small but significant alteration in elbow joint kinematics, regardless of implant size [48].

In youth baseball pitchers, increasing pitch count is associated with increasing elbow flexion angle at ball release [45]. Five kinematic parameters during the stride phase and their combination were associated with peak elbow varus torque [41]. Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns [44]. Pitch velocity was the most influential variable in predicting pitching arm kinetics, but pitching mechanics also significantly influenced both elbow and shoulder stress [49].

Classification

Elbow LCL Instability: Active motion reduces instability in elbow lateral collateral ligament injuries compared with passive motion [1].

Reverse Total Shoulder Arthroplasty (RTSA) Planning: Available biomechanical evidence regarding subscapularis repair in reverse total shoulder arthroplasty is limited [5]. Simulated range of motion shows significant differences across all movement planes when protocols include or exclude adjustment for posture in reverse total shoulder arthroplasty preoperative planning [12].

Throwing Mechanics & Injury Mechanisms: Specific aspects of the throwing motion place athletes at risk for injury [9]. Decreased rotational motion in adolescent and Little League baseball players may cause increased stress at the physis during throwing [14]. Significant kinematic differences exist between fastball, changeup, curveball, and dropball pitch types in collegiate softball pitchers [19]. No kinematic or kinetic differences were noted between throwing balls and strikes in professional baseball pitchers [57]. The thrower's shoulder model demonstrates abnormal kinematics and path of glenohumeral motion throughout a rotational range of motion compared with an intact shoulder [59].

Spinopelvic Mechanics: Consistent nomenclature, advanced imaging, and integration of artificial intelligence are needed to personalize care based on individual anatomy and biomechanics in spinopelvic mechanics [21]. The position of the lumbar spine center of rotation changes with variations in load and differs between movement types [40].

Proximal Humeral Fractures: A novel biomechanical model distinguishes between different mechanisms of injury and resulting fracture configurations in proximal humeral fractures [43]. A construct of blocked threaded wires for three-part humeral head fractures is biomechanically valid, allowing only micromovements that do not cause humeral head rotation and translation [58].

Hip Dysplasia: Fossa-foveolar mismatch is highest in dysplastic hips and during external rotation [46].

Scapular Dyskinesis: A comprehensive classification test validates the assessment of scapular dyskinesis, especially in the lowering phase of arm elevation [61].

Other Considerations: A 3-dimensional motion capture system is effective in investigating the kinematics of rugby tackling [60].

Clinical Presentation

History: Specific aspects of the throwing motion place professional baseball pitchers at risk for injury [9]. Decreased rotational motion in adolescent/little league baseball players may cause increased stress at the physis during throwing [14]. Patient-estimated range of motion is not a reliable tool for assessing outcomes due to significant differences from measured values [4].

Inspection: Recognizing trick elbow motions in patients with brachial plexus injuries allows surgeons to correctly identify deficits and choose appropriate nerve or tendon transfers [39]. Healthy scapular motions are not strictly symmetric, although differences between dominant and nondominant shoulders might be difficult to detect in clinical settings [15].

Range of Motion: Active motion reduces instability in elbow lateral collateral ligament injuries compared with passive motion [1]. Sagittal and rotational motion in the elbow have a weak relationship but both significantly influence upper limb function [7]. Extremes variables lead to a drop in range of motion, and more precise range of motion such as internal rotation must be investigated separately [36].

Stability and Special Tests: Improvement in kinematic changes may be a key to successful conservative treatment for symptomatic rotator cuff tears [2]. Significant alterations in kinematical parameters are observed between patients with multidirectional shoulder instability and asymptomatic volunteers [6]. Significant changes from preoperative to postoperative conditions were not demonstrated for other kinematic parameters after reverse total shoulder arthroplasty [10].

Kinematic Patterns: Alterations of scapular kinematics in symptomatic subjects are multifactorial [3]. Patients with symptomatic rotator cuff tears who reached at least 85° of motion compensated for loss of glenohumeral motion by increased scapulothoracic contribution, suggesting structural damage interferes with motion mechanics [17]. Clavicular shortening of -10% affects scapular kinematics and might produce clinical symptoms [37].

Data Interpretation: Multiple inconsistencies exist between the abstract, results text, and figures regarding the association between knee kinematics and patient-reported outcomes in a study by Hodge et al., requiring clarification for accurate data interpretation [18]. Biomechanical and clinical studies are needed to understand the true clinical relevance of anatomic variations in the ulnar greater sigmoid notch coverage angle [33].

Investigations

Plain radiography: Cineroentgenography provides a diagnostic and investigative technique with an additional dimension compared to standard roentgenograms, though exact measurement of ranges of motion is difficult due to image magnification and change [62]. Radiographic evolution of proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty was satisfactory at mid-term follow-up [26].

MRI: Physiologic but higher joint incongruency in the sagittal and coronal planes can be expected when evaluating an elbow MRI in supination [54]. Further developments in deep learning processing of magnetic resonance imaging have the potential to allow surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology [69].

CT: Manual positioning of the 3 scapula anatomical landmarks recommended by the International Society of Biomechanics can be performed in a reliable manner across measures and observers on surface bone models obtained from CT scan images [78].

Other Considerations: Active motion reduces instability in elbow lateral collateral ligament injuries compared with passive motion [1]. Improvement of kinematic changes may be a key to successful conservative treatment for symptomatic rotator cuff tears [2]. Alterations of scapular kinematics in symptomatic subjects are multifactorial [3]. Patient-estimated range of motion is not a reliable tool for assessing outcomes due to significant differences from measured values [4]. Significant alterations in kinematical parameters are observed between patients with multidirectional shoulder instability and asymptomatic volunteers [6]. Significant changes from preoperative to postoperative conditions were not demonstrated for other kinematic parameters after reverse total shoulder arthroplasty [10]. The long-term durability of arthroscopic ulnohumeral arthroplasty regarding preservation of range of motion and radiographic progression of arthritis remains unknown [13]. Healthy scapular motions are not strictly symmetric, although differences between dominant and nondominant shoulders may be difficult to detect in clinical settings [15]. Consistent nomenclature, advanced imaging, and the integration of artificial intelligence are needed to personalize care based on individual anatomy and biomechanics in spinopelvic mechanics [21]. Loss in the range of supination-pronation can be expected with residual angular malalignment of 20 degrees or more in fractures of both bones of the forearm [27]. Anatomic anterolateral ligament reconstruction did not reduce anterolateral rotational laxity in the knee [68]. Both TightRope and traditional docking ulnar collateral ligament reconstruction techniques restored native joint kinematics from 15 to 75 degrees of flexion under low loading conditions [70]. Sectioning both the anterolateral ligament and iliotibial band produced small increases in rotation limits at higher flexion angles which would likely not be clinically detectable in the anterior cruciate ligament–intact knee [71]. All-epiphyseal anterior cruciate ligament reconstruction more effectively reduced axial rotation and posterolateral contact stresses during a simulated pivot shift exam compared to complete transphyseal reconstruction in pediatric patients [75]. The medial rotation knee exhibited motion patterns similar to those observed in the normal knee, but with less tibial rotation during tibiofemoral kinematic analysis of knee flexion [82].

Treatment

Non-Operative

Conservative management strategies focus on restoring kinematics and managing symptoms without surgical intervention. Improvement of kinematic changes represents a key factor in the successful conservative treatment of symptomatic rotator cuff tears [2]. Successful exercise therapy for small full-thickness supraspinatus tears yields improvements in glenohumeral joint kinematics and patient-reported outcomes by increasing rotator cuff muscle strength and joint stability [42]. For elbow lateral collateral ligament injuries, active motion reduces instability compared with passive motion during rehabilitation [1]. In cases of coxa vara, moderate nonprogressive deformity often does not require surgery, whereas operative management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [72]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures, with selection depending on disease stage and patient factors [77].

Operative

Indications: Surgical intervention is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in coxa vara [72]. In revision acromioclavicular joint stabilization, adequately restoring native joint biomechanics is necessary to ensure an optimal healing environment that translates into patient satisfaction and long-term stability [11]. For adhesive capsulitis, operative considerations must account for the risks associated with immobilization; operative immobilization yields a lasting reduction in total range of motion and an increase in joint stiffness in an adhesive capsulitis model [23].

Surgical Approach / Technique: Restoring natural peri-articular soft-tissue tension is clinically important due to its obvious effects on joint stability and range of motion in a bi-cruciate retaining TKA-design [55]. Restoring elbow biomechanics and preserving range of motion can be aided by information on elbow soft tissue footprints and anatomy [8]. Both sagittal and rotational motion in the elbow need to be addressed individually, as they have a weak relationship but both significantly influence upper limb function [7]

Implant Selection: The motion pattern after total elbow replacement is less constrained than in the normal elbow, particularly in unlinked prostheses [80]. A reduced neck-shaft angle reduces the minimum abduction angle but does not improve overall range of motion in reverse shoulder arthroplasty [56]. Available biomechanical evidence regarding subscapularis repair in reverse total shoulder arthroplasty is limited, and further studies are needed [5]. All investigated constructs for subscapularis repairs after shoulder arthroplasty exhibited comparably robust biomechanical performance immediately postoperatively [24]. A 6-mm acromiograft significantly reduced superior translation of the humeral head and improved subacromial contact mechanics compared to the massive cuff tear condition, supporting its biomechanical efficacy in bursal acromial resurfacing [51].

Alignment / Balancing Strategy: All movement planes showed significant differences in simulated range of motion when comparing protocols with and without adjustment for posture in reverse total shoulder arthroplasty preoperative planning [12]. None of the described procedures for graft fixation at the coracoid process restores the kinematics of the native coracoclavicular ligaments [83]. ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations [65].

Adjuncts: Increased motion between lumbar vertebrae after excision of the capsule and cartilage of the facets may increase tensile strain in a graft, potentially predisposing to non-union in lumbar arthrodesis without instrumentation [74].

Other Considerations: Patient-estimated range of motion is not a reliable tool for assessing outcomes due to significant differences from measured values [4]. The four biomechanical stages of fracture repair provide a standard for correlating variables related to ultimate strength and an objective way to predict delayed unions and non-unions [81]. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance for multi-segmental kinematics of the thoracolumbar spine [20].

Complications

Instability: Active motion reduces instability in elbow lateral collateral ligament injuries compared with passive motion [1].

Stiffness / Arthrofibrosis: Operative immobilization yields a lasting reduction in total range of motion and an increase in joint stiffness [23]. Biceps adhesions may limit range of motion and clinical outcomes in situations where the biceps is at risk for scarring [66]. Loss in the range of rotation can be expected with residual angles of 20 degrees or more in fractures of both bones of the forearm [27].

Other Considerations: Patient-estimated range of motion is not a reliable tool for assessing outcomes due to significant differences from actual measurements [4]. Alterations of scapular kinematics in symptomatic subjects are multifactorial [3]. Patients with symptomatic rotator cuff tears compensate for loss of glenohumeral motion by increasing scapulothoracic contribution, suggesting structural damage interferes with motion mechanics [17]. Muscle imbalance and impaired longitudinal growth contribute to range of motion and force changes consistent with clinically observed deformity following brachial plexus birth palsy, with impaired muscle growth having the most substantial effects [25]. The long-term durability of arthroscopic ulnohumeral arthroplasty regarding preservation of range of motion and radiographic progression of arthritis remains unknown [13]. Elbow kinematics deviate increasingly from those of the native joint with a 2 mm to 4 mm lengthening of the radius in radial head arthroplasty [16]. Reverse shoulder arthroplasty leads to significant biomechanical changes in the remaining rotator cuff, including reduced rotational moment arms and decreased origin-to-insertion distance, which may explain clinically observed impaired external and internal rotation [76].

Recovery

Rehabilitation protocol: Following ulnar collateral ligament repairs and reconstructions, elbow range of motion is reliably preserved or improved with a predictable trajectory of rapid improvement within the first 2 to 4 months [79]. For posterior cruciate ligament reconstruction, simulated early range of motion and early partial weightbearing did not result in clinically significant acquired graft laxity in common graft options utilized for double-bundle reconstruction [90]. In the rehabilitation of elbow lateral collateral ligament injuries, active motion reduces instability compared with passive motion [1].

Functional milestones: Functional elbow range of motion necessary for activities of daily living may be greater than previously reported [86]. Improvement of kinematic changes may be a key to successful conservative treatment for symptomatic rotator cuff tears [2]. Adequately restoring native joint biomechanics is needed for ensuring an optimal healing environment that will translate into patient satisfaction and long-term stability in revision acromioclavicular joint stabilization [11].

Other Considerations: All investigated subscapularis repair constructs exhibited comparably robust biomechanical performance immediately postoperatively [24]. Alterations of scapular kinematics in symptomatic subjects are multifactorial [3]. Further clinical studies are necessary to determine the actual functional impact of mechanoreceptors and free nerve endings in the lateral collateral ligament of the elbow beyond mechanical stabilization [73].

Key Evidence

  • [L5] Active motion reduced instability compared with passive motion. (10.1016/j.jse.2016.09.038)
  • [L4] Improvement of these kinematic changes may be a key to successful conservative treatment for symptomatic RCTs. (10.1016/j.jse.2015.06.003)
  • [L4] Alterations of scapular kinematics in symptomatic subjects are multifactorial. (10.1016/j.jse.2015.04.007)
  • [L3] These differences may be too great for patient-estimated range of motion to be used as a reliable tool for assessing outcomes. (10.1177/1758573215626104)
  • [L4] Available biomechanical evidence is limited, and further studies are needed. (10.1016/j.xrrt.2022.05.006)
  • [L3] Significant alterations in kinematical parameters were observed between patients with multidirectional instability and asymptomatic volunteers. (10.1007/s00167-005-0012-7)
  • [L4] Both sagittal and rotational motion in the elbow need be addressed individually as they have a weak relationship but both significantly influence upper limb function. (10.1177/1758573214524935)
  • [L5] This study provides the upper extremity surgeon with information that may aid in restoring elbow biomechanics and preserving range of motion in these patients. (10.1016/j.jse.2014.05.003)
  • [L4] Specific aspects of the throwing motion that place the athlete at risk for injury were identified. (10.1177/03635465010290031701)
  • [L4] However, significant changes from the preoperative to postoperative conditions were not demonstrated for other kinematic parameters. (10.1016/j.jseint.2025.04.025)
  • [L5] Adequately restoring native joint biomechanics is needed for ensuring an optimal healing environment that will translate into patient satisfaction and long-term stability. (10.1007/s00167-019-05742-6)
  • [L4] All movement planes showed significant differences in simulated range of motion when comparing protocols with and without adjustment for posture. (10.1302/0301-620x.106b11.bjj-2024-0110.r1)
  • [L4] The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown. (10.1016/j.jse.2006.09.001)
  • [L4] This decrease in rotational motion may cause increased stress at the physis during throwing. (10.1177/0363546504269936)
  • [L4] Although these differences might be difficult to detect in clinical settings, we should keep in mind that healthy scapular motions are not strictly symmetric. (10.1016/j.jse.2010.09.012)
  • [L5] The kinematics of the elbow deviated increasingly from those of the native joint with a 2 mm to a 4 mm lengthening of the radius. (10.1302/0301-620x.106b10.bjj-2024-0405.r1)
  • [L4] Patients who reached at least 85° compensated for the loss of glenohumeral motion by increased scapulothoracic contribution, suggesting that structural damage interferes with motion mechanics. (10.1016/j.jse.2016.02.031)
  • [L5] The letter identifies multiple inconsistencies between the abstract, results text, and figures regarding the association between knee kinematics and patient-reported outcomes in a study by Hodge et al., urging clarification to ensure accurate interpretation of the data. (10.1016/j.arth.2024.04.003)
  • [L4] Significant kinematic differences exist between pitch types, but these differences may be necessary to execute desired pitch outcomes. (10.1177/0363546520988172)
  • [L1] Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance. (10.1186/s12891-022-05925-2)
  • [L5] The review underscores the need for consistent nomenclature, advanced imaging, and the integration of artificial intelligence to personalize care based on individual anatomy and biomechanics. (10.1302/0301-620x.106b11.bjj-2024-0373)
  • [L3] Elbow and shoulder kinetics increase with time, particularly after age 13. (10.1177/0363546517732034)
  • [L5] Operative immobilization yielded a lasting reduction in total ROM and also an increase in joint stiffness. (10.1016/j.jse.2015.06.015)
  • [L5] All constructs investigated exhibited comparably robust biomechanical performance immediately postoperatively. (10.1016/j.jse.2010.01.014)
  • [L5] Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity, although the most substantial effects resulted from impaired muscle growth. (10.1016/j.jhsa.2015.02.025)
  • [L4] The radiographic evolution was satisfactory at mid-term follow-up. (10.1016/j.jses.2019.09.011)
  • [L5] Loss in the range of rotation can be expected with residual angles of 20 degrees or more. (10.2106/00004623-198264010-00003)
  • [L4] Four subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. (10.1186/s12891-018-2233-1)
  • [L5] Elbow position affects the kinematics of the distal radioulnar joint, which are primarily affected by forearm rotation and secondarily by elbow flexion. (10.1016/j.jhsa.2009.04.025)
  • [L5] Biomechanical and clinical studies are needed to understand the true clinical relevance of these anatomic variations. (10.1016/j.jse.2015.06.006)
  • [Abstract] Extremes variables lead to a drop in ROM, and more precise ROM such as internal rotation has to be investigated separately. (10.1016/j.jse.2022.01.082)
  • [L5] The results suggest that clavicular shortening of -10% affects scapular kinematics and might produce clinical symptoms. (10.1177/0363546509355143)
  • [L4] Recognizing these trick motions allows surgeons to correctly identify deficits and choose appropriate nerve or tendon transfers. (10.1016/j.jhsa.2014.04.040)
  • [L4] The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine. (10.1186/s12891-025-08410-8)
  • [L4] Five kinematic parameters during the stride phase and their combination were associated with peak elbow varus torque. (10.1177/2325967120968068)
  • [L4] Successful exercise therapy for treatment of small full-thickness supraspinatus tears results in improvements in glenohumeral joint kinematics and patient-reported outcomes through increases in rotator cuff muscle strength and joint stability. (10.1016/j.jse.2015.08.048)
  • [L5] The novel biomechanical model distinguished between different mechanisms of injury and resulting fracture configurations. (10.1177/1758573218768535)
  • [L4] Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns. (10.1177/23259671231202524)
  • [L5] These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. (10.1016/j.jse.2024.05.050)
  • [L2] From all analyzed motions, the highest FFM was found in external rotation in all groups. (10.1016/j.asmr.2025.101288)
  • [L4] Although both the included clinical and biomechanical studies would suggest minimal changes in glenohumeral ROM following the remplissage procedure, strong conclusions are limited by the heterogeneity in reporting ROM data and lack of comparative studies. (10.1016/j.arthro.2018.09.029)
  • [L5] This study showed a small but significant alteration in elbow joint kinematics with placement of a distal humeral hemiarthroplasty implant, regardless of implant size. (10.1016/j.jse.2014.02.011)
  • [L3] Pitch velocity was the most influential variable in both models, but pitching mechanics also significantly influenced both elbow and shoulder stress. (10.1177/03635465211054506)
  • [L5] Small but significant asymmetries exist between the dominant and nondominant shoulders in terms of kinematics. (10.1016/j.jse.2013.08.020)
  • [L5] The 6-mm acromiograft significantly reduced superior translation of the humeral head and improved subacromial contact mechanics compared to the massive cuff tear condition, supporting its biomechanical efficacy. (10.1016/j.arthro.2024.06.019)
  • [L5] The carrying angle of the forearm remains constant as the elbow flexes. (10.2106/00004623-198163040-00003)
  • [L4] When evaluating an MRI in supination, one should be aware that in sagittal and coronal plane a physiologic but higher joint incongruency can be expected. (10.1016/j.jse.2023.02.099)
  • [L5] Restoration of natural peri-articular soft-tissue tension is clinically important because of its obvious effects on joint stability and range of motion. (10.1007/s00167-019-05639-4)
  • [L5] A reduced neck-shaft angle reduces minimum abduction angle but does not improve overall range of motion. (10.1016/j.jse.2014.12.031)
  • [L3] No kinematic or kinetic differences were noted between throwing balls and strikes. (10.1177/0363546517730052)
  • [L5] The studied construct is biomechanically valid; it only allows micromovements that are not able to cause humeral head rotation and translation. (10.1016/j.jseint.2021.06.007)
  • [L5] The study demonstrates abnormal kinematics and path of glenohumeral motion throughout a rotational range of motion in the thrower's model compared with an intact shoulder. (10.1177/0363546506287740)
  • [L5] The 3-dimensional motion capture system was effective in investigating the kinematics of rugby tackling. (10.1177/0363546518781808)
  • [L4] The findings also validated the use of a comprehensive classification test to assess scapular dyskinesis, especially in the lowering phase of arm elevation. (10.1016/j.jse.2014.12.022)
  • [L5] Cineroentgenography is an adjunct to standard roentgenograms providing a diagnostic and investigative technique with an additional dimension, though exact measurement of ranges of motion is difficult due to image magnification and change. (10.2106/00004623-196446080-00018)
  • [L5] A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. (10.1186/s12891-023-06273-5)
  • [L5] Implant designs that create a more lateralized center of rotation are associated with increased total range-of-motion. (10.1016/j.jseint.2025.101414)
  • [L5] Consequently, ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations. (10.1007/s00167-017-4472-3)
  • [L5] In situations where the biceps is at risk for scarring, the biomechanical consequence of biceps adhesions may limit ROM and clinical outcomes. (10.1016/j.jse.2012.07.003)
  • [L5] Anatomic ALL reconstruction did not reduce anterolateral rotational laxity. (10.1177/2325967116s00027)
  • [L3] Further developments of this technology have the potential to allow for surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology. (10.1016/j.jseint.2023.05.008)
  • [L5] Both the TR and DO techniques restored native joint kinematics from 15 to 75 degrees of flexion under low loading conditions. (10.1177/0363546513482567)
  • [L5] Sectioning both the ALL and ITB produced small increases in rotation limits at higher flexion angles which would likely not be clinically detectable. (10.1016/j.arthro.2016.08.034)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] However, further clinical studies are necessary to determine the actual functional impact beyond mechanical stabilization. (10.1016/j.jse.2025.04.005)
  • [L5] This increased motion may increase tensile strain in a graft, potentially predisposing to non-union in lumbar arthrodesis without instrumentation. (10.2106/00004623-199412000-00012)
  • [L5] While both AE and CT reconstructions reduced anterior translations and posteromedial contact stresses in response to an anterior load, the AE technique more effectively reduced axial rotation and posterolateral contact stresses during a simulated pivot shift exam. (10.1177/2325967114s00112)
  • [L5] Reduced rotational moment arms in conjunction with the decrease of origin-to-insertion distance may be a possible explanation for the clinically observed impaired external and internal rotation. (10.1186/1749-799x-6-42)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L4] Manual positioning of the 3 scapula anatomical landmarks recommended by the International Society of Biomechanics can be performed in a reliable manner across measures and observers on surface bone models obtained from CT scan images. (10.1016/j.jseint.2024.09.027)
  • [L4] Following UCL repairs and reconstructions, elbow ROM is reliably preserved or improved with a predictable trajectory of rapid improvement within the first 2 to four months. (10.1016/j.jse.2025.10.002)
  • [L4] The motion pattern after total elbow replacement is less constrained than in the normal elbow, particularly in unlinked prostheses. (10.1016/j.jse.2008.03.003)
  • [L5] This staging system provides a standard for correlating variables related to ultimate strength and an objective way to predict delayed unions and non-unions. (10.2106/00004623-197759020-00009)
  • [L4] The medial rotation knee exhibited motion patterns similar to those observed in the normal knee, but less tibial rotation. (10.1007/s00167-009-0777-1)
  • [L5] None of the described procedures for graft fixation restores the kinematics of the native coracoclavicular ligaments. (10.1016/j.arthro.2012.08.026)
  • [L4] Functional elbow range of motion necessary for activities of daily living may be greater than previously reported. (10.2106/jbjs.i.01633)
  • [L5] Simulated early range of motion and early partial weightbearing did not result in clinically significant acquired graft laxity in common graft options utilized for DB-PCLR. (10.1007/s00167-016-4056-7)

See Also

References

[1] Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.09.038

[2] In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.003

[3] 3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.04.007

[4] Accuracy of patient-reported range of elbow motion. Shoulder & Elbow. 2016. DOI: 10.1177/1758573215626104

[5] Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.05.006

[6] Kinematic and muscle activity characteristics of multidirectional shoulder joint instability during elevation. Knee Surgery, Sports Traumatology, Arthroscopy. 2005. DOI: 10.1007/s00167-005-0012-7

[7] Post-traumatic elbow rotational stiffness. Shoulder & Elbow. 2014. DOI: 10.1177/1758573214524935

[8] Three-dimensional analysis of elbow soft tissue footprints and anatomy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.05.003

[9] Relationships between Throwing Mechanics and Shoulder Distraction in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290031701

[10] Do shoulder kinematics change after reverse total shoulder arthroplasty?. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.025

[11] The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05742-6

[12] SECEC Grammont Award 2024: The critical role of posture adjustment for range of motion simulation in reverse total shoulder arthroplasty preoperative planning. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0110.r1

[13] Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.001

[14] Rotational Motion Changes in the Glenohumeral Joint of the Adolescent/Little League Baseball Player. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504269936

[15] In vivo 3-dimensional analysis of scapular kinematics: comparison of dominant and nondominant shoulders. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.09.012

[16] Elbow kinematics with increased lengthening of a radial head arthroplasty evaluated with dynamic radiostereometric analysis. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b10.bjj-2024-0405.r1

[17] Scapulohumeral rhythm relative to active range of motion in patients with symptomatic rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.031

[18] Letter to the Editor on “Are Kinematics an Indicator of Outcome After Total Knee Arthroplasty?”. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.04.003

[19] Kinematic Differences Exist Between the Fastball, Changeup, Curveball, and Dropball Pitch Types in Collegiate Softball Pitchers. The American Journal of Sports Medicine. 2021. DOI: 10.1177/0363546520988172

[20] Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05925-2

[21] Contemporary insights into spinopelvic mechanics. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0373

[22] Changes in Youth Baseball Pitching Biomechanics: A 7-Year Longitudinal Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517732034

[23] In vivo kinetic evaluation of an adhesive capsulitis model in rats. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.015

[24] Biomechanical similarities among subscapularis repairs after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.01.014

[25] Contributions of Muscle Imbalance and Impaired Growth to Postural and Osseous Shoulder Deformity Following Brachial Plexus Birth Palsy: A Computational Simulation Analysis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.02.025

[26] Proximal humeral bony adaptations with a short uncemented stem for shoulder arthroplasty: a quantitative analysis. JSES Open Access. 2019. DOI: 10.1016/j.jses.2019.09.011

[27] The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.. The Journal of Bone & Joint Surgery. 1982. DOI: 10.2106/00004623-198264010-00003

[28] Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2233-1

[32] Elbow Position Affects Distal Radioulnar Joint Kinematics. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.04.025

[33] The ulnar greater sigmoid notch “coverage angle”: bone and cartilage contribution. Magnetic resonance imaging anatomic study on 78 elbows. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.006

[36] Virtual ROM RSA: An Analysis Based On 10’000 Scapula. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.082

[37] Effect of Shortening Deformity of the Clavicle on Scapular Kinematics. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546509355143

[39] Trick Elbow Motions in Patients With Brachial Plexus Injuries. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.040

[40] In vivo kinematic study of lumbar center of rotation under different loads. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08410-8

[41] Stride-Phase Kinematic Parameters That Predict Peak Elbow Varus Torque. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120968068

[42] Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.048

[43] The biomechanics of proximal humeral fractures: Injury mechanism and cortical morphology. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218768535

[44] Relationship Between Arm Path, Ball Velocity, and Elbow Varus Torque in Professional Baseball Pitchers. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231202524

[45] Increasing pitch count is associated with increasing elbow flexion angle at ball release in youth baseball pitchers. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.050

[46] Fossa-Foveolar Mismatch Is Highest in Dysplastic Hips and During External Rotation. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101288

[47] Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.09.029

[48] Hemiarthroplasty of the elbow: the effect of implant size on kinematics and stability. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.02.011

[49] Machine Learning and Statistical Prediction of Pitching Arm Kinetics. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211054506

[50] Dominance effect on scapula 3-dimensional posture and kinematics in healthy male and female populations. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.08.020

[51] Bursal Acromial Resurfacing Improves Shoulder Biomechanics in a Cadaveric Model of Massive Rotator Cuff Tear. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.019

[52] Kinematics of the elbow.. The Journal of Bone & Joint Surgery. 1981. DOI: 10.2106/00004623-198163040-00003

[54] Joint Position And Hyperlaxity Affect Elbow Joint Congruency In MRI. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.099

[55] Knee joint laxity is restored in a bi-cruciate retaining TKA-design. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05639-4

[56] Effect of implant geometry on range of motion in reverse shoulder arthroplasty assessed using glenohumeral separation distance. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.031

[57] Biomechanical Comparisons Among Fastball, Slider, Curveball, and Changeup Pitch Types and Between Balls and Strikes in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517730052

[58] Three-part humeral head fractures treated with a definite construct of blocked threaded wires: finite element and parametric optimization analysis. JSES International. 2021. DOI: 10.1016/j.jseint.2021.06.007

[59] Path of Glenohumeral Articulation Throughout the Rotational Range of Motion in a Thrower's Shoulder Model. The American Journal of Sports Medicine. 2006. DOI: 10.1177/0363546506287740

[60] Kinematics of Rugby Tackling: A Pilot Study With 3-dimensional Motion Analysis. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518781808

[61] Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.022

[62] Normal and Selected Abnormal Motion of the Cervical Spine from the Second Cervical Vertebra to the Seventh Cervical Vertebra Based on Cineroentgenography. The Journal of Bone & Joint Surgery. 1964. DOI: 10.2106/00004623-196446080-00018

[63] Elliptical and spherical heads show similar obligate glenohumeral translation during axial rotation in total shoulder arthroplasty. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06273-5

[64] Effect of combined version on impingement-free rotational range-of-motion in three different implant types in reverse shoulder arthroplasty. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101414

[65] Function and strain of the anterolateral ligament part I: biomechanical analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4472-3

[66] The effect of biceps adhesions on glenohumeral range of motion: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.07.003

[68] Biomechanical Analysis of Simulated Clinical Testing and Reconstruction of the Anterolateral Ligament of the Knee. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00027

[69] Comparing bone shape models from deep learning processing of magnetic resonance imaging to computed tomography-based models. JSES International. 2023. DOI: 10.1016/j.jseint.2023.05.008

[70] Biomechanical Evaluation of the TightRope Versus Traditional Docking Ulnar Collateral Ligament Reconstruction Technique. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513482567

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