Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Engineering Science


Biomedical Engineering

Collaborative Specialization

Musculoskeletal Health Research


Lalone, Emily


Recently, studies have started employing dynamic four-dimensional computed tomography (4DCT) imaging as a biomechanical assessment tool. These studies would benefit from the valuable work that has been done in the past using three-dimensional computed tomography (3DCT). Thus, a structured review was conducted to examine the extent and range of methods employing CT imaging to measure shoulder kinematics. The findings of the review were utilized to conduct a study that employed 4DCT imaging to measure glenohumeral joint congruency and arthrokinematics during internal rotation to the back in a population of healthy individuals. The results of this work show the importance of anterior-posterior translation throughout the motion to achieve maximum range of motion. In conclusion, the use of 4DCT as a biomechanical measuring tool has shown to be a reliable technique in quantifying joint congruency and arthrokinematics of the glenohumeral joint and shows promise for future studies.

Summary for Lay Audience

The shoulder is the most mobile joint in the human body with a wide range of motion. Thus, it is more susceptible to injury and disorders which affect the shoulder’s function. Its special range of motion makes the assessment of shoulder motion a challenging task. Static imaging techniques, such as x-ray and computed tomography (CT), can only visualize the position of the bones when the shoulder is stationary. This is a problem when developing treatment plans after injuries, as an understanding of dynamic healthy motion is required to develop treatment plans. As new studies emerge that employ dynamic imaging and replace traditional static techniques, these studies would benefit from the valuable work that has been done in the past. To inform researchers of previously used techniques and their associated limitations, a literature review was conducted. The review (Chapter 2) outlined current gaps and discrepancies in research studies and made recommendations for future studies investigating shoulder motion pathways while using computed tomography (CT) imaging. These recommendations were then utilized in a subsequent study (Chapter 3) that uses a dynamic imaging modality called four-dimensional computed tomography (4DCT) as a motion measuring tool while participants rotated their shoulder behind their back. This motion is important in activities of daily living, such as washing the back and opposite shoulder, using a back pocket, managing toileting and clasping a brassiere. Yet, studies have shown that patients could not fully perform this motion after undergoing a shoulder surgery called reverse shoulder arthroplasty, as the shoulder was limited to only rotate. Thus, this thesis used dynamic 4DCT to measure the movement of shoulder bones surfaces in healthy adults. The results explain the importance of translation in performing the motion, which is restricted after the surgery thus limiting the motion. The use of 4DCT as a measuring tool has shown to be a reliable technique in quantifying the motion of shoulder bones surfaces. Dynamic measuring of healthy shoulder motion can help clinicians and researchers in the development of pre- and post-operative treatment plans and enhance implant designs.