The Evaluation of Shoulder Balance in Healthy Adolescent Population and its Correlation with Radiological Measures

Methods: Adolescents without orthopedic pathology formed the study group. They were asked to fillout a questionnaire assessing shoulder perception, and had their digital picture taken simultaneously with a P-A chest X-ray during which they were asked to stand straight and have their arms on sides. The clinical shoulder balance was evaluated by measuring the digital pictures with special software. The X-rays were used to evaluate the radiological shoulder balance. The evaluated parameters were T1-Tilt, clavicular angle (CA), coracoid height difference (CHD), clavicular tilt angle difference (CTAD) and the difference between clavicula-rib cage intersection points (CRID).

Results: The study group was composed of 71 adolescents. All stated that their shoulders were level. The clinical shoulder balance demonstrated level shoulders in only 11(16%). Radiological examination showed level shoulders in 9 with CTAD, 8 with CA, 36 with CRID and 6 with CHD. T1 tilt was zero in 23. The average CTAD was 3.9±3.4(0-20), CA was 2.3±1.8(0-11), CHD was 7.3±5,1mm (0-27.5), T1-Tilt was 1.4±1.4(0-6) and CRID 1.7±2.1mm (0-7.6). The evaluation of the pictures revealed an average 7.7±5.9mm (0-27) heigth difference between shoulders. All radiological parameters but CRID correlated with clinical picture(p <0 .01). Clavicular angle(r="0.80)" and coracoid height difference(r="0.77)" demonstrated strong, CTAD moderate correlation(r="0.59)."

Discussion: In contrast to common belief, the shoulders are not level in healthy adolescents. Clavicular angle and coracoid height difference can be used reliably to evaluate clinical shoulder balance. Although CTAD demonstrated moderate correlation, it is still a valuable alternative when the shoulders are not completely seen on the X-ray. Discussion: In contrast to common belief, the shoulders are not level in healthy adolescents. Clavicular angle and coracoid height difference can be used reliably to evaluate clinical shoulder balance. Although CTAD demonstrated moderate correlation, it is still a valuable alternative when the shoulders are not completely seen on the X-ray.