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Noteboom L, Belli I, Hoozemans MJM, Seth A, Veeger HEJ, Van Der Helm FCT. Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk. Front Physiol 2024; 15:1393235. [PMID: 38974522 PMCID: PMC11224528 DOI: 10.3389/fphys.2024.1393235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of < 1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of < 1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.
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Affiliation(s)
- L. Noteboom
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - I. Belli
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Cognitive Robotics, Delft University of Technology, Delft, Netherlands
| | - M. J. M. Hoozemans
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - A. Seth
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - H. E. J. Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - F. C. T. Van Der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
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2
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Oswald A, Menze J, Hess H, Jacxsens M, Rojas JT, Lädermann A, Schär M, Ferguson SJ, Zumstein MA, Gerber K. Effect of patient-specific scapular morphology on the glenohumeral joint force and shoulder muscle force equilibrium: a study of rotator cuff tear and osteoarthritis patients. Front Bioeng Biotechnol 2024; 12:1355723. [PMID: 38807649 PMCID: PMC11132099 DOI: 10.3389/fbioe.2024.1355723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction: Osteoarthritis (OA) and rotator cuff tear (RCT) pathologies have distinct scapular morphologies that impact disease progression. Previous studies examined the correlation between scapular morphology and glenohumeral joint biomechanics through critical shoulder angle (CSA) variations. In abduction, higher CSAs, common in RCT patients, increase vertical shear force and rotator cuff activation, while lower CSAs, common in OA patients, are associated with higher compressive force. However, the impact of the complete patient-specific scapular morphology remains unexplored due to challenges in establishing personalized models. Methods: CT data of 48 OA patients and 55 RCT patients were collected. An automated pipeline customized the AnyBody™ model with patient-specific scapular morphology and glenohumeral joint geometry. Biomechanical simulations calculated glenohumeral joint forces and instability ratios (shear-to-compressive forces). Moment arms and torques of rotator cuff and deltoid muscles were analyzed for each patient-specific geometry. Results and discussion: This study confirms the increased instability ratio on the glenohumeral joint in RCT patients during abduction (mean maximum is 32.80% higher than that in OA), while OA patients exhibit a higher vertical instability ratio in flexion (mean maximum is 24.53% higher than that in RCT) due to the increased inferior vertical shear force. This study further shows lower total joint force in OA patients than that in RCT patients (mean maximum total force for the RCT group is 11.86% greater than that for the OA group), attributed to mechanically advantageous muscle moment arms. The findings highlight the significant impact of the glenohumeral joint center positioning on muscle moment arms and the total force generated. We propose that the RCT pathomechanism is related to force magnitude, while the OA pathomechanism is associated with the shear-to-compressive loading ratio. Overall, this research contributes to the understanding of the impact of the complete 3D scapular morphology of the individual on shoulder biomechanics.
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Affiliation(s)
- Alexandra Oswald
- School of Biomedical and Precision Engineering, Personalized Medicine Research, University of Bern, Bern, Switzerland
| | - Johanna Menze
- School of Biomedical and Precision Engineering, Personalized Medicine Research, University of Bern, Bern, Switzerland
| | - Hanspeter Hess
- School of Biomedical and Precision Engineering, Personalized Medicine Research, University of Bern, Bern, Switzerland
| | - Matthijs Jacxsens
- Department of Orthopedic Surgery and Traumatology, Kantonsspital St Gallen, St. Gallen, Switzerland
| | - J. Tomas Rojas
- Department of Orthopedic Surgery, Clinica Santa Maria, Providencia, Chile
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System), Meyrin, Switzerland
| | - Michael Schär
- Department of Orthopaedic Surgery, Inselspital, Bern, Switzerland
| | | | - Matthias A. Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland
| | - Kate Gerber
- School of Biomedical and Precision Engineering, Personalized Medicine Research, University of Bern, Bern, Switzerland
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Mattar LT, Mahboobin AB, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction. J Biomech 2024; 162:111859. [PMID: 37989027 PMCID: PMC10843663 DOI: 10.1016/j.jbiomech.2023.111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.
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Affiliation(s)
- Luke T Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Arash B Mahboobin
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - William J Anderst
- Biodynamics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - James J Irrgang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States.
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4
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Genter J, Croci E, Ewald H, Müller AM, Mündermann A, Baumgartner D. Ex vivo experimental strategies for assessing unconstrained shoulder biomechanics: A scoping review. Med Eng Phys 2023; 117:104003. [PMID: 37331756 DOI: 10.1016/j.medengphy.2023.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Biomechanical studies of the shoulder often choose an ex vivo approach, especially when investigating the active and passive contribution of individual muscles. Although various simulators of the glenohumeral joint and its muscles have been developed, to date a testing standard has not been established. The objective of this scoping review was to present an overview of methodological and experimental studies describing ex vivo simulators that assess unconstrained, muscular driven shoulder biomechanics. METHODS All studies with ex vivo or mechanical simulation experiments using an unconstrained glenohumeral joint simulator and active components mimicking the muscles were included in this scoping review. Static experiments and humeral motion imposed through an external guide, e.g., a robotic device, were excluded. RESULTS Nine different glenohumeral simulators were identified in 51 studies after the screening process. We identified four control strategies characterized by: (a) using a primary loader to determine the secondary loaders with constant force ratios; (b) using variable muscle force ratios according to electromyography; (c) calibrating the muscle path profile and control each motor according to this profile; or (d) using muscle optimization. CONCLUSION The simulators with the control strategy (b) (n = 1) or (d) (n = 2) appear most promising due to its capability to mimic physiological muscle loads.
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Affiliation(s)
- Jeremy Genter
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Basel, Switzerland
| | - Andreas M Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
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Lavaill M, Martelli S, Cutbush K, Gupta A, Kerr GK, Pivonka P. Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study. J Biomech 2023; 155:111639. [PMID: 37245383 DOI: 10.1016/j.jbiomech.2023.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
The surgical Latarjet procedure aims to stabilise the glenohumeral joint following anterior dislocations. Despite restoring joint stability, the procedure introduces alterations of muscle paths which likely modify the shoulder dynamics. Currently, these altered muscular functions and their implications are unclear. Hence, this work aims to predict changes in muscle lever arms, muscle and joint forces following a Latarjet procedure by using a computational approach. Planar shoulder movements of ten participants were experimentally assessed. A validated upper-limb musculoskeletal model was utilised in two configurations, i.e., a baseline model, simulating normal joint, and a Latarjet model simulating its related muscular alterations. Muscle lever arms and differences in muscle and joint forces between models were derived from the experimental marker data and static optimisation technique. Lever arms of most altered muscles, hence their role, were substantially changed after Latarjet. Altered muscle forces varied by up to 15% of the body weight. Total glenohumeral joint force increased by up to 14% of the body weight after Latarjet, mostly due to increase in compression force. Our simulation indicated that the Latarjet muscular alterations lead to changes in the muscular recruitment and contribute to the stability of the glenohumeral joint by increasing compression force during planar motions.
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Affiliation(s)
- Maxence Lavaill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia.
| | - Saulo Martelli
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, Australia
| | - Graham K Kerr
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Movement Neuroscience Group, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia
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Dasgupta A, Sharma R, Mishra C, Nagaraja VH. Machine Learning for Optical Motion Capture-Driven Musculoskeletal Modelling from Inertial Motion Capture Data. Bioengineering (Basel) 2023; 10:bioengineering10050510. [PMID: 37237580 DOI: 10.3390/bioengineering10050510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Marker-based Optical Motion Capture (OMC) systems and associated musculoskeletal (MSK) modelling predictions offer non-invasively obtainable insights into muscle and joint loading at an in vivo level, aiding clinical decision-making. However, an OMC system is lab-based, expensive, and requires a line of sight. Inertial Motion Capture (IMC) techniques are widely-used alternatives, which are portable, user-friendly, and relatively low-cost, although with lesser accuracy. Irrespective of the choice of motion capture technique, one typically uses an MSK model to obtain the kinematic and kinetic outputs, which is a computationally expensive tool increasingly well approximated by machine learning (ML) methods. Here, an ML approach is presented that maps experimentally recorded IMC input data to the human upper-extremity MSK model outputs computed from ('gold standard') OMC input data. Essentially, this proof-of-concept study aims to predict higher-quality MSK outputs from the much easier-to-obtain IMC data. We use OMC and IMC data simultaneously collected for the same subjects to train different ML architectures that predict OMC-driven MSK outputs from IMC measurements. In particular, we employed various neural network (NN) architectures, such as Feed-Forward Neural Networks (FFNNs) and Recurrent Neural Networks (RNNs) (vanilla, Long Short-Term Memory, and Gated Recurrent Unit) and a comprehensive search for the best-fit model in the hyperparameters space in both subject-exposed (SE) as well as subject-naive (SN) settings. We observed a comparable performance for both FFNN and RNN models, which have a high degree of agreement (ravg,SE,FFNN=0.90±0.19, ravg,SE,RNN=0.89±0.17, ravg,SN,FFNN=0.84±0.23, and ravg,SN,RNN=0.78±0.23) with the desired OMC-driven MSK estimates for held-out test data. The findings demonstrate that mapping IMC inputs to OMC-driven MSK outputs using ML models could be instrumental in transitioning MSK modelling from 'lab to field'.
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Affiliation(s)
- Abhishek Dasgupta
- Doctoral Training Centre, University of Oxford, 1-4 Keble Road, Oxford OX1 3NP, UK
| | - Rahul Sharma
- Laboratory for Computation and Visualization in Mathematics and Mechanics, Institute of Mathematics, Swiss Federal Institute of Technology Lausanne, 1015 Lausanne, Switzerland
| | - Challenger Mishra
- Department of Computer Science & Technology, University of Cambridge, 15 J.J. Thomson Ave., Cambridge CB3 0FD, UK
| | - Vikranth Harthikote Nagaraja
- Natural Interaction Laboratory, Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, UK
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7
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Junior ANT, Pécora JOR, Neto AAF, Roesler CRDM, Fancello EA. A numerical study of the contact geometry and pressure distribution along the glenoid track. Med Eng Phys 2022; 110:103898. [PMID: 36564134 DOI: 10.1016/j.medengphy.2022.103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/17/2022] [Accepted: 09/25/2022] [Indexed: 01/18/2023]
Abstract
The glenoid track geometry and the contact forces acting on the glenohumeral joint at static positions of 30°, 60°, 90° and 120° of abduction with 90° of external rotation were evaluated using a finite element model of the shoulder that, differently from most usual approximations, accounts the humeral head translations and the deformable-to-deformable non-spherical joint contact. The model was based on data acquired from clinical exams of a single subject, including the proximal humerus, scapula, their respective cartilages concerning the glenohumeral joint, and the rotator cuff and deltoid muscles. The forces acting on the glenohumeral joint were estimated using a simulation framework consisting of an optimization procedure allied with finite element analysis that seeks the minimum muscle forces that stabilize the joint. The joint reaction force magnitude increases up to 680.25 N at 90° of abduction and decreases at further positions. From 60° onward the articular contact remains at the anterior region of the glenoid cartilage and follows an inferior to superior path at the posterior region of the humeral head cartilage. The maximum contact pressure of 3.104 MPa occurs at 90° abduction. Although translating inferiorly throughout the movement, the projection of the humeral head center at the glenoid plane remains at the central region of the glenoid surface. The model results qualitatively matched the trends observed in the literature and supports the consideration of the translational degrees of freedom to evaluate the joint contact mechanics.
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Affiliation(s)
- Alexandre Neves Trichez Junior
- Universidade Federal de Santa Catarina, Grupo de Análise e Projeto Mecânico (GRANTE) - Departamento de Engenharia Mecânica, 88040-900, Florianópolis, SC, Brasil; Universidade Federal de Santa Catarina, Laboratório de Engenharia Biomecânica (LEBm), Hospital Universitário, 88040-900, Florianópolis, SC, Brasil
| | | | | | - Carlos Rodrigo de Mello Roesler
- Universidade Federal de Santa Catarina, Laboratório de Engenharia Biomecânica (LEBm), Hospital Universitário, 88040-900, Florianópolis, SC, Brasil
| | - Eduardo Alberto Fancello
- Universidade Federal de Santa Catarina, Grupo de Análise e Projeto Mecânico (GRANTE) - Departamento de Engenharia Mecânica, 88040-900, Florianópolis, SC, Brasil; Universidade Federal de Santa Catarina, Laboratório de Engenharia Biomecânica (LEBm), Hospital Universitário, 88040-900, Florianópolis, SC, Brasil.
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8
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The effects of anatomical errors on shoulder kinematics computed using multi-body models. Biomech Model Mechanobiol 2022; 21:1561-1572. [PMID: 35867281 DOI: 10.1007/s10237-022-01606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022]
Abstract
Joint motion calculated using multi-body models and inverse kinematics presents many advantages over direct marker-based calculations. However, the sensitivity of the computed kinematics is known to be partly caused by the model and could also be influenced by the participants' anthropometry and sex. This study aimed to compare kinematics computed from an anatomical shoulder model based on medical images against a scaled-generic model and quantify the effects of anatomical errors and participants' anthropometry on the calculated joint angles. Twelve participants have had planar shoulder movements experimentally captured in a motion lab, and their shoulder anatomy imaged using an MRI scanner. A shoulder multi-body dynamics model was developed for each participant, using both an image-based approach and a scaled-generic approach. Inverse kinematics have been performed using the two different modelling procedures and the three different experimental motions. Results have been compared using Bland-Altman analysis of agreement and further analysed using multi-linear regressions. Kinematics computed via an anatomical and a scaled-generic shoulder models differed in average from 3.2 to 5.4 degrees depending on the task. The MRI-based model presented smaller limits of agreement to direct kinematics than the scaled-generic model. Finally, the regression model predictors, including anatomical errors, sex, and BMI of the participant, explained from 41 to 80% of the kinematic variability between model types with respect to the task. This study highlighted the consequences of modelling precision, quantified the effects of anatomical errors on the shoulder kinematics, and showed that participants' anthropometry and sex could indirectly affect kinematic outcomes.
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9
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Lavaill M, Martelli S, Kerr GK, Pivonka P. Statistical Quantification of the Effects of Marker Misplacement and Soft-Tissue Artifact on Shoulder Kinematics and Kinetics. Life (Basel) 2022; 12:life12060819. [PMID: 35743850 PMCID: PMC9227025 DOI: 10.3390/life12060819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
The assessment of shoulder kinematics and kinetics are commonly undertaken biomechanically and clinically by using rigid-body models and experimental skin-marker trajectories. However, the accuracy of these trajectories is plagued by inherent skin-based marker errors due to marker misplacements (offset) and soft-tissue artifacts (STA). This paper aimed to assess the individual contribution of each of these errors to kinematic and kinetic shoulder outcomes computed using a shoulder rigid-body model. Baseline experimental data of three shoulder planar motions in a young healthy adult were collected. The baseline marker trajectories were then perturbed by simulating typically observed population-based offset and/or STA using a probabilistic Monte-Carlo approach. The perturbed trajectories were then used together with a shoulder rigid-body model to compute shoulder angles and moments and study their accuracy and variability against baseline. Each type of error was studied individually, as well as in combination. On average, shoulder kinematics varied by 3%, 6% and 7% due to offset, STA or combined errors, respectively. Shoulder kinetics varied by 11%, 27% and 28% due to offset, STA or combined errors, respectively. In conclusion, to reduce shoulder kinematic and kinetic errors, one should prioritise reducing STA as they have the largest error contribution compared to marker misplacements.
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Affiliation(s)
- Maxence Lavaill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; (S.M.); (P.P.)
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD 4000, Australia;
- Correspondence:
| | - Saulo Martelli
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; (S.M.); (P.P.)
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD 4000, Australia;
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA 5042, Australia
| | - Graham K. Kerr
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD 4000, Australia;
- Movement Neuroscience Group, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; (S.M.); (P.P.)
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD 4000, Australia;
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10
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Sulkar HJ, Knighton TW, Amoafo L, Aliaj K, Kolz CW, Zhang Y, Hermans T, Henninger HB. In Vitro Simulation of Shoulder Motion Driven by Three-Dimensional Scapular and Humeral Kinematics. J Biomech Eng 2022; 144:051008. [PMID: 34817051 PMCID: PMC8822462 DOI: 10.1115/1.4053099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/12/2021] [Indexed: 11/08/2022]
Abstract
In vitro simulation of three-dimensional (3D) shoulder motion using in vivo kinematics obtained from human subjects allows investigation of clinical conditions in the context of physiologically relevant biomechanics. Herein, we present a framework for laboratory simulation of subject-specific kinematics that combines individual 3D scapular and humeral control in cadavers. The objectives were to: (1) robotically simulate seven healthy subject-specific 3D scapulothoracic and glenohumeral kinematic trajectories in six cadavers, (2) characterize system performance using kinematic orientation accuracy and repeatability, and muscle force repeatability metrics, and (3) analyze effects of input kinematics and cadaver specimen variability. Using an industrial robot to orient the scapula range of motion (ROM), errors with repeatability of ±0.1 mm and <0.5 deg were achieved. Using a custom robot and a trajectory prediction algorithm to orient the humerus relative to the scapula, orientation accuracy for glenohumeral elevation, plane of elevation, and axial rotation of <3 deg mean absolute error (MAE) was achieved. Kinematic accuracy was not affected by varying input kinematics or cadaver specimens. Muscle forces over five repeated setups showed variability typically <33% relative to the overall simulations. Varying cadaver specimens and subject-specific human motions showed effects on muscle forces, illustrating that the system was capable of differentiating changes in forces due to input conditions. The anterior and middle deltoid, specifically, showed notable variations in patterns across the ROM that were affected by subject-specific motion. This machine provides a platform for future laboratory studies to investigate shoulder biomechanics and consider the impacts of variable input kinematics from populations of interest, as they can significantly impact study outputs and resultant conclusions.
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Affiliation(s)
- Hema J. Sulkar
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112
| | - Tyler W. Knighton
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112
| | - Linda Amoafo
- Department of Epidemiology, University of Utah, Salt Lake City, UT 84132
| | - Klevis Aliaj
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112
| | - Christopher W. Kolz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112
| | - Yue Zhang
- Department of Epidemiology, University of Utah, Salt Lake City, UT 84132
| | - Tucker Hermans
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112; Robotics Center and School of Computing, University of Utah, Salt Lake City, UT 84112
| | - Heath B. Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112
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11
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Kian A, Pizzolato C, Halaki M, Ginn K, Lloyd D, Reed D, Ackland D. The effectiveness of EMG-driven neuromusculoskeletal model calibration is task dependent. J Biomech 2021; 129:110698. [PMID: 34607281 DOI: 10.1016/j.jbiomech.2021.110698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
Calibration of neuromusculoskeletal models using functional tasks is performed to calculate subject-specific musculotendon parameters, as well as coefficients describing the shape of muscle excitation and activation functions. The objective of the present study was to employ a neuromusculoskeletal model of the shoulder driven entirely from muscle electromyography (EMG) to quantify the influence of different model calibration strategies on muscle and joint force predictions. Three healthy adults performed dynamic shoulder abduction and flexion, followed by calibration tasks that included reaching, head touching as well as active and passive abduction, flexion and axial rotation, and submaximal isometric abduction, flexion and axial rotation contractions. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using subject-specific EMG-driven neuromusculoskeletal models that were uncalibrated and calibrated using (i) all calibration tasks (ii) sagittal plane calibration tasks, and (iii) scapular plane calibration tasks. Joint forces were compared to published instrumented implant data. Calibrating models across all tasks resulted in glenohumeral joint force magnitudes that were more similar to instrumented implant data than those derived from any other model calibration strategy. Muscles that generated greater torque were more sensitive to calibration than those that contributed less. This study demonstrates that extensive model calibration over a broad range of contrasting tasks produces the most accurate and physiologically relevant musculotendon and EMG-to-activation parameters. This study will assist in development and deployment of subject-specific neuromusculoskeletal models.
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Affiliation(s)
- Azadeh Kian
- Department of Biomedical Engineering, University of Melbourne, Australia; Institute for Health and Sport, Victoria University, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Karen Ginn
- Discipline of Anatomy & Histology, Faculty of Medicine and Health, The University of Sydney, Australia
| | - David Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Australia
| | - Darren Reed
- Discipline of Anatomy & Histology, Faculty of Medicine and Health, The University of Sydney, Australia
| | - David Ackland
- Department of Biomedical Engineering, University of Melbourne, Australia.
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12
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Péan F, Favre P, Goksel O. Influence of rotator cuff integrity on loading and kinematics before and after reverse shoulder arthroplasty. J Biomech 2021; 129:110778. [PMID: 34670177 DOI: 10.1016/j.jbiomech.2021.110778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Reverse Shoulder Arthroplasty has become a very common procedure for shoulder joint replacement, even for scenarios where an anatomical reconstruction would traditionally be used. Our hypothesis is that implanting a reverse prosthesis with a functional rotator cuff may lead to higher joint reaction force (JRF) and have a negative impact on the prosthesis. Available motion capture data during anterior flexion was input to a finite-element musculoskeletal shoulder model, and muscle activations were computed using inverse dynamics. Simulations were carried out for the intact joint as well as for various types of rotator cuff tears: superior (supraspinatus), superior-anterior (supraspinatus and subscapularis), and superior-posterior (supraspinatus, infraspinatus and teres minor). Each rotator cuff tear condition was repeated after shifting the humerus and the glenohumeral joint center of rotation to represent the effect of a reverse prosthesis. Changes in compressive, shear, and total JRF were analyzed. The model compared favorably to in vivo JRF measurements, and existing clinical and biomechanical knowledge. Implanting a reverse prosthesis with a functional rotator cuff or with an isolated supraspinatus tear led to more than 2 times higher compressive JRF than with massive rotator cuff tears (superior-anterior or superior-posterior), while the shear force remained comparable. The total JRF increased more than 1.5 times. While a lower shear to compressive ratio may reduce the risk of glenosphere loosening, higher JRF might increase the risk for other failure modes such as fracture or polyethylene wear of the reverse prosthesis.
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Affiliation(s)
- Fabien Péan
- Computer-assisted Applications in Medicine (CAiM), ETH Zurich, Switzerland
| | | | - Orcun Goksel
- Computer-assisted Applications in Medicine (CAiM), ETH Zurich, Switzerland.
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13
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Saffert AS, Melzner M, Dendorfer S. Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing. Technol Health Care 2021; 30:177-186. [PMID: 34806631 PMCID: PMC8842773 DOI: 10.3233/thc-219001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements. OBJECTIVE For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture. METHODS Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position. RESULTS The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture. CONCLUSIONS Elevating the right shoulder while playing the violin may pose a potential problem.
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Affiliation(s)
- Anne-Sophie Saffert
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Maximilian Melzner
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
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14
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Sarshari E, Boulanaache Y, Terrier A, Farron A, Mullhaupt P, Pioletti D. A Matlab toolbox for scaled-generic modeling of shoulder and elbow. Sci Rep 2021; 11:20806. [PMID: 34675343 PMCID: PMC8531442 DOI: 10.1038/s41598-021-99856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022] Open
Abstract
There still remains a barrier ahead of widespread clinical applications of upper extremity musculoskeletal models. This study is a step toward lifting this barrier for a shoulder musculoskeletal model by enhancing its realism and facilitating its applications. To this end, two main improvements are considered. First, the elbow and the muscle groups spanning the elbow are included in the model. Second, scaling routines are developed that scale model’s bone segment inertial properties, skeletal morphologies, and muscles architectures according to a specific subject. The model is also presented as a Matlab toolbox with a graphical user interface to exempt its users from further programming. We evaluated effects of anthropometric parameters, including subject’s gender, height, weight, glenoid inclination, and degenerations of rotator cuff muscles on the glenohumeral joint reaction force (JRF) predictions. An arm abduction motion in the scapula plane is simulated while each of the parameters is independently varied. The results indeed illustrate the effect of anthropometric parameters and provide JRF predictions with less than 13% difference compared to in vivo studies. The developed Matlab toolbox could be populated with pre/post operative patients of total shoulder arthroplasty to answer clinical questions regarding treatments of glenohumeral joint osteoarthritis.
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Affiliation(s)
- Ehsan Sarshari
- Automatic Control Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Yasmine Boulanaache
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland. .,Department of Orthopedics and Traumatology, University Hospital Centre and University of Lausanne (CHUV), Lausanne, Switzerland.
| | - Alain Farron
- Department of Orthopedics and Traumatology, University Hospital Centre and University of Lausanne (CHUV), Lausanne, Switzerland
| | - Philippe Mullhaupt
- Automatic Control Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dominique Pioletti
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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15
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A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading. J Shoulder Elbow Surg 2020; 29:1967-1973. [PMID: 32499200 DOI: 10.1016/j.jse.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/21/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The critical shoulder angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA. METHODS An inverse dynamics 3-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane and slow and fast forward flexion measured by a 3-dimensional motion capture system were used to quantify joint reaction shear and compressive forces. RESULTS Increasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; P < .05). Reducing CSA results in increased lateromedial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion (P < .01). DISCUSSION/CONCLUSION Changes in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that could contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces that contribute to joint wear.
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16
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Goetti P, Denard PJ, Collin P, Ibrahim M, Hoffmeyer P, Lädermann A. Shoulder biomechanics in normal and selected pathological conditions. EFORT Open Rev 2020; 5:508-518. [PMID: 32953136 PMCID: PMC7484714 DOI: 10.1302/2058-5241.5.200006] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing.
Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006
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Affiliation(s)
- Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick J Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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17
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Urbanczyk CA, Prinold JAI, Reilly P, Bull AMJ. Avoiding high-risk rotator cuff loading: Muscle force during three pull-up techniques. Scand J Med Sci Sports 2020; 30:2205-2214. [PMID: 32715526 DOI: 10.1111/sms.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
Heavily loaded overhead training tasks, such as pull-ups are an effective strength training and rehabilitation exercise requiring high muscle forces maintained over a large range of motion. This study used experiments and computational modeling to examine loading patterns during three different pull-up variants and highlighted risks to vulnerable musculoskeletal structures. Optical motion tracking and a force platform captured kinematics and kinetics of 11 male subjects with no history of shoulder pathology, during performance of three pull-up variants-pronated front grip, pronated wide grip, and supinated reverse grip. UK National Shoulder model (UKNSM) simulated biomechanics of the shoulder girdle. Muscle forces and activation patterns were analyzed by repeated measures ANOVA with post-hoc comparisons. Motor group recruitment was similar across all pull-up techniques, with upper limb depression occurring secondary to torso elevation. Stress-time profiles show significant differences in individual muscle patterns among the three pull-up variants, with the most marked differences between wide grip and reverse grip. Comparing across techniques, latissimus dorsi was relatively more active in wide pull-ups (P < .01); front pull-ups favored activation of biceps brachii and brachialis (P < .02); reverse pull-ups displayed higher proportional rotator cuff activation (P < .01). Pull-ups promote stability of the shoulder girdle and activation of scapula stabilizers and performing pull-ups over their full range of motion is important as different techniques and phases emphasize different muscles. Shoulder rehabilitation and strength & conditioning programs should encourage incorporation of all three pull-up variants with systematic progression to provide greater global strengthening of the torso and upper limb musculature.
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Affiliation(s)
| | | | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
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18
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Taylor SA, Shah SS, Chen X, Gentile J, Gulotta LV, Dines JS, Dines DM, Cordasco FA, Warren RF, Kontaxis A. Scapular Ring Preservation: Coracoacromial Ligament Transection Increases Scapular Spine Strains Following Reverse Total Shoulder Arthroplasty. J Bone Joint Surg Am 2020; 102:1358-1364. [PMID: 32769603 DOI: 10.2106/jbjs.19.01118] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular fractures following reverse total shoulder arthroplasty (RSA) are devastating complications with substantial functional implications. The role of the coracoacromial ligament (CAL), which is often transected during surgical exposure for RSA, is not fully known. We hypothesized that the CAL contributes to the structural integrity of the "scapular ring" and that the transection of this ligament during RSA alters the scapular strain patterns. METHODS RSA was performed on 8 cadaveric specimens without evidence of a prior surgical procedure in the shoulder. Strain rosettes were fixed onto the acromial body (at the location of Levy type-II fractures) and the scapular spine (Levy type III). With use of a shoulder simulator, strains were recorded at 0°, 30°, and 60° glenohumeral abductions before and after CAL transection. The deltoid and glenohumeral joints were functionally loaded (middle deltoid = 150 N, posterior deltoid = 75 N, and joint compression = 300 N). Maximum principal strains were calculated from each rosette at each abduction angle. A repeated-measures analysis of variance with post hoc analysis was performed to compare the maximum principal strain at each abduction angle. RESULTS With the CAL intact, there was no significant difference between strain experienced by the acromion and scapular spine at 0°, 30°, and 60° of glenohumeral abduction. CAL transection generated significantly increased strain in the scapular spine at all abduction angles compared with an intact CAL. The maximum scapular spine strain observed was increased 19.7% at 0° of abduction following CAL transection (1,216 ± 300.0 microstrain; p = 0.011). Following CAL transection, acromial strains paradoxically decreased at all abduction angles (p < 0.05 for all). The smallest strains were observed at 60° of glenohumeral abduction at the acromion following CAL transection (296 ± 121.3 microstrain; p = 0.048). CONCLUSIONS The CAL is an important structure that completes the "scapular ring" and therefore serves to help distribute strain in a more normalized fashion. Transection of the CAL substantially alters strain patterns, resulting in increased strain at the scapular spine following RSA. CLINICAL RELEVANCE CAL preservation is a modifiable risk factor that may reduce the risk of bone microdamage and thus the occurrence of fatigue/stress fractures in the scapular spine following RSA.
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Affiliation(s)
| | - Sarav S Shah
- New England Baptist Hospital, Boston, Massachusetts
| | - Xiang Chen
- Hospital for Special Surgery, New York, NY
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19
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McFarland DC, Brynildsen AG, Saul KR. Sensitivity of Neuromechanical Predictions to Choice of Glenohumeral Stability Modeling Approach. J Appl Biomech 2020; 36:249-258. [PMID: 32369767 DOI: 10.1123/jab.2019-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022]
Abstract
Most upper-extremity musculoskeletal models represent the glenohumeral joint with an inherently stable ball-and-socket, but the physiological joint requires active muscle coordination for stability. The authors evaluated sensitivity of common predicted outcomes (instability, net glenohumeral reaction force, and rotator cuff activations) to different implementations of active stabilizing mechanisms (constraining net joint reaction direction and incorporating normalized surface electromyography [EMG]). Both EMG and reaction force constraints successfully reduced joint instability. For flexion, incorporating any normalized surface EMG data reduced predicted instability by 54.8%, whereas incorporating any force constraint reduced predicted instability by 43.1%. Other outcomes were sensitive to EMG constraints, but not to force constraints. For flexion, incorporating normalized surface EMG data increased predicted magnitudes of joint reaction force and rotator cuff activations by 28.7% and 88.4%, respectively. Force constraints had no influence on these predicted outcomes for all tasks evaluated. More restrictive EMG constraints also tended to overconstrain the model, making it challenging to accurately track input kinematics. Therefore, force constraints may be a more robust choice when representing stability.
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20
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Aurbach M, Spicka J, Süß F, Dendorfer S. Evaluation of musculoskeletal modelling parameters of the shoulder complex during humeral abduction above 90°. J Biomech 2020; 106:109817. [PMID: 32517973 DOI: 10.1016/j.jbiomech.2020.109817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Based on electromyographic data and force measurements within the shoulder joint, there is an indication that muscle and resulting joint reaction forces keep increasing over an abduction angle of 90°. In inverse dynamics models, no single parameter could be attributed to simulate this force behaviour accordingly. The aim of this work is to implement kinematic, kinetic and muscle model modifications to an existing model of the shoulder (AnyBody™) and assess their single and combined effects during abduction up to 140° humeral elevation. The kinematics and the EMG activity of 10 test subjects were measured during humeral abduction. Six modifications were implemented in the model: alternative wrapping of the virtual deltoid muscle elements, utilization of a three element Hill model, strength scaling, motion capture driven clavicle elevation/protraction, translation of the GH joint in dependency of the acting forces and an alteration of the scapula/clavicle rhythm. From the six modifications, 16 different combinations were considered. Parameter combinations with the Hill model changed the resultant GH joint reaction force and led to an increase in force during abduction of the humerus above 90°. Under the premise of muscle activities and forces within the GH joint rising after 90° of humeral abduction, we propose that the Hill type muscle model is a crucial parameter for accurately modelling the shoulder. Furthermore, the outcome of this study indicates that the Hill model induces the co-contraction of the muscles of the shoulder without the need of an additional stability criterion for an inverse dynamics approach.
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Affiliation(s)
- Maximilian Aurbach
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany.
| | - Jan Spicka
- New Technologies Research Centre, University of West Bohemia (UWB), Pilsen, Czech Republic
| | - Franz Süß
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
| | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany; Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
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21
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Garcia JC, Altoe LS, do Amaral RFM, Aihara AY, Lutfi HV, Mello MBD. Double-Blinded Randomized Study of the Correlation between Simple Radiography and Magnetic Resonance Imaging in the Evaluation of the Critical Shoulder Angle: Reproducibility and Learning Curve. Rev Bras Ortop 2020; 56:78-82. [PMID: 33627904 PMCID: PMC7895620 DOI: 10.1055/s-0040-1701288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022] Open
Abstract
Objective To evaluate the feasibility of magnetic resonance imaging (MRI) to obtain the critical shoulder angle (CSA) comparing the results obtained through radiography and MRI, and assess the learning curves. Methods In total, 15 patients were evaluated in a blinded and randomized way. The CSA was measured and compared among groups and subgroups. Results The mean angles measured through the radiographic images were of 34.61 ± 0.67 and the mean angles obtained through the MRI scans were of 33.85 ± 0.53 ( p = 0.29). No significant differences have been found among the groups. The linear regression presented a progressive learning curve among the subgroups, from fellow in shoulder surgery to shoulder specialist and radiologist. Conclusion There was no statistically significant difference in the X-rays and MRI assessments. The MRI seems to have its efficacy associated with more experienced evaluators. Data dispersion was smaller for the MRI data regardless of the experience of the evaluator.
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Affiliation(s)
| | | | | | - Andre Yui Aihara
- Diagnósticos da América S/A (Dasa), São Paulo, SP, Brasil.,Departamento de Radiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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22
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Sabesan VJ, Lima DJL, Yang Y, Stankard MC, Drummond M, Liou WW. The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis. J Shoulder Elbow Surg 2020; 29:347-354. [PMID: 31606318 DOI: 10.1016/j.jse.2019.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lack of greater tuberosity (GT) healing in proximal humerus fractures has been negatively correlated with outcomes for hemiarthroplasty; however, there is still debate regarding the effects of GT healing in reverse shoulder arthroplasty (RSA). Our goal was to examine the effects of GT healing using a kinematic finite element analysis (FEA) model. MATERIAL AND METHODS Computer-aided design models of a medialized glenoid with a lateralized humerus (MGLH) RSA design were uploaded into an FEA shoulder model in 2 different configurations: healed greater tuberosity (HGT) and nonunion greater tuberosity (NGT). Deltoid muscle forces and joint reaction forces (JRFs) on the shoulder were calculated during abduction (ABD), forward flexion (FF), and external rotation (ER). RESULTS Force magnitude of the anterior, middle, and posterior deltoid muscle as well as JRFs modeled in both GT scenarios were similar for ABD (muscle forces P = .91, P = .75, P = .71, respectively; and JRF P = .93) and for FF (muscle forces P = .89, P = .83, P = .99, respectively; and JRF P = .90). For ER, the force magnitude between 2 GT settings showed statistically significant differences (HGT: 9.51 N vs. NGT: 6.13 N) (P < .001). Likewise, during ER, JRFs were different, and the NGT group showed a steep drop in JRF after 10° of ER (HGT: 28.4 N vs. NGT: 18.38 N) (P < .001). CONCLUSION GT healing does not seem to impact RSA biomechanics during abduction or forward flexion; however, it does affect biomechanics during external rotation. Overall orthopedic surgeons can expect good results for patients after RSA even with poor GT healing.
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Affiliation(s)
- Vani J Sabesan
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Diego J L Lima
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Yang Yang
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
| | - Matthew C Stankard
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Mauricio Drummond
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - William W Liou
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, MI, USA
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23
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Barnamehei H, Tabatabai Ghomsheh F, Safar Cherati A, Pouladian M. Muscle and joint force dependence of scaling and skill level of athletes in high-speed overhead task: Musculoskeletal simulation study. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100415] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Kian A, Pizzolato C, Halaki M, Ginn K, Lloyd D, Reed D, Ackland D. Static optimization underestimates antagonist muscle activity at the glenohumeral joint: A musculoskeletal modeling study. J Biomech 2019; 97:109348. [DOI: 10.1016/j.jbiomech.2019.109348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/23/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
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Forces acting on the clavicle during shoulder abduction, forward humeral flexion and activities of daily living. Clin Biomech (Bristol, Avon) 2019; 69:79-86. [PMID: 31302493 DOI: 10.1016/j.clinbiomech.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The forces acting on the human clavicle in vivo are difficult if not impossible to measure. The goal of this study is to quantify the forces acting on the human clavicle during shoulder abduction, forward humeral elevation and three activities of daily living using the Delft Shoulder and Elbow Model. METHODS The Delft Shoulder and Elbow Model and a computed tomography scan of a clavicle were used to calculate the forces and moments acting on the entire clavicle and on three planes within the middle third of the clavicle during the simulated movements. FINDINGS The largest resultant force simulated across the clavicle was 126 N during abduction. Maximum resultant moments of 2.4 Nm were identified during both abduction and forward humeral elevation. The highest forces in the middle third of the clavicle were of a compressive nature along the longitudinal axis of the clavicle, increasing to 97 N during forward humeral elevation and 91 N during abduction. Forces in opposite direction along the y-axis were identified on either side of the conoid ligament. The three simulated activities of daily living had similar ranges of forces and moments irrespective of the sagittal plane in which these activities were performed. INTERPRETATION Peak forces occurred at different locations on the middle third of the clavicle during different movements. The results create an understanding of the forces and their distribution across the clavicle during activities of daily living. These data may be helpful in the development of clavicular fixation devices. LEVEL OF EVIDENCE Biomechanical study.
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Mulla DM, Hodder JN, Maly MR, Lyons JL, Keir PJ. Modeling the effects of musculoskeletal geometry on scapulohumeral muscle moment arms and lines of action. Comput Methods Biomech Biomed Engin 2019; 22:1311-1322. [DOI: 10.1080/10255842.2019.1661392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daanish M. Mulla
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Joanne N. Hodder
- Faculty of Applied Health and Community Studies, Sheridan College, Brampton, ON, Canada
| | - Monica R. Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - James L. Lyons
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Peter J. Keir
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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Central screw use delays implant dislodgement in osteopenic bone but not synthetic surrogates: A comparison of reverse total shoulder models. J Biomech 2019; 93:11-17. [DOI: 10.1016/j.jbiomech.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
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Gao X, Fraulob M, Haïat G. Biomechanical behaviours of the bone-implant interface: a review. J R Soc Interface 2019; 16:20190259. [PMID: 31362615 PMCID: PMC6685012 DOI: 10.1098/rsif.2019.0259] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023] Open
Abstract
In recent decades, cementless implants have been widely used in clinical practice to replace missing organs, to replace damaged or missing bone tissue or to restore joint functionality. However, there remain risks of failure which may have dramatic consequences. The success of an implant depends on its stability, which is determined by the biomechanical properties of the bone-implant interface (BII). The aim of this review article is to provide more insight on the current state of the art concerning the evolution of the biomechanical properties of the BII as a function of the implant's environment. The main characteristics of the BII and the determinants of implant stability are first introduced. Then, the different mechanical methods that have been employed to derive the macroscopic properties of the BII will be described. The experimental multi-modality approaches used to determine the microscopic biomechanical properties of periprosthetic newly formed bone tissue are also reviewed. Eventually, the influence of the implant's properties, in terms of both surface properties and biomaterials, is investigated. A better understanding of the phenomena occurring at the BII will lead to (i) medical devices that help surgeons to determine an implant's stability and (ii) an improvement in the quality of implants.
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Affiliation(s)
- Xing Gao
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
- Research Centre for Medical Robotics and Minimally Invasive Surgical Devices, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Manon Fraulob
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
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Khandare S, Arce RA, Vidt ME. Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study. J Electromyogr Kinesiol 2019; 62:102335. [DOI: 10.1016/j.jelekin.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 11/26/2022] Open
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Anthropometric Scaling of Anatomical Datasets for Subject-Specific Musculoskeletal Modelling of the Shoulder. Ann Biomed Eng 2019; 47:924-936. [DOI: 10.1007/s10439-019-02207-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
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Bouaicha S, Ernstbrunner L, Jud L, Meyer DC, Snedeker JG, Bachmann E. The lever arm ratio of the rotator cuff to deltoid muscle explains and predicts pseudoparalysis of the shoulder. Bone Joint J 2018; 100-B:1600-1608. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0493.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims In patients with a rotator cuff tear, tear pattern and tendon involvement are known risk factors for the development of pseudoparalysis of the shoulder. It remains unclear, however, why similar tears often have very different functional consequences. The present study hypothesizes that individual shoulder anatomy, specifically the moment arms (MAs) of the rotator cuff (RC) and the deltoid muscle, as well as their relative recruitment during shoulder abduction, plays a central role in pseudoparalysis. Materials and Methods Biomechanical and clinical analyses of the pseudoparalytic shoulder were conducted based on the ratio of the RC/deltoid MAs, which were used to define a novel anatomical descriptor called the Shoulder Abduction Moment (SAM) index. The SAM index is the ratio of the radii of two concentric spheres based on the centre of rotation of the joint. One sphere captures the humeral head (numerator) and the other the deltoid origin of the acromion (denominator). A computational rigid body simulation was used to establish the functional link between the SAM index and a potential predisposition for pseudoparalysis. A retrospective radiological validation study based on these measures was also undertaken using two cohorts with and without pseudoparalysis and massive RC tears. Results Decreased RC activity and improved glenohumeral stability was predicted by simulations of SAM indices with larger diameters of the humeral head, being consequently beneficial for joint stability. Clinical investigation of the SAM index showed significant risk of pseudoparalysis in patients with massive tears and a SAM < 0.77 (odds ratio (OR) 11). Conclusion The SAM index, which represents individual biomechanical characteristics of shoulder morphology, plays a determinant role in the presence or absence of pseudoparalysis in shoulders with massive RC tears.
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Affiliation(s)
- S. Bouaicha
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - L. Ernstbrunner
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - L. Jud
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - D. C. Meyer
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - J. G. Snedeker
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland
| | - E. Bachmann
- Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland
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Vidt ME, Santago AC, Marsh AP, Hegedus EJ, Tuohy CJ, Poehling GG, Freehill MT, Miller ME, Saul KR. Modeling a rotator cuff tear: Individualized shoulder muscle forces influence glenohumeral joint contact force predictions. Clin Biomech (Bristol, Avon) 2018; 60:20-29. [PMID: 30308434 PMCID: PMC6252115 DOI: 10.1016/j.clinbiomech.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/31/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models. METHODS Fourteen older individuals (age 63.4 yrs. (SD 1.8)) were studied; 7 with rotator cuff tear, 7 matched controls. Muscle volume measurements were used to scale a nominal upper limb model's muscle forces to develop individualized models and perform dynamic simulations of movement tracking participant-derived kinematics. Peak resultant glenohumeral joint contact force, and direction and magnitude of force components were compared between groups using ANCOVA. FINDINGS Results show individualized muscle force distributions for rotator cuff tear participants had reduced peak resultant joint contact force for pull and axilla wash (P ≤ 0.0456), with smaller compressive components of peak resultant force for pull (P = 0.0248). Peak forces for pull were within the glenoid. For axilla wash, peak joint contact was directed near/outside the glenoid rim for three participants; predictions required individualized muscle forces since nominal muscle forces did not affect joint force location. INTERPRETATION Older adults with rotator cuff tear had smaller peak resultant and compressive forces, possibly indicating increased instability or secondary joint damage risk. Outcomes suggest predicted joint contact force following rotator cuff tear is sensitive to including individualized muscle forces.
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Affiliation(s)
- Meghan E Vidt
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC 27109, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC 27268, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Engineering Building 3, Campus Box 7910, 911 Oval Drive, Raleigh, NC 27695-7910, USA
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Kerkhof FD, Vereecke EE, Vanovermeire O, Vanhaecke J, Vanneste M, Stockmans F. Trapeziometacarpal stabilization through dorsoradial ligament reconstruction: An early post-surgery in vivo biomechanical analyses. J Orthop Res 2018; 36:2851-2864. [PMID: 29947128 DOI: 10.1002/jor.24103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
Ligament reconstruction can provide pain relief in patients with a painful, unstable, pre-arthritic trapeziometacarpal (TMC) joint. Imbrication of the dorsoradial ligament (DRL) has been proposed as a minimal invasive stabilization technique. It requires less invasive surgery than an Eaton-Littler technique and shows promising long-term clinical outcome. We used dynamic CT to objectively review the effects of the imbrication. Four patients with pain and laxity at the TMC joint, but without radiographic signs of osteoarthritis, were recruited. Dynamic CT scans were made during active thumb abduction-adduction, flexion-extension, and two functional grip tasks using a radiolucent jig. Scans of the patients were acquired before and 3 to 6 months after DRL reconstruction. Motion of each bone in the articular chain of the thumb was quantified. In addition, we mapped changes in the contact patterns between the articular facets during the entire thumb motion. After DRL imbrication, we found no overall decrease in MC1 movement in three out of four patients. Furthermore, no increase in TMC joint congruency, defined as proximity area size, was found for three out of four patients. Pre- and post-operative differences in congruency across different tasks were patient-dependent and relatively small. We demonstrated that, from a biomechanical perspective, there is high variability in post-operative outcome between patients that undergo identical surgical procedures performed by the same surgeon. A post-operative decrease in range of motion, increase in joint congruency or decrease in proximity area shift during thumb motion is not omnipresent. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2851-2864, 2018.
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Affiliation(s)
- Faes D Kerkhof
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie E Vereecke
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | | | - Maarten Vanneste
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Filip Stockmans
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium.,AZ Groeninge, Kortrijk, Belgium
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Odle B, Reinbolt J, Forrest G, Dyson-Hudson T. Construction and evaluation of a model for wheelchair propulsion in an individual with tetraplegia. Med Biol Eng Comput 2018; 57:519-532. [PMID: 30255235 DOI: 10.1007/s11517-018-1895-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
Upper limb overuse injuries are common in manual wheelchair users with spinal cord injury. Patient-specific in silico models enhance experimental biomechanical analyses by estimating in vivo shoulder muscle and joint contact forces. Current models exclude deep shoulder muscles that have important roles in wheelchair propulsion. Freely accessible patient-specific models have not been generated for persons with tetraplegia, who have a greater risk for shoulder pain and injury. The objectives of this work were to (i) construct a freely accessible, in silico, musculoskeletal model capable of generating patient-specific dynamic simulations of wheelchair propulsion and (ii) establish proof-of-concept with data obtained from an individual with tetraplegia. Constructed with OpenSim, the model features muscles excluded in existing models. Shoulder muscle forces and activations were estimated via inverse dynamics. Mean absolute error of estimated muscle activations and fine-wire electromyography (EMG) recordings was computed. Mean muscle activation for five consecutive stroke cycles demonstrated good correlation (0.15-0.17) with fine-wire EMG. These findings, comparable to other studies, suggest that the model is capable of estimating shoulder muscle forces during wheelchair propulsion. The additional muscles may provide a greater understanding of shoulder muscle contribution to wheelchair propulsion. The model may ultimately serve as a powerful clinical tool. Graphical abstract ᅟ.
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Affiliation(s)
- Brooke Odle
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Blvd, Newark, NJ, 07102, USA. .,Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA. .,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Jeffrey Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, 1512 Middle Drive, Knoxville, TN, 37996, USA
| | - Gail Forrest
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07101, USA
| | - Trevor Dyson-Hudson
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07101, USA
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Ameln DJD, Chadwick EK, Blana D, Murgia A. The Stabilizing Function of Superficial Shoulder Muscles Changes Between Single-Plane Elevation and Reaching Tasks. IEEE Trans Biomed Eng 2018; 66:564-572. [PMID: 29993505 DOI: 10.1109/tbme.2018.2850522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of this study was to determine whether and how much the stabilizing role of the shoulder muscles changes as a function of humeral elevation and the plane of elevation. METHODS A musculoskeletal model, comprising a personalized scapulohumeral rhythm, was used to calculate the ratio of shear over compressive force (stability ratio) of three rotator cuff muscles (supraspinatus, infraspinatus and subscapularis) and three superficial shoulder muscles (middle deltoid, clavicular part of pectoralis major and latissimus dorsi) during abduction, flexion and reaching movements in 10 healthy adults. RESULTS The range of the stability ratios was [Formula: see text] for the rotator cuff muscles compared to [Formula: see text] for the superficial shoulder muscles. In the superior-inferior direction, the stability ratios of all muscles changed with humeral elevation and for infraspinatus, subscapularis, latissimus dorsi and deltoid also with the plane of elevation. In the anterior-posterior direction, the stability ratios of all muscles changed with humeral elevation, except for the deltoid, and with the plane of elevation, except for the supraspinatus, with interaction effects in all muscles. CONCLUSION The rotator cuff muscles provide greater compression than shear forces during all tasks. The stabilizing function of the superficial shoulder muscles examined in this study varies during tasks. SIGNIFICANCE The findings can be used to predict in which movements the shoulder joint becomes more unstable and can be applied to understand how shear and compressive forces change in populations with abnormal shoulder motion.
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Klemt C, Prinold JA, Morgans S, Smith SH, Nolte D, Reilly P, Bull AM. Analysis of shoulder compressive and shear forces during functional activities of daily life. Clin Biomech (Bristol, Avon) 2018; 54:34-41. [PMID: 29550641 PMCID: PMC6405441 DOI: 10.1016/j.clinbiomech.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knowledge of forces acting through the glenohumeral joint during activities of daily living is a prerequisite for improving implant design and aiding rehabilitation planning. Existing data are limited by the number of activities performed and, in some cases, the lack of representation of the glenohumeral loading direction, although high shear force components may cause joint dislocation or implant loosening. This study aims to analyse shoulder compression and shear force components during essential functional activities of daily living. METHODS This is a combined modelling and experimental study. Motion data and external forces measured from 25 participants for 26 activities of daily living serve as input into an upper limb musculoskeletal model that quantifies glenohumeral loading. FINDINGS The shoulder contact force exceeds 50% of the body weight in 10/26 activities of daily living with a maximum contact force of 164% of the body weight (SD 69%) for a sit to stand task. The ratio of glenohumeral shear force component to compression force component exceeds 0.5 in 8/26 functional activities, with maximum ratios for reaching across the body (1.09; SD 0.41) and pick and place an everyday object (0.88; SD 0.36). INTERPRETATION This study demonstrates substantial loads through the glenohumeral joint during activities of daily living. The ratios of glenohumeral shear force component to compression force component are considerable when high loads act at long lever arms and at high angles of arm elevation. These glenohumeral ratios represent a key component of loading that should be considered when designing implants, surgical procedures, or rehabilitation protocols.
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Affiliation(s)
- Christian Klemt
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom,Corresponding author.
| | - Joe A. Prinold
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Sharon Morgans
- Physiotherapy Unit, Imperial College Healthcare NHS Trust, London, NW8 9NH, United Kingdom
| | - Samuel H.L. Smith
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Daniel Nolte
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom,Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, W2 1NY, United Kingdom
| | - Anthony M.J. Bull
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom
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Carlos Q, Margarida A, Jorge A, S. B. G, João F. Influence
of the Musculotendon Dynamics on the Muscle Force-Sharing Problem of the Shoulder—A Fully Inverse
Dynamics Approach. J Biomech Eng 2018; 140:2676614. [DOI: 10.1115/1.4039675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 01/05/2023]
Abstract
Abstract
Most dynamic simulations are based on inverse dynamics, being the time-dependent physiological nature of the muscle properties rarely considered due to numerical challenges. Since the influence of muscle physiology on the consistency of inverse dynamics simulations remains unclear, the purpose of the present study is to evaluate the computational efficiency and biological validity of four musculotendon models that differ in the simulation of the muscle activation and contraction dynamics. Inverse dynamic analyses are performed using a spatial musculoskeletal model of the upper limb. The muscle force-sharing problem is solved for five repetitions of unloaded and loaded motions of shoulder abduction and shoulder flexion. The performance of the musculotendon models is evaluated by comparing muscle activation predictions with electromyography (EMG) signals, measured synchronously with motion for 11 muscles, and the glenohumeral joint reaction forces estimated numerically with those measured in vivo. The results show similar muscle activations for all muscle models. Overall, high cross-correlations are computed between muscle activations and the EMG signals measured for all movements analyzed, which provides confidence in the results. The glenohumeral joint reaction forces estimated compare well with those measured in vivo, but the influence of the muscle dynamics is found to be negligible. In conclusion, for slow-speed, standard movements of the upper limb, as those studied here, the activation and musculotendon contraction dynamics can be neglected in inverse dynamic analyses without compromising the prediction of muscle and joint reaction forces.
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Affiliation(s)
- Quental Carlos
- IDMEC,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais 1,Lisboa 1049-001, Portugale-mail:
| | - Azevedo Margarida
- IDMEC,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais 1,Lisboa 1049-001, Portugale-mail:
| | - Ambrósio Jorge
- IDMEC,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais 1,Lisboa 1049-001, Portugale-mail:
| | - Gonçalves S. B.
- IDMEC,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais 1,Lisboa 1049-001, Portugale-mail:
| | - Folgado João
- IDMEC,Instituto Superior Técnico,Universidade de Lisboa,Av. Rovisco Pais 1,Lisboa 1049-001 Portugale-mail:
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Blache Y, Begon M. Influence of Shoulder Kinematic Estimate on Joint and Muscle Mechanics Predicted by Musculoskeletal Model. IEEE Trans Biomed Eng 2018. [DOI: 10.1109/tbme.2017.2716186] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schneider DK, Gokeler A, Otten E, Ford KR, Hewett TE, Divine JG, Colosimo AJ, Heidt RS, Myer GD. A Novel Mass-Spring-Damper Model Analysis to Identify Landing Deficits in Athletes Returning to Sport After Anterior Cruciate Ligament Reconstruction. J Strength Cond Res 2018; 31:2590-2598. [PMID: 27465632 DOI: 10.1519/jsc.0000000000001569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Schneider, DK, Gokeler, A, Otten, E, Ford, KR, Hewett, TE, Divine, JG, Colosimo, AJ, Heidt, RS, and Myer, GD. A Novel mass-spring-damper model analysis to identify landing deficits in athletes returning to sport after anterior cruciate ligament reconstruction. J Strength Cond Res 31(9): 2590-2598, 2017-A mass-spring-damper (MSD) model may serve as an extension of biomechanical data from 3-dimensional motion analysis and epidemiological data which helps to delineate populations at risk for anterior cruciate ligament (ACL) injuries. The purpose of this study was to evaluate such a model. Thirty-six ACL reconstruction (ACLR) group subjects and 67 controls (CTRL) completed single-leg drop landing and single-leg broad jump tasks. Landing ground reaction force data were collected and analyzed with an MSD model. Medians, interquartile ranges, and limb symmetry indices (LSIs) were calculated and comparisons were made within and between groups. During a single-leg drop landing, the ACLR group had a lower spring LSI than the CTRL group (p = 0.015) and landed with decreased stiffness in the involved limb relative to the uninvolved limb (p = 0.021). The ACLR group also had an increased damping LSI relative to the CTRL group (p = 0.045). The ACLR subjects landed with increased stiffness (p = 0.006) and decreased damping (p = 0.003) in their involved limbs compared to CTRL subjects' nondominant limbs. During a single-leg forward broad jump, the ACLR group had a greater spring LSI value than the CTRL group (p = 0.045). The CTRL group also recorded decreased damping values in their nondominant limbs compared with the involved limbs of the ACLR group (p = 0.046). Athletes who have undergone ACLR display different lower-limb dynamics than healthy controls, according to an MSD model. Quadriceps dominance and leg dominance are components of ACLR athletes' landing strategies and may be identified with an MSD model and addressed during rehabilitation.
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Affiliation(s)
- Daniel K Schneider
- 1Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 2Division of Sports Medicine, The Sport Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 3College of Medicine, University of Cincinnati, Cincinnati, Ohio; 4Center for Human Movement Sciences, University of Groningen, Groningen, the Netherlands; 5Department of Physical Therapy, High Point University, High Point, North Carolina; 6Departments of Orthopaedic Surgery, Physical Medicine and Rehabilitation, and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; 7Department of Sports Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio; 8Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; 9Wellington Orthopaedic Surgery and Sports Medicine, Mercy Health, Cincinnati, Ohio; 10Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; and 11The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
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40
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Wu W, Fong J, Crocher V, Lee PVS, Oetomo D, Tan Y, Ackland DC. Modulation of shoulder muscle and joint function using a powered upper-limb exoskeleton. J Biomech 2018; 72:7-16. [PMID: 29506759 DOI: 10.1016/j.jbiomech.2018.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 11/18/2022]
Abstract
Robotic-assistive exoskeletons can enable frequent repetitive movements without the presence of a full-time therapist; however, human-machine interaction and the capacity of powered exoskeletons to attenuate shoulder muscle and joint loading is poorly understood. This study aimed to quantify shoulder muscle and joint force during assisted activities of daily living using a powered robotic upper limb exoskeleton (ArmeoPower, Hocoma). Six healthy male subjects performed abduction, flexion, horizontal flexion, reaching and nose touching activities. These tasks were repeated under two conditions: (i) the exoskeleton compensating only for its own weight, and (ii) the exoskeleton providing full upper limb gravity compensation (i.e., weightlessness). Muscle EMG, joint kinematics and joint torques were simultaneously recorded, and shoulder muscle and joint forces calculated using personalized musculoskeletal models of each subject's upper limb. The exoskeleton reduced peak joint torques, muscle forces and joint loading by up to 74.8% (0.113 Nm/kg), 88.8% (5.8%BW) and 68.4% (75.6%BW), respectively, with the degree of load attenuation strongly task dependent. The peak compressive, anterior and superior glenohumeral joint force during assisted nose touching was 36.4% (24.6%BW), 72.4% (13.1%BW) and 85.0% (17.2%BW) lower than that during unassisted nose touching, respectively. The present study showed that upper limb weight compensation using an assistive exoskeleton may increase glenohumeral joint stability, since deltoid muscle force, which is the primary contributor to superior glenohumeral joint shear, is attenuated; however, prominent exoskeleton interaction moments are required to position and control the upper limb in space, even under full gravity compensation conditions. The modeling framework and results may be useful in planning targeted upper limb robotic rehabilitation tasks.
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Affiliation(s)
- Wen Wu
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Justin Fong
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Vincent Crocher
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Denny Oetomo
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Ying Tan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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Blache Y, Begon M, Michaud B, Desmoulins L, Allard P, Dal Maso F. Muscle function in glenohumeral joint stability during lifting task. PLoS One 2017; 12:e0189406. [PMID: 29244838 PMCID: PMC5731701 DOI: 10.1371/journal.pone.0189406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 11/26/2017] [Indexed: 11/23/2022] Open
Abstract
Ensuring glenohumeral stability during repetitive lifting tasks is a key factor to reduce the risk of shoulder injuries. Nevertheless, the literature reveals some lack concerning the assessment of the muscles that ensure glenohumeral stability during specific lifting tasks. Therefore, the purpose of this study was to assess the stabilization function of shoulder muscles during a lifting task. Kinematics and muscle electromyograms (n = 9) were recorded from 13 healthy adults during a bi-manual lifting task performed from the hip to the shoulder level. A generic upper-limb OpenSim model was implemented to simulate glenohumeral stability and instability by performing static optimizations with and without glenohumeral stability constraints. This procedure enabled to compute the level of shoulder muscle activity and forces in the two conditions. Without the stability constraint, the simulated movement was unstable during 74%±16% of the time. The force of the supraspinatus was significantly increased of 107% (p<0.002) when the glenohumeral stability constraint was implemented. The increased supraspinatus force led to greater compressive force (p<0.001) and smaller shear force (p<0.001), which contributed to improved glenohumeral stability. It was concluded that the supraspinatus may be the main contributor to glenohumeral stability during lifting task.
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Affiliation(s)
- Yoann Blache
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université Lyon 1, Université de Lyon, Lyon, France
- * E-mail:
| | - Mickaël Begon
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Benjamin Michaud
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Landry Desmoulins
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Paul Allard
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Fabien Dal Maso
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
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Understanding the Basics of Computational Models in Orthopaedics: A Nonnumeric Review for Surgeons. J Am Acad Orthop Surg 2017; 25:684-692. [PMID: 28953083 DOI: 10.5435/jaaos-d-16-00320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Computational models represent more than just finite element analysis, a term that many clinicians may know and globally apply. Over the past 30 years, many published studies have addressed clinically relevant orthopaedic questions with speed and precision by using a wide variety of computational approaches. Given such a wide spectrum of techniques, clinicians often do not have a full understanding of the methods used to create models and therefore do not appreciate the strengths, weaknesses, and potential pitfalls of published results. The short, nonnumeric summaries of the methodologies employed for various computational approaches presented here can help address this issue.
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Effect of lateralized design on muscle and joint reaction forces for reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:564-572. [PMID: 28038912 DOI: 10.1016/j.jse.2016.09.045] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Manufacturers of reverse shoulder arthroplasty (RSA) implants have recently designed innovative implants to optimize performance in rotator cuff-deficient shoulders. These advancements are not without tradeoffs and can have negative biomechanical effects. The objective of this study was to develop an integrated finite element analysis-kinematic model to compare the muscle forces and joint reaction forces (JRFs) of 3 different RSA designs. METHODS A kinematic model of a normal shoulder joint was adapted from the Delft model and integrated with the well-validated OpenSim shoulder model. Static optimizations then allowed for calculation of the individual muscle forces, moment arms, and JRFs relative to net joint moments. Three-dimensional computer models of 3 RSA designs-humeral lateralized design (HLD), glenoid lateralized design, and Grammont design-were integrated, and parametric studies were performed. RESULTS Overall, there were decreases in deltoid and rotator cuff muscle forces for all 3 RSA designs. These decreases were greatest in the middle deltoid of the HLD model for abduction and flexion and in the rotator cuff muscles under both internal rotation and external rotation. The JRFs in abduction and flexion decreased similarly for all RSA designs compared with the normal shoulder model, with the greatest decrease seen in the HLD model. CONCLUSIONS These findings demonstrate that the design characteristics implicit in these modified RSA prostheses result in mechanical differences most prominently seen in the deltoid muscle and overall JRFs. Further research using this novel integrated model can help guide continued optimization of RSA design and clinical outcomes.
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Effect of various upper limb multibody models on soft tissue artefact correction: A case study. J Biomech 2017; 62:102-109. [PMID: 28274475 DOI: 10.1016/j.jbiomech.2017.01.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 02/04/2023]
Abstract
Soft tissue artefacts (STA) introduce errors in joint kinematics when using cutaneous markers, especially on the scapula. Both segmental optimisation and multibody kinematics optimisation (MKO) algorithms have been developed to improve kinematics estimates. MKO based on a chain model with joint constraints avoids apparent joint dislocation but is sensitive to the biofidelity of chosen joint constraints. Since no recommendation exists for the scapula, our objective was to determine the best models to accurately estimate its kinematics. One participant was equipped with skin markers and with an intracortical pin screwed in the scapula. Segmental optimisation and MKO for 24-chain models (including four variations of the scapulothoracic joint) were compared against the pin-derived kinematics using root mean square error (RMSE) on Cardan angles. Segmental optimisation led to an accurate scapula kinematics (1.1°≤RMSE≤3.3°) even for high arm elevation angles. When MKO was applied, no clinically significant difference was found between the different scapulothoracic models (0.9°≤RMSE≤4.1°) except when a free scapulothoracic joint was modelled (1.9°≤RMSE≤9.6°). To conclude, using MKO as a STA correction method was not more accurate than segmental optimisation for estimating scapula kinematics.
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Subject-specific musculoskeletal modeling in the evaluation of shoulder muscle and joint function. J Biomech 2016; 49:3626-3634. [PMID: 28327299 DOI: 10.1016/j.jbiomech.2016.09.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/30/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
Abstract
Upper limb muscle force estimation using Hill-type muscle models depends on musculotendon parameter values, which cannot be readily measured non-invasively. Generic and scaled-generic parameters may be quickly and easily employed, but these approaches do not account for an individual subject's joint torque capacity. The objective of the present study was to develop a subject-specific experimental testing and modeling framework to evaluate shoulder muscle and joint function during activities of daily living, and to assess the capacity of generic and scaled-generic musculotendon parameters to predict muscle and joint function. Three-dimensional musculoskeletal models of the shoulders of 6 healthy subjects were developed to calculate muscle and glenohumeral joint loading during abduction, flexion, horizontal flexion, nose touching and reaching using subject-specific, scaled-generic and generic musculotendon parameters. Muscle and glenohumeral joint forces calculated using generic and scaled-generic models were significantly different to those of subject-specific models (p<0.05), and task dependent; however, scaled-generic model calculations of shoulder glenohumeral joint force demonstrated better agreement with those of subject-specific models during abduction and flexion. Muscles in generic musculoskeletal models operated further from the plateau of their force-length curves than those of scaled-generic and subject-specific models, while muscles in subject-specific models operated over a wider region of their force length curves than those of the generic or scaled-generic models, reflecting diversity of subject shoulder strength. The findings of this study suggest that generic and scaled-generic musculotendon parameters may not provide sufficient accuracy in prediction of shoulder muscle and joint loading when compared to models that employ subject-specific parameter-estimation approaches.
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Blache Y, Creveaux T, Dumas R, Chèze L, Rogowski I. Glenohumeral contact force during flat and topspin tennis forehand drives. Sports Biomech 2016; 16:127-142. [PMID: 27595163 DOI: 10.1080/14763141.2016.1216585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The primary role of the shoulder joint in tennis forehand drive is at the expense of the loadings undergone by this joint. Nevertheless, few studies investigated glenohumeral (GH) contact forces during forehand drives. The aim of this study was to investigate GH compressive and shearing forces during the flat and topspin forehand drives in advanced tennis players. 3D kinematics of flat and topspin forehand drives of 11 advanced tennis players were recorded. The Delft Shoulder and Elbow musculoskeletal model was implemented to assess the magnitude and orientation of GH contact forces during the forehand drives. The results showed no differences in magnitude and orientation of GH contact forces between the flat and topspin forehand drives. The estimated maximal GH contact force during the forward swing phase was 3573 ± 1383 N, which was on average 1.25 times greater than during the follow-through phase, and 5.8 times greater than during the backswing phase. Regardless the phase of the forehand drive, GH contact forces pointed towards the anterior-superior part of the glenoid therefore standing for shearing forces. Knowledge of GH contact forces during real sport tasks performed at high velocity may improve the understanding of various sport-specific adaptations and causative factors for shoulder problems.
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Affiliation(s)
- Yoann Blache
- a Inter-University Laboratory of Human Movement Biology , University Claude Bernard Lyon 1 , Lyon , France
| | - Thomas Creveaux
- a Inter-University Laboratory of Human Movement Biology , University Claude Bernard Lyon 1 , Lyon , France
| | - Raphaël Dumas
- b Biomechanics and Impact Mechanics Laboratory , University Claude Bernard Lyon 1 , Lyon , France
| | - Laurence Chèze
- b Biomechanics and Impact Mechanics Laboratory , University Claude Bernard Lyon 1 , Lyon , France
| | - Isabelle Rogowski
- a Inter-University Laboratory of Human Movement Biology , University Claude Bernard Lyon 1 , Lyon , France
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Hölscher T, Weber T, Lazarev I, Englert C, Dendorfer S. Influence of rotator cuff tears on glenohumeral stability during abduction tasks. J Orthop Res 2016; 34:1628-35. [PMID: 26756861 DOI: 10.1002/jor.23161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1628-1635, 2016.
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Affiliation(s)
- Thomas Hölscher
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tim Weber
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Igor Lazarev
- Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
| | | | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
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48
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Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track? Phys Ther 2016; 96:1162-9. [PMID: 26847012 DOI: 10.2522/ptj.20140230] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 01/24/2016] [Indexed: 11/17/2022]
Abstract
Stabilization exercises have been a focus and mainstay of many therapeutic and performance training programs in the past decade. Whether the focus is core stabilization for the spine or scapular stabilization, clinicians and trainers alike have endorsed these programs, largely on the basis of conceptual theory and anecdotal experience. The notion that an unstable scapula is related to shoulder dysfunction and pathology is well accepted, but is it accurate? The aim of this perspective article is to challenge the concept of scapular stabilization through the application of biomechanical and motor control constructs. The objectives are to critically examine current beliefs about scapular stabilization, to discuss definitions of stabilization and stability in the context of the scapulothoracic region, and to evaluate key evidence regarding scapular stabilization and scapular dyskinesia. Several new approaches that may affect the understanding of normal and atypical scapula motion are explored. Finally, a historical analogy is presented and future research and clinical directions are suggested. The aims are to lead readers to the essential concepts implied on scapular stabilization, to increase the critical thought process in rehabilitation practice, and to suggest some open topics to be explored in future research.
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49
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Hillen RJ, Bolsterlee B, Veeger DHEJ. The biomechanical effect of clavicular shortening on shoulder muscle function, a simulation study. Clin Biomech (Bristol, Avon) 2016; 37:141-146. [PMID: 27467816 DOI: 10.1016/j.clinbiomech.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malunion of the clavicle with shortening after mid shaft fractures can give rise to long-term residual complaints. The cause of these complaints is as yet unclear. METHODS In this study we analysed data of an earlier experimental cadaveric study on changes of shoulder biomechanics with progressive shortening of the clavicle. The data was used in a musculoskeletal computer model to examine the effect of clavicle shortening on muscle function, expressed as maximal muscle moments for abduction and internal rotation. FINDINGS Clavicle shortening results in changes of maximal muscle moments around the shoulder girdle. The mean values at 3.6cm of shortening of maximal muscle moment changes are 16% decreased around the sterno-clavicular joint decreased for both ab- and adduction, 37% increased around the acromion-clavicular joint for adduction and 32% decrease for internal rotation around the gleno-humeral joint in resting position. INTERPRETATION Shortening of the clavicle affects muscle function in the shoulder in a computer model. This may explain for the residual complaints after short malunion with shortening. LEVEL OF EVIDENCE Basic Science Study. Biomechanics. Cadaveric data and computer model.
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Affiliation(s)
- Robert J Hillen
- Waterland Ziekenhuis Purmerend, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
| | - Bart Bolsterlee
- Neuroscience Research Australia Margarete Ainsworth Building, Barker St Randwick, NSW 2031, Australia
| | - Dirkjan H E J Veeger
- Faculty Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Human Movement Sciences, Research institute MOVE, Vrije Universiteit Amsterdam, The Netherlands
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Viehöfer AF, Snedeker JG, Baumgartner D, Gerber C. Glenohumeral joint reaction forces increase with critical shoulder angles representative of osteoarthritis-A biomechanical analysis. J Orthop Res 2016; 34:1047-52. [PMID: 26638117 DOI: 10.1002/jor.23122] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/25/2015] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) of the glenohumeral joint constitutes the most frequent indication for nontraumatic shoulder joint replacement. Recently, a small critical shoulder angle (CSA) was found to be associated with a high prevalence of OA. This study aims to verify the hypothesis that a small CSA leads to higher glenohumeral joint reaction forces during activities of daily living than a normal CSA. A shoulder simulator with simulated deltoid (DLT), supraspinatus (SSP), infraspinatus/teres minor (ISP/TM), and subscapularis (SSC) musculotendinous units was constructed. The DLT wrapping on the humerus was simulated using a pulley that could be horizontally adjusted to simulate the 28° CSA found in OA or the 33° CSA found in disease-free shoulders. Over a range of motion between 6° and 82° of thoracohumeral abduction joint forces were measured using a six-axis load cell. An OA-associated CSA yielded higher net joint reaction forces than a normal CSA over the entire range of motion. The maximum difference of 26.4 N (8.5%) was found at 55° of thoracohumeral abduction. Our model thus suggests that a CSA typical for OA predisposes the glenohumeral joint to higher joint reaction forces and could plausibly play a role in joint overloading and development of OA. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1047-1052, 2016.
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Affiliation(s)
- Arnd F Viehöfer
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland
| | - Daniel Baumgartner
- Institute of Mechanical Systems Organization, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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