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Longo UG, Carnevale A, Massaroni C, Lo Presti D, Berton A, Candela V, Schena E, Denaro V. Personalized, Predictive, Participatory, Precision, and Preventive (P5) Medicine in Rotator Cuff Tears. J Pers Med 2021; 11:255. [PMID: 33915689 PMCID: PMC8066336 DOI: 10.3390/jpm11040255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022] Open
Abstract
Rotator cuff (RC) disease is a common musculoskeletal disorder of the shoulder entailing pain, with reduced functionality and quality of life. The main objective of this study was to present a perspective of the current scientific evidence about personalized, predictive, participatory, precision, and preventive approaches in the management of RC diseases. The personalized, predictive, participatory, precision and preventive (P5) medicine model is an interdisciplinary and multidisciplinary approach that will provide researchers and clinicians with a comprehensive patrimony of knowledge in the management of RC diseases. The ability to define genetic predispositions in conjunction with the evaluation of lifestyle and environmental factors may boost the tailoring of diagnosis and therapy in patients suffering from RC diseases.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (C.M.); (D.L.P.); (E.S.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 00128 Rome, Italy; (A.C.); (A.B.); (V.C.); (V.D.)
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Mulla DM, Hodder JN, Maly MR, Lyons JL, Keir PJ. Glenohumeral stabilizing roles of the scapulohumeral muscles: Implications of muscle geometry. J Biomech 2020; 100:109589. [PMID: 31911053 DOI: 10.1016/j.jbiomech.2019.109589] [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: 05/03/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
Dynamic stability provided by muscles is integral for function and integrity of the glenohumeral joint. Although the high degree of inter-individual variation that exists in musculoskeletal geometry is associated with shoulder injuries, there is limited research associating the effects of muscle geometry on the potential stabilizing capacities of shoulder muscles. The purpose of this investigation was to evaluate the stabilizing functions of the scapulohumeral muscles using computational modeling and to quantify the sensitivity of muscle stabilizing roles to changes in muscle geometry. Muscle stability ratios in the superior/inferior and anterior/posterior directions were computed as the ratio between the muscle's shear components relative to compression throughout arm elevation in the scapular plane. Muscle attachment locations on the clavicle, scapula, and humerus were iteratively adjusted using Monte Carlo simulations. Consistent with previous experimental studies, the rotator cuff muscles were identified as the primary stabilizers of the glenohumeral joint; whereas the deltoids and coracobrachialis have a strong potential for superiorly translating the humerus at low elevation angles. Variations in the stability ratios due to altered muscle geometry were muscle- and angle-specific. In general, the highest variation was observed for the subscapularis and deltoids (at low elevation angles), while the remaining rotator cuff muscles largely maintained their capacity to provide compressive stabilizing forces at the glenohumeral joint. Changes in muscle stability ratios may affect dynamic stability of the humerus that could differentially predispose individuals to greater risk for injury.
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Affiliation(s)
- Daanish M Mulla
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Joanne N Hodder
- Faculty of Applied Health & 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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Seth A, Dong M, Matias R, Delp S. Muscle Contributions to Upper-Extremity Movement and Work From a Musculoskeletal Model of the Human Shoulder. Front Neurorobot 2019; 13:90. [PMID: 31780916 PMCID: PMC6856649 DOI: 10.3389/fnbot.2019.00090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
Musculoskeletal models enable movement scientists to examine muscle function by computing the mechanical work done by muscles during motor tasks. To estimate muscle work accurately requires a model that is physiologically plausible. Previous models of the human shoulder have coupled scapula movement to humeral movement. While coupled movement produces a stereotypical scapulohumeral rhythm, it cannot model shrugging or independent movement of the scapula and humerus. The artificial coupling of humeral elevation to scapular rotation permits muscles that cross the glenohumeral joint, such as the rotator-cuff muscles and deltoids, to do implausible work to elevate and rotate the scapula. In reality, the motion of the scapula is controlled by thoracoscapular muscles, yet the roles of these muscles in shoulder function remains unclear. To elucidate the roles of the thoracoscapular muscles, we developed a shoulder model with an accurate scapulothoracic joint and includes scapular muscles to drive its motion. We used the model to compute the work done by the thoracoscapular muscles during shrugging and arm elevation. We found that the bulk of the work done in upper-extremity tasks is performed by the largest muscles of the shoulder: trapezius, deltoids, pectoralis major, and serratus-anterior. Trapezius and serratus anterior prove to be important synergists in performing upward-rotation of the scapula. We show that the large thoracoscapular muscles do more work than glenohumeral muscles during arm-elevation tasks. The model, experimental data and simulation results are freely available on SimTK.org to enable anyone to explore our results and to perform further studies in OpenSim 4.0.
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Affiliation(s)
- Ajay Seth
- Neuromuscular Biomechanics Lab, Bioengineering and Mechanical Engineering Departments, Stanford University, Stanford, CA, United States
| | - Meilin Dong
- Neuromuscular Biomechanics Lab, Bioengineering and Mechanical Engineering Departments, Stanford University, Stanford, CA, United States
| | - Ricardo Matias
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Human Movement Analysis Lab, Escola Superior Saúde-Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Scott Delp
- Neuromuscular Biomechanics Lab, Bioengineering and Mechanical Engineering Departments, Stanford University, Stanford, CA, United States
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