A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements. PLoS One. 2016;11:e0141028. [PMID: 26734761 PMCID: PMC4712143 DOI: 10.1371/journal.pone.0141028]

A novel biomechanical model of the mouse forelimb predicts muscle activity in optimal control simulations of reaching movements

Mice are key model organisms in neuroscience and motor systems physiology. Fine motor control tasks performed by mice have become widely used in assaying neural and biophysical motor system mechanisms. Although fine motor tasks provide useful insights into behaviors which require complex multi-joint motor control, there is no previously developed physiological biomechanical model of the adult mouse forelimb available for estimating kinematics nor muscle activity or kinetics during behaviors. Here, we developed a musculoskeletal model based on high-resolution imaging of the mouse forelimb that includes muscles spanning the neck, trunk, shoulder, and limbs. Physics-based optimal control simulations of the forelimb model were used to estimate in vivo muscle activity present when constrained to the tracked kinematics during reaching movements. The activity of a subset of muscles was recorded and used to assess the accuracy of the muscle patterning in simulation. We found that the synthesized muscle patterning in the forelimb model had a strong resemblance to empirical muscle patterning, suggesting that our model has utility in providing a realistic set of estimated muscle excitations over time when given a kinematic template. The strength of the similarity between empirical muscle activity and optimal control predictions increases as mice performance improves throughout learning of the reaching task. Our computational tools are available as open-source in the OpenSim physics and modeling platform. Our model can enhance research into limb control across broad research topics and can inform analyses of motor learning, muscle synergies, neural patterning, and behavioral research that would otherwise be inaccessible.

Personalizing the shoulder rhythm in a computational upper body model improves kinematic tracking in high range-of-motion arm movements

Musculoskeletal models of the shoulder are needed to understand the mechanics of overhead motions. Existing models implementing the shoulder rhythm are generic and might not accurately represent an individual's scapular kinematics. We introduce a method to personalize the shoulder rhythm of a computational model of the upper body that defines the orientations of the clavicle and scapula based on glenohumeral joint angles. During five static calibration poses, we palpate and measure the orientation of the scapula. We explore the importance of representing shoulder elevation by introducing clavicle elevation as a degree of freedom that is independent of the glenohumeral angles. For ten subjects, we record the five calibration poses, ten additional static poses, and dynamic arm raises covering the participants' full range of motion in each body plane using optical motion capture. We examine the data using a dynamically-constrained inverse kinematics analysis. Shoulder rhythm personalization, independent clavicle elevation, and both in combination reduce the average upper body marker tracking error compared to the generic model in the static poses (26 mm to 17-20 mm) and in the dynamic trials (22 mm to 14-17 mm). Only personalization reduces the average scapula marker error (51 mm to 36-38 mm) and scapula axis-angle error (15° to 10°) compared with the palpated ground truth measurements in the static poses, and in the dynamic trials at instances that best match the static poses (53 mm to 37-40 mm, 15° to 9°). Our results show that personalizing upper body models improves kinematic tracking. We provide our experimental data, model, and methods to allow researchers to reproduce and build upon our results.

Verification of acromion marker cluster and scapula spinal marker cluster methods for tracking shoulder kinematics: a comparative study with upright four-dimensional computed tomography

BACKGROUND

This study validated the accuracy of the acromion marker cluster (AMC) and scapula spinal marker cluster (SSMC) methods compared with upright four-dimensional computed tomography (4DCT) analysis.

METHODS

Sixteen shoulders of eight healthy males underwent AMC and SSMC assessments. Active shoulder elevation was tracked using upright 4DCT and optical motion capture system. The scapulothoracic and glenohumeral rotation angles calculated from AMC and SSMC were compared with 4DCT. Additionally, the motion of these marker clusters on the skin with shoulder elevation was evaluated.

RESULTS

The average differences between AMC and 4DCT during 10°-140° of humerothoracic elevation were - 2.2° ± 7.5° in scapulothoracic upward rotation, 14.0° ± 7.4° in internal rotation, 6.5° ± 7.5° in posterior tilting, 3.7° ± 8.1° in glenohumeral elevation, - 8.3° ± 10.7° in external rotation, and - 8.6° ± 8.9° in anterior plane of elevation. The difference between AMC and 4DCT was significant at 120° of humerothoracic elevation in scapulothoracic upward rotation, 50° in internal rotation, 90° in posterior tilting, 120° in glenohumeral elevation, 100° in external rotation, and 100° in anterior plane of elevation. However, the average differences between SSMC and 4DCT were - 7.5 ± 7.7° in scapulothoracic upward rotation, 2.0° ± 7.0° in internal rotation, 2.3° ± 7.2° in posterior tilting, 8.8° ± 7.9° in glenohumeral elevation, 2.0° ± 9.1° in external rotation, and 1.9° ± 10.1° in anterior plane of elevation. The difference between SSMC and 4DCT was significant at 50° of humerothoracic elevation in scapulothoracic upward rotation and 60° in glenohumeral elevation, with no significant differences observed in other rotations. Skin motion was significantly smaller in AMC (28.7 ± 4.0 mm) than SSMC (38.6 ± 5.8 mm). Although there was smaller skin motion in AMC, SSMC exhibited smaller differences in scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation compared to 4DCT.

CONCLUSION

This study demonstrates that AMC is more accurate for assessing scapulothoracic upward rotation and glenohumeral elevation, while SSMC is preferable for evaluating scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation, with smaller differences compared to 4DCT.

Tacklers' shoulder abduction and flexion at contact alter when engaging in different front-on, one-on-one tackle instructions from an expert coach

OBJECTIVES

To ascertain how the three-dimensional shoulder kinematics of tacklers alter when performing four legal types of front-on, one-on-one, rugby-style torso tackles.

DESIGN

Controlled laboratory study.

METHODS

Three-dimensional motion capture measured 15 male amateur-level rugby code players (24.3 ± 6.1 years) who were instructed by an expert coach to perform four sets of 10 front-on, one-on-one tackles. Four sets comprised two smother and two dominant tackles: two based on the Australian National Rugby League coaching manual (Dominant NRL, Smother NRL); and two modifications via increasing the contact height from the lower- to mid-torso (Dominant, Torso Stick) or from the upper- to mid-upper torso with a vertical 'pop action' that changes the way the tackler contacted the ball carrier's upper torso (Smother, Pop, Lock). Mixed general linear models were applied.

RESULTS

Greater shoulder abduction, flexion and internal rotation were displayed by the DNRL tackle technique than in any other technique (p < 0.001). At contact, the Smother and Dominant NRL (p < 0.03) showed greater head-uptrunk contralateral rotation away from the tackle than the Smother, Pop, Lock.

CONCLUSIONS

Tacklers modified the way they positioned their shoulder joint when engaging in legal front-on, one-on-one tackles with different tackle instructions. More prominent positions of shoulder abduction and flexion, and head-uptrunk contralateral rotation were observed when executing the traditional tackle techniques (Smother NRL, Dominant NRL) as opposed to two variants of these (Smother, Pop, Lock, Dominant, Torso Stick). Inclusion of tackle specific coaching instructions provides emerging scientific evidence to support revised coaching tackling technique interventions that might enhance player safety.

Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk

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.

Dancers Show More Accurate Trunk-Pelvic Joint Angle Reproduction While Wearing a Jacket Augmented With Elastic Bands

Purpose: The Backalast® compression jacket is intended to improve posture and proprioception of the trunk and shoulder girdle for dancers and dance students during dance training by way of elastic bands in the rear of the garment (which include bands enclosing the inferior thorax). This study was intended to investigate whether there is evidence to support those objectives. Materials and Methods: Fifteen dance students participated (4 male, mean age 19.9 ± 1.4 years old). The dependent variables of trunk-pelvis angle and proximity of trunk axis to global vertical for each participant were measured using optical motion capture before and after the completion of a series of trunk movements. The Helen Hayes model, which we used to represent the trunk, includes the shoulder girdles as part of the trunk. We compared the effect of the type of garment (Backalast® or control compression shirt) worn upon the 2 dependent variables, within-subject with paired t-tests. The order of whether Backalast® or control compression shirt was worn first was alternated between participants. Results: The pre/posttest difference in trunk proprioception as represented by the construct of ability to reproduce trunk-pelvis angle wearing the Backalast® was 0.8° ± 0.8°, but for the control shirt, the difference was 1.8° ± 1.4°, P = .03. The difference between garments in vertical trunk alignment, measured after the series of trunk movements, was not significant. Conclusion: Our findings suggest that the Backalast® can help enhance trunk proprioception when compared to the control compression shirt, although it did not change the angle at which the participants' held their trunks while standing erect (proximity to global vertical).

Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions

Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.

Is an ellipsoid surface suitable to model the scapulothoracic sliding plane?

Closed loop kinematic chain approaches are commonly used to assess scapular kinematics but with heterogeneous ellipsoid calibration procedures. This study aimed to assess whether an ellipsoid surface can model the scapulothoracic sliding plane and determine the optimal number of static poses to calibrate the ellipsoid parameters. An intracortical pin with a rigid cluster of four reflective markers was inserted into the left scapular spine of two healthy males (P1 and P2). They performed arm elevations, internal rotations, ball throwing, hockey shooting, and eating movements. Ellipsoid radii and center location were functionally calibrated for each participant and each movement, either based on all frames of a movement or based on a reduced number of frames (from 3 to 200 equally position-distributed frames). Across both participants and all movements, ellipsoid radii varied up to 10.2 cm, 3.9 cm, and 18.4 cm in the antero-posterior, medio-lateral, and cranio-caudal directions, respectively. When all frames of a movement were considered for calibration, the median scapula-to-ellipsoid distance was, on average, 0.52 mm and 0.38 mm for P1 and P2, respectively. When only five frames were considered for ellipsoid calibration, the scapula-to-ellipsoid median distance slightly increased with 0.57 mm and 0.47 mm for P1 and P2, respectively. To conclude, this study highlights that an ellipsoid surface may effectively be appropriate to model the scapulothoracic sliding plane, especially when the calibration is functional, participant- and movement-specific. Furthermore, the number of poses required for the ellipsoid calibration can be reduced to five, minimizing the experimental cost.

Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction

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.

AddBiomechanics: Automating model scaling, inverse kinematics, and inverse dynamics from human motion data through sequential optimization

Creating large-scale public datasets of human motion biomechanics could unlock data-driven breakthroughs in our understanding of human motion, neuromuscular diseases, and assistive devices. However, the manual effort currently required to process motion capture data and quantify the kinematics and dynamics of movement is costly and limits the collection and sharing of large-scale biomechanical datasets. We present a method, called AddBiomechanics, to automate and standardize the quantification of human movement dynamics from motion capture data. We use linear methods followed by a non-convex bilevel optimization to scale the body segments of a musculoskeletal model, register the locations of optical markers placed on an experimental subject to the markers on a musculoskeletal model, and compute body segment kinematics given trajectories of experimental markers during a motion. We then apply a linear method followed by another non-convex optimization to find body segment masses and fine tune kinematics to minimize residual forces given corresponding trajectories of ground reaction forces. The optimization approach requires approximately 3-5 minutes to determine a subject's skeleton dimensions and motion kinematics, and less than 30 minutes of computation to also determine dynamically consistent skeleton inertia properties and fine-tuned kinematics and kinetics, compared with about one day of manual work for a human expert. We used AddBiomechanics to automatically reconstruct joint angle and torque trajectories from previously published multi-activity datasets, achieving close correspondence to expert-calculated values, marker root-mean-square errors less than 2 cm, and residual force magnitudes smaller than 2% of peak external force. Finally, we confirmed that AddBiomechanics accurately reproduced joint kinematics and kinetics from synthetic walking data with low marker error and residual loads. We have published the algorithm as an open source cloud service at AddBiomechanics.org, which is available at no cost and asks that users agree to share processed and de-identified data with the community. As of this writing, hundreds of researchers have used the prototype tool to process and share about ten thousand motion files from about one thousand experimental subjects. Reducing the barriers to processing and sharing high-quality human motion biomechanics data will enable more people to use state-of-the-art biomechanical analysis, do so at lower cost, and share larger and more accurate datasets.

Does enforcing glenohumeral joint stability matter? A new rapid muscle redundancy solver highlights the importance of non-superficial shoulder muscles

The complexity of the human shoulder girdle enables the large mobility of the upper extremity, but also introduces instability of the glenohumeral (GH) joint. Shoulder movements are generated by coordinating large superficial and deeper stabilizing muscles spanning numerous degrees-of-freedom. How shoulder muscles are coordinated to stabilize the movement of the GH joint remains widely unknown. Musculoskeletal simulations are powerful tools to gain insights into the actions of individual muscles and particularly of those that are difficult to measure. In this study, we analyze how enforcement of GH joint stability in a musculoskeletal model affects the estimates of individual muscle activity during shoulder movements. To estimate both muscle activity and GH stability from recorded shoulder movements, we developed a Rapid Muscle Redundancy (RMR) solver to include constraints on joint reaction forces (JRFs) from a musculoskeletal model. The RMR solver yields muscle activations and joint forces by minimizing the weighted sum of squared-activations, while matching experimental motion. We implemented three new features: first, computed muscle forces include active and passive fiber contributions; second, muscle activation rates are enforced to be physiological, and third, JRFs are efficiently formulated as linear functions of activations. Muscle activity from the RMR solver without GH stability was not different from the computed muscle control (CMC) algorithm and electromyography of superficial muscles. The efficiency of the solver enabled us to test over 3600 trials sampled within the uncertainty of the experimental movements to test the differences in muscle activity with and without GH joint stability enforced. We found that enforcing GH stability significantly increases the estimated activity of the rotator cuff muscles but not of most superficial muscles. Therefore, a comparison of shoulder model muscle activity to EMG measurements of superficial muscles alone is insufficient to validate the activity of rotator cuff muscles estimated from musculoskeletal models.

Computer simulation on the cueing movements in cue sports: a validation study

Background

Simulation models have been applied to analyze daily living activities and some sports movements. However, it is unknown whether the current upper extremity musculoskeletal models can be utilized for investigating cue sports movements to generate corresponding kinematic and muscle activation profiles. This study aimed to test the feasibility of applying simulation models to investigate cue sports players' cueing movements with OpenSim. Preliminary muscle forces would be calculated once the model is validated.

Methods

A previously customized and validated unimanual upper extremity musculoskeletal model with six degrees of freedom at the scapula, shoulder, elbow, and wrist, as well as muscles was used in this study. Two types of cueing movements were simulated: (1) the back spin shot, and (2) 9-ball break shot. Firstly, kinematic data of the upper extremity joints were collected with a 3D motion capture system. Using the experimental marker trajectories of the back spin shot on 10 male cue sports players, the simulation on the cueing movements was executed. The model was then validated by comparing the model-generated joint angles against the experimental results using statistical parametric mapping (SPM1D) to examine the entire angle-time waveform as well as t-tests to compare the discrete variables (e.g., joint range of motion). Secondly, simulation of the break shot was run with the experimental marker trajectories and electromyographic (EMG) data of two male cue sports players as the model inputs. A model-estimated muscle activation calculation was performed accordingly for the upper extremity muscles.

Results

The OpenSim-generated joint angles for the back spin shot corresponded well with the experimental results for the elbow, while the model outputs of the shoulder deviated from the experimental data. The discrepancy in shoulder joint angles could be due to the insufficient kinematic inputs for the shoulder joint. In the break shot simulation, the preliminary findings suggested that great shoulder muscle forces could primarily contribute to the forward swing in a break shot. This suggests that strengthening the shoulder muscles may be a viable strategy to improve the break shot performance.

Conclusion

It is feasible to cater simulation modeling in OpenSim for biomechanical investigations of the upper extremity movements in cue sports. Model outputs can help better understand the contributions of individual muscle forces when performing cueing movements.

Influence of marker weights optimization on scapular kinematics estimated with a multibody kinematic optimization

Scapular kinematic estimates are altered by soft tissue artefacts, therefore experimental and numerical methods should be developed to improve their accuracy. This study aimed to assess the influence of weights applied to the scapula markers within a closed-loop multibody kinematic optimization on scapular kinematic estimates. Fifteen healthy volunteers performed static postures mimicking analytical, daily living and sport movements. Scapulo-thoracic angles were computed either from a scapula locator as the reference, or from a closed-loop multibody-kinematic optimization (MKO) including a participant-specific point-on-ellipsoid scapulothoracic joint. Weights applied to scapula markers in the MKO were optimized to minimize the difference in scapular orientation from the reference. Optimizing weighting sets significantly (p < 0.0001) improved scapular orientation from 0.9° to 12.1° in comparison to scapular kinematics estimated with non-optimized weighting sets. The mean optimized weighting set contained no neglectable weight for all markers from the acromion to the medial border of the scapular spine but showed no significant difference (p = 0.547) compared to homogeneous weights. Optimized weighting sets were participant- and movement- specific. To conclude, homogenous weights applied on redundant markers located from acromion to scapular medial border spine are recommended when estimating scapular kinematics in upper limb MKO.

Upper limb modeling and motion extraction based on multi-space-fusion

Modeling and motion extraction of human upper limbs are essential for interpreting the natural behavior of upper limb. Owing to the high degrees of freedom (DOF) and highly dynamic nature, existing upper limb modeling methods have limited applications. This study proposes a generic modeling and motion extraction method, named Primitive-Based triangular body segment method (P-BTBS), which follows the physiology of upper limbs, allows high accuracy of motion angles, and describes upper-limb motions with high accuracy. For utilizing the upper-limb modular motion model, the motion angles and bones can be selected as per the research topics (The generic nature of the study targets). Additionally, P-BTBS is suitable in most scenarios for estimating spatial coordinates (The generic nature of equipment and technology). Experiments in continuous motions with seven DOFs and upper-limb motion description validated the excellent performance and robustness of P-BTBS in extracting motion information and describing upper-limb motions, respectively. P-BTBS provides a new perspective and mathematical tool for human understanding and exploration of upper-limb motions, which theoretically supports upper-limb research.

AddBiomechanics: Automating model scaling, inverse kinematics, and inverse dynamics from human motion data through sequential optimization

Creating large-scale public datasets of human motion biomechanics could unlock data-driven breakthroughs in our understanding of human motion, neuromuscular diseases, and assistive devices. However, the manual effort currently required to process motion capture data and quantify the kinematics and dynamics of movement is costly and limits the collection and sharing of large-scale biomechanical datasets. We present a method, called AddBiomechanics, to automate and standardize the quantification of human movement dynamics from motion capture data. We use linear methods followed by a non-convex bilevel optimization to scale the body segments of a musculoskeletal model, register the locations of optical markers placed on an experimental subject to the markers on a musculoskeletal model, and compute body segment kinematics given trajectories of experimental markers during a motion. We then apply a linear method followed by another non-convex optimization to find body segment masses and fine tune kinematics to minimize residual forces given corresponding trajectories of ground reaction forces. The optimization approach requires approximately 3-5 minutes to determine a subjecťs skeleton dimensions and motion kinematics, and less than 30 minutes of computation to also determine dynamically consistent skeleton inertia properties and fine-tuned kinematics and kinetics, compared with about one day of manual work for a human expert. We used AddBiomechanics to automatically reconstruct joint angle and torque trajectories from previously published multi-activity datasets, achieving close correspondence to expert-calculated values, marker root-mean-square errors less than 2 c m , and residual force magnitudes smaller than 2 % of peak external force. Finally, we confirmed that AddBiomechanics accurately reproduced joint kinematics and kinetics from synthetic walking data with low marker error and residual loads. We have published the algorithm as an open source cloud service at AddBiomechanics.org, which is available at no cost and asks that users agree to share processed and de-identified data with the community. As of this writing, hundreds of researchers have used the prototype tool to process and share about ten thousand motion files from about one thousand experimental subjects. Reducing the barriers to processing and sharing high-quality human motion biomechanics data will enable more people to use state-of-the-art biomechanical analysis, do so at lower cost, and share larger and more accurate datasets.

Customized Series Elastic Actuator for a Safe and Compliant Human-Robot Interaction: Design and Characterization

When it comes to robotic-mediated rehabilitation it is mandatory to design a system that guarantees a safe and compliant human-machine interaction. Dealing with rehabilitative upper limb exoskeletons, Series Elastic Actuators offer a potential solution for this purpose. This work proposes four different solutions for SEAs' spring design. After an analysis on the mechanical requirements, four different solutions are explored and presented. The performances of the proposed highly integrated SEAs are compared. An initial static characterization provided insights on the linearity and repeatability of each spring torque-angle performances. The dynamics of the springs and their frequency responses are then analysed to show how it is possible to exploit our system for human-robot interaction applications.

A novel method for estimating sternoclavicular posterior rotation with promising accuracy: A validity comparison with minimizing acromioclavicular rotation approach

The human shoulder complex's motion is modeled by nine rotational degrees of freedom (DoF) at the sternoclavicular (SC), acromioclavicular (AC), and glenohumeral joints. Non-invasive measurement of these rotations is desirable for shoulder kinematic assessment or musculoskeletal modeling. Accuracy of the conventional method for estimating SC posterior rotation is unclear and might be overestimated because it assumes no rotation in the AC joint. We aimed to explore whether our new method, allowing AC rotation, provides a more accurate estimation of SC posterior rotation than the conventional method. We compared estimates by both methods, in 18 postures among 8 healthy men, with those measured by the registration method from magnetic resonance images. Posthoc analyses showed significant differences between the registration and conventional methods in all 18 postures and in only one posture when compared to our method. While the conventional method tended toward overestimation and showed a 22.7° root-mean-square error for all postures, the new method had greater accuracy (6.8° root-mean-square error). By combining this method with the scapulothoracic rotation measurement method and other traditional methods, it should be possible to indirectly measure 3-DoF AC rotation, implying that non-invasive measurement of all 9-DoF rotations of the shoulder complex would now be possible.

Neuromuscular control: from a biomechanist's perspective

Understanding neural control of movement necessitates a collaborative approach between many disciplines, including biomechanics, neuroscience, and motor control. Biomechanics grounds us to the laws of physics that our musculoskeletal system must obey. Neuroscience reveals the inner workings of our nervous system that functions to control our body. Motor control investigates the coordinated motor behaviours we display when interacting with our environment. The combined efforts across the many disciplines aimed at understanding human movement has resulted in a rich and rapidly growing body of literature overflowing with theories, models, and experimental paradigms. As a result, gathering knowledge and drawing connections between the overlapping but seemingly disparate fields can be an overwhelming endeavour. This review paper evolved as a need for us to learn of the diverse perspectives underlying current understanding of neuromuscular control. The purpose of our review paper is to integrate ideas from biomechanics, neuroscience, and motor control to better understand how we voluntarily control our muscles. As biomechanists, we approach this paper starting from a biomechanical modelling framework. We first define the theoretical solutions (i.e., muscle activity patterns) that an individual could feasibly use to complete a motor task. The theoretical solutions will be compared to experimental findings and reveal that individuals display structured muscle activity patterns that do not span the entire theoretical solution space. Prevalent neuromuscular control theories will be discussed in length, highlighting optimality, probabilistic principles, and neuromechanical constraints, that may guide individuals to families of muscle activity solutions within what is theoretically possible. Our intention is for this paper to serve as a primer for the neuromuscular control scientific community by introducing and integrating many of the ideas common across disciplines today, as well as inspire future work to improve the representation of neural control in biomechanical models.

Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study

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.

A Shoulder Musculoskeletal Model with Three-Dimensional Complex Muscle Geometries

Muscle structure is an essential component in typical computational models of the musculoskeletal system. Almost all musculoskeletal models represent muscle geometry using a set of line segments. The straight-line approach limits models' ability to accurately predict the paths of muscles with complex geometry. This approach needs knowledge of how the muscle changes shape and interacts with fundamental structures like muscles, bones, and joints that move. Moreover, the moment arms are supposed to be equivalent to all the fibers in the muscle. This study aims to create a shoulder musculoskeletal model that includes complex muscle geometries. We reconstructed the shape of fibers in the entire volume of six muscles adjacent to the shoulder using an automated technique. This method generates many fibers from the surface geometry of the skeletal muscle and its attachment areas. Highly discretized muscle representations for all muscles were created and used to simulate different shoulder movements. The moment arms of each muscle were calculated and validated against cadaveric measurements and models of the same muscles from the literature. We found that simulations using the developed musculoskeletal models generated more realistic geometries, which expands the physical representation of muscles compared to line segments. The shoulder musculoskeletal model with complex muscle geometry is created to increase the anatomical reality of models and the lines action of muscle fibers, and to be used for finite element investigations.

Evaluation of the range of motion of scapulothoracic, acromioclavicular and sternoclavicular joints: State of the art

The scapulothoracic, acromioclavicular and sternoclavicular joints play a fundamental role in the shoulder function. Shoulder complex kinematics have been studied with different methods using: goniometers, 2 static radiographs, 3D motion analyzers (invasive or noninvasive) and digital inclinometers. Goniometers have been used traditionally to assess scapular rotation in relation to the thorax. The intrinsic limit of multiple static two-dimensional shoulder radiographs is the attempt of describing in two what is occurring in three dimensions. Technology innovations have led to the development of the 3D shoulder complex kinematics analysis ETS (Electromagnetic tracking systems) using sensors (invasive bone-pin markers or noninvasive skin surface marker) stitched to the scapula/clavicula, thorax, and humerus. Despite being uncomfortable, invasive 3D motion cortical pins analyzers still represent the current gold standard for tracking shoulder complex kinematics. Therefore, access to three-dimensional biomechanical instrumentations for collecting kinematic data represents an active problem for many physicians. A precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet. Further researches are necessary to design a new non-invasive method able to draw and analyze the kinematics of the scapula and the whole shoulder complex, precisely.

Comparison of a Scaled Cadaver-Based Musculoskeletal Model With a Clinical Upper Extremity Model

Reliably and accurately estimating joint/segmental kinematics from optical motion capture data has remained challenging. Studies objectively characterizing human movement patterns have typically involved inverse kinematics and inverse dynamics techniques. Subsequent research has included scaled cadaver-based musculoskeletal (MSK) modeling for noninvasively estimating joint and muscle loads. As one of the ways to enhance confidence in the validity of MSK model predictions, the kinematics from the preceding step that drives such a model needs to be checked for agreement or compared with established/widely used models. This study rigorously compares the upper extremity (UE) joint kinematics calculated by the Dutch Shoulder Model implemented in the AnyBody Managed Model Repository (involving multibody kinematics optimization (MKO)) with those estimated by the Vicon Plug-in Gait model (involving single-body kinematics optimization (SKO)). Ten subjects performed three trials of (different types of) reaching tasks in a three-dimensional marker-based optical motion capture laboratory setting. Joint angles, processed marker trajectories, and reconstruction residuals corresponding to both models were compared. Scatter plots and Bland-Altman plots were used to assess the agreement between the two model outputs. Results showed the largest differences between the two models for shoulder, followed by elbow and wrist, with all root-mean-squared differences less than 10 deg (although this limit might be unacceptable for clinical use). Strong-to-excellent Spearman's rank correlation coefficients were found between the two model outputs. The Bland-Altman plots showed a good agreement between most of the outputs. In conclusion, results indicate that these two models with different kinematic algorithms broadly agree with each other, albeit with few key differences.

Kinetics influence of multibody kinematics optimisation for soft tissue artefact compensation

Soft tissue artefact (STA) remains a major source of error in human movement analysis. The multibody kinematics optimisation (MKO) approach is widely stated as a solution to reduce the effects of STA. This study aimed at assessing the influence of the MKO STA-compensation on the errors of estimation of the knee intersegment moments. Experimental data were issued from the CAMS-Knee dataset where six participants with instrumented total knee arthroplasty performed five activities of daily living: gait, downhill walking, stair descent, squat, and sit-to-stand. Kinematics was measured both on the basis of skin markers and a mobile mono-plane fluoroscope, used to obtain the STA-free bone movement. For four different lower limb models and one corresponding to a single-body kinematics optimization (SKO), knee intersegmental moments (estimated using model-derived kinematics and ground reaction force) were compared with an estimate based on the fluoroscope. Considering all participants and activities, mean root mean square differences were the largest along the adduction/abduction axis: of 3.22Nm with a SKO approach, 3.49Nm with the three-DoF knee model, and 7.66Nm, 8.52Nm, and 8.54Nm with the one-DoF knee models. Results showed that adding joint kinematics constraints can increase the estimation errors of the intersegmental moment. These errors came directly from the errors in the estimation of the position of the knee joint centre induced by the constraints. When using a MKO approach, we recommend to analyse carefully joint centre position estimates that do not remain close to the one obtained with a SKO approach.

Bilateral upper extremity trunk model for cross-country sit-skiing double poling propulsion: model development and validation

The subacromial impingement syndrome is a high-incidence injury for cross-country sit-skiing skier, which is often accompanied by muscle imbalance. However, at present, no musculoskeletal model has been identified for this sport. Thus, this research aimed to establish a bilateral upper extremity trunk (BUET) musculoskeletal model suitable for cross-country sit-skiing based on OpenSim software and verify the function of the model. By splicing three existing OpenSim models, an upper limb model with 17 segments, 35 degrees of freedom, and 472 musculotendon actuators was established. The clavicle and scapula were modeled as individual bodies and then connected to the torso through a three-degrees-of-freedom rotational joint and to the clavicle through a weld joint, respectively. The five lumbar vertebrae were established separately and coupled into a three-degree-of-freedom joint. Kinematics, kinetic, and EMG signal data of five 15-s maximal effort interval tests were obtained by using seven cameras, ergometers, and surface EMG synchronous collection. Based on the resulting rotator cuff muscle geometry of the model, simulated muscle activation patterns were comparable to experimental data, and muscle-driven ability was proven. The model will be available online ( https://simtk.org/projects/bit ) for researchers to study the muscle activation of shoulder joint movement.

Biomechanical and functional analysis of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome: A case control study

The motions of the shoulder are mainly carried out through the glenohumeral joint, but are also assisted by the scapulothoracic joint. Therefore, changes in the biomechanics of the thoracic spine and scapula affect the function of the shoulder. However, there is limited information on the biomechanical and functional characteristics of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome (SIS). In this study, the biomechanical and functional characteristics of the shoulder complex and thoracic spine were analyzed in patients with SIS compared to healthy individuals. A total of 108 participants were included in this study. Participants were classified into 2 groups, the SIS (n = 55) and healthy (n = 53) groups. The shoulder and thoracic range of motion (ROM), scapular position, and isokinetic shoulder strength were measured in all participants. The shoulder ROM was significantly decreased in the SIS group compared to the healthy group (P < .001). The thoracic spine ROM showed significantly limited extension in the SIS group (P < .001). The scapular position showed significantly increased anterior tilting (P = .005), internal rotation (P = .032), protraction (P < .001), and decreased upward rotation (P = .002) in the SIS group. The isokinetic shoulder external rotation (P < .001) and abduction (P < .001) strength were significantly lower in the SIS group. Patients with SIS showed reduced shoulder ROM and end-range extension of the thoracic spine compared to healthy individuals, and the scapula was in a more anterior-tilted, protracted, and downward rotated position. In addition, it showed lower external rotation and abduction strength. These results suggest the need for interventions to improve the limited thoracic extension and altered scapular position, which may affect shoulder ROM and muscle strength in the rehabilitation of patients with SIS.

How does computed tomography inform our understanding of shoulder kinematics? A structured review

The objective of this structured review was to review how computed tomography (CT) scanning has been used to measure the kinematics of the shoulder. A literature search was conducted using Evidence-based Medicine Reviews (Embase) and PubMed. In total, 29 articles were included in the data extraction process. Forty percent of the studies evaluated healthy participants' shoulder kinematics. The glenohumeral joint was the most studied, followed by the scapulothoracic, acromioclavicular, and sternoclavicular joints. Three-dimensional computed tomography (3DCT) and 3DCT with biplane fluoroscopy are the two primary imaging techniques that have been used to measure shoulder joints' motion under different conditions. Finally, many discrepancies in the reporting of the examined motions were found. Different authors used different perspectives and planes to report similar motions, which results in confusion and misunderstanding of the actual examined motion. The use of 3DCT has been widely used in the examination of shoulder kinematics in a variety of populations with varying methods employed. Future work is needed to extend these methodologies to include more diverse populations, to examine the shoulder complex as a whole, and to standardize their reporting of motion examined to make study to study comparisons possible.

Resection and reconstruction with and without neoadjuvant denosumab in campanacci grade III giant cell tumors of proximal humerus: a retrospective comparative study

BACKGROUND

Giant cell tumors (GCT) of the proximal humerus are rarely reported case that requires complex surgeries due to involvement of the shoulder joint. Therefore, we report the first retrospective comparative study where the postoperative functional outcomes, recurrence rate and complications in patients who underwent arthrodesis of shoulder after resection of grade III GCT with and without neoadjuvant denosumab are compared.

METHODS

A retrospective review of eight cases of grade III GCT of proximal humerus receiving resection and fibular strut graft and arthrodesis between January 2014 and December 2019 is performed. They were stratified into two groups: one group of four patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of four patients did not receive denosumab before surgery. Primary outcomes included the functional outcomes assessed by revised Musculoskeletal tumor society (MSTS) score and shoulder pain and disability index (SPDI) at 6-weeks and 12-months postoperatively while secondary outcomes included complications and recurrences.

RESULTS

There was no significant difference in terms of SPDI at 6 weeks and 12 months, MSTS at 12 months, complications, recurrence among denosumab and non-denosumab groups. At 6-weeks follow-up, a significantly better pain score in SPDI and MSTS was acquired in the denosumab group.

CONCLUSIONS

Resection and reconstruction with or without neoadjuvant denosumab for Grade III GCT of proximal humerus had similar functional outcomes and with no major differences in recurrence and complications. Hence, postoperative pain relief while long-term benefits were not discovered with the use of neoadjuvant denosumab.

Feasibility and validity of a single camera CNN driven musculoskeletal model for muscle force estimation during upper extremity strength exercises: Proof-of-concept

Muscle force analysis can be essential for injury risk estimation and performance enhancement in sports like strength training. However, current methods to record muscle forces including electromyography or marker-based measurements combined with a musculoskeletal model are time-consuming and restrict the athlete's natural movement due to equipment attachment. Therefore, the feasibility and validity of a more applicable method, requiring only a single standard camera for the recordings, combined with a deep-learning model and musculoskeletal model is evaluated in the present study during upper-body strength exercises performed by five athletes. Comparison of muscle forces obtained by the single camera driven model against those obtained from a state-of-the art marker-based driven musculoskeletal model revealed strong to excellent correlations and reasonable RMSD's of 0.4–2.1% of the maximum force (Fmax) for prime movers, and weak to strong correlations with RMSD's of 0.4–0.7% Fmax for stabilizing and secondary muscles. In conclusion, a single camera deep-learning driven model is a feasible method for muscle force analysis in a strength training environment, and first validity results show reasonable accuracies, especially for prime mover muscle forces. However, it is evident that future research should investigate this method for a larger sample size and for multiple exercises.

Musculoskeletal modeling-based definition of load cases and worst-case fracture orientation for the design of clavicle fixation plates

Mechanical performance of clavicle fracture fixation plates is often evaluated using finite element (FE) analysis. Typically, these studies use simplified loading conditions and assume a transversal fracture orientation. However, the loading conditions and fracture orientation influence how the fracture site and thus fixation plate is loaded. In this study, a musculoskeletal model that included the clavicle muscles and scapulohumeral rhythm was defined based on previously published models. The standard OpenSim workflow (inverse kinematics, inverse dynamics, static optimization, and joint reaction analysis) was used to calculate muscle and joint contact forces based on 3D marker data collected in three subjects during seven activities of daily living (ADL). These loading conditions were then applied to a 3D clavicle model with three different fracture orientations and the mean resulting moments on both fragments were calculated to assess fracture stability. Magnitude of glenohumeral contact forces showed good agreement with instrumented shoulder prosthesis data, whereas simulated muscle activations were comparable to experimental EMG data. An oblique fracture orienting from superomedial to inferolateral was the least self-stabilizing. The loading to which the clavicle is exposed during ADL tasks is more complex than the simplified loading conditions typically used as boundary conditions in FE analyses of clavicle fracture fixation plates. Additionally, transversal fractures did not represent the least self-stabilizing fracture orientation, and thus calculated stresses in the plate could be underestimated. Therefore, more complex loading conditions and evaluation of a midshaft fracture running from superomedial to inferolateral is more relevant in FE analyses of midshaft clavicle fracture fixation plates.

Three-Dimensional Quantitative Evaluation of the Scapular Skin Marker Movements in the Upright Posture

Motion capture systems using skin markers are widely used to evaluate scapular kinematics. However, soft-tissue artifact (STA) is a major limitation, and there is insufficient knowledge of the marker movements from the original locations. This study explores a scapular STA, including marker movements with shoulder elevation using upright computed tomography (CT). Ten healthy males (twenty shoulders in total) had markers attached to scapular bony landmarks and underwent upright CT in the reference and elevated positions. Marker movements were calculated and compared between markers. The bone-based and marker-based scapulothoracic rotation angles were also compared in both positions. The median marker movement distances were 30.4 mm for the acromial angle, 53.1 mm for the root of the scapular spine, and 70.0 mm for the inferior angle. Marker movements were significantly smaller on the superolateral aspect of the scapula, and superior movement was largest in the directional movement. Scapulothoracic rotation angles were significantly smaller in the marker-based rotation angles than in the bone-based rotation angles of the elevated position. We noted that the markers especially did not track the inferior movement of the scapular motion with shoulder elevation, resulting in an underestimation of the marker-based rotation angles.

The effects of anatomical errors on shoulder kinematics computed using multi-body models

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.

A penalty method for constrained multibody kinematics optimisation using a Levenberg-Marquardt algorithm

An alternative method for solving constrained multibody kinematics optimisation using a penalty method on constraints and a Levenberg-Marquardt algorithm is proposed. It is compared to an optimisation resolution with hard kinematic constraints. These methods are applied to two pairs of experiments and models. The penalty method was at least 20 times faster than the optimisation resolution while keeping similar reconstruction errors and constraints violation. The potential of the method is shown to accurately solve the multibody kinematics optimisation problem in a reasonable amount of time. A computational gain lies in implementing this resolution with a compiled and optimised program code.

Pose2Sim: An End-to-End Workflow for 3D Markerless Sports Kinematics—Part 2: Accuracy

Two-dimensional deep-learning pose estimation algorithms can suffer from biases in joint pose localizations, which are reflected in triangulated coordinates, and then in 3D joint angle estimation. Pose2Sim, our robust markerless kinematics workflow, comes with a physically consistent OpenSim skeletal model, meant to mitigate these errors. Its accuracy was concurrently validated against a reference marker-based method. Lower-limb joint angles were estimated over three tasks (walking, running, and cycling) performed multiple times by one participant. When averaged over all joint angles, the coefficient of multiple correlation (CMC) remained above 0.9 in the sagittal plane, except for the hip in running, which suffered from a systematic 15° offset (CMC = 0.65), and for the ankle in cycling, which was partially occluded (CMC = 0.75). When averaged over all joint angles and all degrees of freedom, mean errors were 3.0°, 4.1°, and 4.0°, in walking, running, and cycling, respectively; and range of motion errors were 2.7°, 2.3°, and 4.3°, respectively. Given the magnitude of error traditionally reported in joint angles computed from a marker-based optoelectronic system, Pose2Sim is deemed accurate enough for the analysis of lower-body kinematics in walking, cycling, and running.

Subject-specific model-derived kinematics of the shoulder based on skin markers during arm abduction up to 180° - assessment of 4 gleno-humeral joint models

Accuracy of shoulder kinematics predicted by multi-body kinematics optimisation depend on the joint models used. This study assesses the influence of four different subject-specific gleno-humeral joint models within multi-body kinematics optimisation: a 6-degree-of-freedom joint (i.e. single-body kinematics optimisation), a sphere-on-sphere joint (with two spheres of different radii) and a spherical joint with or without penalised translation. To drive these models, the 3D coordinates of 12 skin markers of 6 subjects performing static arm abduction poses up to 180° were used. The reference data was obtained using biplane X-rays from which 3D bone reconstructions were generated: scapula and humerus were 3D reconstructed by fitting a template model made of geometrical primitives on the two bones' X-rays. Without any motion capture system, the recording of the skin markers was performed at the very same time than the X-rays with radiopaque markers. The gleno-humeral displacements and angles, and scapula-thoracic angles were computed. The gleno-humeral sphere-on-sphere joint provided slightly better results than the spherical joint with or without penalised translation, but considerably better gleno-humeral displacements than the 6-DoF joint. Considering that it can easily be personalised from medical images, this sphere-on-sphere model seems promising for shoulder multi-body kinematics optimisation.

Effect of two types of shoulder prosthesis on the muscle forces using a generic multibody model for different arm motions

Background

This study aims to analyze the effects of a novel dual-bearing shoulder prosthesis and a conventional reverse shoulder prosthesis on the deltoid and rotator cuff muscle forces for four different arm motions. The dual-bearing prosthesis is a glenoid-sparing joint replacement with a moving center of rotation. It has been developed to treat rotator cuff arthropathy, providing an increased post-operative functionality.

Methods

A three-dimensional musculoskeletal OpenSim® model of an upper body, incorporating a natural gleno-humeral joint and a scapula-thoracic joint developed by Blana et al. (J Biomech 41: 1714-1721, 2008), was used as a reference for the natural shoulder. It was modified by integrating first a novel dual-bearing prosthesis, and second, a reverse shoulder prosthesis into the shoulder joint complex. Four different arm motions, namely abduction, scaption, internal and external rotation, were simulated using an inverse kinematics approach. For each of the three models, shoulder muscle forces and joint reaction forces were calculated with a 2 kg weight in the hand.

Results

In general, the maximal shoulder muscle force and joint reaction force values were in a similar range for both prosthesis models during all four motions. The maximal deltoid muscle forces in the model with the dual-bearing prosthesis were 18% lower for abduction and 3% higher for scaption compared to the natural shoulder. The maximal rotator cuff muscle forces in the model with the dual-bearing prosthesis were 36% lower for abduction and 1% higher for scaption compared to the natural shoulder. Although the maximal deltoid muscle forces in the model with the dual-bearing prosthesis in internal and external rotation were 52% and 64% higher, respectively, compared to the natural shoulder, the maximal rotator cuff muscle forces were 27% lower in both motions.

Conclusion

The study shows that the dual-bearing shoulder prosthesis is a feasible option for patients with rotator cuff tear and has a strong potential to be used as secondary as well as primary joint replacement. The study also demonstrates that computer simulations can help to guide the continued optimization of this particular design concept for successful clinical outcomes.

A Guide to Inverse Kinematic Marker-Guided Rotoscoping using IK Solvers

X-ray Reconstruction of Moving Morphology (XROMM) permits researchers to see beneath the skin, usually to see musculoskeletal movements. These movements can be tracked and later used to provide information regarding the mechanics of movement. Here, we discuss “IK marker-guided rotoscoping”—a method that combines inverse kinematic solvers with that of traditional scientific rotoscoping methods to quickly and efficiently overlay 3D bone geometries with the X-ray shadows from XROMM data. We use a case study of three Nile crocodiles’ (Crocodylus niloticus) forelimbs and hindlimbs to evaluate this method. Within these limbs, different marker configurations were used: some configurations had six markers, others had five markers, and all forelimb data only had three markers. To evaluate IK marker-guided rotoscoping, we systematically remove markers in the six-marker configuration and then test the magnitudes of deviation in translations and rotations of the rigged setup with fewer markers versus those of the six-marker configuration. We establish that IK marker-guided rotoscoping is a suitable method for “salvaging” data that may have too few markers.

Closed-loop multibody kinematic optimization coupled with double calibration improves scapular kinematic estimates in asymptomatic population

Non-invasive methods still need to better estimate scapular kinematics because of soft tissue artifact issue. This study aimed to develop and assess new procedures to estimate scapular kinematics by combining closed kinematic chain optimization and double calibration. Sixteen healthy volunteers performed static postures mimicking analytical and daily living movements. Scapulo-thoracic angles were computed either with a scapula locator (Ref), or with a closed-loop multibody kinematic optimization (Ell) or with double calibration involving linear (DClin), exponential (DCexp) or logarithmic (DClog) correction. Double calibration corrections enforced scapulo-thoracic angles to be the same than those measured with Ref at the end of the movement performed. DClin and DClog significantly (p < 0.01) reduced scapulo-thoracic misorientation for at least the second third of the movement with averaged improvement ranging from 9° to 32°. Moreover, for arm elevation in the sagittal plane, internal rotations and mimicking hair combing, the beneficial effect of DClin and DClog propagates up to half of the movement. To conclude, when a kinematic chain is required, coupling double calibration (using either linear or logarithmic correction), to a closed-loop multibody kinematic optimization is an efficient and fast method in regard with improvement in scapular kinematic estimates in healthy population.

Contralateral hemopneumothorax after penetrating thoracic trauma: A case report

BACKGROUND

Trauma is the leading cause of death in young adults up to the age of 45 years. Hemothorax is a frequent consequence of penetrating thoracic trauma, and is usually associated with pneumothorax and pneumoderma. Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma, and uncontrolled bleeding is the main cause of death.

CASE SUMMARY

In this case report, a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined. A 19-year-old male patient, who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax, was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging. Chest tube thoracostomy was performed as the initial intervention. Bleeding control was achieved with right posterolateral thoracotomy in the patient, who developed massive hemorrhage after 1 h and hemodynamic instability. The patient recovered and was discharged on the fourth postoperative day.

CONCLUSION

Contralateral hemopneumothorax that accounts for 30% of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30% of cases was emphasized and the contralateral development mechanism was addressed.

Mobile Health: making the leap to research and clinics

Health applications for mobile and wearable devices continue to experience tremendous growth both in the commercial and research sectors, but their impact on healthcare has yet to be fully realized. This commentary introduces three articles in a special issue that provides guidance on how to successfully address translational barriers to bringing mobile health technologies into clinical research and care. We also discuss how the cross-organizational sharing of data, software, and other digital resources can lower such barriers and accelerate progress across mobile health.

Systems Engineering Information Model of Vehicle-Pedestrian Collisions

Engineering analysis of motor vehicle collisions as a complex type of research combines the application of scientific approaches from different fields: mechanics, mathematics, structural design, etc. This implies accurate and unambiguous determination of input data and their application in computational procedures for finding solutions in iterative mode. Hence, the reason to apply the specific research method of information modelling in the present study to one of the main types of road accidents, namely the pedestrian-car collision.

Exploring the functional morphology of the Gorilla shoulder through musculoskeletal modelling

Musculoskeletal computer models allow us to quantitatively relate morphological features to biomechanical performance. In non‐human apes, certain morphological features have long been linked to greater arm abduction potential and increased arm‐raising performance, compared to humans. Here, we present the first musculoskeletal model of a western lowland gorilla shoulder to test some of these long‐standing proposals. Estimates of moment arms and moments of the glenohumeral abductors (deltoid, supraspinatus and infraspinatus muscles) over arm abduction were conducted for the gorilla model and a previously published human shoulder model. Contrary to previous assumptions, we found that overall glenohumeral abduction potential is similar between Gorilla and Homo. However, gorillas differ by maintaining high abduction moment capacity with the arm raised above horizontal. This difference is linked to a disparity in soft tissue properties, indicating that scapular morphological features like a cranially oriented scapular spine and glenoid do not enhance the abductor function of the gorilla glenohumeral muscles. A functional enhancement due to differences in skeletal morphology was only demonstrated in the gorilla supraspinatus muscle. Contrary to earlier ideas linking a more obliquely oriented scapular spine to greater supraspinatus leverage, our results suggest that increased lateral projection of the greater tubercle of the humerus accounts for the greater biomechanical performance in Gorilla. This study enhances our understanding of the evolution of gorilla locomotion, as well as providing greater insight into the general interaction between anatomy, function and locomotor biomechanics.

Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach

BACKGROUND

The rotator cuff (RC) and the deltoid muscle are 2 synergistic units that enable the functionally demanding movements of the shoulder. A number of biomechanical studies assume similar force contribution of the force couple (RC and deltoid) over the whole range of motion, whereas others propose position-dependent force distribution. There is a lack of in vivo data regarding the deltoid's contribution to shoulder flexion and abduction strength. This study aimed to create reliable in vivo data quantifying the deltoid's contribution to shoulder flexion and abduction strength throughout the range of motion.

METHODS

Active range of motion and isometric muscle strength of shoulder abduction and flexion in 0°, 30°, 60°, 90°, and 120° of abduction/flexion as well as internal and external rotation in 0° and 90° of abduction were obtained in 12 healthy volunteers on the dominant arm before and after an ultrasound-guided isolated axillary nerve block. Needle electromyography was performed before and after the block to confirm deltoid paralysis. Radiographs of the shoulder and an ultrasonographic examination were used to exclude relevant shoulder pathologies.

RESULTS

Active range of motion showed a minimal to moderate reduction to 94% and 88% of the preintervention value for abduction and flexion. Internal and external rotation amplitude was not impaired. The abduction strength was significantly reduced to 76% at 0° (P = .002) and to 25% at 120° (P < .001) of abduction. The flexion strength was significantly reduced to 64% at 30° (P < .001) and to 30% at 120° (P < .001) of flexion. The strength reduction was linear, depending on the flexion/abduction angle. The maximal external rotation strength showed a significant decrease to 53% in 90° (P < .001) of abduction, whereas in adduction no strength loss was observed (P = .09). The internal rotation strength remained unaffected in 0° and 90° of abduction (P = .28; P = .13).

CONCLUSION

The deltoid shows a linear contribution to maximal shoulder strength depending on the abduction or flexion angle, ranging from 24% in 0° to 75% in 120° of abduction and from 11% in 0° to 70% in 120° of flexion, respectively. The overall contribution to abduction strength is higher than to flexion strength. The combination of deltoid muscle and teres minor contributes about 50% to external rotation strength in 90° of abduction. The internal rotation strength is not influenced by a deltoid paralysis. This study highlights the position-dependent contribution of the shoulder muscles to strength development and thereby provides an empirical approach to better understand human shoulder kinematics.

OpenSim Moco: Musculoskeletal optimal control

Musculoskeletal simulations are used in many different applications, ranging from the design of wearable robots that interact with humans to the analysis of patients with impaired movement. Here, we introduce OpenSim Moco, a software toolkit for optimizing the motion and control of musculoskeletal models built in the OpenSim modeling and simulation package. OpenSim Moco uses the direct collocation method, which is often faster and can handle more diverse problems than other methods for musculoskeletal simulation. Moco frees researchers from implementing direct collocation themselves-which typically requires extensive technical expertise-and allows them to focus on their scientific questions. The software can handle a wide range of problems that interest biomechanists, including motion tracking, motion prediction, parameter optimization, model fitting, electromyography-driven simulation, and device design. Moco is the first musculoskeletal direct collocation tool to handle kinematic constraints, which enable modeling of kinematic loops (e.g., cycling models) and complex anatomy (e.g., patellar motion). To show the abilities of Moco, we first solved for muscle activity that produced an observed walking motion while minimizing squared muscle excitations and knee joint loading. Next, we predicted how muscle weakness may cause deviations from a normal walking motion. Lastly, we predicted a squat-to-stand motion and optimized the stiffness of an assistive device placed at the knee. We designed Moco to be easy to use, customizable, and extensible, thereby accelerating the use of simulations to understand the movement of humans and other animals.

Reliable interpretation of scapular kinematics depends on coordinate system definition

BACKGROUND

Interpretation of shoulder motion across studies has been complicated due to the use of numerous scapular coordinate systems in the literature. Currently, there are no simple means by which to compare scapular kinematics between coordinate system definitions when data from only one coordinate system is known.

RESEARCH QUESTION

How do scapular kinematics vary based on the choice of coordinate system and can average rotation matrices be used to accurately convert kinematics between scapular local coordinate systems?

METHODS

Average rotation matrices derived from anatomic landmarks of 51 cadaver scapulae (29 M/22 F; 59 ± 13 yrs; 26R/25 L; 171 ± 11 cm; 70 ± 19 kg; 23.7 ± 5.5 kg/m²) were generated between three common scapular coordinate systems. Absolute angle of rotation was used to determine if anatomical variability within the cadaver population influenced the matrices. To quantify the predictive capability to convert kinematics between the three coordinate systems, the average rotation matrices were applied to scapulothoracic motion data collected from 19 human subjects (10 M/9 F; 43 ± 17 yrs; 19R; 173 ± 9 cm; 71 ± 16 kg; 23.6 ± 4.5 kg/m²) using biplane fluoroscopy. Root mean squared error (RMSE) was used to compare kinematics from an original coordinate system to the kinematics expressed in each alternative coordinate system.

RESULTS

The choice of scapular coordinate system resulted in mean differences in scapulothoracic rotation of up to 23°, with overall different shapes and/or magnitudes of the curves. A single average rotation matrix between any two coordinate systems achieved accurate conversion of scapulothoracic kinematics to within 4° of RMSE of the known solution. The average rotation matrices were independent of sex, side, decomposition sequence, and motion.

SIGNIFICANCE

Scapulothoracic kinematic representations vary in shape and magnitude based solely on the choice of local coordinate system. The results of this study enhance interpretability and reproducibility in expressing scapulothoracic motion data between laboratories by providing a simple means to convert data between common coordinate systems. This is necessitated by the variety of available motion analysis techniques and their respective scapular landmark definitions.

Feasibility of an alternative method to estimate glenohumeral joint center from videogrammetry measurements and CT/MRI of patients

Videogrammetry is commonly used to record upper limb motions. However, it cannot track the glenohumeral joint center (GH). GH is required to reconstruct upper limb motions. Therefore, it is often estimated by separately measuring scapular motions using scapular kinematics measurements devices (SKMD). Applications of SKMD are neither straightforward nor always noninvasive. Therefore, this work investigates the feasibility of an alternative method to estimate GH from videogrammetry using a CT/MRI image of subject's glenohumeral joint and without requiring SKMD. In order to evaluate the method's accuracy, its GH estimations were compared to reference GH trajectories. The method was also applied to estimate scapular configurations and reconstruct an abduction motion measured by videogrammetry. The accuracy of GH estimations were within 5 mm, and the reconstructed motion was in good agreement with reported in vivo measurements.

Surface-based modeling of muscles: Functional simulation of the shoulder

Musculoskeletal simulations are an essential tool for studying functional implications of pathologies and of potential surgical outcomes, e.g., for the complex shoulder anatomy. Most shoulder models rely on line-segment approximation of muscles with potential limitations. Comprehensive shoulder models based on continuum-mechanics are scarce due to their complexity in both modeling and computation. In this paper, we present a surface-based modeling approach for muscles, which simplifies the modeling process and is efficient for computation. We propose to use surface geometries for modeling muscles, and devise an automatic approach to generate such models, given the locations of the origin and insertion of tendons. The surfaces are expressed as higher-order tensor B-splines, which ensure smoothness of the geometrical representation. They are simulated as membrane elements within a finite element simulation. This is demonstrated on a comprehensive model of the upper limb, where muscle activations needed to perform desired motions are obtained by using inverse dynamics. In synthetic examples, we demonstrate our proposed surface elements both to be easy to customize (e.g., with spatially varying material properties) and to be substantially (up to 12 times) faster in simulation compared to their volumetric counterpart. With our presented automatic approach of muscle wrapping around bones, the humeral head is exemplified to be wrapped physiologically consistently with surface elements. Our functional simulation is shown to successfully replicate a tracked shoulder motion during activities of daily living. We demonstrate surface-based models to be a numerically stable and computationally efficient compromise between line-segment and volumetric models, enabling anatomical correctness, subject-specific customization, and fast simulations, for a comprehensive simulation of musculoskeletal motion.