The developing shoulder has a limited capacity to recover after a short duration of neonatal paralysis

Mechanical stimuli are required for the proper development of the musculoskeletal system. Removal of muscle forces during fetal or early post-natal timepoints impairs the formation of bone, tendon, and their attachment (the enthesis). The goal of the current study was to examine the capacity of the shoulder to recover after a short duration of neonatal rotator cuff paralysis, a condition mimicking the clinical condition neonatal brachial plexus palsy. We asked if reapplication of muscle load to a transiently paralyzed muscle would allow for full recovery of tissue properties. CD-1 mice were injected with botulinum toxin A to paralyze the supraspinatus muscle from birth through 2 weeks and subsequently allowed to recover. The biomechanics of the enthesis was determined using tensile testing and the morphology of the shoulder joint was determined using microcomputed tomography and histology. A recovery period of at least 10 weeks was required to achieve control properties, demonstrating a limited capacity of the shoulder to recover after only two weeks of muscle paralysis. Although care must be taken when extrapolating results from an animal model to the human condition, the results of the current study imply that treatment of neonatal brachial plexus palsy should be aggressive, as even short periods of paralysis could lead to long-term deficiencies in enthesis biomechanics and shoulder morphology.     

Towards a model for force predictions in the human shoulder.

In this paper the concept of a three-dimensional biomechanical model of the human shoulder is introduced. This model is used to analyze static load sharing between the muscles, the bones and the ligaments. The model consists of all shoulder structures, which means that different positions and different load situations may be analyzed using the same model. Solutions can be found for the complete range of shoulder motion. However, this article focuses only on elevation in the scapular plane and on forces in structures attached to the humerus. The intention is to expand the model in future studies to also involve the forces acting on the other shoulder bones: the scapula and the clavicle. The musculoskeletal forces in the shoulder complex are predicted utilizing the optimization technique with the sum of squared muscle stresses as an objective function. Numerical results predict that among the muscles crossing the glenohumeral joint parts of the deltoideus, the infraspinatus, the supraspinatus, the subscapularis, the pectoralis major, the coracobrachialis and the biceps are the muscles most activated during this sort of abduction. Muscle-force levels reached values of 150 N when the hand load was 1 kg. The results from the model seem to be qualitatively accurate, but it is concluded that in the future development of the model the direction of the contact force in the glenohumeral joint must be constrained.     

Shoulder model validation and joint contact forces during wheelchair activities

Chronic shoulder impingement is a common problem for manual wheelchair users. The loading associated with performing manual wheelchair activities of daily living is substantial and often at a high frequency. Musculoskeletal modeling and optimization techniques can be used to estimate the joint contact forces occurring at the shoulder to assess the soft tissue loading during an activity and to possibly identify activities and strategies that place manual wheelchair users at risk for shoulder injuries. The purpose of this study was to validate an upper extremity musculoskeletal model and apply the model to wheelchair activities for analysis of the estimated joint contact forces. Upper extremity kinematics and handrim wheelchair kinetics were measured over three conditions: level propulsion, ramp propulsion, and a weight relief lift. The experimental data were used as input to a subject-specific musculoskeletal model utilizing optimization to predict joint contact forces of the shoulder during all conditions. The model was validated using a mean absolute error calculation. Model results confirmed that ramp propulsion and weight relief lifts place the shoulder under significantly higher joint contact loading than level propulsion. In addition, they exhibit large superior contact forces that could contribute to impingement. This study highlights the potential impingement risk associated with both the ramp and weight relief lift activities. Level propulsion was shown to have a low relative risk of causing injury, but with consideration of the frequency with which propulsion is performed, this observation is not conclusive.     

Do relevant shear forces appear in isokinetic shoulder testing to be implemented in biomechanical models?

Isokinetic dynamometers measure joint torques about a single fixed rotational axis. Previous studies yet suggested that muscles produce both tangential and radial forces during a movement, so that the contact forces exerted to perform this movement are multidirectional. Then, isokinetic dynamometers might neglect the torque components about the two other Euclidean space axes. Our objective was to experimentally quantify the shear forces impact on the overall shoulder torque, by comparing the dynamometer torque to the torque computed from the contact forces at the hand and elbow. Ten healthy women performed isokinetic maximal internal/external concentric/eccentric shoulder rotation movements. The hand and elbow contact forces were measured using two six-axis force sensors. The main finding is that the contact forces at the hand were not purely tangential to the direction of the movement (effectiveness indexes from 0.26 ± 0.25 to 0.54 ± 0.20), such that the resulting shoulder torque computed from the two force sensors was three-dimensional. Therefore, the flexion and abduction components of the shoulder torque measured by the isokinetic dynamometer were significantly underestimated (up to 94.9%). These findings suggest that musculoskeletal models parameters should not be estimated without accounting for the torques about the three space axes.     

Shoulder joint loadings in post total hip replacement surgery patients during assisted walking: The influence of the crutch setup

A crutch is prescribed to permit the patient to walk safely and independently immediately after total hip replacement (THR) surgery. Purpose of this study is to evaluate the influence of the crutch setup on upper limbs biomechanics, including shoulder joint kinematics and kinetics parameters that will be evaluated to detect possible differences related to the crutch length.Thirty patients were randomly assigned to elbow flexed (EF) or elbow extended (EE) forearm crutch setup. Subjects were asked to walk on the laboratory path, instrumented with motion tracking system and force platforms. Spatiotemporal gait parameters, crutch ground reaction force (GRF) and crutch displacement (measured as the relative distance between the crutch position on the floor and the shoulder joint center), were evaluated. A three-dimensional (3D) biomechanical model was implemented to determine shoulder joint kinematics and kinetics during crutch walking.Results showed that the stride length significantly decreased, and base of support width increased for the EF group when compared to the EE group. Crutch forces and distance to the body significantly decreased in the EE group. Furthermore, shoulder joint moments in all planes of motion, vertical and lateral forces were significantly reduced in the EE group.The present study showed that crutch setup influenced performance and upper limb loading during walking, with EE setup allowing a more stable walking and reducing stress on the shoulder joint when compared to the EF setup. Results may help therapists in rationalizing crutch length adjustments for patients after THR surgery.     

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.     

Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting

The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting.     

Upper extremity biomechanics in computer tasks differ by gender

ObjectivesThis laboratory study examined gender differences in upper extremity postures, applied forces, and muscle activity when a computer workstation was adjusted to individual anthropometry according to current guidelines.MethodsFifteen men and 15 women completed five standardized computer tasks: touch-typing, completing a form, editing text, sorting and resizing graphical objects and navigating intranet pages. Subjects worked at a height-adjustable workstation with the keyboard on top of the work surface and the mouse to the right. Subjects repeated the text editing task with the mouse in two other locations: a “high” mouse position, which simulated using a keyboard drawer with the mouse on the primary work surface, and “center” mouse position with the mouse between the keyboard and the body, centered with the body’s center line. Surface electromyography measured muscle activity; electrogoniometric and magnetic motion analysis system measured wrist, forearm and upper arm postures; load-cells measured typing forces; and a force-sensing mouse measured applied forces.ResultsRelative forces applied to the keyboard, normalized muscle activity of two forearm muscles, range of motion for the wrist and shoulder joints and external rotation of the shoulder were higher for women (p < 0.05). When subjects were dichotomized instead by anthropometry (either large/small shoulder width or arm length), the differences in forces, muscle activity of the shoulder and wrist posture and shoulder posture became more pronounced with smaller subjects having higher values. Postural differences between the genders increased in the high mouse position and decreased in the center mouse location.ConclusionsWhen a workstation is adjusted per current guidelines differences in upper extremity force, muscle activity and postural factors still exist between genders. However, these were often stronger when subjects were grouped by anthropometry suggesting that perhaps the computer input devices themselves should be scaled to be more in proportion with the anthropometry and strength of the user.     

Comparison of an EMG-based and a stress-based method to predict shoulder muscle forces

The estimation of muscle forces in musculoskeletal shoulder models is still controversial. Two different methods are widely used to solve the indeterminacy of the system: electromyography (EMG)-based methods and stress-based methods. The goal of this work was to evaluate the influence of these two methods on the prediction of muscle forces, glenohumeral load and joint stability after total shoulder arthroplasty. An EMG-based and a stress-based method were implemented into the same musculoskeletal shoulder model. The model replicated the glenohumeral joint after total shoulder arthroplasty. It contained the scapula, the humerus, the joint prosthesis, the rotator cuff muscles supraspinatus, subscapularis and infraspinatus and the middle, anterior and posterior deltoid muscles. A movement of abduction was simulated in the plane of the scapula. The EMG-based method replicated muscular activity of experimentally measured EMG. The stress-based method minimised a cost function based on muscle stresses. We compared muscle forces, joint reaction force, articular contact pressure and translation of the humeral head. The stress-based method predicted a lower force of the rotator cuff muscles. This was partly counter-balanced by a higher force of the middle part of the deltoid muscle. As a consequence, the stress-based method predicted a lower joint load (16% reduced) and a higher superior–inferior translation of the humeral head (increased by 1.2 mm). The EMG-based method has the advantage of replicating the observed cocontraction of stabilising muscles of the rotator cuff. This method is, however, limited to available EMG measurements. The stress-based method has thus an advantage of flexibility, but may overestimate glenohumeral subluxation.     

A comparison of static and dynamic optimization muscle force predictions during wheelchair propulsion

The primary purpose of this study was to compare static and dynamic optimization muscle force and work predictions during the push phase of wheelchair propulsion. A secondary purpose was to compare the differences in predicted shoulder and elbow kinetics and kinematics and handrim forces. The forward dynamics simulation minimized differences between simulated and experimental data (obtained from 10 manual wheelchair users) and muscle co-contraction. For direct comparison between models, the shoulder and elbow muscle moment arms and net joint moments from the dynamic optimization were used as inputs into the static optimization routine. RMS errors between model predictions were calculated to quantify model agreement. There was a wide range of individual muscle force agreement that spanned from poor (26.4% F_max error in the middle deltoid) to good (6.4% F_max error in the anterior deltoid) in the prime movers of the shoulder. The predicted muscle forces from the static optimization were sufficient to create the appropriate motion and joint moments at the shoulder for the push phase of wheelchair propulsion, but showed deviations in the elbow moment, pronation–supination motion and hand rim forces. These results suggest the static approach does not produce results similar enough to be a replacement for forward dynamics simulations, and care should be taken in choosing the appropriate method for a specific task and set of constraints. Dynamic optimization modeling approaches may be required for motions that are greatly influenced by muscle activation dynamics or that require significant co-contraction.     

Long-term repeatability of force, endurance time and muscle activity during isometric contractions.

We determined the repeatability and correlations between force, endurance and muscle activity during isometric contractions over three years. Twenty-six subjects, with and without complaints of the shoulder and neck, performed standardized maximal and submaximal shoulder-abduction contractions and wrist extension-contractions at yearly intervals from 1997 to 1999. Peak forces developed during maximal contraction and the endurance times of submaximal contractions during shoulder abduction and wrist extension were measured. Electromyography (EMG) of muscle activity was recorded bilaterally from the upper trapezius, middle deltoid, and forearm extensor muscles. Root mean square EMG amplitudes were calculated. We found statistically significant associations between peak forces developed during wrist extension and shoulder abduction, and between endurance times of submaximal wrist extension and shoulder abduction. No statistically significant changes in peak force and EMG(peak) were found over the measurement years. The responses were not statistically significantly influenced by gender, or neck and shoulder pain. However, we observed considerable intra-individual variation in the inter-year measurements particularly for the responses to submaximal contraction. Such large variations represent a challenge when attempting to use the responses to interpret the effects of therapies.     

Shoulder demands in manual wheelchair users across a spectrum of activities

ObjectiveInvestigate shoulder joint kinetics over a range of daily activity and mobility tasks associated with manual wheelchair propulsion to characterize demands placed on the shoulder during the daily activity of manual wheelchair users.DesignCase series.SubjectsTwelve individuals who were experienced manual wheelchair users.MethodsUpper extremity kinematics and handrim wheelchair kinetics were measured over level propulsion, ramp propulsion, start and stop over level terrain, and a weight relief maneuver. Shoulder intersegmental forces and moments were calculated from inverse dynamics for all conditions.ResultsWeight relief resulted in significantly higher forces and ramp propulsion resulted in significantly higher moments than the other conditions. Surprisingly, the start condition resulted in large intersegmental moments about the shoulder equivalent with that of the ramp propulsion, while the demand imparted by the stop condition was shown to be equivalent to level propulsion across all forces and moments.ConclusionsThis study provides characterization of daily living and mobility activities associated with manual wheelchair propulsion not previously reported and identifies activities that result in higher shoulder kinetics when compared to standard level propulsion.     

An upper extremity inverse dynamics model for pediatric Lofstrand crutch-assisted gait

The objective of this study was to develop an instrumented Lofstrand crutch system, which quantifies three-dimensional (3-D) upper extremity (UE) kinematics and kinetics using an inverse dynamics model. The model describes the dynamics of the shoulders, elbows, wrists, and crutches and is compliant with the International Society of Biomechanics (ISB) recommended standards. A custom designed Lofstrand crutch system with four, six-degree-of-freedom force transducers was implemented with the inverse dynamics model to obtain triaxial UE joint reaction forces and moments. The crutch system was validated statically and dynamically for accuracy of computing joint reaction forces and moments during gait. The root mean square (RMS) error of the system ranged from 0.84 to 5.20%. The system was demonstrated in children with diplegic cerebral palsy (CP), incomplete spinal cord injury (SCI), and type I osteogenesis imperfecta (OI). The greatest joint reaction forces were observed in the posterior direction of the wrist, while shoulder flexion moments were the greatest joint reaction moments. The subject with CP showed the highest forces and the subject with SCI demonstrated the highest moments. Dynamic quantification may help to elucidate UE joint demands in regard to pain and pathology in long-term assistive device users.     

Which data should be tracked in forward-dynamic optimisation to best predict muscle forces in a pathological co-contraction case?

The choice of the cost-function for predicting muscle forces during a movement remains a challenge, especially in patients with neuromuscular disorders. Forward dynamics-based optimisations mainly track joint kinematics or torques, combined with a least-excitation criterion. Tracking marker trajectories and/or electromyography (EMG) has rarely been proposed. Our objective was to determine the best tracking objective-function to accurately predict the upper-limb muscle forces. A musculoskeletal model was created and EMG was simulated to obtain a reference movement – a shoulder abduction. A Gaussian noise (mean = 0; standard deviation = 15%) was added to the simulated EMG. Another noise – corresponding to the actual soft tissue artefacts (STA) of experimental shoulder abduction movements – was added to the trajectories of the markers placed on the model. Muscle forces were estimated from these noisy data, using forward dynamics assisted by six non-linear least-squared objective-functions. These functions involved the tracking of marker trajectories, joint angles or torques, with and without EMG-tracking. All six approaches used the same musculoskeletal model and were solved using a direct multiple shooting algorithm. Finally, the predicted joint angles, muscle forces and activations were compared to the reference values, using root-mean-square errors (RMSe) and biases. The force RMSe of the approach tracking both marker trajectories and EMG (18.45 ± 12.60 N) was almost five times lower than the one of the approach tracking only joint angles (82.37 ± 66.26 N) or torques (85.10 ± 116.40 N). Therefore, using EMG as a complementary tracking-data in forward dynamics seems to be promising for the estimation of muscle forces.     

MSCT-3D技术在动物与人骨骼形态比较研究中的应用

目的应用MSCT-3D显示技术比较正常贵州香猪、Marshall比格犬、恒河猴与人上肢带骨及躯干骨的形态学差异。方法采用MSCT分别对贵州香猪、比格犬和恒河猴进行CT全身扫描并进行图像重建,观察其上肢带骨、躯干骨形态结构与人的异同。结果比格犬、恒河猴、贵州香猪脊椎骨和肋的基本组成与人相同,脊椎骨由椎体和附件组成,肋骨包括真肋、假肋和浮肋。而脊柱曲度、各段椎骨数目、胸骨结构、肋的数目、胸肋连接、上肢带骨的组成与人不同,恒河猴的脊柱曲度和上肢带骨连接与人相同,有颈、胸、腰、骶四个生理性弯曲并由锁骨和肩胛骨共同连接自由上肢骨,比格犬和贵州香猪只有颈、胸腰、骶三个生理性弯曲,仅由肩胛骨连接自由上肢骨。结论恒河猴躯干骨和上肢带骨与人有良好的相似性,而比格犬和贵州香猪与人差别较大。MSCT-3D技术为实验动物形态学比较研究提供了一种相对无创、快速、可以在体研究并动态连续观察的科学有效方法。     

Glenohumeral contact forces in reversed anatomy shoulder replacement

A major requirement to design an implant is to develop our understanding of the applied internal forces during everyday activities. In the absence of any basic apparatus for measuring forces directly, it is essential to rely on modelling. The major aim of this study was therefore to understand the biomechanical function of subjects with the reversed anatomy Bayley?Walker prosthesis, using an inverse dynamic shoulder model. In this context, the muscle and joint forces of 12 Bayley–Walker subjects were compared to those of 12 normal subjects during 12 activities of daily living.Maximum glenohumeral contact forces for normal and Bayley–Walker subjects were found to be 77% (±15) and 137% (±21) body weight for lifting a 2 kg shopping bag, and the least forces 29% (±4) and 67% (±8) body weight for reaching to opposite axilla, respectively. For normal subjects, middle deltoid, supraspinatus and infraspinatus were found to be the most active muscles across the subjects and tasks. On the other hand, for implanted subjects with a lack of rotator cuff muscles, the middle deltoid and coracobrachialis muscles were found to be the most active. The biomechanical model can therefore be used in order to gain knowledge about the pathology as well as possible post surgical rehab for subjects with reversed shoulder replacement.     

Targeted gripping reduces shoulder muscle activity and variability

The purpose of this study was to determine if the effect of visually targeted gripping on shoulder muscle activity was maintained with repeated exposures. Eleven healthy males had eight shoulder muscles monitored via surface electromyography while maintaining shoulder elevation at 90° in the scapular plane with and without a 30% grip force. Three non-gripping trials were followed by 15 gripping trials and another 3 non-gripping control trials. Gripping significantly decreased the activity of the anterior deltoid, trapezius, and latissimus dorsi over the exposure of 15 trials. Gripping also reduced variability in all muscles' activity. The changes in shoulder muscle activity are likely in response to forces being transferred through multi-articular muscles spanning from the forearm to the shoulder. Targeted gripping during shoulder elevation resulted in small but significant decreases in muscle activity and reduced variability which supports previous evidence for increased risk of upper extremity disorders in occupational settings.     

In vivo gleno-humeral joint loads during forward flexion and abduction

To improve design and preclinical test scenarios of shoulder joint implants as well as computer-based musculoskeletal models, a precise knowledge of realistic loads acting in vivo is necessary. Such data are also helpful to optimize physiotherapy after joint replacement and fractures. This is the first study that presents forces and moments measured in vivo in the gleno-humeral joint of 6 patients during forward flexion and abduction of the straight arm. The peak forces and, even more, the maximum moments varied inter-individually to a considerable extent. Forces of up to 238%BW (percent of body weight) and moments up to 1.74%BWm were determined. For elevation angles of less than 90° the forces agreed with many previous model-based calculations. At higher elevation angles, however, the measured loads still rose in contrast to the analytical results. When the exercises were performed at a higher speed, the peak forces decreased. The force directions relative to the humerus remained quite constant throughout the whole motion. Large moments in the joint indicate that friction in shoulder implants is high if the glenoid is not replaced. A friction coefficient of 0.1-0.2 seems to be realistic in these cases.