Novel device for improved diagnosis and monitoring of rotator cuff injury

Rotator cuff disease impacts approximately over 50% of the population above the age of 60, causing pain and ultimately possible loss of shoulder function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder and aid in the movement of the arm. History of trauma and increased age can lead to a rotator cuff tear, which can range in severity from a partial-thickness tear to a full-thickness, total rupture. Currently, diagnostic techniques for rotator cuff disease are based on physical assessment, detailed patient history, and medical imaging, primarily X-ray, MRI and ultrasonography. However, limitations still exist regarding rotator cuff diagnosis and monitoring. Ultrasound has been shown to have good accuracy in the identification and measurement of full-thickness and partial-thickness rotator cuff tears. Quantitative data regarding rotator cuff tears is not as readily available as the qualitative data provided by the aforementioned techniques. The device designed through this study improves the method of transduction and the analysis of in situ measurement of rotator cuff biomechanics. Improvements include the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining an ultrasound image and the addition of Bluetooth for ease of data transfer. Preliminary studies were performed with the device on both post-operative and healthy patients, in which the stress and strain experienced by the rotator cuff tissue was analyzed. This device will ultimately aid in developing a more thorough predictive diagnostic model for the treatment of rotator cuff disease and aid clinicians in choosing the best treatment option for patients

Dry Needling of Myofascial Trigger Points: Quantification of the Biomechanical Response Using a Myotonometer.

Background: Biomechanical stiffness has been linked to risk of injury and found to be a measureable characteristic in musculoskeletal disorders. Specific identification of stiffness may clarify who is most likely to benefit from the trigger point dry needling (TDN). The purpose of this study is to investigate the reliability and concurrent validity of the MyotonPRO® to the criterion of shear wave ultrasound elastography for the measurement of biomechanical stiffness in the infraspinatus, erector spinae, and gastrocnemius of healthy subjects over increasing muscle contraction. Second purpose is to investigate the biomechanical effects of TDN to latent myofascial trigger points (MTrPs) in the infraspinatus, erector spinae, or gastrocnemius. Research Design and Method: The first phase of the study investigated 30 subjects who completed three levels of muscle contraction in standardized test positions for the infraspinatus, erector spinae and gastrocnemius. Biomechanical stiffness measures were collected using shear wave elastography and MyotonPRO®. The second phase of the study investigated 60 new subjects who were categorized into infraspinatus, erector spinae, or gastrocnemius group based on an identified latent MTrP. These subjects underwent TDN while monitoring biomechanical stiffness at baseline, immediately post TDN, and 24 hours later. Analysis: Discriminate ability, reliability, and correlations were calculated for measured stiffness variable across the three conditions of contraction in the first phase of the study. Differences between stiffness at baseline and after TDN were calculated in the second phase of the study. Results: Correlation of the two measurement methods in the three muscle regions was significant and strongest in the gastrocnemius. MyotonPRO reliability was excellent, and demonstrated ability to discriminate between the three levels of muscle contraction. In the second phase, immediate decreased stiffness was observed in the MTrP following TDN treatment. Significant decreased stiffness was found in in the erector spinae and gastrocnemius group who also demonstrated a localized twitch response during TDN. Stiffness returned to near baseline values after 24 hours. Discussion: The MyotonPRO® stiffness measurement was found to be reliable and discriminate across predefined muscle contraction intensities. TDN may cause an immediate change in stiffness but this change was not observed at 24 hours. It is not known whether these effects are present in a symptomatic population or related to improvements in other clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is an indication of patient improvement in pain and function

Supraspinatus tendon micromorphology in individuals with subacromial pain syndrome

Study Design: Cross-sectional cohort. Introduction: Tendon collagen organization can be estimated by peak spatial frequency radius (PSFR) on ultrasound images. Characterizing PSFR can define the contribution of collagen disruption to shoulder symptoms. Purpose of the Study: The purpose of this was to characterize the (1) supraspinatus tendon PSFR in participants with sub acromial pain syndrome (SPS) and healthy controls; (2) PSFR between participants grouped on a tendon visual quality score; and (3) relationship between PSFR with patient-reported pain, function, and shoulder strength. Methods: Participants with SPS (n ¼ 20) and age, sex, and arm-dominance matched healthy controls (n ¼ 20) completed strength testing in scaption and external rotation, and patient-reported pain, and functional outcomes. Supraspinatus tendon ultrasound images were acquired, and PSFR was calculated for a region of interest 15 mm medial to the supraspinatus footprint. PSFR was compared between groups using an independent t-test and an analysis of variance to compare between 3 groups for visually qualitatively rated tendon abnormalities. Relationships between PSFR with pain, function, and strength were assessed using Pearson correlation coefficient. Results: Supraspinatus tendon PSFR was not different between groups (P ¼ .190) or tendon qualitative ratings (P ¼ .556). No relationship was found between PSFR and pain, functional loss, and strength (P \u3e .05). Conclusions: Collagen disruption (PSFR) measured via ultrasound images of the supraspinatus tendon was not different between participants with SPS or in those with visually rated tendon defects. PSFR is not related to shoulder pain, function, and strength, suggesting that supraspinatus tendon collagen disorganization may not be a contributing factor to shoulder SPS. However, collagen disruption may not be isolated to a single region of interest. Level of Evidence: 3b: case-control study

Ultrasound assessment of deep fascia sliding mobility in vivo: a scoping review

Introdução: A falha do deslizamento fascial pode ocorrer em casos de uso excessivo ou inadequado, trauma ou cirurgia, resultando em inflamação local, dor, sensibilização e potencial disfunção. As propriedades mecânicas dos tecidos fasciais, incluindo a sua mobilidade, têm sido avaliadas in vivo através de ecografia. No entanto, este parece ser um método que ainda não está devidamente padronizado nem validado. Objetivos: Identificar, sintetizar e comparar os princípios metodológicos da investigação científica que utilizou a avaliação ecográfica do deslizamento da fáscia profunda em humanos in vivo, e avaliar a sua fiabilidade. Métodos: Realizou-se uma pesquisa sistemática da literatura nas bases de dados ScienceDirect, PubMed (Medline), Web of Science e B-On, de acordo com as diretrizes PRISMA Extension for Scoping Reviews (PRISMA-ScR). A revisão seguiu três etapas principais: (1) identificação da questão e da literatura relevante; (2) seleção da literatura; e (3) agrupamento, mapeamento e resumo dos dados. Critérios de elegibilidade: Foram incluídos os artigos que usaram a ecografia para avaliar o deslizamento da fáscia profunda em seres humanos in vivo, usando o termo “sliding” ou outro com significado semelhante. Foram excluídos os estudos: não disponíveis em publicações revistas por partes, não disponíveis em inglês, português ou espanhol ou cujo texto completo não se encontrava acessível. Resultados: De um total de 104 artigos completos avaliados para elegibilidade, foram incluídos 18 artigos que avaliaram as fáscias profundas das regiões toracolombar (n=4), abdominal (n=7), femoral (n=4) e crural (n=3). Estes estudos abordaram questões de diagnóstico (n=11) e benefícios terapêuticos (n=7) e apresentaram níveis de evidência entre II e IV. Foram usados vários termos para descrever as medidas de resultados correspondentes ao deslizamento fascial. Foram usados diversos posicionamentos dos participantes, procedimentos para induzir o deslizamento fascial e características dos dispositivos de ecografia. Os métodos de análise do deslizamento fascial incluíram a comparação de imagens ecográficas inicial (estado de repouso) e final (estado alvo) e o uso de técnicas de software de correlação-cruzada através de algoritmos de rastreamento automatizado. Estes métodos mostraram-se fiáveis para medir o deslizamento entre a fáscia toracolombar, as junções músculo-fasciais do transverso abdominal, a fáscia lata e a fáscia crural e as fáscias epimisiais adjacentes. No entanto, os artigos incluídos apresentaram terminologias, questões de investigação, populações participantes e metodologias heterogéneas. É escassa a investigação de alta qualidade para determinar a fiabilidade dos métodos atuais para analisar outras fáscias e avaliar a influência da idade, de características relacionadas com o género, composição corporal ou condições clínicas específicas nas medidas de deslizamento fascial. Conclusão: Os métodos ecográficos de medição do deslizamento fascial incluem a comparação entre frames inicial e final de uma gravação de vídeo de ultrassom e a análise de relação cruzada através de algoritmos de rastreamento automatizado. Estes métodos parecem ser fiáveis para medir o deslizamento de algumas fáscias, mas é necessária literatura para confirmar a sua fiabilidade para outras. Além disso, são necessários protocolos de avaliação específicos e padronizados para cada região anatómica, de modo que a avaliação ecográfica do deslizamento fascial in vivo possa ser usada adequadamente na investigação e na prática clínica

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Kinetic and Kinematic Variables Related to Medial Elbow Joint Space in Collegiate Baseball Pitchers

The ulnar collateral ligament (UCL) is a prime stabilizer in the elbow against valgus force. It is also a commonly injured structure in the overhead-throwing athlete. The majority of literature to date assesses the medial elbow by adding a valgus stress or evaluates the elbow after injury has occurred. The purpose of this dissertation is to explore static changes to the medial elbow and the relationship with the overhead throw. The first investigation sought to determine if there was a bilateral difference in the medial joint space of the elbow in general population college-aged students. There was no significant difference bilaterally; suggesting that the magnitude of stress applied to the elbow by daily activities is not substantial enough to produce an anatomical change to the connective tissue. However, there was a significant gender effect with males exhibiting larger joint spaces. The second study investigated the bilateral difference in the medial joint space of the elbow in male and female overhead athletes with the same protocol from the previous study. In this study, there was a significant difference between the dominant and non-dominant arms. The third study measured the medial joint space of collegiate baseball pitchers before, after, and 48 hours following the throwing of a simulated game. This study also included measures of grip strength and ball kinematics, in order to investigate a relationship between kinetic and kinematic factors and the changes in the medial joint space. There were no significant changes in the medial joint space following pitching a simulated game, although interestingly, grip strength increased following pitching. Ball kinematics did not indicate a relationship with the changes in the medial elbow joint space

Effects of Seat and Axle Position on Pain, Pathology, and Independence in Pediatric Manual Wheelchair Users with Spinal Cord Injury

Manual wheelchair (MWC) users with spinal cord injury (SCI) rely heavily on their upperextremities to complete daily occupations. Due to repetitive shoulder use during wheelchair mobility and propulsion, MWC users are at greater risk of shoulder pain and shoulder pathology, and thus decreased independence, and lower quality of life. The relative fit of the wheelchair and its parameters are critical and can further impact the user’s propulsion biomechanics. Parameters such as seat angle and axle position may put the user in detrimental shoulder positions for longer periods of time, impacting health outcomes even more. Although the effects of wheelchair setup on health outcomes have been explored in adult populations, little is known about the impact on pediatric MWC users, which is unfortunate because these children will live with the secondary medical conditions of an SCI longer than their adult counterparts. Limited research also exists on the wheelchair parameters currently being used by pediatric MWC users with SCI, and there are very few recommendations for wheelchair setup and fit specific to the pediatric population. This study aims to explore the seat and axle positions that are currently being used by pediatric MWC users with SCI, to identify the presence of shoulder pain and pathology in this population, and to determine if the relative fit of the pediatric wheelchair is related to pain, pathology, or independence scores in children with SCI. A total of 9 pediatric MWC users with SCI, ages 6-21, participated in this study. Three-dimension (3D) kinematics data were collected using 14-camera Vicon (Oxford Metric Group, Oxford, UK) Vantage and TS motion analysis systems. Shoulder pathologies were identified using diagnostic and quantitative ultrasound. Pain and independence outcomes were analyzed using the Wheelchair Users Shoulder Pain Index (WUSPI) and the Spinal Cord Independence Measure (SCIM). The mean seat angle used by the group was 5.16 degrees of elevation. Of the 9 participants, 7 used rearward axle positions in relation to their shoulders, while 2 used the adult recommended, forward axle position. Similarly, 4 of the participants followed the adult guideline to have an elbow flexion angle between 100-120 degrees, while 5 of the participants had their axles positioned non-optimally in the vertical direction according to adult guidelines. Shoulder pathologies were identified in 44% of the participants, and the average occupation ratio (percentage of the subacromial space occupied by the supraspinatus tendon) for the supraspinatus tendon was 69.62%. The average WUSPI score for the group was a 3.40 out of 150, and 4 of the 9 participants reported experiencing some level of shoulder pain on the assessment. The average SCIM score for all participants was a 67.13 out of 100, with age and time since injury strongly and significantly correlating with independence scores. After analyzing the data, a strong negative correlation between seat angle and occupation ratio was found. There was also a moderate correlation between the use of a non-optimal elbow angle and a higher WUSPI score. Finally, there was a strong positive correlation between seat angle and SCIM independence scores. Only weak correlations were found between horizontal axle positioning and the various outcomes, unlike the adult population. Results of this study will help to inform clinical decision-making when prescribing wheelchairs to children with SCI and when making wheelchair setup recommendations to pediatric MWC users and their families

Ultrasound and photoacoustic methods for anatomic and functional imaging in image guided radiation therapy

(MATERIAL and METHODS) First, we define the physical principals and optimal protocols that provide contrast when imaging with US and the transducer properties contributing to resolution limits. The US field of view (FOV) was characterized to determine the optimal settings with regard to imaging depth, focal region, with and without harmonic imaging, and artifact identification. This will allow us to determine the minimum errors expected when registering multimodal volumes (CT, US, CBCT). Next, we designed an in-house integrated US manipulator and platform to relate CT, 3D-US and linear accelerator coordinate systems. To validate our platform, an agar-based phantom with measured densities and speed-of-sound consistent with tissues surrounding the bladder was fabricated. This phantom was rotated relative to the CT and US coordinate systems and imaged with both modalities. These CT and 3D-US images were imported into the treatment planning system, where US-to-US and US-to-CT images were co-registered and the registration matrix used to re-align the phantom relative to the linear accelerator. The measured precision in the phantom setup, which is defined by the standard deviation of the transformation matrix components, was consistent with and exceeding acceptable clinical patient re-alignments (2 mm). Statistical errors from US-US registrations for different patient orientations ranged from 0.06-1.66 mm for x, y, and z translational components, and 0.00-1.05 degrees for rotational components. Statistical errors from US-CT registrations were 0.23-1.18 mm for the x, y and z translational components, and 0.08-2.52 degrees for the rotational components. The high precision in the multimodal registrations suggest the ability to use US for patient positioning when targeting abdominal structures. We are now testing this on a dog patient to obtain both inter and intra-fractional positional errors. The objective of this experiment is to confirm Hill’s equation describing the relationship between hemoglobin saturation (SaO2) and the partial pressure of dissolved oxygen (pO2). The relationship is modeled as a sigmoidal curve that is a function of two parameters – the Hill coefficient, n, and the net association constant of HbO2, K (or pO2 at 50% SaO2). The goal is to noninvasively measure SaO2 in breast tumors in mice using photoacoustic computed tomographic (PCT) imaging and compare those measurements to a gold standard for pO2 using the OxyLite probe. First, a calibration study was performed to measure the SaO2 (co-oximeter) and pO2 (Oxylite probe) in blood using Hill’s equation (P50=23.2 mmHg and n=2.26). Next, non-invasive localized measurements of SaO2 in MDA-MD-231 and MCF7 breast tumors using PCT spectroscopic methods were compared to pO 2 levels using Oxylite probe. The fitted results for MCF7 and MDA-MD-231 data resulted in a P50 of 17.2 mmHg and 20.7 mmHg and a n of 1.76 and 1.63, respectively. The lower value of the P50 is consistent with tumors being more acidic than healthy tissue. Current work applying photon fluence corrections and image artifact reduction is expected to improve the quality of the results. In summary, this study demonstrates that photoacoustic imaging can be used to monitor tumor oxygenation, and its potential use to investigate the effectiveness of radiation therapy and the ability to adapt therapeutic protocols

Optimal Port Placement And Automated Robotic Positioning For Instrumented Laparoscopic Biosensors

OPTIMAL SURGICAL PORT PLACEMENT AND AUTOMATED ROBOTIC POSITIONING FOR RAMAN AND OTHER BIOSENSORS by BRADY KING January 2011 Advisors: Dr. Abhilash Pandya, Dr. Darin Ellis, Dr. Le Yi Wang, and Dr. Greg Auner Major: Computer Engineering Degree: Doctor of Philosophy Medical biosensors can provide new information during minimally invasive and robotic surgical procedures. However, these biosensors have significant physical limitations that make it difficult to find optimal port locations and place them in vivo. This dissertation explores the application of robotics and virtual/augmented reality to biosensors to enable their optimal use in vivo. In the first study, human performance in the task of port placement was evaluated to determine if computer intervention and assistance was needed. Using a virtual surgical environment, we present a number of targets on one or more tissue surfaces. A human factors study was conducted with 20 subjects that analyzed the subject\u27s placement of a port with the goal of scanning as many targets as possible with a biosensor. The study showed performance to be less than optimal with significant degradation in several specific scenarios. In the second study, an automated intelligent port placement system for biosensor use was developed. Patient data was displayed in an environment in which a surgeon could indicate areas of interest. The system utilized biosensor physical limitations and provided the best port location from which the biosensor could reach the targets on a collision-free path. The study showed that it is possible to find an optimal port location for proper biosensor data capture. In the final study, a surgical robot was investigated for potential use in holding and positioning a biosensor in vivo. A full control suite was developed for an AESOP 1000, enabling the positioning of the biosensor without hand manipulation. It was found that the robot lacks the accuracy needed for proper biosensor utilization. Specific causes for the inaccuracies were identified for analysis and consideration in future robotic platforms. Overall, the results show that the application of medical robotics and virtual/augmented reality is able to overcome of the significant physical limitations inherent to biosensor design that currently limit their use in surgery. We conjecture that a complete system, with a more accurate robot, could be used in vivo. We believe that results taken from the individual studies will result in improvements to pre-operative port placement and robotic design

Risk Factors for Upper Extremity Musculoskeletal Symptoms among Bovine Veterinarians

Background Bovine veterinarians experience an increased risk of reporting upper-limb musculoskeletal (MSK) symptoms when compared to the general population. One hypothesized cause is reproductive exams performed on cattle via rectal palpation, but this has not been conclusively verified via epidemiological study design or ergonomic assessment. Objectives This thesis answers the following research questions: 1) What self-reported individual and work-related risk factors are associated with work-preventing upper-extremity MSK symptoms in Western Canadian bovine practitioners? 2) Which physical ergonomic hazards (posture, repetition, force, and workplace design) are associated with bovine reproductive exams? Methods Multiple logistic regression analysis was performed on data from a cross-sectional survey of western Canadian bovine veterinarians to determine individual and workplace characteristics associated with work-preventing MSK symptoms in the past 12 months. Field ergonomic assessments were performed on seven bovine veterinarians at routine reproductive exam appointments on beef and dairy cattle. Posture, repetition, force, and workplace characteristics were assessed as potential ergonomic hazards. Results The final regression model retained three variables that predicted work-preventing upper-extremity MSK symptoms: height (continuous, OR 0.93 [0.87-0.99]), number of veterinarians in the practice (continuous, OR 1.32 [1.05-1.66]), and practice type (mixed animal vs. primarily bovine, OR 3.20 [0.96-10.64]). While annually estimated number of reproductive exams was not significant in the regression model, the field ergonomic assessment confirmed that during reproductive exam appointments veterinarians are exposed to awkward postures, repetitive movements, and forceful exertions both from the exams themselves and ancillary work-related tasks. Conclusion Bovine veterinarians are exposed to a variety of physical hazards that have been associated with upper limb MSK symptoms in other professions. Personal risk factors, such as height, number of co-workers, and practice type, may exacerbate the risk of developing these symptoms. It is imperative that prevention strategies be prioritized to ensure that bovine tasks become safer to ensure a healthy future for the bovine veterinary profession