Simulation of fatigue-initiated subacromial impingement: clarifying mechanisms

AbstractSubacromial impingement in the shoulder precedes many cases of rotator cuff pathology. However, debate exists regarding the mechanism, and even existence, of fatigue-initiated impingement. The controversy centers on two primary impingement mechanisms: 1) superior humeral head migration and 2) scapular reorientation. A linked series of in vivo experiments and in silica simulations accomplishes the integration of stochastic, orthopedic, geometric, kinematic, physiologic, literature-derived, and experimental data sources to help resolve the mechanism debate. A major focus is the multi-scale modeling of relevant variability. The described techniques have direct implications for musculoskeletal modeling and simulation of the shoulder region, with specific application to assessing occupational and activities of daily living in diverse populations

Three-dimensional comparison of static and dynamic scapular motion tracking techniques

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.jelekin.2013.09.011. © 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/The shoulder is complex and comprised of many moving parts. Accurately measuring shoulder rhythm is difficult. To classify shoulder rhythm and identify pathological movement, static measures have been the preferred method. However, dynamic measures are also used and can be less burdensome to obtain. The purpose of this paper was to determine how closely dynamic measures represent static measures using the same acromion marker cluster scapular tracking technique. Five shoulder angles were assessed for 24 participants using dynamic and static tracking techniques during humeral elevation in three planes (frontal, scapular, sagittal). ANOVAs were used to identify where significant differences existed for the factors of plane, elevation angle, and tracking technique (static, dynamic raising, dynamic lowering). All factors were significantly different for all shoulder angles (p<0.001), except for elevation plane in scapulothoracic protraction/retraction (p=0.955). Tracking techniques were influential (p<0.001), but the grouped mean differences fell below a clinically relevant 5° benchmark. There was large variation in mean differences of the techniques across individuals. While population averages are similar, individual static and dynamic shoulder assessments may be different. Caution should be taken when dynamic shoulder assessments are performed on individuals, as they may not reflect those obtained in static scapular motion tracking.Natural Sciences and Engineering Research Council || Canada Foundation for Innovatio

Investigating the reliability and validity of subacromial space measurements using ultrasound and MRI

Abstract Background While ultrasound (US) measures of the subacromial space (SAS) have demonstrated excellent reliability, measurements are typically captured by experts with extensive ultrasound experience. Further, the agreement between US measured SAS width and other imaging modalities has not been explored. This research evaluated the agreement between SAS measures captured by novice and expert raters and between US and magnetic resonance imaging (MRI). This study also evaluated the effect of US transducer tilt on measured SAS. Methods Nine men and nine women participated in this study. US images were captured by a novice and expert with the participant in both seated and supine positions. An inclinometer was fixed to the US probe to measure transducer tilt. SAS width was measured in real time from freeze framed images. MRI images were captured, and the humerus and acromion manually segmented. The SAS width was measured using a custom algorithm. Results Intraclass correlation coefficients (ICCs) between novice and expert raters were 0.74 and 0.63 for seated and supine positions, respectively. Intra-rater agreement was high for both novice (ICC = 0.83–0.84) and expert (ICC ≥ 0.94) raters. Agreement between US and MRI was poor (ICC = 0.21–0.49) but linearly related. Conclusions Moderate agreement between novice and expert raters was demonstrated, while the agreement between US and MRI was poor. High intra-rater reliability within each rater suggests that US measures of the SAS may be completed by a novice with introductory training

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial

<div><p>Objective</p><p>Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis.</p><p>Design</p><p>Single-blind, three-arm randomized controlled trial.</p><p>Setting</p><p>Community in Southwestern Ontario, Canada.</p><p>Participants</p><p>A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth.</p><p>Interventions</p><p>Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week.</p><p>Measurements</p><p>Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention.</p><p>Results</p><p>The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE.</p><p>Conclusions</p><p>The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required.</p><p>Trial registration</p><p>ClinicalTrials.gov (<a href="https://clinicaltrials.gov/ct2/show/NCT02370667" target="_blank">NCT02370667</a>)</p></div

Self-reported physical function measured using the Knee Osteoarthritis Outcome Score.

<p>Data are presented as mean ± standard error change (follow-up minus baseline values) in scores relative to the minimal clinically important difference (MCID) values. Significant between-group differences are denoted with <b>**</b> and within-group change with *.</p