Soft Tissue Compression Risk in Rotator Cuff Disease Development

肩袖疾病发展中的软组织受压风险

• 批准号: 8443595
• 负责人: PAULA Marie LUDEWIG
• 金额: $ 6.79万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8443595
• 关键词: Affect; Anatomic Models; Articular Range of Motion; Cadaver; Clinical; Complex; Data; Development; Disease; Distal; Effectiveness; Exercise; Exercise stress test; Exposure to; Functional disorder; Head; Image; Imagery; Imaging Techniques; Intervention; Investigation; Joint structure of shoulder region; Joints; Kinetics; Knowledge; Lead; Ligaments; Link; Literature; Magnetic Resonance Imaging; Measures; Mechanics; Methods; Modeling; Motion; Movement; Movement Disorders; Muscle; Occupational Exposure; Pain; Pathology; Persons; Physical therapy exercises; Physiological; Population; Positioning Attribute; Prevalence; Prevention strategy; Public Health; Randomized Controlled Clinical Trials; Rehabilitation therapy; Resolution; Risk; Rotator Cuff; Shoulder; Shoulder Pain; Source; Spinal cord injury; Stroke; Structure; Surface; Tendon structure; Testing; Upper Extremity; Validation; Work; arm; base; biceps brachii muscle; clavicle; cost; cost effective; disability; improved; in vivo; kinematics; novel; pressure; public health relevance; reconstruction; rehabilitation strategy; research study; scapula; soft tissue; standard of care; three-dimensional modeling; trial comparing

DESCRIPTION (provided by applicant): The PIs' long-term objective is to develop and test the effectiveness of biomechanically-based rehabilitation strategies for improving upper extremity function and reducing pain and disability in persons with shoulder pathologies. Rotator cuff pathologies have up to 50% prevalence rates across several populations including persons with spinal cord injury, stroke, occupational exposure to repetitive overhead work, and athletes with repetitive overhead motion exposure. In the painful shoulder, there are two distinct impingement types, subacromial and internal (tendon undersurface contact). There is increasing evidence linking altered shoulder kinematics with disabling pain and dysfunction in these populations. The altered kinematics is hypothesized to reduce the space available for rotator cuff tendon clearance, resulting in impingement of the musculotendinous structures. However, there is very little direct evidence of rotator cuff clearance during arm motions. Past work has identified that without comprehensive 3D modeling and visualization, incorrect clinical interpretation can lead to misguided intervention strategies. The aims of this R03 application are to: 1) generate subject specific 3D shoulder anatomical models including rotator cuff muscle/tendon, coracoacromial ligament, and long head biceps soft tissue data; 2) identify the glenohumeral joint positions and motion alterations that most compromise or optimize rotator cuff tendon clearance across the physiological joint range of motion; and 3) validate that modeled positions identified in Aim 2 result in rotator cuff soft tissue impingement through in-vivo vertically open MR imaging and cadaveric pressure distribution testing. The PIs' approach for these aims will be to use high resolution MR imaging to reconstruct 20 subject specific comprehensive anatomical shoulder models. Using these reconstructions, modeling of position and motion alterations across the spectrum of physiologic range of motion will determine which specific kinematic positions and alterations most reduce, and which maximize rotator cuff tendon clearance with the coracoacromial arch or glenoid (Aim 2). Identified most and least risk positions will be validated cadaverically for pressure distribution, and in-vivo for direct visualization (Aim 3). The PIs' general hypotheses are that current clinical impingement test positions are not consistent with specific glenohumeral joint positions that minimize rotator cuff tendon clearance, and that potential positions and movements which optimize rotator cuff clearance are distinct for subacromial versus internal impingement. Comprehensive 3D modeling and visualization of shoulder kinematic effects on rotator cuff tendon proximity incorporating soft tissue data is a critical next step in understanding rotator cuff tendon mechanical impingement. This work is novel in its direct, comprehensive assessment of rotator cuff tendon clearance for all possible shoulder joint positions, and in its use of advanced subject specific modeling and imaging techniques. Subsequent investigations will further test exercise interventions derived from these data through randomized controlled clinical trials comparing to the current standard of care.

描述（由申请人提供）：PI的长期目标是开发和测试基于生物力学的康复策略的有效性，以改善肩关节疾病患者的上肢功能并减少疼痛和残疾。肩袖病变在几个人群中的患病率高达50%，包括脊髓损伤、中风、职业暴露于重复头顶工作的人和重复头顶运动暴露的运动员。在疼痛的肩部，有两种不同的撞击类型，肩峰下和内部（肌腱下表面接触）。有越来越多的证据表明，这些人群的肩关节运动学改变与致残性疼痛和功能障碍有关。运动学的改变被假设为减少了肩袖肌腱间隙的可用空间，导致肌腱结构的撞击。然而，很少有直接证据表明，肩袖间隙在手臂运动。过去的工作已经确定，如果没有全面的3D建模和可视化，不正确的临床解释可能会导致错误的干预策略。该R 03应用程序的目的是：1）生成受试者特定的3D肩关节解剖模型，包括肩袖肌肉/肌腱、喙肩韧带和长头二头肌软组织数据; 2）识别在生理关节活动范围内最大程度地损害或优化肩袖肌腱间隙的盂肱关节位置和运动改变;以及3）通过体内垂直开放MR成像和尸体压力分布测试，确认目标2中确定的建模位置会导致肩袖软组织撞击。PI实现这些目标的方法是使用高分辨率MR成像重建20个受试者特定的全面解剖肩关节模型。使用这些重建，对生理活动范围内的位置和运动改变进行建模，将确定哪些特定的运动学位置和改变最能减少，以及哪些最大限度地提高肩袖肌腱与喙肩弓或关节盂的间隙（目标2）。将在尸体上确认所识别的最大和最小风险位置的压力分布，并在体内进行直接可视化（目标3）。PI的一般假设是，目前的临床撞击测试位置与最小化肩袖肌腱间隙的特定盂肱关节位置不一致，并且优化肩袖间隙的潜在位置和运动对于肩峰下撞击与内部撞击是不同的。肩关节运动学对肩袖肌腱邻近度的影响的综合3D建模和可视化结合软组织数据是理解肩袖肌腱机械撞击的关键下一步。这项工作是新颖的，在其直接，全面评估肩袖肌腱间隙的所有可能的肩关节位置，并在其使用先进的主题特定的建模和成像技术。随后的研究将通过随机对照临床试验与当前的护理标准进行比较，进一步测试从这些数据中得出的运动干预措施。