Quantifying the Biomechanical and Neural Factors Contributing to Shoulder Instability

量化导致肩部不稳定的生物力学和神经因素

• 批准号: 10083705
• 负责人: Constantine Nicolozakes
• 金额: $ 1.05万
• 依托单位: NORTHWESTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10083705
• 关键词: Activities of Daily Living; Affect; Anatomy; Biomechanics; Clinical; Clinical assessments; Computer Analysis; Consensus; Custom; Development; Disease; Financial compensation; Freedom; Future; Goals; Impairment; Individual; Intervention; Isometric Exercise; Joint structure of shoulder region; Joints; Knowledge; Lifting; Manuals; Measures; Mechanics; Methods; Military Personnel; Motion; Motor; Muscle; Occupations; Operative Surgical Procedures; Outcome; Pain; Pathology; Patient-Focused Outcomes; Patients; Physical therapy; Posture; Production; Relaxation; Reporting; Research; Research Design; Research Personnel; Research Proposals; Resistance; Risk; Rotation; Shoulder; Shoulder Pain; Side; Skeletal Muscle; Sleep; Structure; Testing; Tissues; Torque; Translations; Upper Extremity; Work; active control; active lifestyle; alternative treatment; arm; base; clinical Diagnosis; clinical examination; clinically relevant; design; electric impedance; impression; improved; mechanical properties; neuroregulation; personalized medicine; prevent; reconstruction; relating to nervous system; research clinical testing; response; shoulder injury; young adult

PROJECT SUMMARY Multidirectional instability (MDI) is a common shoulder pathology in younger individuals impacting those in the military, employed in heavy lifting occupations, and participating in high demand activities. MDI is characterized by multidirectional atraumatic shoulder laxity with concurrent pain that limits participation in activities of daily living. Treatment for MDI begins with non-operative physiotherapy, but short-term and long-term outcomes are often ineffective. Subsequent surgical treatment is unpredictable, especially when compared to similar surgical treatment for unidirectional instability. In contrast to MDI, many individuals present clinically with multidirectional atraumatic shoulder laxity but report no pain (asymptomatic) with shoulder function. It is hypothesized that individuals with asymptomatic laxity, unlike patients with MDI, use neural activation of shoulder musculature to compensate for any deficits in passive shoulder structures. However, research has yet to investigate or quantify the inability to compensate with neural activation of shoulder musculature for passive deficits in MDI. This proposal will focus on identifying and quantifying differences in active and passive shoulder stability between individuals with MDI and asymptomatic laxity to isolate components of shoulder mechanics unique to shoulders with MDI. Aim 1 will quantify translational impedance (resistance to joint motion) of the shoulder in multiple directions and multiple arm postures during shoulder relaxation. Aim 2 will quantify translational impedance of the shoulder during constant isometric torque production in three rotational degrees-of-freedom. Passive and active translational impedance will be assessed in individuals with clinically- diagnosed MDI, asymptomatic shoulder laxity, and asymptomatic shoulders negative for clinical laxity. A custom-adapted linear motor will apply long slow (Aim 1) and small quick stochastic (Aim 1 and Aim 2) translational perturbations to the shoulder. The stiffness component of impedance will be quantified with computational analysis of shoulder displacement and forces following translational perturbations. The results of this work will provide the first comparison of passive and active translational shoulder impedance in individuals with MDI and asymptomatic laxity, informing future studies designed to predict individuals that progress from asymptomatic laxity to MDI and develop personalized MDI treatments to target individual biomechanical deficits.

项目总结 多向不稳定(MDI)是年轻人群中常见的肩部病变，影响 军人，受雇于重型起重职业，并参加高需求活动。MDI的特点是 由于多向无创性肩部松弛并伴有疼痛，限制了日常活动的参与 活着。MDI的治疗始于非手术物理治疗，但短期和长期结果是 通常是无效的。随后的手术治疗是不可预测的，特别是与类似的手术相比。 单向不稳定的治疗。与MDI相反，许多人在临床上表现为 多向无创性肩关节松弛，但报告肩功能无疼痛(无症状)。它是 假设与MDI患者不同，无症状性松弛的个体使用神经激活 肩部肌肉系统，以弥补被动肩部结构的任何缺陷。然而，研究还没有 研究或量化被动肩部肌肉神经激活对补偿能力的影响 计量吸入器的赤字。这项建议将侧重于识别和量化主动和被动的差异 患有MDI和无症状松弛以分离肩部各组成部分的个体之间的肩部稳定性 带有MDI的肩膀所独有的机械装置。目标1将量化平移阻抗(关节阻力 肩部放松时肩部的多个方向和多个手臂姿势。目标2将 量化在三个旋转的恒定等长扭矩产生过程中肩部的平移阻抗 自由度。被动和主动翻译阻抗将在临床上有以下症状的个体中进行评估 诊断为MDI，无症状肩关节松弛，无症状肩关节临床松弛阴性。一个 自适应直线电机将采用长慢速(目标1)和小快随机(目标1和目标2) 肩部的转位紊乱。阻抗的刚度分量将用以下公式量化 平移摄动后肩部位移和力的计算分析。结果是 这项工作将首次对个体被动和主动平移肩阻抗进行比较。 随着MDI和无症状的松弛，通知未来的研究旨在预测个人的进展 无症状的MDI松弛和开发针对个体生物力学的个性化MDI治疗 赤字。