Carpometacarpal Osteoarthritis: Understanding the Intersection of Muscle Mechanics, Joint Instability, and Pain

腕掌骨关节炎：了解肌肉力学、关节不稳定和疼痛的交叉点

• 批准号: 10597142
• 负责人: Jennifer A. Nichols
• 金额: $ 44.89万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597142
• 关键词: Absenteeism at work; Address; Adopted; Affect; Anatomy; Area; Articular Range of Motion; Biomechanics; Biometry; Clinical; Clinical Treatment; Clinical Trials; Compensation; Complex; Data; Data Set; Degenerative Disorder; Degenerative polyarthritis; Disease; Electromyography; Electronics; Equilibrium; Excision; Fascicle; Future; Goals; Hand; Hand functions; Household; Individual; Intervention; Joint Instability; Joint repair; Joints; Kinetics; Knowledge; Length; Ligaments; Measurement; Measures; Mechanics; Motor; Movement; Muscle; Muscle Contraction; Muscle function; Musculoskeletal; Musculoskeletal Pain; Operative Surgical Procedures; Orthopedics; Pain; Pain Research; Patient Self-Report; Pattern; Play; Postoperative Period; Quality of life; Research; Research Methodology; Role; Sensory; Severities; Severity of illness; Standardization; Structure; Symptoms; Techniques; Testing; Thumb structure; Time; Ultrasonography; Uninsured Medical Expense; Visual; Wages; analog; biomechanical test; biopsychosocial; bone; clinical care; cohort; design; effective therapy; exercise intervention; experimental study; improved; in vivo; kinematics; muscular structure; novel; pain relief; reconstruction; simulation; soft tissue; strength training; therapy design; ultrasound

PROJECT SUMMARY Individuals with thumb carpometacarpal osteoarthritis (CMC OA) can lose up to 50% of hand function. Unfortunately, current conservative and surgical treatments do not provide the pain relief, strength, and mobility needed to restore both fine and gross motor function. Improvements in clinical treatments are limited by a lack of understanding regarding the complex relationship between thumb biomechanics and musculoskeletal pain. In this proposal, we address this critical knowledge gap by examining the role of thumb muscles in modulating the two primary symptoms of CMC OA: pain and joint instability. Individuals across the full spectrum of disease severity and healthy controls will be studied to evaluate individuals who present with only joint instability, only pain, both, or neither. In Aim 1, to what extent muscle structure changes in the presence of CMC OA and how these changes affect muscle force-generating capacity will be evaluated. Collected data will include fascicle length and cross-section area measured in vivo through ultrasound imaging and thumb muscle operating ranges calculated through musculoskeletal simulations. Completion of this aim will identify changes in muscle structure that mitigate versus aggravate CMC OA symptoms and also establish baseline data describing healthy targets for thumb muscle force-generating parameters. In Aim 2, how thumb muscle activity influences pain will be examined through an experiment that integrates biomechanical techniques (e.g., electromyography) and quantitative pain testing (e.g., movement-evoked pain, quantitative sensory testing). Completion of this aim will enhance our understanding the relationship between muscle activity and pain, thereby elucidating protective versus detrimental compensatory movement strategies adopted by individuals with CMC OA. In Aim 3, how thumb muscle activity influences joint stability will be examined. Collected data will include experimental measurements of muscle activity, thumb kinematics, and thumb kinetics during functional and range of motion tasks as well as biomechanical assessments of joint instability in the presence of active versus passive muscle contraction. Completion of this aim will identify how CMC OA and muscle activity influences CMC joint stability, thereby informing clinical decisions regarding how muscles should (or should not) be considered during CMC OA treatment. Overall, this study will critically advance our mechanistic understanding of how the structure and function of thumb muscles change in the presence of CMC OA. By evaluating muscle mechanics (Aim 1), pain (Aim 2), and joint stability (Aim 3) in individuals with and without CMC OA, we will elucidate the co-evolution of muscle mechanics, symptom severity, and disease severity. This knowledge will inform current and future treatment of CMC OA, thereby improving the quality of life of individuals living with this disease.

项目摘要 拇指腕骨骨关节炎（CMC OA）的个体最多可能会失去50％的手部功能。 不幸的是，目前的保守和手术治疗无法提供缓解疼痛，力量和流动性 需要恢复精细的运动功能。临床治疗的改善受到缺乏的限制 了解拇指生物力学与肌肉骨骼疼痛之间的复杂关系。在 这项建议，我们通过检查拇指肌肉在调节的角色中的作用来解决这一关键知识差距 CMC OA的两个主要症状：疼痛和关节不稳定性。各种疾病的个人 将研究严重性和健康对照，以评估仅出现关节不稳定性的个体，仅 疼痛，无论是痛苦还是都不是。在AIM 1中，肌肉结构在存在CMC OA的情况下发生变化以及如何在 这些变化会影响肌肉力量产生能力。收集的数据将包括casticle 通过超声成像和拇指肌肉操作范围在体内测量的长度和横截面区域 通过肌肉骨骼模拟计算。该目标的完成将确定肌肉结构的变化 减轻与加重的CMC OA症状，还建立了描述健康目标的基线数据 用于拇指肌肉产生参数。在AIM 2中，拇指肌肉活动如何影响疼痛 通过整合生物力学技术（例如肌电图）和 定量疼痛测试（例如，运动诱发的疼痛，定量感觉测试）。这个目标的完成 增强我们的理解肌肉活动与疼痛之间的关系，从而阐明保护性 CMC OA的个人采用的与有害补偿运动策略相对于有害的补偿运动策略。在AIM 3中，如何 将检查拇指肌肉活动影响关节稳定性。收集的数据将包括实验 在功能和运动范围内测量肌肉活动，拇指运动学和拇指动力学 在有活跃肌肉和被动肌肉的情况下，任务以及对关节不稳定性的生物力学评估 收缩。该目标的完成将确定CMC OA和肌肉活动如何影响CMC关节稳定性， 从而告知有关在CMC期间如何（或不应考虑肌肉）的临床决定 OA处理。总体而言，这项研究将严格提高我们对结构和如何方式的机械理解 在CMC OA存在下，拇指肌肉的功能会发生变化。通过评估肌肉力学（AIM 1），疼痛 （AIM 2）和具有CMC OA的个体的联合稳定性（AIM 3），我们将阐明共同发展 肌肉力学，症状严重程度和疾病严重程度。这些知识将为当前和未来提供信息 治疗CMC OA，从而改善了患有这种疾病的人的生活质量。