Movement-related pathogenesis of rotator cuff disease in persons with shoulder pain

 描述(申请人提供)：肩痛是残疾人和普通人群中常见的肌肉骨骼症状，可极大地影响他们进行功能性活动的能力。大多数肩痛患者都有退行性肩袖疾病的证据，但简单地将肩袖确定为疼痛的来源并不足以指导医疗和康复策略，从而降低治疗效果。康复策略通常侧重于解决肩部异常运动，据信这是疼痛的基础。然而，肩胛骨运动异常对肩袖疾病发病机制的具体影响仅是理论化的，因此临床医生很难针对最有效的干预策略进行针对性的治疗。我研究的长期目标是确定与肩痛发病机制相关的基于运动的机制，并开发和测试有针对性的康复干预的有效性。将首先评估肩胛骨向上旋转减少的影响，因为这是一种常见的临床观察到的运动功能障碍，被认为会导致肩袖受压，从而导致肩袖疾病。这项建议的具体目的是：1)确定肩胛骨向上旋转减少对肩痛患者肩袖压缩的影响；以及2)确定胸锁和肩锁关节运动促进肩胛骨向上旋转的机制。我的中心假设是，与无症状的对照组相比，肩胛骨向上旋转减少的有症状个体将通过不同的机制增加肩袖压缩并产生肩胛骨向上旋转。拟议的项目将使用先进的技术和方法来量化人体运动并分析复杂的多维数据集。研究培训计划是专门为加速实现我的长期职业目标而制定的，方法是加强科学和专业技能，促进网络和合作，并提供大量产生和传播研究的机会。这项建议的导师Ludewig博士和Keefe博士非常适合提供科学和专业指导，因为他们都是生物力学和多元数据可视化和分析领域的资深研究人员。这两家公司都有成功的导师、出版、联邦资助和跨学科合作的良好历史。一个由研究人员和临床医生组成的咨询委员会将提供矫形外科肩部手术、生物力学和统计方面的内容专业知识，以帮助优化拟议研究的范围和影响。获得Ruth L.Kirschstein NRSA奖学金将加强我的导师、顾问委员会和明尼苏达大学丰富的研究环境之间的协同作用，确保我未来作为一名独立和有影响力的研究人员取得成功。

 DESCRIPTION (provided by applicant): Shoulder pain is a common musculoskeletal complaint among persons with disabilities and the general population, and can substantially impact their ability to perform functional activities. The majority of patients with shoulder pain have evidence of degenerative rotator cuff disease, yet simply identifying the rotator cuff as the source of pain proves insufficient to direct medical and rehabilitation strategies resulting in diminished treatment efficacy. Rehabilitation strategies typically focus on addressing abnormal shoulder motion believed to underlie the pain. However, the specific impact of abnormal scapular motion on the pathogenesis of rotator cuff disease is only theorized, thereby making it difficult for clinicians to target the most effective intervention strategies. The long-term objectves of my research are to identify movement-based mechanisms related to the pathogenesis of shoulder pain, and to develop and test the effectiveness of targeted rehabilitation interventions. will first assess the impact of decreased scapular upward rotation because it is a common clinically-observed movement dysfunction and is believed to cause rotator cuff compression, which can lead to rotator cuff disease. The specific aims of this proposal are to: 1) Determine the impact of decreased scapular upward rotation on rotator cuff compression in persons with shoulder pain; and 2) Identify the mechanisms by which sternoclavicular and acromioclavicular joint motion contribute to scapular upward rotation. My central hypothesis is that compared to asymptomatic controls, symptomatic individuals with decreased scapular upward rotation will have increased rotator cuff compression and will produce scapular upward rotation through different mechanisms. The proposed project will use advanced technologies and approaches for quantifying human motion and analyzing complex, multi-dimensional datasets. The research training plan has been developed specifically to accelerate the achievement of my long-term career objectives by strengthening scientific and professional skills, fostering networking and collaboration, and providing numerous opportunities to produce and disseminate research. The mentors for this proposal, Drs. Ludewig and Keefe, are well-suited to provide scientific and professional guidance as both are established researchers in the fields of biomechanics and multivariate data visualization and analysis, respectively. Both have a strong history of successful mentorship, publication, federal funding, and interdisciplinary collaborations. An advisory committee consisting of researchers and clinicians will provide content expertise in orthopaedic shoulder surgery, biomechanics, and statistics to help optimize the scope and impact of the proposed research. Receiving a Ruth L. Kirschstein NRSA Fellowship will enhance the synergy between my mentors, advisory committee, and the rich research environment at the University of Minnesota ensuring my future success as an independent and impactful researcher.