Soft Tissue Compression Risk in Rotator Cuff Disease Development

描述(由申请人提供)：PIS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，以改善肩部疾病患者的上肢功能，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、职业暴露于重复的头顶工作，以及重复头顶运动暴露的运动员。在疼痛的肩部，有两种截然不同的撞击型，肩峰下撞击型和肩峰内撞击型(肌腱表面下接触)。越来越多的证据表明，在这些人群中，肩关节运动学改变与致残性疼痛和功能障碍有关。改变的运动学假设是为了减少可用于肩袖肌腱清除的空间，从而导致肌腱结构的撞击。然而，在手臂运动过程中，几乎没有直接证据表明肩袖的间隙。过去的工作已经证实，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误导的干预策略。此R03应用程序的目标是：1)生成特定于受试者的3D肩部解剖模型，包括肩袖肌肉/肌腱、喙肩韧带和长头二头肌的软组织数据；2)确定最影响或优化肩袖肌腱在生理关节活动范围内间隙的关节位置和运动改变；以及3)通过体内垂直开放磁共振成像和身体压力分布测试，验证目标2中确定的建模位置是否导致肩袖软组织撞击。为了达到这些目的，PI的方法将是使用高分辨率MR成像来重建20个特定于受试者的综合解剖肩部模型。利用这些重建，对生理范围内的位置和运动变化进行建模，将确定哪些特定的运动学位置和变化最大程度地减少，以及哪些肩袖肌腱与喙肩弓或关节突之间的间隙最大化(目标2)。确定的风险最高和风险最低的位置将在身体上进行压力分布验证，并在体内进行直接可视化验证(目标3)。PIS的一般假设是，目前的临床撞击测试位置与将肩袖肌腱间隙降至最低的特定肩关节关节位置不一致，并且对于肩峰下撞击和内部撞击，优化肩袖间隙的潜在位置和运动是不同的。结合软组织数据，对肩部运动对肩袖肌腱邻近部位的影响进行全面的3D建模和可视化是理解肩袖肌腱机械撞击的关键下一步。这项工作的新颖之处在于，它直接、全面地评估了所有可能的肩关节位置的肩袖肌腱间隙，并使用了先进的特定对象建模和成像技术。随后的研究将通过随机对照临床试验进一步测试根据这些数据得出的运动干预措施，并与目前的护理标准进行比较。

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.