Mechanisms of Rotator Cuff Injury During Manual Wheelchair Propulsion

项目摘要/摘要 肩痛和关节疾病严重威胁着手动轮椅使用者的健康和行动能力 脊髓损伤。对功能独立性、生活质量、照顾者有后续的影响 负担和医疗保健利用率。特别是，肩袖撕裂对这些人来说是毁灭性的，因为 通常的临床疗程(修复)通常是不可行的。他们的上肢已经成为他们的主要手段 活动度和术后肩部固定是不切实际的。因此，肩关节的健康至关重要。 是为这群人保留的。为了应对预防肩部疾病的主要挑战和 对于手动轮椅使用者的功能障碍进展，我们需要评估各种 与肩袖软组织健康相关的干预措施。除了关节扭矩的逆动力学计算 或肌电测量，测量干预对肩袖软组织压缩的影响 在机械性理解和结果评估方面取得了重要进展。我们的建议将结合 来自明尼苏达大学的现有数据集(20个精确的3D肩部重建，包括软组织) 和梅奥诊所(10名参与者在轮椅推进过程中的精确3D肩部运动学)进行测量 肩袖压缩用于200种独特的肩部几何和运动学组合。目标1将 描述解剖特征和运动方式对肩袖肌腱压缩的影响 在手动轮椅推进过程中“。临床医生和转型科学家需要了解亲属 轮椅推进过程中运动和解剖/几何对肩袖应力的影响。 这项调查的结果将为机械调查和临床试验提供信息，以评估预防 干预措施。此外，直接评估软组织影响的方法是劳动和技术密集型的。我们的 拟议的目标2将“确定低保真模型预测活体肌腱受压的能力。 手动轮椅推进“通过直接比较高保真和低保真技术。成功完成 将决定劳动密集型、特定学科模型的必要性或益处 在研究肩袖肌腱损伤机制和预防结果时的低保真度替代方案。 然后，这些知识可以广泛应用于我们小组和其他人未来的工作，包括评估 关于转让和其他职能活动的信息。未来工作的适当样本量也可以通过 通过这一拟议项目获得的知识。该项目提供了一个独特的协作机会 在经验丰富的调查人员之间，并结合现有数据来确定各种 更大规模调查计划的方法。我们的做法是响应NICHD的特别通知 兴趣(非HD-20-200)，因为它利用有价值的现有数据来促进对肩部柔软的理解 组织疾病以及我们的多学科小组和其他人对未来研究的规划。

Project Summary/Abstract Shoulder pain and joint disease is a serious threat to health and mobility for manual wheelchair users living with spinal cord injury. There are subsequent implications for functional independence, quality of life, caregiver burden, and healthcare utilization. In particular, rotator cuff tears are devastating for these individuals as the usual clinical course (repair) is not typically viable. Their upper extremities have become their primary means of mobility, and post-surgical shoulder immobilization is impractical. As such, it is critical that shoulder joint health is preserved for this population. In order to address the major challenges of preventing shoulder disease and dysfunction progression for manual wheelchair users, we need to assess the impact of and need for various interventions relative to rotator cuff soft tissue health. In addition to inverse dynamic calculations of joint torques or electromyographic measures, measuring the impact of interventions on rotator cuff soft tissue compression is an important advancement in mechanistic understanding and outcomes assessment. Our proposal will combine existing data sets from the University of Minnesota (20 precise 3D shoulder reconstructions including soft tissue) and Mayo Clinic (10 participants’ precise 3D shoulder kinematics during wheelchair propulsion) to measure rotator cuff compression for 200 unique combinations of shoulder geometry and kinematics. Aim 1 will “Characterize the effect of anatomical features and movement patterns on rotator cuff tendon compression during manual wheelchair propulsion”. Clinicians and transformational scientists need to know the relative impacts of motion and anatomy/geometry on rotator cuff stresses during wheelchair propulsion. Outcomes of this investigation will inform both mechanistic investigations and clinical trials assessing preventive interventions. In addition, methods to directly assess soft tissue impact are labor- and technology-intensive. Our proposed Aim 2 will “Determine the capability of low-fidelity models to predict in vivo tendon compression during manual wheelchair propulsion” by directly comparing high- and low-fidelity techniques. Successful completion of this project will determine the necessity or benefit of labor-intensive, subject-specific models over lower fidelity alternatives in studying rotator cuff tendon injury mechanisms, and preventative outcomes. This knowledge can then be applied extensively in future work by our group and others, including assessment of transfers and other functional activities. Appropriate sample sizes for future work can also be planned with the knowledge gained through this proposed project. This project provides a unique opportunity for collaboration between experienced investigators and to combine existing data to determine relative utility of various approaches for larger scale investigation planning. Our approach is responsive to the NICHD Notice of Special Interest (NOT-HD-20-200) in that it leverages valuable existing data to advance understanding of shoulder soft tissue disease and planning for future investigations by our multidisciplinary groups and others.