Biomechanical Assessment of a Human Joint under Natural and Clinically Modified Conditions: The Shoulder

Abstract

Unbalanced muscle forces in the shoulder joint may lead to functional impairment in the setting of rotator cuff tear and progressive arthritis in cuff tear arthropathy. A model, which predicts muscle forces for common shoulder movements, could be used to help in treatment decision-making and in improving the design of total shoulder prosthesis. Unfortunately, the shoulder has many muscles that overlap in function leading to an indeterminate system. A finite element model employing an optimization algorithm could be used to reduce the number of degrees of freedom and predict loading of the glenohumeral joint. The goal of this study was to develop an anatomically and physiologically correct computational model of the glenohumeral joint. This model was applied to: 1) estimate the force in each muscle during the standard glenohumeral motions (flexion/extension, abduction/adduction and internal/ external rotation), and 2) determine stress concentrations within the scapula during these motions. These goals were realized through the following steps: First, a three dimensional bone reconstruction was performed using computed tomography (CT) scan data. This allowed for a precise anatomical representation of the bony components. Then muscle lever arms were estimated based on the reconstructed bones using computer-aided design software. The origins, insertions, and muscle paths were obtained from the literature. This model was then applied to estimate the forces within each of the muscles that are necessary to stabilize the joint at a fixed position. Last, finite element analysis of the scapula was performed to study the stress concentrations. These were identified and related to the morphology of the bone. A force estimation algorithm was then developed to determine the necessary muscle force distribution. This algorithm was based on an applied external moment at the joint, and the appropriate selection of muscles that could withstand it, ensuring stability, while keeping the reaction force at a minimum. This method offered an acceptable solution to the indeterminate problem, a unique solution was found for each shoulder motion. The model was then applied to determine the stress concentration within various regions of the scapula for each of the shoulder motions. The rotator cuff was found to act as the main stabilizer under rotation, and had a significant stabilizing role under flexion and abduction. The finite element model of the shoulder that was developed can be used to gain a better understanding of the load transfer mechanisms within the glenohumeral joint and the impact of muscle forces on scapular morphology. This information can then be used to assist with treatment decision-making for rotator cuff tears and with the design of new implants for total shoulder arthroplasty.