The shoulder is the most frequently dislocated joint of the body. Up to 90% of individuals less than 25 years of age that dislocate their glenohumeral joint and have unidirectional anterior instability suffer recurrence that is difficult to diagnose and necessitates surgical repair. Following surgical treatment, return to normal function remains inadequate with unsatisfactory results in 20-25% of patients due to loss of range of motion, recurrent instability, rotator cuff damage, or osteoarthritis. Therefore, research efforts to better understand the function of the passive stabilizers of the shoulder are needed to design better diagnostic protocols and surgical approaches as well as to improve the long-term outcome. The overall hypothesis is that the outcome of shoulder surgery will be improved when the repaired glenohumeral capsule can reproduce the function of the intact shoulder, both at the immediate post-operative periods and in the long-term. Current models of the shoulder stabilizers describe the glenohumeral capsule as a collection of uniaxial elements (glenohumeral ligaments). Therefore, the goal of this project is to perform a comprehensive analysis of the anatomy and biomechanics of the glenohumeral capsule using a novel model of anterior glenohumeral joint stability. The proposed work will utilize a combined experimental and computational approach to characterize the structure and function of the glenohumeral capsule in clinically relevant joint positions. The three Specific Aims of this proposal are: 1) quantify the local multi-axial material properties, microstructural morphology and appropriate constitutive model of the posterior, antero-superior and antero-inferior regions of the glenohumeral capsule as a function of age and gender; 2) develop and validate subject-specific finite element models of the glenohumeral capsule in clinically relevant joint positions; and 3) determine the stress and strain distribution as well as force in the glenohumeral capsule using subject-specific finite element models with the joint in mid-abduction, abduction and apprehension positions. The quantitative data obtained from these innovative and validated models is the first critical step towards the development of new biomechanically based strategies for improved diagnostic procedures and surgical repair following shoulder dislocation. This methodology will also serve as the state-of-the-art for analysis of other joint capsules throughout the musculoskeletal system. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR050218-03
Application #
7055381
Study Section
Special Emphasis Panel (ZRG1-SBSR (02))
Program Officer
Panagis, James S
Project Start
2004-04-01
Project End
2008-03-31
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
3
Fiscal Year
2006
Total Cost
$222,944
Indirect Cost
Name
University of Pittsburgh
Department
Biomedical Engineering
Type
Schools of Engineering
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
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Rainis, Carrie A; Brown, Andrew J; McMahon, Patrick J et al. (2012) Effects of simulated injury on the anteroinferior glenohumeral capsule. Med Biol Eng Comput 50:1299-307
Drury, Nicholas J; Ellis, Benjamin J; Weiss, Jeffrey A et al. (2011) Finding consistent strain distributions in the glenohumeral capsule between two subjects: implications for development of physical examinations. J Biomech 44:607-13
Moore, Susan M; Ellis, Benjamin; Weiss, Jeffrey A et al. (2010) The glenohumeral capsule should be evaluated as a sheet of fibrous tissue: a validated finite element model. Ann Biomed Eng 38:66-76
Voycheck, Carrie A; Rainis, Eric J; McMahon, Patrick J et al. (2010) Effects of region and sex on the mechanical properties of the glenohumeral capsule during uniaxial extension. J Appl Physiol 108:1711-8
Drury, Nicholas J; Ellis, Benjamin J; Weiss, Jeffrey A et al. (2010) The impact of glenoid labrum thickness and modulus on labrum and glenohumeral capsule function. J Biomech Eng 132:121003
Ellis, Benjamin J; Drury, Nicholas J; Moore, Susan M et al. (2010) Finite element modelling of the glenohumeral capsule can help assess the tested region during a clinical exam. Comput Methods Biomech Biomed Engin 13:413-8
Rainis, Eric J; Maas, Steve A; Henninger, Heath B et al. (2009) Material properties of the axillary pouch of the glenohumeral capsule: is isotropic material symmetry appropriate? J Biomech Eng 131:031007
Moore, Susan M; Stehle, Jens H; Rainis, Eric J et al. (2008) The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation. J Orthop Res 26:1598-604
Ellis, Benjamin J; Debski, Richard E; Moore, Susan M et al. (2007) Methodology and sensitivity studies for finite element modeling of the inferior glenohumeral ligament complex. J Biomech 40:603-12

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