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Research Papers

Multibody System of the Upper Limb Including a Reverse Shoulder Prosthesis

[+] Author and Article Information
C. Quental

e-mail: cquental@dem.ist.utl.pt

J. Folgado

e-mail: jfolgado@dem.ist.utl.pt

J. Ambrósio

e-mail: jorge@dem.ist.utl.pt
IDMEC,
Instituto Superior Técnico,
University of Lisbon,
Av. Rovisco Pais,
Lisbon 1049-001,Portugal

J. Monteiro

Faculty of Medicine,
University of Lisbon,
Av. Professor Egas Moniz,
Lisbon 1649-028,Portugal,
e-mail: jac.monteiro@hsm.min-saude.pt

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received January 16, 2013; final manuscript received August 22, 2013; accepted manuscript posted September 6, 2013; published online September 26, 2013. Assoc. Editor: Kenneth Fischer.

J Biomech Eng 135(11), 111005 (Sep 26, 2013) (10 pages) Paper No: BIO-13-1022; doi: 10.1115/1.4025325 History: Received January 16, 2013; Revised August 22, 2013; Accepted September 06, 2013

The reverse shoulder replacement, recommended for the treatment of several shoulder pathologies such as cuff tear arthropathy and fractures in elderly people, changes the biomechanics of the shoulder when compared to the normal anatomy. Although several musculoskeletal models of the upper limb have been presented to study the shoulder joint, only a few of them focus on the biomechanics of the reverse shoulder. This work presents a biomechanical model of the upper limb, including a reverse shoulder prosthesis, to evaluate the impact of the variation of the joint geometry and position on the biomechanical function of the shoulder. The biomechanical model of the reverse shoulder is based on a musculoskeletal model of the upper limb, which is modified to account for the properties of the DELTA® reverse prosthesis. Considering two biomechanical models, which simulate the anatomical and reverse shoulder joints, the changes in muscle lengths, muscle moment arms, and muscle and joint reaction forces are evaluated. The muscle force sharing problem is solved for motions of unloaded abduction in the coronal plane and unloaded anterior flexion in the sagittal plane, acquired using video-imaging, through the minimization of an objective function related to muscle metabolic energy consumption. After the replacement of the shoulder joint, significant changes in the length of the pectoralis major, latissimus dorsi, deltoid, teres major, teres minor, coracobrachialis, and biceps brachii muscles are observed for a reference position considered for the upper limb. The shortening of the teres major and teres minor is the most critical since they become unable to produce active force in this position. Substantial changes of muscle moment arms are also observed, which are consistent with the literature. As expected, there is a significant increase of the deltoid moment arms and more fibers are able to elevate the arm. The solutions to the muscle force sharing problem support the biomechanical advantages attributed to the reverse shoulder design and show an increase in activity from the deltoid, teres minor, and coracobrachialis muscles. The glenohumeral joint reaction forces estimated for the reverse shoulder are up to 15% lower than those in the normal shoulder anatomy. The data presented here complements previous publications, which, all together, allow researchers to build a biomechanical model of the upper limb including a reverse shoulder prosthesis.

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Figures

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Fig. 1

Geometrical description of the upper limb including a reverse shoulder prosthesis

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Fig. 9

Glenohumeral joint reaction forces for models HC and RC for (a) the unloaded abduction in the coronal plane, and (b) the unloaded anterior flexion in the sagittal plane. The compressive and shear components of the reaction forces, acting perpendicular and along the plane of the glenoid, respectively, are represented in the right column. The humeral elevation in the x-axis is described with respect to the thorax.

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Fig. 8

Force estimates for the motion of anterior flexion in the sagittal plane for (a) model HC, and (b) model RC. Since the contributions of the passive elements are negligible in the considered range of motion, only the contributions of the active elements are presented. The numbering of the bundles is performed using the following convention: deltoid scapular, 11 bundles from lateral to medial; deltoid clavicular, four bundles from lateral to medial. The humeral elevation in the x-axis is described with respect to the thorax.

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Fig. 7

Force estimates for the motion of abduction in the coronal plane for (a) model HC, and (b) model RC. Since the contributions of the passive elements are negligible in the considered range of motion, only the contributions of the active elements are presented. The numbering of the bundles is performed using the following convention: serratus anterior, three bundles from caudal to cranial; trapezius scapular, three bundles from cranial to caudal; deltoid scapular, 11 bundles from lateral to medial. The humeral elevation in the x-axis is described with respect to the thorax.

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Fig. 6

Muscle lengths in the anatomical reference position of the upper limb, with the forearm flexed 90 deg, for the anatomical and reverse shoulder models. The numbering of the muscle bundles is performed using the following convention: pectoralis major (PMJ), three bundles from cranial to caudal; latissimus dorsi (LTD), three bundles from cranial to caudal; deltoid (DLT), the first four bundles correspond to the clavicular part, ordered from the most medial to the most lateral fibers, and the last 11 bundles correspond to the scapular part, ordered from the most medial to the most posterior fibers; teres major (TMJ), one bundle; teres minor (TMN), three bundles; coracobrachialis (CRCB), one bundle; biceps brachii (BB), bundles one and two correspond to the long and short head, respectively.

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Fig. 5

Muscle moment arms, throughout the elevation of the arm from 0 deg to 90 deg with respect to the scapula, for the numerically simulated motions of (a) abduction in the scapular plane, (b) abduction in the coronal plane, and (c) anterior flexion in the sagittal plane. As in most studies in the literature, the scapula was considered fixed during the elevation of the arm. Positive moment arms assist the elevation of the arm, whereas negative moment arms oppose it. The numbering of the muscle bundles is performed using the following convention: pectoralis major, three bundles from cranial to caudal; latissimus dorsi, three bundles from cranial to caudal. The first bundle of pectoralis major corresponds to its clavicular portion, while the remaining bundles correspond to its thoracic portion, ordered from cranial to caudal. The bundles of biceps brachii correspond, by order, to the long and short heads, respectively.

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Fig. 4

Deltoid muscle in the native joint geometry: (a) schematic representation, and (b) numerical implementation. The clavicular bundles are represented by black lines, while the scapular bundles are represented by yellow lines. As a whole, the bundles of the deltoid are sequentially ordered from 1 to 15 from anterior to posterior.

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Fig. 3

Mechanical functions, between 0 deg and 90 deg of humeral elevation with respect to the scapula, of the different bundles of the deltoid muscle for the numerically simulated motions of (a) abduction in the scapular plane, (b) abduction in the coronal plane, and (c) anterior flexion in the sagittal plane. As in most studies in the literature, the scapula was considered fixed during the elevation of the arm. Positive moment arms assist the elevation of the arm, whereas negative moment arms oppose it. The first four bundles, from 1 to 4, correspond to the clavicular part of the deltoid, ordered from the most medial to the most lateral fibers, and the last 11 bundles correspond to the scapular part of the deltoid, ordered from the most medial to the most posterior fibers.

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Fig. 2

Mean moment arms, throughout the elevation of the arm from 0 deg to 90 deg with respect to the scapula, for the different bundles of the deltoid muscle for the numerically simulated motions of (a) abduction in the scapular plane, (b) abduction in the coronal plane, and (c) anterior flexion in the sagittal plane. As in most studies in the literature, the scapula was considered fixed during the elevation of the arm. Positive moment arms assist the elevation of the arm, whereas negative moment arms oppose it. The first four bundles, from 1 to 4, correspond to the clavicular part of the deltoid, ordered from the most medial to the most lateral fibers, and the last 11 bundles correspond to the scapular part of the deltoid, ordered from the most medial to the most posterior fibers.

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