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Science Robotics Jun 2024Repetitive overhead tasks during factory work can cause shoulder injuries resulting in impaired health and productivity loss. Soft wearable upper extremity robots have...
Repetitive overhead tasks during factory work can cause shoulder injuries resulting in impaired health and productivity loss. Soft wearable upper extremity robots have the potential to be effective injury prevention tools with minimal restrictions using soft materials and active controls. We present the design and evaluation of a portable inflatable shoulder wearable robot for assisting industrial workers during shoulder-elevated tasks. The robot is worn like a shirt with integrated textile pneumatic actuators, inertial measurement units, and a portable actuation unit. It can provide up to 6.6 newton-meters of torque to support the shoulder and cycle assistance on and off at six times per minute. From human participant evaluations during simulated industrial tasks, the robot reduced agonist muscle activities (anterior, middle, and posterior deltoids and biceps brachii) by up to 40% with slight changes in joint angles of less than 7% range of motion while not increasing antagonistic muscle activity (latissimus dorsi) in current sample size. Comparison of controller parameters further highlighted that higher assistance magnitude and earlier assistance timing resulted in statistically significant muscle activity reductions. During a task circuit with dynamic transitions among the tasks, the kinematics-based controller of the robot showed robustness to misinflations (96% true negative rate and 91% true positive rate), indicating minimal disturbances to the user when assistance was not required. A preliminary evaluation of a pressure modulation profile also highlighted a trade-off between user perception and hardware demands. Finally, five automotive factory workers used the robot in a pilot manufacturing area and provided feedback.
Topics: Humans; Robotics; Wearable Electronic Devices; Equipment Design; Biomechanical Phenomena; Male; Shoulder; Adult; Range of Motion, Articular; Torque; Muscle, Skeletal; Electromyography; Industry; Shoulder Injuries; Female; Young Adult; Task Performance and Analysis; Shoulder Joint; Exoskeleton Device
PubMed: 38865477
DOI: 10.1126/scirobotics.adi2377 -
Journal of Orthopaedic Research :... Jun 2024Full-thickness rotator cuff tears can lead to poor coaptation of the humeral head to the glenoid, disrupting muscle forces required for glenohumeral joint stability,...
Full-thickness rotator cuff tears can lead to poor coaptation of the humeral head to the glenoid, disrupting muscle forces required for glenohumeral joint stability, ultimately leading to joint subluxation. The aim of this study was to evaluate muscle forces and glenohumeral joint translations during elevation in the presence of isolated and combined full-thickness rotator cuff tears. Eight fresh-frozen upper limbs were mounted to a computer-controlled testing apparatus that simulated joint motion by simulated muscle force application. Scapular-plane abduction was performed, and glenohumeral joint translations were measured using an optoelectronic system. Testing was performed in the native shoulder, a following an isolated tear to the supraspinatus, as well as combined tears involving the supraspinatus and subscapularis, as well as supraspinatus, infraspinatus, and teres minor. Rotator cuff tears significantly increased middle deltoid force at 30°, 60°, and 90° of abduction relative to that in the native shoulder (p < 0.05). Significantly greater superior translations were observed relative to the intact shoulder due to combined tears to the supraspinatus and infraspinatus at 30° of abduction (mean increase: 1.6 mm, p = 0.020) and 60° of abduction (mean increase: 4.8 mm, p = 0.040). This study illustrates the infraspinatus-teres minor complex as a major humeral head depressor and contributor to glenohumeral joint stability. An increase in deltoid force during abduction occurs in the presence of rotator cuff tears, which exacerbates superior migration of the humeral head. The findings may help in the development of clinical tests in rotator cuff tear diagnostics, in surgical planning of rotator cuff repair, and in planning of targeted rehabilitation.
PubMed: 38864683
DOI: 10.1002/jor.25909 -
Surgical and Radiologic Anatomy : SRA Jun 2024This study shows the danger zone and the safety corridor in the lateral approach with bridge plating by measuring the distance between the lateral side of the plate...
PURPOSE
This study shows the danger zone and the safety corridor in the lateral approach with bridge plating by measuring the distance between the lateral side of the plate positioned on the lateral aspect of the humerus and the radial nerve after it pierces the lateral intermuscular septum, in the different forearm positions.
METHODS
Forty arms of 20 human cadavers were used, the radial nerve was identified and marked on the lateral surface the radial nerve at the exit of the lateral intermuscular septum and anteriorisation of the nerve in relation to the humeral shaft and the lateral epicondyle was also marked. The distances were measured with a digital caliper. A submuscular extraperiosteal corridor was created, proximally between the biceps brachialis and deltoid muscle and distally between the triceps and brachioradialis muscle, followed by the positioning of the low contact large fragments contoured plate with 14 combined holes (fixed and cortical angle), inserted from distal to proximal. Measurements were performed in four positions (elbow flexion with forearm pronation, elbow flexion with forearm supination, elbow extension with forearm pronation and elbow extension with forearm supination).
RESULTS
Significant statistical differences occurred with the different positions, and the elbow flexion with forearm supination was shown to be the position that provides the safest submuscular extraperiosteal corridor in a lateral approach of the humerus.
CONCLUSION
The danger zone of radial nerve is an area that extends from 15 cm to 5 cm proximal to the lateral epicondyle and the safest way to create a submuscular and extraperiosteal corridor in the lateral region of the humerus is with the elbow in flexion and the forearm in supination.
PubMed: 38858314
DOI: 10.1007/s00276-024-03405-x -
Journal of Safety Research Jun 2024Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in...
BACKGROUND
Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries.
METHODS
A commercial passive arm-support exoskeleton was used. One surgical nurse, one attending surgeon, and five surgical trainees participated. Twenty-seven surgeries were completed, 12 with and 15 without the exoskeleton. Upper-body postures and muscle activation levels were measured during the surgeries using inertial measurement units and electromyography sensors, respectively. Postures, muscle activation levels, and self-report metrics were compared between the baseline and exoskeleton conditions using non-parametric tests.
RESULTS
Using the exoskeleton significantly decreased the percentage of time in demanding postures (>45° shoulder elevation) for the right shoulder by 7% and decreased peak muscle activation of the left trapezius, right deltoid, and right lumbar erector spinae muscles, by 7%, 8%, and 12%, respectively. No differences were found in perceived effort, and overall scores on usability ranged from "OK" to "excellent."
CONCLUSIONS
Arm-support exoskeletons have the potential to assist OR team members in reducing musculoskeletal pain and fatigue indicators. To further increase usability in the OR, however, better methods are needed to identify the surgical tasks for which an exoskeleton is effective.
Topics: Humans; Exoskeleton Device; Male; Female; Adult; Posture; Electromyography; Ergonomics; Patient Care Team; Operating Rooms; Arm
PubMed: 38858056
DOI: 10.1016/j.jsr.2024.02.003 -
European Journal of Applied Physiology Jun 2024Peripheral responses might be important in handcycling, given the involvement of small muscles compared to other exercise modalities. Therefore, the goal of this...
PURPOSE
Peripheral responses might be important in handcycling, given the involvement of small muscles compared to other exercise modalities. Therefore, the goal of this study was to compare changes in muscle oxygen saturation (∆SmO) and deoxyhemoglobin level (∆[HHb]) between different efforts and muscles.
METHODS
Handcyclists participated in a Wingate, a maximal incremental test and a 20-min time-trial (TT). Oxygen uptake (VO) as well as ∆SmO, ∆[HHb], deoxygenation and reoxygenation rates in the triceps brachii (TB), biceps brachii (BB), anterior deltoid (AD) and extensor carpi radialis brevis (ER) were measured.
RESULTS
ER ∆[HHb]max was 37% greater in the incremental test than in the Wingate (ES = 0.392, P = 0.031). TT mean power (W/kg) was associated with BB ∆SmOmin measured in the incremental test (r = -0.998 [-1.190, -0.806], P = 0.002) and in the Wingate (r = -0.994 [-1.327, -0.661], P = 0.006). MAP (W/kg) was associated with Wingate BB ∆SmOmin (r = -0.983 [-0.999, -0.839], P = 0.003), and Wingate peak (r = 0.649 [0.379, 0.895], P = 0.008) and mean power (W/kg) (r = 0.925 [0.752, 0.972], P = 0.003) was associated with right handgrip force. The strongest physiological predictor for TT performance was BB ∆SmOmin in the incremental test (P = 0.002, r= 0.993, SEE 0.016 W/kg), Wingate BB ∆SmOmin for MAP (P = 0.003, r= 0.956, SEE 0.058 W/kg) and right handgrip force for Wingate peak power (P = 0.005, r= 0.856, SEE 0.551 W/kg).
CONCLUSION
Peripheral aerobic responses (muscle oxygenation) were predictive of handcycling performance.
PubMed: 38856729
DOI: 10.1007/s00421-024-05524-0 -
Physiology & Behavior Jun 2024Muscle testing is an integral component in assessing musculoskeletal function and tailoring rehabilitation efforts. This study aimed i. to identify an objective... (Review)
Review
Muscle testing is an integral component in assessing musculoskeletal function and tailoring rehabilitation efforts. This study aimed i. to identify an objective evaluation system sensitive to analyze changes in different muscular conditions in different neuromuscular tests across a spectrum of professional experience levels; and ii. to analyze differences in objective parameters and clinical judgment between participants of different levels of expertise in different muscular conditions in different neuromuscular tests. Participants included 60 subjects with Level I to III expertise who performed blinded neuromuscular tests on the middle deltoid and rectus femoris muscles of 40 volunteer subjects. The methodology centered on standardizing test protocols to minimize variability, employing EMG to quantify muscle activity, thermography to capture thermographic muscular response, and digital dynamometry to measure muscular resistance. The findings revealed that while traditional methods like thermography and electromyography provide valuable insights, digital dynamometry stands out for its sensitivity in detecting muscle condition changes in neuromuscular test. Moreover, the data underscored the pivotal role of advanced training and expertise in enhancing the precision and accuracy of neuromuscular diagnostics, since there were significant differences in objective parameters and clinical judgment between participants of different levels of expertise in the different muscular conditions in Middle deltoid and Rectus femoris neuromuscular tests analyzed, presenting higher expertise participant clinical judgment like objective validated instrument.
PubMed: 38851442
DOI: 10.1016/j.physbeh.2024.114602 -
Journal of Orthopaedic Surgery and... Jun 2024Arthroscopic tuberoplasty is an optional technique for managing irreparable rotator cuff tears. However, there is a lack of studies investigating the resistance force...
BACKGROUND
Arthroscopic tuberoplasty is an optional technique for managing irreparable rotator cuff tears. However, there is a lack of studies investigating the resistance force during shoulder abduction in cases of irreparable rotator cuff tears and tuberoplasty.
HYPOTHESES
In shoulders with irreparable rotator cuff tears, impingement between the greater tuberosity (GT) and acromion increases the resistance force during dynamic shoulder abduction. Tuberoplasty is hypothesized to reduce this resistance force by mitigating impingement.
STUDY DESIGN
Controlled laboratory study.
METHODS
Eight cadaveric shoulders, with a mean age of 67.75 years (range, 63-72 years), were utilized. The testing sequence included intact rotator cuff condition, irreparable rotator cuff tears (IRCTs), burnishing tuberoplasty, and prosthesis tuberoplasty. Burnishing tuberoplasty refers to the process wherein osteophytes on the GT are removed using a bur, and the GT is subsequently trimmed to create a rounded surface that maintains continuity with the humeral head. Deltoid forces and actuator distances were recorded. The relationship between deltoid forces and actuator distance was graphically represented in an ascending curve. Data were collected at five points within each motion cycle, corresponding to actuator distances of 20 mm, 30 mm, 40 mm, 50 mm, and 60 mm.
RESULTS
In the intact rotator cuff condition, resistance forces at the five points were 34.25 ± 7.73 N, 53.75 ± 7.44 N, 82.50 ± 14.88 N, 136.25 ± 30.21 N, and 203.75 ± 30.68 N. In the IRCT testing cycle, resistance forces were 46.13 ± 7.72 N, 63.75 ± 10.61 N, 101.25 ± 9.91 N, 152.5 ± 21.21 N, and 231.25 ± 40.16 N. Burnishing tuberoplasty resulted in resistance forces of 32.25 ± 3.54 N, 51.25 ± 3.54 N, 75.00 ± 10.69 N, 115.00 ± 10.69 N, and 183.75 ± 25.04 N. Prosthesis tuberoplasty showed resistance forces of 29.88 ± 1.55 N, 49.88 ± 1.36 N, 73.75 ± 7.44 N, 112.50 ± 7.07 N, and 182.50 ± 19.09 N. Both forms of tuberoplasty significantly reduced resistance force compared to IRCTs. Prosthesis tuberoplasty further decreased resistance force due to a smooth surface, although the difference was not significant compared to burnishing tuberoplasty.
CONCLUSION
Tuberoplasty effectively reduces resistance force during dynamic shoulder abduction in irreparable rotator cuff tears. Prosthesis tuberoplasty does not offer a significant advantage over burnishing tuberoplasty in reducing resistance force.
CLINICAL RELEVANCE
Tuberoplasty has the potential to decrease impingement, subsequently reducing resistance force during dynamic shoulder abduction, which may be beneficial in addressing conditions like pseudoparalysis.
Topics: Humans; Rotator Cuff Injuries; Middle Aged; Aged; Biomechanical Phenomena; Cadaver; Male; Female; Shoulder Joint; Rotator Cuff; Arthroscopy; Range of Motion, Articular; Shoulder Impingement Syndrome
PubMed: 38849918
DOI: 10.1186/s13018-024-04740-w -
Journal of Science and Medicine in Sport Jun 2024
Reply to the Letter to the Editor concerning "Posterior deltoid shoulder tightness and greater contralateral lower limb muscle strength are associated with swimmers' shoulder pain".
Topics: Humans; Shoulder Pain; Muscle Strength; Swimming; Lower Extremity; Deltoid Muscle
PubMed: 38849161
DOI: 10.1016/j.jsams.2024.04.010 -
Journal of Science and Medicine in Sport Jun 2024
Topics: Humans; Swimming; Muscle Strength; Lower Extremity; Deltoid Muscle; Male; Shoulder; Female
PubMed: 38849160
DOI: 10.1016/j.jsams.2024.03.014 -
EJNMMI Reports Jun 2024During a phase 0 clinical trial of an investigational programmed cell death ligand-1 (PD-L1) PET tracer in patients with non-small cell lung cancer (NSCLC), three...
BACKGROUND
During a phase 0 clinical trial of an investigational programmed cell death ligand-1 (PD-L1) PET tracer in patients with non-small cell lung cancer (NSCLC), three patients received booster doses of COVID-19 vaccines before PD-L1 imaging.
METHODS
Five patients underwent whole-body PET/CT imaging with a novel PD-L1 tracer, constructed by attaching Zr to the anti PD-L1 antibody durvalumab. Intramuscular (deltoid) booster doses of mRNA BNT162b2 COVID-19 mRNA vaccine were coincidentally given to three patients in the month before PD-L1 tracer injection.
RESULTS
Two recently-vaccinated patients, in remission of NSCLC and receiving non-immunosuppressive cancer therapies (immunotherapy and tyrosine kinase inhibitor respectively), showed increasing PD-L1 tracer uptake in ipsilateral axillary lymph nodes. No asymmetric nodal uptake was seen in a third recently-vaccinated patient who was receiving immunosuppressive chemotherapy, or in two patients not recently-vaccinated.
CONCLUSION
Immune response to mRNA BNT162b2 vaccination may involve regulation by PD-L1 positive immune cells in local draining lymph nodes in immunocompetent patients.
TRIAL REGISTRATION
This trial was registered with the Australian New Zealand Clinical Trials Registry. Registration number ACTRN12621000171819. Date of Trial Registration 8/2/2021. Date of enrolment of 1st patient 11/4/2021. URL of trial registry record: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12621000171819 .
PubMed: 38844699
DOI: 10.1186/s41824-024-00196-7