Scientific articleComputational Sensitivity Analysis to Identify Muscles That Can Mechanically Contribute to Shoulder Deformity Following Brachial Plexus Birth Palsy
Section snippets
Musculoskeletal model
We used a 3-dimensional computer model of the upper limb musculoskeletal system20 to perform a sensitivity analysis to assess the impact of 2 potential deformity mechanisms, strength imbalance and impaired growth, on shoulder biomechanics. The model, implemented for dynamic musculoskeletal simulation in the OpenSim 3.0 software platform (Stanford University, Stanford, CA),21 has been widely used to evaluate both healthy and pathological upper limb function.17, 18, 22, 23, 24, 25, 26
Potential contributors to osseous deformity: strength imbalance mechanism
Through the simulated strength imbalance mechanism, several muscles increased the glenohumeral joint force in the axial plane and were therefore mechanically capable of contributing to osseous deformity (Fig. 2). Muscles that increased the posteriorly directed, compressive glenohumeral joint force included the infraspinatus, subscapularis, long head of biceps, latissimus dorsi, teres major, teres minor, and posterior deltoid. The infraspinatus produced the highest glenohumeral joint force
Discussion
Muscles that can alter shoulder forces may provide a mechanical stimulus for the development of shoulder deformity. In our computational simulations, the posteriorly directed, compressive glenohumeral joint force was increased the most by the infraspinatus, subscapularis, latissimus dorsi, and long head of biceps, which are therefore mechanically capable of contributing to osseous deformity. Likewise, because they reduced shoulder ROM the most, the subscapularis, anterior deltoid, pectoralis
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Influence of Brachial Plexus Birth Injury Location on Glenohumeral Joint Morphology
2021, Journal of Hand SurgeryGlenoid vault and humeral head alignment in relation to the scapular blade axis in young patients with pre-osteoarthritic static posterior subluxation of the humeral head
2021, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Although the development of the scapular body is dependent on the surrounding thoracic shape, muscular imbalances can significantly alter the bony development of the glenoid. Literature studying glenoid changes seen in brachial plexus birth palsy clearly shows the direct association between the severity of the muscular imbalance and the severity of glenoid abnormality, especially excessive glenoid retroversion.2,3,14 Given that the unaffected shoulder undergoes normal growth in patients with brachial plexus birth palsy, the surrounding muscles must be capable of producing forces that contribute to shoulder deformity, and genetic influences do not seem to be the only possible cause.2
Preganglionic and Postganglionic Brachial Plexus Birth Injury Effects on Shoulder Muscle Growth
2021, Journal of Hand SurgeryIntegrated iterative musculoskeletal modeling predicts bone morphology following brachial plexus birth injury (BPBI)
2020, Journal of BiomechanicsCitation Excerpt :Computational analyses predicted that net glenohumeral joint loading was higher in the postganglionic case than preganglionic and as a result there were more severe predicted bone deformations, suggesting that altered mechanical loading could account for observed changes in glenoid morphology after BPBI. Our past simulations (Crouch et al., 2014; Cheng et al., 2015) also revealed that these muscle changes could be drivers of increased postural deformity (i.e., contracture) in postganglionic but not preganglionic BPBI. Thus, taken together, these simulations reveal that mechanical underpinnings of both postural and bone deformity can be linked to altered structure of muscle.
Computational analysis of glenohumeral joint growth and morphology following a brachial plexus birth injury
2019, Journal of Biomechanics
This work was supported by a research grant from the Pediatric Orthopaedic Society of North America and the Orthopaedic Research and Education Foundation.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.