Biomechanical Effect of Increasing or Decreasing Degrees of Freedom for Surgery of Trapeziometacarpal Joint Arthritis: A Simulation Study
Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, Ohio 44195, USA. Journal of Orthopaedic Research
(Impact Factor: 2.99).
11/2011; 29(11):1675-81. DOI: 10.1002/jor.21453
Osteoarthritis of the trapeziometacarpal (TMC) joint can be treated by arthrodesis and arthroplasty, which potentially decreases or increases the degrees of freedom (DoF) of the joint, respectively. The aim of our study was to bring novel biomechanical insights into these joint surgery procedures by investigating the influence of DoF at the TMC joint on muscle and joint forces in the thumb. A musculoskeletal model of the thumb was developed to equilibrate a 1 N external force in various directions while the thumb assumed key and pulp pinch postures. Muscle and joint forces were computed with an optimization method. In comparison to that of the 2-DoF (intact joint) condition, muscle forces slightly decreased in the 0-DoF (arthrodesis) condition, but drastically increased in the 3-DoF (arthroplasty) condition. TMC joint forces in the 3-DoF condition were 12 times larger than the 2-DoF joint. This study contributes to a further understanding of the biomechanics of the intact and surgically repaired TMC joint and addresses the biomechanical consequences of changing a joint's DoF by surgery.
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ABSTRACT: Contemporary musculoskeletal modelling research is based upon the assumption that such models will evolve into clinical tools that can be used to guide therapeutic interventions. However, there are a number of questions that must be addressed before this becomes a reality. At its heart, musculoskeletal modelling is a process of formulating and then solving the equations of motion that describe the movement of body segments. Both of these steps are challenging. This article argues that traditional approaches to musculoskeletal modelling have been heavily influenced by the need to simplify this process (and in particular the solution process), and that this has to some degree resulted in approaches that are contrary to the principles of classical mechanics. It is suggested that future work is required to understand how these simplifications affect the outputs of musculoskeletal modelling studies. Equally, to increase their clinical relevance, the models of the future should adhere more closely to the classical mechanics on which they are based.
Available from: F. Marin
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ABSTRACT: Musculoskeletal disorders of the hand are mostly due to repeated or awkward manual tasks in the work environment and are considered a public health issue. To prevent their development, it is necessary to understand and investigate the biomechanical behavior of the musculoskeletal system during the movement. In this study a biomechanical analysis of the upper extremity during a cylinder grasping task is conducted by using a parameterized musculoskeletal model of the hand and forearm. The proposed model is composed of 21 segments, 28 musculotendon units, and 20 joints providing 24 degrees of freedom. Boundary conditions of the model are defined by the three-dimensional coordinates of 43 external markersfixed to bony landmarks of the hand and forearm and tracked with an optoelectronic motion capture system. External marker positions fromfive healthy participants were used to test the model. A task consisting of closing and openingfingers around a cylinder 25 mm in diameter was investigated. Based on experimental kinematic data, an inverse dynamics process was performed to calculate output data of the model (joint angles, musculotendon unit shortening and lengthening patterns). Finally, based on an optimization procedure, joint loads and musculotendon forces were computed in a forward dynamics simulation. Results of this study assessed reproducibility and consistency of the biomechanical behavior of the musculoskeletal hand system. Relevance to industry:This musculoskeletal model may be employed to predict internal biomechanical parameters during manual handling in the manufacturing industry. Subsequently workplace or tool design may benefit from this process by decreasing the risk of developing work-related musculoskeletal disorders.
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ABSTRACT: Background One of the surgical treatment options for trapeziometacarpal (TMC) joint arthritis is a prosthetic ball-and-socket replacement. One of the complications in the postoperative setting is de Quervain tendinopathy. Purposes Although this complication has been reported following a resection athroplasty, we questioned whether lengthening of the thumb following the Ivory (Memometal, Stryker Corporate, Kalamazoo, MI, USA) ball-and-socket arthroplasty could be a causal factor. Methods In a prospective study regarding the overall outcome of the Ivory prosthesis, we analyzed 96 cases (83 patients; 69 female, 12 male, 8 bilateral) of primary implanted Ivory prosthesis and the incidence of de Quervain disease during the first year following surgery. We found a particularly high incidence (17%) of de Quervain tendinopathy the first year following this ball-and-socket arthroplasty. We measured the lengthening of the thumb radiographically in the group presenting de Quervain and the asymptomatic group and compared this measure between the two groups. Results We did not find any measurable or statistically significant difference between the groups regarding lengthening. Discussion These findings suggest that lengthening of the thumb following ball-and-socket arthroplasty is not a causal factor in the development of de Quervain tendinopathy within one year after surgery.
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