In vivo measurement of shoulder joint loads during walking with crutches. 2012

P Westerhoff, and F Graichen, and A Bender, and A Halder, and A Beier, and A Rohlmann, and G Bergmann
Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Germany. peter.westerhoff@charite.de

BACKGROUND Following surgery or injury of the lower limbs, the use of walking aids like crutches can cause high loads on the shoulder joint. These loads have been calculated so far with computer models but with strongly varying results. METHODS Shoulder joint forces and moments were measured during crutch-assisted walking with complete and partial unloading of the lower limbs. Using telemeterized implants in 6 subjects axillary crutches and forearm crutches were compared. A force direction was more in the direction of the long humeral axis, and slightly lower forces were assumed using axillary crutches. Similar force magnitudes as those experienced during previously measured wheelchair weight relief tasks were expected for complete unloading. The friction-induced moment was hypothesized to act mainly around the medio-lateral axis during the swing phase of the body. RESULTS Maximum loads of up 170% of the bodyweight and 0.8% of the bodyweight times meter were measured with large variations among the patients. Higher forces were found in most of the patients using forearm crutches. The hypothesized predominant moment around the medio-lateral axis was only found in some patients. More often, the other two moments had larger magnitudes with the highest values in female patients. The assumed different load direction could only be found during partial unloading. CONCLUSIONS In general the force magnitudes were in the range of activities of daily living. However, the number of repetitions during long-lasting crutch use could lead to shoulder problems as a long-term consequence. The slightly lower forces with axillary crutches could be caused by loads acting directly from the crutch on the scapula, thus bypassing the glenohumeral joint. The higher bending moments in the female patients could be a sign of lacking muscle strength for centring the humeral head on the glenoid.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010003 Osteoarthritis A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. Arthritis, Degenerative,Osteoarthrosis,Osteoarthrosis Deformans,Arthroses,Arthrosis,Arthritides, Degenerative,Degenerative Arthritides,Degenerative Arthritis,Osteoarthritides,Osteoarthroses
D003446 Crutches Wooden or metal staffs designed to aid a person in walking. (UMDNS,1999)
D004867 Equipment Design Methods and patterns of fabricating machines and related hardware. Design, Equipment,Device Design,Medical Device Design,Design, Medical Device,Designs, Medical Device,Device Design, Medical,Device Designs, Medical,Medical Device Designs,Design, Device,Designs, Device,Designs, Equipment,Device Designs,Equipment Designs
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D012785 Shoulder Joint The articulation between the head of the HUMERUS and the glenoid cavity of the SCAPULA. Glenohumeral Joint,Glenoid Labrum,Glenohumeral Joints,Joint, Glenohumeral,Joint, Shoulder,Joints, Glenohumeral,Joints, Shoulder,Labrum, Glenoid,Shoulder Joints
D013314 Stress, Mechanical A purely physical condition which exists within any material because of strain or deformation by external forces or by non-uniform thermal expansion; expressed quantitatively in units of force per unit area. Mechanical Stress,Mechanical Stresses,Stresses, Mechanical

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