Amélioration de la géométrie des modèles musculosquelettiques de l'épaule

Understanding and treating musculoskeletal disorders of the shoulder requires additional knowledge of the contribution and function of each muscle of the glenohumeral joint. The analysis of muscle and joint forces is an important step in understanding injury mechanisms and pathologies. These muscle forces can be estimated non-invasively using musculoskeletal models. The challenge is to physiologically predict muscle trajectories and moment arms to ensure consistency of muscle forces in musculoskeletal models. The aim of this thesis was to improve muscle geometry in musculoskeletal models of the shoulder by testing several different techniques for implementing muscle trajectories. Our specific objectives were to: (1) improve muscle geometry of rigid multibody models by using transverse constraints; (2) assess the reliability of a finite element model for estimating moment arms and (3) evaluate the sensitivity of moment arm predictions to uncertainties in muscle insertion areas; (4) create a database of 3D moment arms for movements with high ranges of motion; (5) experimentally quantify muscles’ architectural changes between resting state and different levels of isometric contractions. (1) Two rigid multibody models of the rotator cuff were developed: a classic model representing muscles with lines of action in 1D and a 2D model with transverse constraints between lines of action of a single muscle. The 2D model (with transverse constraints) gives a more physiological representation of muscle trajectories and moment arms than the classical 1D model. However, for arm movements beyond 90° of elevation, when the origin and insertion points get closer, moment arms and muscle lengths are misestimated due to the mode’s inability to account for muscle volume deformations. (2) A finite element model of the glenohumeral joint was developed based on medical imaging. Moment arms were computed and compared to the literature and MRI data. Our finite element model produces moment arms consistent with the literature and MRI data. Unlike rigid multibody models, our finite element model accounts for the fact that one muscle can have several actions depending on the position of its line of action relative to the centre of rotation of the joint. (3) The model was used to study moment arm sensitivity: insertion areas of rotator cuff muscles and the deltoid were moved, and associated moment arms have been computed. Results showed that a 10 mm variation in insertion points on the humeral head could cause a muscle to change function (for example performing adduction rather than abduction). (4) The 3D moment arms were assessed on four post-mortem human surrogates during movements with high ranges of motion. Results of the study gave us a better understanding of muscle functions during different movements. The main findings of the study were that the anterior deltoid was the largest flexor and had an adduction component, the median deltoid was a strong abductor, and the posterior deltoid acted in extension. Unlike the deltoid, the infraspinatus and teres minor were the largest external rotators of the shoulder. (5) Experimental measurements were performed on 14 subjects in order to quantify changes in muscle geometry and pennation angles associated with different levels of contraction for the biceps, triceps and deltoid. Pennation angles were measured on subjects using a portable ultrasound system. External muscle deformations were measured with an iPad equipped with a structure sensor. Changes in muscle architecture for the biceps, triceps and deltoid during isometric contractions occurred mostly between 0 and 25% of maximal voluntary contraction (no significant difference was observed between 25 and 50%). Changes were higher for the biceps than other muscles. This thesis evaluated different approaches to model muscle geometry: the approach leading to the most physiological result was the finite element model due to modeling of the interactions between structure and muscle deformations. Additionally, we demonstrated the importance of rigorously estimating input parameters (muscle insertion areas) and of properly evaluating the bio-fidelity of the models developed before using them in clinical contexts. New data was acquired regarding muscle deformations and pennation angles to evaluate models integrating muscle activation.

Keyphrases: Shoulder, 3D moment arms, Rigid multibody model, Finite element model, Evaluation of musculoskeletal models, Model sensitivity, Muscle deformation