Simulation of fatigue-initiated subacromial impingement: clarifying mechanisms

Subacromial impingement in the shoulder precedes many cases of rotator cuff pathology. However, debate exists regarding the mechanism, and even existence, of fatigue-initiated impingement. The controversy centers on two primary impingement mechanisms: 1) superior humeral head migration and 2) scapular reorientation. A linked series of in vivo experiments and in silica simulations accomplishes the integration of stochastic, orthopedic, geometric, kinematic, physiologic, literature-derived, and experimental data sources to help resolve the mechanism debate. A major focus is the multi-scale modeling of relevant variability. The described techniques have direct implications for musculoskeletal modeling and simulation of the shoulder region, with specific application to assessing occupational and activities of daily living in diverse populations.