Carpometacarpal Osteoarthritis: Understanding the Intersection of Muscle Mechanics, Joint Instability, and Pain

腕掌骨关节炎：了解肌肉力学、关节不稳定和疼痛的交叉点

基本信息

批准号：
10597142
负责人：
Jennifer A. Nichols
金额：
$ 44.89万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597142
关键词：
Absenteeism at work Address Adopted Affect Anatomy Area Articular Range of Motion Biomechanics Biometry Clinical Clinical Treatment Clinical Trials Compensation Complex Data Data Set Degenerative Disorder Degenerative polyarthritis Disease Electromyography Electronics Equilibrium Excision Fascicle Future Goals Hand Hand functions Household Individual Intervention Joint Instability Joint repair Joints Kinetics Knowledge Length Ligaments Measurement Measures Mechanics Motor Movement Muscle Muscle Contraction Muscle function Musculoskeletal Musculoskeletal Pain Operative Surgical Procedures Orthopedics Pain Pain Research Patient Self-Report Pattern Play Postoperative Period Quality of life Research Research Methodology Role Sensory Severities Severity of illness Standardization Structure Symptoms Techniques Testing Thumb structure Time Ultrasonography Uninsured Medical Expense Visual Wages analog biomechanical test biopsychosocial bone clinical care cohort design effective therapy exercise intervention experimental study improved in vivo kinematics muscular structure novel pain relief reconstruction simulation soft tissue strength training therapy design ultrasound

项目摘要

PROJECT SUMMARY Individuals with thumb carpometacarpal osteoarthritis (CMC OA) can lose up to 50% of hand function. Unfortunately, current conservative and surgical treatments do not provide the pain relief, strength, and mobility needed to restore both fine and gross motor function. Improvements in clinical treatments are limited by a lack of understanding regarding the complex relationship between thumb biomechanics and musculoskeletal pain. In this proposal, we address this critical knowledge gap by examining the role of thumb muscles in modulating the two primary symptoms of CMC OA: pain and joint instability. Individuals across the full spectrum of disease severity and healthy controls will be studied to evaluate individuals who present with only joint instability, only pain, both, or neither. In Aim 1, to what extent muscle structure changes in the presence of CMC OA and how these changes affect muscle force-generating capacity will be evaluated. Collected data will include fascicle length and cross-section area measured in vivo through ultrasound imaging and thumb muscle operating ranges calculated through musculoskeletal simulations. Completion of this aim will identify changes in muscle structure that mitigate versus aggravate CMC OA symptoms and also establish baseline data describing healthy targets for thumb muscle force-generating parameters. In Aim 2, how thumb muscle activity influences pain will be examined through an experiment that integrates biomechanical techniques (e.g., electromyography) and quantitative pain testing (e.g., movement-evoked pain, quantitative sensory testing). Completion of this aim will enhance our understanding the relationship between muscle activity and pain, thereby elucidating protective versus detrimental compensatory movement strategies adopted by individuals with CMC OA. In Aim 3, how thumb muscle activity influences joint stability will be examined. Collected data will include experimental measurements of muscle activity, thumb kinematics, and thumb kinetics during functional and range of motion tasks as well as biomechanical assessments of joint instability in the presence of active versus passive muscle contraction. Completion of this aim will identify how CMC OA and muscle activity influences CMC joint stability, thereby informing clinical decisions regarding how muscles should (or should not) be considered during CMC OA treatment. Overall, this study will critically advance our mechanistic understanding of how the structure and function of thumb muscles change in the presence of CMC OA. By evaluating muscle mechanics (Aim 1), pain (Aim 2), and joint stability (Aim 3) in individuals with and without CMC OA, we will elucidate the co-evolution of muscle mechanics, symptom severity, and disease severity. This knowledge will inform current and future treatment of CMC OA, thereby improving the quality of life of individuals living with this disease.

项目概要患有拇指腕掌骨关节炎 (CMC OA) 的人可能会丧失高达 50% 的手部功能。不幸的是，目前的保守治疗和手术治疗无法缓解疼痛、增强力量和活动能力需要恢复精细和粗大运动功能。临床治疗的改进因缺乏而受到限制了解拇指生物力学和肌肉骨骼疼痛之间的复杂关系。在在这项提议中，我们通过研究拇指肌肉在调节 CMC OA 的两个主要症状：疼痛和关节不稳定。患有全谱疾病的个体将研究严重程度和健康对照，以评估仅出现关节不稳定的个体，仅疼痛，两者都有，或者两者都没有。在目标 1 中，肌肉结构在 CMC OA 存在下发生多大程度的改变以及如何改变这些变化对肌肉产生力量的能力的影响将被评估。收集的数据将包括分册通过超声成像和拇指肌肉操作范围在体内测量长度和横截面积通过肌肉骨骼模拟计算。完成该目标将识别肌肉结构的变化减轻或加重 CMC OA 症状，并建立描述健康目标的基线数据用于拇指肌肉力生成参数。在目标 2 中，拇指肌肉活动如何影响疼痛将是通过整合生物力学技术（例如肌电图）的实验进行检查定量疼痛测试（例如运动诱发的疼痛、定量感觉测试）。这一目标的完成将增强我们对肌肉活动与疼痛之间关系的理解，从而阐明保护作用与 CMC OA 患者采取的有害代偿性运动策略相比。在目标 3 中，如何将检查拇指肌肉活动对关节稳定性的影响。收集的数据将包括实验数据功能性和运动范围内肌肉活动、拇指运动学和拇指动力学的测量主动与被动肌肉存在下的任务以及关节不稳定性的生物力学评估收缩。完成这一目标将确定 CMC OA 和肌肉活动如何影响 CMC 关节稳定性，从而为 CMC 期间应该（或不应该）如何考虑肌肉的临床决策提供信息骨关节炎治疗。总的来说，这项研究将极大地增进我们对结构和机制如何的机械理解。 CMC OA 时拇指肌肉的功能会发生变化。通过评估肌肉力学（目标 1）、疼痛（目标 2），以及患有和不患有 CMC OA 的个体的关节稳定性（目标 3），我们将阐明肌肉力学、症状严重程度和疾病严重程度。这些知识将为当前和未来提供信息治疗 CMC OA，从而改善患有这种疾病的个体的生活质量。