SlideShare una empresa de Scribd logo
1 de 13
Descargar para leer sin conexión
10/10/13

Physiological and Mechanical Adaptations of Muscle
to Tendon Rupture
Samuel R. Ward, PT, PhD
Associate Professor
Muscle Physiology Lab
Departments of Radiology, Orthopaedic Surgery, and Bioengineering
University of California San Diego
VA Medical Center San Diego

MuscleTech Network, Barcelona, Oct 15, 2013

Background
•  Cuff injuries effect ~30% of people over 60 1
•  20-50% of repairs will fail 2
•  Chronic tears
–  Muscle retraction, fatty atrophy and fibrosis 3
–  Nerve injury 4
–  Difficult to repair 5
–  High re-tear rates 2
–  Insensitive to rehabilitation 6

Healthy

1

Lehman et al, Bull Hosp Jt Dis, 1995
Harryman et al, JBJS 1991
Gerber et al, JBJS, 2004
4 Costouros et al, Arthroscopy, 2007
5 Peterson, et al JSES 2011
6 Gerber et al, JBJS, 2000
2
3

Severe Tear

1
10/10/13

Skeletal Muscle Hierarchy

Lieber, Skeletal Muscle Structure and Function, 2010

Muscle Force

Structure-Function Relationships

Muscle Length

Winters et al, J Biomech, 2012
Powell et al, J Appl Physiol, 1984
Bodine et al, J Neurophysiol , 1982

2
10/10/13

Normal Architecture

Ward, et al Clin Orthop, 2006

30.0

PCSA (cm2)

25.0

Deltoid
Subscapularis

20.0
15.0

Infraspinatus

10.0

Supraspinatus

5.0

teres minor

0.0
0.0

2.0

4.0
6.0
8.0
Fiber Length (cm)

10.0

12.0

Ward, et al Clin Orthop 2006
Altobelli, et al, Submitted J Biomech 2013

3
10/10/13

Pathology

Normal

Tear
47.72 mm

30.47mm

Anterior
Biceps tendon
SS tendon attached to Infraspinatus
and anterior capsule

Muscle Area Changes with Tear and Age (Human)

Barry et al, JSES 2012	


4
10/10/13

Muscle Structural Changes After Tear (Sheep)

Fat

Muscle

Gerber C, et al JBJS 2004

Muscle Fiber Length Changes After Tear (Human)

80

No Tear

Tear

Fiber Length (mm)

70
60
50
40
30
20
10
0
1

Tomioka et al, JSES 2009	


5
10/10/13

Architectural Adaptations to Tear and Nerve Injury

Relative Muscle Tension"

Sato, et al, In Submission JBJS

100"
80"
60"
40"
20"
0"
0.5"

1.0"

1.5"

2.0"

2.5"

3.0"

3.5"

4.0"

Sarcomere Length (µm) "

6
10/10/13

Whole Supraspinatus Muscle Stiffness

Gerber et al, JSES, 1998- Human	

Safran, et al, JBJS 2005- Dog	

Gerber et al, JBJS 2004- Sheep	

	

	


Human Passive Mechanics

Injured Cuff Elastic Modulus (kPa)

700
600
500

Supraspinatus
Infraspinatus

Control	


*

400
300
200
100
0

Single Fiber

Fiber Bundle

Silldorff, Submitted JBJS

7
10/10/13

Tissue Adaptations to Tear and Nerve Injury (rat)

Sato, et al, In Submission JBJS

Structural Change- Summary

Muscle Force

Healthy

Tear

Muscle Length

8
10/10/13

Rabbit Lower Extremity Tenotomy
C:
TA
T:
TA
10 mm

C:
ED
L
T:
EDL
10 mm

C:
EDI
I
T:
EDI
I

10 mm

Active & Passive Mechanics
In Vivo Mechanical Testing

Tenotomy

&

Length-Tension Curve

Muscle Architecture

Fiber Area

Muscle Tension

Control

100 µm

Muscle Length

9
10/10/13

Tenotomy Alters LT Relationship
Stress After Repair
Normalized Fiber Length [mm]

40
300

Control
Tenotomy

Control
Tenotomy

*
*

250
30

200

*
*

20
150

TA

*
*

100
10

50
0
0

TA
TA

EDL
EDL

EDII
EDII

EDL

EDII

* = p < 0.05

4000

250

*

Control
Tenotomy

6000

*

*

TA

200

Stress [kPa]

Passive Stiffness [kPa]

Tentomy Alters Passive Stiffness

2000

150
100
50

0

Control
Tenotomy

0

TA
250

EDL

0

EDII

EDL

40

Fiber Length [mm]

60

80

EDII

250

200

20

Stress [kPa]

Stress [kPa]

200

150
100
50

Control
Tenotomy

0
0

5

10

15

20

Fiber Length [mm]

25

30

150
100
50

Control
Tenotomy

0
0

5

10

Fiber Length [mm]

15

20

10
10/10/13

ECM Remodeling
Control

Tenotomy

TA

50 µm

EDL

Winters, et al, In Progress

50 µm

50 µm

50 µm

EDII

50 µm

50 µm

New Histology Methods
H&E

Wheat Germ Agglutinin Picro-sirius Red

KI67

αSMA

Trichrome

Reticulin

pCEβ

Winters, Buck et al, In Progress

11
10/10/13

Human Muscle Gene Expression

Choo, McCarthy et al, In Progress JBJS

Summary
•  Structural Changes
–  Radial and longitudinal atrophy

•  Physiological Changes
–  After chronic tears, function does not follow structure
–  Evidence for ECM changes leading to muscle stiffness

•  Rehabilitation
–  Massive tears in the shoulder don’t appear to recover

12
10/10/13

Faculty
Doug Chang, MD- UCSD
Adam Engler, PhD- UCSD
Don Fithian, MD – Kaiser
Larry Frank, PhD- UCSD
Jan Fridén, MD- Göteborg, Sweden
Christian Gerber, MD- Balgrist, Switzerland
Eric Hentzen, MD, PhD- UCSD
John Lane, MD- Coast Surgery Center
Rick Lieber, PhD- UCSD
Hiro Okuno, MDJoseph Sarver, PhD- Penn
Simon Schenk, PhD- UCSD
Lou Soslowsky, PhD- Penn
Andrea Taylor, PhD- Duke
Steve Thomopoulos, PhD- Wash U

Students
Grant Altobelli, MD – Tufts
Geoff Abrams, MD- Stanford
Alex Choo, MD- UCSD
Carolyn Eng, BS- Harvard
Ki Lee, MD- Yonsei
Meagan McCarthy, MD- UCSD
Randy McKnight- UCSD
Morgan Silldorff, MD- UCSD
Gretchen Meyer, PhD- UCSD
Eugene Sato, BS- UCSD
Ana Rodriguez-Soto, BS- UCSD

13

Más contenido relacionado

La actualidad más candente

Biomechanical properties of Anterolateral ligament of the knee compared with...
Biomechanical properties of  Anterolateral ligament of the knee compared with...Biomechanical properties of  Anterolateral ligament of the knee compared with...
Biomechanical properties of Anterolateral ligament of the knee compared with...KHALIFA ELMAJRI
 
Three Techniques, One System: How to Effectively Characterize Complete Muscle...
Three Techniques, One System: How to Effectively Characterize Complete Muscle...Three Techniques, One System: How to Effectively Characterize Complete Muscle...
Three Techniques, One System: How to Effectively Characterize Complete Muscle...InsideScientific
 
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...Christopher Connelly, CSCS, EP-C
 
Fuzzy knee proprioception would be of benefit
Fuzzy knee proprioception would be of benefitFuzzy knee proprioception would be of benefit
Fuzzy knee proprioception would be of benefitKHALIFA ELMAJRI
 
Performance of a Novel Knee Implant to Treat Osteoarthritis Without Violatin...
Performance of a  Novel Knee Implant to Treat Osteoarthritis Without Violatin...Performance of a  Novel Knee Implant to Treat Osteoarthritis Without Violatin...
Performance of a Novel Knee Implant to Treat Osteoarthritis Without Violatin...Rajshree Hillstrom, PhD MBA
 
BiomechanicsPoster to Print
BiomechanicsPoster to PrintBiomechanicsPoster to Print
BiomechanicsPoster to PrintJamie Cozens
 
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...InsideScientific
 
Physical Activity, Exercise and Ageing
Physical Activity, Exercise and AgeingPhysical Activity, Exercise and Ageing
Physical Activity, Exercise and Ageingmtrenell
 
An emg driven-musculoskeletal_model_to_e
An emg driven-musculoskeletal_model_to_eAn emg driven-musculoskeletal_model_to_e
An emg driven-musculoskeletal_model_to_esami bennour
 
01907-bonejointscience-suturefix
01907-bonejointscience-suturefix01907-bonejointscience-suturefix
01907-bonejointscience-suturefixBrett McKenzie
 
Pediatric injury biomechanics
Pediatric injury biomechanics Pediatric injury biomechanics
Pediatric injury biomechanics Julio Duart
 
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...CrimsonPublishers-SBB
 
Crimson Publishers-Stem Cell Therapy in Osteoarthritis
Crimson Publishers-Stem Cell Therapy in OsteoarthritisCrimson Publishers-Stem Cell Therapy in Osteoarthritis
Crimson Publishers-Stem Cell Therapy in OsteoarthritisCrimsonPublishersOPROJ
 
Knee Replacement - Desun Hospital Health Insight
Knee Replacement - Desun Hospital Health InsightKnee Replacement - Desun Hospital Health Insight
Knee Replacement - Desun Hospital Health InsightDESUN Hospital
 
BMES 2015_Poster_Revised
BMES 2015_Poster_RevisedBMES 2015_Poster_Revised
BMES 2015_Poster_RevisedAnil Oberoi
 
CBI Poster_Carissa Miyano- workloop-ALH edits (2)
CBI Poster_Carissa Miyano- workloop-ALH edits (2)CBI Poster_Carissa Miyano- workloop-ALH edits (2)
CBI Poster_Carissa Miyano- workloop-ALH edits (2)Carissa Miyano
 

La actualidad más candente (20)

Biomechanical properties of Anterolateral ligament of the knee compared with...
Biomechanical properties of  Anterolateral ligament of the knee compared with...Biomechanical properties of  Anterolateral ligament of the knee compared with...
Biomechanical properties of Anterolateral ligament of the knee compared with...
 
Three Techniques, One System: How to Effectively Characterize Complete Muscle...
Three Techniques, One System: How to Effectively Characterize Complete Muscle...Three Techniques, One System: How to Effectively Characterize Complete Muscle...
Three Techniques, One System: How to Effectively Characterize Complete Muscle...
 
Bme bone poster
Bme bone posterBme bone poster
Bme bone poster
 
Dawo_Sallu_RP
Dawo_Sallu_RPDawo_Sallu_RP
Dawo_Sallu_RP
 
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...
Comparative Analysis of Hip Muscle Activation During Common Closed-Chain Reha...
 
Fuzzy knee proprioception would be of benefit
Fuzzy knee proprioception would be of benefitFuzzy knee proprioception would be of benefit
Fuzzy knee proprioception would be of benefit
 
Performance of a Novel Knee Implant to Treat Osteoarthritis Without Violatin...
Performance of a  Novel Knee Implant to Treat Osteoarthritis Without Violatin...Performance of a  Novel Knee Implant to Treat Osteoarthritis Without Violatin...
Performance of a Novel Knee Implant to Treat Osteoarthritis Without Violatin...
 
BiomechanicsPoster to Print
BiomechanicsPoster to PrintBiomechanicsPoster to Print
BiomechanicsPoster to Print
 
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...
Beyond Isometric Twitch: Utilizing lengthening, shortening and isotonic contr...
 
Dissertation
DissertationDissertation
Dissertation
 
The Efficacy of Exercise on Arthritis
The Efficacy of Exercise on ArthritisThe Efficacy of Exercise on Arthritis
The Efficacy of Exercise on Arthritis
 
Physical Activity, Exercise and Ageing
Physical Activity, Exercise and AgeingPhysical Activity, Exercise and Ageing
Physical Activity, Exercise and Ageing
 
An emg driven-musculoskeletal_model_to_e
An emg driven-musculoskeletal_model_to_eAn emg driven-musculoskeletal_model_to_e
An emg driven-musculoskeletal_model_to_e
 
01907-bonejointscience-suturefix
01907-bonejointscience-suturefix01907-bonejointscience-suturefix
01907-bonejointscience-suturefix
 
Pediatric injury biomechanics
Pediatric injury biomechanics Pediatric injury biomechanics
Pediatric injury biomechanics
 
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...
Crimson Publishers- The Effect of Medial Hamstring Weakness on Soft Tissue Lo...
 
Crimson Publishers-Stem Cell Therapy in Osteoarthritis
Crimson Publishers-Stem Cell Therapy in OsteoarthritisCrimson Publishers-Stem Cell Therapy in Osteoarthritis
Crimson Publishers-Stem Cell Therapy in Osteoarthritis
 
Knee Replacement - Desun Hospital Health Insight
Knee Replacement - Desun Hospital Health InsightKnee Replacement - Desun Hospital Health Insight
Knee Replacement - Desun Hospital Health Insight
 
BMES 2015_Poster_Revised
BMES 2015_Poster_RevisedBMES 2015_Poster_Revised
BMES 2015_Poster_Revised
 
CBI Poster_Carissa Miyano- workloop-ALH edits (2)
CBI Poster_Carissa Miyano- workloop-ALH edits (2)CBI Poster_Carissa Miyano- workloop-ALH edits (2)
CBI Poster_Carissa Miyano- workloop-ALH edits (2)
 

Destacado

Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...
Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...
Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...MuscleTech Network
 
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...MuscleTech Network
 
Michael Harbo. Clinical Expert in Sports Physiotherapy.
Michael Harbo. Clinical Expert in Sports Physiotherapy.Michael Harbo. Clinical Expert in Sports Physiotherapy.
Michael Harbo. Clinical Expert in Sports Physiotherapy.MuscleTech Network
 
Miguel Khoury. M.D. University of Buenos Aires.
Miguel Khoury. M.D. University of Buenos Aires.	Miguel Khoury. M.D. University of Buenos Aires.
Miguel Khoury. M.D. University of Buenos Aires. MuscleTech Network
 
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...MuscleTech Network
 
Henning Langberg. Professor at the Institute of Health University of Copenhag...
Henning Langberg. Professor at the Institute of Health University of Copenhag...Henning Langberg. Professor at the Institute of Health University of Copenhag...
Henning Langberg. Professor at the Institute of Health University of Copenhag...MuscleTech Network
 
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...MuscleTech Network
 
Henning Langberg: Professor at the Institute of Health University of Copenhag...
Henning Langberg: Professor at the Institute of Health University of Copenhag...Henning Langberg: Professor at the Institute of Health University of Copenhag...
Henning Langberg: Professor at the Institute of Health University of Copenhag...MuscleTech Network
 
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...MuscleTech Network
 
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...MuscleTech Network
 
Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.MuscleTech Network
 
Hamstring strain pp
Hamstring strain ppHamstring strain pp
Hamstring strain ppDion Obst
 

Destacado (16)

Daniel Medina
Daniel MedinaDaniel Medina
Daniel Medina
 
Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...
Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...
Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surger...
 
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...
Ricard Pruna. Senior Researcher and Sports Medicine Specialist at the Medical...
 
Richard L. Lieber
Richard L. LieberRichard L. Lieber
Richard L. Lieber
 
Michael Harbo. Clinical Expert in Sports Physiotherapy.
Michael Harbo. Clinical Expert in Sports Physiotherapy.Michael Harbo. Clinical Expert in Sports Physiotherapy.
Michael Harbo. Clinical Expert in Sports Physiotherapy.
 
Xavier Yanguas
Xavier YanguasXavier Yanguas
Xavier Yanguas
 
Roald Bahr
Roald BahrRoald Bahr
Roald Bahr
 
Miguel Khoury. M.D. University of Buenos Aires.
Miguel Khoury. M.D. University of Buenos Aires.	Miguel Khoury. M.D. University of Buenos Aires.
Miguel Khoury. M.D. University of Buenos Aires.
 
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...
Ramon Balius. Senior Researcher and Sports Medicine Specialist at the Sport C...
 
Henning Langberg. Professor at the Institute of Health University of Copenhag...
Henning Langberg. Professor at the Institute of Health University of Copenhag...Henning Langberg. Professor at the Institute of Health University of Copenhag...
Henning Langberg. Professor at the Institute of Health University of Copenhag...
 
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...
Lluis Til. Sports Medicine & Orthopedics - FCBarcelona; Olympic Training Cent...
 
Henning Langberg: Professor at the Institute of Health University of Copenhag...
Henning Langberg: Professor at the Institute of Health University of Copenhag...Henning Langberg: Professor at the Institute of Health University of Copenhag...
Henning Langberg: Professor at the Institute of Health University of Copenhag...
 
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...
Peter Mallarias. Research Fellow, LaTrobe University and Queen Mary, Universi...
 
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...
Dylan Morrissey. Senior Clinical Lecturer and Consultant Physiotherapist Cent...
 
Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.
 
Hamstring strain pp
Hamstring strain ppHamstring strain pp
Hamstring strain pp
 

Similar a Samuel R. Ward: Associate professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego.

Bryan Heiderscheit - MRI findings
Bryan Heiderscheit - MRI findingsBryan Heiderscheit - MRI findings
Bryan Heiderscheit - MRI findingsMuscleTech Network
 
199192 - LGB556 - Strength And Conditioning Programme
199192 - LGB556 - Strength And Conditioning Programme199192 - LGB556 - Strength And Conditioning Programme
199192 - LGB556 - Strength And Conditioning ProgrammeMatt St Clair
 
NSCA National Conference (2013) Podium Presentation
NSCA National Conference (2013) Podium PresentationNSCA National Conference (2013) Podium Presentation
NSCA National Conference (2013) Podium Presentationcoachademia
 
5. faizan biomechanics of bone.pptx
5. faizan biomechanics of bone.pptx5. faizan biomechanics of bone.pptx
5. faizan biomechanics of bone.pptxSalmaAzeem3
 
Muscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryMuscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryYumnah Babar
 
Muscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryMuscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryYumnah Babar
 
Anthony Shield - is nmi a risk factor for hamstring strain injury
Anthony Shield - is nmi a risk factor for hamstring strain injuryAnthony Shield - is nmi a risk factor for hamstring strain injury
Anthony Shield - is nmi a risk factor for hamstring strain injuryMuscleTech Network
 
Implant Selection In Revision T.K.R
Implant Selection In Revision T.K.RImplant Selection In Revision T.K.R
Implant Selection In Revision T.K.RMurtuza Rassiwala
 
bone and_cartilage_tissue_engineering by Sumit
 bone and_cartilage_tissue_engineering by Sumit bone and_cartilage_tissue_engineering by Sumit
bone and_cartilage_tissue_engineering by SumitDcrust
 
Experimental Muscle Mechanics in Aging and Disease
Experimental Muscle Mechanics in Aging and DiseaseExperimental Muscle Mechanics in Aging and Disease
Experimental Muscle Mechanics in Aging and DiseaseInsideScientific
 
Post exercise cold water immersion attenuates acute anabolic signalling
Post exercise cold water immersion attenuates acute anabolic signallingPost exercise cold water immersion attenuates acute anabolic signalling
Post exercise cold water immersion attenuates acute anabolic signallingFernando Farias
 
Bone Loss in Long-Duration Spaceflight: Measurements and Countermeasures
Bone Loss in Long-Duration Spaceflight: Measurements and CountermeasuresBone Loss in Long-Duration Spaceflight: Measurements and Countermeasures
Bone Loss in Long-Duration Spaceflight: Measurements and CountermeasuresAmerican Astronautical Society
 
Analytical study of flexible stimulation waveforms in muscle fatigue reduction
Analytical study of flexible stimulation waveforms in muscle fatigue reduction Analytical study of flexible stimulation waveforms in muscle fatigue reduction
Analytical study of flexible stimulation waveforms in muscle fatigue reduction IJECEIAES
 
DETRAINING IN RELATION TO SKELETAL MUSCLE
DETRAINING IN RELATION TO SKELETAL MUSCLE DETRAINING IN RELATION TO SKELETAL MUSCLE
DETRAINING IN RELATION TO SKELETAL MUSCLE Dzevad Saric
 

Similar a Samuel R. Ward: Associate professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego. (20)

Bryan Heiderscheit - MRI findings
Bryan Heiderscheit - MRI findingsBryan Heiderscheit - MRI findings
Bryan Heiderscheit - MRI findings
 
199192 - LGB556 - Strength And Conditioning Programme
199192 - LGB556 - Strength And Conditioning Programme199192 - LGB556 - Strength And Conditioning Programme
199192 - LGB556 - Strength And Conditioning Programme
 
NSCA National Conference (2013) Podium Presentation
NSCA National Conference (2013) Podium PresentationNSCA National Conference (2013) Podium Presentation
NSCA National Conference (2013) Podium Presentation
 
EC2ON Masters Thesis
EC2ON Masters ThesisEC2ON Masters Thesis
EC2ON Masters Thesis
 
Bed Rest PDF
Bed Rest PDF Bed Rest PDF
Bed Rest PDF
 
5. faizan biomechanics of bone.pptx
5. faizan biomechanics of bone.pptx5. faizan biomechanics of bone.pptx
5. faizan biomechanics of bone.pptx
 
Muscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryMuscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injury
 
Muscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injuryMuscle and bone plasticity after spinal cord injury
Muscle and bone plasticity after spinal cord injury
 
D0661618
D0661618D0661618
D0661618
 
Muscle plasticity
Muscle plasticityMuscle plasticity
Muscle plasticity
 
Anthony Shield - is nmi a risk factor for hamstring strain injury
Anthony Shield - is nmi a risk factor for hamstring strain injuryAnthony Shield - is nmi a risk factor for hamstring strain injury
Anthony Shield - is nmi a risk factor for hamstring strain injury
 
Implant Selection In Revision T.K.R
Implant Selection In Revision T.K.RImplant Selection In Revision T.K.R
Implant Selection In Revision T.K.R
 
bone and_cartilage_tissue_engineering by Sumit
 bone and_cartilage_tissue_engineering by Sumit bone and_cartilage_tissue_engineering by Sumit
bone and_cartilage_tissue_engineering by Sumit
 
Experimental Muscle Mechanics in Aging and Disease
Experimental Muscle Mechanics in Aging and DiseaseExperimental Muscle Mechanics in Aging and Disease
Experimental Muscle Mechanics in Aging and Disease
 
Post exercise cold water immersion attenuates acute anabolic signalling
Post exercise cold water immersion attenuates acute anabolic signallingPost exercise cold water immersion attenuates acute anabolic signalling
Post exercise cold water immersion attenuates acute anabolic signalling
 
Bone Loss in Long-Duration Spaceflight: Measurements and Countermeasures
Bone Loss in Long-Duration Spaceflight: Measurements and CountermeasuresBone Loss in Long-Duration Spaceflight: Measurements and Countermeasures
Bone Loss in Long-Duration Spaceflight: Measurements and Countermeasures
 
Analytical study of flexible stimulation waveforms in muscle fatigue reduction
Analytical study of flexible stimulation waveforms in muscle fatigue reduction Analytical study of flexible stimulation waveforms in muscle fatigue reduction
Analytical study of flexible stimulation waveforms in muscle fatigue reduction
 
DETRAINING IN RELATION TO SKELETAL MUSCLE
DETRAINING IN RELATION TO SKELETAL MUSCLE DETRAINING IN RELATION TO SKELETAL MUSCLE
DETRAINING IN RELATION TO SKELETAL MUSCLE
 
Reeves 2006
Reeves 2006Reeves 2006
Reeves 2006
 
Poster PDf
Poster PDfPoster PDf
Poster PDf
 

Más de MuscleTech Network

Neuromuscular plasticity in quadriceps functions in response to training
Neuromuscular plasticity in quadriceps functions in response to trainingNeuromuscular plasticity in quadriceps functions in response to training
Neuromuscular plasticity in quadriceps functions in response to trainingMuscleTech Network
 
Rectus Femoris Injuries: what and when? William Garret
Rectus Femoris Injuries: what and when? William GarretRectus Femoris Injuries: what and when? William Garret
Rectus Femoris Injuries: what and when? William GarretMuscleTech Network
 
Quadriceps Muscle Injuries: James Moore
Quadriceps Muscle Injuries: James MooreQuadriceps Muscle Injuries: James Moore
Quadriceps Muscle Injuries: James MooreMuscleTech Network
 
Rectus Femoris Injuries: what and when? Ramon Cugat
Rectus Femoris Injuries: what and when? Ramon CugatRectus Femoris Injuries: what and when? Ramon Cugat
Rectus Femoris Injuries: what and when? Ramon CugatMuscleTech Network
 
Rectus Femoris Injuries: what and when? Sakari Orava
Rectus Femoris Injuries: what and when? Sakari OravaRectus Femoris Injuries: what and when? Sakari Orava
Rectus Femoris Injuries: what and when? Sakari OravaMuscleTech Network
 
Presentation of research projects. Bioibérica-FCB-Leitat
Presentation of research projects. Bioibérica-FCB-LeitatPresentation of research projects. Bioibérica-FCB-Leitat
Presentation of research projects. Bioibérica-FCB-LeitatMuscleTech Network
 
Return to play in rectus femoris muscle injuries. Our experience with profess...
Return to play in rectus femoris muscle injuries. Our experience with profess...Return to play in rectus femoris muscle injuries. Our experience with profess...
Return to play in rectus femoris muscle injuries. Our experience with profess...MuscleTech Network
 
Rehabilitation of rectus femoris injuries. Experience at Barcelona FC
Rehabilitation of rectus femoris injuries. Experience at Barcelona FCRehabilitation of rectus femoris injuries. Experience at Barcelona FC
Rehabilitation of rectus femoris injuries. Experience at Barcelona FCMuscleTech Network
 
Rectus Femoris Injuries. Experience at Sevilla FC
Rectus Femoris Injuries. Experience at Sevilla FCRectus Femoris Injuries. Experience at Sevilla FC
Rectus Femoris Injuries. Experience at Sevilla FCMuscleTech Network
 
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)MuscleTech Network
 
Ramon Balius - Quadriceps Muscle Injuries Diagnosis
Ramon Balius - Quadriceps Muscle Injuries DiagnosisRamon Balius - Quadriceps Muscle Injuries Diagnosis
Ramon Balius - Quadriceps Muscle Injuries DiagnosisMuscleTech Network
 
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuries
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuriesEduard Alentorn Geli - Risk factors for rectus femoris muscle injuries
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuriesMuscleTech Network
 
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)MuscleTech Network
 
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017MuscleTech Network
 
George Kouloris: MR Imaging of the Quadricepc Muscle Complex
George Kouloris: MR Imaging of the Quadricepc Muscle ComplexGeorge Kouloris: MR Imaging of the Quadricepc Muscle Complex
George Kouloris: MR Imaging of the Quadricepc Muscle ComplexMuscleTech Network
 
Ara Kassarjian: MRI of the Rectus Femoris - PRP
Ara Kassarjian: MRI of the Rectus Femoris - PRPAra Kassarjian: MRI of the Rectus Femoris - PRP
Ara Kassarjian: MRI of the Rectus Femoris - PRPMuscleTech Network
 
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRP
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRPIsabel Miguel: Quadriceps muscle anatomy Cadaver study - PRP
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRPMuscleTech Network
 
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...MuscleTech Network
 
John Orchard: Mechanism of Rectus Femoris Injuries - PRP
John Orchard: Mechanism of Rectus Femoris Injuries - PRPJohn Orchard: Mechanism of Rectus Femoris Injuries - PRP
John Orchard: Mechanism of Rectus Femoris Injuries - PRPMuscleTech Network
 

Más de MuscleTech Network (20)

Neuromuscular plasticity in quadriceps functions in response to training
Neuromuscular plasticity in quadriceps functions in response to trainingNeuromuscular plasticity in quadriceps functions in response to training
Neuromuscular plasticity in quadriceps functions in response to training
 
Rectus Femoris Injuries: what and when? William Garret
Rectus Femoris Injuries: what and when? William GarretRectus Femoris Injuries: what and when? William Garret
Rectus Femoris Injuries: what and when? William Garret
 
Quadriceps Muscle Injuries: James Moore
Quadriceps Muscle Injuries: James MooreQuadriceps Muscle Injuries: James Moore
Quadriceps Muscle Injuries: James Moore
 
Rectus Femoris Injuries: what and when? Ramon Cugat
Rectus Femoris Injuries: what and when? Ramon CugatRectus Femoris Injuries: what and when? Ramon Cugat
Rectus Femoris Injuries: what and when? Ramon Cugat
 
Rectus Femoris Injuries: what and when? Sakari Orava
Rectus Femoris Injuries: what and when? Sakari OravaRectus Femoris Injuries: what and when? Sakari Orava
Rectus Femoris Injuries: what and when? Sakari Orava
 
Presentation of research projects. Bioibérica-FCB-Leitat
Presentation of research projects. Bioibérica-FCB-LeitatPresentation of research projects. Bioibérica-FCB-Leitat
Presentation of research projects. Bioibérica-FCB-Leitat
 
Return to play in rectus femoris muscle injuries. Our experience with profess...
Return to play in rectus femoris muscle injuries. Our experience with profess...Return to play in rectus femoris muscle injuries. Our experience with profess...
Return to play in rectus femoris muscle injuries. Our experience with profess...
 
Rehabilitation of rectus femoris injuries. Experience at Barcelona FC
Rehabilitation of rectus femoris injuries. Experience at Barcelona FCRehabilitation of rectus femoris injuries. Experience at Barcelona FC
Rehabilitation of rectus femoris injuries. Experience at Barcelona FC
 
Rectus Femoris Injuries. Experience at Sevilla FC
Rectus Femoris Injuries. Experience at Sevilla FCRectus Femoris Injuries. Experience at Sevilla FC
Rectus Femoris Injuries. Experience at Sevilla FC
 
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)
Andreas Serner - Rectus Femoris Injuries Experiencies (Aspetar)
 
Xavier Valle: Rectus Femoris
Xavier Valle: Rectus FemorisXavier Valle: Rectus Femoris
Xavier Valle: Rectus Femoris
 
Ramon Balius - Quadriceps Muscle Injuries Diagnosis
Ramon Balius - Quadriceps Muscle Injuries DiagnosisRamon Balius - Quadriceps Muscle Injuries Diagnosis
Ramon Balius - Quadriceps Muscle Injuries Diagnosis
 
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuries
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuriesEduard Alentorn Geli - Risk factors for rectus femoris muscle injuries
Eduard Alentorn Geli - Risk factors for rectus femoris muscle injuries
 
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)
Quadriceps Muscle Injuries - William Garret (Eduard Alentor-Geli)
 
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017
Stefano Della Villa - Presentation of the Isokinetic Congress, May 2017
 
George Kouloris: MR Imaging of the Quadricepc Muscle Complex
George Kouloris: MR Imaging of the Quadricepc Muscle ComplexGeorge Kouloris: MR Imaging of the Quadricepc Muscle Complex
George Kouloris: MR Imaging of the Quadricepc Muscle Complex
 
Ara Kassarjian: MRI of the Rectus Femoris - PRP
Ara Kassarjian: MRI of the Rectus Femoris - PRPAra Kassarjian: MRI of the Rectus Femoris - PRP
Ara Kassarjian: MRI of the Rectus Femoris - PRP
 
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRP
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRPIsabel Miguel: Quadriceps muscle anatomy Cadaver study - PRP
Isabel Miguel: Quadriceps muscle anatomy Cadaver study - PRP
 
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...
Dr. Frank van Hellemondt: Epidemiology of Rectus Femoris injuries in Qatar Pr...
 
John Orchard: Mechanism of Rectus Femoris Injuries - PRP
John Orchard: Mechanism of Rectus Femoris Injuries - PRPJohn Orchard: Mechanism of Rectus Femoris Injuries - PRP
John Orchard: Mechanism of Rectus Femoris Injuries - PRP
 

Último

ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 

Último (20)

ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 

Samuel R. Ward: Associate professor in the Departments of Radiology, Orthopaedic Surgery and Bioengineering at the University of California, San Diego.

  • 1. 10/10/13 Physiological and Mechanical Adaptations of Muscle to Tendon Rupture Samuel R. Ward, PT, PhD Associate Professor Muscle Physiology Lab Departments of Radiology, Orthopaedic Surgery, and Bioengineering University of California San Diego VA Medical Center San Diego MuscleTech Network, Barcelona, Oct 15, 2013 Background •  Cuff injuries effect ~30% of people over 60 1 •  20-50% of repairs will fail 2 •  Chronic tears –  Muscle retraction, fatty atrophy and fibrosis 3 –  Nerve injury 4 –  Difficult to repair 5 –  High re-tear rates 2 –  Insensitive to rehabilitation 6 Healthy 1 Lehman et al, Bull Hosp Jt Dis, 1995 Harryman et al, JBJS 1991 Gerber et al, JBJS, 2004 4 Costouros et al, Arthroscopy, 2007 5 Peterson, et al JSES 2011 6 Gerber et al, JBJS, 2000 2 3 Severe Tear 1
  • 2. 10/10/13 Skeletal Muscle Hierarchy Lieber, Skeletal Muscle Structure and Function, 2010 Muscle Force Structure-Function Relationships Muscle Length Winters et al, J Biomech, 2012 Powell et al, J Appl Physiol, 1984 Bodine et al, J Neurophysiol , 1982 2
  • 3. 10/10/13 Normal Architecture Ward, et al Clin Orthop, 2006 30.0 PCSA (cm2) 25.0 Deltoid Subscapularis 20.0 15.0 Infraspinatus 10.0 Supraspinatus 5.0 teres minor 0.0 0.0 2.0 4.0 6.0 8.0 Fiber Length (cm) 10.0 12.0 Ward, et al Clin Orthop 2006 Altobelli, et al, Submitted J Biomech 2013 3
  • 4. 10/10/13 Pathology Normal Tear 47.72 mm 30.47mm Anterior Biceps tendon SS tendon attached to Infraspinatus and anterior capsule Muscle Area Changes with Tear and Age (Human) Barry et al, JSES 2012 4
  • 5. 10/10/13 Muscle Structural Changes After Tear (Sheep) Fat Muscle Gerber C, et al JBJS 2004 Muscle Fiber Length Changes After Tear (Human) 80 No Tear Tear Fiber Length (mm) 70 60 50 40 30 20 10 0 1 Tomioka et al, JSES 2009 5
  • 6. 10/10/13 Architectural Adaptations to Tear and Nerve Injury Relative Muscle Tension" Sato, et al, In Submission JBJS 100" 80" 60" 40" 20" 0" 0.5" 1.0" 1.5" 2.0" 2.5" 3.0" 3.5" 4.0" Sarcomere Length (µm) " 6
  • 7. 10/10/13 Whole Supraspinatus Muscle Stiffness Gerber et al, JSES, 1998- Human Safran, et al, JBJS 2005- Dog Gerber et al, JBJS 2004- Sheep Human Passive Mechanics Injured Cuff Elastic Modulus (kPa) 700 600 500 Supraspinatus Infraspinatus Control * 400 300 200 100 0 Single Fiber Fiber Bundle Silldorff, Submitted JBJS 7
  • 8. 10/10/13 Tissue Adaptations to Tear and Nerve Injury (rat) Sato, et al, In Submission JBJS Structural Change- Summary Muscle Force Healthy Tear Muscle Length 8
  • 9. 10/10/13 Rabbit Lower Extremity Tenotomy C: TA T: TA 10 mm C: ED L T: EDL 10 mm C: EDI I T: EDI I 10 mm Active & Passive Mechanics In Vivo Mechanical Testing Tenotomy & Length-Tension Curve Muscle Architecture Fiber Area Muscle Tension Control 100 µm Muscle Length 9
  • 10. 10/10/13 Tenotomy Alters LT Relationship Stress After Repair Normalized Fiber Length [mm] 40 300 Control Tenotomy Control Tenotomy * * 250 30 200 * * 20 150 TA * * 100 10 50 0 0 TA TA EDL EDL EDII EDII EDL EDII * = p < 0.05 4000 250 * Control Tenotomy 6000 * * TA 200 Stress [kPa] Passive Stiffness [kPa] Tentomy Alters Passive Stiffness 2000 150 100 50 0 Control Tenotomy 0 TA 250 EDL 0 EDII EDL 40 Fiber Length [mm] 60 80 EDII 250 200 20 Stress [kPa] Stress [kPa] 200 150 100 50 Control Tenotomy 0 0 5 10 15 20 Fiber Length [mm] 25 30 150 100 50 Control Tenotomy 0 0 5 10 Fiber Length [mm] 15 20 10
  • 11. 10/10/13 ECM Remodeling Control Tenotomy TA 50 µm EDL Winters, et al, In Progress 50 µm 50 µm 50 µm EDII 50 µm 50 µm New Histology Methods H&E Wheat Germ Agglutinin Picro-sirius Red KI67 αSMA Trichrome Reticulin pCEβ Winters, Buck et al, In Progress 11
  • 12. 10/10/13 Human Muscle Gene Expression Choo, McCarthy et al, In Progress JBJS Summary •  Structural Changes –  Radial and longitudinal atrophy •  Physiological Changes –  After chronic tears, function does not follow structure –  Evidence for ECM changes leading to muscle stiffness •  Rehabilitation –  Massive tears in the shoulder don’t appear to recover 12
  • 13. 10/10/13 Faculty Doug Chang, MD- UCSD Adam Engler, PhD- UCSD Don Fithian, MD – Kaiser Larry Frank, PhD- UCSD Jan Fridén, MD- Göteborg, Sweden Christian Gerber, MD- Balgrist, Switzerland Eric Hentzen, MD, PhD- UCSD John Lane, MD- Coast Surgery Center Rick Lieber, PhD- UCSD Hiro Okuno, MDJoseph Sarver, PhD- Penn Simon Schenk, PhD- UCSD Lou Soslowsky, PhD- Penn Andrea Taylor, PhD- Duke Steve Thomopoulos, PhD- Wash U Students Grant Altobelli, MD – Tufts Geoff Abrams, MD- Stanford Alex Choo, MD- UCSD Carolyn Eng, BS- Harvard Ki Lee, MD- Yonsei Meagan McCarthy, MD- UCSD Randy McKnight- UCSD Morgan Silldorff, MD- UCSD Gretchen Meyer, PhD- UCSD Eugene Sato, BS- UCSD Ana Rodriguez-Soto, BS- UCSD 13