Intramuscular pressure of the infra- and supraspinatus muscles in relation to hand load and arm posture.

In work engaging the upper extremities, the musculoskeletal system of the shoulder is sometimes exposed to prolonged excessive load, leading to musculoskeletal disorders of the shoulder. One way of reducing work-related shoulder disorders is to establish guidelines for working postures. The purpose of this study was to identify harmful working positions, by performing a comprehensive survey of the intramuscular pressure (IMP) in the infra- and supraspinatus muscles in relation to different arm positions and external loads. Ten healthy males participated, and the IMP in the infra- and supraspinatus muscles was studied in a total of 112 combinations of arm positions and hand loads at levels that occur frequently in industrial work. High-precision spatial recordings were accomplished with a three-dimensional motion-analysis system, and the IMP was measured using the microcapillary infusion technique. The mean IMP of the infraspinatus muscle as well as that of the supraspinatus muscle increased continuously from a resting pressure at 0 degrees of upper arm elevation to a maximal pressure at 90 degrees of upper arm elevation, for all elevation planes. The mean IMP of the supraspinatus muscle appeared to be more dependent upon the elevation plane and less dependent upon the hand load, compared to the infraspinatus muscle. Even during only moderate arm elevation, the mean IMP of the infra- and supraspinatus muscles, presented here in polar diagrams, had already exceeded the levels of reduced recovery from local muscle fatigue and blood flow impairment. The elevation angle and the hand load primarily influence the development of IMP in the infra- and supraspinatus muscles.

Effects of isokinetic muscle activity on pressure in the supraspinatus muscle and shoulder torque.

Work-related shoulder pain is an increasing problem. Work in overhead positions, which causes high pressure in the supraspinatus muscle, has been shown to increase the shoulder load. It is not known how different types of muscle activity in the shoulder affect pressure in the muscle. The aim of this study was to investigate the difference between contraction modes. This has not been done before for shoulder muscles. The results are relevant from several aspects, both clinical and experimental. Pressure in the supraspinatus muscle and torque generation in the shoulder during isokinetic concentric and eccentric activity were measured in nine healthy human subjects. Torque and arm position were measured continuously with a computerized ergonometer. The contraction velocity was 60 degrees per second, and the range of movement was 0-120 degrees of abduction. Electromyographic measurements were recorded with a surface electrode above the supraspinatus muscle belly. Intramuscular pressure was recorded with a microcapillary infusion technique. Peak intramuscular pressure did not differ significantly between the two modes of contraction, but the peak was reached at 115 degrees (SD = 15 degrees) of abduction during concentric activity and at 6 degrees (SD = 7 degrees) of abduction during eccentric activity. The ratio between intramuscular pressure and torque was 3.0 mm Hg/Nm (0.40 kPa/Nm) during concentric activity and 2.3 mm Hg/Nm (0.31 kPa/Nm) during eccentric activity. The peak torque occurred at 44 degrees of abduction during concentric muscle activity and at 74 degrees of abduction during eccentric activity. Intramuscular pressure was higher during isometric contraction than during eccentric and concentric activity, and the torque was in between the two latter contraction modes. We conclude that the supraspinatus muscle is heavily loaded not only in high arm positions during concentric contraction but also during eccentric contraction in arm positions of 0-30 degrees of abduction.

Assessment of workload and arm position during different work sequences: a study with portable devices on construction workers.

It is recognised that work related shoulder pain is overrepresented among construction workers compared to other occupations. Studies have shown that working with hands above shoulder level increases the shoulder load. Most studies have been confined to the laboratory. The present project was carried out to map the muscular engagement and postures of construction workers undertaking ceiling fitting, and to compare the results to those of the laboratory studies. Two ambulatory devices were used, one allowing recording of electromyographic (EMG) signals bilaterally from the trapezius muscle, and the other to record the position of both arms and back by means of measuring the angles between the vertical line and the back and both upper arms. These recordings were performed during 1.5-2 h work sequences. The results show that the work was mostly performed in an upright position, that both arms were used to a similar amount and that the workers for a large proportion of their working time had their upper arms at levels that are considered harmful in view of shoulder load. The EMG data showed that nearly 50% of the work was spent with trapezius activity that exceeded that of the reference contraction used (about 15% of maximal voluntary contraction) and that the time spent in muscular relaxation was 10%. It was concluded that the exposure of construction workers undertaking ceiling fitting meets the criteria formulated on the basis of laboratory experiments with respect to a high risk of acquiring chronic shoulder pain, due to rotator cuff tendinitis.

The effect of light manual precision work on shoulder muscles--an EMG analysis.

In order to clarify if light manual precision work influences the activity of shoulder muscles, seven shoulder muscles were examined using electromyography (EMG) in five different arm positions in ten subjects. The subjects were asked to perform light precision work with the hand while maintaining the same arm position. The EMG activity in the shoulder muscles with the arm in specific positions was compared to the activity when manual precision work was added. The results were analysed statistically using a non-parametric method. We found an increased EMG activity in almost all arm positions and muscles. The increase was significant in four out of five arm positions regarding the infraspinatus and in three out of five positions concerning the levator scapulae. In the supraspinatus the increase was significant with the arm in its highest location. The average increase in shoulder muscle activity amounted to 22% of the resting activity.

Consequences of trapezius relaxation on the distribution of shoulder muscle forces: an electromyographic study.

This study was focused on the ability to reduce voluntarily the muscle activity in the descending part of the trapezius muscle without changing the arm position or hand load, and its consequences on the distribution of shoulder muscle forces. Visual feedback techniques were used. Six different arm positions were investigated in 11 subjects. Electromyography was used for monitoring the muscle involvement. The selection of relevant muscles was performed by a model simulation of the shoulder using a newly developed biomechanical model of the human shoulder. The ability to reduce the muscle activity of the descending part of the trapezius was confirmed and the reduction ranged from 60 to 76% depending on the arm position. Among the muscles studied the rhomboid major and minor and the transverse part of the trapezius were affected the most, increasing their activity on the average to 232, 175 and 201% respectively, compared to the initial activity. The anterior part of the deltoid and the medial part of the serratus anterior also intensified their activity. The influence on the levator scapulae was, contrary to simulation results and to empirical knowledge, a decrease of the muscle activity. It is suggested that attention is given to the rhomboids and the transverse part of the trapezius when muscle activity is reduced in the descending part of the trapezius, for instance in biofeedback-based therapy. In conclusion, the study showed that reducing the trapezius activity caused a redistribution of muscle forces in the shoulder.

Hand grip increases shoulder muscle activity, An EMG analysis with static hand contractions in 9 subjects.

We examined 4 shoulder muscles--the supraspinatus, infraspinatus, the middle portion of the deltoid and the descending part of the trapezius--with electromyography (EMG) in adducted and flexed arm positions, in 9 healthy subjects. The subjects were asked to produce a static handgrip force of 30% and 50% of maximal voluntary contraction (MVC) in 8 different arm positions. In all positions, the subjects held a dynamometer in the hand. The myoelectric activity in the shoulder muscles with only the dynamometer in the hand was compared to the EMG activity when static contractions were added. There was an association between static handgrip and shoulder muscle activity, as revealed by E < G. The EMG activity increased in the supraspinatus muscle in humeral flexion from and above 60 degree in 120 degree abduction. In the infraspinatus muscle, the changes were less; a significant increase, however, was noticed in flexion. In the deltoid muscle there was a tendency towards increased activity in positions lower than 90 degree, in the higher arm positions, the activity decreased. There was no significant alteration regarding the EMG activity of the trapezius. Our findings imply that high static handgrip force, particularly in elevated arm positions, increases the load on some shoulder muscles. The stabilizing muscles (the rotator cuff) were more influenced than the motor muscles by hand activity. Handgrip activity is important to evaluate while assessing shoulder load in manual work an in clinical evaluations of patients with shoulder pain.

Voluntary redistribution of muscle activity in human shoulder muscles.

Four shoulder muscles (the supraspinatus, the infraspinatus, the anterior and middle portion of the deltoid, and the descending part of the trapezius) were examined with electromyography in abducted arm positions. By using feedback techniques, we found that the subjects could reduce the EMG activity voluntarily by 22-47% in the trapezius muscle while keeping different static postures. This was not true for any other muscle investigated. When the trapezius activity was reduced there was a tendency towards an increase of EMG activity in some other shoulder muscles, particularly the infraspinatus. The findings may be related to relaxation from an initial overstabilization of the shoulder, or redistribution of load among synergists. It is suggested that the possibility of reducing trapezius activity may be of ergonomic significance. It is also noted that EMG trapezius activity may not serve as a universal descriptor of total muscular load in the shoulder.

Influences of handgrip on shoulder muscle activity.

Four shoulder muscles (the supraspinatus, the infraspinatus, the middle portion of the deltoid and the descending part of the trapezius muscle) were examined using electromyography (EMG) in abducted and flexed arm positions, in nine subjects who had no history of illness from arm or shoulder. The subjects were asked to supply an intermittent isometric handgrip force of 30% and 50% of maximal voluntary contraction, in a total of eight different arm positions. The EMG activity with and without hand activity was compared in all positions. There was a statistically significant increase in the EMG activity in the supraspinatus muscle in humeral flexion from and above 60 degrees. In the infraspinatus muscle the changes were less; a significant decrease was however noticed in abduction. In the deltoid muscle there was a significant decrease with hand activity in flexion from and above 90 degrees. There was no statistically significant alteration regarding the EMG activity of the trapezius muscle. The result of this study implies that high demands on handgrip force, particularly while using hand tools in elevated arm positions, adds further to the already high load on some shoulder muscles. This factor should be considered in the design of manual work and in the places of work.