In vivo measurement of shoulder joint loads during walking with crutches.
BACKGROUND
Following surgery or injury of the lower limbs, the use of walking aids like crutches can cause high loads on the shoulder joint. These loads have been calculated so far with computer models but with strongly varying results.


METHODS
Shoulder joint forces and moments were measured during crutch-assisted walking with complete and partial unloading of the lower limbs. Using telemeterized implants in 6 subjects axillary crutches and forearm crutches were compared. A force direction was more in the direction of the long humeral axis, and slightly lower forces were assumed using axillary crutches. Similar force magnitudes as those experienced during previously measured wheelchair weight relief tasks were expected for complete unloading. The friction-induced moment was hypothesized to act mainly around the medio-lateral axis during the swing phase of the body.


RESULTS
Maximum loads of up 170% of the bodyweight and 0.8% of the bodyweight times meter were measured with large variations among the patients. Higher forces were found in most of the patients using forearm crutches. The hypothesized predominant moment around the medio-lateral axis was only found in some patients. More often, the other two moments had larger magnitudes with the highest values in female patients. The assumed different load direction could only be found during partial unloading.


CONCLUSIONS
In general the force magnitudes were in the range of activities of daily living. However, the number of repetitions during long-lasting crutch use could lead to shoulder problems as a long-term consequence. The slightly lower forces with axillary crutches could be caused by loads acting directly from the crutch on the scapula, thus bypassing the glenohumeral joint. The higher bending moments in the female patients could be a sign of lacking muscle strength for centring the humeral head on the glenoid.
Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Germany. peter.westerhoff@charite.de
P
P
Westerhoff
F
F
Graichen
A
A
Bender
A
A
Halder
A
A
Beier
A
A
Rohlmann
G
G
Bergmann
D000368:Aged; D003446:Crutches; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D012785:Shoulder Joint / Q000503:physiopathology*; D013314:Stress, Mechanical; D014160:Transducers, Pressure; D016474:Weight-Bearing