title: Shoulder muscle forces during driving: Sudden steering can load the rotator cuff beyond its repair limit.
abstract: BACKGROUND
  Driving is one of the most common everyday tasks and the rotator cuff muscles are the primary shoulder stabilisers. Muscle forces during driving are not currently known, yet knowledge of these would influence important clinical advice such as return to activities after surgery. The aim of this study is to quantify shoulder and rotator cuff muscle forces during driving in different postures.
  
  
  METHODS
  A musculoskeletal modelling approach is taken, using a modified driving simulator in combination with an upper limb musculoskeletal model (UK National Shoulder Model). Motion data and external force vectors were model inputs and upper limb muscle and joint forces were the outputs.
  
  
  RESULTS
  Comparisons of the predicted glenohumeral joint forces were compared to in vivo literature values, with good agreement demonstrated (61 SD 8% body weight mean peak compared to 60 SD 1% body weight mean peak). High muscle activation was predicted in the rotator cuff muscles; particularly supraspinatus (mean 55% of the maximum and up to 164 SD 27 N). This level of loading is up to 72% of mean failure strength for supraspinatus repairs, and could therefore be dangerous for some cases. Statistically significant and large differences are shown to exist in the joint and muscle forces for different driving positions as well as steering with one or both hands (up to 46% body weight glenohumeral joint force).
  
  
  CONCLUSIONS
  These conclusions should be a key consideration in rehabilitating the shoulder after surgery, preventing specific upper limb injuries and predicting return to driving recommendations.
authors.affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
authors.forename: Petros
authors.initials: P
authors.lastname: Pandis
authors.affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
authors.forename: Joe A I
authors.initials: JA
authors.lastname: Prinold
authors.affiliation: Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK. Electronic address: a.bull@imperial.ac.uk.
authors.forename: Anthony M J
authors.initials: AM
authors.lastname: Bull
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000517:prevention & control / Q000534:rehabilitation; D001334:Automobile Driving; D001696:Biomechanical Phenomena; D006801:Humans; D008297:Male; D055595:Mechanical Phenomena; D009068:Movement; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000502:physiology*; D011187:Posture; D017006:Rotator Cuff / Q000502:physiology*; D012782:Shoulder / Q000502:physiology*; D012785:Shoulder Joint / Q000502:physiology*; D055815:Young Adult
keywords: Daily activities; Driving; Musculoskeletal biomechanics modelling; Shoulder functionality; Steering; Supraspinatus; Surgical repair; Upper limb muscle forces