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TITLE: A Cadaveric, Finite Element, and Magnetic Resonance Imaging (MRI) Based Approach to Supraspinatus Tendon Mechanics

ABSTRACT: Shoulder pain is the third most common musculoskeletal complaint reported to general practitioners. Degeneration from chronic overuse throughout one’s life is the primary cause of rotator cuff (RC) tears, with an increasing prevalence in the general population with age. Non-operative treatment is initially indicated for patients with RC tears; however, this fails to relieve symptoms in 25 – 75% of patients and does not address the underlying tear. Due to repetitive damage over time and the tendon's hypo-vascularity, there is limited healing potential. Ultimately, this results in the progression of the tear, as 29% of patients will experience an increase in tear size > 5mm in just one year. However, there is little knowledge as to why some patients will experience tear progression and loss of function while others may not. Moreover, there are no methods to evaluate the tendon’s mechanical health. This dissertation aims to identify clinically relevant tear sizes based on biomechanical changes to the supraspinatus tendon and use non-invasive quantitative magnetic resonance imaging (qMRI) to assess tear severity. To do so, I propose the following specific aims: 1.) To identify the initiation and progression of RC tears and the subsequent changes to the biomechanical properties due to fatigue loading, which represents chronic overuse. 2.) Identify structural and material properties in healthy controls and cadaveric tendons with pre-existing degenerative RC tears and evaluate the efficacy of qMRI to predict mechanical function and tear severity. 3.) Develop and validate finite element models of the RC to assess tissue strain in the presence of an RC tear. 4.) Use qMRI to identify structural and mechanical changes to tendons due to fatigue loading. These aims will comprehensively evaluate RC tendon mechanics to identify clinically relevant tear classifications based on biomechanical changes and a non-invasive method to evaluate tendon health.

COMMITTEE: ADVISOR/CHAIR Professor Ara Nazarian, ME/Orthopaedic Surgery, Harvard Medical School; Professor Michael Albro, ME/MSE/BME; Professor Katherine Yanhang Zhang, ME/BME/MSE