human evolution; evolutionary medicine; palaeopathology; subacromial impingement syndrome; functional morphology; geometric morphometrics; low back pain; lumbar lordosis
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Musculoskeletal disorders are extremely common in modern people. Their socioeconomic burden exceeds that of cancer and cardiovascular diseases. Growing life expectancy and escalations in obesity will further increase their impact. An important factor in their aetiology is biomechanical stress, part of which might be directly at-tributable to our bipedal posture and locomotion and modern daily behaviour. In fact, musculoskeletal disorders are surprisingly uncommon among non-human primates. Thus, neck and low back problems, but also shoulder im-pingement syndrome are regularly attributed to trade-offs of bipedalism. This project will test these suppositions by using an evolutionary approach based on the analysis of the fossil record.Subproject A SPINE will shed light on the aetiology of our universal low back problems. Here, we focus on three aspects of the lower back. Early hominids differ from modern humans by a more cranial position of the transition from thoracic type to lumbar type articular facets. This is thought to have increased the sagittal mobility of the spine, which would have facilitated the critical adoption of the lumbar lordosis. Yet, a more mobile back could be correlated with low back problems. In work package (WP) A1, we will analyse the impact of facet joint orientation on sagittal mobility and musculoskeletal disorders of the spine by using functional lumbar radiographs of low back patients. In WP A2, we will study the change of the lumbar lordosis angle during the course of human evolution to understand why Neanderthals had a more ape-like lumbar curve than Australopithecus and Homo erectus. In WP A3 we will assess the prevalence of vertebral pathologies in hominid fossils and evaluate morpho-logical and biomechanical factors that might explain these pathologies. Subproject B SHOULDER analyses the evolutionary background of the impingement syndrome that ac-counts for the majority of shoulder complaints in modern people. In WP B1, we will analyse known anatomical risk factors for impingement syndrome in scapulae and associated humeri of modern humans, fossil hominids and great apes. We hypothesize that characteristics unique to the human lineage are crucial in the aetiology of shoulder impingement syndrome. While previous studies were all based on two-dimensional radiographs and MRI sections, our study will be the first that fully acknowledge the complex 3D anatomy of the shoulder girdle. In the related WP B2, we will use 3D geometric morphometrics to investigate the reorganization of scapular morphology during the evolution from a shoulder girdle adapted to overhead activities to one adapted for use of the arm in a lowered position. This allows us to study the associated reorganization of the rotator cuff muscles that is thought to be an important factor in the aetiology of shoulder impingement syndrome. In WP B3, we will examine the value of the manubrium and the sternoclavicular joint to infer shoulder position in human evolution. Our approach is based on state of the art technologies of comparative morphology. Except for WP A1 of Subproject Spine that analyses X-rays, we will acquire high resolution 3D surface scans of the lumbar vertebrae and pelvis as well as the bones of the shoulder girdle of a large number of modern humans, great apes, and all rel-evant early hominid fossils. The modern comparative sample will supplemented with CT/ MRI scans of clinical patients for which 3D surface models will be generated. 3D landmarks will then be placed analogous to known ra-diologic morphological risk factors for musculoskeletal disorders in addition to standard measurements. This spatial information will be used for statistical shape analysis using vector geometry and Procrustes-based geometric morphometrics.Our results will help to understand the ultimate causes of low back problems and subacromial impingement syndrome. This will provide an evolutionary explanation for the weak points of our bony frame that could have an important impact on our approach to the prevention, diagnosis and treatment of musculoskeletal disorders.