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°. 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°. 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.     

A comprehensive analysis of muscle recruitment patterns during shoulder flexion: an electromyographic study

Although flexion is a common component of the routine clinical assessment of the shoulder the muscle recruitment patterns during this movement are not clearly understood making valid interpretation of potential muscle dysfunction problematic. The purpose of this study was to comprehensively examine shoulder muscle activity during flexion in order to compare the activity levels and recruitment patterns of shoulder flexor, scapular lateral rotator and rotator cuff muscles. Electromyographic (EMG) data were recorded from 12 shoulder muscles sites in 15 volunteers. Flexion was performed in standing in the sagittal plane at no load, 20%, and 60% of each subject's maximum load. EMG data were normalized to maximum values obtained during maximum voluntary contractions. Results indicated that anterior deltoid, pectoralis major, supraspinatus, infraspinatus, serratus anterior, upper, and lower trapezius were activated at similar moderate levels. However, subscapularis was activated at low levels and significantly lower than supraspinatus and infraspinatus. Similar activity patterns across time were demonstrated in the muscles that produce flexion torque, laterally rotate the scapula, as well as supraspinatus and infraspinatus, and did not change as flexion load increased. The onset of activity in supraspinatus and anterior deltoid occurred at the same time and prior to movement of the limb at all loads with infraspinatus activity also occurring prior to movement onset at the medium and high load conditions only. Posterior rotator cuff muscles appear to be counterbalancing anterior translational forces produced during flexion and it would appear that supraspinatus is one of the muscles that consistently "initiates" flexion.     

Rotator cuff muscles perform different functional roles during shoulder external rotation exercises

The aim of this study was to compare activity in shoulder muscles during an external rotation task under conditions of increasing arm support to investigate whether changing support requirements would influence muscle recruitment levels, particularly in the rotator cuff (RC) muscles. Electromyographic recordings were collected from seven shoulder muscles using surface and indwelling electrodes. The dominant shoulder of 14 healthy participants were examined during dynamic shoulder external rotation performed at 90° abduction with the arm fully supported, partially supported, and unsupported. Linear regressions between arm support load and the averaged muscle activity across participants for each muscle showed infraspinatus predominantly contributing to rotating the shoulder whilst supraspinatus, deltoid, upper trapezius, and serratus anterior were predominantly functioning in support/stabilization roles. During dynamic shoulder external rotation in mid‐range abduction, the RC muscles perform different functional roles. Infraspinatus is responsible for producing external rotation torque, supraspinatus is playing a larger joint stabilizer role, and subscapularis is contributing minimally to joint stability. The results also indicate that increasing support load requirements during an external rotation task may be a functionally specific way to retrain the stabilization function of axioscapular muscles. Manipulating joint stabilization requirements while maintaining constant rotational load is a novel method of investigating the differential contribution of muscles to joint movement and stabilization during a given task. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Nerve conduction studies of suprascapular nerve for site-of-lesion diagnosis

Shoulder pain is a common symptom, resulting not only from bone and shoulder joint diseases, but also from neurogenic lesions. Entrapment neuropathy of the suprascapular nerve also causes shoulder symptoms. Conduction of the suprascapular nerve was studied in 12 healthy control subjects and 25 patients suffering from shoulder pain and/or dysfunction. Surface stimulation was performed at Erb's point, and compound muscle action potentials(M waves) were recorded from the supraspinatus and the infraspinatus muscles with concentric needle electrodes. To determine the optimal site for recording M waves from the infraspinatus muscle, simultaneous multi-channel recordings of M waves using pairs of surface electrodes were obtained from different sites over the infraspinatus muscle. In two patients, latency of the M waves to the infraspinatus muscle was prolonged, whereas that to the supraspinatus muscle was normal. These findings indicate entrapment neuropathy at the spinoglenoid notch. In three patients, the latency to the infraspinatus and supraspinatus muscles was prolonged. These findings are compatible with entrapment neuropathy at the suprascapular notch. The latency to the supraspinatus and infraspinatus muscles was prolonged in patients with brachial plexus injury and in those with suprascapular nerve injury. In patients with myopathy, those with neuralgic amyotrophy and those with cervical radiculopathy, the latency was normal. Thus, conduction studies of the suprascapular nerve using multiple-channel recordings are useful, especially for the diagnosis of entrapment neuropathy of the suprascapular nerve.     

Exploring the functional morphology of the Gorilla shoulder through musculoskeletal modelling

Musculoskeletal computer models allow us to quantitatively relate morphological features to biomechanical performance. In non-human apes, certain morphological features have long been linked to greater arm abduction potential and increased arm-raising performance, compared to humans. Here, we present the first musculoskeletal model of a western lowland gorilla shoulder to test some of these long-standing proposals. Estimates of moment arms and moments of the glenohumeral abductors (deltoid, supraspinatus and infraspinatus muscles) over arm abduction were conducted for the gorilla model and a previously published human shoulder model. Contrary to previous assumptions, we found that overall glenohumeral abduction potential is similar between Gorilla and Homo. However, gorillas differ by maintaining high abduction moment capacity with the arm raised above horizontal. This difference is linked to a disparity in soft tissue properties, indicating that scapular morphological features like a cranially oriented scapular spine and glenoid do not enhance the abductor function of the gorilla glenohumeral muscles. A functional enhancement due to differences in skeletal morphology was only demonstrated in the gorilla supraspinatus muscle. Contrary to earlier ideas linking a more obliquely oriented scapular spine to greater supraspinatus leverage, our results suggest that increased lateral projection of the greater tubercle of the humerus accounts for the greater biomechanical performance in Gorilla. This study enhances our understanding of the evolution of gorilla locomotion, as well as providing greater insight into the general interaction between anatomy, function and locomotor biomechanics.     

Muscle sizes and moment arms of rotator cuff muscles determined by magnetic resonance imaging

Biomechanical models which require information on, e.g., joint torque and muscle force are useful in the estimation of when and how mechanical overload of the musculoskeletal system may lead to disorders. The aim was to study the reliability and validity of magnetic resonance imaging (MRI) to quantify muscle sizes and moment arms by MRI and to test selected anthropometric measures as predictors of muscle sizes and moment arms. A total of 20 healthy Scandinavian women (age 22-58 years) participated in an MRI scanning of their dominant shoulder. With a PC-based program the reliability and the validity of the MRI measurements was estimated to be high, and mean anatomical cross-sectional areas (ACSA) and muscle lengths were measured to be 4.0, 9.8 and 12.1 cm(2) and 12.0, 12.6 and 12.8 cm for m. supraspinatus, m. infraspinatus and m. subscapularis, respectively. Volumes were calculated to be 48.8, 125.1 and 153.6 cm(3). Moment arms were measured with the upper arm in a neutral position and in a functional position of 34 degrees abduction for m. supraspinatus only, and were 2.4 and 2.6 cm. Physiological cross-sectional area (PCSA) and its fiber force component were estimated from dissected fiber length and pennation angle. MRI volume and PCSA were 1.4-1.7 times higher than dissection data, primarily because of age differences. No external anthropometric measures were found to be predictors of volumes or moment arms.     

The influence of experimentally induced pain on shoulder muscle activity

Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22–27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0°–105°) at a speed of approximately 120°/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load on the painful structures.     

The moment arms of the muscles spanning the glenohumeral joint: a systematic review

The moment arm of a muscle represents its leverage or torque‐producing capacity, and is indicative of the role of the muscle in joint actuation. The objective of this study was to undertake a systematic review of the moment arms of the major muscles spanning the glenohumeral joint during abduction, flexion and axial rotation. Moment arm data for the deltoid, pectoralis major, latissimus dorsi, teres major, supraspinatus, infraspinatus, subscapularis and teres minor were reported when measured using the geometric and tendon excursion methods. The anterior and middle sub‐regions of the deltoid had the largest humeral elevator moment arm values of all muscles during coronal‐ and scapular‐plane abduction, as well as during flexion. The pectoralis major, latissimus dorsi and teres major had the largest depressor moment arms, with each of these muscles exhibiting prominent leverage in shoulder adduction, and the latissimus dorsi and teres major also in extension. The rotator cuff muscles had the largest axial rotation moment arms regardless of the axial position of the humerus. The supraspinatus had the most prominent elevator moment arms during early abduction in both the coronal and scapular planes as well as in flexion. This systematic review shows that the rotator cuff muscles function as humeral rotators and weak humeral depressors or elevators, while the three sub‐regions of the deltoid behave as substantial humeral elevators throughout the range of humeral motion. The pectoralis major, latissimus dorsi and teres major are significant shoulder depressors, particularly during abduction. This study provides muscle moment arm data on functionally relevant shoulder movements that are involved in tasks of daily living, including lifting and pushing. The results may be useful in quantifying shoulder muscle function during specific planes of movement, in designing and validating computational models of the shoulder, and in planning surgical procedures such as tendon transfer surgery.     

Bilateral suprascapular nerve entrapment

Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles.     

Density of muscle spindles in prosimian shoulder muscles reflects locomotor adaptation

We examined the correlation between the density of muscle spindles in shoulder muscles and the locomotor mode in three species of prosimian primates: the slow loris (Nycticebus coucang), Garnett's galago (Otolemur garnettii), and the ring-tailed lemur (Lemur catta). The shoulder muscles (supraspinatus, infraspinatus, teres major, teres minor, and subscapularis) were embedded in celloidin and cut into transverse serial thin sections (40 microm); then, every tenth section was stained using the Azan staining technique. The relative muscle weights and the density of the muscle spindles were determined. The slow loris muscles were heavier and had sparser muscle spindles, as compared to Garnett's galago. These features suggest that the shoulder muscles of the slow loris are more adapted to generating propulsive force and stabilizing the shoulder joint during locomotion and play a less controlling role in forelimb movements. In contrast, Garnett's galago possessed smaller shoulder muscles with denser spindles that are suitable for the control of more rapid locomotor movements. The mean relative weight and the mean spindle density in the shoulder muscles of the ring-tailed lemur were between those of the other primates, suggesting that the spindle density is not simply a consequence of taxonomic status.     

Normalization of electromyogram in the neck-shoulder region

Summary Linear and curvilinear electromyogram (EMG) normalization methods were compared among ten healthy men during a simulated work cycle demanding attention and static holding of the arm (Solitaire test). Maximal voluntary contractions (MVC) and gradually increasing contractions up to 70% of MVC were used for normalization in different arm postures. The test contractions studied included inward and outward rotations, abduction, shoulder elevation, and flexion in different arm positions. The shoulder load moment was calculated for the flexion tests using a simple two-dimensional model. The effect of arm posture on the EMG versus shoulder load moment relationship was studied on the following muscles: supraspinatus, infraspinatus, trapezius (three parts), deltoid (two parts) and pectoralis major. All muscles participated in the MVC tests performed, and its was not possible to suggest a single recommended test for each muscle. Differences in normalized EMG median values ranging up to 30% of MVC were found between linear and curvilinear normalization methods. Short-term repeatability of normalization based on a contraction with gradually increasing force was good. Arm posture affected the relationships between shoulder load moment and EMG activity of all muscles studied. Arm posture did not, however, have a significant effect on the estimated amplitude probability distribution functions during the simulated work task. Therefore, at least for the tasks studied, the principle of normalizing in the middle position of the range of movement was deemed acceptable.     

Sex differences in muscular load among house painters performing identical work tasks

Purpose

The present study aimed to estimate possible differences in upper body muscular load between male and female house painters performing identical work tasks. Sex-related differences in muscular load may help explain why women, in general, have more musculoskeletal complaints than men.

Methods

In a laboratory setting, 16 male and 16 female house painters performed nine standardised work tasks common to house painters. Unilateral electromyography (EMG) recordings were obtained from the supraspinatus muscle by intramuscular electrodes and from the trapezius, extensor and flexor carpi radialis muscles by surface electrodes. Relative muscular loads in %EMG_max as well as exerted force in Newton, based on ramp calibrations, were assessed. Sex differences were tested using a mixed model approach.

Results

Women worked at about 50 % higher relative muscular loads than men in the supraspinatus and forearm muscles at all percentiles and in all tasks. Women exerted about 30 % less force in the trapezius muscle at the 50th percentile.

Conclusions

Female house painters had a higher relative muscular load than their male colleagues without exerting more force. The effects of a higher relative muscular load accumulated over years of work may in part explain why musculoskeletal complaints in the upper body occur more frequently among women than men.     

Differential effects of mental load on proximal and distal arm muscle activity

Work-related upper extremity disorders (WRUEDs) that result from keyboarding tasks are prevalent and costly. Although the precise mechanisms causing the disorder are not yet fully understood, several risk factors have been proposed. These include the repetitive nature of the motor task and the associated sustained static working postures, but also more psychological factors such as mental load. Epidemiological surveys have shown that WRUEDs are more prone to develop in the postural muscles of the neck/shoulder area than in the executive muscles controlling the hand. The present study investigated whether the activation patterns of these two muscle types are differentially affected by an additional mental load during the performance of a repetitive tapping task. Participants tapped various keying patterns with their dominant index finger at two prescribed tempi. Mental load was manipulated by means of an auditory short-term memory task. We recorded the EMG activity of two neck/shoulder muscles (trapezius and deltoid), two upper arm muscles (biceps and triceps), and four forearm muscles (flexor digitorum superficialis, extensor digitorum, extensor carpi radialis longus and extensor carpi ulnaris) and analyzed the kinematics and impact forces of the index finger. The results confirmed that the upper limb has two functions. Specifically, activity of the executive distal musculature was increased during tapping at the higher pace, while the activity of the postural upper limb musculature was elevated due to the memory task. We argue that continuously increased muscular activity can lead to fatigue and thus eventually cause musculoskeletal complaints. The results are discussed with respect to biomechanical adaptation strategies that deal with the consequences of increased noise in the neuromotor system due to enhanced mental processing.     

Towards the development of a novel experimental shoulder simulator with rotating scapula and individually controlled muscle forces simulating the rotator cuff

A preclinical analysis of novel implants used in shoulder surgery requires biomechanical testing conditions close to physiology. Existing shoulder experiments may only partially apply multiple cycles to simulate postoperative, repetitive loading tasks. The aim of the present study was therefore the development of an experimental shoulder simulator with rotating scapula able to perform multiple humeral movement cycles by simulating individual muscles attached to the rotator cuff. A free-hanging, metallic humerus pivoted in a polyethylene glenoid is activated by tension forces of linear electroactuators to simulate muscles of the deltoideus (DELT), supraspinatus (SSP), infraspinatus/teres minor and subscapularis. The abductors DELT and SSP apply forces with a ratio of 3:1 up to an abduction angle of 85°. The rotating scapular part driven by a rotative electro actuator provides one-third to the overall arm abduction. Resulting joint forces and moments are measured by a 6-axis load cell. A linear increase in the DELT and SSP motors is shown up to a maximum of 150 and 50 N for the DELT and SSP, respectively. The force vector in the glenoid resulted in 253 N at the maximum abduction. The present investigation shows the contribution of individual muscle forces attached to the moving humerus to perform active abduction in order to reproducibly test shoulder implants.     

Scapular muscle activation and co-activation following a fatigue task

Scapular muscles precisely move the scapulothoracic articulation and if fatigued may contribute to pathology. Fatigue of serratus anterior may be a mechanism for shoulder pathology by altering scapula motions and requiring compensation by other shoulder muscles. A total of 28 asymptomatic subjects performed a task to fatigue the serratus anterior, while muscle activity was recorded from three muscles. Mean normalized activation levels and activation ratios were examined before and after the fatigue task during arm elevation and lowering. All muscles demonstrated meaningful declines in the median frequency of the electromyographic signal during the task. Following the task, only the upper trapezius had higher mean activation levels (mean difference 10.79% MVIC), while the serratus anterior/lower trapezius activation ratio was altered (mean difference −0.3). Higher mean upper trapezius activation may be compensatory for fatigue of other shoulder muscles and may reflect fiber type or central control mechanisms. Serratus anterior eccentric endurance training may be beneficial for the prevention of shoulder pathology.     

Differences in distribution of myofiber types between the supraspinatus and infraspinatus muscles of sheep

Background: The m. supraspinatus stabilizes the shoulder joint to bear the body weight, and the m. infraspinatus assists in extension and flexion of the joint in sheep. Postural muscles have many SO myofibers, whereas locomotory muscles have numerous fast-twitch myofibers. In sheep the distribution of myofiber types within the two muscles, necessary for a better understanding of postural function, remains to be clarified. Methods: Muscle samples were removed from the whole transverse sections of the dorsal, middle, and ventral compartments of the m. supraspinatus and m. infraspinatus of sheep. Myofibers were classified into FG, FOG, SO-1, and SO-2 myofibers by histochemical methods. Results: The distribution of SO myofibers changed more greatly in the m. supraspinatus (15.0–99.1%) than in the m. infraspinatus (24.5–62.3%). SO myofibers were concentrated markedly in the caudal and deep regions near the spine and fossa of the scapula in the m. supraspinatus and distributed more in the medial part than in the lateral part in the m. infraspinatus. Such changes were caused by increases in percentage of SO-2 myofibers and not SO-1 myofibers. The craniolateral regions of the m. supraspinatus and the caudolateral regions of the m. infraspinatus had many fast-twitch (FOG plus FG) myofibers suited for rapid extension and flexion of the shoulder joint. Conclusions: The m. supraspinatus has the compartmentalized, deep, and caudal regions occupied by SO myofibers, which seem to be specialized for maintenance of the joint extension. The medial region of the m. infraspinatus may assist in the joint stabilization. © 1995 Wiley-Liss, Inc.     

Nonuniform distribution of reach-related and torque-related activity in upper arm muscles and neurons of primary motor cortex

The present study examined the activity of primate shoulder and elbow muscles using a novel reaching task. We enforced similar patterns of center-out movement while the animals countered viscous loads at their shoulder, elbow, both joints, or neither joint. Accordingly, we could examine reach-related activity during the unloaded condition and torque-related activity by comparing activity across load conditions. During unloaded reaching the upper arm muscles exhibited a bimodal distribution of preferred hand direction. Maximal reach-related activity occurred with hand movements mostly toward or away from the body. Arm muscles also exhibited a bimodal distribution of their preferred torque direction. Maximal torque-related activity typically occurred with shoulder-extension/elbow-flexion torque or shoulder-flexion/elbow-extension torque. Similar biases in reach-related and torque-related activity could be reproduced by optimizing a global measure of muscle activity. These biases were also observed in the neural activity of primary motor cortex (M1). The parallels between M1 and muscular activity demonstrate another link between motor cortical processing and the motor periphery and may reflect an optimization process performed by the sensorimotor system.     

Function of the shoulder muscles during arm elevation: an assessment using positron emission tomography

Although 2‐deoxy‐2‐[¹⁸F]fluoro‐D‐glucose (FDG) positron emission tomography (PET) has been used for the assessment of skeletal muscle activities, its application to the shoulder muscles is only sparse. The purpose of this study was to investigate the activities of the shoulder muscles during arm elevation using PET. Six healthy volunteers performed an arm elevation exercise before and after FDG injection. The exercise consisted of 200 repetitions of arm elevation in the scapular plane with a 0.25‐kg weight fixed to the wrist on both arms. PET examination was performed 50 min after FDG injection. For control data, PET scan was repeated for each subject on a separate day without any exercise. The volume of interest was established for each shoulder muscle. The subscapularis was divided into three portions (superior, middle, and inferior). The standardized uptake value (SUV) was calculated in each muscle to quantify its activity. The SUVs increased significantly after exercise in the deltoid, supraspinatus, and the superior portion of subscapularis. Among three divided portions of the subscapularis, the SUV of the superior one‐third was significantly greater than the rest of the muscle after exercise. Our current study clearly indicated that there were two functionally different portions in the subscapularis muscle and the superior one‐third played an important role during arm elevation in the scapular plane.     

Moment arms of the muscles crossing the anatomical shoulder

The objective of the present study was to determine the instantaneous moment arms of 18 major muscle sub-regions crossing the glenohumeral joint during coronal-plane abduction and sagittal-plane flexion. Muscle moment-arm data for sub-regions of the shoulder musculature during humeral elevation are currently not available. The tendon-excursion method was used to measure instantaneous muscle moment arms in eight entire upper-extremity cadaver specimens. Significant differences in moment arms were reported across sub-regions of the deltoid, pectoralis major, latissimus dorsi, subscapularis, infraspinatus and supraspinatus (P < 0.01). The most effective abductors were the middle and anterior deltoid, whereas the most effective adductors were the teres major, middle and inferior latissimus dorsi (lumbar vertebrae and iliac crest fibers, respectively), and middle and inferior pectoralis major (sternal and lower-costal fibers, respectively). In flexion, the superior pectoralis major (clavicular fibers), anterior and posterior supraspinatus, and anterior deltoid were the most effective flexors, whereas the teres major and posterior deltoid had the largest extensor moment arms. Division of multi-pennate shoulder muscles of broad origins into sub-regions highlighted distinct functional differences across those sub-regions. Most significantly, we found that the superior sub-region of the pectoralis major had the capacity to exert substantial torque in flexion, whereas the middle and inferior sub-regions tended to behave as a stabilizer and extensor, respectively. Knowledge of moment arm differences between muscle sub-regions may assist in identifying the functional effects of muscle sub-region tears, assist surgeons in planning tendon reconstructive surgery, and aid in the development and validation of biomechanical computer models used in implant design.     

Infraspinatus and Supraspinatus Tendon Strain Explained Using Multiple Regression Models

Supraspinatus tendon tears are complex yet common. We have shown that the supraspinatus and infraspinatus tendons interact, indicated by parallel changes in strain in the supraspinatus and infraspinatus with increasing size of supraspinatus tear, load applied to the supraspinatus, and changes in glenohumeral rotation but not abduction angle, suggesting disruption in the interaction between the two tendons with increase in abduction angle. While considering these factors individually is valuable, the contribution of each factor in the context of all others on strain in the supraspinatus, or on the interaction between the two tendons is unknown and has important implications in the management of rotator cuff tears. In this study, regression models using least-square estimation with backward and forward elimination were used to predict strains in the infraspinatus and supraspinatus from joint position, supraspinatus load, and supraspinatus tear size or repair. Interestingly, despite previous findings showing that supraspinatus tear size significantly affects infraspinatus strain, tear size was not a significant predictor of infraspinatus strain, emphasizing the importance of other factors evaluated such as joint position and shoulder loading in management of cuff tears and postoperative care. A better understanding of the loading environment in rotator cuff tendons necessitates multifactorial complex models.