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Musculoskeletal stress markers (MSM):

methodological reflections

Valentina Mariotti, Marco Milella, Maria Giovanna Belcastro

Laboratorio di Bioarcheologia e Osteologia ForenseDipartimento di Biologia Evoluzionistica Sperimentale

Via Selmi, 3 - 40126 Bologna, Italia


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1. Terminology

MSM: Hawkey and Merbs (1995): marks that occur where a muscle, tendonor ligament inserts onto the periosteum and into the ubderlying bony cortex.

Invalidant conditions (fractures,luxations, amputations, etc.)

Some pathologies(DISH, etc.)

age

Type and/or level ofphysical activity

Individual factors(genetics)

Bone architecture

Habitualpostures

Markers of occupational stress(MOS)


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very prominent,but surfacesmooth

not prominent,but surfacerough

evidententhesophyte

very prominentmedial border

smallenthesophyte

enthesophytes,erosions

pitting

??ENTHESOPATHY??

Sardinia,ossuary


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(Mariotti et al., 2004, 2007)

Robusticity : normal surface irregularity or rugosityosteolytic lesion ( OL): presence of pitting or eroded areas

enthesophitic formation ( EF): presence of enthesophytes

MSM(Hawkey and Merbs, 1995)

Robusticity marker : normal reaction to habitual muscle usageseen in its mostextreme expression as sharp ridges, or crests, of bone.

Stress lesion : pitting, or furrow, into the cortex to the degree it superficiallyresembles a lytic lesion.

Ossification exostosis : exostosis, or bony spur.

Pathological

1. denoting an abnormal finding, particularly a morphological alteration

2. resulting from disease(International Dictionary of Medicine and Biology, Whiley and Sons, 1986)

pathological boneresponse to stress.

Enthesopathy


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2. Scoring method

Descriptive standard for evaluation of

type of bone change (ROB, EF, OL)

degree of development

Standardised scoring methodReproducible observationsComparable results

MSMqualitative nature + continuous variation

macroscopic observationsubjectivity

23 entheses ofpostcranial skeleton


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1a 1b 1c 32

1a - slight impression : the surface is practically smooth, even though an oblique line is perceptibleto the touch.

1b low development : the insertion is marked by a line of rugosity.

1c medium development : the line of insertion is marked by obvious rugosity, or there is a slightcrest with smooth surface.

2 - high development : definite crest, possibly discontinuous, but with obvious rugosity.

3 very high development : very raised and rugose crest.

ROBUSTICITY (standard different for each enthesis) (Mariotti et al ., Coll. Antrop., 2007)1 low to medium development

2 high development

3 very high development M. SOLEUS

Interobserver error: about 20%


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ENTESOPATHIES (standard applicable to any enthesis)(Mariotti et al ., Coll. Antropol., 28 (1), 2004)

1 2 3

ENTESOPHYTIC FORMATION (EF)

0 absence

1 - minimal exostosis (4 mm)nr more than 50% of the area isillegible

Interobserver error : about 5%


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OSTEOLYTIC FORMATION (OL)0 - absence

1 - fine porosity (holes 4 mm)nr more than 50% of the area isillegible

1 2 3ba

1 2

1: pitting 2 and 3: erosions

Attention !!!

1


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m.brachioradialis

m.deltoideus

m.lat.dorsii/teres m.

m.pectoralis major

humerus

m.deltoideus

m.pectoralis major trapezoid lig.

conoid lig.

202202costoclavicular lig.

clavicle102001cm.triceps brachii

scapula

OLEFrob.OLEFrob.OLEFrob.OLEFrob.

rightleftrightleftYA/MA/OA/NIM / F / NIYA/MA/OA/NIM / F / NIsex / age

N 33Specimen

Data collecting form

3 I i


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Identification of the factors that influence the expression of MSM3. Interpretation

Difficulty of recognising which factors are responsible for the featureobserved and to which extent, respectively

1. multifactorial etiology (genetic and environmental factors)

age

genetics

diseaseactivity

sex factors

2. monotone bone response to stress (bone production bone resorption)

No biunivocal

correspondencebetweenetiologicalfactors andbone changes

bl h


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living persondry boneMaterial

symptoms, anamnesis,medical tests, evolution of

disease

pattern of bonyalterations

Diagnosis

dynamic prcessstatic situationEvolution

possiblenot possibleSoft tissuesobservation

indirect(x-rays, tomography, etc.)

direct(> resolution)

Bone observation

diseasevariabilityInterestMedicalAnthropologicalApproach

1. Anthropological: study of identified skeletal collections (known age, sex, etc.)

2. Medical: clinical cases of occupational and sports medicine

Possible approaches:


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The Frassetto identified skeletal collections (known age, sex, occupation)(Museum of Anthropology, University of Bologna, Italy)

Sassari (SS Sardinia, Italy), end of 19 th -beginning of 20 th c.

(pathological specimens or specimens with uncertain age excluded)

486

212

274

Tot

Tot

Females

Males

163155168

626684

1018984

> 50(OA)

36-50(MA)

20-35(YA)

occupation known: 173 M (39% farmers)

125 F (95% housewives)


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entheses grouped into six FUNCTIONAL COMPLEXESupper limb: shoulder, elbow -flexion/extension,forearm-pronation/supinationlower limb: hip, knee, foot

Mean score : mean degree of development of theentheses of each functional complex

METHODSMales

L RYA MA OA

Females

L RYA MA OA

frequencies (%) for each ENTHESIS :

ROB: grades 1, 2+3 (low-medium / high development)EF: grades 0+1, 2+3 (absence / presence)

OL: grades 0, 1, 2+3 (absence / pitting / erosions)

- differences among age

classes in M and Frespectively: p ( 2)

- differences betweensexes or sides withineach age class: p (Fisher)

-relation age/score:Spearman R and

relative p value-side differences:Wilcoxon matched pairstest

- sex and activitydifferences: Mann-Whitney U test

ROBUSTICITY BILATERAL ASYMMETRY


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0,4420,3270,5070,3070,0140,790foot

0,5480,1720,3750,8080,5130,557knee

0,1840,2650,0290,2450,8260,638hip0,4920,0580,0710,7120,1640,818lower limb0,1720,0200,1140,5100,1120,038forearm

0,0010,0190,0280,9940,5040,980elbow0,0000,0000,0010,8950,0410,000shoulder

0,0000,0000,0000,6280,0690,000upper limbpppppp

N=86-96N=70-82N=61-75N=50-61N=51-63N=59-75

OAMA YAOAMA YA

MFL / R

ROBUSTICITY BILATERAL ASYMMETRY(Wilcoxon matched pairs test)

1. bilateral asymmetry in both sexes upper limb

2. bilateral asymmetry decreases with age in F, remains stable in M

ROBUSTICITY SEX DIFFERENCES


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ROBUSTICITY SEX DIFFERENCES(Mann-Whitney U test)

2,652,590,0402,211,981,491,40foot2,172,361,921,921,461,42knee2,522,912,162,261,731,75hip2,372,582,052,031,521,51lower limb

1,852,551,561,580,0311,120,93forearmR2,002,430,0261,692,011,491,47elbow2,022,351,901,900,0361,731,61shoulder

0,0321,992,441,771,880,0441,551,46upper limb0,0082,632,812,111,991,541,35foot

2,182,331,881,851,471,38knee2,482,882,162,241,731,66hip

0,0052,372,612,032,011,551,45lower limb

0,0001,852,471,471,500,0211,070,88forearmL2,022,311,731,951,461,44elbow2,012,221,841,761,571,51shoulder

0,0051,982,301,761,771,461,36upper limbpFMpFMpFM

OAMA YAmean score

F>M M>F or F>M M>F

CORRELATION ROB AGE


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CORRELATION ROB - AGE

pM; OA: M>F

Hp: young F worked hard developed entheses in spite of the

young age

lower correlation coefficient with age

Mechanical stress or sex factors?

Frequency of EF (2+3%)


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0,00038,719,04,30,00032,316,94,3Achilles tendon CA

0,8444,03,42,50,1767,12,32,5m.soleus TI0,04613,19,42,60,06212,18,02,5qudriceps tendon TI

0,00119,511,51,30,00020,910,30,0quadriceps tendon PA

0,07912,04,54,80,00315,06,81,2m.iliopsoas FE

0,01010,93,90,00,0806,53,60,0m.triceps brachii UL

0,2074,13,50,00,0757,22,31,2m.biceps brachii RA

0,3305,02,31,30,0065,90,00,0m.deltoideus CL

N=92-101 N=76-89 N=67-84 N=91-101 N=78-88 N=70-83

P( 2)OAMA YAP( 2)OAMA YA

RIGHT LEFT Males

0,00062,515,04,00,00056,114,87,4Achilles tendon CA

0,2931,60,00,01,60,00,0m.soleus TI

0,7131,73,11,20,2763,33,00,0qudriceps tendon TI0,00036,813,61,40,00032,115,03,9quadriceps tendon PA

0,0568,11,61,30,00013,10,00,0m.iliopsoas FE

0,0467,50,01,61,91,71,4m.triceps brachii UL

0,1064,91,60,05,00,00,0m.biceps brachii RA

0,00012,90,00,00,00011,50,00,0m.deltoideus CL

N=53-62 N=57-66 N=63-83 N=57-61 N=60-66 N=74-82

P( 2)OAMA YAP( 2)OAMA YA

RIGHT LEFT FemalesFrequency of EF (2+3%)

Males - LEFT Frequency of OL (1% - 2+3%)


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0,0

5,0

10,0

15,0

20,0

25,0

30,0

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Females - LEFT

YA

MA

OA

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

c o s

t o c

l a v .

C L

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b i c e p s

b r .

R A

s o

l e u s

T I

YA

MA

OA

PITTING (grade 1) EROSIONS (grade 2+3)

Frequency of OL (1% 2 3%)

Males

significant differences amongage classes

pitting (OL 1) increases withage

erosions (OL 2+3) decreaseswith age (except m. biceps brachii )

Females

no significant differencesamong age classes (except m.biceps brachii )

no age pattern

erosions more frequent in Mpitting more frequent in F

PITTING (grade 1) EROSIONS (grade 2+3)

R Humerusd

R Tibia( )

R Humerusf ( )


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EROSIONS PITTING

Males

erosions juvenile featurepitting elderly feature

Sardinia, ossuaryVCN t. 155 (Y)

m. soleus

Tf XXVII-2 (M?, Y)

L HumerusSS 296 M, 62 y.

m. pectoralis major

m. pectoralis major

m. latissimus dorsii / teres major

bone metabolism changes throughtime, bone response thus different?


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OCCUPATION

Males with known occupation

173 males with known occupation, performing 47 different jobs!

39% farmers, 5% masons

237313traders/employees

173565958MALES

49231511other

craftsmen

farmers

3410915

67163219

TotOAMAYA

Few significantdifferences

between jobs

Concluding remarks 1


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Entheses and enthesopathies as activity markers

age markers influenced by activity

instead of

activity markers influenced by age!

Increasing development of ROB and EF with age adaptive response ofthe bone to microtraumas from normal body movements accumulating over time.EF, OL more frequent at some entheses: maybe in relation to the anatomical structure of the enthesis

g

The increased surface area created at the tendon-bone junction may be an adaptive mechanism to ensure the integrity of the interface in response to increased mechanical loads.

Bony spur formation in the rat Achilles tendon is essentially an extension of normal bone development and is endochondral ossification through fibrocartilage rather than hyaline cartilage . (Benjamin et al., 2000 )



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But a hope remains 1. The study of homogeneous samples with respect

to the occupation gave interesting results (seeMilella et al. on porters and shoemakers -TOMORROW!!!)

2. The study of MSM and joint features inindividuals with altered patterns of locomotionhighlighted the influence of mechanical stress, inagreement with medical data (Belcastro and Mariotti,2000; Mariotti and Belcastro 2001)

Two Roman skeletons fromCasalecchio (Bologna, II-III AD)

3. Our results are referred to only 23 entheses,and maybe other entheses are more sensible tomechanical stress

4. We analised only the Sassari sample, but thereare many other known collections that can bestudied and that may give different results



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To obtain reliable results about past activities:1. Exclude individuals affected with diseases influencing the features

considered (e.g. DISH)

2. Exclude individuals with generalised high or low development of enthesesConsider only individuals presenting - clear bilateral asymmetry

- only some entheses developed

3. Compare groups of the same sex and age class (or at least with the sameage distribution), better if MA (or YA)

4. Consider all the possible activity markers (not only MSM)

5. Be very careful in the interpretation (taking into account possible sampling

problems, the age, and, obviously, the archaeological or historical record)

g

Scoring method:

Record ROB, EF and OL separately: they do not behave in the same wayin relation to age

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