Developing stages of subacromial humeral‐impingement facets in the skeletal remains of two human populations

The humeral impingement disorder (HID) results from degenerative changes in the rotator cuff tendon which allows the humerus to press against the acromion and produce pressure facets on both the acromion and the greater humeral tubercle. A previous study of those below 55 years of age in the two populations defined a system of three morphological categories of subacromial features. The first two categories were postulated to be pre‐impingement while the third, distinguished by erosive pitting at the point of attachment of the cuff to the greater tubercle, was regarded as indicative of degenerative change in the cuff and, therefore, of HID. Extending the study to those over 55 years of age has now added two categories of more advanced HID change. Those on the right side, of dominant use, were always more severe, thus enabling a less severe Category 4 to be distinguished from Category 5, the chief feature of which was a raised facet which could be large or small. Confirmation of the earlier study's conclusions was achieved: the degenerative changes of Category 3 began to be common by 40 years of age in both sexes of the Scottish island people, living physically‐stressed lives; in the more wealthy and sedentary Londoners, this does not occur until 10 years later. Nevertheless, in both sexes in both populations, virtually all those over 65 years of age showed Category 4 or 5 change. It seemed likely that a higher proportion of the Londoners reached advanced ages than among the islanders and so had more time for the progressive disorder to show its full effects; for instance, there were 16 Londoners known to be over 80 years of age. Individuals of that age cannot be distinguished by methods for estimating age from those 15 years or so younger but it was regarded as unlikely that there were more than two or three octogenarians among the islanders. Copyright © 2000 John Wiley & Sons, Ltd.     

New light on the acromial attachment of the human coraco-acromial ligament

According to a largely forgotten statement in the anatomical literature, the coraco-acromial ligament is frequently attached to the undersurface of the tip of the acromion as well as to its medial margin. Surgeons, now able to examine this region via an arthroscope, support this observation. Raised impingement facets on the tip region of the undersurface of the acromion, sometimes eburnated because of actual contact with the proximal humerus, commonly complicate disorders of the shoulder-joint complex and are often associated with ossification extending into the attachment of the coraco-acromial ligament. Such enthesophytes thus appear to preserve in ossified form the morphology of the attachment; many seem to arise from the subacromial surface as continuations of impingement facets. Two early 19th century scapulas are described in which much of the soft tissue covering the subacromial surfaces was preserved in mummified form. One had a large enthesophyte apparently extending into the coraco-acromial ligament; the other included some of the superior layer of the subacromial bursa. In both, a tissue containing prominent fibrous strands orientated in the plane of the ligament covered the tip region of the subacromial surface. Short immersion in a solution of sodium orthophosphate softened the dried tissue sufficiently to enable its components to be separated. The fibrous strands had a firm attachment near the lateral acromial margin and passed free across the surface like a sling supposedly into the coraco-acromial ligament. The sling-like character was emphasized in one specimen by the attachment of some fibres to the tip of the enthesophyte. It is postulated that the sling-like character would assist the main ligament to buffer pressures exerted by the proximal humerus in normal function. © 1998 John Wiley & Sons, Ltd.     

Humeral Impingement on the Acromion in a Scottish Island Population of c. 1600 AD

Apparently-articular facets on the undersurface of the anterior third of the acromion have been known in skeletal material since 1922 but without full discussion of the mechanism responsible. Twelve instances are described here, selected because an impingement area could be demonstrated on the greater tubercle of the humerus or on osteophytes that had replaced it. Both sides were affected but, with two exceptions, the right more severely; the less affected side could be regarded as an earlier stage. All were affected by osteoarthrosis. One was complicated by coraco-humeral impingement. The anatomical mechanism that normally prevents the humerus from rising against the coraco-acromial arch is described as well as the causes of the breakdown in the mechanism that leads to the impingement, derived largely from the clinical field, where the disorder is well-known. The complexity of the relation of the disorder to degenerative arthrosis is discussed because the degeneration is an age change in which wear and tear plays a localized part and the changes as they affect the shoulder joint differ fundamentally from those in the weight-bearing hip-joint. The mean estimated age of the group of twelve was 59 years but the occurrence of the acromion impingement disorder in young athletes illustrates the part played by mechanical joint abuse. Women predominated in this small group, partly because, through their longer life-spans, their joints were exposed longer to the susceptible period of age-related degeneration and also because their less robust musculo-skeletal systems were less adapted than men's to the equally shared labour. Two traditional women's tasks, corn-grinding and tweed-shrinking, are shoulder stressful.     

Skeletal pathology of a high‐ranking official from Thrace (Turkey,last quarter of the 4th century BC)

A male human skeleton from Thrace dated at around 320 BC was found in a wealthy tomb 12 km from what is now Tekirdağ, Turkey. The occupant of the tomb died at the age of 40–45 years and has a pathologic left humerus caused most probably by traumatic injury. It is 9 cm shorter than the right humerus. A drainage fistula penetrating into the medullary cavity occurs at its proximal end. Due to severe arthritic destruction, the left humeral head has completely lost normal articulation, with the glenoid cavity of the left scapula displaying, in turn, severe erosive lesions and important reduction in its articular surface. A marked abscess is discernible bilaterally on the chondro‐costal sternal end. The individual also has a hip with a total sacroiliac joint fusion and shows slight or moderately developed exostoses on different parts of his skeleton. These joint destructions most likely indicate that he suffered from chronic osteomyelitis and septic arthritis. Copyright © 2005 John Wiley & Sons, Ltd.     

Injuries to the skeleton due to prolonged activity in hand-to-hand combat

Two complete skeletons from the Hamman-Todd collection of the Cleveland Museum of Natural History (CMNH) show a suite of pathological lesions that suggest the individuals had been involved in boxing or other hand-to-hand combat. These lesions were studied and compared with medical and autopsy records. The aims of the research were to estimate the accumulated damage to the bones over time, to characterize the different types of the damage, and to establish criteria for hand-to-hand combat or violence for archaeological material. Our inspections showed that besides the muscle markings developed and the numerous healed fractures that are expected when someone is involved in such activities, other types of lesion are present that are helpful for a proper differential diagnosis. These are: degenerative changes at the lesser tuberosity of the humerus; focal necrotic changes/bone growth on the trochlea of the humerus; necrotic changes on the distal head of the ulna; bony patches on upper limb bones only; secondary centres of ossification failing to fuse (mainly in vertebrae and acromion); a huge conoid tubercle on the clavicle; bony spurs on the distal articular head of the metacarpals; necrotic changes on the femoral head next to the fovea and on the roof of the acetabulum; and a developed bony ridge for the attachment of the iliotrochanteric ligament. Finally, we propose a set of criteria that will help to identify people in archaeological material who were involved in hand-to-hand combat.     

Morphological changes in the shape of the non‐pathological bony knee joint with age: a morphometric analysis of the distal femur and proximal tibia in three populations of known age at death

This study examines possible morphological variation in the knee joint of Homo sapiens with increasing age in ostensively healthy and non‐pathological distal femora and proximal tibiae. Throughout the lifetime of each individual, the hard tissue of the knee undergoes considerable remodelling as a response to biomechanical stresses, changes in bone microarchitecture and reduction of bone mineral content as a concomitant of ageing. The knee is also subject to greater levels of degenerative joint disease than any other joint. If death occurs whilst such diseases are in the earliest stages, initial bone changes may not be visually obvious in museum specimens. If such specimens are used for comparative analyses, it is hypothesised that changes might render it problematic if all ages are conglomerated into discrete samples. This study therefore investigates the degree to which the distal femur and proximal tibia change shape during ageing and, if changes are present, whether they are expressed similarly in males and females. It also examines whether changes are of greater magnitude than those morphological differences which might exist between populations. In an example population of African‐Americans, results indicate that there is a statistically significant difference in shape between age groups and those differences become progressively greater between the youngest and oldest adults. Results also show that although morphological variation caused by ageing is apparent, those shape differences attributable to sexual dimorphism are more powerful. When two additional populations are analysed jointly with the African‐Americans (Caucasian Americans and the European Spitalfields sample), results indicate that inter‐population shape differences are considerably greater than differences caused by increasing age. Results imply that it is justifiable to combine specimens of all ages into discrete samples for comparative purposes. Copyright © 2007 John Wiley & Sons, Ltd.     

Ohalo II man—unusual findings in the anterior rib cage and shoulder girdle of a 19000-year-old specimen

The analysis of the skeletal remains of Ohalo II man, aged 30–40 years at death and dated to 19 000 years BP, shows advanced and highly unusual ossification of the lower costosternal cartilage; the right humerus is morphologically larger and considerably more robust than the left; degenerative changes were noted unilaterally in the right glenohumeral, acromioclavicular and claviculosternal joints. There is a marked asymmetry of the atlas, axis and occipital condyles. The changes in the costochondral area of the lower anterior rib cage are considered to represent an infectious chronic osteomyelitic process. The marked discrepancy in size between the left and right shoulder girdles and humeri, and the evidence of degenerative disease exclusively on one side only may be the result of a traumatic brachial plexus nerve palsy. The asymmetrical atlas and axis are most probably anatomical variants that do not reflect clinical pathology.     

Morphological Characteristics of Healthy and Osteoarthritic Joint Surfaces in Archaeological Skeletons

Osteoarthritis is a major health concern in living populations, as well as being one of the most common pathological lesions identified in the archaeological record. The aetiology of the disease remains unclear, with a multi‐factorial influence of physical strain, age, genetics, and obesity. Previous studies have identified a relationship between the presence of knee osteoarthritis on the distal femoral joint and the morphology of the intercondylar notch, patellar groove, and medial condyle. The current study expands this research to investigate the relationship between distal femoral, distal humeral, and proximal ulnar joint morphology and osteoarthritis with 3D shape analysis techniques. These methods provide a more detailed analysis of joint morphology in order to determine any relationship between 3D shape and osteoarthritis. The results indicate a complex relationship between joint shape and knee osteoarthritis, with eburnated right femora showing a statistically significant association. The shapes associated with eburnated or affected femoral joints can be explained by osteophyte development, and therefore likely represent systematic shape changes and not a particular joint shape predisposing individuals to the condition. There was no identifiable relationship found in the proximal ulna or distal humerus, indicating that joint shape is unlikely to influence the development of the condition in the elbow joint and that any shape changes produced by osteoarthritis are not systematic or quantifiable. The joints analysed in this study were highly influenced by asymmetry, sexual dimorphism, and allometry, resulting in a small sample size of affected joints in many datasets. Further analyses of large skeletal samples are needed to more thoroughly investigate the possible relationship of distal femoral joint shape and osteoarthritis. Copyright © 2013 John Wiley & Sons, Ltd.     

An Approach to the Diagnosis of Craniofacial Fibrous Dysplasia from the 2500‐Year‐Old Remains of a Skull from Ancient China

A human skull, buried about 2500 years ago in a Bronze Age cemetery at Jinggouzi, a site of an important ethnic group in ancient China, appeared to have characteristics of fibrous dysplasia. The CT images indicated a reduction in bone density and relatively homogeneous lesions. More features were revealed using CT reconstruction techniques. Lesions seen in low‐magnification images using a 3D deep‐field microscope had an irregular honeycomb‐like structure. At higher magnification, the trabeculae morphology and the gaps between the trabeculae were irregular and varied in size and shape. Paraffin‐embedded specimens stained with HE showed trabeculae with tortuous irregular arrangements varying in shape and width. The irregular trabeculae of woven bone has been described as having fibrous dysplasia. Molecular analysis of the GNAS gene indicated no mutation. This provides a non‐invasive approach for us to make more comprehensive diagnoses and to assist research into ancient human diseases.     

Handedness and directional asymmetry in the long bones of the human upper limb

The long bones of the human upper limb usually show lateral asymmetries of length. This pattern can be attributed either to the mechanical consequences of handedness bias or to genetic or hormonal factors acting directly on longitudinal bone growth. Length data was obtained from the long bones of the upper limbs of a large skeletal assemblage from Wharram Percy, Yorkshire (England), predominantly deriving from the 11th-16th centuries A.D. The Wharram Percy adult skeletons had a population distribution of lateral asymmetries of length in the humerus and in the humerus-plus-radius (a proxy arm length index) which closely parallels the pattern of behavioural handedness found in modern populations. This pattern was developing in the skeletons from the infant and juvenile age ranges, but was absent in the neonates (of whom 12 out of 14 had longer left humeri). We argue that this supports the environmental hypothesis that the ontogeny of long bone length asymmetry is consequent to the earlier development of lateral bias in mechanical loading of the upper limbs.     

Osteoporosis among ancient Egyptians

Osteoporosis is a condition of reduced total bone mass per unit volume for the normal ratio of bone mineral to bone matrix. The present work deals with the investigation and evaluation of osteoporosis in ancient Egyptians of two social classes from the Old Kingdom in Giza. The aims of this study are to provide information about the lifestyle and health status of ancient Egyptians, and to detect the causes of osteoporosis. The material consisted of 74 skeletons (43 males and 31 females) from two different social classes (high officials and workers). Skeletons were excavated from the Giza Necropolis and belonged to the Old Kingdom (2687–2191 BC). Dual energy X‐ray absorptiometry (DEXA) was used to measure bone mineral density (BMD) at different skeletal sites (radius, fourth lumbar vertebra and head of femur). Moreover, scanning electron microscopy (SEM) was used to show the microarchitectural structure of the bone. Results showed a significant decrease of BMD values in old age groups compared with younger ones in both sexes. In addition, SEM of trabecular bone in osteoporotic cases demonstrated that the horizontal trabeculae were more affected than the vertical trabeculae. Comparison between high officials and workers revealed that osteoporosis was more frequent in male workers than in male high officials, and in female high officials than in female workers. An elevated prevalence of osteoporosis among male workers may be related to the effects of nutritional stress and excessive workload, while a sedentary lifestyle may have played a role in the occurrence of osteoporosis among female high officials. Moreover, osteoporosis occurs earlier and more frequently in females than males, which may be related to the hormonal changes that accompany the menopause in females. This study emphasises the importance of gender and lifestyle factors in influencing the severity of osteoporosis. Age‐related bone loss at most skeletal sites is noted in both sexes of ancient Egyptians. Copyright © 2008 John Wiley & Sons, Ltd.     

Scanning electron microscope study of normal vertebrae and ribs from early medieval human skeletons

A method is described for the preparation of vertebral body and rib sections of archaeological context, for scanning electron microscopy (SEM). The specimens included in the present paper are macroscopically normal and are male and female in juvenile and adult age brackets. The changing directionality of trabeculae and the changing ratio of trabecular bone to cancellous space are noted in relation to the age at death.     

Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.     

Multicentric osteosarcoma associated with DISH,in a 19th century burial from England

Osteosarcoma is a rare type of malignant neoplasm that is most frequent in adolescents and young adults although it can develop at any age. It can metastasize from a primary site in bone to other bones and soft tissues. Usually the disorder causes a single bone‐forming lesion (unicentric) but some cases have multicentric, bone‐forming lesions. Some of these lesions develop at different sites at different times. In a second variant of multicentric osteosarcoma, synchronous bone‐forming lesions develop at multiple sites. Distinguishing between these two types of multicentric osteosarcoma is challenging in a clinical context and the criteria for doing so are unlikely to be met in an archaeological burial. Wolverhampton burial HB 39 was excavated from an early‐nineteenth century cemetery site in England. It consists of the incomplete skeleton of an adult male of at least 45 years of age with multicentric osteosarcoma. The individual represented by this burial also had diffuse idiopathic skeletal hyperostosis (DISH). Three of the bone‐forming lesions associated with osteosarcoma developed on the bony outgrowths related to DISH. Copyright © 2010 John Wiley & Sons, Ltd.     

The Sunghir 3 Upper Paleolithic Juvenile: Pathology versus Persistence in the Paleolithic

The Mid Upper Paleolithic Sunghir 3 late juvenile early modern human, from the most elaborate burial in the Pleistocene, had pathologically foreshortened and anteriorly bowed femora and, based on her dental enamel hypoplasias and transverse lines, sustained severe and persistent systemic stress throughout her decade of life. Her modest femoral and tibial asymmetry and her femoral bicondylar angles indicate non‐pathological patterns of posture and locomotion. The levels of rigidity for her weight‐bearing tibiae and the non‐dominant left arm reflect normal weight‐bearing and manipulation. These indicators are combined with an elevated level of right humeral strength, leading to pronounced humeral diaphyseal asymmetry, combined with elevated muscular insertion asymmetry. In combination with marked upper limb muscle markings and normal levels of bone formation, these reflections of her robustness indicate that she was fully mobile and participated actively in the tasks of her social group. There is no indication of the skeletal hypotrophy/atrophy that would be associated with less than full participation in the mobility and subsistence of her social group. As such, Sunghir 3 joins a growing list of developmentally or degeneratively pathological Late Pleistocene humans who nonetheless remained mobile and active. Copyright © 2012 John Wiley & Sons, Ltd.     

Radiographic clues to fractures of distal humerus in archaeological remains

Today, distal humeral fractures occur most frequently in children and adolescents, and are usually the result of a fall onto extended arms, or less often on flexed elbows. Trauma to the distal humerus at the physis and epiphyses often produces non‐displaced or mildly displaced fractures that are difficult to recognize radiographically. To help identify these types of injuries, clinicians have developed two measurement techniques that are applied to the X‐rays of the injured bones. In a preliminary attempt to assess the usefulness of these measurement techniques for recognizing trauma in archaeological skeletal remains, 25 humeri from two Ontario ossuary samples were submitted to radiography. Clinical data on distal humeral fractures, their incidence, and mechanisms of injury were also used to interpret the lifestyles and cultural activities of the aboriginal individuals under study. While only one healed fracture was suspected after gross observation, a total of four fractures were ultimately identified using the two measurements, the humerotangential‐angle (HTA) and the anterior hunieral line (AHL). Our results provide indirect, but telling, evidence of accidental childhood injuries to distal humerus in an archaeological population. Copyright © 2001 John Wiley & Sons, Ltd.     

Histomorphometric analysis of bone tissue from a neolithic skeleton

The histomorphometric analysis of neolithic bone tissue from the radiomorphometricly unaffected 9th thoracic vertebral body of a 20–25 year old man showed significantly elevated bone volume in comparison to the contemporary findings (BV/TV, 28.72% versus 20%). Also the number of trabeculae was clearly higher (Tb.N.: 17.7 cm versus 5.4 cm). The mean width (Tb.Th.) of the plate-shaped trabeculae was 160 μm and 180 μm. Thus, they were significantly wider than current normal findings of 120 μm. These results show a structural, obviously multifactual caused degeneration of spongy bone within the last 6200 years, representing a relatively short period in relation to evolutionary criteria. With regards to the irretrievable loss of preserved bone substance the indication to histomorphometric diagnostic has to be restricted; tissue sampling is only to happen after the carrying-out of all possible non-invasive methods of investigation as well as a comprehensive photo and film documentation. Observing these conditions further fundamental findings for the evolution of bone tissue can be expected through histomorphometry.     

A Roman Skeleton with Possible Treponematosis in the North‐East of the Iberian Peninsula: A Morphological and Radiological Study

The main goal of this paper is to describe and discuss pathological lesions observed in a Roman skeleton (between 2^nd and 3^rd century AD) from the north‐east region of the Iberian Peninsula (St Nicasi 18–24 site. Gavà, Barcelona), which may be compatible with treponematosis. Most of the skeleton, with the exception of the neurocranium, was recovered. Only the left tibia was affected, whereas the rest of the recovered skeletal remains were unaffected. Macroscopic examination revealed a male individual between 25 and 30 years of age at death with a sabre‐shaped left tibia. The proximal half of the diaphysis was pitted and the bone overall enlarged. The surface of the tibia showed occasional vascular impressions where, in some instances, small raised plaques of new bone appeared to bridge over them, specifically in the most affected area of the proximal half of the tibia. No destructive lesions were observed. Radiographic examination and gross inspection at the cross section of the tibia showed encroachment into the medullary cavity of coarse cancellous bone and cancellization of the cortex. The observed lesions indicate that the tibia was affected by a chronic infectious disease. Differential diagnoses were considered, and these included other infectious diseases, fibrous dysplasia, Paget's disease, chronic varicose ulcers affecting bone and trauma, with the conclusion that the disease affecting the tibia could have been treponematosis. This could be significant in the history of the treponematoses being one of the oldest examples of treponematosis in pre‐Columbian Europe. Copyright © 2011 John Wiley & Sons, Ltd.     

Comment on the Analysis of Two Skeletons from Terqa,Syria

Recently, a report on two human skeletons from an Early Bronze Age tomb excavated at Tell Ashara, Syria has been published in International Journal of Osteoarchaeology. One individual was identified as a warrior following these criteria: (i) size and robustness of bones, (ii) cut marks on the humerus, (iii) reduction of the ulnar styloid process, both interpreted as healed weapon‐related trauma, (iv) well‐developed muscle insertions, and (v) degenerative joint disease. Actually, none of these five criteria support the conclusion because of the following reasons: (i) not necessarily all tall and robust men become warriors, (ii) the post mortem origin of cut marks on the humerus is more likely than sharp force trauma, (iii) there are several possible causes of the unusual ulnar styloid shape other than weapon‐related trauma, (iv) the interpretation of musculoskeletal stress markers and (v) degenerative joint disease lacked control for age, sex and body size. Copyright © 2012 John Wiley & Sons, Ltd.     

Temporal changes in Arikara humeral and femoral cross-sectional geometry associated with horticultural intensification

Humeral and femoral cross-sectional properties from three archaeological variants of the Arikara, an American Great Plains Indian tribe, were analyzed for temporal (16th to 19th centuries) changes in long bone architecture, asymmetry, and sexual dimorphism associated with intensification of horticulture during the late protohistoric and early historic periods. There were a number of significant changes in long bone, especially femoral, cross-sectional morphology and asymmetry among females through time that probably reflect increases in the workload necessary to produce surplus crops. Changes in long bone architecture among males are restricted to the humerus and may reflect a greater reliance on firearms. The pattern of sexual dimorphism also changes through time among the Arikara due to a combination of environmental (nutrition and disease) and mechanical factors.