Entheses and Activities: The Effects of Entheseal Change for Individuals

from the Milwaukee County Institution Grounds Population

Jessica SkinnerUniversity of Wisconsin-Milwaukee

80th Annual Meeting of the Society for American Archaeology, San Francisco, 15-19 April 2015.

Symposium: People that no one had use for, had nothing to give to, no place to offer: The Milwaukee County Institution Grounds Poor Farm Cemetery

This study aimed to further the work of representing and contextualizing the life experiences of those interred in the cemetery through entheseal change analysis using a replicable non-metric scoring method and 3D geometric morphometric analysis. In addition this project validated a multi-factorial approach to understanding osteological change through the insertion sites of the primary rotator cuff muscles.

A crew digging a trench and laying drain tile. Date Unknown. (Courtesy of the Wisconsin Historical Society)

Osteological Change and Life Lived

Features of Osteological Change

(Boyl and Kim 2011)

“Comparison of the trabecular architecture of the human proximal femur between (a): Wolff’s original analytical trajectory (Wolff, 1892,1986), (b) A natural proximal femur radiograph (Skedros and Baucom, 2007), and (c) A simulated radiograph based on the final computational results.” (Boyl and Kim 2011)

Direct attachmentAttach to long

bone diaphysesCranial ElementsVertebrae

Fibrous Fibrocartilagino

us

Attach in four zones

Attach to long bone epiphyses

Some short bonesSome areas of the

Vertebrae

(Villotte 2012:3).

The Structure of Entheses

Entheseal Structure at the Calcaneal tendon insertion. (Paxton 2014)

Histological Zones of Fibrocartilaginous Entheses

(Supraspinatus Insertion Prepared Slide: Adapted from Benjamin et al., 1986)

Enthesitis observed on the talus and calcaneus using X-ray and MRI (Haibel and Sieper 2015)

A 25 year old male with ankylosing spondylitis. A 1.5 T whole-body MRI coronal STIR illustrates subcoracoid (noted with arrows) and effusion in the acetabulum (noted by points). This study provides evidence of enthesitis presenting in conjunction with ankylosing spondylitis.

(Eshed, e al 2007)

The Location of the Milwaukee County Poor Farm Cemetery

Life at the Milwaukee County Grounds

The Milwaukee County Almshouse, Circa 1917(Courtesy of the Wisconsin Historical Society)

Life at the Milwaukee County Grounds

Above, residents of the County Home For Dependent Children, 1912 (Courtesy of the Milwaukee County Historical Society)

Sample40 Individuals Selected.Osteologically estimated sex for each is male.Osteologically estimated ages range 30-55+The left humerus is the preferred standard.

Data CollectionEntheseal Change Assessment based on

Henderson and Villotte (2012). Geometric Morphometric landmarks collected

using MicroscribeG2 3D digitizer.3D Geometric Morphometric landmarks

analyzed using Geomorph, a package in R.

Study Design

Standardized sex estimation methods from Buikstra and Ubelaker (1994), Phenis(1969) and White(2012), as well as metric assessment methods from Steele(1978), Spradley and Jantz (2011), and Stewart (1979)

Mean age estimated using standardized methods from Brooks and Suchey (1990), Osborne et al (2004), and Buikstra and Ubelaker (1994).

Standardized Osteopathology Methods: Ortner (2003, 2012), Larsen (1997), White (2014), Mewre (2010), Mays (1996), and Waldron (2006).

Age, Sex, and Pathology Assessment

The Primary Rotator Cuff Muscles

o Subscapulariso Supraspinatuso Infraspinatuso Teres Minor

o Each muscle inserts at an acute angle to attachment sites on the proximal humerus

o This acute angle attachment provides stability to the shallow glenohumeral joint.

o This joint in particular provides a large range of motion but is highly susceptible to stress.

Infraspinatus

Tere

s Min

or

Supraspinatus

Subscapularis

atus

Consistent with these methods, the contour opposite the acute angle at which the fibers attach as well as the other areas of the surface and margin of the enthesis were observed.

Features observed on the entheses were scored through a 2 and 3 point degree of expression method and included bone formation, erosions, which are “depressions or excavations involving discontinuity of the cortex”(Henderson et al 2012), pores, and cavitations.

This scale and the entheses examined are delineated on the tables in Table 1.

Entheseal Change Assessment

Zone 1Margin opposite acute angle of

fiber attachment 

Bone Formation BF (Z1)  1 = Small, nodular or slightly raised margin < 1mm 2 = Distinctive sharp crests or other enthesophytes. ≥ 1mm but < 50% of margin 3 = Distinctive sharp crests or other enthesophytes ≥ 1mm but ≥ 50% of margin 

  Erosion ER (Z1)Depressions or

excavations of any shape and involving

discontinuity of the cortex generally greater in width than depth with

irregular margins. Only erosions >2 

mm were recorded

 1 = < 25% of margin2 = 25 to 50% of margin3 = > 50% of margin 

Scoring methods

(Feature, Porosity, Bone Formation, and Cavitation

Scoring Table adapted from Henderson 2010)

Scoring MethodsZone 2 Bone Formation BF  

1=”Roughness/rugosity, change is diffuse, not a distinct structure 2= distinct structure measuring >1mm, affecting < 50% of the surface. 3= distinct structure measuring > 1mm, affecting ≥ 50% of surface 

Remaining Margin Erosion ERDepressions or

excavations of any shape and involving

discontinuity of the cortex generally greater in width than depth with irregular margins. Only erosions >2 mm were

recorded

 1 = < 25% of surface2 = 25 to 50% of surface3 = > 50% of surface 

And Surface Fine Porosity ≥ 1mm FPOSmall, round to oval

perforations with smooth, rounded margins

≤1 mm

 1 = < 50% of margin2 = > 50% of margin 

  Macro-Porosity MPOSmall, round to oval

perforations with smooth, rounded margins

>1 mm

 1 = one or two pores2 = > 2 pores 

  Cavitation CASubcortical cavity with an external opening smaller than the maximum diameter of the cavity

 

 1 = one cavitation2 = two or more cavitations  (Adapted from Henderson 2010)

(Adapted from Henderson 2010)

Zones and feature designation of Entheseal Change Scoring

Digitizing with theMicroscribe G2

Three Dimensional Rendering of Left Subscapularis

The effect of Age

The effect of Age

Morphometric Shape Changes

Subscapularis landmark shape associated with A) Low Entheseal Change Scores B) High entheseal change scores

A) B)

The effect of Pathology

The effect of Pathology

Dr. Patricia RichardsDr. J. Patrick GrayPeter KilloranCatherine JonesShannon FreireBrianne CharlesAdrienne Frie Brooke DrewNick Richards

Thank you to all who made this presentation possible.

Dr. Fred AnapolDr. John RichardsArt AndersenEmily Epstein Alexis JordanDavid StrangeHelen WernerEric BurantThe Wisconsin

Historical Society

Thank you.

Adams, D.C. & Otárola-Castillo, E 2013 Geomorph: an R package for the collection and analysis of geometric morphometric shape data. Methods in Ecology and Evolution. 4:4:393-399.

Arias‐Martorell, J., Potau, J.M., Bello‐Hellegouarch, G., Pastor, J.F. & Pérez‐Pérez, A. 2012 3D geometric morphometric analysis of the proximal epiphysis of the hominoid humerus. Journal of anatomy. 221: 5:394-405.

Brown, E.G.

1976 Poor Relief in a Wisconsin County, 1846-1866: Administration and Recipients. The American Journal of Legal History. 20:2: 79-117.

Cardoso, F.A. & Henderson, C.

2010 Enthesopathy formation in the humerus: Data from known age‐at‐death and known occupation skeletal collections. American Journal of Physical Anthropology. 141:4:550-560.

Cooper, R.R. & Misol, S.

1970 Tendon and ligament insertion. A light and electron microscopic study. The Journal of bone and joint surgery.American volume. 52:1:1-20.

Frost, H.M.

1998 From Wolff's law to the mechanostat: a new" face" of physiology. Journal of orthopaedic science. 3:5:282-286.

Harrold, F., Malhas, A. & Wigderowitz, C.

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Hawkey, D.E. & Merbs, C.F.

1995, "Activity-induced musculoskeletal stress markers (MSM) and subsistence strategy changes among ancient Hudson Bay Eskimos", International Journal of Osteoarchaeology, vol. 5, no. 4, pp. 324-338.

Henderson, C.

2008 When hard work is disease: the interpretation of enthesopathies", BAR INTERNATIONAL SERIES, vol. 1743, pp. 17.

Henderson, C.Y., Mariotti, V., Pany-Kucera, D., Perréard-Lopreno, G., Villotte, S. & Wilczak, C.

2012 The effect of age on entheseal changes at some fibrocartilaginous entheses", American Journal of Physical Anthropology, vol. 147, no. S54, pp. 163.

Henderson, C.Y. & Alves Cardoso, F.

2013 Special issue entheseal changes and occupation: technical and theoretical advances and their applications", International Journal of Osteoarchaeology, vol. 23, no. 2, pp. 127-134.

Henderson, C.Y., Craps, D., Caffell, A., Millard, A. & Gowland, R.

2013 Occupational mobility in 19th century Rural England: the interpretation of entheseal changes", International Journal of Osteoarchaeology, vol. 23, no. 2, pp. 197-210.

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2010, "Scoring entheseal changes: proposal of a new standardised method for fibrocartilaginous entheses", Poster presented at the 18th European Meeting of the Paleopathology Association, Vienna, Austria 23rd–26th of August.

Henderson, C.Y., Mariotti, V., Pany-Kucera, D., Villotte, S. & Wilczak, C.

References

References

Richards, Patricia B. 1997 Unknown Man No. 198: The Archaeology of the Milwaukee County Poor Farm Cemetery. Doctoral Dissertation. University of Wisconsin--Milwaukee.

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