University of Wisconsin-Milwaukee Entheses and Activities: The Effects of Entheseal Change for Individuals from the Milwaukee County Institution Grounds Population Jessica Skinner University of Wisconsin-Milwaukee 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 80th Annual Meeting of the Society for American Archaeology, San Francisco, 15-19 April 2015.

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.

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

Features of Osteological Change “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) (Boyl and Kim 2011)

Fibrous Fibrocartilaginous Direct attachment Attach to long bone diaphyses Cranial Elements Vertebrae Attach in four zones Attach to long bone epiphyses Some short bones Some 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 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)

Study Design Sample 40 Individuals Selected. Osteologically estimated sex for each is male. Osteologically estimated ages range 30-55+ The left humerus is the preferred standard. Data Collection Entheseal 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.

Age, Sex, and Pathology Assessment 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).

The Primary Rotator Cuff Muscles Supraspinatus atus Subscapularis Supraspinatus Infraspinatus Teres Minor Each muscle inserts at an acute angle to attachment sites on the proximal humerus This acute angle attachment provides stability to the shallow glenohumeral joint. This joint in particular provides a large range of motion but is highly susceptible to stress. Infraspinatus Teres Minor Subscapularis

Entheseal Change Assessment 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.

Margin opposite acute angle of fiber attachment Scoring methods Zone 1 Margin 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 margin 2 = 25 to 50% of margin 3 = > 50% of margin (Feature, Porosity, Bone Formation, and Cavitation Scoring Table adapted from Henderson 2010)

Scoring Methods (Adapted from Henderson 2010) Zone 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 ER 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 surface 2 = 25 to 50% of surface 3 = > 50% of surface And Surface Fine Porosity ≥ 1mm FPO Small, round to oval perforations with smooth, rounded margins ≤1 mm 1 = < 50% of margin 2 = > 50% of margin Macro-Porosity MPO Small, round to oval perforations with smooth, rounded margins >1 mm 1 = one or two pores 2 = > 2 pores Cavitation CA Subcortical cavity with an external opening smaller than the maximum diameter of the cavity 1 = one cavitation 2 = two or more cavitations (Adapted from Henderson 2010)

(Adapted from Henderson 2010) Zones and feature designation of Entheseal Change Scoring (Adapted from Henderson 2010)

Digitizing with the Microscribe G2

Three Dimensional Rendering of Left Subscapularis

The effect of Age

The effect of Age

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

The effect of Pathology

The effect of Pathology

Thank you to all who made this presentation possible. Dr. Fred Anapol Dr. John Richards Art Andersen Emily Epstein Alexis Jordan David Strange Helen Werner Eric Burant The Wisconsin Historical Society Dr. Patricia Richards Dr. J. Patrick Gray Peter Killoran Catherine Jones Shannon Freire Brianne Charles Adrienne Frie Brooke Drew Nick Richards

Thank you.

References

References

References