2. VIMS Labs Functional anatomy Functional anatomy Muscle & joint mechanics Muscle & joint mechanics Bone/cement/stem stresses Bone/cement/stem stresses EF adjustability & rigidity EF adjustability & rigidity Implant design & testing Implant design & testing Operative planning Operative planning

3. Biomechanics of TOS Neurogenic thoracic outlet syndrome (nTOS) is controversialNeurogenic thoracic outlet syndrome (nTOS) is controversial TO Area (TOA) has yet to be defined and measured in 3DTO Area (TOA) has yet to be defined and measured in 3D Objectives:Objectives: - DEFINE TOA in 3D - VISUALIZE and QUANTIFY TOA change in 3 provocative maneuvers (Dr. Kato of Iwate Uni.)

4. Costoclavicular Space Between first rib, clavicle(subclavius), first rib and scapulaBetween first rib, clavicle(subclavius), first rib and scapula Compression of subclavian artery, vein and brachial plexusCompression of subclavian artery, vein and brachial plexus Pectoralis Minor Space Interscalene Triangle

5. Costoclavicular Space Sternum 1 st Rib 2 nd Rib Clavicle Scapula

6. Wright’s Test Loss of Pulse with Inspiration Military Brace or Eden Test Drooping test Provocative maneuver for TOS

7. Thoracic Outlet Syndrome Drooping Test Eden Test Wright Test

8. 2D DEA of Carpal Contact Stress Dr. Iwasaki, Hokaido Uni.

9. Radial-Ulnar-Carpal & Intercarpal Contact Force

10. Involved Normal Kienböck Disease 3B

11. Carpal Contact Stress using DEA Simulation

12. VIMS - Model The carpal skeletal complex Dr. Iwasaki & Dr. Genda

13. 3D Contact Area for DEA Radioulnar/Carpal; Carpal/Metacarpat

14. Wrist Ligaments

15. 3D Contact Area/Stress of Distal Radius & Ulna Intact STT SC CH

16. Validation of Carpal Contact Area & Pressure Prof. Hara, Niigata U; Dr. Ide, Yamanashi U

17. Fracture reduction & planning using VIMS Dr. Kim of Korea, J. Lim & R. Armiger

18. Fracture reduction, joint contact & ligament stress under EF

19. Glenohumeral & Scapulothoracic Motion Rhythm Sagittal & Coronal Plane Elevation M. Fung & Dr. Kato

20. DEA (Discrete Element Analysis) Rigid body spring modelRigid body spring model Spring deformity determines joint contact pressure and ligaments tensionSpring deformity determines joint contact pressure and ligaments tension Concept

21. DEA Model Development