1. 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.

2. 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.

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

4. 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)

5. 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).

6. The Structure of Entheses
Entheseal Structure at the Calcaneal tendon insertion. (Paxton 2014)

7. Histological Zones of Fibrocartilaginous Entheses
(Supraspinatus Insertion Prepared Slide: Adapted from Benjamin et al., 1986)

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

9. 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)

10. The Location of the Milwaukee County Poor Farm Cemetery

11. Life at the Milwaukee County Grounds
The Milwaukee County Almshouse, Circa 1917
(Courtesy of the Wisconsin Historical Society)

12. Life at the Milwaukee County Grounds
Above, residents of the County Home For Dependent Children, 1912 (Courtesy of the Milwaukee County Historical Society)

13. Study Design Sample 40 Individuals Selected.
Osteologically estimated sex for each is male.
Osteologically estimated ages range
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.

14. 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).

15. 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

16. 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.

17. 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)

18. 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)

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

20. Digitizing with the Microscribe G2

21. Three Dimensional Rendering of Left Subscapularis

22. The effect of Age

23. The effect of Age

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

25. The effect of Pathology

26. The effect of Pathology

27. 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

28. Thank you.

29. References

30. References

31. References