Injuries and degenerative diseases of the shoulder are common and may relate to the joint’s complex biomechanics, which rely primarily on soft tissues to achieve stability. Despite the prevalence of these disorders, there is little information about their effects on the biomechanics of the shoulder, and a lack of evidence with which to guide clinical practice. Insight into these disorders and their treatments can be gained through in-vitro biomechanical experiments where the achieved physiologic accuracy and repeatability directly influence their efficacy and impact.

This work’s rationale was that developing a simulator with greater physiologic accuracy and testing capabilities would improve the quantification of biomechanical parameters. This dissertation describes the development and validation of a simulator capable of performing passive assessments, which use experimenter manipulation, and active assessments – produced through muscle loading. Respectively, these allow the assessment of functional parameters such as stability, and kinematic/kinetic parameters including joint loading.

The passive functionality enables specimen motion to be precisely controlled through independent manipulation of each rotational degree of freedom (DOF). Compared to unassisted manipulation, the system improved accuracy and repeatability of positioning the specimen (by 205% & 163%, respectively), decreased variation in DOF that are to remain constant (by 6.8°), and improved achievement of predefined endpoints (by 21%). Additionally, implementing a scapular rotation mechanism improved the physiologic accuracy of simulation. This enabled the clarification of the effect of secondary musculature on shoulder function, and the comparison of two competing clinical reconstructive procedures for shoulder instability.

This was the first shoulder system to use real time kinematic feedback and PID control to produce active motion, which achieved unmatched accuracy (<​1°) and repeatability (0.3°). Additionally, the controller increased the physiologic accuracy of motion simulation, compared to previous systems. Using these developments and custom designed adjustable instrumented Reverse Total Shoulder Arthroplasty implants, the effects of implant parameters on muscle loading and joint load were assessed throughout active motion. This study provided new insights, unattainable without this research’s developments.

These developments can be a powerful tool for increasing our understanding of the shoulder and also to provide information which can assist surgeons and improve patient outcomes.