My STEAM project is an infusion of Leonardo da Vinci’s Vitruvian man, his illustrations of the shoulder, and my watercolor booklet paintings with a focus on Shoulder Impingement Syndrome.
Objective: Identify all 22 tissues from slides using your watercolor booklet.
Leonardo da Vinci is a famous Renaissance artist who was a master of mathematics, arts, and sciences. He is well known for multiple masterpieces including the Mona Lisa and The Last Supper. Among his works is the Vitruvian Man which he illustrated in the fifteenth century as an attempt to display the principles of Vitruvius, a Roman architect’s mathematical description of the human body in his book entitled De architectura. At first glance, you may see only two poses of the man but Leonardo created the image to showcase sixteen possible views of the outstretched limbs. Additionally, the square symbolizes the universe (divine) while the circle represents earth (Richman-Abdou, 2018).
I have in my bookshelf a hardcover of Martin Clayton and Ron Philo’s “Leonardo da Vinci: The Mechanics of Man” which I highly recommend to anyone with a passion for anatomy and medicine. In this book you will encounter da Vinci’s sketches and texts of the human body as he investigated cadavers in University of Pavia Medical School through dissection. Leonardo intended to publish this material to contribute to scientific research and the transformation of human anatomy in Europe, however his death in 1519 discontinued these goals. It was not until the modern era were these fully published and understood. One of the most detailed and densest of Leonardo’s anatomical sheets comprised of the shoulders and the arm.
The shoulder consists of bones (humerus, clavicle, and scapula), joints (glenohumeral, acromioclavicular, and scapular-thoracic) ligaments (acromioclavicular, coracoclavicular, costoclavicular, coracohumeral, coracoacromial, and glenohumeral), muscles and tendons (biceps tendon, supraspinatus, infraspinatus, teres minor, and subscapularis), as well as cartilage. These structures work together to perform a variety of ranges of motion such as flexion, abduction, adduction, and extension (UT Health San Antonio, n.d.). Shoulder impingement syndrome occurs when there is compression of the rotator cuff and subacromial bursa (Dong et al., 2015). Over time, rubbing of the rotator cuff between the humerus with the acromion could result to the rotator cuff tendon swelling or inflaming (tendinitis) or the bursa inflaming (bursitis) and a delay in treatment could potentially cause rotator cuff tear (Rotator cuff / Impingement, n.d.).
In the United States Military, shoulder impingement cases are more likely for individuals who are forty years old and above (Hsiao et al., 2015). A bulk of this age group consists of senior-ranking enlisted and commissioned military personnel who have experienced physically-demanding activities over the years. In 2019, it was reported that the third most frequent complaint at military medical encounters were upper musculoskeletal injuries (MSIs), 82% of MSIs resulted from shoulder overuse (Hathcock et al., 2021). When I deployed to Iraq two years ago, I was assigned to a battlefield hospital where I was taught how to screen and treat patients under the direct supervision doctors. We were fortunate enough not to lose any of our comrades while we were there, but we were met with a multitude of MSIs. This was mainly because of poor planning of physical training when it came to weightlifting. News broke out in 2019 that the Army Combat Fitness Test (ACFT: hand-release push-ups, deadlift, standing power throw, sprint-drag carry, leg-tuck, 2 mile run) will eventually replace the decades-old Army Physical Fitness Test (APFT: sit-ups, push-ups, and 2 mile run). Therefore, some soldiers who have not been educated on strength training started working out and overusing different muscle groups carelessly and improperly.
The most significant treatment options for shoulder impingement syndrome (SIS) is a combination of exercises and exercise-based therapies rather than a single intervention. In early stages of SIS, First-line treatments include kinesio-taping, strength exercises for periscapular muscles and rotator cuff tendon, and acupuncture. For alternative treatments, one can utilize localized corticosteroid injection, ultrasound therapy, and electromagnetic field therapy. On the other hand, chronic SIS may be treated surgically or through exercise therapy (Dong et al., 2015).
Clayton, M. a. (2010). Leonardo Da Vinci: The Mechanics of Man. Los Angeles: Getty Publications.
Dong, W., Goost, H., Lin, X. B., Burger, C., Paul, C., Wang, Z. L., Zhang, T. Y., Jiang, Z. C., Welle, K., &
Kabir, K. (2015). Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine, 94(10), e510. https://doi.org/10.1097/MD.0000000000000510
Hathcock, J. A., Boyer, C. W., & Morris, J. B. (2021). Shoulder pain of spinal source in the military: A case series.
Military Medicine, usab059. https://doi.org/10.1093/milmed/usab059
Hsiao, M. S., Cameron, K. L., Tucker, C. J., Benigni, M., Blaine, T. A., & Owens, B. D. (2015). Shoulder impingement in the United States military. Journal of Shoulder and Elbow Surgery, 24(9), 1486–1492. https://doi.org/10.1016/j.jse.2015.02.021
Richman-Abdou, K. (2018, August). The Significance of Leonardo da Vinci’s Famous “Vitruvian Man” Drawing. Retrieved from My Modern Met: https://mymodernmet.com/leonardo-da-vinci-vitruvian-man/
Rotator cuff / impingement. (n.d.). Retrieved July 24, 2021, from https://www.thesteadmanclinic.com/patient-
UT Health San Antonio. (n.d.). Anatomy of the Shoulder. Retrieved from Physicians and care providers of UT Health San Antonio: https://www.uthscsa.edu/patient-care/physicians/sports-medicine/shoulder-anatomy