Gasparik, Aaron Andrew Jack; (2022) Shouldering the load: Analysing temporal and geographical variation in the prevalence, demography and expression of rotator cuff disease in British skeletal assemblages. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Analysing the shoulder joint complex – and the pathological conditions affecting it – can provide insight into changing human activity patterns throughout history. Rotator cuff disease (RCD) is a musculoskeletal condition which frequently affects the shoulder and has associations with age-related tendon degeneration, acute trauma and/or joint overuse during activity. Though RCD and its impacts are regularly discussed in clinical studies, palaeopathological analyses are few in number and limited in scope – meaning RCD prevalence, demography, and the factors influencing its pathogenesis are poorly understood in archaeological contexts. The current research improves this understanding by analysing RCD in the shoulder joints of 305 Anglo-Saxon, 252 medieval and 369 post-medieval skeletons from sites throughout Britain. Using a revised version of Waldron’s criteria for diagnosing RCD in skeletons, disease prevalence was determined and pathological changes at specific entheses were examined to explore how RCD affected different shoulder elements. Given its detailed, diachronic approach, this work represents a novel and replicable way of analysing RCD in palaeopathology. Across all periods surveyed, significant associations between increasing age and RCD prevalence/expression were observed, reflecting clinically recognised associations between RCD and senescence. Prevalence was generally higher in males, though differences between the sexes were non-significant in either the Anglo-Saxon or medieval assemblages. They were, however, significant in post-medieval skeletons, with a 20.71% difference between males and females. Prevalence decreased diachronically but was similar between males from each period and more markedly different between females. Extrinsic factors, such as changes in activity or social hierarchies, may have affected sex-related patterns of RCD within and between periods. Though pathogenesis appeared predominantly age-related, analysing additional archaeological material will help understand how RCD prevalence and distribution varies in different temporal/socio-economic/geographic contexts. Examining skeletal changes in known cases of RCD might also help recognise alternative disease expression patterns and further improve palaeopathological diagnostic methods.

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