Carrying loads and making shoes: skeletal markers of activity in a sample of porters and shoemakers from contemporary Italy
Marco Milella, Stefania Zampetti, Maria Giovanna Belcastro, Valentina Mariotti
Alma Mater Studiorum Università Di Bologna
Laboratorio di Bioarcheologia e Osteologia forense DNA Environment
How much? Activity Markers How much?
Need to take factors as age and sex under control to infer possible levels and patterns of mechanical stress
Importance of Identified Skeletal Collections Importance of Medical studies (Sport and Occupational Medicine) AIM Analyse osseous features possibly representing skeletal markers of activity in skeletons of individuals occupied in two different jobs: shoemakers and porters. Can they tell us something? The Sample •Identified Skeletal Collections of Sassari and Bologna (“Frassetto Collections”) (end of 19th –beginning of 20th century) (M
•Identified “Sperino” Skeletal Collection •(end of 19th –beginning of 20th century) (
useum Of Anthropology, University of Bologna)
Institute of Anatomy, Modena General Hospital)
20-29 30-39 40-49 50-59 60-69 70+ tot yrs yrs yrs yrs yrs yrs Shoemakers 5 4 4 2 1 16 Porters 1 2 1 2 1 2 9 Observed features •Entheses Robusticity (ROB) 23 post cranial sites Enthesophytic Enthesopaties (EF) Osteolytic Enthesopaties (OL) grouped in 6 functional complexes
1) Shoulder 4) Hip 2) Elbow (flexion/extension) 5) Knee Mean robusticity score 3) Forearm (pronation/supination) 6) Foot
•Joint Surfaces Marginal lipping (ML) 8 post cranial functional complexes 1) Shoulder Erosion (Er) Mean 2-3) Elbow (flexion-extension; pronation - supination) Eburneation (Eb) score 4-5) Wrist (adduction-abduction; flexion - extension) Exostosis on joint surface 6) Hip (Exo)
7) Knee Loss of Morphology 8) Ankle
Sacro-iliac accessory facets •Accessory articular facets Sacro-lumbar accessory facets ROBUSTICITY (standard different for each enthesis) (Mariotti et al., Coll. Antrop., 2007) 1 – low to medium development 2 – high development Interobserver error: about 20% 3 – very high development M. SOLEUS
1a - slight impression: the surface is practically smooth, even though an oblique line is perceptible to the touch. 1b – low development: the insertion is marked by a line of rugosity. 1c – medium development: the line of insertion is marked by obvious rugosity, or there is a slight crest with smooth surface. 2 - high development: definite crest, possibly discontinuous, but with obvious rugosity. 3 – very high development: very raised and rugose crest.
1a 1b 1c 2 3 ENTESOPATHIES (same standard for every enthesis) (Mariotti, Facchini & Belcastro, Coll. Antropol., 28 (1), 2004)
ENTESOPHYTIC FORMATION (EF) 0 – absence 1 - minimal exostosis (<1 mm) 2 - clear exostosis (1-4 mm) 3 - substantial exostosis (>4 mm)
“OSTEOLYTIC” FORMATION (OL) 123 0 - absence 1 - fine porosity (holes <1mm) 2 - gross porosity, (holes ∼ 1 mm) or small area of erosion (∼ 4 mm)
3 - a: several small areas of erosion (∼ 4 a b mm); b: extensive and deep osteolytic 12 3 area (> 4 mm) nr – more than 50% of the area is illegible ARTICULAR ALTERATIONS (same standard for every joint)
right humerus Right clavicle left patella left humerus right femur
marginal lipping erosion eburneation exostosis on loss of morphology joint surface Marginal lipping: 4 degrees (0, 1, 2, 3)
Erosion: 4 degrees (0, 1, 2, 3)
Eburneation: 4 degrees (0, 1, 2, 3) Joint surfaces considered
Exostosis on joint surface: 4 degrees (0, 1, 2, 3)
Loss of Morphology: absence/presence (0, 1) Statystical methodology
• % Frequencies • single entheses (ROB, EF,OL) • accessory articular facets
•MeanScore • Single entheses (porters vs shoemakers) (Sum of scores/ n° of values) • Functional complexes of each individual • Articular features of each individual (ML+ Eb + Er + Exo)
• Left mean score/right mean score) x 100 (Hall, 1982; Eshed et al., 2004, Molnar 2006 ) •Bilateral Asymmetry • Intra-group differences Results >100 = left side dominance (entheses & Results <100 = right side dominance articular features) • Wilcoxon matched-pairs test •Mean Score rank (entheses only)
• Inter-group differences Porters/Shoemakers L •Mann-Whitney test (mean scores) (entheses, enthesopaties & articular features) Porters/Shoemakers R •Fisher exact test (frequencies) Intra-group comparisons: 1) Side differences
No side differences except:
In porters: - Knee for articular features (p=0.03)
In shoemakers: Right-side dominance - Shoulder for articular features (p=0.02) -Elbowfor entheses (p=0.008)
In yellow = articular features Intra-group comparisons: 2) Rank ordering of entheses
Porters Shoemakers rank enthesis mean score rank enthesis mean score (l+r)/2 (l+r)/2 1 quadriceps t. (pat) 3.817 1 Achilles t. (calcaneus) 2.813 2 Achilles t. (calcaneus) 3.590 2 quadriceps t. (tib) 2.750 3 m. iliopsoas (femur) 3.521 3 conoid lig. (clav) 2.417 4 m. biceps brachii (radius) 3.188 4 m. pect. major (hum) 2.403 5 m. deltoideus (hum) 2.875 5 m. triceps brachii (ulna) 2.381 6 m. gluteus max (femur) 2.833 6 m. biceps brachii (radius) 2.368 7 quadriceps t. (tib) 2.757 7 trapezoid lig. (clav) 2.292 8 m. pect. major (hum) 2.750 8 m. deltoideus (hum) 2.292
Porter (52 Y) right femur - iliopsoas enthesis Shoemakers: greater Porters: great development of development of the upper limb the lower limb entheses Shoemaker (44 Y) entheses right humerus – pect. Shoemaker (44 Y) left ulna major enthesis – triceps brachii enthesis Intra-group comparisons: 2) Rank ordering of functional complexes (entheses)
Porters: great Porters development of the left right lower limb functional complexes (highest: rank f.complex mean score rank F.complex mean score hip) 1 Hip 3.111 1 Hip 3.167 2 Foot 3.000 2 Foot 3.111 3 Knee 2.688 3 Knee 2.685 4 Elbow 2.541 4 Shoulder 2.545 5 Shoulder 2.451 5 Elbow 2.443 6 Forearm 2.074 6 Forearm 2.222 Porter (44 Y) left femur – gluteus maximus enthesis Shoemakers Shoemakers: greater left right development of the upper rank f.complex mean score rank F.complex mean score limb funcional complexes (highest: shoulder) 1 Foot 2.375 1 Foot 2.500 2 Shoulder 2.125 2 Shoulder 2.245 3 Hip 2.125 3 Elbow 2.157 4 Knee 2.074 4 Hip 2.111 5 Elbow 1.880 5 Knee 1.963 Shoemaker (33 Y) right clavicle – conoid ligament 6 Forearm 1.796 6 Forearm 1.833 enthesis Inter-group comparison
Shoemakers Porters
%2+3 %2+3 p
Biceps brachii Porter (52 Y) left 22% 88% 0.01 radius – biceps brachii (radius) enthesis Brachialis 0% 56% 0.03 Left (ulna) Gluteus max. 25% 86% 0.03 (femur) Iliopsoas 43% 100% 0.03 (femur)
Shoemakers Porters
%2+3 %2+3 p
Iliopsoas Right 33% 100% 0.005 (femur) Porter (50 Y) left ulna - brachialis enthesis
Significant differences: upper limb: biceps brachii, brachialis(left side) lower limb: iliopsoas (both sides) gluteus maximus (left side) In yellow = Shoemakers Porters articular features differences F.Complex Mean Score N Mean Score N p p
Shoulder 0.123 9 0.382 7 0.03 Left Elbow 1.880 9 2.541 9 0.0007 Elbow (ex/fl) 0.046 9 0.302 9 0.04 Wrist (P/S) 0.000 8 0.317 9 0.003 Hip 2.125 9 3.111 9 0.01 Hip 0.215 9 0.630 9 0.005
F. Complex Mean Score N Mean Score N p p
Wrist (P/S) 0.000 8 0.650 9 0.008 Right Hip 2.111 9 3.167 9 0.002 Hip 0.267 9 0.733 9 0.012 Knee 1.963 9 2.685 9 0.02 Knee 0.037 9 0.489 9 0.002
Greater robusticity in Porters for left elbow, right knee and bilaterally for the hip
Greater joint modifications in porters for left shoulder, elbow (ex/fl); right knee Porter (74 Y) and bilaterally for hip and wrist (p/s) R femur with Eb on patellar surface EF p= 0.003
Porters Left Right OL Nn2+3 N n2+3 m.bic. brachii (radius) 8 3 (38%) 8 2 (25%) Shoemakers m.tric brachii (ulna) 8 1 (13%) 8 2 (25%) costoclav. lig. Biceps b. m.brachialis (ulna) 9 1 (11%) 9 - age left right left right m.gl. maximus (femur) 7 1 (14%) 8 1 (13%) SP 128 213321 m.iliopsoas (femur) 8 1 (13%) 9 5 (56%) SP39 34 - 1 - - quad. tendon (patella) 6 3 (50%) 7 3 (43%) SP166 39 1 3 - - quad. tendon (tibia) 9 1 (11%) 9 3 (33%) Achilles tendon (calc) 5 4 (80%) 6 5 (83%)
Shoemakers Left Right Nn2+3N n2+3 m.bic. brachii (radius) 15 2 (13%) 15 - m.tric. brachii (ulna) 15 3 (20%) 14 1 (7%) m.brachialis (ulna) 15 - 15 - m.gl. maximus (femur) 15 1 (7%) 15 - m.iliopsoas (femur) 15 - 15 - quad. tendon (patella) 13 3 (23%) 12 3 (25%) quad. tendon (tibia) 14 3 (21%) 14 6 (21%) Achilles tendon (calc) 14 5 (36%) 14 7 (50%) Articular accessory facets
Sacro-iliac accessory facets Sacro-lumbar accessory facets
N right bilat N right bilat
2/9 3/9 Porters 2 Porters 12 (22%) (33%) 1/16 2/16 Shoemakers 1 Shoemakers 2 (6%) (13%)
Greater accessory facets frequencies in porters
Porter (21 Y) Sacro-lumbar accessory facets Discussion Greater •Porters: > robusticty, > enthesopaties mechanical > accessory facets frequences >articular modifications stress ?
•Porters: high robusticity of lower limb (iliopsoas, gluteus •Load carrying maximus, quadriceps tendon) • Lifting Significant bilateral asymmetry for the knee articular complex Heavy Object with upper limbs Powerful flexion of the elbow (biceps, brachialis) •Wide arm High mean scores for entheses of the shoulder functional movements complex (esp. pectoralis, deltoideus)
•Shoemakers: high ranks for entheses of the shoulder functional complex (pectoralis, deltoid, conoid and trapezoid ligaments) •Cut and Sew High ranks for entheses concerning flexion and extension of Leather the elbow (triceps brachii, biceps brachii) Hammering
Significant bilateral asymmetry for shoulder (articular complex) and elbow (muscular complex) Conclusions
•Importance of identified samples representing specific activities
•Need for approaches combining different skeletal markers of activity (i.e. entheses + joint features)
Purposes for the future: study of other homogenous samples representing specific activities