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the dependence on personal experience and skill of the evaluator, be it the proper
patient, be it a healthcare professional. Further, it must be emphasized that when
using such classical measurement approaches, the flexion and the extension are in-
formation that are most of time analyzed isolatedely instead of intertwined during
the clinical assessment.
Subject to various characteristics, musculoskeletal pain implies in subjective and
multifactorial measurements that should be took into account for evaluation and
treatment [11].
24.3.1
Fuzzy Musculoskeletal Pain Assessment for Patients with
Reduction of Motion on the Shoulder Sagittal Plane
The musculoskeletal system encompasses diverse joint movements. The fuzzy mus-
culoskeletal pain assessment is applied for shoulder joint pain measurement, as a
practical example, when interested in dealing with reduction of range of motion in
the sagittal plane. Such a mathematical and formal proposed approach innovates,
first, in aggregating the input variables of range of motion for shoulder extension and
shoulder flexion by employing logical connectives and, second, by mapping them
into fuzzy pain output classes resulting in a novel mechanism for musculoskeletal
pain assessment.
The shoulder joint is a spheroid type, having movements in (
i
) sagittal, (
ii
)
frontal, and (
iii
) transverse planes, being one of the most important in human for
accomplishing surviving tasks. The shoulder joint is composed of three bones
(humerus, scapula, and clavicle), four joints (sternoclavicular, acromioclavicular,
glenohumeral, and scapular-thoracic), ligaments that provide stability, and sixteen
muscles involved with the shoulder complex system [1].
The movements in the sagittal plane correspond to flexion and extension, while
the frontal plane movements concerns abduction and adduction, and in the trans-
verse plane, movements occur perpendicular to the soil. This paper will focus on
sagittal plane for flexion-extension (FE) motion, as depicted in Fig. 24.4. Flexion is
the bending motion of a bone on the other causing a decrease in joint angle,
θ
flexion
.
The normal tour of motion occurs from 0 to 180 degrees. The extension is the move-
ment that occurs inversely to bending. It is the straightening of a bone on the other,
causing an increased angle of articulation,
θ
ext ension
. Its normal movement is from 0
to 45 degrees.
The input variables for the fuzzy sagittal shoulder joint pain assessment are the
range of motion for shoulder flexion,
X
1
, and the range of motion for shoulder
extension,
X
2
, resulting a Cartesian product,
X
1
×
X
2
, related to the input space.
The linguistic terms
M
flexion
j
flexion
,and
M
ext ension
, respectively, with
j
flexion
=
j
ext ension
=
j
ext ension
1
5, yield a set of 25 fuzzy regions in the bidimensional input space. In general,
this input space is mapped into an output universe of discourse by using a fuzzy IF-
THEN inference mechanism (mapping). The output variable is the quantification of
pain (severity of disorder),
Y
, according to the area of interest, with linguistic terms,
M
pain
/
severity
j
pain
/
severity
,...,
, such that
j
pain
/
severity
=
1
,...,
5.
All the universes of discourse are
