Zong-Ming Li

Interests

Teaching

Biomechanics

Research

Carpal tunnel syndrome, Hand Arthritis, Musculoskeletal Imaging, Biomechanics and motor control of the hand, Neuromuscular control, Musculoskeletal Biomechanics and Rehabilitation, Biomechanics of shoulder arthroplasty, Biomechanical modeling, Biomechanics of orthopaedic implants, Experimental methods in biomechanics, Biorobotics, EMG, Finger coordination, Finger joint stiffness, Gait analyses, Hand biomechanics, Human motor redundancy problem, Human movement analyses, Ligament and tendon mechanics and mechanobiology, Mathematical (optimization) modeling, Molecular mechanisms of flexor tenosynovitis and ligament hypertrophy, Motion analysis, Musculoskeletal Ultrasonography, Neural network modeling, Neuromuscular control of hand and upper extremity, Neural rehabilitation, Posture and balance, Rehabilitation engineering, Shoulder biomechanics, Ultrasonic imaging, Wrist kinematics, Wrist morphometry

Courses

Scholarly Contributions

Journals/Publications

• Abraham, I., Lewandrowski, K., Elfar, J. C., Li, Z., Fiorelli, R. A., Pereira, M. G., Lorio, M. P., Burkhardt, B. W., Oertel, J. M., Winkler, P. A., Yang, H., León, J. F., Telfeian, A. E., Dowling, A., Vargas, R. A., Ramina, R., Asefi, M., de Carvalho, P. S., Defino, H., , Moyano, J., et al. (2023). Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models. Journal of personalized medicine, 13(7), 1044. doi:https://doi.org/10.3390/jpm13071044
  More info

  Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible. Confounding factors, such as the variability of the patient population and selection bias regarding comorbidities and anatomical variations are also difficult to control for. Small sample sizes in study groups comparing iterations of a surgical protocol may amplify bias. It is essentially impossible to conceal the surgical treatment from the surgeon and the operating team. Restrictive inclusion and exclusion criteria may distort the study population to no longer reflect patients seen in daily practice. Hindsight bias is introduced by the inability to effectively blind patient group allocation, which affects clinical result interpretation, particularly if the outcome is already known to the investigators when the outcome analysis is performed (often a long time after the intervention). Randomization is equally problematic, as many patients want to avoid being randomly assigned to a study group, particularly if they perceive their surgeon to be unsure of which treatment will likely render the best clinical outcome for them. Ethical concerns may also exist if the study involves additional and unnecessary risks. Lastly, surgical trials are costly, especially if the tested interventions are complex and require long-term follow-up to assess their benefit. Traditional clinical testing of personalized surgical pain management treatments may be more challenging because individualized solutions tailored to each patient's pain generator can vary extensively. However, high-grade evidence is needed to prompt a protocol change and break with traditional image-based criteria for treatment. In this article, the authors review issues in surgical trials and offer practical solutions.
• Hawk, J., Zhang, H., Margolis, D., & Li, Z. (2021). Robot and ultrasound assisted needle insertion to the transverse carpal ligament. Clinical Biomechanics, 101(1), 105851. doi:10.1016/j.clinbiomech.2022.105851
• Lewandrowski, K., Elfar, J. C., Li, Z., Burkhardt, B. W., Lorio, M. P., Winkler, P. A., Oertel, J. M., Telfeian, A. E., Dowling, A., Vargas, R. A., Ramina, R., Abraham, I., Assefi, M., Yang, H., Zhang, X., Ramírez León, J. F., Fiorelli, R. K., Pereira, M. G., de Carvalho, P. S., , Defino, H., et al. (2023). The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States. Journal of personalized medicine, 13(5), 852. doi:https://doi.org/10.3390/jpm13050852
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  Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.
• Li, Z. (2023). Non-surgical carpal arch space augmentation for median nerve decompression, A paper for ASME 2022 Savio L-Y. Woo Translational Biomechanics Medal.. Journal of Biomechanical Engineering, 145(8), 080801. doi:https://doi.org/10.1115/1.4056651
• Li, Z., & Jordan, D. (2023). Carpal tunnel mechanics and its relevance to carpal tunnel syndrome, https://doi.org/10.1016/j.humov.2022.103044. Human Movement Science, 87(2), 103044. doi:https://doi.org/10.1016/j.humov.2022.103044
• Li, Z., Jordan, D., & Zhang, H. (2023). Spatial relationship of the median nerve and transverse carpal ligament in asymptomatic hands, https://doi.org/10.1115/1.4056290. Journal of Biomechanical Engineering.
• Li, Z., Lui, S., Roemerb, F., Bedricka, E., Guermazic, A., Sun, X., & Kwoh, C. K. (2023). Comparison of evaluation metrics of deep learning for imbalanced imaging data in osteoarthritis studies. Osteoarthritis and Cartilage, 31(9), 1242-1248. doi:10.1016/j.joca.2023.05.006
• Li, Z., Zhang, H., & Jordan, D. (2023). Carpal arch space increased by volar force applied to the skin surface above the carpal tunnel, https://doi.org/10.1016/j.clinbiomech.2023.105888. Clinical Biomechanics, 101, 105851. doi:https://doi.org/10.1016/j.clinbiomech.2023.105888
• Alsafar, F., & Li, Z. (2021). Thenar and hypothenar muscle coverage on the transverse carpal ligament. Journal of Wrist Surgery. doi:10.1055/s-0041-1735887
• Jordan, D., & Li, Z. (2021). Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation. Computer Methods in Biomechanics and Biomedical Engineering.
• Jun, B., Ricchetti, E., Li, Z., & Iannotti, J. (2021). Validation of a 3-D CT Imaging Method for Quantifying Implant Migration following Anatomic Total Shoulder Arthroplasty. https://doi.org/10.1002/jor.25170. Journal of Orthopaedic Research.
• Li, Z., Daulat, S., Hawk, J., & Margolis, D. S. (2022). Dose- and time-dependent effects of collagenase clostridium histolyticum injection on transverse carpal ligament elastic modulus and thickness in vitro.  https://doi.org/10.1371/journal.pone.0277187. PLOS ONE.
• Li, Z., Grandy, E. L., Jenkins, L., Norman, C., Bena, J., Hou, J., Evans, P. J., Seitz, W. H., & Kwoh, C. K. (2022). A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome https://doi.org/10.1186/s12891-022-05943-0. BMC Musculoskeletal Disorder.
• Li, Z., J, Z., Y, X., N, W., L, L., & K, L. (2022). Reach-to-grasp kinematics and kinetics in early-stage Alzheimer’s disease. https://doi.org/10.1186/s12984-022-01108-1. Journal of NeuroEngineering and Rehabilitation.
• Nadeem, M., Li, Z., & Seitz, W. (2021). Functional wrist kinematics during activities of daily living. Journal of Hand Surgery.
• Shah, R., & Li, Z. (2021). Three-dimensional carpal arch morphology using robot-assisted ultrasonography. Transactions on Biomedical Engineering.
• Zhang, H., Loss, J., & Li, Z. (2021). Carpal arch changes in response to thenar muscle loading. Journal of Biomechanical Engineering.
• Lakshminarayanan, K., Shah, R., & Li, Z. M. (2020). Morphological and positional changes of the carpal arch and median nerve associated with wrist deviations. Clinical biomechanics (Bristol, Avon), 71, 133-138.
  More info

  Carpal tunnel and median nerve dynamically change with wrist motion. The purpose of this study was to investigate the morphological changes and positional migration of the carpal arch and median nerve, as well as nerve-arch positional relationship associated with wrist deviation in healthy volunteers.
• Loss, J., & Li, Z. M. (2020). Biometry of thenar muscle origins on the flexor retinaculum. Clinical anatomy (New York, N.Y.), 33(8), 1176-1180.
  More info

  The transverse carpal ligament (TCL), the main part of the flexor retinaculum, serves as an anchor for the thenar muscles: abductor pollicis brevis (APB), superficial head of the flexor pollicis brevis (sFPB), and opponens pollicis (OPP). Biomechanically, the thenar muscles rely on their TCL anchoring to transmit muscle contractions distally for thumb force and motion production, and reciprocally, muscle contraction interacts with the TCL at the proximal end through the origins. However, scarce knowledge exists regarding the distribution pattern of the thenar muscle origins. The purpose of this study was to understand the anatomical interface between the thenar muscles and TCL by examining the origin distributions of the individual muscles. Ten cadaveric specimens were dissected for digitization of the muscle origins and TCL volar surface. Digitized data were used for mesh reconstruction and calculation of surface areas and centroids. The origin areas for APB, sFPB, and OPP were 105.8 ± 30.3, 64.6 ± 15.2, and 245.9 ± 70.7 mm , respectively. The surface area of the TCL was 386.2 ± 86.9 mm . The origin areas of APB and OPP on the TCL were comparable, 18.4 ± 4.8% and 17.3 ± 9.6% of the TCL area, respectively. The origin locations for APB, sFPB, and OPP were in proximal-radial quadrant of the TCL, on distal aponeurosis outside the TCL, and around the ridge of trapezium, respectively. The knowledge of the anatomical interface provides a foundation for the understanding of biomechanical interactions between the muscles and ligaments and pathomechanical implications.
• Shah, R., & Li, Z. M. (2020). Ligament and Bone Arch Partition of the Carpal Tunnel by Three-Dimensional Ultrasonography. Journal of biomechanical engineering.
  More info

  The carpal tunnel is structurally complex and geometrically irregular due to the many intercalated carpal bones by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 ± 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p
• Yao, Y., Grandy, E., Evans, P. J., Seitz, W. H., & Li, Z. M. (2020). Impairment of median nerve mobility in the segmental carpal tunnel of patients with carpal tunnel syndrome. Muscle & nerve, 62(4), 522-527.
  More info

  The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls.

Presentations

• Alsafar, F., Shah, R., & Li, Z. (2021, February). Thenar and hypothenar muscular coverage on the transverse carpal ligament. Annual meeting of the Orthopedic Research Society (ORS), February 13-16, 2021, Virtual (Podium).
• Coleman, K., Li, V., Zhang, H., Kwoh, K., & Li, Z. (2022). Thumb Carpometacarpal Joint Laxity in Pre- and Post- Menopausal Women. 2022 Annual Meeting of Orthopaedic Research Society (ORS).
• Hawk, J., Zhang, H., Margolis, D., & Li, Z. (2022). In Situ Needle Insertion to the Transverse Carpal Ligament Using Robot-Assisted Ultrasound. 2022 Annual Meeting of Orthopaedic Research Society (ORS).
• Huo, J., Zhang, H., Li, Z., & Roveda, J. (2022). Segmentation of Transverse Carpal Ligament in Ultrasound Images Using Convolutional Neural Network. 2022 Annual Meeting of Orthopaedic Research Society (ORS).
• Jordan, D., & Li, Z. (2022). Cross-sectional Changes of the Distal Carpal Tunnel with Simulated Carpal Bone Rotation. 2022 Annual Meeting of Orthopaedic Research Society (ORS).
• Li, Z. (2022, June/Summer).

  Thumb Carpometacarpal Joint Laxity in Young and Postmenopausal Women

  . IFSSH, IFSHT & FESSH Combined Congress 6-10 June 2022. London, UK.
• Li, Z., & Zhang, H. (2021, Jun). Finite element analysis for carpal arch under varying thenar muscle force magnitudes and directions. Summer Biomechanics, Bioengineering and Biotransport Conference (Virtual). June 14-18, 2021.
• Shah, R., & Li, Z. (2021, February). Three-dimensional carpal arch morphological analysis using robot assisted ultrasonography.. Annual meeting of the Orthopedic Research Society (ORS), February 13-16, 2021, Virtual (Poster). Virtual.
• Tamimi, E., Hawk, J., Witte, R., & Li, Z. (2022). Tamimi E, Hawk J, Witte R Li ZM, Load-dependent shear wave elastography of the transverse carpal ligament. 2022 Annual Meeting of Orthopaedic Research Society (ORS).
• Zhang, H., & Li, Z. (2021, February). Effect of musculoligamentous junction location on biomechanical interaction between the thenar muscles and transverse carpal ligament — a finite element study.. Annual meeting of the Orthopedic Research Society (ORS), February 13-16, 2021, Virtual (Poster).
• Zhang, H., & Li, Z. (2022). In Vivo Examination of Thenar Muscle Origins on the Transverse Carpal Ligament by 3-D Ultrasound Reconstruction. 2022 Annual Meeting of Orthopaedic Research Society (ORS).

Poster Presentations

• Li, Z., Tamimi, E., Hawk, J., & Witte, R. (2022). Load-dependent shear wave elastography of the transverse carpal ligament, February 04-08, 2022, Tampa, FL [Poster]. Annual Meeting of Orthopaedic Research Society (ORS).