The aim of this thesis was to study different aspects of the soft tissues of the shoulder joint. The variation in the quality of the tendons and ligaments can be explained by genetic factors. To test the hypothesis that collagen 1 α1 Sp1 polymorphism is related to the occurrence of cruciate ligament ruptures and shoulder dislocations, a total of 358 patients (233 patients with cruciate ligament ruptures and 126 with shoulder dislocations) were included in the study. We found a decreased risk of these injuries associated with collagen type 1 α1 Sp1 polymorphism. To study the mechanical properties of a better type of fixation of soft tissue to bone, 10 skeletally mature New Zealand white rabbits were operated bilaterally on the knees. The medial collateral ligaments were fixed by two types of plates one with a flat undersurface and the other with a pegged undersurface. After 4 weeks the force at failure, stiffness and energy uptake was almost double in the knees operated with the pegged plates. The prevalence and dysfunction of rotator cuff tears was investigated in 106 subjects who had never sought for their shoulder complaints, using Constant score, ultrasound and plain x-ray. The prevalence of full-thickness cuff tears was 30% (21% of all shoulders). The Constant score was lower in subjects with full-thickness tears. Partial-thickness tears and acromioclavicular joint osteoarthritis had no impact on shoulder complaints or Constant score. The subacromial index was lower for shoulders with full-thickness tears. Forty-eight patients with median age 56 years underwent subacromial decompression with or without acromioclavicular joint resection, investigated with MRI pre- and 3 months postoperatively. The Constant score and subjective shoulder value were measured preoperatively and at 3 and 6 months after surgery and even 2 years for subjective shoulder value. Two raters investigated the MRI. The results showed poor inter-rater reliability for MRI. However, both Constant score and subjective shoulder value improved over time. MRI is not a reliable method to study the capsular reaction after subacromial decompression due to high subjectivity of the radiologists.

Darbo tikslas: įvertinti kineziterapijos procedūrų eiliškumo įtaką peties sąnario funkcijoms po artroskopinės sąauginio kapsulito operacijos. Darbo uždaviniai yra šie: 1. Įvertinti kineziterapijos įtaką pacientų po peties sąauginio kapsulito artroskopinės operacijos peties sąnario paslankumui ir jėgai priklausomai nuo kineziterapijos procedūrų eiliškumo. 2. Įvertinti kineziterapijos įtaką pacientų po peties sąauginio kapsulito artroskopinės operacijos skausmo intensyvumui ir savarankiškumui kasdieniniame gyvenime priklausomai nuo kineziterapijos procedūrų eiliškumo. 3. Paruošti rekomendacijas individualios kineziterapijos programos tobulinimui pacientams po peties sąauginio kapsulito artroskopinės operacijos. Hipotezė: ligonių po peties sąauginio kapsulito artroskopinės operacijos peties sąnario paslankumo, jėgos, skausmo ir savarankiškumo kasdieniniame gyvenime pokyčiai yra didesni kineziterapijos procedūras vykdant tokia seka: kineziterapija sausumoje atliekama po kineziterapijos vandenyje. Tyrimo metodika. Tyrimo kontingentą sudarė 36 tiriamieji, kurie buvo reabilituojami Palangos reabilitacijos ligoninėje 2005-2007 metais, po artroskopinės peties sąauginio kapsulito operacijos. Visiems pacientams taikyta ta pati reabilitacijos ir kineziterapijos programa, tik skyrėsi kineziterapijos procedūrų eiliškumas. Tiriamieji buvo suskirstyti į dvi grupes po 18 žmonių: I grupė – tiriamoji, kuriai kineziterapija sausumoje atliekama po kineziterapijos vandenyje, II grupė –... [toliau žr. visą tekstą] / The aim of this work: to evaluate the influence of the order of priority in physiotherapy procedures on treating adhesive shoulder function after arthroscopical release. The goals of this work are: 1. To estimate efficiency of physical therapy impact of shoulder mobility and strength subject to succession after arthroscopic operation of capsule adhesion; 2. To estimate of physical therapy impact of shoulder pain intensity and self-independence in daily life subject to succession after arthroscopic operation of capsule adhesion; 3. To prepare recommendation for individual physical therapy to accomplish program subject to succession after arthroscopic operation of capsule adhesion. Hypothesis: Shoulder mobility, strength, pain and self-independence alteration depends on physical therapy subject to succession after arthroscopic operation of shoulder capsule adhesion. Methodology of investigation: contingent of investigation consist of 36 patients after arthroscopic operation of shoulder capsule adhesion in Palanga rehabilitation hospital in 2005-2007. Each patient had the rehabilitation and physical therapy program. All investigative groups were divided in to groups of 18 patients. The first investigative group had overland physical therapy after physical therapy in swimming pool and the second control group had physical therapy in swimming pool after overland physical therapy. Analyzes of statistics was made with “SPSS” program and MS Excel. Conclusion. Established... [to full text]

BACKGROUND: Adhesive capsulitis is an idiopathic disorder of the shoulder that is characterized by pain in combination with the gradual loss of passive and active range of motion. It is typically self-limiting, although the disease still remains poorly understood. However, there are several treatment modalities, both conservative and surgical, that provide significant clinical benefit for patients with adhesive capsulitis. Corticosteroid injections are an established conservative treatment method for adhesive capsulitis. Several studies have demonstrated that injections provide short-term benefits in terms of shoulder mobility and pain reduction. The intra-articular injections can be performed blindly (landmark) or with ultrasound (US) guidance. Physicians administer injections under US guidance in an attempt to improve the accuracy of the injection. However, it remains unclear whether US-guided injections relieve symptoms of adhesive capsulitis more effectively than landmark injections. OBJECTIVE: To compare the pain relief, self-reported function, and shoulder range of motion (ROM) outcomes of landmark versus US-guided corticosteroid injections for adhesive capsulitis. Methods: A total of 21 patients with adhesive capsulitis were randomized to receive either a landmark or US-guided intra-articular corticosteroid injection. Clinical outcome measures were documented at baseline, 6 weeks, and 12 weeks. These measures included a visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) score for self-reported function, and passive shoulder ROM, including forward flexion, external rotation, and abduction. RESULTS: Both US-guided and landmark glenohumeral (GH) joint injections significantly improved VAS scores, SANE scores, and shoulder ROM outcomes. Improvement was maintained for all outcome measures in both groups throughout the 12 week treatment period. However, there were no significant differences seen in outcome measures between the two groups except that US-guided provided greater improvement in abduction at the 6 week follow-up (P = .004). CONCLUSIONS: This preliminary report found that there is no significant difference in the effectiveness of US-guided and landmark cortisone injection in terms of pain improvement, self-reported functions, and ROM outcomes for adhesive capsulitis.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-10-09T17:06:03Z No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-10-09T17:12:33Z (GMT) No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-09T17:12:33Z (GMT). No. of bitstreams: 2 Tese - Marcos Rassi Fernandes - 2013.pdf: 3024550 bytes, checksum: c4d90a110a9b3b2805efd4361d807ff2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-06-27 / Introduction: The simultaneous assessment of quality of life and functional capacity from the patient's self perception with adhesive capsulitis may contribute to the improvement of health care of this population. Objectives: To describe the techniques and clinical indications of suprascapular nerve block, as well as their complications, based on literature data; to assess the quality of life and functional capacity of patients with adhesive capsulitis at the beginning and end of treatment with blocks and to analyze the factors associated with satisfactory quality of life and better functional capacity. Methods: Prospective clinical study in adults and elderly patients with adhesive capsulitis submitted to weekly treatment with suprascapular nerve blocks, users of a private orthopaedic hospital, located in the city of Goiânia-GO, in the period of august 2010 to february 2012. Quality of life was assessed by the WHOQOL-BREF and functional capacity by DASH at the beginning and end of treatment. The Constant score greater than or equal to 55 points was used for the end of the blocks and the Wilcoxon test to compare the initials and finals scores of the WHOQOL-BREF and DASH. Multiple regression analysis of Poisson was carried out using satisfactory quality of life and better functional capacity as outcomes. Significance level of 5%. Results: Forty-three patients with a mean age of 54,7 years were evaluated. Better scores of quality of life and functional capacity were obtained at the end of treatment, when compared to the initials scores. Patients with age greater than 50 years old were associated with higher scores of quality of life in the physical and psychological WHOQOL-BREF domains and those with better educational level in the physical and environmental domains. Age greater than 50 years old and higher schooling were also associated with better functional capacity of the affected shoulder. Conclusions: There are several techniques and clinical indications for the performance of the suprascapular nerve block. Although rare, complications may occur. Quality of life and shoulder functional capacity of patients with adhesive capsulitis improved at the end of the treatment with suprascapular nerve blocks, being influenced by the higher age and better educational level. / Introdução: A avaliação simultânea da qualidade de vida e da capacidade funcional, a partir da percepção dos próprios pacientes portadores de capsulite adesiva, pode contribuir para a melhoria da atenção à saúde dessa população. Objetivos: Descrever as técnicas e indicações clínicas do bloqueio do nervo supraescapular, bem como suas complicações, a partir de dados da literatura; avaliar a qualidade de vida e a capacidade funcional de pacientes com capsulite adesiva no início e no final do tratamento com bloqueios e analisar os fatores associados à qualidade de vida satisfatória e à melhor capacidade funcional. Métodos: Estudo clínico prospectivo em pacientes adultos e idosos com capsulite adesiva submetidos a tratamento semanal com bloqueios do nervo supraescapular, usuários de um hospital ortopédico privado, localizado na cidade de Goiânia-GO, no período de agosto de 2010 a fevereiro de 2012. A qualidade de vida foi avaliada pelo WHOQOL-BREF e a capacidade funcional pelo DASH, tanto no início quanto no final do tratamento. O escore de Constant maior ou igual a 55 pontos foi utilizado para o término dos bloqueios e o teste de Wilcoxon para comparar os escores iniciais e finais do WHOQOL-BREF e DASH. Foi realizada análise de regressão multivariada de Poisson, utilizando como desfechos a qualidade de vida satisfatória e a melhor capacidade funcional. Nível de significância de 5%. Resultados: Foram avaliados 43 pacientes, com idade média de 54,7 anos. Foram obtidos melhores escores de qualidade de vida e capacidade funcional no final do tratamento, quando comparados aos escores iniciais. Pacientes com idade maior que 50 anos foram associados a escores mais elevados de qualidade de vida nos domínios físico e psicológico do WHOQOL-BREF e aqueles com melhor nível educacional nos domínios físico e ambiental. Idade maior que 50 anos e maior escolaridade também foram associados à melhor capacidade funcional do ombro acometido. Conclusões: Existem diversas técnicas e indicações clínicas para a realização do bloqueio do nervo supraescapular. Apesar de raras, complicações podem ocorrer. A qualidade de vida e a capacidade funcional do ombro dos pacientes com capsulite adesiva melhoraram no final do tratamento com bloqueios do nervo supraescapular, sendo influenciadas pela maior idade e melhor nível educacional.