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Cette thèse s’est d’abord voulue pratique. La chirurgie de l’épaule est en pleine expansion avec le vieillissement croissant de la population et la pratique de plus en plus généralisée du sport. L’épaule est une articulation complexe. Paradoxalement les progrès techniques en chirurgie sont sans cesse grandissants et renouvelés tandis que l’on tientpour acquis des données anatomiques démontrées il y a longtemps et rapportées jusqu’à nos jours. Nous avons voulu confronter l’anatomie avec les techniques diagnostiques actuelles et voir si cela pouvait avoir un impact sur les pratiques chirurgicales. Nous avons également voulu voir si certaines complications chirurgicales pouvaient s’expliquer par des données anatomiques. Ce qui a orienté nos recherches sont les principaux problèmes actuels en pathologie de l’épaule c’est-à-dire la coiffe des rotateurs et le syndrome sous-acromial. Les observations lors des nombreuses dissections de l’épaule nous ont conduit à ces réflexions : comment la glène est-elle vascularisée?, pourquoi est-elle si fragile?, que se passe-t- il dans l’espace sous acromial?, quelle est l’utilité du ligament coraco-acromial?, quels sont ses rapports avec lesuprapinatus?, pourquoi l’insertion du supraspinatus est-elle fragile et difficile à reconstituer ?, la qualité osseuse de la tête humérale a-t-elle un impact sur la géographie des fractures, les échecs des ostéosynthèses, les descellements prothétiques?, qu’est ce que la chape delto-trapézoidienne? Autant de questions que nous nous sommes posées endisséquant cette articulation très complexe qui est l’épaule. Par ailleurs, l’anatomie classique peut maintenant secompléter non seulement de l’histologie, mais aussi de techniques radiologiques modernes comme l’IRM l, le microCT, le synchrotron, la reconstruction 3D, la modélisation en éléments finis. / I would like to make a practical thesis. Shoulder surgery is growing and growing as the population is ageing and people is doing more and more sports activities. A lot of technical progress were done but there are still a lot of surgical complications. On the other way some very old anatomical ideas are still alive. I want to see with the actual knowledge, if some surgical complications could be explained by anatomy. Subacromial pathology and bone quality remain the two mainproblems of shoulder surgery and pathology. That’s what had suggested to me this study about the shoulder. I was supposed to analyze glenoid bone first .The aim was to know more about arterial supply of glenoid. That was my firststudy (article 1). Then, I was interested in glenoid bone quality. And the second study had appeared. (article 2). During the shoulder dissection, I was looking for the fascia delto-trapezoidal which I didn’t found as described in books. It was my third study. (article 3). Going on I found the coraco-acromial ligament and I was surprised to see the constant portion under the acromial process. And that gave me the idea for the fourth study. (article 4).As I had discovered the very interesting technique of micro-Ct densitometry, I would like to apply it to the humeral head bone. There was the fifth study. (article 5)But, I want to know more and more about bone quality and I went on with the greater tuberosity and especially the area ofsupraspinatus insertion. The insertion and the sub-chondral bone were analyzed. There’s the last but not least study!(article 6). I was really interested in supraspinatus muscle and tendon and I want to follow the course of the muscle as the zone of conflict. I was the subject of study in life as I went through RMI . The muscle was reconstructed as finite element. Then it was possible to describe the zone of conflict with the supraspinatus. Here’s the seventh article. (article 7)

Belastungsharninkontinenz (BHI) geht mit einem großen Verlust an Lebensqualität einher. Während bei der Frau durch Einführung der suburethralen Schlingen auf der Grundlage der Integraltheorie (Petros und Ulmsten) seit Jahren eine wirksame Therapieoption der BHI existiert, gibt es für den Mann bisher kein derart gereiftes theoretisches Konzept zur Erklärung der Inkontinenzmechanismen. Ein bestehendes Problem ist hier die noch immer kontrovers diskutierte Mikroanatomie, vor allem aber die Verankerung und das funktionelles Zusammenspiel der Kontinenz erzeugenden Einzelstrukturen. Anliegen dieser Arbeit ist es, eine Analyse der anatomischen Schnittstellen zwischen Beckenwand und Organen im Spatium retropubicum (ventraler vesikourethraler Suspensionsapparat, VVUS) beim Mann durchzuführen, um eine Ableitung von Aufgaben bei der Miktion und Erzeugung von Kontinenz herzustellen. Fernziele sind dabei, klinisch brauchbare Therapieformen der männlichen BHI voranzutreiben und einen Nutzen für die anatomische Lehre abzuleiten. Methodisch basiert die Arbeit auf makroskopisch-anatomischen Präparationen der sogenannten „puboprostatischen Bänder“ (PPL), des Arcus tendineus fasciae pelvis (ATFP) und der Beckenfaszien, ferner des M. pubococcygeus an Alkohol- und Thiel-fixierten männlichen Becken (n=11) mit kontinuierlicher Fotodokumentation. Die histologische Analyse ausgewählter Gewebeblöcke dient der Festlegung von Kontaktstellen der einzelnen Gewebe. Ein Pool aus 650 Dünnschnittpräparaten in HE- und Crossmon-Färbung wurde durch immunhistochemisch mit α-SMCA-AK markierten Schnitten zur exakten Differenzierung der muskulären Grundstruktur komplettiert. Die Schnittstelle zur Klinik bildet eine Pilotserie von MRT-Untersuchungen des VVUS bei 3 gesunden männlichen Probanden, die mit dem Präparationssitus verglichen wurde und Potenzial für zukünftige Studien aufzeigt. Wesentliche Erkenntnisse sind: 1. „Puboprostatische Bänder“ existieren nicht. Ein Komplex aus Einzelstrukturen, die vor allem Assoziation zur Harnblase haben, bildet das makroskopische Korrelat. 2. Die Mm. pubovesicales zeigen einen fächerförmigen Verlauf, daher sollte eine Neubezeichnung als M. collaris vesicae erfolgen. 3. Der ATFP dient als Aponeurose für die Mm. pubovesicales neben der Stabilisierung des vesikourethralen Überganges. 4. Die Endopelvine Faszie existiert, sie trägt zum Erhalt einer bestimmten Höhenlage des vesikourethralen Überganges bei und stabilisiert die Urethra durch ihren langstreckigen lateralen Verlauf. Die Evaluation der Abbildungsweise des VVUS in anatomischen Lehrmedien ist der studentischen Ausbildung geschuldet. Dabei wird auf seine ungleiche Darstellung hingewiesen und eine Revision angeregt. Die Voraussetzung für die Optimierung der männlichen Harnkontinenz bleibt in jedem Fall die enge Zusammenarbeit zwischen Anatomie und Klinik bei der Aus- und Fortbildung.

Thesis (M Sport Sc (Sport Science)--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The purpose of this exploratory study was to assess the fascia alignment in kinetic muscle chains and to determine the relationship between these results and selected biomotor abilities in rugby players. It is suggested that restrictions in the fascia along the kinetic chains inhibit muscle function and therefore influence movement patterns, such as those required by skilled rugby players. The isometric Bunkie-test was used to assess fascia alignment in ten kinetic chains related to movement patterns. Standard functional tests were used to assess agility, speed, speed endurance, lower body explosive power and upper body muscle endurance. The relationship between fascia alignment and injury occurrence was also determined. The subjects (n = 121) were all elite-level rugby players from three rugby academies. They participated voluntarily in a once-off assessment, consisting of the Bunkie-test, an Illinois agility test, a 10m sprint test, a 40m sprint test, a repeated sprint test, a vertical jump test and a maximum pull-ups test. Subjects also completed an injury questionnaire regarding all previous and current injuries. No intervention was applied and the statistical analysis was based on this assessment. Numerous significant relationships (p < 0.05) were found between the results of the Bunkietest and results of the performance tests. Players performing better on the Bunkie-test demonstrated better biomotor abilities. Very few significant findings (p < 0.05) were found when comparing the results of the Bunkie-test to injury occurrence. The conclusion was made that restrictions in the fascia of kinetic chains, as determined by the Bunkie-test, could influence a rugby player’s ability to perform biomotor movements optimally. Whether restrictions in the fascia resulted in an increased injury occurrence could not be shown. The Bunkie-test might be a tool for coaches and rehabilitation therapists to identify weaknesses and imbalances in the kinetic chains of athletes. Addressing these problems could then lead to improvements in sport performance. / AFRIKAANSE OPSOMMING: Die doel van hierdie ondersoekende studie was om die belyning van die fascia in kinetiese spierkettings te evalueer, asook om die verhouding tussen hierdie resultate en geselekteerde biomotoriese vermoëns in rugbyspelers. Daar is aanduidings dat beperkings in die fascia van enige spierketting spierfunksie kan inhibeer en dus ook die effektiwiteit van bewegingspatrone kan beïnvloed. Die isometriese Bankie-toets is gebruik om die fascia belyning in tien spierkettings te evalueer. Hierdie spierkettings is belangrik vir die uitvoer van algemene bewegingspatrone. Standaard funksionele toetse is gebruik om ratsheid, spoed, spoed-uithouvermoë, eksplosiewe krag van die onderste ledemate en spieruithouvermoë van die bolyfspiere te bepaal. Die verwantskap tussen fascia belyning en die aantal beserings in rugbyspelers is ook bepaal. Die proefpersone (n = 121) was almal elite-vlak rugbyspelers verbonde aan een van drie rugby akademies. Alle spelers het vrywillig deelgeneem aan die studie. Toetsing is eenmalig gedoen en het bestaan uit die Bankie-toets, die Illinois ratsheidstoets, ‘n 10m spoedtoets, ‘n 40m spoedtoets, ‘n herhaalde-spoed toets, ‘n vertikale sprong toets en ‘n maksimale optrektoets. Spelers het ook ‘n vraelys aangaande huidige en vorige beserings ingevul. Geen intervensie is in hierdie studie gedoen nie en die statistiese analise was dus op die bogenoemde gebaseer. Verskeie beduidende verwantskappe (p < 0.05) is gevind tussen die resultate van die Bankietoets en die resultate van die funksionele toetse. Spelers wat beter resultate in die Bankie-toets verkry het, het ook beter biomotoriese vermoëns getoon. Min beduidende resultate (p < 0.05) is gevind tussen die resultate van die Bankie-toets en die voorkoms van beserings. Die gevolgtrekking is gemaak dat beperkinge in die fascia van spierkettings, soos deur die Bankie-toets bepaal, wel ‘n rugbyspeler se vermoë om biomotoriese bewegings optimaal uit te voer kan beïnvloed. Of beperkinge in die fascia ook aanleiding gee tot ‘n toename in aantal beserings kon nie met hierdie studie vasgestel word nie. Die Bankie-toets kan moontlik ‘n instrument vir afrigters en rehabilitasie-terapeute wees. Die doel daarvan sal wees om beperkinge en wanbalanse in spierkettings van atlete te bepaal. Indien hierdie probleme aangespreek word, behoort sportprestasie te verbeter.

Background: Dyspraxia, also included under the term Developmental Coordination Disorder (DCD), is a condition characterised by an impairment in motor skills function which impacts negatively on other aspects of daily living such as athletic capability, handwriting, self-esteem and social interaction. However, no effective therapy currently exists to address all of these issues within this group. The aim of the present study therefore was to investigate whether a complementary therapy, called Fascia Bowen therapy, would improve neuromuscular function and psychological wellbeing in males aged 8-11 (at Primary School) diagnosed with this condition. Methods: A group of 10 participants meeting the criteria of 15th centile or below in motor skills functioning, received a Fascia Bowen therapy treatment session from a qualified Fascia Bowen practitioner each week for 6 weeks. All participants’ motor skills function were assessed by an occupational therapist before and after the end of the intervention using the Motor Skills Assessment Battery for Children test (MABC-2). Additionally, parents, teachers and participants completed questionnaires measuring self-esteem, social skills, social interaction, behaviour and scholastic function before and after the intervention. Results: The participants showed significant improvement in neuromuscular function over time using the MABC-2. However, no significant changes were shown in the other measures of functioning. Although parents did provide some anecdotal reports about positive changes in real life, these were not reflected in the measures. The results suggest that while improvements were shown as significant in the motor domain, which was the focus of the therapy, the results did not translate to other domains of life over time. 13 Conclusions: Further research is necessary to test the efficacy of the treatment’s effects using a larger sample, a control group and a longer intervention timescale. A six week intervention period may not be sufficient to show significant changes in self-esteem, social skills, social interaction, behaviour and scholastic functions which have deep-rooted constructs developed over many years. These may therefore take a long time to change.

The potential of the crural fascia to increase the articulation of the posterior thigh muscles through the in series connection of the structures, suggests that the crural fascia may influence the endpoint force direction of the muscles by partially redirecting the muscular force output. Furthermore, not only the in series connections should be considered but also how the parallel alignment of the crural fascia and the triceps surae may influence the force direction from the muscles. A redirection in force may, in turn, affect the intra-limb coordination or contribute to the selection of a task variable muscle activation pattern. The central objective was to evaluate the role of the synergistically located, posterior, distal musculature and connective tissue during locomotion. The central hypothesis was that the crural fascia would redirect the force output from the posterior thigh muscles to the endpoint and consequently increase propulsion within the limb. We selected to perform our studies in the spontaneously locomoting decerebrate cat, which allows us to investigate acute treatments applied to the hindlimb. The overall objective was accomplished by: (1) evaluating the role of the crural fascia during level walking; (2) determine the acute effect of denervating the triceps surae muscles and disrupting the crural fascia during level walking; and (3) evaluating the change in force direction output of selective stimulation of muscles in different limb configurations before and after complete fasciotomy. Our findings demonstrated that the crural fascia not only assists in propulsion but also acts to stabilize the distal limb. Furthermore, the acute denervation of the triceps surae resulted in a decrease in leg length and an increase in ankle yield during the weight acceptance phase of stance. This suggests that the conservation of the limb length as a task level variable is an adaptation rather than an immediate response.

Ce présent projet de recherche a permis de créer un modèle par éléments finis du muscle strié humain dans le but d’étudier les mécanismes engendrant les lésions musculaires traumatiques. Ce modèle constitue une plate-forme numérique capable de discerner l’influence des propriétés mécaniques des fascias et de la cellule musculaire sur le comportement dynamique du muscle lors d’une contraction excentrique, notamment le module de Young et le module de cisaillement de la couche de tissu conjonctif, l’orientation des fibres de collagène de cette membrane et le coefficient de poisson du muscle. La caractérisation expérimentale in vitro de ces paramètres pour des vitesses de déformation élevées à partir de muscles striés humains actifs est essentielle pour l’étude de lésions musculaires traumatiques. Le modèle numérique développé est capable de modéliser la contraction musculaire comme une transition de phase de la cellule musculaire par un changement de raideur et de volume à l’aide des lois de comportement de matériau prédéfinies dans le logiciel LS-DYNA (v971, Livermore Software Technology Corporation, Livermore, CA, USA). Le présent projet de recherche introduit donc un phénomène physiologique qui pourrait expliquer des blessures musculaires courantes (crampes, courbatures, claquages, etc.), mais aussi des maladies ou désordres touchant le tissu conjonctif comme les collagénoses et la dystrophie musculaire. La prédominance de blessures musculaires lors de contractions excentriques est également exposée. Le modèle développé dans ce projet de recherche met ainsi à l’avant-scène le concept de transition de phase ouvrant la porte au développement de nouvelles technologies pour l’activation musculaire chez les personnes atteintes de paraplégie ou de muscles artificiels compacts pour l’élaboration de prothèses ou d’exosquelettes.

The Gluteus Medius and the Tensor Fascia Lata are two of the main muscles involved in the action of hip abduction. This action is important for both dynamic movements in athletic pursuits and in every day ambulation. Weakness in these muscles has been connected to multiple injuries in the lower limb, but the question of the casual relationship between gait change, hip abductor weakness, and lower limb injury is still up for debate. As presented by the current research, younger populations tend to have overuse injuries with females having a greater susceptibility for injuries connected to hip abductor weakness, and older populations tend to have injures related to atrophy and degeneration of either the hip abductor muscles or the joint surrounding the hip. Research in this field has increasingly focused on sub-sets of the populations, such as just females or just males, trying to pinpoint the role that hip abductor weakness plays in these injuries. By trying to minimize or even eliminate the confounding variables that have previously made it difficult to determine the role hip abductor weakness plays in these gait changes and injuries, these studies have been able to make more clear conclusions at the expense of making a broader generalization. Similarities and differences between how the sub-groups present with hip abductor weakness are discussed, as well as discrepancies observed within the research done on similar cohorts. Future directions for research in this field are discussed, as well as implications for clinical implementation of targeted rehabilitation programs to ensure the best possible outcomes.

Afecções ortopédicas são freqüentes em pequenos animais e dentre essas afecções destaca-se a luxação coxofemoral – a mais freqüente dentre as luxações. Devido a tal incidência, a luxação coxofemoral tornou-se objeto de inúmeras pesquisas em medicina veterinária, sendo o tratamento cirúrgico o mais efetivo para sua correção. Ainda não foi, no entanto, desenvolvida uma técnica cirúrgica preferencial, amplamente difundida nas rotinas hospitalares. O presente trabalho avalia comparativamente o implante de fáscia lata bubalina e de pino de Steinmann transarticular para a estabilização de articulações coxofemorais luxadas. Foram utilizados 26 cães, separados em dois grupos que foram também, por sua vez, subdivididos. O primeiro grupo foi denominado “grupo Experimental” e reuniu 16 animais: oito pertencentes ao subgrupo “pino” e oito ao subgrupo “fáscia”. O segundo grupo foi denominado “grupo Rotina” e constituído por dez animais provenientes da rotina de atendimentos do Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (UFRGS), sendo igualmente subdividido nos subgrupos “pino” e “fáscia”, com cinco animais cada um. Os cães foram submetidos às respectivas técnicas de estabilização e acompanhados clínica e radiograficamente durante 60 dias, findos os quais os animais do grupo Experimental passaram por avaliação macroscópica direta das articulações, além da histopatologia e teste de tensiometria. A principal vantagem da fáscia respeita à deambulação dos animais, que apresentaram evolução pós-operatória significativamente precoce em relação ao grupo submetido ao implante do pino de Steinmann transarticular, além de menor grau de atrofia muscular. Os testes de tensiometria, avaliações radiográficas e exames histopatológicos não apresentaram diferenças estatisticamente significativas entre os grupos, evidenciando também que ambas as técnicas não geraram alterações deletérias à articulação operada. Destarte, conclui-se que a técnica de estabilização da articulação coxofemoral com implante de fáscia lata é eficaz e vantajosa quando comparada à técnica do pino transarticular. / The orthopedics disorders are very frequent in small animals and among them we can find the coxofemoral luxation as the most frequent disease. Because of a high incidence it became an important subject for veterinary researches. Surgery is the most effective treatment in cases of coxofomoral luxation, although the techniques that already exist are not so used in the clinics routine because of some difficulties these techniques present. In this paper the bubaline fascia lata implant and Steinmann transarticular pin were compared in surgeries for coxofemoral luxation. Twenty-six animals were used, divided into two groups that were subdivided. The first group was called “Grupo Experimental” and was formed by 16 animals, 8 animals in the subgroup called “pino” and the other 8 animals in the subgroup “fáscia”. The second group was called “Rotina” because these animals came from the routine of the clinic sector of Universidade Federal do Rio Grande do Sul Veterinary Hospital, and these groups were also subdivided in the subgroups “pino” and “fáscia”, with 5 animal each. These groups were submitted to the mentioned above stabilization techniques and after that, they were observed clinically and radiografically during 60 days. After that, it was realized a macroscopic study in the articulations of “Grupo Experimental”, besides an histopatological exam and a tensiometry test. The results showed that the technique with the bubaline fascia lata implant proved to be really efficient and it has some advantages comparing to the transarticular pin technique. The most important advantage is related to the deambulation, where the animals in this group showed a better evolution after the surgery. The level of muscular atrophy in this group was less marked. The tensiometry tests, the radiographic and histopatological exams did not present important differences between the two groups, but they were useful to show that the two techniques did not cause bad alterations in the worked articulation. In this sense it can be concluded that the stabilization of the coxofemoral articulation using bubaline fascia lata implant is a better technique comparing to the transarticular pin technique due to its advantages, mainly related to the deambulation and the muscular atrophy.

Afecções ortopédicas são freqüentes em pequenos animais e dentre essas afecções destaca-se a luxação coxofemoral – a mais freqüente dentre as luxações. Devido a tal incidência, a luxação coxofemoral tornou-se objeto de inúmeras pesquisas em medicina veterinária, sendo o tratamento cirúrgico o mais efetivo para sua correção. Ainda não foi, no entanto, desenvolvida uma técnica cirúrgica preferencial, amplamente difundida nas rotinas hospitalares. O presente trabalho avalia comparativamente o implante de fáscia lata bubalina e de pino de Steinmann transarticular para a estabilização de articulações coxofemorais luxadas. Foram utilizados 26 cães, separados em dois grupos que foram também, por sua vez, subdivididos. O primeiro grupo foi denominado “grupo Experimental” e reuniu 16 animais: oito pertencentes ao subgrupo “pino” e oito ao subgrupo “fáscia”. O segundo grupo foi denominado “grupo Rotina” e constituído por dez animais provenientes da rotina de atendimentos do Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (UFRGS), sendo igualmente subdividido nos subgrupos “pino” e “fáscia”, com cinco animais cada um. Os cães foram submetidos às respectivas técnicas de estabilização e acompanhados clínica e radiograficamente durante 60 dias, findos os quais os animais do grupo Experimental passaram por avaliação macroscópica direta das articulações, além da histopatologia e teste de tensiometria. A principal vantagem da fáscia respeita à deambulação dos animais, que apresentaram evolução pós-operatória significativamente precoce em relação ao grupo submetido ao implante do pino de Steinmann transarticular, além de menor grau de atrofia muscular. Os testes de tensiometria, avaliações radiográficas e exames histopatológicos não apresentaram diferenças estatisticamente significativas entre os grupos, evidenciando também que ambas as técnicas não geraram alterações deletérias à articulação operada. Destarte, conclui-se que a técnica de estabilização da articulação coxofemoral com implante de fáscia lata é eficaz e vantajosa quando comparada à técnica do pino transarticular. / The orthopedics disorders are very frequent in small animals and among them we can find the coxofemoral luxation as the most frequent disease. Because of a high incidence it became an important subject for veterinary researches. Surgery is the most effective treatment in cases of coxofomoral luxation, although the techniques that already exist are not so used in the clinics routine because of some difficulties these techniques present. In this paper the bubaline fascia lata implant and Steinmann transarticular pin were compared in surgeries for coxofemoral luxation. Twenty-six animals were used, divided into two groups that were subdivided. The first group was called “Grupo Experimental” and was formed by 16 animals, 8 animals in the subgroup called “pino” and the other 8 animals in the subgroup “fáscia”. The second group was called “Rotina” because these animals came from the routine of the clinic sector of Universidade Federal do Rio Grande do Sul Veterinary Hospital, and these groups were also subdivided in the subgroups “pino” and “fáscia”, with 5 animal each. These groups were submitted to the mentioned above stabilization techniques and after that, they were observed clinically and radiografically during 60 days. After that, it was realized a macroscopic study in the articulations of “Grupo Experimental”, besides an histopatological exam and a tensiometry test. The results showed that the technique with the bubaline fascia lata implant proved to be really efficient and it has some advantages comparing to the transarticular pin technique. The most important advantage is related to the deambulation, where the animals in this group showed a better evolution after the surgery. The level of muscular atrophy in this group was less marked. The tensiometry tests, the radiographic and histopatological exams did not present important differences between the two groups, but they were useful to show that the two techniques did not cause bad alterations in the worked articulation. In this sense it can be concluded that the stabilization of the coxofemoral articulation using bubaline fascia lata implant is a better technique comparing to the transarticular pin technique due to its advantages, mainly related to the deambulation and the muscular atrophy.