Undesirable work factors, such as awkward upper body postures and repetitive arm motion, in the workplace can lead to upper extremity pain. Research suggests that these work-related factors, and subsequent rotator cuff fatigue, may cause the subacromial space (the space between the inferior acromion surface and superior humerus) of the shoulder to decrease. Reducing this space can create impingement of the interposed tissues, which causes shoulder pain. The aim of this study was to examine superior humeral head excursion and changes in the width of the subacromial space (acromio-humeral interval) after fatiguing the rotator cuff musculature. Four anterior-posterior radiographs of the glenohumeral joint at arm abduction angles of 0˚, 45˚, 90˚ and 135˚ were taken before and after a fatiguing task. The fatiguing task was a simulated job task requiring shoulder flexion/abduction and internal/external rotation, with the intention of exhausting the entire rotator cuff. The position of the humeral head with respect to the glenoid cavity was significantly affected both by arm angle and fatigue state; the mean humeral superior excursion following fatigue was 0.63±1.76mm. In the pre-fatigued state, increasing arm angle was related to superior translation until 90˚, after which the humeral head moved inferiorly to a more central position. In the post-fatigued state, the inability of the rotator cuff to centralize the humeral head led to increasing translations with higher elevations. Although the magnitude of translation in this study was smaller than seen in patients with rotator cuff tears, continuous overhead work demonstrably created rotator cuff fatigue, which apparently inhibited the ability of the shoulder musculature to resist upward translation of the humerus. Therefore, jobs that require overhead and repetitive work arguably put the worker at greater risk for superior translation of the humerus and subsequent related tissue damage.

Undesirable work factors, such as awkward upper body postures and repetitive arm motion, in the workplace can lead to upper extremity pain. Research suggests that these work-related factors, and subsequent rotator cuff fatigue, may cause the subacromial space (the space between the inferior acromion surface and superior humerus) of the shoulder to decrease. Reducing this space can create impingement of the interposed tissues, which causes shoulder pain. The aim of this study was to examine superior humeral head excursion and changes in the width of the subacromial space (acromio-humeral interval) after fatiguing the rotator cuff musculature. Four anterior-posterior radiographs of the glenohumeral joint at arm abduction angles of 0˚, 45˚, 90˚ and 135˚ were taken before and after a fatiguing task. The fatiguing task was a simulated job task requiring shoulder flexion/abduction and internal/external rotation, with the intention of exhausting the entire rotator cuff. The position of the humeral head with respect to the glenoid cavity was significantly affected both by arm angle and fatigue state; the mean humeral superior excursion following fatigue was 0.63±1.76mm. In the pre-fatigued state, increasing arm angle was related to superior translation until 90˚, after which the humeral head moved inferiorly to a more central position. In the post-fatigued state, the inability of the rotator cuff to centralize the humeral head led to increasing translations with higher elevations. Although the magnitude of translation in this study was smaller than seen in patients with rotator cuff tears, continuous overhead work demonstrably created rotator cuff fatigue, which apparently inhibited the ability of the shoulder musculature to resist upward translation of the humerus. Therefore, jobs that require overhead and repetitive work arguably put the worker at greater risk for superior translation of the humerus and subsequent related tissue damage.

xiii, 79 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Subacromial impingement syndrome is the most common disorder of the shoulder. Abnormal superior translation of the humeral head is believed to be one of the major causes of this pathology. The overall purpose of this study was to better understand glenohumeral kinematics in normal healthy individuals using fluoroscopy to help comprehend the mechanism of shoulder impingement. This research was divided into three sections: a validation study to measure humeral head translation, a comparison between dynamic and static arm elevation and lastly, humeral head translation after a suprascapular nerve block. In the first study, fluoroscopy was used to take images of human cadaver shoulders. Scapular orientation was manipulated in different positions while the humerus was at 90 degrees of elevation. Humeral head translation was measured using two methods and was compared to the known translation. Additionally, the accuracy of the contour registration method to measure 2-D scapular rotations was assessed. For the second study, subjects elevated their dominant arm while fluoroscopic images were taken. An edge detection software was utilized to digitize points on both the humeral head and glenoid. Humeral head translation and scapular upward rotation were measured using a contour registration method with respect to the glenoid during arm elevation. Five different arm elevation angles were investigated to measure differences in humeral head translation between trials. There was no difference found between humeral head translation and scapular upward rotation between static and dynamic shoulder elevation. For the third study, humeral head translation was measured before and after a suprascapular never block. The humeral head was superiorly located and the scapula was more upwardly rotated after the block. The differences were observed during mid range of motion. This result showed that there was a compensatory increase in both humeral head translation and scapular upward rotation due to the nerve block. These results suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscle could prevent any increased superior humeral head translation. This may be beneficial in preventing shoulder impingement or rotator cuff tear over time. This dissertation includes unpublished co-authored materials. / Committee in charge: Andrew Karduna, Chairperson, Human Physiology; Li-Shan Chou, Member, Human Physiology; Louis Osternig, Member, Human Physiology; Stephen Frost, Outside Member, Anthropology

The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

L'analyse morpho-fonctionnelle précise de l'épaule, notamment au niveau de l'articulation glénohumérale (GH), permettrait d'améliorer notre compréhension des dysfonctions de l'épaule associées aux ruptures de la coiffe des rotateurs. Cependant, des difficultés techniques compliquent l'analyse de la morphologie et du mouvement de l'épaule dans un contexte clinique. Dans le cadre de la présente thèse, une méthode d'analyse 3D des translations GH basée sur l'acquisition de séquences de radiographies biplanes sous EOS™ a été développée. Une étude pilote sur 10 sujets sains a d'abord permis de vérifier la facilité d'application d'un protocole d'acquisition des images et d'évaluer la répétabilité de l'identification des repères anatomiques de l'épaule sur les radiographies. La méthode proposée en dernier lieu permet, suite à l'acquisition de radiographies, de reconstruire un modèle personnalisé morpho-réaliste de la scapula et un modèle simplifié de l'humérus. Ces modèles sont ensuite recalés interactivement sur les images acquises à différentes positions du bras et utilisés pour décrire les translations GH à ces positions. La méthode a été validée en termes de précision et de répétabilité sur des images acquises d'épaules cadavériques et de patients ayant des ruptures de la coiffe des rotateurs. La dernière partie du travail présenté ici consiste à appliquer la méthode développée à 30 sujets (25 patients et 5 sujets sains) pour lesquels l'état de la coiffe des rotateurs et la fonction de l'épaule ont été évalués, puis à étudier les corrélations entre les translations GH et la fonction de l'épaule. / Precise morpho-functional analysis of the shoulder, including of the glenohumeral (GH) joint, would allow improving our understanding of shoulder dysfunction associated to rotator cuff tears. However, technical difficulties make analysis of shoulder morphology and motion difficult in a clinical setting. The work carried out during this thesis allowed developing a method for 3D analysis of GH translations relying on the acquisition of sequences of biplanar radiographs with the EOS™ system. A pilot study carried out on 10 healthy subjects allowed verifying the ease of application of an image acquisition protocol and evaluating the repeatability of shoulder landmark identification on the radiographs. The final proposed method allows, following the acquisition of radiographs, obtaining a personalized morphologically realistic reconstruction of the scapula and a simplified model of the humerus. These models are then interactively registered to the images acquired at different arm positions and used to describe GH translations for these positions. The proposed method was validated in terms of precision and repeatability on images acquired of cadaveric shoulders and of patients with rotator cuff tears. The last part of the work presented here consists in applying the developed method to 30 subjects (25 patients and 5 asymptomatic subjects) for whom rotator cuff condition and shoulder function were assessed, and to study correlations between GH translations and shoulder function.

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)

Made available in DSpace on 2015-03-26T13:46:36Z (GMT). No. of bitstreams: 1 texto completo.pdf: 832157 bytes, checksum: b5d2369f96a82a9d4af7de68979a2dad (MD5) Previous issue date: 2006-04-11 / This work was developed in order to evaluate microscoply the influence of gallium arsenate (Ga-As) diodo laser associated with chondroitin sulfate and chitosan on the healing process of the articular surface of the humeral head of dogs following experimental osteochondroplasty. Sixteen adult dogs were randomly allocated into four groups of four animals. All animals had the left humeral head injured by a surgical procedure (osteochondroplasty) and those from the TG were submitted to Ga-As diode laser sessions and received orally chondroitin sulfate and chitosan. In order to analyze microscopically the surgical injury the animals of the subgroups (C1, C2, C3, C4, T1, T2, T3 and T4) were killed on the 7th, 21st, 35th and 60th days after the surgery, respectively. The histological assessment revealed an increased vascularization, repairing potential and local osteogenesis, increase of the activity synthesis and keeping the cartilage matrix and better healing of the defect with fibrocartilage tissue of TG compared to those from CG, such findings were attributed to the physiotherapeutic effects of the Ga-As diode laser and chondroitin sulfate and chitosan. / O objetivo deste estudo foi avaliar, microscopicamente, a influência do laser a diodo de Arsenieto de Gálio (As-Ga) associado ao sulfato de condroitina e quitosana no processo de reparação da superfície articular da cabeça umeral de cães após defeito osteocondral experimental. Foram utilizados 16 cães adultos, distribuídos aleatoriamente em quatro subgrupos de quatro animais. Em todos os animais foi induzido um defeito cirúrgico na articulação escápulo-umeral esquerda sendo, posteriormente, submetido à aplicação de laser As-Ga (904nm) e administração oral de sulfato de condroitina e quitosana. Para realizar as análises microscópica do defeito cirúrgico, os animais de cada subgrupo (T1, T2, T3 e T4) foram eutanasiados aos sete, 21, 35 e 60 dias após a cirurgia, respectivamente. Foi evidenciado aumento da vascularização da área de reparação, potencialização da reparação e da osteogênese local, aumento da atividade de síntese e manutenção da matriz cartilaginosa e reparação do defeito por tecido fibrocartilaginoso. Os resultados foram atribuídos aos efeitos fisioterapêuticos do laser associado ao sulfato de condroitina e quitosana administrado via oral.

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