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.

The Photonic Crystal (PC) is a potential candidate for a compact optical integrated circuit on a solid state platform. The fabrication process of a PC is compatible with CMOS technology; thus, it could be potentially employed in hybrid optical and electrical integrated circuits. One of the main obstacles in the implementation of an integrated optical circuit is the polarization dependence of wave propagation. Our goal is to overcome this obstacle by implementing PC based polarization controlling devices. One of the crucial elements of polarization controlling devices is the polarization rotator. The polarization rotator is utilized to manipulate and rotate the polarization of light. In this thesis, we have proposed, designed and implemented an ultra-compact passive PC based polarization rotator. Passive polarization rotator structures are mostly composed of geometrically asymmetric structures. The polarization rotator structure consists of a single defect line PC slab waveguide. The geometrical asymmetry has been introduced on top of the defect line as an asymmetric loaded layer. The top loaded layer is asymmetric with respect to the z-axis propagation direction. To synchronize the power conversion and avoid power conversion reversal, the top loaded layer is alternated around the z-axis periodically. The structure is called periodic asymmetric loaded PC slab waveguide. Due to the compactness of the proposed structure, a rigorous numerical method, 3D-FDTD can be employed to analyze and simulate the final designed structure. For the quick preliminary design, an analytical method that provides good approximate values of the structural parameters is preferred. Coupled-mode theory is a robust and well-known method for such analyses of perturbed waveguide structures. Thus, a coupled-mode theory based on semi-vectorial modes was developed for propagation modeling on square hole PC structures. In essence, we wish to develop a simple yet closed form method to carry out the initial design of the device of interest. In the next step, we refined the design by using rigorous but numerically expensive 3D-FDTD simulations. We believe this approach leads to optimization of the device parameters easily, if desired. To extend the design to a more general shape PC based polarization rotator, a design methodology based on hybrid modes of asymmetric loaded PC slab waveguide was introduced. The hybrid modes of the structure were calculated utilizing the 3D-FDTD method combined with the Spatial Fourier Transform (SFT). The propagation constants and profile of the slow and fast modes of an asymmetric loaded PC slab waveguide were extracted from the 3D-FDTD simulation results. The half-beat length, which is the length of each loaded layer, and total number of the loaded layers are calculated using the aforementioned data. This method provides the exact values of the polarization rotator structure’s parameter. The square hole PC based polarization rotator was designed employing both coupled-mode theory and normal modal analysis for THz frequency applications. Both design methods led to the same results. The design was verified by the 3D-FDTD simulation of the polarization rotator structure. For a square hole PC polarization rotator, a polarization conversion efficiency higher than 90% over the propagation distance of 12 λ was achieved within the frequency band of 586.4-604.5 GHz corresponding to the normalized frequency of 0.258-0.267. The design was extended to a circular hole PC based polarization rotator. A polarization conversion efficiency higher than 75% was achieved within the frequency band of 600-604.5 GHz. The circular hole PC polarization rotator is more compact than the square-hole PC structure. On the other hand, the circular hole PC polarization rotator is narrow band in comparison with the square hole PC polarization rotator. In a circular hole PC slab structure, the Bloch modes (fast and slow modes) couple energy to the TM-like PC slab modes. In both square and circular hole PC slab structures with finite number of rows, and the TM-like PC slab modes are extended to the lower edge of the bandgap. In bandgap calculation using PWEM, it is assumed that the PC structure is extended to infinity, however in practice the number of rows is limited, which is the source of discrepancy between the bandgap calculation using PWEM and 3D-FDTD. In an asymmetric loaded circular hole PC slab waveguide, the leaky TM-like PC slab modes are extended deep inside the bandgap and overlapped with both the slow and fast Bloch modes; whereas, in an asymmetric loaded square hole PC slab waveguide, the leaky TM-like PC slab modes are below the frequency band of slow and fast modes. Therefore, TM-like PC slab modes have significantly more adverse effect on the performance of the circular-hole based polarization rotator leading to a narrow band structure. SOI based PC membrane technology for THz application was developed. The device layer is made of highly resistive silicon to maintain low loss propagation for THz wave. The PC slab waveguide and polarization rotators were fabricated employing this technology. Finally, an a-SiON PC slab waveguide structures were also fabricated at low temperature for optical applications. This technology has the potential to be implemented on any substrate or CMOS chips.

The Photonic Crystal (PC) is a potential candidate for a compact optical integrated circuit on a solid state platform. The fabrication process of a PC is compatible with CMOS technology; thus, it could be potentially employed in hybrid optical and electrical integrated circuits. One of the main obstacles in the implementation of an integrated optical circuit is the polarization dependence of wave propagation. Our goal is to overcome this obstacle by implementing PC based polarization controlling devices. One of the crucial elements of polarization controlling devices is the polarization rotator. The polarization rotator is utilized to manipulate and rotate the polarization of light. In this thesis, we have proposed, designed and implemented an ultra-compact passive PC based polarization rotator. Passive polarization rotator structures are mostly composed of geometrically asymmetric structures. The polarization rotator structure consists of a single defect line PC slab waveguide. The geometrical asymmetry has been introduced on top of the defect line as an asymmetric loaded layer. The top loaded layer is asymmetric with respect to the z-axis propagation direction. To synchronize the power conversion and avoid power conversion reversal, the top loaded layer is alternated around the z-axis periodically. The structure is called periodic asymmetric loaded PC slab waveguide. Due to the compactness of the proposed structure, a rigorous numerical method, 3D-FDTD can be employed to analyze and simulate the final designed structure. For the quick preliminary design, an analytical method that provides good approximate values of the structural parameters is preferred. Coupled-mode theory is a robust and well-known method for such analyses of perturbed waveguide structures. Thus, a coupled-mode theory based on semi-vectorial modes was developed for propagation modeling on square hole PC structures. In essence, we wish to develop a simple yet closed form method to carry out the initial design of the device of interest. In the next step, we refined the design by using rigorous but numerically expensive 3D-FDTD simulations. We believe this approach leads to optimization of the device parameters easily, if desired. To extend the design to a more general shape PC based polarization rotator, a design methodology based on hybrid modes of asymmetric loaded PC slab waveguide was introduced. The hybrid modes of the structure were calculated utilizing the 3D-FDTD method combined with the Spatial Fourier Transform (SFT). The propagation constants and profile of the slow and fast modes of an asymmetric loaded PC slab waveguide were extracted from the 3D-FDTD simulation results. The half-beat length, which is the length of each loaded layer, and total number of the loaded layers are calculated using the aforementioned data. This method provides the exact values of the polarization rotator structure’s parameter. The square hole PC based polarization rotator was designed employing both coupled-mode theory and normal modal analysis for THz frequency applications. Both design methods led to the same results. The design was verified by the 3D-FDTD simulation of the polarization rotator structure. For a square hole PC polarization rotator, a polarization conversion efficiency higher than 90% over the propagation distance of 12 λ was achieved within the frequency band of 586.4-604.5 GHz corresponding to the normalized frequency of 0.258-0.267. The design was extended to a circular hole PC based polarization rotator. A polarization conversion efficiency higher than 75% was achieved within the frequency band of 600-604.5 GHz. The circular hole PC polarization rotator is more compact than the square-hole PC structure. On the other hand, the circular hole PC polarization rotator is narrow band in comparison with the square hole PC polarization rotator. In a circular hole PC slab structure, the Bloch modes (fast and slow modes) couple energy to the TM-like PC slab modes. In both square and circular hole PC slab structures with finite number of rows, and the TM-like PC slab modes are extended to the lower edge of the bandgap. In bandgap calculation using PWEM, it is assumed that the PC structure is extended to infinity, however in practice the number of rows is limited, which is the source of discrepancy between the bandgap calculation using PWEM and 3D-FDTD. In an asymmetric loaded circular hole PC slab waveguide, the leaky TM-like PC slab modes are extended deep inside the bandgap and overlapped with both the slow and fast Bloch modes; whereas, in an asymmetric loaded square hole PC slab waveguide, the leaky TM-like PC slab modes are below the frequency band of slow and fast modes. Therefore, TM-like PC slab modes have significantly more adverse effect on the performance of the circular-hole based polarization rotator leading to a narrow band structure. SOI based PC membrane technology for THz application was developed. The device layer is made of highly resistive silicon to maintain low loss propagation for THz wave. The PC slab waveguide and polarization rotators were fabricated employing this technology. Finally, an a-SiON PC slab waveguide structures were also fabricated at low temperature for optical applications. This technology has the potential to be implemented on any substrate or CMOS chips.

Computer generated three-dimensional (3-D) models are being used at increasing rates in the fields of entertainment, education, research, and engineering. One of the aspects of interest includes the behavior and function of the musculoskeletal system. One such tool used by engineers is the finite element method (FEM) to simulate the physics behind muscle mechanics. There are several ways to represent 3-D muscle geometry, namely a bulk, a central line of action and a spline model. The purpose of this study is to exmine how these three representations affect the overall outcome of muscle movement. This is examined in a series of phases with Phase I using primitive geometry as a simplistic representation of muscle. Phases II and III add anatomical representations of the shoulder joint with increasing complexity. Two methods of contraction focused on an applied maximal force (Fmax) and prescribed displacement. Further analyses tested the variability of material properties as well as simulated injury scenarios. The results were compared based on displacement, von Mises stress and solve time. As expected, more complex models took longer to solve. It was also supported that applied force is a preferred method of contraction as it allows for antagonistic and synergistic interaction between muscles. The most important result found in these studies was the consistency in the levels of displacement and stress distribution across the three different 3-D representations of muscle. This stability allows for the interchangeability between the three different representations of muscles and will permit researchers to choose to use either a bulk, central line of action or a spline model. The determination of which 3-D representation to use lies in what physical phenomenon (motion, injury etc.) is being simulated.

Unbalanced muscle forces in the shoulder joint may lead to functional impairment in the setting of rotator cuff tear and progressive arthritis in cuff tear arthropathy. A model, which predicts muscle forces for common shoulder movements, could be used to help in treatment decision-making and in improving the design of total shoulder prosthesis. Unfortunately, the shoulder has many muscles that overlap in function leading to an indeterminate system. A finite element model employing an optimization algorithm could be used to reduce the number of degrees of freedom and predict loading of the glenohumeral joint. The goal of this study was to develop an anatomically and physiologically correct computational model of the glenohumeral joint. This model was applied to: 1) estimate the force in each muscle during the standard glenohumeral motions (flexion/extension, abduction/adduction and internal/ external rotation), and 2) determine stress concentrations within the scapula during these motions. These goals were realized through the following steps: First, a three dimensional bone reconstruction was performed using computed tomography (CT) scan data. This allowed for a precise anatomical representation of the bony components. Then muscle lever arms were estimated based on the reconstructed bones using computer-aided design software. The origins, insertions, and muscle paths were obtained from the literature. This model was then applied to estimate the forces within each of the muscles that are necessary to stabilize the joint at a fixed position. Last, finite element analysis of the scapula was performed to study the stress concentrations. These were identified and related to the morphology of the bone. A force estimation algorithm was then developed to determine the necessary muscle force distribution. This algorithm was based on an applied external moment at the joint, and the appropriate selection of muscles that could withstand it, ensuring stability, while keeping the reaction force at a minimum. This method offered an acceptable solution to the indeterminate problem, a unique solution was found for each shoulder motion. The model was then applied to determine the stress concentration within various regions of the scapula for each of the shoulder motions. The rotator cuff was found to act as the main stabilizer under rotation, and had a significant stabilizing role under flexion and abduction. The finite element model of the shoulder that was developed can be used to gain a better understanding of the load transfer mechanisms within the glenohumeral joint and the impact of muscle forces on scapular morphology. This information can then be used to assist with treatment decision-making for rotator cuff tears and with the design of new implants for total shoulder arthroplasty.

Rotatorenmanschettenrupturen (RM-Rupturen) haben eine hohe Prävalenz in der Bevölkerung und kommen mit zunehmendem Alter gehäuft vor (Ozaki et al. 1988, Milgrom et al.1995). Die operative Rekonstruktion der RM gilt als Goldstandard der Behandlung. Unbehandelt neigen RM-Rupturen zu Progression und zu fettiger Infiltration des Muskelbauchs und zu Abnahme der Sehnenqualität (Goutallier et al. 1994). Im weiteren Verlauf droht eine Defektarthropathie mit schmerzhafter Bewegungsseinschränkung und hochgradigem Funktionsverlust der Extremität. Eine zeitgerechte Rekonstruktion der RM kann diesen Verlauf günstig beeinflussen und die Funktion des Schultergelenkes signifikant verbessern (Deutsch et al. 1997, Gladstone et al. 2007). Mit zunehmendem Funktionsanspruch, auch noch im fortgeschrittenen Alter, gewinnt die Rekonstruktion der RM zunehmend an Bedeutung (Worland et al. 1999). Die Rerupturrate der operativen Rekonstruktion ist hoch und wird je nach Autor mit bis zu 94% angegeben (Boileau et al. 2005, Galatz et al. 2004). Uneinigkeit herrscht in der Literatur über die Art der Primärrefixation der Sehne im Knochen (Bishop et al. 2006, Boileau et al. 2005, Galatz et al. 2004). Mehrere Autoren berichten, dass die Nahtankerreparatur der transossären Refixation gleichwertig bzw. überlegen ist (Reed et al., 1996, Klinger et al. 2007). Des Weiteren wird die Anzahl und das Platzierungsmuster der Nahtanker, im Hinblick auf die Primärstabilität, kontrovers diskutiert (Apreleva et al. 2002, Craft et al. 1996, Rossouw et al. 1997). 52 Ziel des Schulterchirurgen sollte es sein, eine möglichst hohe Primärfestigkeit der Rekonstruktion zu erreichen, des Weiteren sollte die Refixationsmethode die spannungsfreie Einheilung der Sehne ermöglichen, den Patienten möglichst schnell einer aktiven Rehabilitation zuführen und die Rerupturrate möglichst gering halten (Kim et al. 2005). Ziel der Arbeit war es zu zeigen, ob eine weitere Reihe Nahtanker eine höhere Primärstabilität in Abhängigkeit des verwendeten Nahtmaterials bietet. Hierzu wurden 32 frische Schafsschultern in 4 Gruppen zu je 8 Präparaten aufgeteilt. Eine vollständige RM-Ruptur wurde simuliert und anschließend wurden die Rupturen entweder mit einer Einreihen-Nahtankerversorgung (single-row-Technik) oder mit einer Zweireihen-Nahtankerversorgung (double-row-Technik) refixiert. Dabei kamen 2 verschiedene Nahtmaterialien zum Einsatz (nicht resorbierbares Polyesterfadenmaterial (Ethibond®) und nicht resorbierbares Polyethylenfadenmaterial (HiFi®) der Stärke 2.0). Die Präparate wurden in einer Zugmaschine auf ihre Zugfestigkeit getestet. Die double-row-Technik in Kombination mit nicht-resorbierbarem Polyethylenfadenmaterial (HiFi®, Gruppe IV) erzielte hierbei eine signifikant höhere Ausreißfestigkeit als die anderen Versorgungen. Mehrere Fixationspunkte der Verbindung Knochen-Faden/Naht-Sehne bei der double- row-Technik erreichen so durch eine gleichmäßige Lastverteilung eine höhere Zugfestigkeit Inwieweit diese erhöhte Primärfestigkeit eine Verbesserung des klinischen Ergebnisses und eine Reduktion der Rerupturrate erbringen kann, muss durch zukünftige klinisch-prospektive Studien validiert werden. Der Einsatz dieser kostenintensiven und operativ anspruchsvollen Methode ist unseres Erachtens nur dann gerechtfertigt, wenn die Anzahl an Revisionseingriffen hierdurch signifikant gesenkt werden kann.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.

Tyrimo objektas: Peties sąnario judesių amplitudės, raumenų jėgos, skausmo ir funkcinio pajėgumo pokyčiai taikant pratimus ir peties sąnario mobilizaciją po peties sąnario sukamosios manžetės plyšimo operacijos. Temos aktualumas. Peties sąnario sukamosios manžetės plyšimai dažnai lemia peties sąnario skausmus ir įvairaus pobūdžio negalią vyresniame amžiuje (Khair & Gulotta, 2011). Šią traumą patiria apie 25,0 proc. vyresnių nei 60 m žmonių ir apie 20,0 proc. vyresnių nei 20 m žmonių (Itoj, 2013). Lietuvoje yra atlikta nedaug tyrimų apie peties sąnario sukamosios manžetės plyšimus. Užsienio autoriai daugiau tyrinėja peties sąnario mobilizacijos ir pasyvių techninkų efektyvumą sergant peties ankšumo sindromu, artritu, artroze ir kitomis ligomis. Ypač trūksta informacijos apie gydymą, kuris leistų pacientams išvengti operacijos. Daugelis autorių nurodo, jog reikalingi išsamesni tyrimai šioje srityje. Tyrimo tikslas: įvertinti peties sąnario mobilizacijos ir pratimų efektyvumą gydant peties sąnario sukamosios manžetės plyšimus. Tyrimo uždaviniai: 1. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos paties sąnario judesių amplitudę, raumenų jėgą, skausmą ir funkcinį pajėgumą prieš kineziterapiją. 2. Įvertinti peties sąnario mobilizacijos ir gydomųjų pratimų poveikį pacientų peties sąnario judesių amplitudei, raumenų jėgai, skausmui ir funkciniam pajėgumui po sukamosios manžetės plyšimo operacijos. 3. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos judesių... [toliau žr. visą tekstą] / Object: The change of shoulder range of motion, muscle strength, pain and functional capacity after taking exercises and shoulder joint mobilization for patients after rotator cuff tear reconstruction surgery. Relevance of the topic. In elder age shoulder pain and various disabilities often occur because of the rotator cuff tears (Khair & Gulotta, 2011). 25,0 percent of population over 60 years and 20,0 percent of population over 20 years suffer from this injury (Itoj, 2013). Foreigner scientists more often make studies about the effectiveness of shoulder joint mobilization and other passive physical therapy techniques in curing other shoulder illnesses such as impingement syndrome, arthritis and ect. Especially there is lack of information about treatment that would prevent patients from surgery. Many scientists indicate that more studies are necessary about this topic. Task. The aim of this study was to evaluate the effectiveness of shoulder joint mobilization and therapeutic exercises curing rotator cuff tears. The main goals of this study were: 1. To evaluate range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear arthroscopic reconstruction surgery. 2. To evaluate effectiveness of shoulder joint mobilization and therapeutic exercises for range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear reconstruction surgery. 3. To evaluate how shoulder... [to full text]

The purpose of the study was to investigate the static and dynamic architecture of supraspinatus throughout its volume in the normal and pathological state. The architecture was first investigated in cadaveric specimens free of any tendon pathology. Using a serial dissection and digitization method tailored for supraspinatus, the musculotendinous architecture was modeled in situ. The 3D model reconstructed in Autodesk MayaTM allowed for visualization and quantification of the fiber bundle architecture i.e. fiber bundle length (FBL), pennation angle (PA), muscle volume (MV) and tendon dimensions. Based on attachment sites and architectural parameters, the supraspinatus was found to have two architecturally distinct regions, anterior and posterior, each with three subdivisions. The findings from the cadaveric investigation served as a map and platform for the development of an ultrasound (US) protocol that allowed for the dynamic fiber bundle architecture to be quantified in vivo in normal subjects and subjects with a full-thickness supraspinatus tendon tear. The architecture was studied in the relaxed state and in three contracted states (60º abduction with either neutral rotation, 80º external rotation, or 80º internal rotation). The dynamic changes in the architecture within the distinct regions of the muscle were not uniform and varied as a function of joint position. Mean FBL in the anterior region shortened significantly with contraction (p<0.05) but not in the posterior. In the anterior region, mean PA was significantly smaller in the middle part compared to the deep (p<0.05). Comparison of the normal and pathological muscle found large differences in the percentage change of FBL and PA with contraction. The architectural parameter that showed the largest changes with tendon pathology was PA. In sum, the results showed that the static and dynamic fiber bundle architecture of supraspinatus is heterogeneous throughout the muscle volume and may influence tendon stresses. The architectural data collected in this study and the 3D muscle model can be used to develop future contractile models. The US protocol may serve as an assessment tool to predict the functional outcome of rehabilitative exercises and surgery.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.