Function of the shoulder complex is highly dependent on the relationship between the scapula and the humerus. Etiologies for the disruption of the glenohumeral relationship include impaired or abnormal scapular function, motion, or position. The lateral scapular slide test (LSST) has been developed as a clinical tool to assess this phenomenon, also known as scapular dyskinesis. The primary purpose of this study was to determine the validity of the LSST by comparing the clinical measurements on the skin surface to the actual anatomical distance between the scapula and the spine as seen on radiographic images. The secondary purpose of this study was to determine the intra-rater and inter-rater reliability of the LSST. Nine subjects (18 shoulders) were assessed with the clinical LSST and radiographic images in three test positions (0��, 45��, and 90�� of glenohumeral abduction). Comparison of the clinical LSST measurements with the radiographs revealed the LSST to be valid (>0.80) in only the 0�� and 45�� test positions with respective Pearson correlation values of 0.91 and 0.98. Excellent (>0.75) intra-rater ICC (2,1) reliability (0.91-0.97) was found for all three test positions. Inter-rater ICC (2,1) reliability values were excellent for the 0�� (0.87) and 45�� (0.83) test positions, and fair to good for the 90�� position (0.71). This study demonstrated that the LSST is an accurate and consistent measure of scapular movement and position for the 0�� and 45�� test positions. Clinicians should exercise caution when interpreting measurements obtained at the 90�� test position because the validity and reliability values did not reach established standards. / Graduation date: 2002

published_or_final_version / Behavioral Health / Master / Master of Social Sciences

Shoulder arthroplasty surgery has shown remarkable progress during the last few decades. A number of factors affect postoperative range of motion, pain and prosthetic durability. Among these factors, the length of the lever arm and joint stability is the ones that can be altered by the selected prosthetic component. It is uncertain how much of the normal anatomy needs to be re-established. Stemless prostheses with total reliance on metaphyseal fixation were introduced in France in 2004 (TESS, Zimmer Biomet). The goals were to avoid stem-related complications. Stemless implants have other potential benefits, including the ability to restore shoulder anatomy. Study I: This is a prospective cohort study of 49 patients with one of two versions of the TESS prosthesis (anatomical or reverse) with clinical and radiological follow-up ranging from 9–24 months. The TESS prosthesis showed short-term results that were comparable with other shoulder prosthetic systems. Study II: This is a prospective comparative non-randomised study of 37 patients (40 shoulders) who underwent TESS reverse shoulder arthroplasty (RSA) with a follow-up ranging from 15–66 months. We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. Glenoid overhang influenced the occurrence of scapular notching (SN). Study III: This is a radiological study showing that CT had a good reliability and reproducibility in estimating LHO. Study IV: This is a prospective radiological study of 69 patients (70 shoulders) with primary osteoarthritis (OA) who had undergone stemless total anatomical shoulder arthroplasty (TSA). This study showed that stemless anatomical TSA could be useful in restoring shoulder anatomy. Study V: This is a prospective study of 44 patients with OA who had undergone stemless anatomical TSA with a clinical and radiological follow up ranging from 12 – 50 months. Our study showed that LHO reconstruction close to the anatomy of a healthy contralateral shoulder improved shoulder function. Stemless anatomical TSA help to restore LHO. Increasing LHO may have a negative effect on shoulder function at three months but had no effect at 12 months. The main conclusions of this thesis are: 1. TSA (anatomic and reverse) using stemless humeral components is reliable if bone quality is adequate. The complication rate is comparable with other shoulder prosthetic systems. 2. Glenoid overhang decreased complications in RSA. 3. LHO measurement on AP radiographs is less reliable and underestimates the distance when compared with CT. 4. Stemless TSA could be of help in reconstructing shoulder anatomy. 5. Shoulder reconstruction close to the anatomy of a healthy contralateral shoulder improves shoulder function. / Axelprotes kirurgi har visat avsevärd utveckling under de senaste decennierna. Ett antal faktorer påverkar postoperativt rörelseomfång, smärta och proteshållbarhet. Bland dessa faktorer utgör längden av hävarmen och ledstabilitet de faktorer som kan ändras genom val av proteskomponent. Det är osäkert om den normala anatomin måste återupprättas. Oskaftad protes med eliminering av humerusstamm och tillit till metafysär fixering introducerades i Frankrike år 2004 (TESS, Zimmer Biomet). Målen var att undvika stam relaterade komplikationer. Oskaftat implantat har andra potentiella fördelar, inklusive möjligheten att återställa axelnsanatomi. Syftet med denna avhandling var: (1) Att undersök radiologisk stabilitet av oskaftade axelproteser. (2) Att studera effekten av protes placering vid omvänd axelartroplastik både radiologiska och kliniskt utfall. (3) Att studera tillförlitlighet av mätningen av den laterala humeral offset (LHO), avståndet mellan processus coracoideus till laterala kanten av tuberkulum majus, med användning av CT eller röntgen. (4) Att studera oskaftad axelprotes förmåga att återställa axelnsanatomi. (5) Att studera den kliniska betydelsen av LHO återställning i för det funktionella resultatet efter axelartroplastik. Studie I: Detta är en prospektiv kohortstudie av 49 patienter med en av de två versionerna av TESS (anatomisk eller omvänd) med klinisk och radiologisk uppföljning från 9-24 månader. TESS protes visade lovande resultat på kort sikt med komplikationer som var jämförbar med andra axelprotessystem. Studie II: Detta är en prospektiv jämförande icke-randomiserad studie av 37 patienter (40 skuldror) som opererades med TESS omvänd axelartroplastik med en uppföljning från 15-66 månader. Vi fann en signifikant förbättring av funktion och minskning av smärta i både skaftad och oskaftad grupper. Glenoid overhang bedöms påverka risken för scapular notching (SN). Studie III: Detta är en radiologisk studie som visade att CT hade god tillförlitlighet och reproducerbarhet att mäta LHO. Studie IV: Detta är en prospektiv radiologisk studie av 69 patienter (70 skuldror) med primär artros som hade genomgått oskaftad total anatomisk axelprotes. Denna studie visade att oskaftad axelprotes kan vara till hjälp att återställa axelnsanatomi. Studie V: Detta är en prospektiv studie av 44 patienter med unilateral primär artros som hade genomgått oskaftad total axelprotes med en klinisk och radiologisk uppföljning från 12 - 50 månader. Vår studie visade att LHO rekonstruktion till den friska axeln förbättrar axelfunktion. Oskaftat implantat kan vara av hjälp till att återställa LHO. Ökad LHO kan ha en negativ effekt på axelnsfunktion vid tre månader, men denna effekt påvisade ej vid 12 månader. De viktigaste slutsatserna i denna avhandling är: 1. Oskaftad total axel artroplastik (anatomisk och omvänd) är tillförlitlig om benkvalitén är god med komplikationer som var jämförbar med andra axelprotessystem. 2. Glenoid overhang minskar komplikationer vid omvänd axelartroplastik. 3. LHO mätningen på röntgen är mindre tillförlitlig och underskattar avståndet jämfört med CT. 4. Oskaftad axelprotes skulle kunna vara till hjälp för att rekonstruera axelnsanatomi. 5. Axel rekonstruktion inom anatomi till att efterlikna anatomi på den friska kontralaterala axeln förbättrar axelfunktion.

Orientador: William Dias Belangero / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T10:43:02Z (GMT). No. of bitstreams: 1 LinoJunior_Waldo_D.pdf: 5333220 bytes, checksum: 4d6c975ca8305a2b6b11726f152edba6 (MD5) Previous issue date: 2008 / Resumo: Realizamos o tratamento artroscópico da instabilidade traumática do ombro anterior e ântero-inferior, associando três procedimentos ¿ a reparação do lábio da glenóide, a redução do volume capsular e o fechamento do intervalo rotador ¿ com o objetivo de analisar os resultados, considerando estabilidade e função. Entre janeiro de 1999 e dezembro de 2003, 27 pacientes foram submetidos ao tratamento artroscópico, por reparação do lábio da glenóide com âncoras metálicas, redução do volume capsular por capsulorrafia térmica e sutura do espaço rotador. Esses pacientes foram avaliados no pré e pós-operatórios, pelas escalas de UCLA e Rowe e, no pós-operatório, utilizando a escala de ASES. Durante um período de seguimento médio de 32,4 meses (variando de 22 a 74 meses), todos os ombros permaneceram estáveis. Usando a escala da UCLA, houve melhora do período pré-operatório, passando de 24,7 pontos (em média) para 32,81 pontos (em média) no período pós-operatório. A melhora também foi observada pela escala de Rowe, com a média 39,81 no pré-operatório, para 90,74 no período pós-operatório. Na escala de ASES a média foi de 92,22. Todos os ombros permaneceram estáveis e houve melhora funcional marcante dos pacientes que foram tratados. Esses resultados são comparáveis àqueles observados na cirurgia aberta, considerando critérios de seleção de pacientes similares / Abstract: We performed arthroscopic treatment of traumatic anterior and anteroinferior shoulder instability combining three procedures--labrum repair, reduction of capsular volume and suture of the rotator cuff interval--with the aim of analysing the results with regard to stability and function. Between January 1999 and December 2003, 27 patients underwent arthroscopic treatment for labrum repair with metal anchors, reduction of capsular volume through thermal capsulorrhaphy and suture of rotator cuff interval. These patients were evaluated in the pre- and postoperative period using the UCLA and Rowe scales and in the postoperative period using the ASES scale. During a mean follow-up period of 32.4 months (range 22-74 months) all shoulders remained stable. Using the UCLA scale, there was improvement from the preoperative period, with a mean score of 24.7, to the postoperative period, with a mean of 32.81. Improvement was also shown by the Rowe scale, with a mean score of 39.81 in the preoperative period and 90.74 in the postoperative period. On the ASES scale the mean score was 92.22. All shoulders remained stable and there was marked functional improvement in the patients who were treated. These results are comparable to those obtained with open surgery, observing similar patient selection criteria / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / Impingement syndrome of the shoulder is a very common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this investigation was to investigate the effectiveness of the chiropractic adjustment in order to determine whether or not it is an effective approach in the treatment of impingement syndrome / M

Introduction – Treatment for breast cancer is associated with a risk of chronic shoulder and upper limb morbidity in up to 30% of patients. There is currently no consensus for the possible reason for this often repeated finding in the literature. Previous research has suggested that development of fibrotic tissue in response to cancer treatments such as surgery and radiotherapy could be an underlying cause of musculoskeletal dysfunction and pain. This study investigated if any genetic variants in several key fibrosis-modulating genes could be shown to be associated with risk of upper limb musculoskeletal dysfunction and pain in breast cancer survivors. Participants and Methods – A cross sectional study design was employed, using a candidate gene approach. A total of 326 South African breast cancer survivors were recruited from a tertiary hospital in the Western Cape (343 total, minus 17 samples with insufficient data collected). Each participant was scored for symptom severity using the shoulder pain and disability index (SPADI) questionnaire. Participants were then grouped for symptom severity using low, med or high SPADI scores. The low SPADI group served as controls (controls n=273, cases n=70). Participants were invited to donate a blood sample from which DNA was extracted. Each DNA sample was genotyped at seven polymorphic sites; three in TGF-ß, two in ATM, one in SOD2 and one in XRCC1, using PCR technologies and TaqMan allelic-discrimination probes. The resultant genotypes were analysed using multivariate analysis, including inferred haplotype analysis to search for association to shoulder pain and morbidity after treatment. A logistic regression analysis was also performed to investigate the association between SPADI score and age of participant. Results – When participant age was compared with symptom severity, it was found that younger participants were more likely to have moderate-to-severe symptoms than older participants. There was a significant difference in the minor allele frequencies between case and control groups for the rs4880 (C>T, SOD2) polymorphism. The T allele was present more in the case group than in controls, with minor allele frequencies of 0.67 vs 0.55 respectively. No other independent associations were noted for any of the remainder variants tested. When haplotypes were inferred for genes SOD2 and ATM, combinations between the rare alleles at rs4880 and rs1800058 (C>T, ATM) were associated (F=4.35, pT and ATM rs1800058 is recommended for further study, in addition to the rs4880 polymorphism in SOD2. These novel results are suggesting that there may be an association between fibrotic genes and the development of upper limb sequelae after treatment for breast cancer. A larger case-control study would be required to validate and explore these findings.

Generating accurate simulations of the forces in the Glenohumeral joint is essential for investigation of normal and pathologic Shoulder function. It forms the basis for evaluating fracture treatment, joint replacement design and fixation. However, due to its complex anatomy and large range-of-motion, measuring the dynamic in-vivo forces and kinematics of the Glenohumeral joint remains a challenging problem in the field of biomechanics. This study shows the development and validation of a new testing medium for the Glenohumeral joint. The study uses a combined approach of in-vitro and in-silico testing and validates against previous data. This is achieved using a mechanical testing rig and finite element model which both closely represent the in-vivo Glenohumeral physiological characteristic including; geometry, muscular loading patterns, joint range-of-motion and external loadings. The mechanical model uses two instrumented implants based on current gold standard in-vivo testing. The two head types used are a Stem implant and a resurfacing head type implant. Comparison is made between the two head types as testing mediums for in-vitro testing. It is shown the resurfacing head more closely maintains the natural properties of the bone. Testing displays the significant advantages of in-vitro and in-silico testing over in-vivo testing. Validation is achieved by comparing simulated functional movements and activities of daily living to previous published data. When compared with previous data, recorded results from the mechanical testing rig shows high conformity. Comparison shows -3.95% and 4.14% error during 45° abduction with the resurfacing and stem implants respectively. Activities of daily living display similar loading patterns but lower maximum recorded force agreement. This has highlighted problems with unpredictable and complex muscular combinations when assessing complex movements. FE results show similar loading patterns and stress areas to previous data but record lower maximum forces than previous in-vivo data. Force and stress results from the FE model highlight the significant force increase external loads apply to the joint complex. Cross-validation between the mechanical testing rig and FE model shows high conformity and similar loading patterns. The developed medium is shown to be successfully validated against “gold standard” in-vivo data and other previous studies. Research experiments are used to illustrate the variety of testing possible with the developed medium and to further develop and validate the design. Research into trauma, injury and fixation is discussed and joint forces measured. This data lays a foundation for future testing using the developed test medium. The testing medium provides repeatable and reproducible results for forces within the Glenohumeral joint. This can now be used to further understand joint kinematics, injuries, fracture prorogation and fixation. It will also provide a valuable training aid for a complex joint. Better understanding, testing and training of new techniques, tools and traumas is now possible. This will aid in reducing injury prevalence, severity, healing time and ultimately improving patient quality of life.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal, 2002. / Purpose . Rotator cuff tendinitis is a common problem, however, its diagnosis and management is not completely understood. The purpose of this research project was to investigate the efficacy of the chiropractic adjustment to determine whether or not it is an effective approach in the treatment of rotator cuff tendinitis. Methods This randomized controlled trial consisted of two groups. Each group consisted of thirty subjects, of any age, selected from the general population and randomly allocated to Group 1 or 2, participation in this trial was voluntary. Group 1 received chiropractic adjustment of the glenohumeral or acromioclavicular joint according to the fixations found on motion palpation and group 2 received placebo laser. Subjects in both groups had to comply with certain inclusion criteria before being allowed to participate in the study. Goniometer readings were taken to measure range of motion, algometer readings to measure pain threshold and the Numerical Pain Rating Scale was answered at the initial consultation, and on the third and sixth consultations. The Unpaired and Friedman's T- tests were used to assess the intra and intergroup information from the first, third and sixth consultations. Groups 1 and 2 were compared in terms of age, gender, race and clinical severity prior to onset. / M

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective and Hypothesis The goals of this study are to address the following questions regarding shoulder arthroplasty (TSA): (a) Does restoring range of motion (ROM) lead to increased patient satisfaction? (b) How is ability to carry out activities of daily living (ADLs) influenced by ROM? (c) How does ADL performance correlate with patient satisfaction? We hypothesize that more “normal” ROM following TSA leads to increased patient satisfaction and better performance of ADLs. Methods Patients who underwent TSA, reverse TSA, hemiarthroplasty, or humeral head resurfacing were prospectively enrolled in a shoulder arthroplasty registry. 155 patients who had preoperative and 6 month postoperative data for ROM, patient satisfaction, and performance of ADLs were included in the study. Results Of these 155 shoulders, the response rate for patient satisfaction was only 82 (52.9%), with 96.8% reporting they were “satisfied or “very satisfied”. Postoperative ROM was associated with patient satisfaction for forward flexion, adduction, and external rotation. This association demonstrated a “dose;response” relationship, as higher percentage of normal ROM correlated with higher satisfaction. Mean ADL scores were higher for patients who achieved normal ROM in each plane of motion. The greatest improvement in mean ADL score occurred when a patient achieved normal ROM for at least 3 of 5 measurements. There was also a significant association between improved ADL and higher patient satisfaction. Significance Glenohumeral arthrosis causes considerable morbidity, and rates of shoulder arthroplasty are increasing. As the predominant goals of TSA are pain relief and restoration of ROM, it is important to assess postoperative patient satisfaction. While most historic studies have focused on measures of implant performance, interest is increasing in patient-centered outcomes. Both objective and subjective outcomes should be included in future large multicenter registries. Data collected from these registries has the potential to substantially improve success rates and longevity of shoulder arthroplasty.

Objective: To compare the effectiveness of complex physical therapy and exercise program which have been completed at home (control group) in shoulder impingement syndrome treatment. Discussion: The use of home exercise program in shoulder impingement physical therapy may have a positive impact, but not that much what we can get from complex physical therapy. By comparison all measures showed statistically significant difference. Conclusion: The shoulder impingement syndrome has to be individualized process and the treatment should be multimodal and include several physical therapy methods. The more methods we would use- the better results we could achieve.