Thesis (M.S.)--A.T. Still University, 2004. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--A.T. Still University, 2004. / Includes bibliographical references.

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Submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Aim: The aim of the study was to assess the effect of a single versus multiple cervical spine manipulations, over a two week period, on peak torque of the rotator cuff muscles utilizing the Cybex Orthotron II Isokinetic Rehabilitation System. This study was a pre and post experimental investigation. Method: Forty asymptomatic (in terms of neck and shoulder pain) male chiropractic students were stratified into two equal groups of twenty subjects to ensure that each group consisted of an equal number of subjects from each year of study. All subjects underwent a familiarisation session on the Cybex Orthotron II Isokinetic Rehabilitation System. Group One received a single manipulation. Rotator cuff peak torque was measured pre-manipulation, immediately post manipulation and at a two-week follow up. Group Two received four manipulations over a two week period. Rotator cuff peak torque was measured pre and immediately post the first manipulation. A third rotator cuff peak torque measurement was taken two weeks after the first manipulation. Results: There was no statistically significant effect of a single or multiple manipulations on rotator cuff peak torque (abduction, adduction, internal rotation and external rotation). Inter-group analysis revealed a trend of an effect for abduction as the single manipulation increased at the two-week follow up and the multiple manipulation group decreased; however, this was not statistically significant. Conclusion: No statistically significant results were found possibly due to small sample size and the fact that objective measurements were only taken at the beginning and the end of the research processes and not at regular intervals throughout the study.Further studies are needed to determine the effects of multiple manipulations on peripheral muscle activity, including the treatment of symptomatic patients with rotator cuff pathology. It is also recommended that EMG readings be done in conjunction with peak torque measures to determine muscle activity.

A dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Although studies of manipulation-induced peripheral changes in the muscles have been done, inconsistencies noted by the author’s call for further investigation into the reflex effects of manipulation. Additionally, according to the literature, no effective treatment protocol for the painful shoulder has been found. Therefore this research aimed at addressing these discrepancies by quantifying the immediate effect of cervical spine manipulation in terms of peak torque on rotator cuff musculature in asymptomatic patients with both a cervical spine dysfunction and without. And thus by investigating cervical manipulation to the C4-C7 spinal segment, as a possible added intervention for improving rotator cuff muscle peak torque, a more efficient and effective management protocol for the painful shoulder could be attained. Thus the aims for this study included: 1) To evaluate whether manipulation has an effect on rotator cuff peak torque or not, utilizing the Cybex Orthotron II Isokinetic Rehabilitation System; 2) To ascertain whether manipulation of the specific levels has an effect on the rotator cuff peak torque or not and 3) To ascertain whether the presence or absence / M

Title: Rehabilitation after the shoulder joint arthroplasty Objectives: Confirmation of the hypothesis that there is a correlation between success of the surgery and the type of indication, age of the patient and the dominance of the operated upper extremity. At the end is the comparation of our achievements with foreign studies. Method: The clinical part was processed using standardized questionnaire with 34 patients from the rehabilitation clinic Medicentrum at Praha. This part compares the data 3 months after total shoulder arthroplasty with preoperative condition obtained restrospective at the same time. Results: The results show influence of the indications, age of the patient and dominance of the operated upper extremity on the successfulness after total shoulder arthroplasty. Key words: arthroplasty, shoulder joint, rehabilitation

The glenohumeral joint has the largest range of motion in the body. This is due to its anatomy of the bony structure of the glenoid fossa providing a shallow socket with minimal constraint of the humeral head and the surrounding soft tissue structures serving as restraints to limit excessive humeral head translation. The bony and soft tissue structures function together with a delicate balance that when disrupted lead to several pathologies including degenerative osteoarthritis or glenohumeral instability, which are the focus of this research. For glenohumeral osteoarthritis, the gold standard treatment is total shoulder arthroplasty. Although the surgical success rate is reported at 95%, the long-term failure rate is as high as 30% and often caused by glenoid component failure. For glenohumeral instability, surgical capsular plication can significantly reduce recurrent dislocation rates, however, up to 70% of patients experience joint stiffness and a reduced range of motion. For these treatments, there is little consensus regarding what surgical parameters optimize functional recovery - consequently, several surgical techniques exist. Since long-term follow-ups are lacking and difficult to perform, basic science studies are needed to identify what surgical parameters are most likely to influence patient recovery. The objective of this research was to develop patient-specific computer models to create accurate representations of these pathologies and to investigate the effects of different surgical parameters in total shoulder arthroplasty and glenohumeral instability repair. A total shoulder arthroplasty computer model was developed to investigate the effect of surgical parameters of the glenoid implant component. An initial study performed a cadaveric validation of the methodology to simulate the reaming process for resurfacing the glenoid surface. This validated computer model was then used to investigate how the degree of correction of glenoid retroversion affects cement mantle stress and potential cement failure. The use of physiologic patient-specific bone models revealed that maintaining the cortical bone layer should take precedence over version correction when a high degree of glenoid deformity is encountered. A glenohumeral instability computer model was developed to investigate the effect of capsular repair on shoulder stability and joint range of motion. The computer model suggests that adding a plication of the posterior band of the inferior glenohumeral ligament offloads regions of high strain from the anterior region of the glenoid attachment site which may indicate a reduced risk of anterior capsular repair failure. An anisotropic hyperelastic material behavior was then incorporated to model the glenohumeral capsule by performing an inverse finite element analysis to obtain the optimized material parameters. The computer models developed in this research utilize radiographic patient images in order to replicate and investigate actual pathology. As a result, the studies performed provide a deeper understanding of the glenohumeral joint mechanics associated with the treatments of total shoulder arthroplasty and glenohumeral capsular plication. This information provides insight for the practicing shoulder surgeon in their pre-operative surgical planning to decide the optimal technique and approach for a patient with these challenging pathologies. Moreover, the methodologies developed for simulating these surgical techniques can have a wide application to advance the foundation of pre-surgical virtual simulation and provide critical data for computer aided surgical navigation of other joints and diseases.

by Choi Man. / Year shown on spine: 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 146-153). / Abstract --- p.1 / Chapter 1 --- Introduction --- p.3 / Chapter 1.1 --- Anatomy --- p.4 / Chapter 1.2 --- Kinematics of the overhead sports --- p.6 / Chapter 1.3 --- Isokinetics assessment of the shoulder rotators --- p.8 / Chapter 1.4 --- Objectives of the study --- p.10 / Chapter 1.5 --- Method of investigation --- p.11 / Chapter 1.5.1 --- Subject --- p.12 / Chapter 1.5.2 --- Equipment --- p.13 / Chapter 1.5.3 --- Protocol --- p.14 / Chapter 1.6 --- Data Management --- p.17 / Chapter 1.7 --- Clinical application --- p.18 / Chapter 1.8 --- Definition of terms --- p.18 / Chapter 2 --- Literture Review --- p.20 / Chapter 2.1 --- Anatomy --- p.20 / Chapter 2.1.1 --- Ligament --- p.21 / Chapter 2.1.2 --- Muscles --- p.24 / Chapter 2.2 --- Biomechanics of the overhead movement --- p.30 / Chapter 2.2.1 --- Wind up Phase --- p.32 / Chapter 2.2.2 --- Cocking Phase --- p.33 / Chapter 2.2.3 --- Acceleration Phase --- p.36 / Chapter 2.2.4 --- Deceleration Phase --- p.38 / Chapter 2.3 --- Eccentric contraction --- p.40 / Chapter 2.3.1 --- Physiology of eccentric contraction --- p.40 / Chapter 2.3.2 --- Mechanical trauma in eccentric contraction & DOMS --- p.41 / Chapter 2.3.3 --- Eccentric contraction in Plyometric --- p.43 / Chapter 2.3.4 --- Role of eccentric contraction in overhead sports --- p.44 / Chapter 2.3.5 --- Comparison with concentric contraction --- p.45 / Chapter 2.4 --- Isokinetics --- p.46 / Chapter 2.4.1 --- Introduction to isokinetics --- p.46 / Chapter 2.4.2 --- Reliability of isokinetic assessment on Shoulder rotator --- p.48 / Chapter 2.4.3 --- Agonist / Antagonist Ratio --- p.51 / Chapter 2.4.4 --- Variation of torques with testing protocols --- p.52 / Chapter 2.4.5 --- Comparison of muscle torques in different groups --- p.56 / Chapter 2.4.6 --- Isokinetic eccentric contraction of shoulder Rotators --- p.62 / Chapter 3 --- Method of Investigation --- p.63 / Chapter 3.1 --- Subject --- p.64 / Chapter 3.1.1 --- Part One --- p.64 / Chapter 3.1.2 --- Part Two --- p.65 / Chapter 3.1.3 --- Criteria of subject recruitment --- p.65 / Chapter 3.2 --- Equipment --- p.66 / Chapter 3.2.1 --- Collection of medical history and general informations --- p.66 / Chapter 3.2.2 --- Test for general laxity --- p.66 / Chapter 3.2.3 --- Test for shoulder impingement --- p.72 / Chapter 3.2.4 --- Test for shoulder instability --- p.73 / Chapter 3.2.5 --- Joint range measurement --- p.76 / Chapter 3.2.6 --- Isokinetic strength of shoulder rotators --- p.78 / Chapter 3.3 --- Calibration --- p.79 / Chapter 3.4 --- Testing procedure --- p.79 / Chapter 3.4.1 --- "Explanation,warning & consent" --- p.79 / Chapter 3.4.2 --- Warming up --- p.80 / Chapter 3.4.3 --- Screening --- p.81 / Chapter 3.4.4 --- Isokinetic testing of the rotational strength of both shoulders --- p.81 / Chapter 3.5 --- Operator --- p.87 / Chapter 3.6 --- Data Management --- p.88 / Chapter 3.6.1 --- Part One --- p.88 / Chapter 3.6.2 --- Part Two --- p.89 / Chapter 4 --- Result --- p.91 / Chapter 4.1 --- Part One --- p.89 / Chapter 4.1.1 --- Intra-class correlation coefficient --- p.90 / Chapter 4.1.2 --- Correlation between the PTR & the ASMSTR --- p.92 / Chapter 4.2 --- Part Two --- p.94 / Chapter 4.2.1 --- Comparison between the Members in the Hong Kong Badminton Team with the Non-athlete Subjects --- p.94 / Chapter 4.2.2 --- Comparison between the Badminton Players in the Hong Kong Team and the Hong Kong National Junior Team --- p.105 / Chapter 5 --- Discussion --- p.111 / Chapter 5.1 --- General discussion of the design of the study --- p.111 / Chapter 5.1.1 --- Subject --- p.111 / Chapter 5.1.2 --- Specific test --- p.112 / Chapter 5.1.3 --- Warming up --- p.112 / Chapter 5.1.4 --- Testing protocol --- p.113 / Chapter 5.2 --- Part One --- p.116 / Chapter 5.2.1 --- Test-retest reliability --- p.117 / Chapter 5.2.2 --- Correlation between the PTR and the ASMSTR --- p.120 / Chapter 5.3 --- Part two --- p.122 / Chapter 5.3.1 --- Comparison between the HKT and the non- athletes --- p.123 / Chapter 5.3.2 --- Presentation of torque ratio in the HKJ --- p.133 / Chapter 5.3.3 --- Performance in those with history of shoulder problem --- p.134 / Chapter 5.4 --- Clinical application and suggestion for further study --- p.139 / Chapter 6 --- Conclusion --- p.144 / Chapter 7 --- Reference --- p.146 / Chapter 8 --- Appendix

Joint Position Sense (JPS) of the shoulder as determined by repeated repositioning tasks has been performed under different constrained testing conditions. The variability in the testing protocols for JPS testing of the gleno-humeral joint may incorporate different movement patterns, numbers of trials used to derived a specific JPS variable and range of motion. All of these aspects may play an important role in the assessment of G-H JPS testing. When using a new instrument for assessing JPS all of these issues need to be examined to document the optimal testing protocols for subsequent clinical assessments. By undertaking these studies future clinical trials may be more optimally assessed to determine if there are differences between dominant and non-dominant arms as well as the presence of JPS changes in performance associated with pathology and rehabilitation. This study used a 3-dimensional tracking system to examined gleno-humeral JPS using 2 open kinetic chain movement patterns. The 'conventional' 90 degree abducted, externally rotated movement was compared to the hypothetically more functional D2 movement pattern used in proprioceptive neuromuscular facilitatory techniques. These two patterns were tested at different ranges (low and high). Two cohorts (n=12, n=16) of normal healthy athletic males aged 17-35 years, performed matching tasks of both left and right arms. The second cohort (n=16) were assessed with and without strapping the gleno-humeral joint with sports tape. Accuracy (overall bias) and precision (variability) scores were determined for progressively greater numbers of trials. The findings of the study show that estimates of JPS accuracy and precision become more stable from data derived from 5 to 6 matching trials. There were no statistical differences between sides [95%CI ± 1.5cm]. The accuracy but not precision improved as subjects approximated the 'high' end of range in the 'conventional' or D2 pattern. Furthermore, no systematic differences were detected at different ranges of movement or movement patterns with or without the application of sports tape. These findings provide a guide to the number of trials that optimise the testing of the gleno-humeral joint and also suggest that in normal controls the magnitude of differences between sides and movement patterns is similar. These findings also iii indicate that sports tape applied to the shoulder may not significantly change the JPS performance in healthy, athletic males.

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