Einleitung Funktionsstörungen der Schulter treten mit unterschiedlicher Häufigkeit nach Neck dissection auf. Die durchgeführten Studien untersuchten den Einfluss einer Trapeziusparese und einer Schädigung des Plexus cervicalis auf die Entstehung einer Schulterfunktionsstörung. Hierzu sollten neue Methoden zur Bewertung der Aktivität des Musculus trapezius entwickelt werden. Die genauen Auswirkungen auf die Lebenssituation des Patienten waren bisher unklar. Methode Zur Bewertung der Trapeziusfunktion wurde eine simultane Oberflächenlelektromyographie und Schulterhebekraftmessung durchgeführt. In Vorversuchen erfolgte die Entwicklung des Versuchsaufbaus. Wir verwendeten eine bipolare Ableitung des oberen und unteren Trapeziusanteils und eine isometrische Schulterhebekraftmessung bei 90° Abduktion. Es wurden frequenz- und amplitudenabhängige Merkmale bei rampenförmig ansteigender Schulterhebekraft berechnet (Root Mean Square, Mean Frequency, Mean Power Frequency, Frequenzverhältnis und Turnanalyse nach Willison). Die Datenanalyse erfolgte unter LabVIEW(r). Die Funktion des Plexus cervicalis wurde anhand einer semiquantitativen Erfassung der Oberflächensensibilität festgestellt. Die Auswirkung der Schulterfunktionsstörung auf die Lebenssituation des Patienten wurde mittels des Constant Murley Scores eingeschätzt. Ergebnisse Die erste Studie beinhaltete 90 Probanden und zeigte einen statistisch signifikanten Anstieg (p / Introduction Functional shoulder disorders after neck dissection have different incidences. The following studies investigated the influence of a trapezius muscle palsy and a damage of the cervical plexus on the frequency of painful shoulder complaints. The consequences for shoulder function and for daily life activities were not yet clear. Methods For assessment of the trapezius function a simultaneous surface electromyography and force measurement were performed. We used a bipolar electrode configuration and an increasing isometric contraction in 90° arm abduction. Frequency and amplitude based parameters (Root Mean Square, Mean Frequency, Mean Power Frequency, Frequency Ratio, Turn Analysis of Willison) were computed and analysed in LabVIEW(r). The cervical plexus function was determined by semiquantitative measurement of the cutaneous sensibility. Shoulder function and restriction in daily life activities were assessed by the Constant Murley Score. Results The first group included 90 probands and showed a statistical significant (p

Bakgrund: Rehabiliteringen efter en rotatorkuffrupturoperation är oftast lång och följer olika faser med hänsyn till senans inläkning. Behandlingsresultatet är multifaktoriellt och det rekommenderas att rehabiliteringen individanpassas. För att följa och utvärdera rehabiliteringsprocessen behövs funktionella axeltester. I dagsläget saknas reliabla och validerade funktionella axeltester under rehabiliteringens tidigare faser. Syfte: Syftet med denna studie är att undersöka reliabiliteten hos två standardiserade armlyft, Aktivt armlyft i flexion och Aktivt armlyft i skapulaplanet, med statiskt kvarhåll i 90° under 30 sekunder, för vuxna individer som genomgått enrotatorkuffrupturoperation för cirka tre månader sedan. Metod: Datainsamlingen utfördes i tre steg, först utfördes en videoinspelning av de standardiserade armlyften av två fysioterapeuter. Därefter utfördes två bedömningstillfällen av två andra fysioterapeuter. Videoinspelningarna, armlyften och bedömningarna utfördes enligt standardiserade protokoll. Inter- och intrareliabilitetsbedömningarna baserades på videoinspelningarna där de två bedömarna graderade patienternas förmåga att utföra de två standardiserade armlyften utifrån utfallsmåtten ”Klarar” eller ”Klarar ej”. Överensstämmelsen analyserades i IBM SPSS med Cohens Kappa. Resultat: Åtta manliga studiedeltagare i åldrarna 49–71 år (medelålder 59,4 år) deltog. Videoinspelningarna utfördes i genomsnitt 15,25 (±3,9) veckor efter operation. Den andra bedömningen genomfördes i genomsnitt 9 (±3,1) dagar efterförsta bedömningen. Resultatet visade att interbedömarreliabiliteten var ”God”(k=0,71) till ”Utmärkt” (k=1,00) och intrabedömareliabiliteten var ”Utmärkt”(k=1,00). Slutsats: Denna studie fann att inter- och intrabedömarreliabilitet var ”God” till”Utmärkt” gällande de två standardiserade armlyften. Resultatet bör tolkas med försiktighet på grund av det begränsade deltagarantalet och ingen säker slutsats kandras. Ytterligare forskning behövs för att fastställa klinisk betydelse. / Background: Rehabilitation after rotator cuff tear surgery is often long and follows different phases with consideration for tendon healing. The treatment result is multifactorial, and the rehabilitation is recommended to be individualized.vFunctional shoulder tests are of value and evaluate the rehabilitation process. Currently, reliable and validated functional shoulder tests are lacking during the earlier phases of rehabilitation. Purpose: The purpose of this study is to investigate the reliability of two standardized arm lifts, Active shoulder flexion and Active shoulder scaption, with astatic hold at 90° for 30 seconds, three months post-surgery. Method: Data collection was conducted in three steps. Starting with videorecordings of the standardized arm lifts by two physiotherapists. Followed by two assessment sessions with approximately one week apart, by two other physiotherapists. The video recordings, arm lifts, and assessments were performed according to standardized protocols. Inter- and intrarater reliability assessments were based on the video recordings. The examiners graded the patient’s ability to perform the two functional shoulder tests based on the outcomes "Approved" or "Non-approved". The agreement was calculated with IBM SPSS using Cohen's Kappa. Results: Eight men were included, 49-71 years (mean age 59,4 years). The videorecordings and the first evaluation were performed in mean 15,3 (±3,9) weeks postsurgery. The second evaluation was performed in mean 9,4 (±3,1) days after the first evaluation. The results showed that the interrater-reliability was “Good” (k=0,71) to“Excellent” (k=1,00), and the intrarater-reliability was “Excellent” (k=1,00). Conclusion: This study found that the inter- and intrarater reliability for the two standardized arm lifts were good to excellent. The limited number of participants requires caution with the interpretation of the results and no definitive conclusion can be drawn. Further research is needed to establish any clinical significance.

Bakgrund: Smärta från axelleden är vanligt förekommande hos simmare, därav finns begreppet ”simmaraxel”. Etiologin till tillståndet och smärtan är dock ännu inte fastställd, flertalet studier visar på varierande orsaker och symtom. Den oklara etiologin, skapar delade meningar sett till lämplig behandling för simmaraxlar. Flera teorier finns kring den bästa behandlingsmetoden för axelsmärta hos simmare. Många olika studier har gjorts med syfte att undersöka sambandet mellan axelspecifik styrketräning på axelfunktion hos simmare med axelsmärta. Få studier har gjorts med syfte att undersöka effekten av axelspecifik styrketräning på just smärtan vid simmaraxlar. Syfte: Syftet med denna studie var att på individnivå undersöka hur axelspecifik styrketräning påverkar simmare med axelsmärta gällande smärta och funktion. Metod: Studien baseras på single-case experimentell design (SCED), med en AB-design. I studien medverkade tre deltagare från en simklubb i Stockholm. Deltagarna fick under totalt nio veckor skatta smärta via Numeric Rating Scale (NRS) och axelfunktion via Western Ontario Shoulder Instability Index (WOSI), för att undersöka förändringen på smärta och funktion över tid. Resultatsammanfattning: En deltagare uppnådde signifikant förbättring sett till självskattad smärta. Sett till självskattad funktion fanns signifikant försämring hos två deltagare. En deltagare uppnådde en stabil baslinje. Resterande två deltagare uppgav spridda värden under samtliga faser för NRS och WOSI.  Slutsats: Inga specifika slutsatser går att dras utifrån studiens resultat eftersom endast en deltagare uppnådde en stabil baslinje och på grund av oklarheten kring orsakerna till deltagarnas smärta. / Background: Pain originating from the shoulder joint is frequent among swimmers, therefore the term “swimmer’s shoulder” was constructed. However, the etiology of the condition has not yet been established and numerous studies indicate varying origins. Divided opinions have formed about effective interventions due to the confusion regarding swimmer’s shoulder. Several studies have investigated the interaction between various interventions and their effect on swimmer’s shoulders, however only a few have studied the effect strength training has on pain in the shoulder joint due to the condition.  Purpose: The aim of this study was to investigate at an individual level, how strength training of the shoulders affects active swimmers with shoulder pain, concerning pain and function. Method: This study is designed after a single-case experimental design (SCED), with an AB-design. Three swimmers from a swimming club in Stockholm participated. During a total of nine weeks, the participants had to assess pain via the numeric rating scale (NRS) and shoulder function via the Western Ontario Shoulder Instability Index (WOSI). Results: One participant acquired significant improvement in self-rated pain. Regarding self-rated function two participants showed significant impairment. One participant acquired a stable baseline. The remaining two participants reported scattered values during all phases for both NRS and WOSI.  Conclusion: No specific conclusions can be made based on the results of the study as only one participant achieved a stabile baseline, and there is ambiguity regarding the causes of pain among the swimmers.

No / Objective To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection. Design Randomised controlled trial. Setting Two secondary care National Health Service trusts. Participants One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study. Intervention Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours. Outcome measures All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy – Breast). Results All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year. Conclusion A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.