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

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

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.

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

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 70 leaves ; 30 cm / 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

Functional integration of bone with soft tissues such as tendon is essential for joint motion and musculoskeletal function. This is evident in the rotator cuff of the shoulder, which consists of four muscles and their associated tendons that connect the humerus and scapula. The cuff functions to stabilize the shoulder joint, and actively controls shoulder kinematics. Rotator cuff injuries often occur as a result of tendon avulsion at the tendon-bone interface, with more than 250,000 cuff repair surgeries performed annually in the United States. However, these procedures are associated with a high failure rate, as re-tears often occur due to the lack of biological fixation of the tendon to bone post-surgery. Instead of regenerating the tendon-bone interface, current repair techniques and augmentation grafts focus on improving the load bearing capability of the repaired rotator cuff. Biologically, the supraspinatus tendon inserts into bone via a biphasic fibrocartilaginous transition, exhibiting region-dependent changes in its compositional, structural and mechanical properties, which enables efficient load transfer from tendon to bone as well as multi-tissue homeostasis. Inspired by the native tendon-bone interface, we have designed and evaluated a biomimetic bilayer scaffold, comprised of electrospun poly (lactide-co-glycolide) (PLGA) nanofibers seamlessly integrated with PLGA-hydroxyapatite (HA) fibers, in order to engineer tendon-bone integration. The objective of this thesis is to explore the key design parameters that are critical for integrative tendon-bone repair using this biphasic scaffold as a model. Specifically, intrinsic to the scaffold, effects of fiber alignment, fiber diameter, mineral distribution, and polymer composition on integrative rotator cuff tendon-bone healing were evaluated in vivo using a rat model. Results indicated that an aligned, nanofiber-based scaffold with a distinct order of non-mineralized and mineralized regions will lead to insertion regeneration and integrative tendon-bone repair. Additional tissue engineering design parameters such as healing time and animal model were also tested. It was observed that the biphasic scaffold exhibited a stable long term response, as the mechanical properties of rat shoulders repaired by this scaffold remained comparable to that of the control at 20 weeks post-surgery. This scaffold was also evaluated in a large animal model (sheep), in which a clinically-relevant rotator cuff repair procedure was implemented with the biphasic scaffold. Results demonstrated the scaffold lead to integrative rotator cuff repair through the regeneration of the enthesis in both small and large animal models. In summary, through a series of in vivo studies, the work of this thesis has identified the critical tissue engineering parameters for integrative and functional rotator cuff tendon repair. More importantly, the design principles elucidated here are anticipated to have a broader impact in the field of tissue engineering, as they can be readily applied towards the regeneration of other soft-hard tissue interfaces.

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.

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.

The glenohumeral (GH) joint is the most mobile joint in the human body, but its mobility inherently increases the risk of instability. The humeral head sits in a shallow glenoid in the scapula like a golf ball sitting on a tee. The stability in this joint is provided by the rotator cuff muscles and tendons that actively pull the humerus back into the socket to prevent dislocation, especially during overhead motions. However, the rotator cuff is prone to tears, resulting in pain, loss of mobility, and recreational limitations. Surgical reattachment of the tendon to the bone is challenging due to the mechanical disparity between the two tissues, resulting in stress concentrations and a high risk of retear. Notably, the specialized tissue at the tendon-to-bone attachment, which facilitates stress transfer between tendon and bone in healthy joints, does not regenerate after surgical reattachment and healing, making tendon-to-bone repairs prone to re-tears. A comprehensive understanding of GH joint biomechanics is essential for developing early interventions to prevent rotator cuff injuries. Furthermore, improving tendon-to-bone fixation during rotator cuff repair is critical to improve post-surgery outcomes. In the last decade, bioinspired solutions have shown considerable promise for addressing several biomedical problems. This thesis draws bioinspiration from two animals that have evolved unique mechanical functions: (i) the bat shoulder joint, which facilitates repetitive overhead motions during flight and may offer insights into rotator cuff pathology and (ii) the curvature of python snake teeth, which enables secure grasping of prey without soft tissue tearing. In the first part of the thesis, the bat shoulder was studied for its unique characteristics relative to mice. Overhead motions in humans often lead to shoulder injuries, partly because the bony anatomy of the unstable GH joint places greater stress on the joint's surrounding soft tissues to stabilize these motions. Traditional animal models used to study shoulder pathology are quadrupeds, which lack the capacity for overhead motion. In contrast, bats consistently engage in overhead motion during flight, subjecting their shoulders to substantial loading throughout their relatively long lifespan. Remarkably, the biomechanical demands placed on a bat's shoulder are estimated to exceed those of a competitive swimmer’s by 45-fold, despite sharing similar coracoacromial arch anatomy with humans. We were inspired to study functional adaptations in the shoulders of bats that enable this overhead motion. We performed comparative anatomy studies of the shoulders of bats and mice, similarly-sized quadrupeds. By quantifying the constraints imposed by the bony anatomy, we identified adaptations of the shoulder, including the rotator cuff tendons, that allow bats to sustain overhead motion in a high stress, repeated loading environment, without injury. In the second part of the thesis, python teeth were used as inspiration to develop a repair device optimized to grasp the rotator cuff without tearing. Rotator cuff repair surgeries fail frequently, with 20-94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we examined the specialized teeth of snakes of the Pythonoidea superfamily, which effectively grasp soft tissues without tearing. To apply this non-damaging and effective gripping approach to the surgical repair of tendons, we developed and optimized a python-tooth inspired array as an adjunct to current rotator cuff suture repair, and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, and enabled optimization of a tooth array device to enhance rotator cuff repair to distribute stresses and increase tendon-bone contact. The efficacy of the approach was demonstrated via human cadaver tests, suggesting an alternative to traditional suturing paradigms that may reduce tendon re-tearing. Collectively, these studies contribute to a better understanding of the biomechanics of the GH joint and offer novel, bioinspired approaches for rotator cuff repair. The functional adaptations of bats provide insight into developing new approaches to treat GH joint instability, and a clinically relevant python-tooth inspired device can ultimately reduce the high rates of re-rupture currently observed in rotator cuff repair.