Thesis (Ph. D.)--University of Chicago, Committee on Evolutionary Biology, August 2003. / Includes bibliographical references. Also available on the Internet.

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Introduction: Soft Tissue Injuries (STIs) of the shoulder are common presentations to the Emergency Department but very little is known about the natural history, long-term disability or prognostic factors associated with these injuries. The goals of this pilot study are to describe the three-month outcome of these injuries, to begin to identify prognostic factors associated with poor outcome and to determine the feasibility of a future study aimed at predicting poor outcome. Methods: A cohort of 117 working-age adults presenting to the Emergency Department with acute STIs of the shoulder were prospectively recruited. Patients were interviewed by phone at one week, one month and three months. During the calls, patients completed the Disabilities of the Arm and Shoulder (DASH) questionnaire and provided information about treatments and follow-up that had occurred. Results: Of the 117 subjects, 72.3% had pain and disability above the population norm at one month and that number only decreased to 38.7% at three months. A substantial effect was also seen on Work and Leisure activities. The following prognostic factors were identified as having some association with poor three-month outcome: age, mechanism of injury, ability to rotate arm and abduct arm in ED, pain at one week, whether the injury was work-related, visit with family physician in first week and DASH score (disability) at one week. Conclusions: At the present time, the emergency physician must treat patients with STIs of the shoulder without any substantial knowledge of the morbidity that these injuries cause, which patients are at high risk of poor outcome or what would constitute optimum management. This study has determined that poor outcome is common and it has begun to identify factors that can help predict which patients will have a more complicated course. As it is now felt that the transition from acute to chronic pain begins well before three months, it will be important for future studies to develop a method of early identification of patients at high risk of poor outcome and to determine effective management in an attempt to prevent that transition. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-31 12:12:22.113

Shoulder dysfunction is frequently treated and persistent symptoms are common. Differential diagnosis of shoulder injuries can be challenging and knowledge of a diagnosis alone does not appear to be enough information to predict outcomes. Determination of a set of factors that predict outcome would assist clinicians in making the most effective treatment decision for patients with shoulder pain. The purposes of this dissertation were to investigate patient-clinician agreement in an orthopedic population of patients with shoulder pain and to determine what combination of factors best predicts positive patient-reported outcome following standardized rehabilitation in patients with shoulder pain. In the first study, it was determined that patient-clinician agreement was moderate to good. This further supports the use of patient reported outcomes as an appropriate approximation of “true” outcome. In the second study, patient-nominated functional limitations were reduced to 14 categories for inclusion as candidate predictors in the prediction model. In the third study, we observed that the combination of absence of neck pain, shorter duration of symptoms and report of exercise as a functional limitation were associated with greater odds of positive clinical outcome following 6 weeks of standardized rehabilitation. Due to limited sample size, generalizations cannot yet be made to other samples. Future investigation of this model in a larger sample and subsequent external validation in a separate sample are necessary to further develop the model for clinical use.

Prolonged periods in sitting or standing may negatively influence worker health. Integration of sit-stand workstations has attempted to mitigate these deleterious effects, and has generated positive results in terms of postural discomfort, injury risk and worker fatigue. Identification of how identical tasks are affected by sitting and standing is necessary to take advantage of loading differences between these configurations. The purpose of this research was to determine if differences in workplace configurations between seated and standing postures created changes in posture or muscular activity levels during manual materials handling tasks. Twenty male and twenty female participants performed four manual materials handling tasks: a 40N static push, a 40N static pull, a weighted bottle transfer set at 15% of the participant’s maximal arm elevation force, and a light assembly task in sitting and standing. Upper extremity electromyography was collected at 8 sites, and changes in local joint moments and body discomfort were calculated. Interactions between task and sit/stand configuration resulted in increases of up to 500% in some joint moments, 94% in EMG activity and 880% in some local body discomfort regions when tasks were completed in sitting. A main effect of sitting appeared primarily in joint moments and muscle activity, and generally resulted in increased loading in sitting. Important exceptions existed, which included resultant wrist joint loading 8.2 times larger in standing, and foot/shank discomfort increasing by up to 609%. Task differentially affected all EMG outputs, as well as most local joint moments and body discomfort regions. Future recommendations regarding upper extremity exposures during manual materials handling tasks should consider placing workers in standing postures instead of seated ones to minimize musculoskeletal loading to the upper extremity. In addition, the effects of task and sit/stand configuration should be considered in order to leverage differences between these positions, with tasks in standing generally resulting in decreased musculoskeletal disorder risks.

The study of the human motion as a discipline is ancient almost like the man. Early theories and observations on these topics can be found in Hyppocrates' and Galeno's work. More recently Duchenne de Boulogne (1867), Marey (1885), Braune and Fisher (1888), Sherrington (1933), Luria and finally Haken (1996) applied new techniques to the study of movement trying to understand and localise also the main areas of the brain involved during motion. Despite the richness of the literature produced, "man in motion" still represents a fascinating and partially unknown theme to deal with, particularly in the dynamic behaviour of the arms during the execution of specific tasks. Such movement, indeed individual expression of the complex interaction of biological subsystems (brain, muscles, skeleton, etc. ) against the surrounding environment, hides nowadays its features and very few data are available on its kinematic and dynamic response. This gap is largely due to the lack of knowledge on the dynamic movement of the "shoulder complex" and of the related muscles involved during motion. In fact, the large number of degrees of freedom to be measured and the high deformability of skin and soft tissues prevent the direct measurement of skeletal movements and contribute to increment the above described indetermination. Against this complex background, the rehabilitationist faces the pragmatic difficulties to decide which joints require attention as a priority or, in the case of biological damage, to assess the degree of impairment and subsequent recovery. As a result, clinical assessmentis performed by the use of relatively elementary test tasks, which can be monitored either by timing or by some indirect measurement of the success of the execution. The aim of the present research is then to provide new means of measurements to be used for gaining objective information on the motion particularly of "non visible" joints like the shoulder complex in order to characterise properly their motion and, in turn, the workspace of the arm.

The present research quantified the shoulder rhythm for arm postures that represent the right-handed reachable workspace and compared 3 methods of scapular tracking: acromion marker cluster (AMC), stylus and scapular locator. The shoulder rhythm models can be incorporated into existing and future shoulder biomechanical models to determine shoulder geometry when simulating postures experienced in workplaces and thus have ergonomic implications for correctly identifying risk factors. The results of this research also provide guidance for future studies involving scapular tracking. Fourteen male and 14 female participants performed static arm postures spread over 5 elevation angles: 0, 45, 90, 135, 180 degrees, three elevation planes: 0, 45, 90 degrees to the frontal plane and, three axial rotations: maximum internal, neutral, and maximum external rotation. Kinematic data was recorded using a Vicon MX20+ motion-tracking system. Bone rotations were calculated using Euler angles and continuous prediction models were generated to estimate scapular and clavicular orientations based primarily on thoracohumeral relative orientations. Methods of scapular tracking were compared using repeated measures analysis of variance. Participant characteristics did not influence any of the scapular or the clavicular angles (p>.05). Axial rotation did not influence scapular retraction/protraction and elevation plane did not influence clavicular elevation (p>.05). Elevation angle was the largest contributor to lateral rotation and posterior tilt of the scapula and all clavicular angles. Plane of elevation was the largest contributor to scapular protraction. Using the stylus as the gold standard, the locator and the AMC underestimated lateral rotation, with a maximum difference of 11 degrees and 9 degrees between the locator and the stylus and AMC and the stylus measurements, respectively. The AMC and the locator overestimated posterior tilt at overhead postures and underestimated it at low elevation angles. The maximum difference between the AMC- and the locator- and the stylus-measured tilt was 10 degrees. The scapular locator consistently overestimated protraction by approximately 5 degrees. The AMC underestimated protraction in the frontal plane at low elevation angle but overestimated it at all other postures and the overestimation increased with plane of elevation, internal rotation and elevation angle. Overall, it is recommended to use AMC rather than the scapular locator to measure scapular position.

Thesis (M App Sci in Physiotherapy) --University of South Australia, 1992

Thesis (MAppSc in Physiotherapy) -- University of South Australia

Thesis (MAppSc in Physiotherapy) -- University of South Australia