Indivíduos com Síndrome do Impacto apresentam alterações nos movimentos da escápula em relação ao tórax como uma diminuição da rotação superior, inclinação posterior e aumento da rotação medial, que associada a diminuição do controle e do recrutamento da musculatura estabilizadora podem causar pinçamento dos tecidos moles. O objetivo deste estudo foi determinar o efeito de um protocolo de fortalecimento com carga e complexidade progressivas e aumento da percepção cinestésica na cinemática escapular de indivíduos com síndrome do impacto, enfatizando os músculos serrátil anterior, romboides e porções superior, média e inferior do trapézio. Vinte e cinco indivíduos com diagnóstico da síndrome foram submetidos ao programa de fortalecimento muscular e aumento do controle motor que teve duração de oito semanas, realizados três vezes por semana. O sistema eletromagnético de aquisição de dados foi utilizado para avaliar a cinemática em três planos antes e após o protocolo. A dor e a função do ombro foram avaliadas pelo Shoulder Pain and Disability Index (SPADI-Brasil). O modelo linear de efeitos mistos foi utilizado para as comparações. A escápula apresentou alterações pós-intervenção com redução da rotação interna no repouso, plano sagital e frontal, diminuição da inclinação anterior nos três planos e redução da rotação superior no plano frontal e escapular . Houve diminuição da dor e melhora da função avaliada pelo SPADI-Br. O protocolo de controle motor e fortalecimento muscular altera a cinemática da articulação escapulotorácica e gera diminuição da dor e melhora da qualidade de vida. / Patients with subacromial impingement syndrome have changes in the scapula relative to the thorax movements with decreased upward rotation, posterior tilt and increased medial rotation that if associated with control and recruitment of stabilizer muscles decrease, could result on soft tissues impingement. The aim of this study is to determine the effect of a strengthening and kinesthetic awareness protocol with progressive and complexity load in scapular kinematics of individuals with impingement syndrome, emphasizing the serratus anterior, rhomboids and upper, middle and lower trapezius. Twenty-five diagnosed patients with the syndrome did undergo to the muscle strengthening and increased motor control program during eight weeks, three times a week. The electromagnetic data acquisition system was used to evaluate the kinematic at three planes before and after the protocol. The shoulder pain and function were evaluated by Shoulder Pain and Disability Index (SPADI-Brazil). The linear mixed-effects model was used for comparisons pre- and post-intervention. The scapula showed post-intervention changes with reduced internal rotation at rest, sagittal and frontal plane, decreased anterior tilt in three planes and reducing the upward rotation on the frontal and the scapular planes, decreased pain and improvement in function assessed by SPADI-Br. The motor control and strengthening protocol changes the kinematics scapulothoracic joint and results in decreased pain and improved quality of life.

O objetivo deste estudo foi avaliar a confiabilidade intradia e interdias dos valores de amplitude da eletromiografia de superfície, dos músculos da cintura escapular e membro superior, durante a realização de 3 exercícios isométrico com a extremidade distal do segmento fixa em uma superfície estável e outra superfície instável, com descarga de peso axial controlada para o membro superior. Para tanto, 20 adultos saudáveis realizaram os exercícios push-up, bench-press e wall-press em diferentes níveis de carga (80 e 100% da carga máxima). Os valores de carga produzida por cada um dos exercícios foram registrados de maneira simultânea à eletromiografia. Os sujeitos realizaram três contrações voluntárias máximas (CVM) na posição de prova de função muscular de cada músculo, para obtenção do valor de referência para normalização dos valores de root mean square (RMS) e da integral do envoltório linear (?env). Os sujeitos foram instruídos, a realizarem de forma aleatória, 3 séries de contrações isométricas por 6 segundos em cada exercício, com intervalo de 2 minutos entre as séries e exercícios.Os sinais eletromiográficos dos músculos deltóide porção anterior e posterior, trapézio fibras superiores, serrátil anterior, peitoral maior porção clavicular, bíceps braquial porção longa e tríceps braquial porção longa foram captados por eletrodos de superfície ativos simples diferenciais, realizados em dois testes com intervalo de sete dias. Os dados foram coletados com freqüência de amostragem de 4000Hz e aplicados filtros digitais de passa baixa de 500Hz e passa alta de 20Hz. Os valores de RMS e ?env foram normalizados pelo valor máximo da amplitude eletromiográfica obtida em 1 das 3 CVM do músculo correspondente. As confiabilidades intradia e interdias foram calculadas através do coeficiente de correlação intraclasse (ICC), erro padrão da medida (SEM) e coeficiente de variação (CV). Os resultados indicaram excelente confiabilidade intradia dos valores de amplitude eletromiográfica (ICC ?0,75). A confiabilidade interdias dos valores normalizados de RMS apresentou valores variando entre bom e excelente (ICC 0,52-0,98), já os valores normalizados de ?env apresentaram valores pobres a excelente de confiabilidade (ICC 0,06-0,93). Os valores de carga produzidos durante os exercícios apresentaram excelente confiabilidade intradia e interdias (ICC ?0,97). Por fim, os resultados do presente estudo sugerem que a confiabilidade dos valores normalizados de amplitude eletromiográfica dos músculos analisados apresentam valores mais confiáveis durante os exercícios realizados com superfície estável. Já os níveis de carga empregados (80 e 100%) durante os exercícios parecem não ter influenciado nos níveis de variabilidade, talvez por serem cargas muito próximas. / The objective of the present study was to evaluate the intra and interday reliability of surface electromyography amplitude values of the scapular girdle muscles and upper limbs during the performance of 3 isometric exercises of closed kinetic chain regarding the upper limbs with the fix distal segment extremity on one stable surface and the other one on one unstable surface. In this regard, 20 healthy adults realized the exercises push-up, bench-press and wall-press with different load levels (80 and 100% maximal load). The load values produced for each exercise were recorded simultaneously to the electromyography. The individuals performed three maximal voluntary contractions (MVC) in the muscular testing position of each muscle for the obtainment of the reference value for the root mean square (RMS) normalization values and for the integrated of the linear envelope (?env). The individuals were instructed to realize at random, 3 isometric contraction series taking each exercise 6 seconds with a rest of 2 minutes between the series and the exercises. The electromyographic signals of the anterior and posterior deltoid, upper trapezius, anterior serratus, pectoralis major, biceps and triceps brachial muscle were captured by simple active differential surface electrodes, in two tests with a 7-day interval. Data were collected with a sampling frequency of 4000Hz and 500Hz low and 20Hz high passage digital filters. The RMS and ?env values were normalized by the maximal electromyographic amplitude value obtained in 1 of the 3 MVC of the corresponding muscle. The intra and interday reliabilities were calculated through the intraclass correlation coefficient (ICC), standard error measure (SEM) and coefficient of variation (CV). The results indicated an excellent intraday reliability of the electromyographic amplitude values (ICC ?0.75). The interday reliability of the RMS normalized values presented values varying between good and excellent (ICC 0.52-0.98), whereas the ?env normalized values presented poor to excellent reliability values (ICC 0.06-0.93). The load values produced during the exercises presented excellent intra and interdays reliability. Finally, the results of the present study suggest that the reliability of the electromyographic amplitude normalized values of the analyzed muscles present better values during the performance of the exercises with stable surface. However the load levels utilized during the exercises do not seem to have influenced the variability levels, eventually in view of being very close levels

Orientador: Fausto Berzin / Dissertação (mestrado) - Universidade Estadula de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-24T19:49:56Z (GMT). No. of bitstreams: 1 Fornasari_CarlosAlberto_M.pdf: 1832465 bytes, checksum: 93ee85cbc557a85a6cb4c3005870e44e (MD5) Previous issue date: 1999 / Resumo: Considerando a importância das ações dos músculos (MM.) rombóides maior e menor na manutenção, fixação e estabilização da escápula a proposta deste estudo foi analisá-los eletromiograficamente durante os movimentos dinâmicos e livres de adução do úmero de 150° a 0°, abdução horizontal de 90° a 0° e abdução horizontal de 0° a 50°, em decúbito ventral, combinando-os com as variações de posições do úmero: neutra, rotação medial e rotação lateral. Os registros eletromiográficos foram coletados em oito homens, saudáveis, destros, com idade entre 22 e 25 anos (média 22,8 '+ ou -' 1,0), a partir de um eletromiógrafo multicanal Nicolet Viking, com a utilização do programa MVA (Maximum Voluntary Activity), por meio de utilização de eletrodos de fios Karma Allong, 25 mícron. Os resultados estão apresentados em RMS (Root Mean Square) em 'mu 'V. A análise estatística dos resultados foi realizada por meio dos teste de FRI DMAN e WlLCOXON, em função da não distribuição normal dos dados, com nível de % de significância ( 'alfa '=0,05). Os músculos apresentaram sinal eletromiográfico em todos os movimentos estudados, em todas as variações de posição do úmero. Em todos os movimentos estudados foi observado maior sinal eletromiográfico para o M. rombóide maior do que para o M. rombóide menor (p<0,05). Considerando o M. rombóide maior, este apresentou maior sinal eletromiográfico no movimento de abdução horizontal 0° a 50° e menor sinal eletromiográfico no movimento de adução 150° a 0°, independente da posição do úmero (p<0,05). Quando foi analisado com relação às varias posições em que o úmero foi colocado, o maior sinal eletromiográfico ocorreu na posição de rotação lateral no movimento de adução 150° a 0° para o M. rombóide maior (p<0,05). Nos demais movimentos e variações de posição do úmero os resultados não foram estatisticamente significantes tanto para o M. rombóide maior como para oM. rombóide menor (p>0,05). Na análise particular do M. rombóide menor, este apresentou maior sinal eletromiográfico no movimento de abdução horizontal de 0° a 50°, que foi maior que o sinal eletromiográfico para o movimento de abdução horizontal de 90° a 0°, que por sua vez obteve umsinal eletromiográfico maior que o movimento de adução de 150° a 0° (p<0,05). Os resultados indicam que há um recrutamento diferenciado das unidades motoras entre os músculos quando se variam os movimentos e as posições. Os resultados apontam ainda, para necessidade de novos estudos comparativos, com métodos similares para investigar as relações funcionais entre estes músculos / Abstract: The purpose of the present study was to analyze electromyographically the MM. rhomboideus major and minor in shoulder movements, considering both the importance in the maintenance, fixation and stability of the scapula to the movements of shoulder joint, and the absence of additional studies of these movements. The records of eight healthy man aged 22 to 25 were collected (Nicolet Vicking electromyograph) with fine wire electrodes. The statical analyses of the results was carried out using tests FRIDMAN and WILCOXON (p<0,05). The muscles presented activities for all the movements studied. The M. rhomboideus major presented higher activity than the M. rhomboideus minor. Concerning the movements, the M. rhomboideus major it was verified that the activity for the adduction movement of 150°-0° was lower than the horizontal abduction of 0°-50°. The M. rhomboideus minor presented higher activity in horizontal abduction of 0°50°, for the adduction movemenl of 150° - 0° and horizontal- abduction of 90° -0° movement, with no significant results for the humerus positioning. The results indicate that there is a differential recruitment of the motor units between the muscles, when the moviments and situations vary. Our results indicate the necessity for additional comparative studies to investidate the functional retalions between these muscles / Mestrado / Biologia e Patologia Buco-Dental / Mestre em Odontologia

Repetitive movements of the arm in or above the horizontal plane, can initiate the development of impingement syndrome of the shoulder (Wolin and Tarbet, 1997:56, 59). Impingement syndrome of the shoulder is a common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this pilot study was to determine the most effective treatment protocol in the management of impingement syndrome of the shoulder due to supraspinatus tendonitis. This randomised study consisted of three groups of ten patients, between the ages of eighteen and forty-five. All potential candidates for the trial were examined and admitted once all the exclusion and inclusion criteria had been met. Once joint restrictions were found in the cervical and/ or thoracic spine and the acromioclavicular joint, diversified chiropractic manipulative therapy was administered to all the patients. Group A received cervical and/ or thoracic spine manipulations, Group B received acromioclavicular joint manipulations, and Group C received a combination of spinal manipulations (cervical and/ or thoracic) and acromioclavicular joint manipulations. Patients were treated over a two-week treatment period. Measurements were recorded on the first, third and sixth treatments. The objective data consisted of pain free shoulder abduction range of motion, the presence of a painful arc of the shoulder, a positive supraspinatus test and/or Neers and/or Hawkins impingement test. The subjective data included the numerical pain rating scale 101 questionnaire. The statistical analysis that was conducted included the One Way ANOVA (analysis of variance) as well as the Student-Newman-Keuls Method to compare intra-group and inter-group data. Statistically significant changes were seen in all three groups. However, group A (cervical and/ or thoracic spinal manipulations) and group B (acromioclavicular joint manipulations) showed to be the most effective in treating impingement syndrome of the shoulder. This does however require further research, and a larger sample size. / Dr. M. Moodley Dr. G. Sher

Abstract This study comprised three parts: a cross-sectional survey of 826 high school students, a 7-year follow-up survey of the same sample, and a MRI study of a subgroup (n=31) of the follow-up study population. Firstly, the aims of the study were to determine the prevalence and incidence of neck and shoulder pain (NSP) in populations 15-18 and 22-25 years old, and to evaluate sociodemographic factors, body size measurements, psychological factors and leisure time activities as possible associated and predictive factors of NSP. Secondly, the aim was to find out whether structural changes of the cervical spine detected by magnetic resonance imaging (MRI) were associated with NSP in young adults. The results showed the prevalence of self-reported weekly NSP in 15- to 18-year-old adolescents to be 17%, and in seven years, the prevalence of weekly NSP had increased to 28%. After seven years, the six-month incidence of occasional or weekly NSP was 59% among those asymptomatic at baseline. In the cross-sectional study, female gender, low physical activity, hobbies which statically load the upper extremities, low intensity of physical exercise, self-assessed moderate physical condition and psychosomatic symptoms and depressive mood were associated with a high prevalence of NSP, and sports which dynamically load the upper extremities were associated to a low prevalence of NSP. Symptoms in adolescence were associated with a high prevalence of NSP seven years later. Activity in sports, which dynamically load the upper extremities in adolescence, was associated with a low prevalence of NSP in adulthood. Of all variables in the study, psychosomatic symptoms were most congruently associated with a high prevalence of NSP, and psychosomatic symptoms in adolescence also predicted NSP in adulthood. In the MRI study, disc degeneration and anular tears of the cervical spine were common in asymptomatic and symptomatic subjects. Disc herniations were the only abnormal finding that was significantly more common in symptomatic subjects.

The shoulder is a complex anatomical structure and imaging plays an important role in the diagnosis and management of shoulder conditions. The complexity of the shoulder’s anatomy has led to the development of multiple radiographic projections and techniques within plain film imaging with each projection intended to demonstrate specific aspects of the anatomy of the shoulder. However, reproducing the required projections can be difficult especially if radiographers are not familiar with the projections and their evaluation criteria. Literature has revealed the importance of a comprehensive knowledge and understanding of anatomy, patient positioning, beam direction and centring point, and evaluation criteria to ensure a quality projection for accurate diagnoses. The aim of the study was to determine the knowledge and understanding of radiographers with regard to the supraspinatus outlet projection (SOP) for shoulder impingement syndrome (SIS) and its evaluation criteria. The inferences derived from the research findings were used to develop guidelines for a structured in-service training programme for practising radiographers to optimise their knowledge and understanding of the supraspinatus outlet projection in shoulder impingement syndrome. The proposed study followed a quantitative approach. Furthermore, a descriptive, exploratory, contextual design was employed. The research population consisted of practising radiographers working in the public and private hospitals of the Nelson Mandela Bay Municipality. The data were collected by means of a structured self-administered questionnaire. The questionnaire comprised of three sections. The first section requested demographic information from the participants. The second section assessed their knowledge and understanding regarding the scapular ‘Y’ and the supraspinatus outlet projections and shoulder impingement syndrome. The third section assessed their knowledge and understanding of anatomy and image evaluation/critiquing. The reliability and validity of the data collection instrument was ensured by conducting a pilot study and comparing the results with those of the main study. In addition, the expertise and guidance of a radiographer experienced in the clinical training of radiographers, the supervisor (who has twenty years’ experience in the teaching of radiographers) and a statistician was obtained. Descriptive and inferential statistical analyses were performed by means of a statistical programme and with the guidance of a statistician. The researcher ensured that the study was conducted in an ethical manner by adhering to the ethical principles of beneficence, justice and respect for persons.

abstract: The human shoulder plays an integral role in upper limb motor function. As the basis of arm motion, its performance is vital to the accomplishment of daily tasks. Impaired motor control, as a result of stroke or other disease, can cause errors in shoulder position to accumulate and propagate to the entire arm. This is why it is a highlight of concern for clinicians and why it is an important point of study. One of the primary causes of impaired shoulder motor control is abnormal mechanical joint impedance, which can be modeled as a 2nd order system consisting of mass, spring and damper. Quantifying shoulder stiffness and damping between healthy and impaired subjects could help improve our collective understanding of how many different neuromuscular diseases impact arm performance. This improved understanding could even lead to better rehabilitation protocols for conditions such as stroke through better identification and targeting of damping dependent spasticity and stiffness dependent hypertonicity. Despite its importance, there is a fundamental knowledge gap in the understanding of shoulder impedance, mainly due to a lack of appropriate characterization tools. Therefore, in order to better quantify shoulder stiffness and damping, a novel low-inertia shoulder exoskeleton is introduced in this work. The device was developed using a newly pioneered parallel actuated robot architecture specifically designed to interface with complex biological joints like the shoulder, hip, wrist and ankle. In addition to presenting the kinematics and dynamics of the shoulder exoskeleton, a series of validation experiments are performed on a human shoulder mock-up to quantify its ability to estimate known impedance properties. Finally, some preliminary data from human experiments is provided to demonstrate the device’s ability to collect the measurements needed to estimate shoulder stiffness and damping while worn by a subject. / Dissertation/Thesis / Doctoral Dissertation Mechanical Engineering 2020

研究背景：肩痛是临床的常见症状，常因不正确姿势、受凉、外伤、运动劳损等引发，多被诊断为局关节周围炎、属部的肌臆炎等’带来的疼痛和肢体活动障碍都严重影响正常生活。针灸治疗盾痛效果显著’传统中医在眉痛的诊疗中已有详尽论边，而近年西方医学提出的激痛点疗法，在治疗痛症上也有明确的疗效。总结局痛的激痛点针刺取穴方案，探讨其与传统针灸的失系’对发展当代针灸有十分重要的理论意义和临床价值。研究目的：初步总结盾痛的激痛点针刺取穴方案，探讨激痛点和传统针灸的相关性, 为临床提供新思路。研究方法：文献研究。结论：眉痛的激痛点针刺取穴方案为：盾前痛取胸大肌锁骨部、胸小肌、肱二头肌、喙肱肌、背阔肌、冈下肌、前三角肌、前斜角肌、中斜角肌激痛点；属后痛取大圆肌、小圆肌、肩胛下肌、肱三头肌长头第一、下斜方肌第三、后三角肌激痛点；肩外侧疼痛取中三角肌、冈上肌激痛点。此法优势在于理论系统与诊疗过程明确、操作规范、疗效显著，是属痛的治疗的新思路。对比发现，激痛点理论与经筋理论相似。激痛点针刺取穴与中医整体辨证论治的结合, 势必有助提高临床疗效，值得深入探索。關键字：肩痛激痛点针刺取穴文献研究

Background Shoulder pain and injury is common in both the general population and among athletes. Overhead athletes, such as handball players, are at an even higher risk of shoulder injury. There is currently no consensus regarding how or if these injuries can be prevented.  Purpose The aim of this review was to examine whether preventive training programs reduce acute and/or overuse injuries in overhead athletes. Another aim was to examine if training programs increase the strength of the rotator cuff in overhead athletes.  Method Searches were made in PubMed, Cinahl, and Sport Discus in March and April 2021. Ten studies were included in the study. The PEDro-scale was used to assess methodological quality and GRADE was used to determine level of evidence.  Results The methodological quality was “moderate to high” for five of the studies. The remaining five studies were of lower quality. The level of evidence was “limited” for prevention and “inadequate” for rotator cuff strength.  Conclusion The evidence for prevention of shoulder injuries was “limited” and the evidence for rotator cuff strength was “inadequate”. A narrower focus on one sport might result in more robust evidence.  Keywords overhead athlete, prevention, shoulder, strength

In Canada, approximately 544,000 upper-limb injuries occurred in a 12-month period between 2009 and 2010, many of which were injuries to the rotator cuff muscles of the shoulder. Because of the complex structure and function of the shoulder, it is often difficult to determine which muscles have been injured. The most widely used technology to study human movement is motion capture, wherein markers are affixed to a subject’s skin and are tracked by cameras as the subject moves. The recorded marker trajectories are then used to estimate the bone locations and joint angles during the tracked motion. This is called an inverse kinematic simulation. The simulation can then be used to estimate variables that are difficult or impossible to measure directly, such as the activation of single muscle heads within a muscle group. However, muscles bulge and skin stretches during movement, so the markers that are affixed to the skin generally move relative to the underlying bones. These errors, known as soft-tissue artifacts, lead to uncertainty in the calculation of bone locations and, consequently, uncertainty in the computed skeletal joint angles. This uncertainty limits the use of inverse kinematic simulations in clinical settings. Given the skin tissue’s elastic behaviour, a spring-based equilibrium model can be used to estimate the behaviour of skin during non-impulsive motion. In the proposed model, markers were placed on the surface of ellipsoids (representing the thorax, abdomen, scapula, and upper arm) and were attached to each other via springs. The system was assumed to remain in static equilibrium during sufficiently slow movements to approximate the stretch of the skin. In this thesis, the development and application of a proof-of-concept model to estimate the pose of the skeleton is described. This work demonstrates the feasibility of using such a model to reduce errors due to soft-tissue motion.