Shoulder injuries may be associated with proprioceptive deficits, however, it is unknown whether these changes are due to the experience of pain, tissue damage, or a combination of these. The aim of this study was to investigate the effect of experimentally-induced sub-acromial pain on proprioceptive variables. Sub-acromial pain was induced via hypertonic saline injection in 20 healthy participants. Passive joint replication (PJR) and threshold to detection of movement direction (TTDMD) were assessed with a Biodex System 3 Pro isokinetic dynamometer for baseline control, experimental pain and recovery control conditions with a starting position of 60° shoulder abduction. The target angle for PJR was 60° external rotation, starting from 40°. TTDMD was tested from a position of 20° external rotation. Repeated measures ANOVAs were used to determine differences between PJR absolute and variable errors and TTDMD for the control and experimental conditions. Pain was elicited with a median 7 on the Numeric Pain Rating Scale. TTDMD was significantly decreased for the experimental pain condition compared to baseline and recovery conditions (≈30%, P=0.003). No significant differences were found for absolute (P=0.152) and variable (P=0.514) error for PJR. Movement sense was enhanced for the experimental sub-acromial pain condition, which may reflect protective effects of the central nervous system in response to the pain. Where decreased passive proprioception is observed in shoulders with injuries, these may be due to a combination of peripheral tissue injury and neural adaptations that differ from those due to acute pain.

This study investigated effects of experimentally-induced subacromial pain, induced via hypertonic saline injection, on shoulder muscles activity. Electromyographic activity of 20 healthy participants was assessed for humeral elevation and descent for the control and experimental pain conditions, using fine wire electrodes for subscapularis and supraspinatus and surface electrodes for middle deltoid, upper trapezius, lower trapezius, infraspinatus, and serratus anterior. Normalized mean amplitudes were analyzed for each muscle for four phases for elevation and descent, respectively. Repeated measures analysis of variances (ANOVAs) were used to determine differences between muscle activity in the control and experimental condition for the four phases of elevation and descent. Differences for mean normalized amplitudes were not significant during humeral elevation. Increased activity was found for the pain condition for serratus anterior and middle deltoid during the first (120-90°) and third (60-30°) parts and decreased activity for infraspinatus in the second half of descent (60-0°). No significant differences were found during descent for upper and lower trapezius, subscapularis and supraspinatus. While increased serratus anterior activity during 60-30° of descent may be protective, increased middle deltoid and decreased infraspinatus activity during the same range may threaten subacromial tissues in that range. Overall the changes in muscle activation were individual specific, particularly during the concentric elevation phase.

Background: Shoulder complex injuries are common among overhand throwing athletes. These injuries often manifest as a result of habitual sport performance and often lead to time loss injuries. The mechanisms of these injuries are often non-traumatic and theories on how shoulder injuries manifest differ. Objectives: To describe the proposed mechanisms of commonly reported shoulder injuries as they relate to the phases of the throwing motion. Major findings: Shoulder injuries commonly involve rotator cuff muscles and tendons, scapulothoracic muscles, glenohumeral joint labrum, proximal humeral epiphysis, glenohumeral joint capsule, biceps muscle and tendon, and subacromial bursa. The injuries found in these tissues and their purported mechanisms of injury during the throw vary. Conclusions: The late cocking and deceleration phases have been implicated with the largest number of associated pathologies. Multiple injuries were theorized to occur at more than one phase of the throwing motion. Consensus has not been achieved on the provocative events leading to shoulder injury during the throwing motion.

By understanding the normal humeral and scapular kinematics during the kayak stroke, inferences about the relationship of kayaking technique and shoulder injury may be established. The purpose of this study was to describe scapular and humeral kinematics and to compare dominant versus non-dominant symmetry in healthy whitewater kayakers performing the forward stroke. Twenty-five competent whitewater kayakers (mean age: 34.1±9.4 years, mean height: 1.768±0.093 m, mean mass: 78.2±13.0 kg) underwent humeral and scapular kinematic assessment, using an electromagnetic tracking device, while kayaking on a kayak ergometer. Paired t-tests were used to determine symmetry. Scapular and humeral kinematic means and standard deviations at six time points during the kayak stroke were described. Scapular and humeral kinematics were shown to be similar upon bilateral comparison. The greatest potential for injury during the forward stroke may be at thrust paddle shaft vertical when the humerus is maximally elevated in internal rotation and adduction as subacromial structures may be mechanically impinged. The relationship between scapulohumeral kinematics related to injury at other time points are also described.

Previous studies with college athletes determined that the shoulder girdle plays a vital role in a variety of athletic activities. The previous research showed that a decrease in shoulder range of motion (ROM) was associated with a higher risk injury. Decreased shoulder ROM was shown to be a primary reason that many athletes were unable to perform many overhead lifting variations within their strength and conditioning programs. The purpose of this research was to evaluate a group of athletes by means of a postural assessment using the overhead squat test. This study consisted of a pretest-post test control group design. The dependent variable that was observed was the goniometric measurement of the shoulder ROM in response to the independent variable, which was a specialized upper body stretching protocol. Current NCAA Division I male athletes from a university in the south, who competed in a variety of different intercollegiate sports, volunteered for this study (N = 27). For the purpose of the current study the athlete was asked to perform three trials of the overhead squat test. For each of the trials goniometric data were collected. After the data were collected the athletes were taught the joint-specific stretching protocol that was to be used as the intervention for this study. When the pretest and posttest data were observed, the intervention group had an average decrease of 14.7 degrees over the course of the study, while the control group only showed an average decrease of 1.6 degrees. A one-way ANOVA showed that the means of the two groups were not statistically different at the posttest but were significantly different at the pretest. To check the interaction between the grouping factor and the trial factor, a 2 x 2 ANOVA, at a p-value of 0.05, was used to determine the between measurement interactions. From the data that were collected it was determined that there was a statistically significant time factor as well as interaction effect when comparing the two conditions.

Many tasks of visual computing and communications such as object recognition, matting, compression, etc., need to extract and encode the outer boundary of the object in a digital image or video. In this thesis, we focus on a particular video segmentation task and propose an efficient method for head-and-shoulder of humans through video frames. The key innovations for our work are as follows: (1) a novel head descriptor in polar coordinate is proposed, which can characterize intrinsic head object well and make it easy for computer to process, classify and recognize. (2) a learning-based method is proposed to provide highly precise and robust head-and-shoulder segmentation results in applications where the head-and-shoulder object in the question is a known prior and the background is too complex. The efficacy of our method is demonstrated on a number of challenging experiments. / Thesis / Master of Applied Science (MASc)

This dissertation aimed to develop a joint protection program for people with shoulder arthritis. The program was developed throughout a two-phase process. The first stage in developing the Shoulder Joint Protection Program for patients with different stages of arthritis focused on comprehending existing research and understanding the factors that influence shoulder joint protection. We considered the priorities and preferences of both patients and therapists, integrating different types of evidence like systematic reviews, narrative and scoping reviews, and analysis of shoulder movement. This evidence guided the creation of a preliminary joint protection program. The second stage assessed the content validity of this program, using cognitive interviews with patients and therapists. The findings from each phase were then presented in separate chapters, providing a complete view of the Shoulder Joint Protection Program (SJPP) for individuals with shoulder arthritis. The evidence presented in Chapters 2 and 3 suggests that no single optimal program has been defined for patients undergoing total shoulder joint replacement surgery, including both anatomical and reversed types. Further high-quality RCTs are needed to provide more conclusive results. To assess outcomes, various patient-reported outcomes have been developed and validated. However, our study, as presented in Chapter 4, reveals inconsistencies and a lack of clarity in the conceptual frameworks of the identified PROMs. Our scoping review in Chapter 5 offers comprehensive research on shoulder biomechanics during various activities, and spotlights potential injury prevention strategies. These identified strategies can guide the creation of training programs, coaching practices, and rehabilitation strategies aimed at minimizing the risk of shoulder injuries and bolstering overall shoulder health. Results from Chapter 6 suggest that participants have the capacity to modify their movement patterns to implement joint protection strategies, potentially beneficial in post-surgery rehabilitation and enhancing shoulder function. The application of motion analysis software tools, such as MediaPipe, has yielded reliable results, indicating their potential for future kinematic studies. The developed SJPP comprises two sections: general joint protection principles and specific protective strategies for daily activities. Both digital resources and a printed version were developed to increase the accessibility of the program. The study (Chapter 7) presents a substantial contribution to the resources for patients with shoulder arthritis. It was designed to enhance their quality of life and enable them to navigate everyday activities with greater ease and less discomfort. Further enhancements, such as the inclusion of content on sports and recreational activities, could make the program even more comprehensive and beneficial. Overall, the study underscores the importance of evidence-based, user-friendly resources for patients with shoulder arthritis and provides potential directions for future research and enhancements, such as including content on sports and recreational activities. The SJPP's ultimate goal is to enhance patients' quality of life, allowing them to perform everyday activities with less discomfort. / Thesis / Doctor of Rehabilitation (RhD) / This Ph.D. research project set out to create a program to help people with shoulder arthritis protect their joints. The development process was broken down into two main stages. In the first step, we looked at what we already know from research and figured out the main things that affect how well someone can protect their shoulder joint. We thought about what patients and therapists want and need. We looked at many different kinds of studies and even how people move their shoulders. All this helped us make a first version of our plan. In the second step, we checked how good our plan was. We did this by talking with patients and therapists. We wrote about everything we found out in different chapters. This gave us a full picture of our Shoulder Joint Protection Program (SJPP) for people with shoulder arthritis. Our final SJPP has two main parts: general rules to protect the joint and special tips for everyday activities. We made it available online and on paper so it's easy to get. Our study is a big help for patients with shoulder arthritis. It's meant to make their lives better and help them do everyday things with less pain. In the future, we might add more tips about sports and fun activities, which could make it even more helpful. In conclusion, our research shows how important it is to have easy-to-use, research-based tools for patients with shoulder arthritis. We've also given some ideas for future research. The main goal of the SJPP is to make patients' lives better, helping them do everyday things with less pain.

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Shoulder impingement is the most common cause of shoulder pain. It is often described as mechanical irritation of the tendons of the rotator cuff or long head of the biceps due to compression against either the structures of the subacromial arch or the glenoid and glenoid labrum. Various treatment options exist to address impingement, and recent studies suggest thoracic spine manipulation may be a useful option. The purpose of this study was to assess changes in range of motion (ROM), pain and shoulder function both immediately post- and 7 to 10 days after receiving thoracic spine manipulations. We also attempted to identify changes in scapular kinematics and shoulder muscle activity associated with thoracic spine manipulation in subjects with shoulder impingement. Thirty subjects between the ages of 18 and 45 with signs of shoulder impingement participated in this repeated measures study. All subjects received both a mid-thoracic spine and a cervicothoracic junction manipulation. Changes in pain were assessed using an 11 point numeric pain rating scale. Subjects reported pain with performance of provocative testing (Jobes Empty Can, Hawkins-Kennedy and Neer's tests for impingement) as well as with performance of cervical rotation, thoracic spine flexion and extension and weighted humeral elevation. Shoulder elevation force production pre- and post- manipulation was assessed using hand-held dynamometry. Additionally, subjects completed the Penn Shoulder Score (PSS) and the Sports and Performing Arts Module of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to assess shoulder pain and function 7 to 10 days post thoracic spine manipulation. Electromagnetic sensors tracked three-dimensional scapular and clavicular kinematics as well as cervical, thoracic and humerothoracic ROM. Surface electromyography data were collected from the infraspinatus, serratus anterior, and the upper, middle and lower trapezius muscles with loaded humerothoracic elevation. A repeated measures analysis of variance (ANOVA) was used to compare scapular orientation and muscle activity at 30, 60, 90 ad 120 degrees of humerothoracic elevation before and after spinal manipulation. Paired t - tests revealed significant decreases in pain [(Jobes 2.6 ± 1.1, Neer's 2.6 ± 1.3, Hawkins-Kennedy 2.8 ± 1.3; p<0.001 for all three tests) (weighted shoulder elevation 2.0 ± 1.5, p<0.001; cervical rotation 0.4 ± .9, p=0.039)] as well as improvements in shoulder function (Force production 5.5±3.1, PSS 7.7 ± 9.4 and DASH 16.4 ± 13.2; p<0.001 for each). No significant changes in any of the ROM assessments were observed. No changes in scapular or clavicular kinematics were observed, with the exception of small decrease in scapular upward rotation (p = .04). A small but significant increase in middle trapezius activity (p = .03) was detected; however, no other significant differences in muscle activity were observed following manipulation. Moreover, paired t-tests revealed no significant differences in muscle onset times after manipulation. The findings of this study indicate that thoracic spine manipulation may be an effective intervention to treat pain associated with shoulder impingement; however, the improvements associated with thoracic spine manipulation are not likely explained by changes in scapular kinematics or shoulder muscle activity. Thoracic spine manipulation did not substantially alter scapular kinematics or motor control at the shoulder. / Physical Therapy