Neck-shoulder pain is common in the general population and causes individual suffering as well as large costs for the society. Despite substantial efforts, there is still a shortage of methods for objective diagnosis and effective rehabilitation of such disorders. Thus, there is a great need to develop and evaluate new methods for these purposes. From clinical observations and recent research it has become evident that sensorimotor control can be impaired in people with neck-shoulder pain and may play a role in the pathogenesis of these disorders. In this thesis, precision of goal-directed arm movements, a previously unstudied class of movements in neck-shoulder pain, was studied. The main aim of the thesis was to investigate if people with chronic neck-shoulder pain have a reduced acuity of goal-directed movements of the upper extremity. A second aim was to study associations between reduced movement acuity and symptoms and self-rated characteristics. Upper limb repositioning acuity was assessed in blindfolded subjects performing tests of active, ipsilateral position-matching of two target positions (long and short) in movements constrained to horizontal-adduction of the shoulder. Reduced repositioning acuity, suggesting impaired shoulder proprioception, was found for both subjects with whiplash associated disorders (WAD) and non-specific neck-shoulder pain (NS). The degree of reduced acuity was shown to correlate with self-ratings of various health concepts, functioning and pain. A conspicuous finding was that there was lack of correlation between short and long target errors, along with the fact that associations between repositioning acuity and symptoms and self-rated characteristics was primarily found for the short target position. To further investigate the possible mechanisms underlying the disassociation between long and short target movement control, the association pattern between the outcome of several variants of ipsilateral position matching and velocity-discrimination tests, were studied. It was found that the perception of limb position in position-matching of short target locations appears to be predominantly based on movement velocity, whereas perception of limb position in movements to longer target locations may rely on a location-based perception mechanism. To extend the research on reduced upper extremity proprioception in neck-shoulder pain to a more natural movement situation, acuity of goal-directed pointing including full vision and 3D multi-joint movements was investigated in WAD, NS and healthy controls subjects. The results revealed a reduced acuity for both neck-pain groups. Moreover, distinct associations between end-point acuity and neck movement problems, limitations of some physical functions and, in WAD; some aspects of pain, were revealed. The findings demonstrate that the precision of upper limb movements can be reduced in chronic neck-shoulder pain. Substantial associations with symptoms and self-rated functioning suggest a clinical relevance of acuity measures of goal-directed arm movements. The findings indicate that tests of sensorimotor control can provide objective measures that may be useful in biopsychosocial profiling and characterization of subgroups of patients with chronic neck-shoulder pain, and that training target control of goal-directed movements should be considered in rehabilitation programs of people with these disorders.

Arthritis is one of the most common manifestations of aging and is the single largest cause of disability in the UK, US, Australia, and Canada among people age 30 years and older. Osteoarthritis of appendicular joint surfaces exhibits alterations of bony tissue in and around the joint surface. The degree to which osteoarthritis of articular surfaces occurs as a function of age and sex can be resolved with cemetery populations of known individuals, such as the Terry (19-20th century) and Spitalfields (17-18th century) collections upon which I report (n = 322; 162 males and 160 females). Using the five point scoring system 0-4 of lipping from the Chicago Standards Guide I ask whether (1) age has an influence on the accumulation of OA; (2) sex differences are present in patterns of OA; and (3) population origin is responsible for explaining intensity of OA.

Objetivos del estudio: establecer los efectos de ultrasonidos y ondas de choque radiales en el síndrome subacromial, determinar la posible influencia del sexo y analizar la rentabilidad de ambas técnicas. Realizamos un estudio en veinticuatro pacientes repartidos en dos grupos: un grupo recibió ondas de choque y el otro ultrasonidos. Los pacientes fueron evaluados mediante la escala DASH, Constant&Murley, UCLA, SF-36 y EVA, antes del tratamiento, al mes, a los tres meses y a los seis meses. El estudio no mostró diferencias entre ultrasonidos y ondas de choque, aunque ambos tratamientos mostraron eficacia. Dicha mejoría fue mayor en los varones. Obtuvimos un coste por paciente menor con las ondas de choque. Conclusiones: ambas técnicas son eficaces en el tratamiento del síndrome subacromial, aunque no encontramos diferencias estadísticamente significativas entre ellas. Los resultados fueron mejores en los varones. En dichas condiciones, el abordaje con ondas de choque radiales es más rentable. / Objectives: To set the utility of ultrasound and radial shock waves in subacromial syndrome; to determinate the possible influence of sex; to analyse the profitability of both techniques. We did a clinical trial in twenty-four patients, divided in two groups: one of them received shock waves treatment, the other group received ultrasounds. The patients were evaluated using DASH scale, Constant&Murley, UCLA, SF-36 and VAE scales before treatment, one month, three months and six months later. No significant differences were found between the two techniques, although both treatments improved symptoms and function. That improvement was better in males. We obtained a patients’ cost in shock waves group lower than in ultrasounds one. Conclusions: both techniques are effective in the treatment of subacromial syndrome, although we couldn’t find relevant differences. The results were better in males. Thus, radial shock waves treatment is more profitable than ultrasounds one.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.

Pulsed-neutron borehole measurements involve a physical process in which a source emits energetic neutrons that lose energy upon collisions with formation nuclei, and are eventually captured by a nucleus to form a heavier, excited state. The excited nucleus decays to its ground state by the emission of gamma rays. Both thermal-neutron and gamma-ray populations decay with time at a rate defined by Sigma, which is a nuclear property that quantifies a material’s ability to capture thermal neutrons. The large contrast in Sigma between hydrocarbon and salty connate water enables calculations of water saturation directly from pulsed-neutron measurements. Sigma logs have proven useful in the assessment of thinly bedded formations because they exhibit a small volume of investigation, and have been deemed superior to resistivity logs in the petrophysical evaluation of carbonate formations. The recognized potential of Sigma logs in formation evaluation initiated the development of multi-detector Logging-While-Drilling (LWD) Sigma measurements. These measurements are acquired using one thermal-neutron and two gamma-ray detectors at different spacings from the source. Such a design is aimed at providing distinct radial depths of investigation to detect filtrate invasion in the near-wellbore zone. Despite their formation-evaluation potential, multi-detector time-decay measurements commonly remain affected by invasion, shoulder-bed, and well-deviation effects. The purpose of this dissertation is to develop a fast-forward simulation method to reproduce multi-detector time decays and combine the method with inversion techniques to improve the petrophysical interpretation of LWD Sigma measurements. First-order perturbation theory and a library of pre-calculated Monte Carlo detector-specific sensitivity functions and time decays are used to numerically simulate borehole Sigma measurements in realistic logging environments. The new simulation method is one hundred thousand times faster than rigorous Monte Carlo calculations and remains within two capture units of disparity. Next, the fast-forward simulation method is embedded within inversion algorithms to estimate layer-by-layer radial length of invasion and formation Sigma corrected for shallow invasion, shoulder-bed, and well-deviation effects. Both fast-forward and inverse modeling algorithms are benchmarked against laboratory and synthetic time decays. The improvement of formation Sigma obtained with inversion-based interpretation leads to an improvement in the estimation of Sigma-derived water saturation. Likewise, the estimated radial length of invasion is combined with neutron and density measurements to correct the latter for invasion effects. Results indicate that the inversion-based interpretation method is well suited for the evaluation of high-porosity formations invaded by salty mud filtrate. Inversion-based interpretation of field LWD time decays enables the estimation of lower values of water saturation when compared to conventional Sigma interpretation or resistivity methods. Estimated values of water saturation are as much as fifty percent lower than predicted by conventional interpretation of Sigma logs in the case of measurements affected by shoulder-bed effects, and as much as one hundred percent lower than predicted by the conventional interpretation method for measurements additionally affected by salty filtrate invasion. The key attributes of the combined petrophysical interpretation of multi-detector Sigma, neutron, and density measurements developed in this dissertation are that it explicitly enforces the physics of all nuclear measurements, honors the pressure and temperature dependency of reservoir fluid nuclear properties, and takes into account a-priori information such as mud-filtrate salinity, connate-water salinity, and bed-boundary locations. / text

Methods of regional anaesthesia and regional postoperative analgesia are common in perioperative management of patients in traumatology-orthopaedics. One of most challenging fields of traumatology-orthopaedics is shoulder surgery. Shoulder surgery is associated with intense and long-lasting postoperative pain. It affects patients’ well-being, limits limb function and worsens results of surgical treatment. Determination of optimal methods for postoperative pain relief is very important in clinical practice. Several modern studies compared methods of systemic analgesia with continuous interscalene infusion of bupivacaine 0,15 - 0,25 % solution. Application of these concentrations of bupivacaine resulted in sufficient analgesia but profound motor blockade and anaesthetic toxicity were observed. There are few studies on interscalene infusions of small concentrations of bupivacaine. Data on effects of small doses of bupivacaine on intensity of motor blockade and adjuvant drugs on postoperative analgesia is lacking. AIM OF THE STUDY: to evaluate the quality of post-operative pain treatment after shoulder surgery using continuous perineural infusions of different concentrations (0.1% and 0.15%) of bupivacaine and bupicacaine (0.1%) in combination with adjuvant clonidine and effects on operated hand motor function. To assess clinical advisability of interscalene brachial plexus identification and catheterization using G. Meier’s technique. 159 patients scheduled for elective... [to full text]

Musculo – skeletal stress in nursing staff and its association with health disorders Aim of the study was to investigate health complaints and work pressure among nursing staff, and to evaluate the associations of musculo - skeletal stress with their health disorders. Methods. During October - December, 2003, 300 employees of one Kaunas hospital were interviewed. In this case - control study, 100 respondents were included into the case group, and 200 were controls. The main criterion for the selection of controls was no engagement in activities characteristic of a nurse and an assisting nurse. The questionnaire was anonymous. Statistical analysis of the obtained findings was performed using SPSS 12 statistical software package. Results. Nurses whose work was not related to lifting weights (the control group) more frequently complained of pains in the neck (87,5 %), the shoulder girdle (91,7 %), and the back (93,2 %), whereas those whose work was related to lifting weights, more frequently complained of pains around the waist (73,0 %) and in the legs (94,9 %). The study showed that the pain syndrome in the arms by two times more frequently occurred in the control group (12,1 % compared to 6,0 % in the case group), which is characteristic of the sedentary job, especially computer work. Pain syndrome in the legs by four times more frequently occurred in the case group, compared to controls, which is typical of work related to weight lifting. The evaluation of the activities... [to full text]

Summary Title. The effect of ergonomic education and ergonomic correction of workplace for the reduction of pain in the area of the neck or shoulder girdle for employees who work with computer. Aims. To identify the efficiency of the ergonomic correction of workplace and of employees ergonomic education, in order to relieve chronic neck and shoulder pains. The research is designed for people, who spend the largest part of their working time with computer. Methods. During the survey there were questioned 80 people, who spend the largest part of their working time with computer. It was evaluated the ergonomics of their workplaces. Among 80 respondents there were selected 30, who felt pain, numbness or big discomfort in the zone of their neck, shoulder girdle or upper arms for 14 or more days during last 3 months. For the 30 selected people it was accomplished the correction of their workplace ergonomic errors and explained the importance of correct work ergonomics and its major rules. After 3 months it was performed a second control survey. 26 people have successfully accomplished the research. The survey and evaluation of workplace ergonomics were performed using the questionnaire and recommendations of “Department for Work and Health National Institute for Working Life“, Stockholm, Sweden; „Section of Occupation Medicine in Sahlgrenska University Hospital“, Gothenburg, Sweden; „Department of Occupational Medicine in Karolinska Hospital“, Stockholm, Sweden.” Results. The... [to full text]

Tyrimo tikslas: pagrįsti priešsezoninių peties sąnario testavimų svarbą sportuojantiems pakeltomis rankomis. Tyrimo uždaviniai: 1. Nustatyti žasto vidinės ir išorinės rotacijų amplitudžių skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 2. Nustatyti žasto vidinę ir išorinę rotacijas atliekančių raumenų jėgos skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 3. Nustatyti pagrindinių mentę stabilizuojančių raumenų jėgos skirtumus tarp sportininkų su ankštumo sindromu ir be jo. 4. Nustatyti, ar gauti tyrimo rezultatai gali turėti įtakos sportininkų traumatizmui. Tyrimas buvo atliktas 2010 m. gegužės – spalio mėnesiais Lietuvos Kūno kultūros akademijoje „Žmogaus motorikos laboratorijoje“. Viso dalyvavo 65 tiriamieji iš kurių, pagal klinikinius testus kitiems tyrimams atrinkta 30 tiriamųjų. Sportininkai pagal gautus klinikinių testų rezultatus buvo suskirstyti į dvi grupes: kontrolinė – sveiki sportininkai (n═15) ir tiriamoji – su peties sąnario ankštumo sindromu (n═15). Tyrimo metodai: klinikiniai testai, žasto vidinės bei išorinės rotacijų amplitudžių nustatymas, trapecinio ir priekinio dantytojo raumenų manualinis testavimas, žasto išorinės ir vidinės rotacijų jėgos matavimas izokinetiniu dinamometru bei matematinė statistika. Išvados: 1. Nustatytas reikšmingas žasto išorinės ir vidinės rotacijų amplitudžių skirtumas tarp sportininkų su peties ankštumo sindromu ir be jo. 2. Nustatyta reikšmingai didesnė žasto vidinę ir išorinę rotacijas atliekančių... [toliau žr. visą tekstą] / Research Aim: To determine the importance of preseason shoulder testing for overhead athletes. Research Objectives: 1. Determine and evaluate shoulder external and internal rotation in overhead athletes with shoulder impingement syndrome and without. 2. Determine and evaluate the differences in bilateral isokinetic peak torque during shoulder internal and external rotation movements between overhead athletes with shoulder impingement syndrome and without. 3. Determine and evaluate the difference in strength of main scapular stabilizing muscles between overhead athletes with shoulder impingement syndrome and without. 4. Determine whether results of the research may affect the athletes' shoulder injuries. Research was conducted May-October 2010 in the ,,Human Motor Skills” laboratory at the Lithuanian Academy of Physical Sciences. 65 subjects took part in the research, and based on the results of clinical testing 30 subjects were chosen for comparison. Based on the clinical tests, 15 subjects showed no symptoms (‘control group’) while 15 showed symptoms of shoulder impingement (‘research group’). Research Methods: Clinical tests, shoulder internal and external ROM measurements, measured trapezius and serratus anterior muscle strength peak torque during shoulder internal and external rotation movements, and mathematical statistics. Conclusions: 1. Significant differences were determined in shoulder ROM between overhead athletes with impingement syndrome and those without... [to full text]

Nach Operationen am Schultergelenk ist die Rehabilitation von entscheidender Bedeutung, um das operative Ergebnis zu sichern und die Schulterfunktion wiederherzustellen. Die dafür erforderliche funktionelle Kraft, Mobilität, Stabilität und Schmerzfreiheit soll mittels adäquater Maßnahmen im Therapieprozess entwickelt werden. Einen Untersuchungsschwerpunkt dieser Arbeit stellte die Erhebung von indikationsspezifischen isokinetischen Referenzwerten dar, die als schädigungsfrei erreichbare Steigerungsraten der Kraft innerhalb eines definierten Rehabilitationsprogrammes anzusehen sind. Dafür wurden jeweils 30 Patienten mit ventraler Schulterstabilisierung, arthroskopisch subakromialer Dekompression und Rekonstruktion der Rotatorenmanschette unter Verwendung des Seilzugisokinetikgerätes „Moflex®“ für die Bewegungen Adduktion, Innen- und Außenrotation untersucht. Zusätzlich galten die tägliche Schmerzquantifizierung, die Erfassung der aktiven Beweglichkeit und die subjektive Einschätzung mittels Fragebögen zum Gesundheitszustand (SF-36-Health-Survey) und zur Schulterfunktion (DASH-Score) zu definierten Zeitpunkten der Rehabilitation als obligate Bestandteile der Untersuchung. Auf der Grundlage der ermittelten Referenzwerte werden Empfehlungen für die praktische Anwendung eines therapeutischen Aufbautrainings mit dem Therapieband und dem Seilzugsystem abgeleitet. Einen weiteren Schwerpunkt der Arbeit bildete die Leistungsdiagnostik mit der Überprüfung der körperlichen Leistungsfähigkeit und der kardiopulmonalen Belastung während einer orthopädisch ausgerichteten Rehabilitation. Dafür absolvierten 20 männliche Patienten nach einer Operation am Schultergelenk zu Beginn und zum Abschluss der Rehabilitation einen Spiroergometrietest auf dem Fahrradergometer und eine Spirometrieuntersuchung mit dem „K4b2“ während der Krankengymnastik und der Medizinischen Trainingstherapie. Mit den Resultaten ist erstmalig eine Beurteilung der kardiopulmonalen Belastung von Patienten bei differenten Therapiemaßnahmen möglich. Die Ergebnisse können als Handlungsanleitung für die Belastungsgestaltung im Rahmen der postoperativen Rehabilitation von Schulterpatienten betrachtet werden.