Introdução: O ombro possui a maior amplitude de movimento entre as articulações do corpo humano e essa característica contribui para que seja a articulação mais frequentemente luxada. Os ligamentos glenoumerais participam da estabilização passiva do ombro. A banda anterior do ligamento glenoumeral inferior (BA-LGUI) impede a translação anterior e inferior do úmero na glenoide durante a abdução em 90° e rotação externa. A BA-LGUI fixa-se à glenoide através de dois mecanismos: diretamente ao lábio da glenoide e ao longo do colo, incorporando-se ao periósteo. Foram descritas duas variações distintas de origem. O tipo I com origem principalmente do lábio e o tipo II com origem predominante na borda e colo da glenoide. Objetivo: Avaliar variações anatômicas da origem da banda anterior do ligamento glenoumeral inferior na glenoide. Materiais e métodos: Avaliação retrospectiva de 93 exames consecutivos de artrorressonância magnética de ombro. Foram realizadas duas leituras independentes e às cegas por dois radiologistas para calcular a concordância interobservador. Um consenso dos dois radiologistas foi utilizado para a parte descritiva deste estudo. O padrão de fixação labioperiosteal da BA-LGUI, distinguindo entre dois tipos, origem labral ou periosteal, e sua posição na borda anterior da glenoide foram registrados. Também foram registradas as alterações da fibrocartilagem do lábio anterior da glenoide, incluindo degeneração e avulsão. Resultados: Em 50 exames (54%), a BA-LGUI originou-se principalmente do lábio (tipo I) e em 43 exames (46%) foi observada uma variação tipo II, mostrando sua origem diretamente do colo da glenoide. A BA-LGUI emergiu na posição de 4 horas em 58 casos (62%). Em 14 deles (15%), na posição de 3 horas e em 21 casos (23%), na posição de 5 horas. Avulsão do lábio anterior foi identificada em 55 pacientes (59%) e degeneração sem avulsão foi vista em 23 casos (25%). A concordância inter e intraobservador para a classificação das variações anatômicas da origem labioperiosteal do LGUI foi excelente. Conclusões. Embora seja mais comum a BA-LGUI se originar do lábio anteroinferior, encontramos uma alta prevalência da BA-LGUI principalmente no periósteo do colo da glenoide. A BA-LGUI originou-se entre as posições de 3 e 5 horas, mais frequentemente às 4 horas. / Introduction: The shoulder has the greatest range of motion between the joints of the human body and this feature contributes to be the most frequently dislocates joint. The glenohumeral ligaments take part in the shoulder passive stabilization. The anterior band of the inferior glenohumeral ligament (AB-IGHL) prevents the anterior and inferior translation of the humerus in the glenoid during abduction and external rotation at 90°. The AB-IGHL attaches to the glenoid through two mechanisms: directly to the glenoid labrum and along the neck, merging with the periosteum. Two different attachment variations have been described. A type I with its origin mostly from the labrum and a type II, emerging from the edge and the glenoid neck. Purpose: To evaluate the anatomic variations of the insertion of the anterior band of the inferior glenohumeral ligament to the glenoid. Materials and Methods: Retrospective review of 93 consecutives shoulder magnetic resonance arthrography exams. Two independent and blind readings were performed by two radiologists to measure interobserver agreement. A consensus by the two radiologists was used for the description of this study. The AB-IGHL labral-periosteal attachment pattern, distinguishing between two types, labral or periosteal attachment, and its position on the anterior rim of the glenoid were recorded. Abnormalities of the anterior labrum fibrocartilage of the glenoid were recorded, including degeneration and avulsion. Results: On 50 exams (54%) the AB-IGHL originated mostly from the labrum (type I) and on 43 exams (46%) a type II variation was observed, meaning that its origin attached directly to the glenoid neck. The AB-IGHL emerged at the 4 oclock position on 58 cases (62%). Fourteen of them (15%) from the 3 oclock position and on 21 cases (23%) from the 5 oclock position. Anterior labrum avulsion was identified on 55 patients (59%) and degeneration without avulsion was seen in 23 cases (25%). The inter- and intraobserver agreement for the classification of the anatomic variations of labral periosteal attachment of IGHL was excellent. Conclusions: Although the AB-IGHL originating from the anteroinferior labrum is more frequent, we found a high prevalence of the AB-IGHL emerging from the periosteum of the glenoid neck. The AB-IGHL originated between 3 and 5o clock position, more frequently at 4 oclock.

Introdução: O objetivo desse estudo foi investigar o efeito da instrução para ativação consciente da musculatura abdominal sobre a atividade dos músculos escapulotorácicos durante exercícios de ombro. Métodos: Foram avaliados sessenta e cinco indivíduos assintomáticos do sexo feminino e masculino (média de idade de 23,5 ± 3 anos). Cinco exercícios enfocados no músculo serrátil anterior foram avaliados antes e depois do comando verbal e do estímulo táctil para ativação da musculatura abdominal. Foi utilizado o teste ANOVA para medidas repetitivas com teste Bonferroni post-hoc para comparar os valores eletromiográficos normalizados. Tamanhos de efeito com magnitudes moderadas e grandes foram considerados indicadores de significância em termos práticos. Resultados: Ativação consciente dos músculos abdominais resultou em um incremento significativo (p<,05) na atividade eletromiográfica dos músculos serrátil anterior e trapézio em suas fibras descendente, transversa e ascendente durante os exercícios dinâmicos (Wall Slide, Wall Press e Knee Push). A instrução aumentou a atividade eletromiográfica somente do músculo serrátil anterior durante os exercícios isométricos (Inferior Glide e Isometric Low Row). Conclusão: Ativação consciente dos músculos abdominais incentivada por comando verbal e estímulo tátil foi efetiva para incrementar a ativação dos músculos escapulotorácicos durante exercícios de ombro, principalmente para o músculo serrátil anterior com um tamanho de efeito de moderado a grande. / Introduction: The purpose of this study was to investigate the effect of the instruction for conscious contraction of the abdominal muscles on the scapulothoracic muscles activation during shoulder exercises. Methods: Sixty healthy male and female subjects (mean age 23.5 ± 3 years) volunteered for this study. Five exercises focusing on the serratus anterior muscle were assessed before and after standardized verbal, and tactile feedback applied to encourage abdominal muscle contraction. Repeated measures ANOVA and Bonferroni post-hoc test were used to compare normalized EMG amplitudes. Moderate and large magnitudes of effect size were considered indicators of the practical significance of our findings. Results: Conscious contraction of the abdominal muscles resulted in significant increase (p<.05) in serratus anterior, upper, middle and lower trapezius EMG amplitude, during dynamic exercises (Wall Slide, Wall Press, and Knee Push). Instruction increased EMG amplitude only for serratus anterior muscle during isometric exercises (Inferior Glide and Isometric Low Row). Conclusion: Conscious activation of the abdominal muscles, encouraged by verbal and tactile feedback was effective to increase the activation of periscapular muscles during shoulder exercises, in particular, the serratus anterior with large and moderate magnitudes of effect size.

O Acidente Vascular Cerebral (AVC) é um quadro de alta incidência e uma das principais causas de incapacidade no mundo. Uma de suas complicações frequentes e de grande impacto na funcionalidade é a Síndrome do Ombro Doloroso Hemiplégico (SODH). O presente trabalho consiste em revisar a literatura a respeito da eficácia do tratamento da SODH com toxina botulínica tipo A (TXB-A). Foram pesquisados os bancos de dados eletrônicos PubMed e ISI web of Science, no período de 1996 a 2014. Incluímos os estudos tipo ensaio clínico duplo-cego, randomizado e aleatorizado que utilizaram a TXB-A como tratamento da SODH. Os artigos deveriam obter pontuação 3 ou superior pelos critérios de Jadad. Seis estudos foram encontrados e dois foram considerados de baixa qualidade. Os quatro artigos restantes possuíam 114 participantes no total. Três autores avaliaram os artigos de forma independente quanto aos critérios de inclusão. A extração de dados incluiu as características dos pacientes, dose e marca comercial da TXB-A utilizada, músculos e efeitos na avaliação da dor. Houve grande variação de dose, técnicas de aplicação e músculos tratados, bem como das intervenções após a aplicação. Três estudos demonstraram efeitos positivos do tratamento da dor e função do membro superior. A meta-análise não pode ser realizada, pois a informação quantitativa necessária foi indisponível. Os resultados da literatura são discordantes e apesar dos indícios serem favoráveis, não há resultados estatisticamente significantes para corroborar tal prática. Maior investigação e pesquisa são necessários para definir a indicação da TXB-A como tratamento da SODH. Mesmo assim, esta abordagem pode ser considerada particularmente quando a espasticidade é relevante. A intervenção pode ser realizada como uma alternativa ou ser utilizada em combinação com outros tratamentos. Para melhores resultados, mais de um músculo deve ser alvo, preferencialmente os músculos peitoral maior e subescapular. / The Stroke presents a high incidence and is a major cause of disability the in the world. One of it`s frequent complications and a cause of great loss of quality of life is the post-stroke shoulder pain (PSSP). The purpose of this study is to explore the effectiveness of botulinum neurotoxin type A (BoNT-A) in the treatment of PSSP. The electronic databases PubMed and ISI web of Science were searched from 1996 to 2014. We included double-blind randomized controlled trials that used BoNT-A for the treatment of PSSP in spastic hemiplegic patients. Articles should be scored 3 or more with the Jadad criteria. Six studies fulfilled the first search and two were considered low quality. The four remaining studies comprised 114 participants. Three authors independently evaluated articles eligible for inclusions. Data extracted included patient characteristics, doses and types of commercialized BoNT-A used, muscles injected, and effects on pain evaluation. There was a large variation in doses, injection techniques and treated muscles, as well as post-injection interventions. Three studies demonstrated positive effects of BoNT-A in the treatment of pain or upper limb functioning. Meta-analysis was not performed because of unavailable quantitative data. Literature results are discordant and despite evidence be favorable, there are no statistically significant results to support this practice. Further investigation and research is needed to define the indication of BoNT-A on PSSP. Nevertheless, this approach can be seen particularly when the spasticity is relevant. The intervention may be performed as an alternative or used in combination with other treatments. For best results, more than one muscle should be targeted, preferably the pectoralis major and subscapularis muscles.

A articulação do ombro é muito solicitada em indivíduos com lesão medular usuários de cadeira de rodas, seja no deslocamento diário, na propulsão da cadeira de rodas ou na prática paradesportiva. Diante dessa realidade, este estudo teve por objetivo avaliar e comparar o desempenho muscular através do pico de torque corrigido pela a massa corporal, o trabalho e a potência dos grupos musculares do manguito rotador, relacionados aos movimentos de rotação interna e externa dos ombros, em atletas de basquetebol em cadeira de rodas, com trauma raquimedular, comparando-os com indivíduos com trauma raquimedular, sedentários, utilizando como instrumento o dinamômetro isocinético da marca 4 BIODEX®. Foram avaliados 36 indivíduos com trauma raquimedular, com níveis de lesão completa abaixo de T1 e idades entre 18 e 45 anos. Sendo 18 indivíduos atletas de basquetebol em cadeira de rodas e 18 indivíduos cadeirantes sedentários. Os testes isocinéticos foram realizados na posição sentada, com o ombro em 45° de abdução no plano da escápula e 30° de flexão no plano frontal, com amplitude de movimento de 70°, sendo 40° em rotação externa e 30° para rotação interna. O protocolo foi realizado por meio do teste isocinético com cinco repetições para as velocidades de 60°/s e 180°/s, com propósito de avaliar o pico de torque/peso e o trabalho, e 10 repetições em 300°/s para avaliar a potência muscular, em ambos os ombros, com intervalo de 1 minuto, entre as repetições. As comparações entre as variáveis foram analisadas com o teste do quiquadrado ou teste exato de Fisher. Para a análise das diferenças entre as médias das variáveis contínuas, utilizou-se o teste t, com nível de significância de 5%. Como resultado, observou-se semelhança das variáveis antropométrica entre os grupos; o pico de torque/peso, o trabalho e a potência muscular dos rotadores internos e externos de ambos os ombros dos atletas de basquetebol em cadeira de rodas foram significativamente maiores quando comparados com o grupo controle, em todas as velocidades testadas (P <0,001); também foi encontrada uma correlação do ganho de força muscular com o tempo de lesão medular. Conclui-se que os atletas cadeirantes apresentaram maior desempenho muscular em relação aos cadeirantes que não praticavam nenhum tipo de esporte. / The shoulder joint is much, requested in individuals with spinal cord injury wheelchair users, at offset journal, in wheelchair propulsion, as well as in practice to-sports. Facing this reality, the present research aimed to evaluate and compare the performance through muscle peak torque fixed by body mass, the work and the power of the rotator cuff muscle groups, related to the movements of internal and external rotation of the shoulder, in basketball, wheelchair athletes with spinal cord injury, comparing them to individuals with spinal cord injury, sedentary using as an instrument the isokinetic dynamometer 4 BIODEX® brand. 36 individuals were evaluated with spinal cord injury, with complete injury levels below T1 and between the ages of 18 to 45 years. Being 18 individuals athletes of wheelchair basketball and wheelchair accessible, sedentary individuals 18. The isokinetic tests were performed in a sitting position, with the shoulder in 45° of abduction in scapula and 30° of flexion in the frontal plane, with range of motion of 70°, and 40° in external rotation and 30° for internal rotation. The Protocol was carried out through the isokinetic test with 5 reps for 60°/s speeds and 180°/s with purpose to assess the peak torque/weight and work, and 10 repetitions at 300°/s to assess muscle power, in both shoulders, with 1 minute interval between repetitions. The comparisons between the variables were assessed the Chi-square test or Fisher\'s exact test. For the analysis of the differences between the media of the variables keep, used the t test, with a significance level of 5%. As a result, it was observed there similarity between the groups Anthropometric, that the peak torque/weight work and muscle power of internal and external rotators of both shoulders of the athletes of wheelchair basketball was significantly higher when compared with the control group, the tested velocities (P < 0.001) and correlation of muscle strength gain with time of spinal cord injury. It is concluded that the wheelchair athletes has increased muscle performance in relation to wheelchair users who do not practice any kind of sport.

O objetivo desta pesquisa foi avaliar e comparar a atividade eletromiográfica de sete músculos da cintura escapular e braço durante a realização dos exercícios wall-press, bench-press e push-up sobre uma superfície estável e com carga axial controlada em dois níveis de esforço isométrico, um máximo (100%) e outro submáximo (80%). Os exercícios foram realizados com o braço em 90° de flexão no plano sagital, 0° de extensão do cotovelo e 90° de flexão da mão. Vinte voluntários do sexo masculino, saudáveis, destros e sem história de trauma no membro superior participaram da pesquisa. Os registros eletromiográficos e de força foram adquiridos, respectivamente, por sete canais para eletromiograma e por um canal auxiliar de um sistema de aquisição simultânea, ganho total de 50 vezes, 12 bits de faixa de resolução dinâmica e freqüência de amostragem por canal de 4 KHZ. Os sinais mioelétricos foram captados por eletrodos ativos simples diferencial, ganho de 20 vezes, impedância de entrada de 10G? e CMRR mínimo de 130 dB, colocados nos músculos serrátil anterior, porção anterior e posterior do músculo deltóide, porção clavicular do peitoral maior, fibras superiores do trapézio, cabeça longa do bíceps e tríceps braquial. Os exercícios foram realizados aleatoriamente, nos dois níveis de esforço isométrico, com intervalados entre si por 5 minutos. Os voluntários realizaram três repetições de cada exercício, com duração de 6 segundos cada, intervaladas entre si por 1,5 minutos e manutenção da força dentro dos valores previamente definidos, orientadas por um feedback sonoro. Os sinais brutos foram filtrados por um passa faixa de 20-500Hz, derivando os valores de amplitude eletromiográfica pelo cálculo da Root Mean Square (RMS). Os valores de RMS foram normalizados pelo valor máximo obtido de três contrações isométricas voluntárias máximas obtidas em prova de função muscular. A comparação dos valores normalizados entre os três exercícios nos dois níveis de esforço isométrico e entre o mesmo exercício nos dois níveis de esforço isométrico foi realizada através do Modelo Linear de Efeitos Mistos, com nível de significância de 5%. Os valores normalizados de RMS dos músculos estudados, em valores percentuais, foram usados para graduar o nível de atividade elétrica obtido em cada exercício. Os resultados demonstraram que houve uma diferença nos valores de RMS normalizados dos músculos avaliados nas comparações feitas entre os três exercícios, não confirmando a hipótese inicial deste trabalho, pois os dois níveis de esforços isométricos não foram capazes de influenciar a resposta eletromiográfica. Diferenças entre amplitudes de ativação normalizadas foram constatadas, variando entre os níveis mínimo e alto. O bench-press gerou maiores níveis de atividade eletromiográfica para a maioria dos músculos, possivelmente pelo maior esforço isométrico realizado. O wall-press gerou maior atividade eletromiográfica para a maioria dos músculos quando comparado ao push-up, apesar do esforço isométrico gerado ser menor. Este trabalho concluiu que, apesar de exercícios com carga axial, mesmo com esforço isométrico controlado, causaram diferentes níveis de atividade eletromiográfica nos músculos avaliados. / The purpose of this research was to investigate if biomechanically similar exercises produce similar myoelectric activation when the same level of maximal isometric effort is produced. Twenty volunteers participated in the study. All volunteers were right-handed, healthy men with no history of previous upper limb trauma. Electromyographic (EMG) recordings were obtained using a seven-channel simultaneous acquisition system, with gain of 50, 12 bit A/D converter board with a 4 KHz frequency. To monitor produced force, a load cell was attached through an auxiliary channel and force recording was accomplished simultaneously with the acquisition of EMG signal. Myoelectric signals were obtained using simple differential electrodes, with gain of 20, input impedance of 10 G? and minimum CMRR of 130 dB, placed on the serratus anterior, posterior and anterior deltoid, clavicular portion of the pectoralis major, upper trapezius, and biceps and triceps brachii muscles, following the European Recommendations for Surface Electromyography by SENIAM project, and instructions by Hintermeinster et al. (1998). EMG signals were recorded while performing push-up, bench-press, and wall-press exercises at different force levels (100% and 80% maximum isometric effort) with the dominant upper limb supported on a stable surface. Exercises were randomly performed with five-minute intervals between each exercise. Volunteers performed three repetitions of each exercise, each lasting six seconds, with 1.5-minute intervals, and maintaining the force within previously determined values, guided by audio feedback. Raw EMG signals were filtered by a 20-500 Hz pass-band in order to derivate EMG amplitude values by intervals calculating the Root Mean Square (RMS). RMS values were normalized by the maximum value obtained in three maximal voluntary isometric contractions during muscle testing. Normalized values were compared between the three exercises at both torque levels and between the same exercise at both isometric effort levels through the mixed-effects linear model, with a 5% level of significance. Normalized RMS values of the studied muscles (%) were used to rank the level of electric activity obtained during each exercise. Results indicate that maximal isometric effort levels had no influence on results from the comparison of EMG activity in any of the proposed exercises. Differences between normalized activation amplitudes were observed. However, the values reached levels between minimal and high, that is, under 60% of the activity generated during maximal voluntary isometric contraction. This study concludes that biomechanically comparable exercises did not necessarily produce similar EMG activity, in spite of controlling isometric effort. Moreover, exercises were capable of generating different EMG activity levels in the evaluated muscles. Therefore, such exercises are indicated for different rehabilitation program phases.

L'analyse morpho-fonctionnelle précise de l'épaule, notamment au niveau de l'articulation glénohumérale (GH), permettrait d'améliorer notre compréhension des dysfonctions de l'épaule associées aux ruptures de la coiffe des rotateurs. Cependant, des difficultés techniques compliquent l'analyse de la morphologie et du mouvement de l'épaule dans un contexte clinique. Dans le cadre de la présente thèse, une méthode d'analyse 3D des translations GH basée sur l'acquisition de séquences de radiographies biplanes sous EOS™ a été développée. Une étude pilote sur 10 sujets sains a d'abord permis de vérifier la facilité d'application d'un protocole d'acquisition des images et d'évaluer la répétabilité de l'identification des repères anatomiques de l'épaule sur les radiographies. La méthode proposée en dernier lieu permet, suite à l'acquisition de radiographies, de reconstruire un modèle personnalisé morpho-réaliste de la scapula et un modèle simplifié de l'humérus. Ces modèles sont ensuite recalés interactivement sur les images acquises à différentes positions du bras et utilisés pour décrire les translations GH à ces positions. La méthode a été validée en termes de précision et de répétabilité sur des images acquises d'épaules cadavériques et de patients ayant des ruptures de la coiffe des rotateurs. La dernière partie du travail présenté ici consiste à appliquer la méthode développée à 30 sujets (25 patients et 5 sujets sains) pour lesquels l'état de la coiffe des rotateurs et la fonction de l'épaule ont été évalués, puis à étudier les corrélations entre les translations GH et la fonction de l'épaule. / Precise morpho-functional analysis of the shoulder, including of the glenohumeral (GH) joint, would allow improving our understanding of shoulder dysfunction associated to rotator cuff tears. However, technical difficulties make analysis of shoulder morphology and motion difficult in a clinical setting. The work carried out during this thesis allowed developing a method for 3D analysis of GH translations relying on the acquisition of sequences of biplanar radiographs with the EOS™ system. A pilot study carried out on 10 healthy subjects allowed verifying the ease of application of an image acquisition protocol and evaluating the repeatability of shoulder landmark identification on the radiographs. The final proposed method allows, following the acquisition of radiographs, obtaining a personalized morphologically realistic reconstruction of the scapula and a simplified model of the humerus. These models are then interactively registered to the images acquired at different arm positions and used to describe GH translations for these positions. The proposed method was validated in terms of precision and repeatability on images acquired of cadaveric shoulders and of patients with rotator cuff tears. The last part of the work presented here consists in applying the developed method to 30 subjects (25 patients and 5 asymptomatic subjects) for whom rotator cuff condition and shoulder function were assessed, and to study correlations between GH translations and shoulder function.

Abstract The etiology of musculoskeletal disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain (NP), shoulder pain (SP), and low back pain (LBP) increases drastically during adolescence. Potentially modifiable risk factors of NP, SP, and LBP should be identified at that age. First, this study evaluated the prevalence of NP, SP, LBP and peripheral pains (upper or lower extremities) and the prevalence of multiple pains. Second, the study determined the role of a set of potentially modifiable risk factors for adolescents’ NP, SP, and LBP (physical activity, inactivity, sedentary activities in cross-sectional study design and quantity and quality of sleep in follow-up study design). The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting of 9,479 children with an expected date of birth between July 1, 1985 and June 30, 1986 in the two northernmost provinces of Finland, Oulu and Lapland. NP, SP, and LBP were common at the ages 16 and 18, while medical consultations for these pains were less frequent. The prevalence of pain increased with age. Peripheral pains were rare. Surprisingly many adolescents reported multiple musculoskeletal pains. Girls were more likely to report pain than boys. Both low and high level of physical activity, some risk sport activities, high amount of sedentary activities, and insufficient quantity and quality of sleep increased the risk of NP, SP, and LBP in adolescence. It may be possible to reduce the occurrence of musculoskeletal pain by having a positive impact on potentially modifiable risk factors, such as physical activity, sedentary activities and sleep hygiene. Therefore, intervention studies focusing on these factors are needed in the future. / Tiivistelmä Useimmiten tuki- ja liikuntaelinsairauksien tarkka syy jää epäselväksi ja kipu on niiden pääasiallinen ilmentymä. Niska-, hartia- ja alaselkäkipujen esiintyvyys väestössä nousee merkittävästi teini-iässä. Tämän vuoksi niska-, hartia- ja alaselkäkivun riskitekijöitä tulisikin tutkia nuoruudessa, jotta niihin päästäisiin vaikuttamaan ajoissa. Tässä väitöskirjassa selvitettiin niska-, hartia-, alaselkä- ja laaja-alaisten tuki- ja liikuntaelinkipujen esiintyvyyttä nuorilla. Päätavoite oli kuitenkin tutkia liikunnan, eri urheilulajien, liikkumattomuuden, istumisen ja unen laadun ja määrän yhteyttä niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Tutkimusaineisto muodostui Pohjois-Suomen syntymäkohortin 1986 nuorista, joiden laskettu syntymäaika oli 1.7.1985–30.6.1986. Nuorille lähetettiin 16-vuotiaana postikysely, joka sisälsi tuki- ja liikuntaelinoirekyselyn, kysymyksiä liikunnan, istumisen ja unen määrästä ja laadusta, sekä muista elämäntavoista. Kahden vuoden kuluttua, 18-vuotiaana lähetettiin toinen kysely joka sisälsi mm. tuki- ja liikuntaelinoirekyselyn. Tulokset osoittavat että niska-, hartia- ja alaselkäkivut olivat yleisiä nuoruudessa, joskin hoitoa vaativat kivut ja raajojen kipuoireilu olivat harvinaisia. Laaja-alaiset tuki- ja liikuntaelinkivut olivat odotettua yleisempiä. Tytöt oireilivat enemmän kuin pojat ja oireilu lisääntyi iän myötä. Hyvin aktiivinen liikunnan harrastaminen (6h/vko tai enemmän ripeää liikuntaa) ja erityisesti tietyt riskilajit olivat yhteydessä suurempaan niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Samoin suuri istumisen määrä, riittämätön uni ja huono unen laatu lisäsivät kipujen todennäköisyyttä. Nuorten tuki- ja liikuntaelinkipuja voitaisiin mahdollisesti vähentää vaikuttamalla muunneltavissa oleviin riskitekijöihin, kuten vähentämällä istumista, lisäämällä terveysliikuntaa, sekä parantamalla unitottumuksia. Tämän takia jatkossa tarvitaan näihin riskitekijöihin kohdistuvia interventiotutkimuksia.

Syftet med studien är att försöka lösa passformsproblem på trikåmodeller till dam som har en förlängd axel. Studien skrivs i samarbete med ett stort svenskt klädföretag och undersöker ett problem som företaget själva har identifierat. Problemet gäller passformen på några av företagets trikåmodeller till dam som alla har en förlängd axel och en lösare passform. Passformsproblemen som trikåmodellerna upplevs ha uppstår vid just axeln, ärmhålet och överärmsvidden. Inom forskning och litteratur saknas det information kring passformsproblem och åtgärder vid konstruktion av trikåplagg med en förlängd axel. I dagsläget har inte företaget tid att själva testa och utveckla trikåmodellerna och studien har därför fokuserat på att försöka lösa problemet med passformen åt dem. För att uppnå syftet har en experimentell metod använts. Denna har utförts via digital mönsterkonstruktion, uppsömnad av provplagg och verifierats genom avprovningar på provpersoner och på provdocka. Resultatet av studien visar att en medel- till hög ärmkulle behövs till plagg med en förlängd axel för att uppnå en god passform på ärmen och kring ärmhålet. / The purpose of the study is to try to solve fit problems on women’s jersey models with a dropped shoulder. The study is written in collaboration with a large Swedish clothing company and investigates a problem that the company itself has identified. The problem concerns the fit of some of the company's jersey sweaters for ladies, each with a dropped shoulder and a looser fit. The fit problems that the jersey models are having occurred at the shoulder, the armhole and bicep. In research and literature there is no information about fitting problems and how to adjust the construction of jersey garments with a dropped shoulder. At present, the company does not have time to test and develop the jersey models, and the study has therefore focused on trying to solve the problem of the fit for them. To achieve the aim, an experimental method has been used. This has been done through CAD-based pattern construction, sewing test prototypes and verified by fittings on human fitting models and on a dummy. The result of the study shows that a medium to high sleeve crown is needed for clothes with an extended shoulder to achieve good fit on the sleeve and around the armhole.

Sports scientists and trainers generally agree that the multidimensional training in tennis should start during early childhood in order to ultimately reach a professional playing standard. Evidence suggests that motor skills, including power, strength, agility, speed and explosive power, as well as mental strength and a highly developed neuromuscular coordinating ability are strongly correlated with the level of tournament performance. Turner&Dent (1996) found that 27% of all tennis injuries in junior players occur in the shoulder region. The shoulder girdle is prone to injury because of its ability to maximally accelerate and decelerate the arm while the arm maintains it maintains precise control over the racquet at ball contact. The purpose of this study was to determine whether the occurrence of shoulder injuries could be minimized in tennis players by following a specific exercise programme, focusing on the shoulder girdle. A total of 42 tennis players participated in this study. They were all aged between 14 and 18 years. Both males and females were used for the purpose of this study. All the players were training at the SA Tennis Performance Centre and the International Tennis Federation at the University of Pretoria. They were all elite tennis players practising daily and scheduled for standard major tournaments throughout the year. Each subject completed a questionnaire of his or her tennis and medical history. The players were then divided into a control group and an experimental group. Both groups completed a series of physical scientific tests, consisting of posture analysis, body composition, flexibility, functional strength of the upper body; and isokinetic power and endurance of the shoulder muscles. These tests were executed every 3 months over a 9-month period and the results of each battery of tests were used to adjust and upgrade the new programmes. The experimental group did specific preventative shoulder exercises 5 times a week in addition to their usual gymnasium programme twice a week, while the control group followed a normal strengthening programme twice a week. A medical doctor immediately evaluated any muscle stresses or pains throughout the year. At the end of the year the data was compared to determine the difference in injury occurrence between the two groups. There was a significant difference (p<0.05) in the distribution of the lean body mass with the Lean body mass at T1 being lower than the Lean body mass at T3 in the control group. In the experimental group the fat percentage showed a significant decrease (p<0.05) from T1 to T3. The distribution of the muscle percentage at T1 was significantly different (p<0.05) from the distribution of the muscle percentage at T3 in the experimental group with the muscle percentage at T1 being lower than the muscle percentage at T3. There was a significant difference between the control and experimental group for 1RM bench press (p<0.05) with the 1RM bench press measurements at T3 being lower for the control group than for the experimental group. Also, the 1RM bench press at T1 was lower than the 1RM bench press at T3 in the experimental group. The experimental group showed a significant increase from T1 to T3, peaking at T3 with the 1RM bench press. Results of the tests done to determine isokinetic muscle strength showed that a statistical significant correlation (p<0.05) was found with regard to the strength of the internal rotators of the non-dominant shoulder at T3, with the experimental group having a higher measurement than the control group. The internal rotators and external rotators of both the dominant and non-dominant shoulders were lower at T1 than at T3 in the experimental group (p<0.05). The external rotators of the non-dominant shoulder at T1 were lower than the external rotators of the non-dominant shoulder at T3 in the control group. Results of the tests done to determine flexibility showed a statistically significant difference with the internal rotators and external rotators of the dominant as well as the non-dominant shoulders being lower at T1 than at T3 in the experimental group. Also, the external rotators of the non-dominant shoulder of the control group were lower at T1 than at T3. Results of the tests done to determine posture showed that in the control group, 54.5% of the players had scoliosis at T1 as opposed to 40.9% at T3. In the experimental group 55% had scoliosis at T1 compared to the 30% at T3. In the experimental group, 55% of the players’ shoulder heights were not level at T1, compared to 30% at T3. 63.6% of the control group’s non-dominant shoulders were higher than the dominant shoulder at T1, compared to the 40.9% of subjects at T3. Among the subjects in the experimental group, 50% had a higher non-dominant shoulder and 5% a higher dominant shoulder at T1, compared to 25% and 5% respectively in the control group, at T3. Results of the tests done to determine the occurrence of injuries, showed that the subjects with no injuries in the control group stayed stable from T1 (54.5%) to T2 (54.5%) whereafter it increased to 59.1% at T3. The experimental group stayed stable from T1 (55.0%) to T2 (55.0%) where after it increased to 85% at T3. In the control group the percentage grade 1 and 2 injuries was 13.6% at T1, increasing to 18.2% at T2, and decreasing to 13.6% at T3. In the experimental group 15% of the subjects had grade 1 injuries at T1. This percentage increased to 30% at T2 where after it decreased to 15% at T3 again. The percentage of subjects with grade 2 injuries in the experimental group remained stable at 10.0% from T1 to T2. None of the subjects had grade 2 injuries at T3. In the control group 9% had grade 3 injuries at T1, with none at T2 and T3. In the experimental group the percentage of subjects with grade 3 injuries remained stable at 5.0% from T1 to T2. None of the subjects had grade 3 injuries at T3. In the control group 4.5% of subjects had grade 4 injuries at T1. This stayed more or less stable at T2 (4.6%) and increased to 9.1% at T3. In the experimental group 10.0% had grade 4 injuries at T1. None of the subjects had grade 4 injuries at either T2 or T3. In the control group 4.5% had grade 5 injuries at T1, none had it at T2, and 4.5% had it at T3. In the experimental group none of the subjects had grade 5 injuries at T1, T2 or T3. In the control group none of the subjects had grade 6 injuries at T1 or T3. At T2, however, 4.6% had grade 6 injuries. In the experimental group 5.0% of the subjects had grade 6 injuries at T1 and none had this type of injury at T2 or T3. In conclusion, the results indicate that a specifically designed exercise programme can help to diminish the risk of shoulder injuries in tennis players. It can also improve bi-lateral muscle strength in opposing muscle groups which are used in tennis. / Thesis (DPhil)--University of Pretoria, 2007. / Biokinetics, Sport and Leisure Sciences / unrestricted

L’étude de la biomécanique de la locomotion en fauteuil roulant manuel (FRM) a pour objectif de limiter le risque d’apparitions de blessures du membre supérieur, en optimisant la facilité à se déplacer. De nombreuses études ont montré qu’un ajustement des réglages du FRM avait un impact sur la mobilité. Néanmoins, les modèles utilisés dans la littérature pour représenter les interactions « sujet-FRM » et « FRM-environnement » possédaient plusieurs limitations. Ainsi, l’objectif premier de la thèse était la mise en place d’un modèle musculo-squelettique du membre supérieur permettant de modéliser l’interaction entre le sujet et le FRM, en utilisant des méthodes expérimentales adaptées pour appliquer ce modèle. Le second objectif était de construire un modèle mécanique du FRM en mouvement permettant de calculer les forces de réaction entre le sol et les roues du FRM. Le dernier objectif était d’appliquer une procédure d’optimisation numérique des réglages du FRM incluant les modèles développés durant la thèse. Le modèle musculo-squelettique développé a permis d’analyser la biomécanique du membre supérieur lors de la locomotion en FRM chez les sujets recrutés lors des campagnes de mesures. L’optimisation des réglages du FRM a été mise en place à partir du modèle mécanique du FRM, permettant de confirmer l’influence de plusieurs réglages sur la mobilité en FRM. Enfin, des perspectives d’amélioration de la procédure d’optimisation des réglages ont été explorées, à partir d’algorithmes de génération prédictive du mouvement. / The study of manual wheelchair (MWC) locomotion biomechanics aims at lowering the risk of upper limbs injuries, by optimizing mobility. Several studies have showed that adjusting MWC settings had an impact on MWC mobility. However, the models used in the literature to depict the « user-MWC » and « MWC-floor » interactions had several limitations. Thus, the first aim of this thesis was to develop a musculoskeletal model of the upper limbs allowing to describe the « user-MWC » interaction, by using adapted experimental methods to apply this model. The second aim of the thesis was to implement a mechanical model of the MWC allowing to compute ground reaction forces during locomotion. The final aim of the thesis was to apply a numerical optimisation procedure, including the models developed during the thesis, to optimize MWC settings. The musculoskeletal model developed during the thesis allowed to analyze biomechanics of the upper limbs during MWC locomotion among subjects recruited during experimental sessions. The MWC settings optimization was implemented with the mechanical model developed during the thesis and confirmed the influence of various MWC settings on mobility. Eventually, improvement perspectives for the numerical optimization procedure of MWC settings were explored, based on predictive movement generation with optimal control algorithms.