INTRODUÇÃO: A doença renal crônica (DRC) favorece o desenvolvimento de inúmeras complicações entre elas a amiloidose. Nos ombros os depósitos de amilóide desencadeiam reações inflamatórias e dor intensa o que compromete a qualidade de vida dos pacientes acometidos. As propostas terapêuticas para o tratamento dessa complicação são escassas. OBJETIVO: O objetivo do presente estudo foi avaliar o efeito da estimulação elétrica nervosa transcutânea (do inglês, TENS) no tratamento da dor e capacidade funcional do ombro e dos fatores relacionados à qualidade de vida em pacientes com DRC. MÉTODOS: Trinta pacientes foram avaliados 5 vezes num período de 6 semanas. Na 1ª semana, o aparelho foi programado para não transmitir a corrente elétrica (placebo) e nas 5 semanas subseqüentes, utilizamos corrente de baixa frequência (10Hz, 150 µs, 2xdia, 40 minutos). A dor (escala visual analógica), a funcionalidade do ombro (Escore de Constant e Escala da UCLA) e os fatores relacionados à qualidade de vida (SF-36) foram avaliados. RESULTADOS: Nossos resultados mostram que o tratamento com a TENS reduziu significativamente a dor (p<0,05), melhorou a funcionalidade do ombro (tanto pelo Escore de Constant quanto Escala da UCLA; p<0,05) já na primeira semana e estes benefícios permaneceram até o final do tratamento (5 semanas) quando comparado com o período placebo. Os domínios capacidade funcional, dor, vitalidade e aspectos sociais apresentam uma melhora após 5 semanas de tratamento quando comparado com o período placebo (p<0,05). Foi verificado ainda que este efeito foi observado mesmo com a redução da quantidade de medicação analgésica. CONCLUSÃO: Nossos resultados mostram que a TENS de baixa frequência reduz a dor e melhora a funcionalidade do ombro e os fatores relacionados à qualidade de vida de pacientes com DRC. / INTRODUCTION: Chronic kidney disease (CKD) favors the development of numerous complications such as amyloidosis. In the shoulders, amyloid deposits promote inflammatory reactions and severe pain, which compromises the quality of life of patients with this disease. There are few therapeutic options for the treatment of this complication. OBJECTIVE: The objective of the present study was to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) in the treatment of pain and in shoulder functional capacity, as well as factors related to the quality of life in patients with CKD. METHODS: Thirty patients were evaluated 5 times over a period of 6 weeks. At week 1, the equipment was programmed to not transmit the electrical current (placebo) and in the 5 subsequent weeks we used low frequency current (10Hz, 150 µs, twice a day, 40 minutes). Pain (visual analog scale), shoulder functional capacity (Constant score and UCLA Shoulder Rating Scale) and factors related to the quality of life (SF-36) were evaluated. RESULTS: Our results show that the treatment with TENS significantly reduced pain (p<0.05), improved shoulder functional capacity (using both Constant score and UCLA Shoulder Rating Scale; p<0.05) at week 1 and these benefits remained until the end of the treatment (5 weeks) when compared with the placebo period. The domains of functional capacity, pain, vitality and social functioning present improvement after 5 weeks of treatment when compared with the placebo period (p<0.05). It was also found that this effect was observed even after the administration of analgesics was reduced. CONCLUSION: Our results show that low frequency TENS reduces pain and improves shoulder functional capacity and factors related to the quality of life of patients with CKD.

OBJETIVO: Comparar a força muscular dos rotadores internos e adutores do ombro (propulsores da natação) dos estilos com braçada simultânea (borboleta e peito) e estilos com braçada alternada (livre e costas). CASUÍSTICA E MÉTODOS: Foram avaliados 46 ombros de nadadores federados dos estilo livre e costas (nado alternado GNA) com idade de 21,8 ± 3,8 anos; peso de 71,2 ± 10,0 kg, altura de 177,6 ± 8,5 cm e IMC= 22,3 ± 1,3; 44 ombros de nadadores federados dos estilos peito e borboleta (nado simultâneo - GNS) com idade de 20,3 ± 4,5 anos; peso de 70,5 ± 9,3 kg, altura 167,2 ± 37,6 cm e IMC= 22,6 ± 1,9; 28 ombros de nadadores recreacionais (grupo recreacional GR) com idade de 24,5 ± 4,5 anos; peso de 70,8 ± 16 kg, altura de 173,4 ± 9,2 cm e IMC= 23,3 ± 3,9 e 42 ombros de indivíduos controle (Grupo - GC) com idade de 25,8 ± 3,5 anos; peso de 68,7 ± 11,2 kg, altura 171,9 ± 9,3 cm e IMC= 23,2 ± 2,6. Todos foram avaliados no dinamômetro isocinético Biodex Multi-joint System 3® (Shirley, NY, USA) nas velocidades de 60º/segundo e 300º/segundo. Foram avaliados os movimentos de adução e rotação interna. As variáveis estudadas foram pico de torque corrigido pelo peso corpóreo (PTPC), trabalho total (TT) e relação agonista/antagonista. RESULTADOS: Não houve diferença na musculatura adutora entre os grupos GNS e GNA nas variáveis PTPC (GNS = 114,4 Nm e GNA = 109,4 Nm) e TT (GNS = 642,9J e GNA = 641,5J). Não houve diferença na relação abdução/adução do ombro entre GNS (67,4%) e GNA (68,3%). Não houve diferença na musculatura rotadora interna entre os grupos GNS e GNA nas variáveis PTPC (GNS = 66,4Nm e GNA = 63,4Nm) e TT (GNS = 517,4J e GNA 526,7J). Não houve diferença na relação rotação externa e rotação interna o ombro entre GNS (65,7%) e GNA (61,5%). CONCLUSÃO: Não há diferença na força muscular dos músculos adutores e rotadores internos do ombro quando se compara nados com braçadas simultâneas e alternadas / OBJECTIVE: To compare the muscle strength of internal rotators and adductors of the shoulder (of the propellants swimming) of styles with simultaneous stroke (butterfly and breaststroke) and stroke with alternating colors (free and back). PATIENTS AND METHODS: We evaluated 46 shoulders of competitive swimmers of freestyle and back (alternating swimming - GNA) aged 21.8 ± 3.8 years, weight 71.2 ± 10.0 kg, height 177.6 ± 8.5 cm and BMI = 22.3 ± 1.3. 44 shoulders of competitive swimmers of styles breast and butterfly (swimming simultaneously - GNS) aged 20.3 ± 4.5 years, weight 70.5 ± 9.3 kg, height 167.2 ± 37.6 cm and BMI = 22.6 ± 1.9. Shoulders of 28 recreational swimmers (group recreational - GR) aged 24.5 ± 4.5 years, weight 70.8 ± 16 kg, height 173.4 ± 9.2 cm and BMI = 23.3 ± 3, 9:42 shoulders of individuals (control group - CG) aged 25.8 ± 3.5 years, weight 68.7 ± 11.2 kg, height 171.9 ± 9.3 cm and BMI = 23, 2 ± 2.6. All were assessed using an isokinetic dynamometer Biodex Multi-joint System 3 ® (Shirley, NY, USA) at 60 ° / second and 300 º / second. We evaluated the movements of adduction and internal rotation. The variables were peak torque corrected for body weight (PTPC), total work (TW) and agonist / antagonist. RESULTS: There was no difference in the adductor muscle between the groups in the variables and GNA GNS PTPC (Nm) (GNS = 114.4 and 109.4 = GNA) and TT (J) (GNS = 642.9 and 641.5 = GNA). There was no difference in the abduction / adduction (%) of the shoulder between GNS (GNS = GNA = 67.4 and 68.3). There was no difference in the internal rotator muscles between the groups in the variables and GNA GNS PTPC (Nm) (GNS and GNA = 66.4 = 63.4) and TT (J) (GNS = 517.4 and 526.7 GNA). There was no difference in the external rotation and internal rotation (%) of the shoulder between GNS (GNS = GNA = 65.7 and 61.5). CONCLUSION: No difference in muscle strength of adductor muscles and internal rotators of the shoulder when comparing births with simultaneous and alternate strokes

Universidade de São Paulo, Faculdade de Medicina; 2015. Introdução: Diante de uma rotura traumática do manguito rotador, não há evidência direta que comprove que os reparos realizados precocemente são mais eficazes que aqueles realizados tardiamente. Para abordar essa questão, ensaios biomecânicos e de morfometria óssea foram realizados após roturas extensas do manguito rotador realizadas precocemente (lesões agudas) e tardiamente (lesões crônicas), mediante a utilização de um modelo experimental em ratos. Método: 30 ratos adultos da raça Wistar foram aleatoriamente divididos em três grupos (I, II e III) e submetidos à secção completa dos tendões do supraespinal e infraespinal nos ombros esquerdos. Após oito semanas, nos animais dos grupos I e II, os tendões rotos pertencentes aos ombros esquerdos foram cirurgicamente reparados, e os tendões equivalentes nos ombros direitos foram seccionados e imediatamente reparados. Quatro semanas após os reparos (para os ratos do grupo II) ou oito semanas após os reparos (para os ratos do grupo I), os animais foram submetidos à eutanásia. Os ratos do grupo III foram submetidos à eutanásia oito semanas após a cirurgia de secção tendínea sem que houvesse ocorrido o reparo dos tendões rotos. Os ombros direitos dos animais do grupo III permaneceram intactos e serviram como controles. Após a eutanásia, todos os ratos tiveram seus ombros dissecados e os espécimes foram encaminhados para a realização de testes biomecânicos e de microtomografia computadorizada. Resultados: Para todos os parâmetros biomecânicos analisados, foram encontradas interações significantes referentes aos fatores tempo de cicatrização e reparo, considerando os reparos precoces e tardios. Com relação ao tendão supraespinal para o período de oito semanas de cicatrização, a força máxima até a falha foi significantemente maior nos reparos precoces em comparação aos reparos tardios (31,81 ± 3,86N vs 19,36 ± 6,14N; p < 0,001), bem como a rigidez (17,22 ± 4,35N/mm vs 10,85 ± 4,25N/mm; p=0,034), a tensão máxima até a falha (4,49 ± 2,02N/mm2 vs 1,97 ± 0,61N/mm2; p < 0,001) e o módulo de elasticidade (13,72 ± 5,29N/mm2 vs 6,47 ± 2,42 N/mm2; p=0,033). Com relação ao tendão infraespinal com oito semanas de cicatrização, a força máxima até a falha foi significantemente maior nos reparos precoces em comparação aos reparos tardios (21,26 ± 3,94N vs 12,74 ± 2,87N; p=0,005), assim como a rigidez (12,86 ± 2,65N/mm vs 7,21 ± 3,30N/mm; p=0,014). O grupo com reparo tardio com oito semanas de cicatrização obteve resultados nos testes biomecânicos semelhantes aqueles obtidos nos testes do grupo com lesão sem reparo com oito semanas de cicatrização. A avaliação microtomográfica não apresentou diferenças significantes na microarquitetura óssea entre os reparos realizados precocemente e tardiamente. Conclusões: Os resultados desse estudo demonstram que as roturas extensas do manguito rotador reparadas precocemente produzem um tecido cicatricial na junção ósteo-tendínea com melhores propriedades biomecânicas que as roturas reparadas tardiamente. Porém, ao analisar a morfometria óssea da porção proximal do úmero, verificou-se que os efeitos são equivalentes, tanto para os reparos realizados tardiamente quanto para os reparos realizados precocemente / Introduction: In the event of a traumatic rotator cuff tear, there is no direct evidence that supports early over late surgical repair. To address this knowledge gap, biomechanical and bone morphometry outcomes were assessed following early (acute) and late (chronic) massive rotator cuff tear repairs in an experimental rat model. Methods: 30 adult Wistar rats were randomly divided into three groups (I, II and III), then subjected to combined supraspinatus and infraspinatus tendon tears of the left shoulder. Eight weeks following the injury, animals from groups I and II had the tendons of the injured shoulder surgically repaired. In addition, these animals were subjected to the same injury on the contralateral shoulder, which was immediately repaired. The rats were euthanized four weeks (group II) or eight weeks (group I) following the repairs. Group III was euthanized eight weeks following the injury, without surgical repair of the left shoulder, and the intact right shoulders of this group were used as controls. Tissues from all groups were harvested and subjected to biomechanical testing and bone morphometry analysis. Results: In all biomechanical parameters analyzed, a significant interaction was observed between healing and repair timing. For the supraspinatus tendon with eight weeks healing time, biomechanical properties were significant increased in the early repair group compared to the late repair group, including maximum load to failure (31,81 ± 3,86N vs 19,36 ± 6,14N; p < 0,001), stiffness (17,22 ± 4,35N/mm vs 10,85 ± 4,25N/mm; p=0,034), maximum stress to failure (4,49 ± 2,02N/mm2 vs 1,97 ± 0,61N/mm2; p < 0,001) and modulus of elasticity (13,72 ± 5,29N/mm2 vs 6,47 ± 2,42 N/mm2; p=0,033). For the infraspinatus tendon with eight weeks healing time, biomechanical properties were also significantly increased in the early repair group, including maximum load to failure (21,26 ± 3,94N vs 12,74 ± 2,87N; p=0,005) and stiffness (12,86 ± 2,65N/mm vs 7,21 ± 3,30N/mm; p=0,014). There were no significant differences between the late repair with eight weeks of healing time and the group without surgical repair for supraspinatus and infraspinatus tendons. Concerning bone morphometry of the humeral head, no significant differences were observed when comparing early and late repair groups. Conclusions: The results from this study indicate that early surgical repair of a massive rotator cuff tear leads to increased biomechanical properties of the tissue after healing. However, proximal humerus bone morphometry was unaffected by surgical repair timing

Background: Microscopy at work involves a combination of external exposures that pose an increased risk for eye-neck/shoulder symptoms such as; visually demanding near work, eye-hand coordination, static work postures and repetitive work. Objectives: To explore the pattern of fluctuations in eye-neck/shoulder symptoms and the reproducibility of these fluctuations during separate workdays and workweeks, for individuals who regularly perform microscopic duties at work. Method: Data was collected at 8 different times for all participants (n=16); Monday morning and afternoon and Friday morning and afternoon, during 2 different weeks at work. Results: Musculoskeletal complaints in the neck/shoulders and symptoms of eye strain increased significantly (∆Musculoskeletal complaints; p&lt;0,01, ∆Symptoms of eye stain; p&lt;0,05)  during the workweek.  The highest levels of self-reported symptoms did not correlate with the self-reported time in microscopy during the workweek (p&gt;0.05).  The same tendency for the increments in symptoms was observed during both work weeks. Only for musculoskeletal complaints did the increments of symptoms correlated with one another (p&lt;0.05).  Conclusion: The results indicate that microscopy at work is a risk factor, primarily for increased musculoskeletal complaints in the neck/shoulders. More studies are needed to assess the relationship between microscopy at work and the onset and development of eye-neck/shoulder complaints. / Bakgrund: Mikroskopering som arbetsuppgift medför en kombination flera aspekter av extern exponering som innebär ökad risk för muskuloskeletala besvär och besvär från ögonen; synkrävande närarbete med krav på öga-hand koordination, låsta arbetsställningar som medför långvarigt lågintensivt muskelarbete i nacke och axel/skuldra, samt repetitiva arbetsmönster. Trots det har mycket få studier publicerats inom området sedan början av 1980-talet. Syfte: Att undersöka variationer av muskuloskeletala besvär i nacke-axel/skuldra och besvär från ögonen under arbetsdagen och arbetsveckan, samt att undersöka upprepbarheten av variationer under arbetsdagen och arbetsveckan för personer som mikroskoperar i arbetet. Metod: Studien genomfördes med en webbaserad enkät. Datainsamling skedde vid 8 tillfällen; måndag förmiddag och eftermiddag samt fredag förmiddag och eftermiddag, under två separata arbetsveckor. Studiedeltagarna kom från en elektronisk industri (n=11) och en laboratoriemedicinsk enhet (n=6). Studien hade ett bortfall (n=1). Resultat: Muskuloskeletala besvär i nacke-axel/skuldra och värk/överansträngning i ögon ökade signifikant (∆Muskuloskeletala besvär; p&lt;0,01, ∆Värk/överansträngning i ögon p&lt;0,05) under arbetsveckan. De högsta nivåerna av besvär kunde inte relateras till deltagarnas skattade tid i mikroskopering under arbetsveckan. Samma trend av ökning i besvär kunde ses för både arbetsvecka 1 och 2. Enbart för muskuloskeletala besvär i nacke-axel/skuldra så korrelerade ökningar under arbetsvecka 1 signifikant med ökningar under arbetsvecka 2 (p&lt;0,05). Slutsats: Resultaten indikerar att mikroskoparbete är en riskfaktor, primärt för ökade muskuloskeletala besvär i nacke-axel/skuldra. Fler studier behövs inom området, bl.a. för att undersöka förekomst av kausalitet mellan mikroskopering som arbetsuppgift och utvecklandet av muskuloskeletala besvär i nacke-axel/skuldra samt besvär i ögon.

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.

Title: Corrected arm hang as a compensatory element in physioterapy Objective: The main objective of this master thesis is to measure and compare the level of engagement of muscles stabilizing the scapula during arm hang and supported exercise. Methods: Our study included nine probands whose measurement results were evaluated quantitatively. The age of probands at the time of measurement was from 18 to 25 years. A condition for inclusion in the investigated group was absence of subjective symptoms, functional impairment, traumatic injury, orthopedic defects or diseases of the upper limb. All probands were active athletes. Biomonitor ME 6000 manufacturer Mega Electronics Ltd. was used for recording the electrical activity of the muscles. The obtained data were processed by the Megawin software. All measurements for the purposes of the study took place in the laboratory of biomechanics FTVS UK. The resulting data were compared intraindividual and interindividual. Results: The results demonstrated that middle and lower portions of m. Trapezius is more active in the corrected arm hang. In contrast, the supported exercise leads to greater activity of m. Serratus anterior and lower activity of upper portion of m. Trapezius. Keywords: arm hang, supported exercise, surface electromyography, stabilization...

Introduction: Shoulder pain cases represents about 7% to 50% in the population and its prevalence in athletes between 15 and 19 years old is about 43.5%. Additionally, another pathology in the upper limb is scapular dyskinesia, caused by the scapular´s movements and position alteration. Objective: To determine association between scapula-vertebral distance and shoulder pain in athletes from a private university in Lima. Materials and Methods: Cross-sectional analytical study - preliminary. The study population were athletes from a private university in Lima. The shoulder pain variables were measured by four orthopedic tests Jobe, Patte, Gerber, and Hawkins Kennedy, where shoulder pain (YES) is considered when at least one of the tests is positive and no shoulder pain (NO) when all tests are negative. And the scapular-vertebral distance variables were evaluated in three positions, by the lateral scapular sliding test (LSST); measured in (cm). Results: 51 athletes from climbing, rugby, volleyball, and basketball sports were evaluated in this study. The age ranged was 19 to 21 years. The scapula-vertebral distance of the right side was mayor than the left. 17.65% had shoulder pain. The frequency of training and sex associated with shoulder pain (p<0.05). The scapula-vertebral distance from athletes who had shoulder pain was higher than those without it (p<0.05). Conclusion: Was found association between scapula-vertebral and shoulder pain in athletes from a private university in Lima. Its recommended doing more researches with a considerable sample to reach an adequate statistical power. / Introducción: El dolor de hombro representa casos de 7% al 50% en la población, su prevalencia en deportistas entre 15 y 19 años es de 43,5%. Adicionalmente, otra patología en la extremidad superior es la disquinesia escapular, generada por la alteración de la posición y el movimiento de la escápula. Objetivo: Determinar si existe asociación entre la distancia escápulo-vertebral y el dolor de hombro en deportistas de una universidad privada de Lima. Materiales y métodos: Estudio transversal analítico - preliminar. La población fueron deportistas de una universidad privada de Lima. Las variables fueron, dolor de hombro medido por cuatro test ortopédicos Jobe, Patte, Gerber y Hawkins Kennedy, donde se considera dolor de hombro (SI) cuando al menos de unos de los test da positivo y no dolor de hombro (NO) cuando todos los tests dan negativo, respecto a la variable distancia escápulo-vertebral evaluada en tres posiciones, por la prueba de deslizamiento escapular lateral (LSST) medido en (cm). Resultado: Se evaluaron 51 deportistas de escalada, rugby, vóley y básquetbol. La edad tuvo un rango de 19 a 21 años. La distancia escápulo-vertebral del lado derecho fue mayor que el izquierdo. El 17.65% de la población si tuvo dolor de hombro. La frecuencia de entrenamiento y el sexo estuvieron asociados con el dolor de hombro (p<0.05). La distancia escápulo-vertebral de los que tenían dolor de hombro era mayor que en los que no tenían dolor (p<0.05). Conclusiones: Si se encontró asociación entre la distancia escápulo vertebral y el dolor de hombro en los deportistas de una universidad privada de Lima. Se recomienda realizar estudios con mayor tamaño de muestra para alcanzar un adecuado poder estadístico. / Tesis

Ma thèse vise à contribuer au développement et l’amélioration de la cinématique de la partie supérieure du robot HYDROïD pour des tâches bi-manuelles, tout en basant sur une étude biomécanique de cette partie chez l’être humain.Pour atteindre notre objectif majeur, ce travail adopte dans un premier temps une nouvelle structure hybride de 4 degrés de liberté (ddl) pour le torse du robot, distribués en 3 ddl au niveau lombaire et un ddl au niveau thoracique. Cette structure était identifiée après une analyse de l’espace de travail d’un modèle multi-corps simulant la colonne vertébrale d’un être humain, et une étude d’optimisation de ce modèle permettant la synthèse de la structure envisagée.Dans un second temps, une amélioration de la cinématique du bras du robot a été mise en place, en introduisant la notion de l’épaule complexe au présente structure. Le choix de ce nouveau degré de liberté était le fruit d’une approche systématique pour augmenter l’anthropomorphisme géométrie du bras souhaité vers un bras humain de la même taille.Les 2 structures proposées ont passé par la suite par la phase de conception mécanique tout en respectant les contraintes géométriques et en se basant sur l’énergie hydraulique comme étant l’énergie d’ actionnement de ces systèmes. Enfin, le Modèle Géometrique Inverse (MGI) pour la solution générique du torse a été établi et son adaptation à notre cas particulier a été identifiée. Une solution optimisée pour ce mécanisme basée sur 2 différents critères a ensuite été donnée. / My thesis aims at contributing to the development and improvement of the upper body of HYDROïD robot for bi-manual tasks, while basing on a bio-mechanical study of this part of the human being. To reach our major goal, this work adopts, at first, a novel hybrid structure of 4 degrees of freedom (DOF) for the trunk of the robot, distributed in three DOF at the lumbar level and one DOF at the thoracic level. This structure was identified after an analysis of the work-space of a multi-body model feigning the vertebral column of a human being, and an optimization study of that model allowing the synthesis of the envisaged structure. Secondly, an improvement of the kinematics of the robor arm was organized, by introducing the notion of the shoulder complex in the present structure. The choice of this new degree of freedom was the fruit of a systematic approach to increase the anthropomorphism geometry of the arm wished towards a humanitarian arm of the same size.The two proposed structures crossed afterward by the mechanical design phase while respecting all the geometrical constraints and by using the hydraulic energy as being the type of actuation of these systems. Finally, the Inverse Geometrical Model (IGM) for the generic solution of the trunk was established and its adaptation to our particular case was identified. An optimized solution for this mechanism based on 2 various criteria was then given.

Context: Medical management for head and neck cancer (HNC) often includes neck dissection surgery, a side effect of which is shoulder dysfunction. There is no consensus for which patient-reported outcome measure (PRO) is most appropriate to quantify shoulder dysfunction in this population. Objective: The aims of this research study were to: (1) use Rasch methodologies to assess construct validity and overall appropriateness of test score interpretation of Disability of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI) and Neck Dissection Impairment Index (NDII) in the HNC population; (2) determine appropriateness of use of University of Washington Quality of Life (UW-QoL) shoulder subscale as a screening tool for shoulder impairment; (3) recommend a new PRO, or combination of PROs, that more accurately portrays the construct of shoulder dysfunction in the HNC population. Design: One hundred and eight-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months completed the PROs. Rasch methodologies were utilized to address the primary aim of the study through consideration of scale dimensionality [principal components analysis, item and person fit, differential item functioning (DIF)], scale hierarchy (gaps/redundancies, floor/ceiling effects, coverage of ability levels), response scale structure, and reliability (person and item reliability and separation statistics). The secondary aim was addressed through correlational analysis of the UW-QoL (shoulder subscale), DASH, QuickDASH, SPADI and NDII. Results: The DASH did not meet criteria for unidimensionality, and was deemed inappropriate for utilization in this sample. The QuickDASH, SPADI and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, DIF, coverage of ability levels, gaps/redundancies, and optimal rating scale requirements. The NDII meets most requirements. All measures were found to meet thresholds for person and item separation and reliability statistics. The third aim of this study was not addressed because the NDII was determined to be appropriate for this population. Conclusions: Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation. The DASH and the UW-QoL (shoulder subscale) are not recommended.

Die vorliegende Studie befasste sich mit zwei Fragestellungen. Im ersten Teil wurde die Projektionsabhängigkeit von radiologischen Landmarken im konventionellen Röntgenbild der Schulter und damit deren klinische Anwendbarkeit untersucht. Im zweiten Teil wurde das Auftreten von sog. röntgenhellen Linien (RLL) bei Glenoidersatz im konventionellen Röntgen und im CT untersucht. Beide Fragestelllungen sind in der Beurteilung von Landmarken von Glenoidkomponenten in der Endoprothetik der Schulter von Bedeutung. Zur Beantwortung der ersten Frage wurden 6 mit Markierungen versehene humane Scapula-Leichenpräparate in 25 Projektionen geröntgt und der Einfluss der Projektionen auf gängige Landmarken gemessen. Die Landmarken wurden an der Margo lateralis, Margo medialis, knöchernen Glenoid, Coracoidbasis, Fossa supraspinata und oberen Linie der Spina scapulae festgelegt. Zur Beantwortung der zweiten Frage wurden 10 humane Glenoid-Leichenpräparate mit einzementierter Glenoidkomponente im konventionellen Röntgen und im CT untersucht. Alle gewonnenen radiologischen Bilder wurden von zwei Untersuchern vermessen und die Interobserverreliabilität errechnet. Die Ergebnisse des ersten Teiles sowohl der Messwerte der Landmarken als auch der Interobserverreliabilität zeigten, dass die Margo medialis des Schulterblattes die zuverlässigsten Ergebnisse bei der Robustheit gegen Verkippung zur Beurteilung des Kunststoff Glenoids aufwiesen. Im klinischen Alltag ist diese Landmarke jedoch auf vielen Röntgenbildern der Schulter nicht mit abgebildet. Es zeigte sich, dass die am wenigsten projektionsabhängige Landmarke, die regelmässig auf Schulteraufnahmen abgebildet ist, die Margo lateralis scapulae ist. Als Ergebnis des zweiten Teiles zeigte sich, dass im konventionellen Röntgen sichtbare RLL im CT nicht alle zur Darstellung kamen und somit als Artefakte zu werten waren. Aufgrund der klinisch schwierig durchzuführenden Röntgentechnik kann nicht immer eine exakte AP Aufnahme im konventionellen Röntgen gewonnen werden, wodurch auch projektionsbedingt Doppellinien erscheinen können. Diese wurden vermutlich durch die konvexe Form des PE Glenoids und Zementfehlern verursacht. Zur Beurteilung einer Lockerung sollte also eine Computertomografie angefertigt werden. Weiterhin zeigte sich aber auch im CT, dass frisch implantierte Glenoidkomponenten trotz optimaler Bedingungen RLL aufweisen. Dies zeigte deutlich, dass die Zementiertechnik auch in ihrer modernen Form noch nicht voll ausgereift war und deshalb weiterhin nach Verbesserungsmöglichkeiten gesucht werden sollte. / The aim of this study was to evaluate the reliability of different bony landmarks on radiographs after implantation of a total shoulder arthroplasty when the scapula is tilted compared with the ideal ap view. To assess loosening of the glenoid component, serial evaluation of ap radiographs of the scapula has been established as the 'gold standard. This study also verified the incidence of radiolucent lines (RLL) in radiographs and on CTscans to show different measurements of localization and appearance of the RLL. For the first aim of this study glenoid components were implanted into 6 human cadaveric scapulae. Radiographs were taken exactly anterior-posterior in the frontal plane, as well as craniocaudal tilted (±15° and ±30°) and mediolateral tilted (±10° and ±20°). The following landmarks were evaluated: lateral margin of the scapula, medial margin of the scapula, floor of the fossa supraspinatus line, spine of the scapula line, glenoid fossa line, and coracoid base line. In the second part of this study, 10 glenoid components were implanted into human cadaveric glenoids and a CT-scan as well as radiographs were made in an exact anteriorposterior view. The images were compared to evaluate the localization, incidence and form of the RLL. Every X-ray was measured by two different examiners to show the interobserver reliability. Regarding robustness against glenoid tilt, the medial margin of the scapula had the best intraobserver and interobserver reliability, whereas the lateral margin of the scapula had an acceptable intraobserver and interobserver reliability. In measuring medial migration, the glenoid fossa line had a significantly lower intraobserver and interobserver reliability than the coracoid base line. Because conventional radiographs were hardly done in exact ap direction despite the laboratory within, RLL were seen on X-ray although no RLL actually existed. The CT-scans highlighted the existence of artefacts, which looked like RLL on conventional radiography. The curved form of the glenoid component can cause double lines, which look like RLL on X-rays. However, the conventional radiography can still be used to detect an increase of RLL in postoperativ control X-rays. To be absolutely sure whether RLL do exist a CT-scan has to be done. This study shows that, even under best conditions for an implantation of glenoid components RLL can be viewed due to false cementation technique. The results underline that the cement implantation can still be improved to minimize the incidence of RLL.