The purpose of the study was to investigate the static and dynamic architecture of supraspinatus throughout its volume in the normal and pathological state. The architecture was first investigated in cadaveric specimens free of any tendon pathology. Using a serial dissection and digitization method tailored for supraspinatus, the musculotendinous architecture was modeled in situ. The 3D model reconstructed in Autodesk MayaTM allowed for visualization and quantification of the fiber bundle architecture i.e. fiber bundle length (FBL), pennation angle (PA), muscle volume (MV) and tendon dimensions. Based on attachment sites and architectural parameters, the supraspinatus was found to have two architecturally distinct regions, anterior and posterior, each with three subdivisions. The findings from the cadaveric investigation served as a map and platform for the development of an ultrasound (US) protocol that allowed for the dynamic fiber bundle architecture to be quantified in vivo in normal subjects and subjects with a full-thickness supraspinatus tendon tear. The architecture was studied in the relaxed state and in three contracted states (60º abduction with either neutral rotation, 80º external rotation, or 80º internal rotation). The dynamic changes in the architecture within the distinct regions of the muscle were not uniform and varied as a function of joint position. Mean FBL in the anterior region shortened significantly with contraction (p<0.05) but not in the posterior. In the anterior region, mean PA was significantly smaller in the middle part compared to the deep (p<0.05). Comparison of the normal and pathological muscle found large differences in the percentage change of FBL and PA with contraction. The architectural parameter that showed the largest changes with tendon pathology was PA. In sum, the results showed that the static and dynamic fiber bundle architecture of supraspinatus is heterogeneous throughout the muscle volume and may influence tendon stresses. The architectural data collected in this study and the 3D muscle model can be used to develop future contractile models. The US protocol may serve as an assessment tool to predict the functional outcome of rehabilitative exercises and surgery.

No description available.

To explore the potential mechanisms of tendon degeneration, we investigated the role of c-Jun N-terminal Kinase (JNK) activation and the regulation of matrix metalloproteinase 1 (MMP1) in tendon matrix degradation under oxidative stress. JNK and MMP1 activity in samples from normal and ruptured human supraspinatus tendons were evaluated by immunohistochemistry. Real-time quantitative PCR was utilized to evaluate MMP1 mRNA expression and western blotting for MMP1 and JNK protein detection. JNK activation and increased MMP1 activity were found in the torn human supraspinatus tendon tissue, as well as in human tendon cells under in vitro oxidative stress. Inhibition of JNK prevented MMP1 over-expression in oxidative stressed human tendon cells. Results from the current study indicated that stress activated JNK plays an important role in tendon matrix degradation, possibly through upregulating of MMP1.

Rotator cuff pathologies involving supraspinatus are a common cause of musculoskeletal morbidity and can lead to significant disability affecting the overall quality of life. Architectural parameters of the muscle directly influence its functional properties. Therefore, understanding of fiber bundle changes with surgery and different exercises can assist clinicians in planning better surgical and shoulder rehabilitative protocols. The first objective of this thesis was to systematically review human cadaveric studies of the normal supraspinatus architecture and highlight the key aspects that should be considered while performing studies of skeletal muscle architecture. The second objective was to understand the impact of surgical repair on the structural and functional recovery of the supraspinatus. The final objective was to provide a scientific rationale behind choosing an exercise to strengthen supraspinatus by investigating its muscle architecture. Study 1 systematically reviewed human cadaveric studies of the normal supraspinatus architecture. Results showed that the overall quality of majority of included is poor and there was a large range in the reported architectural values of the entire muscle. In conclusion, there were only a few studies providing the level of detail and quality suitable for advancing our understanding of shoulder biomechanics. Study 2 quantified and compared the fiber bundle architecture of the pathologic supraspinatus pre- and post-operatively at multiple time points. Results showed significant lengthening of fiber bundles after one month of surgery which then decreased significantly by 6 months of surgery. In contrast, an initial decrease followed by an increase in pennation angle overtime was found. The results suggest that the stretching applied to the tendon and muscle during repair could affect the length-tension relationship of the muscle, which in turn can compromise its function and may lead to inferior surgical outcomes. Study 3 compared the efficacy of three commonly prescribed supraspinatus strengthening exercises in the rehabilitation setting based on the architectural changes following resistance training. Results showed there was no change in FBL and increased strength after resistance training with prone horizontal abduction exercise. Findings suggest that prone horizontal abduction may be a more suitable exercise to strengthen supraspinatus.

Resumo: A tendinose calcificante do músculo supra-espinhoso é pouco conhecida em cães. Sua apresentação e relevância clínicas, bem como os padrões epidemiológicos, permanecem obscuros nesta espécie. Neste estudo, objetivou-se a descrição clínico-epidemiólogica da afecção e dos padrões radiográficos e ultrasonográficos das lesões. Para tal, foi realizado levantamento retrospectivo em 2164 cães submetidos à avaliação radiográfica dos ombros, atendidos na Clínica Cirúrgica de pequenos animais da Universidade de Giessen, Alemanha, no período compreendido entre janeiro de 1996 a julho de 2006. Alterações radiográficas compatíves com tendinose calcificante do supra-espinhoso foram observadas em 144 cães. Observouse, dentro da população estudada, que 93% dos cães era de raças de grande porte, especialmente Rottweilers, concentrados na faixa de 4 a 7,9 anos e machos. As lesões foram diagnosticadas unilateralmente em mais de 80% dos cães, sendo que 70% apresentavam sinais clínicos. A maioria destes cães (75%) era portadora de outra afecção ortopédica, destacando-se a fragmentação do processo coronóide medial da ulna, dificultando a confirmação da tendinose como causa da manifestação clínica. Adicionalmente, foram revisadas imagens radiográficas de 138 ombros acometidos pela afecção e ultra-sonográficas de 21 ombros, a fim de se detalhar os padrões de imagem existentes. As lesões observadas por meio de radiografia foram classificadas em cinco graus. Na maioria dos cães sintomáticos, não portadores de outra afecção ortopédica, as lesões foram classificadas como de graus 3 e 4 à radiografia e mostraram-se como áreas hiperecóicas com sombreamento acústico à ultra-sonografia. A avaliação ultrasonográfica permitiu acessar o parênquima tendíneo com detalhes e a presença de hipoecogenicidade circundante à área calcificada foi sugestiva de processo inflamatório. / Abstract: Supraspinatus calcifying tendinosis is a relatively unknown disorder in dogs. Its clinical presentation, relevance and epidemiological pattern remain unclear. In the present study, we aimed its clinical-epidemiological, radiological and sonographic description performing a retrospective study in dogs presented to the Small Animal Surgery Clinics of the Giessen University, Germany, between January 1996 and July 2006. In 2164 dogs which shoulders were submitted to radiographies, 144 presented lesions compatible to supraspinatus calcifying tendinosis. It was observed that 93% were large breed dogs, specially Rottweilers, male, aging between 4 and 7,9 years old. The calcifying lesions were unilateral in 80% of the cases; 70% of the dogs showed clinical symptoms however, a great amount (75%) of them presented also some other orthopedic abnormality, speccially ulnae fragmented coronoid process, which was considered the clinical signs cause. Additionally, 138 shoulder radiographies and 21 shoulder sonographies were reviewed and their findings described. A radiological classification system in five degrees was proposed, according to the lesion appearance. In the major part of the symptomatic dogs, not affected by other orthopedic abnormality, the lesions were radiologically classified in degree 3 and 4 and showed a dense distal shadowing by sonographic evaluation. Sonography also allowed tendon parenchyma evaluation, providing tissue details. The presence of hypoechoic area surrounding the calcific lesion was sugestive of infflamatory process. / Orientador: João Guilherme Padilha Filho / Coorientador: Martin Kramer / Banca: Júlio Carlos Canola / Banca: Paola Castro de Moraes / Banca: Naida Cristina Borges / Banca: Fernando de Biasi / Doutor

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-01Bitstream added on 2014-06-13T20:21:58Z : No. of bitstreams: 1 mestieri_mla_dr_jabo.pdf: 2694352 bytes, checksum: 4e6a0aa7574c83896fbcf276fbb312ff (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A tendinose calcificante do músculo supra-espinhoso é pouco conhecida em cães. Sua apresentação e relevância clínicas, bem como os padrões epidemiológicos, permanecem obscuros nesta espécie. Neste estudo, objetivou-se a descrição clínico-epidemiólogica da afecção e dos padrões radiográficos e ultrasonográficos das lesões. Para tal, foi realizado levantamento retrospectivo em 2164 cães submetidos à avaliação radiográfica dos ombros, atendidos na Clínica Cirúrgica de pequenos animais da Universidade de Giessen, Alemanha, no período compreendido entre janeiro de 1996 a julho de 2006. Alterações radiográficas compatíves com tendinose calcificante do supra-espinhoso foram observadas em 144 cães. Observouse, dentro da população estudada, que 93% dos cães era de raças de grande porte, especialmente Rottweilers, concentrados na faixa de 4 a 7,9 anos e machos. As lesões foram diagnosticadas unilateralmente em mais de 80% dos cães, sendo que 70% apresentavam sinais clínicos. A maioria destes cães (75%) era portadora de outra afecção ortopédica, destacando-se a fragmentação do processo coronóide medial da ulna, dificultando a confirmação da tendinose como causa da manifestação clínica. Adicionalmente, foram revisadas imagens radiográficas de 138 ombros acometidos pela afecção e ultra-sonográficas de 21 ombros, a fim de se detalhar os padrões de imagem existentes. As lesões observadas por meio de radiografia foram classificadas em cinco graus. Na maioria dos cães sintomáticos, não portadores de outra afecção ortopédica, as lesões foram classificadas como de graus 3 e 4 à radiografia e mostraram-se como áreas hiperecóicas com sombreamento acústico à ultra-sonografia. A avaliação ultrasonográfica permitiu acessar o parênquima tendíneo com detalhes e a presença de hipoecogenicidade circundante à área calcificada foi sugestiva de processo inflamatório. / Supraspinatus calcifying tendinosis is a relatively unknown disorder in dogs. Its clinical presentation, relevance and epidemiological pattern remain unclear. In the present study, we aimed its clinical-epidemiological, radiological and sonographic description performing a retrospective study in dogs presented to the Small Animal Surgery Clinics of the Giessen University, Germany, between January 1996 and July 2006. In 2164 dogs which shoulders were submitted to radiographies, 144 presented lesions compatible to supraspinatus calcifying tendinosis. It was observed that 93% were large breed dogs, specially Rottweilers, male, aging between 4 and 7,9 years old. The calcifying lesions were unilateral in 80% of the cases; 70% of the dogs showed clinical symptoms however, a great amount (75%) of them presented also some other orthopedic abnormality, speccially ulnae fragmented coronoid process, which was considered the clinical signs cause. Additionally, 138 shoulder radiographies and 21 shoulder sonographies were reviewed and their findings described. A radiological classification system in five degrees was proposed, according to the lesion appearance. In the major part of the symptomatic dogs, not affected by other orthopedic abnormality, the lesions were radiologically classified in degree 3 and 4 and showed a dense distal shadowing by sonographic evaluation. Sonography also allowed tendon parenchyma evaluation, providing tissue details. The presence of hypoechoic area surrounding the calcific lesion was sugestive of infflamatory process.

Surgical repair of torn rotator cuff tendons have a high rate of failure and does not address the underlying pathophysiology. Tissue engineering strategies, employing the use of multipotent progenitor cells or growth factors, represent potential therapies to improve the outcome of rotator cuff surgery. The use of glycosaminoglycan-based biomaterials in these therapies may enhance the effectiveness of cell and growth factor delivery techniques. Furthermore, understanding the cellular and molecular mediators in tendon overuse can help elucidate the causes of tendon degeneration. Thus the overall goals of this dissertation were to 1) develop heparin-based biomaterials to enhance cell pre-culture and maintain growth factor bioactivity and 2) characterize the histological and enzymatic changes in a supraspinatus tendon overuse model. To investigate the use of heparin in enhancing dynamic signaling, mesenchymal stem cells (MSCs) were encapsulated in heparin-containing hydrogels and evaluated for differentiation markers when cocultured with a small population of differentiated cells. To probe the effect of sulfation of heparin on the interactions with protein, selectively desulfated heparin species were synthesized and evaluated for their ability to bind and protect proteins. Finally, to develop a tendon overuse model that can become a test bed for testing future targeted therapeutics, an animal model was evaluated for tissue damage and protease activity. Together these studies represent a multi-pronged approach to understanding how tendon tissues become degenerative and for developing technologies to improve the biological fixation of tendon to bone in order to reduce the need for revision surgeries.

Made available in DSpace on 2016-06-02T20:18:20Z (GMT). No. of bitstreams: 1 5258.pdf: 7048287 bytes, checksum: a29ea2c867092740240721084371d1d4 (MD5) Previous issue date: 2013-05-10 / Universidade Federal de Minas Gerais / Athlete´s shoulder most frequent lesions are anterior shoulder instability and superior labrum anterior and posterior lesion ( SLAP), altering structures and functions of the shoulder joint, leading to impairments in sports activity. The aim of this thesis was to evaluate functional and supraspinatus morphological adaptations of shoulder in athletes with anterior instability and SLAP lesion. Three studies were developed. The first study investigated functional differences regarding clinical complaints and the scoring systems of American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and the Athletic Shoulder Outcome Rating Scale (ASORS) in 249 athletes (153 with instability and 96 with SLAP lesion). The groups presented functional differences related mainly to sports activitiy and, even with more complaints of shoulder pain, SLAP lesion athlete´s tolerate more training hours compared to instability athletes. The second study evaluated isokinetic strenght and muscular control of shoulder rotators in four groups: instability group (n=10), instability control group (n=10), SLAP group (n=10) and SLAP control group (n=10). The torque steadiness and rotator cuff strength in 90 and 180°/s were evaluated. Athlete´s with anterior stability presented shoulder rotation weakness, while athletes with SLAP lesion showed higher torque fluctuation of shoulder internal rotation. The third study characterized the different fiber types of supraspinatus and shoulder function in those lesions. This study performed muscles biopsies in 10 athletes undergoing to arthroscopy repair of shoulder anterior instability and SLAP lesion. The volunteers were functionally evaluated with ASES and ASORS, and muscle samples were processed with histochemical reaction for myosin adenosine triphosphatase (mATPase). Muscles fibers were then characterized in type I, IIa, IIb and hybrid, and percentual and lesser diameter of each fiber type were calculated. In this study, volunteers presented evident functional limitations in sports activity and hypertrophy of all typees of muscles fibers. Most of the sample also presented a great number of type IIa and IIb in the supraspinatus muscle. In conjuction, those studies proves different functional and supraspinatus morphologic adaptations in athletes with anterior shoulder instability and SLAP lesion, justifying the need of different rehabilitations approaches. / As lesões mais frequentes presentes no ombro do atleta são a instabilidade anterior do ombro e a lesão do lábio glenoidal superior, anterior e posterior (Superior Labrum Anterior and Posterior- SLAP), que levam a alterações nas estruturas e funções do ombro, prejudicando a atividade esportiva. O objetivo desta tese foi avaliar as adaptações funcionais do ombro e morfológicas do músculo supraespinal em atletas com instabilidade anterior ou lesão SLAP. Para isso foram desenvolvidos três estudos. O primeiro estudo investigou as diferenças funcionais entre essas lesões por meio das queixas clínicas e os questionários do American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) e a Escala de Resultados do Ombro do Esportista (EROE), em 249 atletas (153 com instabilidade e 96 com lesão SLAP). Os grupos apresentaram diferenças funcionais relacionadas especialmente às atividades esportivas, de forma que mesmo apresentando mais queixas de dor, os atletas com lesão SLAP toleraram mais horas de treinamento comparado aos atletas com instabilidade. O segundo estudo avaliou o torque isocinético e o controle muscular dos rotadores do ombro de quatro grupos: grupo instabilidade (n=10), grupo controle da instabilidade (n=10), grupo SLAP (n=10) e grupo controle do SLAP (n=10). Foram avaliados o controle da flutuação do torque isométrico submáximo e o torque de rotadores em 90 e 180°/s. Os atletas com instabilidade anterior apresentaram fraqueza na rotação do ombro, enquanto atletas com lesão SLAP demonstraram alterações no controle da força de rotação medial. O terceiro estudo permitiu caracterizar os diferentes tipos de fibras musculares do músculo supraespinal, assim como as atividades funcionais do ombro em atleta com essas lesões. Para tanto, foram realizadas biópsias do músculo supraespinal em 10 atletas submetidos ao reparo artroscópico da instabilidade anterior ou lesão SLAP. Os voluntários foram avaliados funcionalmente por meio da escalas ASES e EROE e fragmentos do músculo foram processados pela reação histoenzimológicas para Adenosina Trifosfatase Miofibrilar (mATPase). As fibras musculares foram então classificadas em tipo I, IIa, IIb e híbridas, e a porcentagem e o diâmetro menor de cada tipo de fibra foram calculadas. Os resultados mostraram que os voluntários apresentaram limitações funcionais mais evidentes nas atividades esportivas e uma hipertrofia de todos os tipos de fibras musculares. Além disso, na maioria da amostra, houve um maior número de fibras do tipo IIa e IIb no músculo supraespinal. Em conjunto, esses estudos comprovam a existência de diferentes adaptações funcionais e morfológicas do músculo supraespinal em atletas com instabilidade anterior e lesão SLAP, o que justifica a necessidade de diferentes enfoques na reabilitação dessas lesões.

Pertinence. Compléter des tests d’endurance cardiorespiratoire maximaux basés sur la performance chez les utilisateurs de fauteuils roulants manuels est très pertinent pour développer des programmes d'entraînement cardiorespiratoire personnalisés et pour évaluer leurs impacts au fil du temps. Cependant, ces tests augmentent potentiellement l’exposition au risque de développement de troubles musculosquelettiques secondaires aux membres supérieurs, particulièrement aux épaules. Par conséquent, il est fondamental de trouver un équilibre entre la nécessité de mesurer la capacité aérobie et le risque accru de développer des troubles musculosquelettiques secondaires lors de la réalisation d'un test basé sur les performances. Objectif. Caractériser les effets de la performance d’un test de propulsion progressif par paliers sur tapis roulant sur l'intégrité des tendons de la longue portion du biceps et du supra-épineux en utilisant des biomarqueurs obtenus via l'imagerie musculosquelettique par ultrasonographie. Méthode. Quinze utilisateurs de fauteuils roulants manuels vivant avec une lésion chronique de la moelle épinière ont complété le test de propulsion progressif par paliers sur tapis roulant. Des images des tendons de la longue portion du biceps et du supra- épineux ont été enregistrées avec un appareil d’imagerie musculosquelettique par ultrasonographie dans les plans transversal et longitudinal avant, immédiatement après et 48 heures après la fin du test en suivant un protocole standardisé. Des biomarqueurs ultrasonographiques liés à la géométrie, à la luminosité et à la texture d’une région d’intérêt ont permis de caractériser l'intégrité des tendons. Résultats. Les participants ont propulsé en moyenne pendant 10,2 ± 2,9 minutes alors que la majorité d’entre eux (N = 13/15) a atteint au moins le huitième stade du test (vitesse = 0,8 m / s; pente = 3,6 ̊). Aucun des biomarqueurs géométriques, de luminosité et de texture caractérisant l'intégrité des deux tendons, mesurés dans les plans longitudinal et transverse, n’a changé de façon significative (p = 0,063 à 1 000) entre les trois temps de mesure. Conclusion. La performance du test de propulsion progressif par paliers sur tapis roulant motorisé pour évaluer la capacité aérobie n'amène aucun changement délétère observable immédiatement après et 48 heures après la réalisation du test. / Relevance. The completion of performance-based maximal cardiorespiratory fitness tests among manual wheelchair user is highly relevant to develop personalized cardiorespiratory fitness training programs and to assess their impacts over time. However, these tests could potentially increase risk exposure for the development of upper limb secondary musculoskeletal impairments specifically to the shoulder. Hence, finding an equilibrium between the need to measure aerobic fitness and the increased risk of developing secondary musculoskeletal impairments when completing performance-based test is fundamental. Objective. To characterize the effect of the completion of a recently- developed treadmill-based progressive workload incremental test on the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers. Method. Fifteen manual wheelchair users living with a spinal cord injury completed the treadmill-based progressive workload incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded with a musculoskeletal ultrasound imaging device in the transversal and longitudinal planes before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, luminosity, and texture-related ultrasound biomarkers of a region of interest have characterized tendon integrity. Results. The participants propelled an average of 10.2 ± 2.9 minutes with the majority (N = 13/15) reached at least the eighth stage of the test (speed = 0.8 m/s; slope = 3.6 ̊). None of the geometric, luminosity and texture biomarkers characterizing the integrity of the two tendons, measured in the longitudinal and transversal planes, changed significantly (p=0.063 to 1.000) between the three measurement times. Conclusion. The performance of the treadmill-based progressive workload propulsion test to assess aerobic capacity does not result in any observable deleterious change immediately after and 48 hrs after the performance of the test.