Introdução: A epicondiloalgia lateral (EL) é caracterizada por uma desordem musculoesquelética envolvendo o tendão extensor comum originado no epicôndilo lateral. O Teste de Comprometimento Funcional da Mão, Pescoço, Ombro e Braço - FIT-HaNSA foi desenvolvido para analisar o desempenho durante três tarefas que realizam atividades repetitivas de elevação do membro superior, além de posturas sustentadas em pacientes com disfunção no ombro, medida em até 300 segundos. O objetivo deste estudo foi avaliar a confiabilidade e a validade do teste FIT-HaNSA em pacientes com EL do cotovelo, bem como avaliar as estratégias biomecânicas utilizadas pelo membro superior durante a execução deste teste. Método: Uma versão brasileira do dispositivo do teste foi desenvolvida. Foram incluídos 10 voluntários destros assintomáticos e 20 pacientes com EL. Para a análise da confiabilidade foi utilizado o Coeficiente de Correlação Intraclasse (CCI) por meio do SPSS, com um intervalo de confiança de 95% e para a análise da validade de construto, o Coeficiente de Correlação de Spearman por meio do Software Mini Tab®. Foram coletados dados de preensão palmar, limiar doloroso e questionário DASH. Para a coleta dos dados eletromiográficos foi utilizado o equipamento da marca Delsys® (Trigno® Wireless Systems). A preparação da pele seguiu as recomendações do Projeto SENIAM. Os eletrodos foram posicionados em músculos do tronco, costas, braço e antebraço. Para a análise cinemática foi utilizado o software de imagens 3D (Vicon Motion Systems Ltd®), composto por 8 câmeras infravermelho que captaram o movimento de 16 marcadores reflexivos passivos. Os dados eletromiográficos e cinemáticos foram adquiridos de forma sincronizada e simultânea e o processamento dos sinais foi realizado off-line no Matlab®. Foi utilizada análise de variância (ANOVA) e pos hoc de Bonferroni (p<=0.05). Resultados: A média do tempo das tarefas 1, 2 e 3 foram respectivamente, 300s, 297s e 268s para o grupo assintomático e 249s, 141s e 264s para o grupo paciente. O teste apresentou entre excelente e boa confiabilidade teste reteste para o grupo assintomático para as tarefas 1, 2 e 3 respectivamente, 0,99 (0,91 - 0,99), 0,89 (0,02 - 0,98) e 0,95 (0,54 - 0,99) e para o grupo pacientes, excelente confiabilidade para as tarefas 1 e 2 respectivamente 0,98 (0,82 - 0,99) e 0,92 (0,29 - 0,99) e não aceitável para a tarefa 3 0,60 (-2,76 - 0,95), sem alteração do padrão doloroso após o teste. Apresentou correlação moderada entre o score médio do teste e a dor (r=0,67), assim como a força de preensão (r=0,56) e fraca correlação do teste com o questionário DASH (r=- 0,42). O músculo extensor ulnar do carpo esteve bastante ativo durante a realização das três tarefas. Conclusão: A versão adaptada do FIT-HaNSA-Br mostrou ser válida e reprodutível para pacientes com EL. A principal estratégia biomecânica foi a maior ativação do extensor ulnar do carpo com maior ADM de desvio ulnar ao realizar preensão com deslocamento de carga. Esta ferramenta pode ser utilizada como uma variável de desfecho em estudos clínicos para verificar a efetividade dos recursos fisioterapêuticos no tratamento conservador da EL do cotovelo. / Introduction: The lateral epicondylalgia (LE) is characterized by a musculoskeletal disorder involving the common extensor tendon which is originated at the lateral epicondyle. The Functional Impairment Test-Hand, and Neck/ Shoulder/Arm - FIT-HANSA was developed to analyze the performance during three tasks that perform repetitive activities of the upper limb elevation, and sustained postures, in patients with dysfunction in the shoulder, measured up to 300 seconds. The aim of this study was to evaluate the reliability and validity of FIT-HANSA in patients with LE and evaluate the biomechanical strategies used by the upper limb during the execution of this test. Method: A Brazilian version of FIT-HANSA device has been developed. The study included 10 healthy volunteers and 20 patients with LE. For the analysis of reliability we used the intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%, using the SPSS. For the analysis of the construct validity, the Spearman\'s correlation coefficient (r) was calculated in Software Mini Tab®. They were collected handgrip data, pain threshold and questionnaire DASH. Electromyographic data was collected using a Delsys® (Trigno® Wireless Systems) equipment. The preparation of skin followed the recommendations of SENIAM Project. The electrodes were placed in the trunk muscles, back, arm and forearm. For kinematic analysis we used a software for 3D image analysis (Vicon Motion Systems Ltd ®), composed of 8 infrared cameras, which capture the movement through 16 reflective markers. Kinematic and electromyographic data were acquired synchronized and simultaneously via Vicon Nexus® Software and signal processing was performed offline in Matlab® software. Statistical analysis was performed by means of analysis of variance (ANOVA) and post hoc Bonferroni (p <= 0.05). Results: The average time of the tasks 1, 2 and 3 were, respectively, 300s, 297s e 268s for the asymptomatic group and 249s, 141s e 264s for the patient group. The test showed between excellent and good test-retest reliability for the asymptomatic group for the tasks 1, 2 and 3 respectively 0.99 (0.91 to 0.99) and 0.89 (0.02 to 0.98) and 0.95 (0.54 to 0.99), and the group patients, excellent reliability for tasks 1 and 2 respectively, 0.98 (0.82 to 0.99) and 0.92 (0.29 to 0.99) and not acceptable for the task 3 0.60 (-2.76 to 0.95), without changing the painful pattern after the test. Moderate correlation was found between the average score of the test and pain (r = 0.67) and grip strength (r = 0.56) and weak correlation between the test and DASH questionnaire (r = -0.42). The long extensor Carpi ulnaris muscle was significantly active during the course of the three tasks. Conclusion: The adapted version of the FIT-HANSA-Br showed to be valid and reproducible for patients with LE. The main biomechanical strategy was greater activation of the extensor carpi ulnaris muscle with more ulnar deviation performed to hold the load-displacement. This tool can be used as an outcome variable in clinical studies to assess the effectiveness of physical therapy resources in the conservative treatment of LE.

The modern game of tennis has changed in recent years as a result of lightweight, stiffer racquets. The evolution of the tennis racquet, with respect to both design and materials, has increased the speed of the game but also the levels of stress placed on the player's bodies. Many believe that injuries such as lateral epicondylitis (tennis elbow) are caused and aggravated by the absorption of racquet energy by the player, in the form of shock and vibration. This thesis presents an experimental investigation into the absorption of racquet vibration to the player's hand and forearm. Quantification of the tennis grip has been achieved in this research using different experimental techniques to analyse different aspects of the tennis grip. Grip pressure distribution profiles during impact have been established using both pressure sensitive film and real-time data acquisition methods. Quantification of grip tightness during impact, together with gripping times, has also been quantified using a strain gauge cantilever system manufactured specifically for this research. The experimental data acquired in this research has provided the base for grip pressure distribution profiles to be established for three stroke types (e.g. Forehand, service and the problematic backhand). The profiles depict the distribution of pressure in the tennis grip in relation to the ball impact, in the time domain. Based on these grip profiles, the research hypothesises hand movements in an attempt to establish muscle contractions (and moreover locations of vibration absorption) specific to stroke types. The research investigates the absorption of racquet vibrations by the player's hand in the time domain. Filtering of accelerometer data allows for the isolation of specific frequencies of interest (i.e. below 200Hz). Logarithmic decrement of racquet vibration has been calculated and related to the grip pressure distributions in the time domain, and the relationship between grip pressure and vibration damping has been modelled. The correlation between grip pressure and the logarithmic decrement has been show to be significant (p less than 0.005) and non-linear. The relationship between the tennis grip and the damping of racquet vibrations has been found to be dependant on both grip pressure and the proximity of grip pressure application in proximity to the handle node. Grip pressure applied to the racquet close to the handle node has a greater damping effect than a similar pressure further away. In addition to these key research findings, the effectiveness of a piezoelectric racquet damping system is also investigated. A comprehensive modal analysis of two tennis racquets is given with further ball impact tests. The ball impact tests showed that the damping system has a 28% difference in racquet vibrations during freely suspended grip conditions. However, under hand-held grip conditions the inclusion of grip damping into the system provides a much greater damping entity (880% greater). Therefore, the effect of the piezoelectric system was deemed to be negligible.

Introdução: A epicondiloalgia lateral (EL) é caracterizada por uma desordem musculoesquelética envolvendo o tendão extensor comum originado no epicôndilo lateral. O Teste de Comprometimento Funcional da Mão, Pescoço, Ombro e Braço - FIT-HaNSA foi desenvolvido para analisar o desempenho durante três tarefas que realizam atividades repetitivas de elevação do membro superior, além de posturas sustentadas em pacientes com disfunção no ombro, medida em até 300 segundos. O objetivo deste estudo foi avaliar a confiabilidade e a validade do teste FIT-HaNSA em pacientes com EL do cotovelo, bem como avaliar as estratégias biomecânicas utilizadas pelo membro superior durante a execução deste teste. Método: Uma versão brasileira do dispositivo do teste foi desenvolvida. Foram incluídos 10 voluntários destros assintomáticos e 20 pacientes com EL. Para a análise da confiabilidade foi utilizado o Coeficiente de Correlação Intraclasse (CCI) por meio do SPSS, com um intervalo de confiança de 95% e para a análise da validade de construto, o Coeficiente de Correlação de Spearman por meio do Software Mini Tab®. Foram coletados dados de preensão palmar, limiar doloroso e questionário DASH. Para a coleta dos dados eletromiográficos foi utilizado o equipamento da marca Delsys® (Trigno® Wireless Systems). A preparação da pele seguiu as recomendações do Projeto SENIAM. Os eletrodos foram posicionados em músculos do tronco, costas, braço e antebraço. Para a análise cinemática foi utilizado o software de imagens 3D (Vicon Motion Systems Ltd®), composto por 8 câmeras infravermelho que captaram o movimento de 16 marcadores reflexivos passivos. Os dados eletromiográficos e cinemáticos foram adquiridos de forma sincronizada e simultânea e o processamento dos sinais foi realizado off-line no Matlab®. Foi utilizada análise de variância (ANOVA) e pos hoc de Bonferroni (p<=0.05). Resultados: A média do tempo das tarefas 1, 2 e 3 foram respectivamente, 300s, 297s e 268s para o grupo assintomático e 249s, 141s e 264s para o grupo paciente. O teste apresentou entre excelente e boa confiabilidade teste reteste para o grupo assintomático para as tarefas 1, 2 e 3 respectivamente, 0,99 (0,91 - 0,99), 0,89 (0,02 - 0,98) e 0,95 (0,54 - 0,99) e para o grupo pacientes, excelente confiabilidade para as tarefas 1 e 2 respectivamente 0,98 (0,82 - 0,99) e 0,92 (0,29 - 0,99) e não aceitável para a tarefa 3 0,60 (-2,76 - 0,95), sem alteração do padrão doloroso após o teste. Apresentou correlação moderada entre o score médio do teste e a dor (r=0,67), assim como a força de preensão (r=0,56) e fraca correlação do teste com o questionário DASH (r=- 0,42). O músculo extensor ulnar do carpo esteve bastante ativo durante a realização das três tarefas. Conclusão: A versão adaptada do FIT-HaNSA-Br mostrou ser válida e reprodutível para pacientes com EL. A principal estratégia biomecânica foi a maior ativação do extensor ulnar do carpo com maior ADM de desvio ulnar ao realizar preensão com deslocamento de carga. Esta ferramenta pode ser utilizada como uma variável de desfecho em estudos clínicos para verificar a efetividade dos recursos fisioterapêuticos no tratamento conservador da EL do cotovelo. / Introduction: The lateral epicondylalgia (LE) is characterized by a musculoskeletal disorder involving the common extensor tendon which is originated at the lateral epicondyle. The Functional Impairment Test-Hand, and Neck/ Shoulder/Arm - FIT-HANSA was developed to analyze the performance during three tasks that perform repetitive activities of the upper limb elevation, and sustained postures, in patients with dysfunction in the shoulder, measured up to 300 seconds. The aim of this study was to evaluate the reliability and validity of FIT-HANSA in patients with LE and evaluate the biomechanical strategies used by the upper limb during the execution of this test. Method: A Brazilian version of FIT-HANSA device has been developed. The study included 10 healthy volunteers and 20 patients with LE. For the analysis of reliability we used the intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%, using the SPSS. For the analysis of the construct validity, the Spearman\'s correlation coefficient (r) was calculated in Software Mini Tab®. They were collected handgrip data, pain threshold and questionnaire DASH. Electromyographic data was collected using a Delsys® (Trigno® Wireless Systems) equipment. The preparation of skin followed the recommendations of SENIAM Project. The electrodes were placed in the trunk muscles, back, arm and forearm. For kinematic analysis we used a software for 3D image analysis (Vicon Motion Systems Ltd ®), composed of 8 infrared cameras, which capture the movement through 16 reflective markers. Kinematic and electromyographic data were acquired synchronized and simultaneously via Vicon Nexus® Software and signal processing was performed offline in Matlab® software. Statistical analysis was performed by means of analysis of variance (ANOVA) and post hoc Bonferroni (p <= 0.05). Results: The average time of the tasks 1, 2 and 3 were, respectively, 300s, 297s e 268s for the asymptomatic group and 249s, 141s e 264s for the patient group. The test showed between excellent and good test-retest reliability for the asymptomatic group for the tasks 1, 2 and 3 respectively 0.99 (0.91 to 0.99) and 0.89 (0.02 to 0.98) and 0.95 (0.54 to 0.99), and the group patients, excellent reliability for tasks 1 and 2 respectively, 0.98 (0.82 to 0.99) and 0.92 (0.29 to 0.99) and not acceptable for the task 3 0.60 (-2.76 to 0.95), without changing the painful pattern after the test. Moderate correlation was found between the average score of the test and pain (r = 0.67) and grip strength (r = 0.56) and weak correlation between the test and DASH questionnaire (r = -0.42). The long extensor Carpi ulnaris muscle was significantly active during the course of the three tasks. Conclusion: The adapted version of the FIT-HANSA-Br showed to be valid and reproducible for patients with LE. The main biomechanical strategy was greater activation of the extensor carpi ulnaris muscle with more ulnar deviation performed to hold the load-displacement. This tool can be used as an outcome variable in clinical studies to assess the effectiveness of physical therapy resources in the conservative treatment of LE.

Title The objectification of using of kinesio taping to influence a muscle tone in epicondylitis. Objectives The aim of this master thesis is to find an effect of inhibitive kinesiotape application to muscle tone of hypertonic m. extensor digitorum communis and to pain of lateral epicondyl in lateral epicondylitis. Method The master thesis is divided to theoretical part and empirical research, which is based on the first part. The evaluation of m. extensor digitorum communis tension after kinesiotape application is provided by myotonometry method. The measurement is performed in 5 tested persons before and after two-day kinesio tape application. The questionaire Numeric pain rating scale helps to find a change of pain before and after kinesio tape application and then the dependence of pain to muscle tone change. Results The myotonometer measurement found a decrease of m. extensor digitorum communis tension for 4 from 5 tested persons after two-day application. The pain of lateral epicondyl was reduced for all probands. Keywords lateral epicondylitis, tennis elbow, muscle tone, kinesio taping, myotonometer

Objectives: To study the treatment practice of chronic tennis elbow (TE) among general practitioners (GPs) and physiotherapists (PTs), the effects of a simple, graded home exercise regime versus expectation, the effects of eccentric versus concentric exercise, and the involvement of the substance P – NK1 receptor system in the peripheral, painful tissue of chronic TE patients by positron emission tomography (PET). Materials and methods: A postal survey regarding therapeutic methods used in patients with chronic TE was sent to 129 GPs and 77 PTs, 81 subjects with chronic TE were randomly and blindly assigned to either an exercise group or a wait list group, 120 subjects were randomly assigned to either eccentric or concentric exercise and ten subjects were examined by PET and the NK1 specific radioligand [11C]GR205171. Results: High proportions of GPs and PTs used ergonomic counselling and stretching in the treatment of chronic TE. The majority of GPs prescribed passive anti-inflammatory measures such as sick leave and anti-inflammatory medication. Many PTs prescribed dynamic, particularly eccentric, exercise. Graded dynamic exercise according to a simple low-cost protocol, has better effect on pain than a wait-and-see attitude. Adjusted for outcome affecting variables, eccentric graded exercise has quicker effect than concentric graded exercise. During PET scan with the NK1 specific radioligand [11C]GR205171, voxel volume and signal intensity of this volume was significantly higher in the affected than the unaffected arm in subjects with unilateral chronic TE. Conclusions: GPs and PTs used many treatments to a similar extent but differed regarding the use of exercise. Chronic TE responds favourably to graded dynamic exercise aimed specifically at the painful tissue. The exercise should stress the eccentric work phase. The substance P – NK1 receptor system seems to play a part in the peripheral, painful tissue of a chronic, soft tissue pain condition such as chronic TE. / Epi-X

Author: Bc. Modinat Sanni Supervisor: Ing. Miroslav Vilímek, PhD Title: MUSCLES ACTIVATION DURING "SHOULDER MOUNT"POLE ACROBATIC EXERCISE Purpose: This study is an empirical - theoretical study presents the literature review regarding to the topic of the shoulder function anatomy, kinesiology, biomechanics, non-traumatic injuries of the shoulder and their prevention by using the available literatures. Further, the study also compares by surface electromyography the amplitudes, shapes and durations of myoelectric signals of m. latissimus dorsi, m. pectoralis maior, m. biceps brachii, m. infraspinatus and m. supraspinatus of dominant shoulder in two healthy individuals during acrobatic exercise on vertical pole known as "Shoulder Mount". The purpose was monitor the changes in two different conditions; i.e. kinesiotape and elbow brace and compare with the control condition for the reason of finding out their ability to affect the myoelectric activities of selected muscles. Further, the Shoulder Mount exercise had recorded by six Qualisys cameras for motion analyses. Methods and materials: The potentially eligible scientific articles perform a search of studies on the topic of kinesiotapes and tennis elbow brace as measured by EMG mainly on myoelectric activity of the shoulder complex were seared from...

Syfte Syftet med föreliggande studie var att försöka klargöra om stötvågsbehandling har någon effekt på smärta och handgreppstyrka hos patienter med lateral epikondylalgia. Frågeställningar 1. Har stötvågsbehandling någon effekt på smärta hos patienter med lateral epikondylalgia, i så fall vilken? 2. Har stötvågsbehandling någon effekt på handgreppsstyrka hos patienter med lateral epikondylalgia, i så fall vilken? Metod Sökning av litteratur utfördes i PubMed, Cochrane, Cinahl och PEDro. Detta resulterade i 14 artiklar, som granskades och bedömdes enligt PEDro Scale. Poängbedömningen utifrån PEDro Scale omsattes till Statens Beredning för medicinsk Utrednings (SBU) mall för bevisvärde. Utifrån artiklarnas sammantagna bevisvärde bestämdes evidensnivån enligt SBU:s fyra nivåer. Resultat Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling har en smärtlindrande effekt vid lateral epikondylalgia. Studier av likartad vetenskaplig kvalitet påvisar motsägande resultat avseende om stötvågsbehandling är bättre än placebo, kortison eller tenotomi. Detta innebär att det vetenskapliga underlaget är otillräckligt och att mer forskning behövs. Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling leder till förbättrad handgreppsstyrka vid lateral epikondylalgia. Vidare förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling inte är bättre än någon annan behandling gällande ökning av handgreppsstyrka vid lateral epikondylalgia. Slutsats Stötvågsbehandling har en smärtlindrande effekt hos patienter med lateral epikondylalgia. Det finns dock ingen evidens för att stötvågsbehandling är bättre ur smärthänseende än någon annan behandling såsom placebo, kortison eller tenotomi. Stötvågsbehandling leder till förbättrad handgreppsstyrka men är inte bättre än placebo, kortison eller tenotomi på att öka handgreppsstyrkan hos patienter med lateral epikondylalgia. / Aim The aim of the present study was to try to find out whether shock wave therapy has any effect on pain and grip strength in patients with lateral epicondylitis. Objectives 1. Does shock wave therapy reduce pain in patients with lateral epicondylitis? 2. Does shock wave therapy improve grip strength in patients with lateral epicondylitis? Method A literature review was performed in the databases PubMed, Cochrane, Cinahl and PEDro. Fourteen articles were found and critically reviewed. These articles were scored according to the PEDro scale and the scores were translated into a scale of evidence by the Statens Beredning för medicinsk Utredning (SBU) and the level of evidence was determined based on the four different grades presented by the SBU. Results According to the GRADE-system there was a strong scientific evidence for a reduction of pain using shock wave therapy in patients with lateral epicondylitis. Contradictory results whether shock wave therapy was better than placebo, corticosteoroid injection or tenotomy have been reported in studies of similar scientific quality. This means that more research is needed in this field. According to the GRADE-system there was a strong scientific evidence for an improvement of grip strength using shock wave therapy. Furthermore, there was a strong scientific evidence for that shock wave is not better than any other therapy in terms of improving grip strength in patients with lateral epicondylitis. Conclusion Shock wave therapy reduces pain in patients with lateral epicondylitis. There is, however, no evidence for shock wave therapy to be superior to any other treatment such as placebo, corticosteoroid injection or tenotomy. Shock wave therapy improves grip strenght but is not better than placebo, corticoidsteroid injection or tenotomy in increasing grip strength in patients with lateral epicondylitis.