PURPOSE: To compare glenohumeral joint position sense (JPS), concentric internal (IR) and external rotation (ER) strength, functional ability, and level of satisfaction in patients who underwent three types of glenohumeral capsulorrhaphy with age-matched controls. RESEARCH DESIGN: Four 4x2 and two 4x3 ANOVAs were used to identify differences in JPS and concentric IR/ER strength between groups: Open Capsulorrhaphy (n=21), Thermal Capsulorrhaphy (n=16), Arthroscopic Capsulorrhaphy (n=14) and Controls (n=22). Pearson correlation analyses were performed to determine the relationship between objective American Shoulder and Elbow Surgeons (ASES) evaluations and subjective Shoulder Rating Questionnaire (SRQ) scores. Stepwise multiple regression analyses were performed to predict ASES and SRQ scores from various objective and subjective outcome measures. SUBJECTS: 73 adults (51 postsurgical patients, 22 healthy controls; mean age, 23.7 ± 6.8 yrs) participated in this retrospective study. The 51 patients who underwent capsulorrhaphy for recurrent, anterior glenohumeral instability were evaluated at an average of 32.1 months postsurgery. MEASUREMENTS: JPS was measured bilaterally using a reproduction of passive positioning protocol at 2 target angles: 60% and 90% of maximum passive external rotation (60% and 90% ER[subscript max]). Concentric IR and ER peak torques were measured bilaterally at 90°/sec, 180°/sec and 270°/sec. Objective postoperative function was quantified with the clinician-based ASES form, while functional status and patient satisfaction were assessed with the patient-based SRQ form. RESULTS: The accuracy of JPS in patients' surgical limbs was similar to that present in their contralateral, uninjured shoulders at both target angles. The Open group demonstrated significantly better involved-limb JPS acuity (4.2° ± 1.9°) than the Arthroscopic group (6.8° ± 3.2°) and Control group (6.6° ± 3.5°) (p<.05). However, the Open group had 31% less IR strength than Control subjects and 33% less than the Arthroscopic group, with IR peak torques significantly less in their postsurgical shoulders than their uninvolved limbs (p<.002). There was a strong, positive correlation (r =.64, p≤.001) between objective ASES and subjective SRQ scores. Patients' postoperative level of pain and ASES scores were significant predictors of their SRQ clinical scores (R=.81, p<.003). CONCLUSIONS: Glenohumeral JPS and rotator cuff strength were similar in both the postsurgical and uninvolved shoulders of the Arthroscopic and Thermal groups. Patients in the Open capsulorrhaphy group demonstrated significantly better involved-limb JPS than Arthroscopic and Control groups. The large strength deficits observed in the Open group, particularly in IR, were of significant concern. We observed a higher failure rate, more revision surgeries, and lower patient satisfaction with the Thermal capsulorrhaphy technique. Patient-based outcomes were significant predictors of operative success as measured by clinician-based evaluation. Prospective, randomized controlled studies are still needed to evaluate the outcomes of these glenohumeral capsulorrhaphy procedures over the longer term. / Graduation date: 2005

Pedicle screw breakage and loosening remain as clinical complications of short segment instrumentation procedures for spinal stabilization. This study has directly visualized and measured elastic, plastic and total vertebral pedicle trabecular bone full-field strains in the regions immediately surrounding the pedicle screw during pedicle screw insertion by utilizing functional microCT imaging and digital volume correlation. Human, porcine and polyurethane foam samples were analyzed and compared. Analysis showed that when osteoporotic human, normal human and porcine pedicle trabecular bone samples were compared, osteoporotic samples showed higher peak plastic strains and greater variability of these strains from their means. This suggests that osteoporotic human samples are non-uniformly elastic and plastic, while normal human and porcine samples are more uniformly elastic and plastic throughout the trabecular structure. PU-foams are not appropriate as models for pedicle trabecular bone in the in vivo environment since strain results showed dissimilar plastic and elastic strain magnitudes than human and porcine pedicle trabecular bone. This study may aid in the development of performance criteria for new PU-foams and improved pedicle screw designs. / Graduation date: 2004

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Anatomy / Master / Master of Philosophy

No description available.

This study investigated the effects of hyperbaric oxygen (HBO) therapy on acute ankle injuries and determined if HBO therapy shortened time to recovery, decreased edema and pain, and increased range of motion and strength of the ankle. Subjects were randomly assigned to either an experimental (HBO) group (n = 4) or a control group (n = 4). All subjects received the same standardized physical therapy for lateral ankle sprains at the McGill Sport Medicine Clinic. The HBO group received 5 consecutive HBO treatments at 2.5 ATA for 90 minutes starting within 24 hours post injury. The control group received no HBO treatments. All subjects were evaluated by a physician within 24 hours of injury. All subjects suffered a second-degree lateral ankle sprain. Pain, range of motion, strength, volume displacement, and function were evaluated on the day of injury (Day 1), on Day 6 post injury, and on the day of return to play (Day RTP). There was no significant difference in time to return to play. However, the HBO group (25.5 +/- 11.6 days) did return 31% faster than the control group (36.8 +/- 19.4 days). There were no differences found between groups on the variables. There was a decrease in pain found over time (Day 1 was 57 mm, Day 6 was 18.5 mm, and Day RTP was 7 mm). The results of this study suggest that with treatment of HBO there is no effect on ankle sprains for return to play or improved function.

The objective of this study was to determine the effect of multiple ice treatments on the signs and symptoms of exercise induced muscle damage. Twenty-four women performed vigorous eccentric exercise of elbow flexors to induce muscle damage. Subjects were randomly assigned into one of three groups(control, experimental group 1, experimental group 2). Experimental groups 1 and 2 received two and six ice bag treatments respectively for two consecutive days post exercise-induced muscle damage. Dependent variables included pain perception, resting arm angle, bicep, forearm, and wrist circumferences, elbow range of motion, and plasma concentrations of creatine kinase. Baseline measurements were obtained on day one and were repeated every 24 hours post-exercise for five days. No significant differences were observed between groups. The results of this study indicate that ice bag treatments do not have any affect on signs/symptoms of exercise-induced muscle damage. / School of Physical Education

Blast-induced traumatic brain injury (bTBI) has been a health concern in both military and civilian populations due to recent military and geopolitical conflicts. Military service members are frequently exposed to single and repeated blasts throughout their training and deployment. As a result of blast exposures, military personnel report symptoms of various neurological and neurosensory deficits. Our group has previously reported decreased long term potentiation (LTP) following either single or repeated bTBI in a rat organotypic hippocampal slice culture (OHSC) model. LTP is a neuronal correlate for learning and memory and is a neurological metric that can be used to evaluate blast injury severity and the efficacy of therapeutic interventions. In the first aim of this thesis, we characterized LTP deficits following repeated bTBI to develop tolerance criteria for blast exposures. We did so by varying the blast injury severity, the inter-blast interval between blasts, and the recovery period following blast exposure. We determined that LTP deficits were compounded as a result of repeated mild bTBI. LTP deficits were attenuated with increasing inter-blast intervals and with increasing recovery periods after injury. Even after three repeated mild bTBIs, LTP spontaneously recovered after 6 days. In the second aim, we investigated the pathological changes in OHSCs following repeated blast exposures. Following injury, we observed robust microglial activation, evidenced by increased expression of the pro-inflammatory marker, CD-68, and decreased expression of the anti-inflammatory marker, CD-206. We also observed increased expression of MIP-1α, IL-1β, MCP-1, IP-10, and RANTES and decreased expression of IL-10 in the acute period after both single and repeated bTBI. Following partial depletion of microglia prior to injury, injury induced LTP deficits were significantly reduced. Lastly, treatment with a novel drug, MW-189, immediately after a repeated bTBI prevented LTP deficits. In the third aim, we investigated changes in inflammatory markers like cyclooxygenase (COX) and tested the efficacy of COX or prostaglandin receptor (EP3R) inhibitors in attenuating LTP deficits. We observed that expression of COX-2 increased 48 hours following repeated blast injury; however, COX-1 expression was unchanged. Following repeated bTBI, EP3R expression was upregulated and cyclic adenosine monophosphate (cAMP) concentration was decreased. Treatment of blast injured OHSCs with a COX-1 specific inhibitor, SC-560, a COX-2 specific inhibitor, rofecoxib, a pan-COX inhibitor, ibuprofen, or an EP3R inhibitor, L-798,106 improved LTP deficits. Delayed treatment with L-798,106 and ibuprofen also improved LTP deficits. Our data suggests that bTBI induced neuroinflammation may be partially responsible for the functional deficits that we have observed in blast-injured OHSCs. Additionally, we also conclude that COX and EP3R inhibition may be viable therapeutic strategies to reduce bTBI induced neurophysiological deficits. In the final aim, we investigated bTBI induced changes to the electrophysiological network of OHSCs. Following blast exposure, sham and injured OHSCs were administered increasing concentrations of bicuculline, a GABAA receptor antagonist. Doing so revealed an increase in connectivity and clustering coefficients in sham slices compared to injured slices. This suggested that the underlying neuronal network of injured slices was dysfunctional. Biologically, this dysfunction could be explained by the decreased expression of GABAA receptor α1 and α5 subunits. A loss of GABAA receptor expression or function may explain the electrophysiological network disruptions that we observed. More work will be required to determine how blast exposure decreases the expression of GABAA receptors and how these receptors may contribute to network deficits. This thesis has expanded upon the tolerance criteria for repeated blast exposures. These studies have also further characterized the pathological changes in microglial activation and explored promising therapeutic pathways that could be used to attenuate functional deficits. Lastly, this thesis has also provided novel ways to interrogate neuronal networks following blast injury, revealing subtle deficits that will need to be explored in more detail.

No description available.

In summary, the biomechanical stimulations can augment osteotendinous healing processes by facilitating better fibrocartilagious transitional zone regeneration as well as the restoration of proprioceptions, and the early application showed the more beneficial effects. However, further experimental and clinical studies are still needed to explore the optimal timing, intensity, frequency, and duration of the proposed postoperative biomechanical stimulation protocols. / LIPUS is a "non-contact" biomechanical stimulation, which can provide a direct mechanical stimulation through cavitation and acoustic microstreaming effects to improve tissue healing in a less-than-rigid biomechanical environment. So the mechanical stimulation induced from LIPUS could be applied immediately after surgery without worrying about the mechanical strain exceed the structural property at the osteotendinous healing interface in the early phase of repair. In this part of study, we also examined the effects of the regime of biomechanical stimulations applying immediately after repair on the osteotendinous healing interface. By using the same healing junction model, forty-two female New Zealand white rabbits were randomly divided into two groups; daily mechanical stimulation was applied immediately after surgery lasting up to post-operative 12 weeks on the healing interface in the treatment group. The regime of mechanical stimulations included by LIPUS was 20 minutes, 5 days per week for 4 weeks, followed by cyclic mechanical stimulation generated from quadriceps muscles induced by FES for 8 weeks. Results showed that early application of biomechanical stimulations on the osteotendinous healing interface were significantly better radiologically, histologically and biomechanically than that of not any or later application of the biomechanical stimulations during the osteotendinous healing processes when assessing at the same healing time point. In addition, the early application of biomechanical stimulations showed the better functional recovery in terms of the restoration of the proprioceptions, which an increased numbers of sensory nerve endings labeled by calcitonin gene-relate peptide (CGRP) was detected in the whole osteotendinous healing complex. / Sports or trauma injuries around osteotendinous junctions are common; treatments usually require surgical reattachment of the involved tendon to bone. Restoration of osteotendinous junction after repair is slow and difficult due to regenerating the intermitted fibrocartilage zone to connect two different characteristic tissues, tendon to bone. Although the factors influencing fibrocartilage zone regeneration and remodeling during osteotendinous repair are poorly understood, however, is believed that the mechanical environment plays an important role in such healing process. In present study, the effects of mechanical stimulation on osteotendinous healing process were examined, in the way of mechanical stimulations induced by biophysical stimulations, surface functional electric stimulation (FES) and low intensity pulsed ultrasound (LIPUS), applying on the patellar tendon to patellar bone healing interface in an established partial patellectomy model in rabbits. / The mechanotransductive stimulation linked to the transmission of forces across osteotendinous junction can be generated from its muscle contraction induced by FES. In the partial patellectomy model, thirty-five female New Zealand white rabbits were randomly divided into two groups with initial immobilization for 6 weeks, daily FES was applied to quadriceps muscles for 30 minutes, 5 days per week for 6 weeks in treatment group and compared with non-treatment control group at postoperative week 6, 12 and 18, radiologically, histologically and biomechanically. Results showed that FES-induced cyclic mechanical stimulation significantly increased new bone formation and its bone mineral density. An elevated expression of tenascin C and TGFbeta1; an increased proteoglycant stainability; mature fibrocartilage zone formation with better resumptions of biomechanical properties also observed on the osteotendinous healing interface, indicating that the post-operative programmed cyclic mechanical stimulation generated from its muscle contraction has beneficial effects on osteotendinous healing processes by facilitating the fibrocartilagious transitional zone regeneration. / by Wang Wen. / Advisers: Kai Ming Chan; Ling Qin. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1550. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 159-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.