Rotator cuff tears are a common injury impacting a large and diverse group of patients and refer to a partial or full discontinuation of one or more of the muscles or tendons comprising the shoulder complex. It may occur as a result of traumatic injury, applied weight, overuse, or intrinsic degeneration over a period of years. The incidence of rotator cuff tears has been found to increase with age. Though not a life-threatening condition, rotator cuff tears adversely affect the quality of one's lifestyle causing significant pain, weakness, and limitation of motion that hinders a person from performing routine daily activities as adequately and frequently as desired. Data from cadaveric studies suggest that as many as 65% of individuals over the age of 70 have a partial-thickness rotator cuff tear. Oftentimes, rotator cuff tears are asymptomatic which can make diagnosis and early treatment challenging. The decision to pursue operative versus conservative management is often controversial. Though surgical intervention may provide more immediate pain relief and functional improvement, it portends a higher risk of morbidity than conservative measures, particularly with an older demographic of patients. Moreover, surgical repair is often followed by long recovery periods and has variable outcomes. A number of conservative treatment options are currently being utilized for the management of partial rotator cuff tears including oral medication, corticosteroid injection, and targeted physical therapy. This review seeks to assess an innovative, biologic approach to treating partial rotator cuff tears using autologous platelet-rich plasma (PRP). The use of PRP for the conservative management of both degenerative and acutely injured tissues is quickly becoming a more popular option within the clinical community. PRP treatment has received significant attention from the media and has been used by several professional athletes as a means of expediting the healing process. The appeal of PRP stems from the fact that it is produced from a patient's own blood. After a blood sample is obtained, it is placed into a centrifuge, a tool used to separate the blood into its many components. A large concentration of platelet-enriched plasma can then be collected and augmented before administration to an injured area of bone or soft tissue, such as a tendon or ligament. Platelets contain an abundance of growth factors essential for cellular recruitment, proliferation, and specialization required for the healing process. PRP is given to a patient via an injection, often under ultrasound assistance for more precise placement. This study reviewed a collection of current literature on the efficacy of PRP in rotator cuff repair. Published studies have generally illustrated a general trend towards effectiveness, suggesting PRP may improve patient outcomes and prevent the need for surgery in patients with partial rotator cuff tears. Study designs and results have proved to be inconsistent at times. However, further clinical investigation is required to validate the use of PRP as an additional non-surgical treatment option.

MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand / Introduction Rotator cuff tears can cause great impairment of the shoulder joint with debilitating pain and dysfunction. The surgical repair of rotator cuff tears result in an extensive rehabilitation being required. This process can be affected by various demographic, surgical and rehabilitative factors. There appear to be no studies relating these factors to the rehabilitation process. The aim of this study was to determine the prevalence of partial and full thickness tears seen in one physiotherapy practice over the period of four and a half years. It also was to identify and analyse the factors affecting the amount of physiotherapy following a rotator cuff repair. Methods This was a retrospective record review. It was also a cross sectional correlational study. Results The prevalence of partial and full thickness rotator cuff tears seen over a period of four and a half years in one physiotherapy practice is very similar. Partial thickness tears constituted 46% of the entire sample and full thickness made up 54% of the sample. Four out of eleven factors were found to be associated with the amount of physiotherapy received after a rotator cuff repair. These factors included the age of the patient, whether the patient was injured on duty, iv preoperative physiotherapy and additional procedures after surgery such as a revision of the repair or a manipulation of the shoulder. Conclusion There are only a few factors shown to be associated with the rehabilitation process after a rotator cuff repair. These factors would need to be correlated against outcome in future studies.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal, 2002. / Purpose . Rotator cuff tendinitis is a common problem, however, its diagnosis and management is not completely understood. The purpose of this research project was to investigate the efficacy of the chiropractic adjustment to determine whether or not it is an effective approach in the treatment of rotator cuff tendinitis. Methods This randomized controlled trial consisted of two groups. Each group consisted of thirty subjects, of any age, selected from the general population and randomly allocated to Group 1 or 2, participation in this trial was voluntary. Group 1 received chiropractic adjustment of the glenohumeral or acromioclavicular joint according to the fixations found on motion palpation and group 2 received placebo laser. Subjects in both groups had to comply with certain inclusion criteria before being allowed to participate in the study. Goniometer readings were taken to measure range of motion, algometer readings to measure pain threshold and the Numerical Pain Rating Scale was answered at the initial consultation, and on the third and sixth consultations. The Unpaired and Friedman's T- tests were used to assess the intra and intergroup information from the first, third and sixth consultations. Groups 1 and 2 were compared in terms of age, gender, race and clinical severity prior to onset. / M

Aim: This pilot study compared the efficacy of superficial dry needling (SDN), deep dry needling (DDN), placebo dry needling (PDN) and a common physiotherapy control group (CON) when used in the treatment of myofascial trigger points (MTrPs) in rotator cuff syndrome (RCS) patients. Methodology: A randomised, single-blind, placebo-controlled pilot study (n=20) was conducted comparing the three needling groups to each other and to a common physiotherapy protocol. Participants were selected patients presenting for treatment in a private practice. The objectives of the study were to compare the groups on three levels: Pre trial-Post trial, within individual treatment session (Intra-treatment), and between treatment sessions (Inter-treatment). All groups were treated with the same basic common protocol but three of them had the addition of one each of the needling interventions. A modified Constant-Murley scale, range of motion and power were used as outcomes measures. Ethical permission was obtained from the University of the Witwatersrand. Results: Results were analysed for the four groups using an ANCOVA. DDN had significant improvement over CON over the trial period (p≤0.05) and SDN (p≤0.02). This was particularly due to highly significant intra-treatment effect on internal range of motion at session 3 (p≤0.01) and the highly significant inter-treament effect between session 3 and 4 (p≤0.03). DDN was significantly less effective than the other groups at session 3 (p≤0.01) and session 4 (p≤0.03). External rotation power was also significantly greater for DDN between sessions 2 and 3 (inter-treatment) (p≤0.05). 49% of the MTrPs identified were found within the infraspinatus muscles. Discussion: Twitch-obtaining dry needling (DDN) appears to show greater clinical benefit on the effects of myofascial trigger points than SDN, CON or PDN. The effect appears to correlate with the greater incidence of MTrPs in the infrapinatus muscles whose functions directly relate to the improved parameters. The clinical effect may be related to the effects of the bleeding elicited by intramuscular needling (humoral effects). This is evidenced by the transiently poor effect of DDN immediate following treatment becoming significanly better by the following treatment. Conclusion: The pilot study showed that DDN may be an effective treatment for RCS when used in conjunction with a conventional physiotherapy programme. The elicitation of a local twitch response and associated bleeding may be significant. In future studies, particular attention should be paid to both the infraspinatus muscle and the timing of the intervention and observation intervals.

Previous investigations have indicated that shoulder stiffness was related with the degree of inflammation and the number of myofibroblasts in subacromial bursa tissue of rotator cuff lesions. But the interaction mechanism between inflammatory cytokines and myofibroblasts induced shoulder stiffness has not been fully explored. The purpose of this research is to study the effect of IL-1 £] on myofibroblasts in rotator cuff lesions with shoulder stiffness. Myofibroblasts from subacromial bursa tissue of rotator cuff lesions were cultured with or without IL-1 £]. The gene and protein expression of £\-smooth muscle actin (£\-SMA) and prolyl 4-hydroxylase (PH-4) were determined. The results showed that high levels of PH-4 and low levels of £\-SMA were expressed in myofibroblasts cultured with IL-1 £]. PH-4 gene had higher expression in tissue of stiff patients than non-stiff patients, but £\-SMA gene expression had no significant difference. According to the results, myofibroblasts cultured with extra IL-1 £] showed increased PH-4 expression and decreased £\-SMA expression. This indicates myofibroblasts might transdifferentiate into fibroblasts via IL-1 £] effect.

Analysis techniques specific to the proximal upper extremity have historically been overlooked in the field of ergonomics. This research effort provides a methodology that will allow the ergonomics practitioner to analyze a job and predict whether or not that job exposes workers to increased risk of proximal upper extremity disorders. Literature from the fields of physiology, biomechanics, and epidemiology was assimilated in order to understand the theories of pathogenesis of disorders in the rotator cuff and to identify the risk factors associated with proximal upper extremity disorders. A retrospective epidemiological study was conducted to identify job task variables that may contribute to the occurrence of proximal upper extremity disorders. Two proximal upper extremity constructs were proposed: a fatigue-based model and a compressive load-based model. The constructs incorporated lessons learned from the literature and results from the epidemiological study. Validation of the models was performed using data from the epidemiological study. It was determined that the fatigue-based model was a good predictor of proximal upper extremity disorders.

Many electrophysiological experiments require the recording, stimulating, or both in the peripheral nervous system. There are many electrodes currently on the market, but they are either not designed for implantation or are not robust enough to be used multiple times in situ. The cost of buying these electrodes from a manufacturer can be prohibitive and many labs prefer to make their own. This introduces variability between studies, as different techniques and configurations in the design and fabrication of electrodes can create variance in electrical impedance, spatial arrangement, or other factors. This paper presents a detailed methodology for the construction of electrodes that are robust, have uniform impedance values of Z = 2.38 ± 0.906 kΩ. at 1 kHz alternating current (AC), and can be used in multiple in vitro or in situ experiments, or for chronic implantation in vivo. This method will reduce the amount of time and material needed to construct electrodes for experimental studies in animals.

Spinal cord injury results in life-long damage to sensory and motor functions. Recovery from these injuries is limited and often insufficient because the lack of stimulation from supraspinal systems results in further atrophy of the damaged neural pathways. Current studies have shown that repeated sensory activity obtained by applying stimulation enhances plasticity of neural circuits, and in turn increases the ability to create new pathways able to compensate for the damaged neurons. Functional electrical stimulation has been proven to show success in this form of rehabilitation, but it has its limitations. Stimulating neural pathways with electricity results in also stimulating surrounding neurons and muscle tissue. This results in attenuation of the intended effect. The use of optogenetics mitigates this issue, but comes with its own complications. Optogenetics is a growing method of neural stimulation which utilizes genetic modification to create light activated ion channels in neurons to allow for activation or suppression of neural pathways. In order to activate the neurons, light of the appropriate wavelength must be able to penetrate the nerves. Applying the light transcutaneously is insufficient, as the skin and muscle tissue attenuate the signal. The target nerve may also move relative to an external point on the body, creating further inconsistency. Specifically in the case of using a rat model, an external object will be immediately removed by the animal. This thesis seeks to address this issue for a rat model by designing a nerve cuff capable of both optical and electrical stimulation. This device will be scaled to fit the sciatic nerve of a rat and allow for both optical activation and inhibition of the neural activity. It will be wired such that each stimulus may be operated individually or in conjunction with each other. The simultaneous stimulation is required in order to validate the neural inhibition facet. The circuit itself will be validated through the use of an optical stimulation rig, using a photoreceptor in place of an EMG. The application of the cuff will be verified in a live naive rat. Aim 1: Design and build an implantable electrical stimulation nerve cuff for the sciatic nerve of rats. An electrical nerve cuff for the sciatic nerve of a rat will be designed and assembled such that it is able to reliably activate the H-reflex. For it to be used in a walking rat, the cuff must be compatible with a head mount in order to prevent the rat from being able to chew at the wiring or their exit point. The cuff will be controlled through a Matlab program that is able to output specified signals and compare these outputs directly with the resultant EMG inputs. Aim 2: Implement LEDs onto the cuff and perform validation experiments. Light delivery capability will be added to the cuff through the use of LEDs. The functionality of the cuff will be validated through tests on naive rats. If successful, only an electric stimulation will result in a muscle twitch. An optical stimulation should result in no twitches, which would then validate that no current is leaking from the nerve cuff, given that the rat does not express any light sensitive protein channels. Ultimately, with a rat expressing ChR2 opsins on the sciatic nerve, an activation of the nerve using a blue light of wavelength 470nm will result in activating an h-wave without an m-wave when optically stimulated. Similarly, using the nerve cuff with a rat expressing ArchT opsins will result in suppressing the h-wave from an electric stimulation once the sciatic nerve is illuminated with green light of a wavelength of 520 nm. / Bioengineering

Bakgrund Bristfällig kuffhantering kan leda till skador på slemhinnan, bidra till ineffektiv ventilation och mikroaspirationer som kan leda till ventilatorassocierad pneumoni (VAP). I dagsläget skiljer sig handhavandet åt och det finns inget standardiserat handhavande av kuffen hos patienter med endotrakealtub eller trakealtub. Specialistsjuksköterskor inom intensivvård ansvarar för säkerställandet av ett evidensbaserat yrkesutövande som stärker patientsäkerhet. Syfte Syftet var att sammanställa kunskapsläget gällande kuffhantering hos vuxna patienter på intensivvårdsavdelningar för att bidra till ökad patientsäkerhet. Metod Systematisk litteraturöversikt av kvantitativa studier med en induktiv ansats. 16 vetenskapliga studier inkluderades och kvalitetsgranskades med hjälp av en granskningsmall för kvantitativa studier. Deskriptiv syntes med narrativ analys användes för resultatet. Resultat Resultatet redovisades utifrån två huvudteman; mätmetoder ochomvårdnadsåtgärder som påverkar kufftrycket. Sex subteman skapades till de två temana. Resultatet visade att meningsskiljaktigheter råder huruvida kontinuerlig mätning anses vara mer fördelaktigt än intermittent mätning. Vidare pekade resultatet på att olika omvårdnadsåtgärder kontribuerar till förändringar av kufftrycket. Slutsats Resultatet tyder på att kuffhantering är komplext. Kufftrycket påverkas av flera faktorer och bör följas regelbundet, en exakt definition på hur ofta går dock ej att fastställa. För att intensivvårdspatienter skall erhålla evidensbaserad vård, och därmed öka patientsäkerheten, behövs ytterligare forskning inom kuffhantering eftersom evidensen i nuläget är begränsad. Dock pekar uppsatsens resultat på att kontinuerlig mätning kan vara fördelaktigt utifrån ett patientsäkerhetsperspektiv, eftersom på-och avkoppling av manometer sågs vara ett riskmoment. / Background Inadequate cuff-management can lead to mucosal damage, contribute to ineffective ventilation and microaspirations that can lead to ventilator-associated pneumonia (VAP). At present, there are differences in practice and no standardized practice of cuff-management in patients with endotracheal tubes or tracheal tubes. Specialist nurses in intensive care are responsible for ensuring evidence-based professional practice that enhances patient safety. Aim The aim was to summarize the current state of knowledge on cuff-management in adult patients in intensive care units to contribute to improved patient safety. Method Systematic literature review of quantitative studies with an inductive approach. 16 articles were included and quality reviewed using a review template for quantitative studies. Descriptive synthesis with narrative analysis was used for the results. Result The results were presented using two main themes; measurement procedures and nursing interventions that influence cuff pressure. Six subthemes were created for the two themes. Opinions are divided as to whether continuous measurement is considered more beneficial than intermittent measurement. Furthermore, nursing-interventions were found to influence the cuff pressure. Conclusion Cuff-management is a complex topic. Cuff pressure is influenced by several factors and should be monitored regularly, however, how often is not possible to determine. For intensive care patients to receive evidence-based care and thereby increase patient safety, further research in cuff-management is required as the evidence is currently limited. However, continuous measurement may be beneficial from a patient safety perspective, as switching on and off the manometer is considered a risk factor.

The purpose of this study is to evaluate anatomical variations of the coracoacromial ligament (CAL) in relation to the etiology of subacromial impingement syndrome and rotator cuff tears. A knowledge and understanding of these variations will help to determine how such variations may influence the surrounding tissues and how the biomechanics of the shoulder works, as well as improving accurate diagnosis and subsequent treatment of shoulder impingement syndrome. The methodological approach involved the dissection of 220 cadaveric shoulders in the Centre for Anatomy and Human Identification (CAHID) with a mean age of 82 years (range 53 to 102 years). The CAL was classified according to its morphology and composed band number. The rotator cuff tendons were inspected for tears that were categorized into partial bursal and complete tears. Furthermore, the study inspected the CAL’s parameters and attachment sites: degenerative changes include acromial and coracoid spurs and attrition lesions at the undersurface of the acromion. Results: the multiple banded ligament was the most commonly observed type and was seen in 101 (46%) specimens. The attachment sites of the ligament varied as the size or number of bands of the ligament increased. An association was found between rotator cuff tears and shoulders which had three or more CAL bands (52%). In addition, shoulders with rotator cuff tears had wider attachments, thicker ligaments and larger subacromial insertions. Shoulders with rotator cuff tears also had a significant incidence and size of acromial spurs. The size of the spurs was correlated with the size of the CAL and attrition lesions on the undersurface of the acromion, and changes in morphology of the acromion. Attrition lesions at the subacromial insertion of the CAL were associated with tears in the rotator cuff tendons, and worsened as the size of the subacromial insertion increased. In conclusion, anatomical variations of the CAL showed a relationship with rotator cuff tears.