Rotator cuff (RC) muscle insertion was previously thought to consist of singular, individual tendons inserting onto predefined areas on the greater and lesser tuberosities. However, more recent publications describe the RC muscle tendons as forming a singular insertion across the tuberosities, consisting of both tendinous and capsular portions. Orthopaedic surgeons are now considering these two layers in their surgical approach and treatment plans; therefore this study aimed to test and compare the elastic modulus and maximum load to failure for both tendinous and capsular layers taken from supraspinatus (SS), infraspinatus (IS) and subscapularis (SC). Fourteen (n = 14) fresh/frozen arms were used in this study. Each RC muscle was reverse dissected and trimmed to a 2 x 2cm strip, which was separated into its two layers, still attached to the humerus. An Instron 1342 with a 1kN load cell was used to place the samples under tensile testing till failure (Newtons/N). Accompanying Integrated Design Tools (IDT) NX8-S2 cameras captured images for full-field strain measurements with the Image Systems TEMA software package through digital image correlation (DIC). SS, IS, and SC tendinous layers yielded higher average elastic moduli readings (72.34 MPa, 67.04 MPa, and 59.61 MPa respectively) compared to their capsular components (27.38 MPa, 32.45 MPa, and 41.49 MPa respectively). Likewise, the tendinous layers for SS, IS and SC all showed higher average loads to failure (252.74 N, 356.27 N and 385.94 N, respectively) when compared to the capsular layers (211.21 N, 168.54 N and 281.74 N, respectively). These biomechanical differences need to be taken into account during surgical repair owing to the fact that, should these layers be repaired as one singular structure, it may place the weaker less elastic, capsular layer under more strain, possibly leading to either re-tear complications or reduced postoperative healing and functionality. Thus, based on the results, it is recommended that surgeons consider and repair each layer independently for better postoperative biomechanical integrity. / Dissertation (MSc)--University of Pretoria, 2019. / Anatomy / MSc / Unrestricted

STUDY DESIGN: Block-counterbalanced, repeated-measures crossover study. OBJECTIVES: To assess scapular upward rotation positional adaptations to experimentally induced subacromial pain. BACKGROUND: Existing subacromial pathology is often related to altered scapular kinematics during humeral elevation, such as decreased upward rotation and posterior tilting. These changes have the potential to limit subacromial space and mechanically impinge subacromial structures. Yet, it is unknown whether these changes are the cause or result of injury and what the acute effects of subacromial pain on scapular upward rotation may be. METHODS: Subacromial pain was induced via hypertonic saline injection in 20 participants, aged 18 to 31 years. Scapular upward rotation was measured with a digital inclinometer at rest and at 30°, 60°, 90°, and 120° of humeral elevation during a painful condition and a pain-free condition. Repeated-measures analyses of variance were conducted for scapular upward rotation position, based on condition (pain or control) and humeral position. Post hoc testing was conducted with paired t tests as appropriate. RESULTS: Scapular upward rotation during the pain condition was significantly increased (range of average increase, 3.5°-7.7°) compared to the control condition at all angles of humeral elevation tested. CONCLUSION: Acute subacromial pain elicited an increase in scapular upward rotation at all angles of humeral elevation tested. This adaptation to acute experimental pain may provide protective compensation to subacromial structures during humeral elevation.

STUDY DESIGN: Block-counterbalanced, repeated-measures crossover study. OBJECTIVES: To assess scapular upward rotation positional adaptations to experimentally induced subacromial pain. BACKGROUND: Existing subacromial pathology is often related to altered scapular kinematics during humeral elevation, such as decreased upward rotation and posterior tilting. These changes have the potential to limit subacromial space and mechanically impinge subacromial structures. Yet, it is unknown whether these changes are the cause or result of injury and what the acute effects of subacromial pain on scapular upward rotation may be. METHODS: Subacromial pain was induced via hypertonic saline injection in 20 participants, aged 18 to 31 years. Scapular upward rotation was measured with a digital inclinometer at rest and at 30°, 60°, 90°, and 120° of humeral elevation during a painful condition and a pain-free condition. Repeated-measures analyses of variance were conducted for scapular upward rotation position, based on condition (pain or control) and humeral position. Post hoc testing was conducted with paired t tests as appropriate. RESULTS: Scapular upward rotation during the pain condition was significantly increased (range of average increase, 3.5°-7.7°) compared to the control condition at all angles of humeral elevation tested. CONCLUSION: Acute subacromial pain elicited an increase in scapular upward rotation at all angles of humeral elevation tested. This adaptation to acute experimental pain may provide protective compensation to subacromial structures during humeral elevation.

Objective: To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. Design: Scoping review. Literature Search: We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. Study Selection Criteria: We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. Data Synthesis: We performed a qualitative synthesis that identified items included in patient advice and education. Results: Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. Conclusion: While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change.

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<p>The purpose of the thesis was to evaluate the neuromuscular control of shoulder muscles when performing concurrent shoulder and hand or elbow efforts in healthy and injured individuals. Of particular interest was the response of the supraspinatus and infraspinatus muscles to performing an additional hand task, such as gripping, while also performing different shoulder actions. Two studies were undertaken to provide the necessary groundwork for the subsequent two studies of this thesis. The first study investigated whether changes to shoulder muscle activity previously seen with gripping where the result of the novelty of using feedback to regulate grip force. This study found that changes in shoulder muscle activity with gripping are not diminished with repetition. The second study provided an improved method of normalizing electromyograms from dynamic contractions and was used in the subsequent studies of this thesis. Studies 3 and 4 of this thesis examined the response of shoulder muscles in healthy individuals during static sub-maximal efforts and maximal dynamic efforts in flexion and scapular planes with neutral and supinated forearm postures. Three conditions were tested in both studies: (i) no additional load, (ii) gripping to 30% of maximum and (iii) contracting the biceps to 30% of maximum. A prevailing theme found during sub-maximal contractions was individuality in neuromuscular recruitment strategies and precluded any significant effects of gripping or biceps contractions. During dynamic contractions, concurrent shoulder efforts with gripping and biceps contractions was found to significantly decrease deltoid, supraspinatus and infraspinatus muscle forces during flexion with supinated forearm posture. This thesis provided a thorough examination of shoulder electromyography in healthy individuals, improving our understanding of the neuromuscular control of the shoulder musculature. A common theme of this thesis was the individuality of neuromuscular strategies of the shoulder.</p> / Doctor of Science (PhD)

Yes / Non-invasive imaging methods are required to monitor the inflammatory content of atherosclerotic plaques. FEDAA1106 (N-(5-fluoro-2-phenoxyphenyl)-N-(2-(2-fluoroethoxy)-5- methoxybenzyl) acetamide) is a selective ligand for TSPO-18kDa (also known as peripheral benzodiazepine receptor), which is expressed by activated macrophages. We compared 18F- FEDAA1106 and 18F-FDG (a marker of glucose metabolism) for PET imaging of vascular inflammation. This was tested using a murine model where focal inflammation was induced in the carotid artery via placement of a constrictive cuff. Immunostaining revealed CD68-positive cells (macrophages) at a disturbed flow site located downstream from the cuff. Dynamic PET imaging using 18F-FEDAA1106 or 18F-FDG was registered to anatomical data generated by CT/CT angiography. Standardized uptake values (SUV) were significantly increased at cuffed compared to contralateral arteries using either 18F-FEDAA1106 (p<0.01) or FDG (p<0.05). However, the 18F-FEDAA1106 signal was significantly higher at the inflamed disturbed flow region compared to the non-inflamed uniform flow regions, whereas differences in FDG uptake were less distinct. We conclude that 18F-FEDAA1106 can be used in vivo for detection of vascular inflammation. Moreover, the signal pattern of 18F-FEDAA1106 correlated with vascular inflammation more specifically than FDG uptake. / : This study was funded by the British Heart Foundation and through a grant from the Swiss National Science Foundation (310030_143343/1 to B.R.K.)

The prevalence of cardiovascular disease is on a continuous exponential growth across the globe. Thus, research into the underlying factors, effective methods of diagnoses, and preventive measures is necessary. Endothelial dysfunction is an early detector of cardiovascular diseases and can be used to inform people of preventative measures and early treatments before any extreme medical conditions occur. Something that is also on the rise and closely linked with cardiovascular disease is diabetes. There have been many past research studies that show the impact of diabetes on cardiovascular disease and more specifically endothelial dysfunction. A calibrated cuff plethysmography device is a promising solution to measure endothelial function by specifically looking at the arterial compliance of certain blood vessels. IN this study, a calibrated cuff plethysmography device was used to test for the impact diabetes has on arterial compliance. Although the results did not show significant differences between the diabetic and control group it shows trends that we would expect from previous studies and is promising for more research. In this study the results showed no statistically significant difference between the diabetics and non-diabetics with a p-value of 0.805677 for the 0 mmHg – 75 mmHg range and a p-value of 0.668734 for the 25 mmHg – 75 mmHg range. However, when comparing the baseline measurements to the hyperemia measurements for the 0 mmHg – 75 mmHg range there was a statistically significant difference with a p-value of 0.0034 for diabetics and a p-value of 0.04347 for the non-diabetics. Given this statistically significant difference, the device used was concluded to effectively measure arterial compliance and area.