Elbow joint laxity is a problem that normally comes with age; it increases up to critical levels due to rupture or damage to the ligaments of the elbow and affects the stability and capacities of the joint, interfering even with daily activities. This work investigates the kinematics of the elbow through in-vivo experimental measurement. To this end, a platform based on Stewart Platform mechanism was built and used at the bioengineering labs of Brunel University in West London, the UK, to measure the six degrees of freedom of the joint. This thesis aims to develop a method to simulate such motion which could be used for elbow implant design and manufacture. This work contributes to both the basic science of joint movement measurement and to the clinical applications of diagnosing elbow illness. In addition this research presents the preliminary results for a design for elbow implants. Tracking system developed in house was used to measure the degrees of freedom in healthy elbow motion. A pilot study was performed to assess the joint motion and its repeatability. A group of volunteers with normal elbow movement was used to carry out this study. A Stewart Platform mechanism based on the tracking system was used in this study as a non-invasive tool to capture elbow joint motion and track the trajectory and pattern of the motion in three-dimensional space. This thesis aimed to develop a method to simulate the elbow joint motion that could potentially be used for the elbow implants design and there manufacture. The goal of this study was achieved by in vivo measurement of the elbow movement. It was found that the results vary from person to person, but a healthy pattern of motion can be distinguished from an abnormal pattern. To ensure the result, the motion of the right and left hand of each person was compared,allowing the behaviour of the elbow motion to be judged and the results can help surgeons to analyze the motion of the elbow joint and follow up suspicions of abnormal behaviour in the joint or trace any possible joint laxity. Furthermore, the errors involved with the mechanism were calculated and appropriate factors were applied to correct them. As part of this study the manufacturing of medical implants was reviewed and discussed.

A dissertation proposal presented in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / Lateral epicondylitis is a relatively common disorder affecting approximately one third of the nearly thirty-two million tennis players worldwide. It usually presents as a chronic disorder that follows a remitting relapsing course, and as such represents a challenge to manage. At present the scientific literature does not favour any particular treatment modality and as such well designed placebo studies are required to assess the efficacy of the various modalities of treatment, with a long term view of establishing an effective treatment protocol to manage lateral epicondylitis. The purpose of this study was to determine the efficacy of dry needling the posterior distal muscles of the upper extremity as a treatment for lateral epicondylitis. Sixty patients were included in the study. They all under went a case history, physical examination and an elbow regional examination. They were then randomly allocated into the experimental or control groups. The thirty patients in the experimental group received dry needling while the thirty included in the control group received placebo or 'sham' needling. All participants in the study received three treatments over a nine-day period with subjective and objective measurements being taken before the 1st. 2nd, and 3rd treatments, with a 4th being taken after the third treatment. Examination of the statistical data revealed that a significant improvement in the experimental group versus the control group in terms of both subjective / M

M.Tech. (Chiropractic) / Lateral elbow tendinopathy is the most frequent periarticular lesion which affects 1% to 3% of the general population and is a difficult condition to manage with a wide range of procedures and management protocols advocated (Abrahamson and Comfort, 2010). This study aimed to assess the efficacy of managing lateral elbow tendinopathy using therapeutic ultrasound (U/S), interferential current (IFC) or alternatively a combination of IFC and therapeutic U/S in addition to chiropractic manipulative therapy of the cervical spine and elbow. This study was a comparative study consisting of three groups of ten participants each with an equal gender ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. Group A received therapeutic U/S; Group B received IFC and Group C received combination therapy of IFC and therapeutic U/S. All three groups received chiropractic manipulative therapy to the cervical spine and joints of the elbow complex. Subjective data was obtained using the Numerical Pain Rating Scale (NPRS). Objective data was obtained using the pressure algometer (pain pressure threshold) and the Jamar grip strength dynamometer (pain-free grip strength) on the affected side. The study was conducted over a course of three weeks for a total of seven visits per participant. Subjective and objective data was collected pre-intervention on the first and fourth visits and on the seventh evaluation only visit. Analysis of the data collected was performed by a statistician. All three groups showed statistically significant clinical improvements in all measures. The only group not exhibiting a statistical significance was the therapeutic U/S group in the initial pain pressure threshold results. In the objective measures of all intervals none of the groups showed statistical superiority over one another. However, the final NPRS results showed statistically significant improvement in therapeutic U/S and combination therapy groups over IFC alone. From the results it can be concluded that all groups were effective for lateral elbow tendinopathy in conjunction with chiropractic manipulative therapy. With respects to subjective pain therapeutic U/S and combination therapy appeared to have a greater efficacy than IFC, but no superior modality was identified with respects to objective measures.

M.Tech. (Chiropractic) / The purpose of this study was to establish whether cervical spinal manipulation induces an appreciable and sustainable alteration in muscle torque performance regarding the elbow flexor muscles. Forty asymptomatic individuals participated in this study. Twenty individuals were randomly assigned to either an experimental or control group. Participants selected had to be between 18 and 40 years of age and had to present with cervical motion restrictions involving the fourth to sixth cervical vertebrae, as determined by motion palpation assessment. Participants were randomly recruited from the University of Johannesburg and surrounding areas, based on their response to information pamphlets and word of mouth. The experimental group received cervical spinal manipulation involving the lower cervical segments on three separate occasions. The control group received no intervention. Elbow flexion torque assessments were conducted using the Biodex System 3, isokinetic dynamometer. Two assessments were done prior to intervention and one test following one week of intervention, to ascertain whether cervical manipulation can provoke a sustainable improvement in elbow flexion performance. Cervical range of motion (CROM) assessment was used as a secondary objective evaluation to assess the effectiveness of the manipulation procedures, considering that improvement in cervical range of motion following spinal manipulation is well documented. Minimal improvement in elbow flexion torque involving both arms was observed in the experimental group following one weeks‟ intervention however, no statistical significance was reported. Gender relations regarding the elbow flexion torque performances revealed and improvement in strength in the male participants and a reduction in performance in the female participants. Statistical significance was reported although the significance regarding intervention remains unclear. No sustainable improvement in elbow flexion torque was revealed following spinal manipulative therapy and therefore does not provide conclusive evidence to substantiate the motor neuron excitability theory. The contradictory results with regards to the female participants bring into context an indefinite and unfamiliar neuromusculoskeletal paradigm which requires additional research to clarify these anomalous findings.

Empirical and modelling studies are reported which explore ways in which the central nervous system might consider musculo-skeletal geometry when generating commands for single degree of freedom elbow flexion and extension movements. In a series of experiments it is shown that subjects do not perform rapid, goal-directed flexion and extension movements equally accurately in different parts of the elbow's workspace. In these experiments, movements of 10, 20 and 30 degrees in amplitude were tested using up to five different initial elbow angles. When performing flexions, subjects tended to overshoot targets when starting from extended positions, to undershoot targets when starting from more flexed positions, and to perform relatively accurate movements when starting from the centre of the workspace. Final position accuracy was more variable for extensions. When reliable differences existed for extensions, subjects tended to produce a pattern of results opposite to that of flexions: subjects overshot targets when starting from flexed positions and undershot targets when starting from more extended positions. A model of elbow movement based on the $ lambda$ version of the equilibrium-point hypothesis was used to assess the extent to which the pattern of errors obtained in the empirical studies could be reproduced by a control scheme that does not adjust commands in response to changing musculo-skeletal geometry, but rather uses one single invariant command throughout the workspace. The motivation for testing the invariant command notion was to explore the possibility that motion planning might be achieved without an explicit representation of musculo-skeletal geometry. Predicted patterns of final position errors across the workspace matched empirically obtained error patterns for flexions, but the model performed less well when predicting the pattern of errors observed for extension movements.