Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth. Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rating Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined. Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections. Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.

Title: The effect of shoulder girdle stabilization exercises on muscle activity during direct impact in rugby players with sub-acromial impingement syndrome Objectives: Comparison of muscle activity during direct impact while performing the rugby tackle to tackle bag and to player using electromyographic amplitude analysis before and after intervention programme for players with subacromial impingement syndrome (SIS). Application of intervention programme consisting stabilization excercises for shoulder complex and activation of deep stabilization muscles of the spine. Methods: Theoretical part contains topics about shoulder girdle, rugby and rugby injuries, mainly subacromial impingement syndrome. Mentioned issues are included into the thesis due to the research of current literature from international sources and studies. Practical part regards the aplication of three-months long intervention programme for eight players at junior national level with diagnosis of SIS, when pre-testing a post-testing is realized by clinical tests and EMG measurement. Assessment of enter and control examination is realized with analysis of variance ANOVA. Results: Intervention programme was sufficient for changes in EMG amplitude for two muscle groups in rugby players with SIS. Hypothesis comparing the EMG measure...

TitleVVVVVVV VVVVV Objectives:VVV VVVVVVVVV VVVVVV Methods: VVVVVVVV VVVVVVVVV VVVVVVVVV VVVVVVVVV VVVVVVVVV VVVVVVVVV VV Results VVVVVVVVV VVVVVVVVV VVVVVVVVV V Key words Comparative analysis of chosen muscles in locomotion through shoulder girdle The aim of this study is to describe and to compare the canoe forward stroke with selected exercises performer during indoor training The research was conducted in an intentionally chosen sample of ten probands with high level of performance in whitewater slalom. We watched activity of ten selected muscles during canoe forward stroke, on simulator, diagonal pull, stretch of arms with elastic resistance, dumbbell pulls and pull ups by surface electromyography. Study evaluates intraindividual and subsequently interindividual the size of the muscle activation considering reference movement, forward stroke on flat water. The results proved similarities of the forward stroke and on simulator in terms of average muscle activation. M. latissimus dorsi shows higher activation during canoe forward stroke, on simulator, stretch of arms with elastic resistance, dumbbell pulls compared with other tested exercices. locomotion through the shoulder girdle, shot, canoeing, paddling, electromyography, muscular activity

Title Objectives: Methods: Results Key words Comparative analysis of chosen muscles in locomotion through shoulder girdle The aim of this study is to describe and to compare selected exercises performer during indoor training toward the canoe forward stroke. The research was conducted in an intentionally chosen sample of ten probands with high level of performance in whitewater slalom. We watched activity of ten selected muscles during canoe forward stroke, on simulator, diagonal pull, stretch of arms with elastic resistance, dumbbell pulls and pull ups by surface electromyography. Study evaluates intraindividual and subsequently interindividual the size of the muscle activation considering reference movement, forward stroke on flat water. The results proved similarities of the forward stroke and on simulator in terms of average muscle activation. M. latissimus dorsi shows higher activation during canoe forward stroke, on simulator, stretch of arms with elastic resistance, dumbbell pulls compared with other tested exercices. locomotion through the shoulder girdle, shot, canoeing, paddling, electromyography, muscular activity

No description available.

Die vorliegende Arbeit untersucht, inwieweit sich minimalinvasive Zugangswege gegenüber der medianen Sternotomie bei isolierten Aortenklappeneingriffen positiv auf die postoperative Schultergelenks- und Schultergürtelmobilität auswirken. Die Beurteilung erfolgt dabei postoperativ primär durch Anwendung des Constant-Murley-Score (CMS). Weiterhin werden der Disabilities of the Arm, Shoulder and Hand Fragebogen (DASH) sowie Untersuchungen von Gelenkbeweglichkeiten und Muskelfunktion (Verlängerbarkeit und Kraft) durchgeführt. Bis dato existiert kein gesondertes Testinstrument zur Beurteilung der funktionellen Einheit Schultergürtel / Schultergelenk in der Herzchirurgie. Existierende Untersuchungen deuten jedoch darauf hin, dass größere, insbesondere herzchirurgische Eingriffe sowohl lokal als auch systemisch Einfluss auf die Funktionalität von Muskulatur haben. Sei es durch direkte Affektion oder aufgrund postoperativer Immobilisation. Für den DASH gibt es ebenfalls bereits veröffentlichte Ergebnisse, die eine Verschlechterung der Funktion der oberen Extremität nach einer Herz-OP zeigen. Bei Betrachtung der Ergebnisse des CMS in dieser Arbeit haben die Patienten nach minimalinvasivem Aortenklappenersatz sowohl rechts (78,9±10,4 minimalinvasiv vs. 60,8±8,6 konventionell, p<0,01) als auch links (80,0±8,0 minimalinvasiv vs. 61,8±5,6 konventionell, p<0,01) eine signifikant bessere Schulterfunktion als nach medianer Sternotomie. Auch die Ergebnisse des DASH zeigen nach minimalinvasiver Operation eine signifikant bessere Funktion der oberen Extremität (40,9±13,6 minimalinvasiv vs. 62,5±22,1 konventionell, p=0,02). Die Beweglichkeitsuntersuchungen lassen bessere postoperative Ergebnisse bei den minimalinvasiv Operierten, insbesondere für nach vorne gerichteten Bewegungen, wie der Protraktion links (20±2,9° minimalinvasiv vs. 13±5,7° konventionell, p<0,01) und der horizontalen Adduktion rechts (115±9,8° minimalinvasiv vs. 103±9,7° konventionell, p=0,03), erkennen. Muskelverlängerbarkeit und -kraft hingegen offenbaren in diesem Setting keine signifikanten Unterschiede zwischen minimalinvasiver und konventioneller Gruppe. Ein Grund dafür kann unter anderem das lange Untersuchungsintervall postoperativ sein. Aufgrund der kleinen Anzahl eingeschlossener Patienten ist die statistische Aussagekraft dieser Arbeit eingeschränkt. Insgesamt wird jedoch die Annahme unterstützt, dass minimalinvasive Verfahren in der Aortenklappenchirurgie eine bessere Funktion der Schulter postoperativ ermöglichen, als dies durch die mediane Sternotomie der Fall ist. Diese bessere Funktion lässt sich durch etablierte Instrumente wie den Constant-Murley-Score sowie den DASH-Fragebogen darstellen.

Title The most often problems in shoulder girdle of women basketball players and options of physiotherapeutic affect. Objectives The main goal of the thesis is in theoretical part to summarize potentional problems in shoulder girdle of basketball players, options and solutions of these problems. There is complex examination of shoulder girdle of dominant upper limb of women basketball players in an experimental part and figure out where is the main problem in this part. Methods There are two parts of the thesis, the first one is the theoretical background for second experimental part where complex functional physiotherapeutic examination of shoulder girdle with using of aspection, palpation and special tests for shoulder girdle were made. The most often problems in shoulder girdle of women basketball player has been determined by using the results of testing process. Results Testing of shoulder girdle of women basketball players showed how often blockage of ribs is. Blockage of fifth rib was present in 90% of the probands, frequent was also decentred position of shoulder and shoulder blade, hypertone of upper fixators of shoulder blade and pectoral muscles. Most of probands had restriction of passive motion to segment in thoracic spine and hypermobility of shoulder. Often was present weakness of...

The aim of this study is to evaluate the effect of dynamic stabilizing strategy on handgrip and pinchgrip strength. Exercise utilized in this study was based on rehabilitative approach called Dynamic Neuromuscular Stabilization (DNS) - a developmental kinesiology approach. The exercise program consisted of four primal developmental positions (3½ month supine position, oblique sitting position with support on forearm, position on all fours, and the "bear" position). A study file consisted of ten females who were instructed in basic scheme of DNS exercise. They were instructed to exercise at home five times weekly for a 6- weeks period. One exercise lesson took about thirty minutes. Both handgrip and pinchgrip strength was measured using the digital dynamometer CITEC CT 3001 recording maximum voluntary isometric contraction (MVIC). Three-pinch grip strength and fist grip strength was measured for both upper extremities. Fist grip strength was measured in three positions of forearm (pronation, supination and neutral position). Overall eight variables (for each extremity, grip form and position of the forearm) measured before and after exercise program were compared using the paired t-test. Significant increase in muscle strength (p<0,05) was identified for all eight variables after a 6 weeks exercise...

INTRODUÇÃO: As distrofias musculares de cinturas (DMC) representam um grupo heterogêneo de desordens hereditárias e degenerativas da musculatura esquelética, com evolução progressiva, caracterizadas pelo acometimento predominante das cinturas escapular e/ou pélvica. São classificadas de acordo com o padrão de herança e o gene envolvido, podendo ser autossômicas dominantes ou autossômicas recessivas. No presente estudo, foi feita a análise de pacientes com diagnóstico de distrofia muscular de cinturas 2B (DMC2B). Trata-se de condição autossômica recessiva, cujo gene envolvido na sua fisiopatologia é o DYSF; sua mutação pode associar-se a alterações na proteína disferlina. OBJETIVOS: Avaliar a distribuição da fraqueza muscular na distrofia muscular de cinturas 2B com ênfase no acometimento dos membros superiores; realizar avaliação objetiva da força muscular para preensão palmar e pinças; correlacionar a força muscular dos diferentes movimentos com a idade de início dos sintomas, idade na ocasião da avaliação, tempo de evolução da doença e capacidade funcional. METODOLOGIA: Estudo prospectivo, observacional, corte transversal, caso-controle. Foi feita avaliação clínica da força muscular de membros superiores e superiores dos pacientes, através de instrumentos clínicos específicos e dinamômetro de pinça e de preensão palmar; adicionalmente, foram aplicadas escalas de capacidade funcional (Escala de Vignos e Escala de Brooke). RESULTADOS: Foram avaliados 12 pacientes com diagnóstico molecular confirmado de DMC2B e recrutados 41 pacientes para o grupo controle. Os grupos não diferiram por gênero nem nas médias etárias. A média da idade de início dos sintomas dos pacientes foi de 26,9 anos (DP 10,05); a idade média na ocasião da avaliação foi de 43,6 anos (DP 9,34). A avaliação clínica da força muscular evidenciou maior acometimento de membros inferiores em relação aos membros superiores. A dinamometria de pinça (bidigital e trigidital) e de preensão palmar evidenciou diferença significativa entre os pacientes e o grupo controle para todos os movimentos citados. Os valores de CK apresentaram média de 2769 U/L (cerca de quinze vezes o limite superior de normalidade). As escalas de avaliação de capacidade funcional evidenciaram uma correlação significativa entre a idade do paciente na ocasião da avaliação e o escore na escala de Brooke. CONCLUSÃO: A análise do padrão de fraqueza dos pacientes com DMC2B evidenciou acometimento de membros inferiores e também de membros superiores. A análise objetiva com dinamometria demonstrou acometimento em todos os movimentos avaliados, evidenciando o envolvimento distal de membros superiores. A análise da capacidade funcional de membros superiores apresentou correlação com idade na avaliação (quanto maior a idade do paciente, maior o grau de incapacidade para membros superiores). Os valores de CK e de força muscular correlacionaram-se com a idade do início dos sintomas e idade na avaliação, ou seja, o início mais precoce da doença correlacionou-se com quadros mais graves (maiores valores de CK e maior envolvimento de força muscular - principalmente distal de membros superiores) / INTRODUCTION: Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of hereditary and degenerative disorders of the skeletal muscle, with progressive evolution, characterized by the predominant involvement of the scapular and / or pelvic girdles. They are classified according to the inheritance pattern and the involved gene, being autosomal dominant or autosomal recessive. In the present study, we evaluated patients with a diagnosis of 2D (LGMD2B). The LGMD2B is an autosomal recessive condition whose gene involved in its pathophysiology is DYSF; its mutation may be associated with changes in protein dysferlin. OBJECTIVES: To assess the distribution of muscle weakness in 2D womb muscular dystrophy with emphasis on upper limb involvement; perform objective evaluation of muscle strength for palmar grip and forceps; to correlate the muscular strength of the different movements with the age of onset of symptoms, age at the time of evaluation, duration of disease and functional capacity. METHODS: Prospective, observational, cross-sectional, case-control study. Clinical evaluation of the muscular strength of the upper and upper limbs of the patients was made through specific clinical instruments and pinch dynamometer and palmar grip; In addition, functional capacity scales were applied (Vignos Scale and Brooke Scale). RESULTS: Twelve patients with confirmed molecular diagnosis of DMC2B were evaluated and 41 patients were recruited for the control group. The groups did not differ by gender nor in the age groups. The mean age of onset of the patients\' symptoms was 26.9 years (SD 10.05); the mean age at the time of the evaluation was 43.6 years (SD 9.34). The clinical evaluation of muscle strength showed a greater involvement of the lower limbs in relation to the upper limbs. Pinch dynamometry (bidigital and trigidital) and handgrip dynamometry showed a significant difference between the patients and the control group for all the mentioned movements. CK values presented a mean of 2769 U / L (about eight times the upper limit of normality); there was a significant negative correlation (p <0.01) between the age of the patient at the time of the evaluation and the maximum value of CK. The functional capacity evaluation scales showed a significant correlation between the age of the patient at the time of the evaluation and the score on the Brooke scale. The correlation values between the muscular strength between the different movements evaluated and the age of onset of symptoms, age at the time of evaluation and time of evaluation of the disease presented values of significance close to 0.05 for the upper limb distal muscles and age of onset and age at the time of evaluation. CONCLUSION: The analysis of the weakness pattern of patients with LGMD2B showed involvement of lower limbs as well as upper limbs. Objective analysis with dynamometry showed involvement in all the movements evaluated, showing the distal involvement in the upper limbs. The analysis of functional capacity of upper limbs showed correlation with age in the evaluation (the higher the patient\'s age, the greater the degree of incapacity for upper limbs). The values of CK and muscle strength correlated with the age of onset of symptoms and age at the assessment, ie the earlier onset of the disease was correlated with more severe conditions (higher CK values and greater involvement of muscle strength - mainly distal upper limbs)

Introdução: As disferlinopatias são doenças genéticas causadas por alterações no gene da disferlina (DYSF), também denominadas distrofia muscular de cinturas (DMC) do tipo 2B, sendo a segunda em frequência em diversos países. A determinação de biomarcadores de função muscular desta doença se faz necessária. Objetivo: Estudo de caracterização da força e da função muscular nas disferlinopatias para estabelecer biomarcadores de habilidades motoras. Método: Amostra de 40 pacientes com dados de prontuário de força muscular (Medical Research Council - MRC), índice MRC, tempo de deambulação de 10 metros e, escalas de Vignos, Egen Klassifikation, Avaliação Funcional para distrofia muscular de Duchenne (FES-DMD) e North Star Ambulatory Assessment adaptada (a-NSAA). Resultados: Prevalência da disferlinopatia de 25,5% no Centro de Pesquisa sobre o Genoma Humano e Células Tronco, idade média de 36,5 anos, 52,5% do sexo masculino e 75% deambuladores. Músculos mais acometidos: abdominal, glúteo, íliopsoas, isquiotibial, quadríceps femoral, tibial anterior e deltoide médio. Correlação forte entre MRC e tempo de deambulação de 10 metros (média r=0,77) e, muito forte da MRC distal dos MMII com a-NSAA (r=0,90). Interação da MRC dos membros superiores (MMSS) e membros inferiores (MMII) entre os segmentos proximal e distal (p < 0,001), sendo mais evidente em MMSS do que em MMII. Taxa variável de progressão da doença, com 60% dos pacientes moderadamente ou gravemente afetados com menos de 12 anos de doença. Conclusão: Os achados caracterizam o padrão de fraqueza muscular dos brasileiros com disferlinopatia como proximal e distal dos MMII, com comprometimento associado da região proximal dos MMSS, além de elucidar as habilidades motoras em relação ao processo de locomoção. A forte correlação encontrada entre a força muscular, o tempo de deambulação de 10 metros e a escala a-NSAA, associada ao acompanhamento da evolução do desempenho de alguns grupos músculos podem fornecer um biomarcador adequado para o estudo da doençaCharacterization of muscle strength and function in Brazilian subjects with dysferlinopathy / Introduction: Dysferlinopathies are genetic diseases, caused to changes in the disferlina gene (DYSF), also named limb-girdle dystrophy type 2B, that is the second one in frequency in several countries. The small number of biomarkers of functional performance researches brings the need for studies in this area. Objective: This study characterizes muscle strength and function in subjects with dysferlinopathy to establish biomarkers of motor skills. Method: Data were available from 40 patients and included muscle strength assessment using the Medical Research Council (MRC) power scale, MRC index, timed motor performances for walking and data from the Vignos, Egen Klassifikation, Functional Assessment for Duchenne muscular dystrophy (FES-DMD) and the adapted North Star Ambulatory Assessment (a-NSAA) scales. Results: The prevalence of dysferlinopathy was 25.5% in the Centre for the Study of the Human Genome and Stem Cells (CEGH-CEL), the mean cohort age was 36.5 years, 52.5% were males and 75% were walkers. The weaker muscle found were the abdominal, gluteus, iliopsoas, hamstrings, quadriceps femoris, tibialis anterior and medial deltoid. Strong correlations were observed between the MRC power score and walking time (r = 0.77) and very strong between the MRC distal lower limb power score and a-NSAA (r = 0.90). Interactions of MRC scores were observed between the upper and lower limbs and the proximal and distal regions (p < 0.001) but were more evident in the upper limbs. The disease progression rates were variable with 60% of patients moderately or severely affected after more than 12 years since diagnosis. Conclusion: These findings suggest the pattern of muscular weakness in Brazilians with dysferlinopathy is predominantly in the lower limbs (proximal and distal) with associated involvement of the proximal upper limbs and elucidates the motor abilities in relation to locomotion. Due to the strong correlation with muscle strength, the walking time and the a-NSAA scale, in association with monitoring the evolution of the performance of some specific muscles can provide a suitable biomarker for the study of the disease