Title: Effect of rehabilitation intervention on soft tissue of shoulder joint in handball players Objectives: The aim of the thesis is to explore the benefits of 10-session conservative therapy in handball players diagnosed with throwing shoulder. The chosen therapy should eliminate the players' difficulties as much as possible and allow them to once again fully engage in the activity. Methods: Experiment-based qualitative research with randomized control study was conducted. The objective was to assess the findings of four probands - players of a major-league team - diagnosed with shoulder joint soft tissue injury caused by playing handball. Two women and two men between the ages of 19 and 30 took part in the research. The subjects were divided into two groups. The first group, a man and a woman, took part in 10 therapeutic sessions, whereas the other did not receive any kind of treatment and served as a reference group. Both initial and final kinesiologic examinations were carried out at the beginning and the end of the therapy, consisting of anamnesis, physical inspection, palpation, anthropometric and goniometric measuring, examination of muscle, muscle shortening, joint movement and movement stereotype. Measured data was analysed and evaluated. Results: After ten successive therapeutic...

A high degree of variability is commonly encountered in biomechanical investigations of the shoulder. Researchers have hypothesized that the variation between individuals explains why only certain workers are injured when performing the same tasks as other individuals. One source for the variability is inter-individual differences in shoulder musculoskeletal geometry. The purpose of this thesis was to use computational modeling to assess the functional roles of the scapulohumeral muscles, compare model-predicted data to the reviewed literature, and quantify the sensitivity of these functional roles to changes in muscle geometry. Muscle moment arms, lines of action, stability ratios, and forces were quantified throughout arm elevation in the scapular plane using a widely investigated upper extremity model. Monte Carlo simulations were performed to iteratively adjust muscle attachment locations in order to reflect potential inter-individual differences in muscle geometry. Model-predicted muscle moment arms agreed well qualitatively with the reviewed literature; however, several muscle lines of action were inconsistent between the model and previous data collected in cadavers available in the literature. Sensitivity of muscle functional roles to attachment changes was muscle-specific, and depended upon the elevation angle as well as outcome measure. Regressions were developed to identify which attachment locations at the clavicle, scapula, and humerus caused the greatest change in muscle functional roles. In general, muscle moment arms were most sensitive to changes of the muscle attachment closest to the joint centre (humeral attachment for rotator cuff muscles; scapular attachment for deltoids). Lines of action were most affected by perturbations in scapular attachment location. Overall, these findings indicate that inter-individual musculoskeletal geometry differences can substantially alter muscle functional roles, which are expected to require altered muscle activity and kinematic coordination patterns between people. These variations in musculoskeletal geometry may differentially affect risk of work-related shoulder musculoskeletal disorders among individuals. / Thesis / Master of Science (MSc)

Reverse shoulder arthroplasty (RSA) is performed to decrease pain and improve function and range of motion (ROM) primarily for patients with rotator cuff arthropathy, an arthritis of the shoulder secondary to rotator cuff insufficiency. However, RSA has suffered from high early to mid-term rates of complication, with instability being one of the most common. The shoulder biomechanics post-RSA depend on multiple factors such as implant geometry, positioning, and cuff integrity. This study built upon prior finite element (FE) analysis of RSA to investigate the effects of glenoid lateralization and retentive liner design on shoulder stability. A previously validated FE model was extended to model shoulder external rotation (ER) after implantation of the Zimmer Trabecular Metal RSA system. The FE model included the scapula bone with an implanted glenosphere implant, the humerus bone with implanted humeral sections of the RSA implant, and muscle tendons representing the subscapularis, infraspinatus, and deltoid. Six different models matched glenospheres in three cases of lateralization (2mm, 4mm, and 10mm) with two humeral poly liner designs (normal: 150° neck shaft angle or retentive: 155° neck shaft angle). Using Abaqus/Explicit FE software, the proximal ends of the soft tissues were pulled to their anatomical positions, and then fixed in space while the humerus was externally rotated 80° about the humeral long axis from a neutral position with the shoulder abducted 25°. The displacements, deltoid and subscapularis forces, impingement-free ROMs, and subluxation gap distances were recorded. Although greater glenosphere lateralization was associated with higher impingement-free ROM, larger deltoid and subscapularis forces developed. Deltoid tension contributes to shoulder stability and control, but elevated amounts of deltoid tension may contribute to scapular fractures and greater stress at impingement sites post-RSA. Further analysis such as inclusion of more anatomical features and additional motions may offer greater insight to orthopedic surgeons when planning for RSA insertion.

Introduction The length of a muscle has been described as one of the factors contributing to the ideal movement at a joint. A decrease in the length of a muscle results in a decrease in the range of motion at the joint in direct relation to the function of that specific muscle. M Latissimus Dorsi is a muscle which undergoes length changes (loss of extensibility) and this muscle has a functional role in many aspects of sport and rehabilitation. The loss of extensibility may result in a decreased range of motion at the glenohumeral joint leading to dysfunction. Evidence-based practise requires the use of objective, valid and reliable tests for measuring the length of a muscle. No scientific evidence of reliability for any documented technique testing the length of m Latissimus Dorsi (LD) was found. Aim The aim of this study was to assess the inter-rater and intra-rater reliability of a technique adapted by Commerford and Mottram (2012) for assessing the length of LD. Study design The design of the study is a within-participant test-retest non-experimental quantitative study for reliability purposes Method Fifty-six volunteering students recruited from the Physiotherapy Department of the University of Pretoria were the participants in this study. Four qualified physiotherapists with varying numbers of years of clinical experience independently performed the test for assessing the length of LD. The test was performed twice by each physiotherapist on every participant and two measurement sessions were done. A pilot study was also done. Data Analysis and conclusion A sample of 56 participants provided an intraclass correlation coefficient (ICC) of less than 0.9 and this is regarded as poor reliability. The agreement between each rater and the differences in the two levels of experience of raters were also assessed. The ICC was used to determine the inter-rater and intra-rater reliability of the LD length test. A 0.05 level of significance was employed. The ICC between the experienced raters was found to be 0.48 with a novice rater ICC of 0.48 as well. The ICC between all the raters was 0.33. This constitutes poor reliability. The poor reliability of the technique testing the length of LD was identified and addressed in order for adequate usage thereof, in research and in practice. Recommendations of a new technique to test the length of LD was provided by the researcher. A suggestion was made regarding a manner of testing its reliability. / Dissertation (MPhysT)--University of Pretoria, 2014. / Physiotherapy / MPhysT / Unrestricted

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Title: Evaluation of the physiotherapy effectiveness in women handball players with an anterior instability of the glenohumeral joint. Objectives: The aim of this diploma thesis is to summarize the anterior instability of the glenohumeral joint knowledge in women handball players. Subsequently to perform and evaluate the effect of the three months long physiotherapy intervention based on proprioceptive neuromuscular facilitation by which we wanted to eliminite the anterior instability of the glenohumeral joint. In the last part of the research are compared the results which were reached by the group which did the three months intervention program and the control group without any physiotherapeutical intervention. Methods: The experiment was performed in handball team HC Slavia Praha by women players range in age from 15 -19 years. It was carried out using 3 tests evaluating the instability of the anterior glenohumeral joint, which were evaluated by 2 different physiotherapists and 3 motor tests evaluating the explosive force of the upper limb. Testing was performed twice, before and after the three months long physiotherapeutical intervention. Results: After the three months intervention, there was a significant improvement of the results in the group which underwent the physiotherapy intervention....

The most frequent sequelae following an obstetric brachial plexus lesion without complete functional recovery concern the impaired shoulder rotation movements and the associated structural changes of the growing glenohumeral joint. <p>This pathology is often unrecognized and may lead to a limitation in active movements, a pathologic and less efficient motion pattern in the affected limb, and the development of a severely incongruent and dysplastic glenohumeral joint prone to further arthrosis.<p><p>Hypothesis<p><p>Glenohumeral dysplasia after obstetric brachial plexus lesion has multiple etiologies: A hypothetic obstetric trauma may precede the motor imbalance, due to the initial palsy and prevalent recovery of the medial rotators of the shoulder.<p>The correction of the muscular imbalance, by neurotization of the lateral rotators (supra- and infraspinatus muscle) using a local nerve transfer or by a later muscle transfer surgery, improves function, seems to prevent the development of joint dysplasia and limits the articular deformities once they are present. <p>The early (peripartal) glenohumeral subluxation must be recognized and treated immediately to prevent the development of a severe joint contracture and dysplasia.<p> <p>Material and methods<p><p>Two retrospective and one prospective study evaluate how surgery may correct the muscular imbalance.<p>In a first series of 65 children, we analyse the recovery of the supra- and infraspinatus muscle after a nerve transfer onto the suprascapular nerve.<p>In a second retrospective analysis on 114 children, we study the outcome after secondary surgery (anterior joint release, modified Hoffer muscle transfer) dedicated to improve active and passive lateral rotation of the shoulder.<p>A prospective study of 50 magnetic resonance (MRI) scans of the glenohumeral joint describes the articular deformities.<p>Finally, 10 children presenting a very early glenohumeral subluxation have undergone a closed orthopaedic reposition and plaster immobilisation and were followed for a minimum of 2 years.<p><p>Results<p><p>In the first group, neurotization of the suprascapular nerve has been performed either by a dorsal or a ventral approach at a mean age of 14 months. The mean follow up is of 3 years and the improvement in aLR(ABD) is 68°and only 25°in aLR(ADD). None of these children with improved active lateral rotation of the shoulder developed clinical signs of a glenohumeral dysplasia within the follow up period.<p><p>Among the 114 children operated between 6 months and 44 years with a shoulder release, 74 had an isolated release procedure, 40 an associated tendon transfer or a suprascapular neurotization. The mean improvement in passive lateral rotation with the arm adducted (pLR (ADD)) was 60°. Active lateral rotation was possible in 63 % of children who underwent an isolated joint release.<p>The Hoffer muscle transfer was performed in 29 children and improved the aLR (ABD) by 60° (mean postoperative follow-up of 30 months). No signs of severe glenohumeral dysplasia developed in these children later on.<p><p>The prospective study of 50 consecutive MRI scans in children presenting at the consultation with a rotatory imbalance of their shoulder, as a sequel from obstetric brachial plexus palsy (Bahm et al. 2007) shows 37 congruent joints, 10 dorsal subluxations, 2 dorsal luxations and one complete dislocation associated with the formation of an independent neoglenoid. The humeral head was deformed in 12 cases; the glenoid in 34 children (flat in 23, biconcave 7 times, convex 3 times).<p><p>The follow up of 2 years in 10 children who underwent an immediate closed reposition shows evidence of joint congruence with a limited (30°) pLR (ADD), definitely lower than after a surgical release.<p><p>Conclusion<p><p>Some osteo-articular deformities secondary to neuromuscular diseases are well described ;those following an obstetric brachial plexus lesion are insufficiently recognized. Their etiology is unclear.<p>At the level of the shoulder joint, these sequels might be very important.<p>Our neuroorthopaedic hypothesis concerning a multifactorial etiology and treatment strategy raises the need of an early and precise screening of the deforming forces to render normal biomechanics and function.<p>The surgical strategy includes the reconstruction of the responsible motor nerve and the improvement of the passive and active range of motion of the shoulder in lateral rotation<p>It seems to be efficient to limit the progression to severe glenohumeral dysplasia and further arthrosis.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

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