This project investigas humeral torsion and activity-related change in the human upper limb. Increased humeral torsion angles have been identified in the professional throwing athlete and may be associated with strenuous activity. The nature of humeral torsion as an osteogenic response to the strain environment is investigated to identify its role in the behavioural morphology of the upper limb. These physical manifestations of strenuous physical activity provide an insight into the make-up of medieval armies prior to the establishment of standing armies. Populations analysed include two blade-injured samples, Towton and a subsample of blade-injured men from the Priory of St. Andrew, Fishergate, York. The men from the Mary Rose, a Tudor warship are also investigated. Other samples analysed include the rural sites of Wharram Percy and Hickleton, the urban cemeteries from the Priory of St. Andrew, Fishergate,York and the leprosarium of Sts. James and Mary Magdalene, Chichester, the modern cadaver-based Terry collection and non-human primates, Gorilla sp., Pan sp., Pongo sp., and Macaca sp.. Measurement of the humeral torsion angle and external measurements and indices of architecture, articulations and robusticity are employed. Cross-sectional geometric properties are investigated using CT imaging of the paired humeri from a sub-sample of blade-injured individuals and a comparative sample of those who were not. Bilateral asymmetry is investigated to identify the role of plasticity within the humerus and to reveal aspects of limb dominance. The results are compared with non-human primate species to obtain insight into inter-species differences. Results indicate the humeral torsion is not ontogenetically constrained, but is highly variable between and within populations, individuals and even between sides. Biomechanical analyses indicate that in the Towton population, humeral torsion may serve as part of a two-stage adaptation, in which the architecture is modified to enable greater biomechanical efficiency in distributing strain, reducing the need of increased cortical thickness. Changes in humeral torsion related to strenuous activity have been identified, although in the blade-injured samples it is decreased torsion angles, w hile in the comparative sample it is increased torsion angles that significantly correlate with limb hypertrophy. Humeral torsion appears to be influenced by other measurementd of humeral architecture, specifically, the amount of anterior bowing and anterior curvature to the distal humeral shaft. This work demonstrates the need for individual rather than population-based analyses, as the heterogeneity within population samples obscures individual variation in activity patterns. This analysis provides baseline data for typical populations of the Middle Ages. From this, it is then possible to investigate the individual within this baseline, to identify those who stand out from their samples through habitual, strenuous activity patterns. Movement patterns identified related to warfare include those consistent with the use of the longbow in the Towton sample and the use of a sword in the Fishergate blade-injured sample. These men, and those of the Mary Rose, appear to have either been selected for combat based on size, or benefited from a more nutritious diet during growth.

L'épaule est souvent affectée par des troubles musculo-squelettiques. Toutefois, leur évaluation est limitée à des mesures qualitatives qui nuisent à la spécificité et justesse du diagnostic. L'analyse de mouvement tridimensionnel pourrait complémenter le traitement conventionnel à l'aide de mesures quantitatives fonctionnelles. L'interaction entre les articulations de l'épaule est estimée par le rythme scapulo-huméral, mais la variabilité prononcée qu'il affiche nuit à son utilisation clinique. Ainsi, l'objectif général de cette thèse était de réduire la variabilité de la mesure du rythme scapulo-huméral. L'effet de la méthode de calcul du rythme scapulo-huméral et des conditions d'exécution du mouvement (rotation axiale du bras, charge, vitesse, activité musculaire) ont été testées. La cinématique des articulations de l'épaule a été calculé par chaîne cinématique et filtre de Kalman étendu sur des sujets sains avec un système optoélectronique. La méthode usuelle de calcul du rythme scapulo-huméral extrait les angles d'élévation gléno-humérale et de rotation latérale scapulo-thoracique. Puisque ces angles ne sont pas co-planaires au thorax, leur somme ne correspond pas à l'angle d'élévation du bras. Une nouvelle approche de contribution articulaire incluant toutes les rotations de chaque articulation est proposée et comparée à la méthode usuelle. La méthode usuelle surestimait systématiquement la contribution gléno-humérale par rapport à la méthode proposée. Ce nouveau calcul du rythme scapulo-huméral permet une évaluation fonctionnelle dynamique de l'épaule et réduit la variabilité inter-sujets. La comparaison d'exercices de réadaptation du supra-épineux contrastant la rotation axiale du bras a été réalisée, ainsi que l'effet d'ajouter une charge externe. L'exercice «full-can» augmentait le rythme scapulo-huméral et la contribution gléno-humérale ce qui concorde avec la fonction du supra-épineux. Au contraire, l'exercice «empty-can» augmentait la contribution scapulo-thoracique ce qui est associé à une compensation pour éviter la contribution gléno-humérale. L'utilisation de charge externe lors de la réadaptation du supra-épineux semble justifiée par un rythme scapulo-huméral similaire et une élévation gléno-humérale supérieure. Le mouvement de l'épaule est souvent mesuré ou évalué en condition statique ou dynamique et passive ou active. Cependant, l'effet de ces conditions sur la coordination articulaire demeure incertain. La comparaison des ces conditions révélait des différences significatives qui montrent l'importance de considérer les conditions de mouvement pour l'acquisition ou la comparaison des données. / The shoulder is often afflicted by musculo-skeletal diseases. However, shoulder evaluation is limited to qualitative measures affecting the specificity and accuracy of diagnosis. Three-dimensional motion analysis could complement conventional treatment with quantitative functional measures. The interaction between shoulder joints is estimated by the scapulo-humeral rhythm, but its pronounced variability of measurement ampers appropriate clinical use. Hence, the main objective of the thesis was to reduce the variability in the measure of the scapulo-humeral rhythm. The effect of the calculation method and conditions of motion (arm axial rotation, load, velocity, muscular activity) were tested on healthy subjects. Shoulder joints kinematics were obtained with an optoelectronic system using a kinematical chain and an extended Kalman filter. The common method of scapulo-humeral rhythm calculation extracts the angles of gleno-humeral elevation and scapulo-thoracic lateral rotation. Since these angles are not co-planar, their sum does not correspond to the arm elevation angle. A novel approach of joint contribution including all the rotations of each joint was developed and compared to the common method. The common method systematically overestimated gleno-humeral contribution in comparison to the proposed method. The new scapulo-humeral rhythm calculation allows a dynamic functional evaluation of the shoulder and reduces inter-subject variability. Shoulder coordination was compared on typical supraspinatus rehabilitation exercises contrasting in arm axial rotation, and the effect of adding external load was tested. The ''full-can'' exercise increased the scapulo-humeral rhythm and gleno-humeral contribution, which correspond to supraspinatus function. In contrast, the ''empty-can'' exercise increased scapulo-thoracic contribution, which is associated to compensation to avoid gleno-humeral contribution. The use of external load in supraspinatus rehabilitation seems justified by a similar scapulo-humeral rhythm and superior gleno-humeral elevation. Shoulder motion is often measured or evaluated in static or dynamic and passive or active conditions. However, the effect of these conditions on shoulder coordination remains uncertain. The comparison of these conditions revealed significant differences on shoulder kinematics showing the importance to consider conditions of motion for acquisition or comparison of data.

Cette thèse s’est d’abord voulue pratique. La chirurgie de l’épaule est en pleine expansion avec le vieillissement croissant de la population et la pratique de plus en plus généralisée du sport. L’épaule est une articulation complexe. Paradoxalement les progrès techniques en chirurgie sont sans cesse grandissants et renouvelés tandis que l’on tientpour acquis des données anatomiques démontrées il y a longtemps et rapportées jusqu’à nos jours. Nous avons voulu confronter l’anatomie avec les techniques diagnostiques actuelles et voir si cela pouvait avoir un impact sur les pratiques chirurgicales. Nous avons également voulu voir si certaines complications chirurgicales pouvaient s’expliquer par des données anatomiques. Ce qui a orienté nos recherches sont les principaux problèmes actuels en pathologie de l’épaule c’est-à-dire la coiffe des rotateurs et le syndrome sous-acromial. Les observations lors des nombreuses dissections de l’épaule nous ont conduit à ces réflexions : comment la glène est-elle vascularisée?, pourquoi est-elle si fragile?, que se passe-t- il dans l’espace sous acromial?, quelle est l’utilité du ligament coraco-acromial?, quels sont ses rapports avec lesuprapinatus?, pourquoi l’insertion du supraspinatus est-elle fragile et difficile à reconstituer ?, la qualité osseuse de la tête humérale a-t-elle un impact sur la géographie des fractures, les échecs des ostéosynthèses, les descellements prothétiques?, qu’est ce que la chape delto-trapézoidienne? Autant de questions que nous nous sommes posées endisséquant cette articulation très complexe qui est l’épaule. Par ailleurs, l’anatomie classique peut maintenant secompléter non seulement de l’histologie, mais aussi de techniques radiologiques modernes comme l’IRM l, le microCT, le synchrotron, la reconstruction 3D, la modélisation en éléments finis. / I would like to make a practical thesis. Shoulder surgery is growing and growing as the population is ageing and people is doing more and more sports activities. A lot of technical progress were done but there are still a lot of surgical complications. On the other way some very old anatomical ideas are still alive. I want to see with the actual knowledge, if some surgical complications could be explained by anatomy. Subacromial pathology and bone quality remain the two mainproblems of shoulder surgery and pathology. That’s what had suggested to me this study about the shoulder. I was supposed to analyze glenoid bone first .The aim was to know more about arterial supply of glenoid. That was my firststudy (article 1). Then, I was interested in glenoid bone quality. And the second study had appeared. (article 2). During the shoulder dissection, I was looking for the fascia delto-trapezoidal which I didn’t found as described in books. It was my third study. (article 3). Going on I found the coraco-acromial ligament and I was surprised to see the constant portion under the acromial process. And that gave me the idea for the fourth study. (article 4).As I had discovered the very interesting technique of micro-Ct densitometry, I would like to apply it to the humeral head bone. There was the fifth study. (article 5)But, I want to know more and more about bone quality and I went on with the greater tuberosity and especially the area ofsupraspinatus insertion. The insertion and the sub-chondral bone were analyzed. There’s the last but not least study!(article 6). I was really interested in supraspinatus muscle and tendon and I want to follow the course of the muscle as the zone of conflict. I was the subject of study in life as I went through RMI . The muscle was reconstructed as finite element. Then it was possible to describe the zone of conflict with the supraspinatus. Here’s the seventh article. (article 7)

Made available in DSpace on 2015-03-26T13:46:36Z (GMT). No. of bitstreams: 1 texto completo.pdf: 832157 bytes, checksum: b5d2369f96a82a9d4af7de68979a2dad (MD5) Previous issue date: 2006-04-11 / This work was developed in order to evaluate microscoply the influence of gallium arsenate (Ga-As) diodo laser associated with chondroitin sulfate and chitosan on the healing process of the articular surface of the humeral head of dogs following experimental osteochondroplasty. Sixteen adult dogs were randomly allocated into four groups of four animals. All animals had the left humeral head injured by a surgical procedure (osteochondroplasty) and those from the TG were submitted to Ga-As diode laser sessions and received orally chondroitin sulfate and chitosan. In order to analyze microscopically the surgical injury the animals of the subgroups (C1, C2, C3, C4, T1, T2, T3 and T4) were killed on the 7th, 21st, 35th and 60th days after the surgery, respectively. The histological assessment revealed an increased vascularization, repairing potential and local osteogenesis, increase of the activity synthesis and keeping the cartilage matrix and better healing of the defect with fibrocartilage tissue of TG compared to those from CG, such findings were attributed to the physiotherapeutic effects of the Ga-As diode laser and chondroitin sulfate and chitosan. / O objetivo deste estudo foi avaliar, microscopicamente, a influência do laser a diodo de Arsenieto de Gálio (As-Ga) associado ao sulfato de condroitina e quitosana no processo de reparação da superfície articular da cabeça umeral de cães após defeito osteocondral experimental. Foram utilizados 16 cães adultos, distribuídos aleatoriamente em quatro subgrupos de quatro animais. Em todos os animais foi induzido um defeito cirúrgico na articulação escápulo-umeral esquerda sendo, posteriormente, submetido à aplicação de laser As-Ga (904nm) e administração oral de sulfato de condroitina e quitosana. Para realizar as análises microscópica do defeito cirúrgico, os animais de cada subgrupo (T1, T2, T3 e T4) foram eutanasiados aos sete, 21, 35 e 60 dias após a cirurgia, respectivamente. Foi evidenciado aumento da vascularização da área de reparação, potencialização da reparação e da osteogênese local, aumento da atividade de síntese e manutenção da matriz cartilaginosa e reparação do defeito por tecido fibrocartilaginoso. Os resultados foram atribuídos aos efeitos fisioterapêuticos do laser associado ao sulfato de condroitina e quitosana administrado via oral.

This project investigas humeral torsion and activity-related change in the human upper limb. Increased humeral torsion angles have been identified in the professional throwing athlete and may be associated with strenuous activity. The nature of humeral torsion as an osteogenic response to the strain environment is investigated to identify its role in the behavioural morphology of the upper limb. These physical manifestations of strenuous physical activity provide an insight into the make-up of medieval armies prior to the establishment of standing armies. Populations analysed include two blade-injured samples, Towton and a subsample of blade-injured men from the Priory of St. Andrew, Fishergate, York. The men from the Mary Rose, a Tudor warship are also investigated. Other samples analysed include the rural sites of Wharram Percy and Hickleton, the urban cemeteries from the Priory of St. Andrew, Fishergate,York and the leprosarium of Sts. James and Mary Magdalene, Chichester, the modern cadaver-based Terry collection and non-human primates, Gorilla sp., Pan sp., Pongo sp., and Macaca sp.. Measurement of the humeral torsion angle and external measurements and indices of architecture, articulations and robusticity are employed. Cross-sectional geometric properties are investigated using CT imaging of the paired humeri from a sub-sample of blade-injured individuals and a comparative sample of those who were not. Bilateral asymmetry is investigated to identify the role of plasticity within the humerus and to reveal aspects of limb dominance. The results are compared with non-human primate species to obtain insight into inter-species differences. Results indicate the humeral torsion is not ontogenetically constrained, but is highly variable between and within populations, individuals and even between sides. Biomechanical analyses indicate that in the Towton population, humeral torsion may serve as part of a two-stage adaptation, in which the architecture is modified to enable greater biomechanical efficiency in distributing strain, reducing the need of increased cortical thickness. Changes in humeral torsion related to strenuous activity have been identified, although in the blade-injured samples it is decreased torsion angles, w hile in the comparative sample it is increased torsion angles that significantly correlate with limb hypertrophy. Humeral torsion appears to be influenced by other measurementd of humeral architecture, specifically, the amount of anterior bowing and anterior curvature to the distal humeral shaft. This work demonstrates the need for individual rather than population-based analyses, as the heterogeneity within population samples obscures individual variation in activity patterns. This analysis provides baseline data for typical populations of the Middle Ages. From this, it is then possible to investigate the individual within this baseline, to identify those who stand out from their samples through habitual, strenuous activity patterns. Movement patterns identified related to warfare include those consistent with the use of the longbow in the Towton sample and the use of a sword in the Fishergate blade-injured sample. These men, and those of the Mary Rose, appear to have either been selected for combat based on size, or benefited from a more nutritious diet during growth. / Arts and Humanities Research Board (AHRB), Francis Raymond Hudson Fund, Andy Jagger Fund.

Shoulder arthroplasty surgery has shown remarkable progress during the last few decades. A number of factors affect postoperative range of motion, pain and prosthetic durability. Among these factors, the length of the lever arm and joint stability is the ones that can be altered by the selected prosthetic component. It is uncertain how much of the normal anatomy needs to be re-established. Stemless prostheses with total reliance on metaphyseal fixation were introduced in France in 2004 (TESS, Zimmer Biomet). The goals were to avoid stem-related complications. Stemless implants have other potential benefits, including the ability to restore shoulder anatomy. Study I: This is a prospective cohort study of 49 patients with one of two versions of the TESS prosthesis (anatomical or reverse) with clinical and radiological follow-up ranging from 9–24 months. The TESS prosthesis showed short-term results that were comparable with other shoulder prosthetic systems. Study II: This is a prospective comparative non-randomised study of 37 patients (40 shoulders) who underwent TESS reverse shoulder arthroplasty (RSA) with a follow-up ranging from 15–66 months. We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. Glenoid overhang influenced the occurrence of scapular notching (SN). Study III: This is a radiological study showing that CT had a good reliability and reproducibility in estimating LHO. Study IV: This is a prospective radiological study of 69 patients (70 shoulders) with primary osteoarthritis (OA) who had undergone stemless total anatomical shoulder arthroplasty (TSA). This study showed that stemless anatomical TSA could be useful in restoring shoulder anatomy. Study V: This is a prospective study of 44 patients with OA who had undergone stemless anatomical TSA with a clinical and radiological follow up ranging from 12 – 50 months. Our study showed that LHO reconstruction close to the anatomy of a healthy contralateral shoulder improved shoulder function. Stemless anatomical TSA help to restore LHO. Increasing LHO may have a negative effect on shoulder function at three months but had no effect at 12 months. The main conclusions of this thesis are: 1. TSA (anatomic and reverse) using stemless humeral components is reliable if bone quality is adequate. The complication rate is comparable with other shoulder prosthetic systems. 2. Glenoid overhang decreased complications in RSA. 3. LHO measurement on AP radiographs is less reliable and underestimates the distance when compared with CT. 4. Stemless TSA could be of help in reconstructing shoulder anatomy. 5. Shoulder reconstruction close to the anatomy of a healthy contralateral shoulder improves shoulder function. / Axelprotes kirurgi har visat avsevärd utveckling under de senaste decennierna. Ett antal faktorer påverkar postoperativt rörelseomfång, smärta och proteshållbarhet. Bland dessa faktorer utgör längden av hävarmen och ledstabilitet de faktorer som kan ändras genom val av proteskomponent. Det är osäkert om den normala anatomin måste återupprättas. Oskaftad protes med eliminering av humerusstamm och tillit till metafysär fixering introducerades i Frankrike år 2004 (TESS, Zimmer Biomet). Målen var att undvika stam relaterade komplikationer. Oskaftat implantat har andra potentiella fördelar, inklusive möjligheten att återställa axelnsanatomi. Syftet med denna avhandling var: (1) Att undersök radiologisk stabilitet av oskaftade axelproteser. (2) Att studera effekten av protes placering vid omvänd axelartroplastik både radiologiska och kliniskt utfall. (3) Att studera tillförlitlighet av mätningen av den laterala humeral offset (LHO), avståndet mellan processus coracoideus till laterala kanten av tuberkulum majus, med användning av CT eller röntgen. (4) Att studera oskaftad axelprotes förmåga att återställa axelnsanatomi. (5) Att studera den kliniska betydelsen av LHO återställning i för det funktionella resultatet efter axelartroplastik. Studie I: Detta är en prospektiv kohortstudie av 49 patienter med en av de två versionerna av TESS (anatomisk eller omvänd) med klinisk och radiologisk uppföljning från 9-24 månader. TESS protes visade lovande resultat på kort sikt med komplikationer som var jämförbar med andra axelprotessystem. Studie II: Detta är en prospektiv jämförande icke-randomiserad studie av 37 patienter (40 skuldror) som opererades med TESS omvänd axelartroplastik med en uppföljning från 15-66 månader. Vi fann en signifikant förbättring av funktion och minskning av smärta i både skaftad och oskaftad grupper. Glenoid overhang bedöms påverka risken för scapular notching (SN). Studie III: Detta är en radiologisk studie som visade att CT hade god tillförlitlighet och reproducerbarhet att mäta LHO. Studie IV: Detta är en prospektiv radiologisk studie av 69 patienter (70 skuldror) med primär artros som hade genomgått oskaftad total anatomisk axelprotes. Denna studie visade att oskaftad axelprotes kan vara till hjälp att återställa axelnsanatomi. Studie V: Detta är en prospektiv studie av 44 patienter med unilateral primär artros som hade genomgått oskaftad total axelprotes med en klinisk och radiologisk uppföljning från 12 - 50 månader. Vår studie visade att LHO rekonstruktion till den friska axeln förbättrar axelfunktion. Oskaftat implantat kan vara av hjälp till att återställa LHO. Ökad LHO kan ha en negativ effekt på axelnsfunktion vid tre månader, men denna effekt påvisade ej vid 12 månader. De viktigaste slutsatserna i denna avhandling är: 1. Oskaftad total axel artroplastik (anatomisk och omvänd) är tillförlitlig om benkvalitén är god med komplikationer som var jämförbar med andra axelprotessystem. 2. Glenoid overhang minskar komplikationer vid omvänd axelartroplastik. 3. LHO mätningen på röntgen är mindre tillförlitlig och underskattar avståndet jämfört med CT. 4. Oskaftad axelprotes skulle kunna vara till hjälp för att rekonstruera axelnsanatomi. 5. Axel rekonstruktion inom anatomi till att efterlikna anatomi på den friska kontralaterala axeln förbättrar axelfunktion.

Background: The shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction. - Case presentation: We present the case of a 16-year-old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain. - Conclusion: The pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.

No description available.