Shoulder impingement is the most common cause of shoulder pain. It is often described as mechanical irritation of the tendons of the rotator cuff or long head of the biceps due to compression against either the structures of the subacromial arch or the glenoid and glenoid labrum. Various treatment options exist to address impingement, and recent studies suggest thoracic spine manipulation may be a useful option. The purpose of this study was to assess changes in range of motion (ROM), pain and shoulder function both immediately post- and 7 to 10 days after receiving thoracic spine manipulations. We also attempted to identify changes in scapular kinematics and shoulder muscle activity associated with thoracic spine manipulation in subjects with shoulder impingement. Thirty subjects between the ages of 18 and 45 with signs of shoulder impingement participated in this repeated measures study. All subjects received both a mid-thoracic spine and a cervicothoracic junction manipulation. Changes in pain were assessed using an 11 point numeric pain rating scale. Subjects reported pain with performance of provocative testing (Jobes Empty Can, Hawkins-Kennedy and Neer's tests for impingement) as well as with performance of cervical rotation, thoracic spine flexion and extension and weighted humeral elevation. Shoulder elevation force production pre- and post- manipulation was assessed using hand-held dynamometry. Additionally, subjects completed the Penn Shoulder Score (PSS) and the Sports and Performing Arts Module of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to assess shoulder pain and function 7 to 10 days post thoracic spine manipulation. Electromagnetic sensors tracked three-dimensional scapular and clavicular kinematics as well as cervical, thoracic and humerothoracic ROM. Surface electromyography data were collected from the infraspinatus, serratus anterior, and the upper, middle and lower trapezius muscles with loaded humerothoracic elevation. A repeated measures analysis of variance (ANOVA) was used to compare scapular orientation and muscle activity at 30, 60, 90 ad 120 degrees of humerothoracic elevation before and after spinal manipulation. Paired t - tests revealed significant decreases in pain [(Jobes 2.6 ± 1.1, Neer's 2.6 ± 1.3, Hawkins-Kennedy 2.8 ± 1.3; p<0.001 for all three tests) (weighted shoulder elevation 2.0 ± 1.5, p<0.001; cervical rotation 0.4 ± .9, p=0.039)] as well as improvements in shoulder function (Force production 5.5±3.1, PSS 7.7 ± 9.4 and DASH 16.4 ± 13.2; p<0.001 for each). No significant changes in any of the ROM assessments were observed. No changes in scapular or clavicular kinematics were observed, with the exception of small decrease in scapular upward rotation (p = .04). A small but significant increase in middle trapezius activity (p = .03) was detected; however, no other significant differences in muscle activity were observed following manipulation. Moreover, paired t-tests revealed no significant differences in muscle onset times after manipulation. The findings of this study indicate that thoracic spine manipulation may be an effective intervention to treat pain associated with shoulder impingement; however, the improvements associated with thoracic spine manipulation are not likely explained by changes in scapular kinematics or shoulder muscle activity. Thoracic spine manipulation did not substantially alter scapular kinematics or motor control at the shoulder. / Physical Therapy

Modern gas turbine engines operate in environments where particle ingestion, especially sand ingestion, can affect the cooling of various turbine parts. The most critical areas are in the combustor and the first stage components of the turbine. Gas temperatures in these areas are the highest compared to other areas and exceed the melting points of the constituent metals. To extend the life of hot section components, internal convective cooling and external film-cooling are required. This study examined the effects of sand ingestion on various cooling geometries. The first part investigated impingement and film-cooling implemented in a double-walled cooling geometry for the purpose of reducing sand size and thereby reducing blockage due to sand ingestion. The second part analyzed the cooling performance of actual turbine blade outer air seals injected with sand. Results from these studies showed areas of impingement that promote particle fragmentation are advantageous in reducing particle size and reducing blockage due to particle ingestion. Blockage was significantly increased based on the percentage of large particles present in the sand samples. Increasing the pressure ratio and decreasing the sand amount were also shown to reduce blockage. / Master of Science

Aim of this thesis is to evaluate distribution of plantar pressure and the movement of spine and pelvis in patients diagnosed with femoroacetabular impingement syndrome. The results were obtained using Diers pedoscan system which can record the pressure distribution of feet during stance and motion. Also Diers formetric III 4D system was used to obtain photogrammetic records of spine and pelvis movement. We use rasterstereography based on Moiré topografy. Measured data represent three dimensional model of back surface during static or dynamic analysis. In addition we evaluated the effect of treatment using Dynamic neuromuscular stabilization. Obtained results were statistically processed. Powered by TCPDF (www.tcpdf.org)

Introduction: Question of femoroacetabular impingement is very actual. This young concept brings mechanism which leads to early degenerative changes of the hip joint of young and active individuals (athletes). Objectives: To review influence of sport activity on condition of the hip joint of young athletes (players of table tennis) and to determine incidence of femoroacetabular impingement and its clinical significance. Methods: We performed ultrasound and clinical examination and questionnaire with 22 individuals from 2 training groups. Groups vary in age, height, weight, volume of sport activity and how long they do sports. We found out incidence of cam-type impingement and evaluated pain of anterior impingement test, ranges of motions of the hip joint and deep squat. Results: Cam impingement was found in 27 hip joints, 16 in older group, 11 in younger one. In older group there were 12 from 16 impingements painful during anterior impingement test, 4 from 11 in younger one. In older group there were 4 symptomatic individuals, none in younger one. Older group has lower ranges of motion of flexion and internal rotation. 4 individuals did not perform deep squat, all of them with bilateral cam-type impingement. Conclusion: Femoracetabular impingement is frequent among young athletes. It causes...

Title: The evaluation of surgical treatment of the hip in the diagnosis of femor- acetabular impingement syndrome. Objectives: The main objective of this work is to evaluate the effect of the surgery of the hip in diagnosis of femor-acetabular hip impingement. Methods: In our work we have cooperated with 103 patients who have been operated on hip with the diagnosis of femor-acetabular hip impingement (FAI). We used standardized questionnaires of WOMAC and NAHS, which assesses functional self- care, limitations in motion and painfulness. Patients completed questionnaires twice. For the first time before surgery and second time at least one year after the surgery. The specimens of questionnaire are attached in the Annex. Results: We found out that postoperative condition is significantly different from the preoperative state in terms of improved self-care, increased range of motion and reduction of painfulness. Keywords: Femor-acetabular impingement, hip surgery, WOMAC, NAHS

The supraspinatus tendon is an important structure of the rotator cuff. Subacromial impingement is a common reason for shoulder pain. Despite extensive scientific work in this field, the cause of impingement syndrome is still not fully understood. The general aim of the present thesis was to generate new knowledge with respect to pathogenesis and treatment of impingement syndrome. A combination of animal and clinical studies were performed. Different methods were used such as histology, immunohistochemistry, development and assessment of a novel measuring device and clinical and radiological assessment. Thirty rats were injected with triamcinolone or saline into the subacromial bursa. After five corticosteroid injections, we found focal inflammation, degradation and fragmentation of collagen bundles in the supraspinatus tendon, whereas the control specimens were normal (p=0.035). Subacromial bursitis was induced by injections of carrageenan into the subacromial space (n=28). Fibrocartilaginous metaplasia and bony metaplasia were found in the supraspinatus tendon. Even in specimens with no histologic changes of the collagen bundles the staining for fibronectin was significantly increased. The distance between the anterolateral acromion and the supraspinatus tendon was measured in patients with impingement syndrome intraoperatively (n=30) and in controls (instability, n=15). The mean value of the subacromial distance in controls was 16 mm, the 95% mean confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five showed calcific deposits in the rotator cuff on radiographs preoperatively. In 13 patients the calcific deposits totally disappeared postoperatively. In another six patients the calcifications had decreased in size. Four patients still showed calcifications, which were 5 mm or greater in size. The postoperative results measured by the Constant score were almost identical in the calcific and the non-calcific groups. Tillander 010916 8 Human surgical supraspinatus tendon specimens were studied from patients with impingement (n=16), ruptured supraspinatus tendons (n=7) and controls (n=10). Degradation of tendinous tissue and fibrin were found only in some specimens from ruptures. The difference in fibronectin staining was significant between controls and patients with a rupture (p=0.002). Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens. In conclusion, subacromial corticosteroid injections may cause rupture of the supraspinatus tendon. Metaplasia of the supraspinatus tendon may play a role in the pathogenesis of impingement and rupture of the supraspinatus tendon. The subacromial distance can be measured intraoperatively and was shown to be lower in patients with impingement than in patients with instability. Calcifications disappear or decrease in size after arthroscopic subacromial decompression and do not seem to influence the postoperative outcome in patients with impingement. Degradation of tendon tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.

Femoroacetabular impingement (FAI) is recognized as a pathomechanical process that leads to hip osteoarthritis (OA). It is hypothesized that mechanical stimuli are prominent at higher range of motions in hips with cam FAI (aspherical femoral head-neck deformity). Adverse loading conditions can impose elevated mechanical stimuli levels at the articulating surfaces and underlying subchondral bone, which plays a predominant mechanical role in early OA. The aim of this research was to determine the levels of mechanical stimuli within the hip, examining the effects of severe cam impingement on the onset of OA, using patient-specific biomechanics data, CT data, and finite element analysis (FEA). Patient-specific hip joint reaction forces were applied to two symptomatic patient models and two control-matched models, segmented from patient-specific CT data. The finite element models were simulated to compare the locations and magnitudes of mechanical stimuli during two quasi-static positions from standing to squatting. Maximum-shear stress (MSS) was analyzed to determine the adverse loading conditions within the joint and strain energy density (SED) was determined to examine its effect on the initiation of bone remodelling. The results revealed that peak mechanical stimuli concentrations were found on the antero-superior acetabulum during the squatting position, underlying to the cartilage. The MSS magnitudes were significantly higher and concentrated for the FAI patients (15.145 ± 1.715 MPa) in comparison with the MSS magnitudes for the control subjects (4.445 ± 0.085 MPa). The FAI group demonstrated a slight increase in peak SED values on the acetabulum from standing (1.005 ± 0.076 kPa) to squatting (1.018 ± 0.082 kPa). Insignificant changes in SED values were noticed for the control subjects. Squatting orients the femoral head into the antero-superior acetabulum, increasing the contact area with the cartilage and labral regions, thus resulting in higher peaks behind the cartilage on the acetabulum. The resultant location of the peak MSS and SED concentrations correspond well with the region of initial cartilage degradation and early OA observed during open surgical dislocation. Due to the relatively low elastic modulus of the articular cartilage, loads are transferred and amplified to the subchondral bone. This further suggests that elevated stimuli levels can provoke stiffening of the underlying subchondral plate, through bone remodelling, and consequently accelerating the onset of cartilage degradation. Since mechanical stimuli results are unique to their patient-specific loading parameters and conditions, it would be difficult to determine a patient-specific threshold to provoke bone remodeling at this stage.

Femoroacetabular impingement (FAI) is recognized as a pathomechanical process that leads to hip osteoarthritis (OA). It is hypothesized that mechanical stimuli are prominent at higher range of motions in hips with cam FAI (aspherical femoral head-neck deformity). Adverse loading conditions can impose elevated mechanical stimuli levels at the articulating surfaces and underlying subchondral bone, which plays a predominant mechanical role in early OA. The aim of this research was to determine the levels of mechanical stimuli within the hip, examining the effects of severe cam impingement on the onset of OA, using patient-specific biomechanics data, CT data, and finite element analysis (FEA). Patient-specific hip joint reaction forces were applied to two symptomatic patient models and two control-matched models, segmented from patient-specific CT data. The finite element models were simulated to compare the locations and magnitudes of mechanical stimuli during two quasi-static positions from standing to squatting. Maximum-shear stress (MSS) was analyzed to determine the adverse loading conditions within the joint and strain energy density (SED) was determined to examine its effect on the initiation of bone remodelling. The results revealed that peak mechanical stimuli concentrations were found on the antero-superior acetabulum during the squatting position, underlying to the cartilage. The MSS magnitudes were significantly higher and concentrated for the FAI patients (15.145 ± 1.715 MPa) in comparison with the MSS magnitudes for the control subjects (4.445 ± 0.085 MPa). The FAI group demonstrated a slight increase in peak SED values on the acetabulum from standing (1.005 ± 0.076 kPa) to squatting (1.018 ± 0.082 kPa). Insignificant changes in SED values were noticed for the control subjects. Squatting orients the femoral head into the antero-superior acetabulum, increasing the contact area with the cartilage and labral regions, thus resulting in higher peaks behind the cartilage on the acetabulum. The resultant location of the peak MSS and SED concentrations correspond well with the region of initial cartilage degradation and early OA observed during open surgical dislocation. Due to the relatively low elastic modulus of the articular cartilage, loads are transferred and amplified to the subchondral bone. This further suggests that elevated stimuli levels can provoke stiffening of the underlying subchondral plate, through bone remodelling, and consequently accelerating the onset of cartilage degradation. Since mechanical stimuli results are unique to their patient-specific loading parameters and conditions, it would be difficult to determine a patient-specific threshold to provoke bone remodeling at this stage.

Femoroacetabular impingement (FAI) is recognized as a pathomechanical process that leads to hip osteoarthritis (OA). It is hypothesized that mechanical stimuli are prominent at higher range of motions in hips with cam FAI (aspherical femoral head-neck deformity). Adverse loading conditions can impose elevated mechanical stimuli levels at the articulating surfaces and underlying subchondral bone, which plays a predominant mechanical role in early OA. The aim of this research was to determine the levels of mechanical stimuli within the hip, examining the effects of severe cam impingement on the onset of OA, using patient-specific biomechanics data, CT data, and finite element analysis (FEA). Patient-specific hip joint reaction forces were applied to two symptomatic patient models and two control-matched models, segmented from patient-specific CT data. The finite element models were simulated to compare the locations and magnitudes of mechanical stimuli during two quasi-static positions from standing to squatting. Maximum-shear stress (MSS) was analyzed to determine the adverse loading conditions within the joint and strain energy density (SED) was determined to examine its effect on the initiation of bone remodelling. The results revealed that peak mechanical stimuli concentrations were found on the antero-superior acetabulum during the squatting position, underlying to the cartilage. The MSS magnitudes were significantly higher and concentrated for the FAI patients (15.145 ± 1.715 MPa) in comparison with the MSS magnitudes for the control subjects (4.445 ± 0.085 MPa). The FAI group demonstrated a slight increase in peak SED values on the acetabulum from standing (1.005 ± 0.076 kPa) to squatting (1.018 ± 0.082 kPa). Insignificant changes in SED values were noticed for the control subjects. Squatting orients the femoral head into the antero-superior acetabulum, increasing the contact area with the cartilage and labral regions, thus resulting in higher peaks behind the cartilage on the acetabulum. The resultant location of the peak MSS and SED concentrations correspond well with the region of initial cartilage degradation and early OA observed during open surgical dislocation. Due to the relatively low elastic modulus of the articular cartilage, loads are transferred and amplified to the subchondral bone. This further suggests that elevated stimuli levels can provoke stiffening of the underlying subchondral plate, through bone remodelling, and consequently accelerating the onset of cartilage degradation. Since mechanical stimuli results are unique to their patient-specific loading parameters and conditions, it would be difficult to determine a patient-specific threshold to provoke bone remodeling at this stage.

Thesis (MHSc--Health Science) -- AUT University, 2009. / Includes bibliographical references. Also held in print ( leaves : ill. ; 30 cm.) in the Archive at the City Campus (T 617.572044 HAR)