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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Analysis of the effect of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living

Hall, Laurie Cathryn January 2010 (has links)
Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.
22

Kineziterapijos efektyvumas ankstyvuoju laikotarpiu po peties sukamosios manžetės operacijų / The effectiveness of physical therapy in the early period after the surgery of rotator cuff

Bušmanienė, Giedra 18 May 2005 (has links)
A lot of patients come to consult different doctors because of the shoulder aches. In order to help them the right diagnosis should be known. After degenerative or traumatic lesions, if it‘s done in a timely matter, surgical treatment is very affective. But for further progress a big role is being plaid by physical therapy. It helps the patients to restore lost function of the shoulder. After analysing some literature, I noticed that insufficient attention is being spared to the role of physical therapy in the early post surgical period, so I decided to gert a deeper view of this topic. The aim of this study was to evaluate the effectiveness of physical therapy in the early period after the surgery of the rotator cuff. The goals of the study: 1. to evaluate the effectiveness of physical therapy on the subjective criteria of a shoulder in the early period after the surgery; 2. to estimate the change of the amplitude in the shoulder’s muscle and changes of shoulder retraction force using physical therapy in the early period after the surgery. Organization and methods of the study. 36 patients who were after the rotator cuff split surgery underwent examination. Physical therapy was used at rehabilitation department of Kaunas Red Cross Hospital in 2004-2005. The evaluation of results was based on the Constant scale. The results were evaluated six and eight weeks after the surgery. The patients were grouped into two groups. Each group consisted of ten men and eight women age 54... [to full text]
23

The effect of a single versus multiple cervical spine manipulations on peak torque of the rotator cuff muscles in asymptomatic subjects with cervical spine fixation

Blakeney, Carmen January 2009 (has links)
Submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / Aim: The aim of the study was to assess the effect of a single versus multiple cervical spine manipulations, over a two week period, on peak torque of the rotator cuff muscles utilizing the Cybex Orthotron II Isokinetic Rehabilitation System. This study was a pre and post experimental investigation. Method: Forty asymptomatic (in terms of neck and shoulder pain) male chiropractic students were stratified into two equal groups of twenty subjects to ensure that each group consisted of an equal number of subjects from each year of study. All subjects underwent a familiarisation session on the Cybex Orthotron II Isokinetic Rehabilitation System. Group One received a single manipulation. Rotator cuff peak torque was measured pre-manipulation, immediately post manipulation and at a two-week follow up. Group Two received four manipulations over a two week period. Rotator cuff peak torque was measured pre and immediately post the first manipulation. A third rotator cuff peak torque measurement was taken two weeks after the first manipulation. Results: There was no statistically significant effect of a single or multiple manipulations on rotator cuff peak torque (abduction, adduction, internal rotation and external rotation). Inter-group analysis revealed a trend of an effect for abduction as the single manipulation increased at the two-week follow up and the multiple manipulation group decreased; however, this was not statistically significant. Conclusion: No statistically significant results were found possibly due to small sample size and the fact that objective measurements were only taken at the beginning and the end of the research processes and not at regular intervals throughout the study.Further studies are needed to determine the effects of multiple manipulations on peripheral muscle activity, including the treatment of symptomatic patients with rotator cuff pathology. It is also recommended that EMG readings be done in conjunction with peak torque measures to determine muscle activity.
24

Instabilidade do ombro : variação do retardo eletromecânico em ombros saudáveis e instáveis

Von Kossel, Markus January 2013 (has links)
Introdução: Instabilidades adquiridas do ombro são uma afecção comum do membro superior na prática esportiva, ocasionadas particularmente pela posição de abdução e rotação lateral da articulação glenoumeral durante movimentos explosivos. O manguito rotador proporciona grande parte da estabilidade dinâmica do ombro, sendo que nos movimentos esportivos, a estabilização necessita ser rápida para evitar a movimentação excessiva da cabeça umeral. O tempo entre a ativação do músculo e a produção de tensão é conhecida como Retardo Eletromecânico (REM), podendo este estar associado à velocidade a qual um músculo transmite sua tensão à articulação. Objetivo: avaliar o REM do músculo infraespinhal durante a rotação lateral (RL), o REM do músculo Peitoral Maior durante a rotação medial (RM) e o atraso entre a ativação do Peitoral Maior e Infraespinhal durante uma RM e relacionar estes eventos com a presença ou não da instabilidade glenoumeral adquirida. O comportamento mecânico do infraespinhal foi avaliado também por meio de mecanomiografia, possibilitando subdividir o REM em relação aos eventos elétricos e mecânicos. Métodos: Os músculos Peitoral Maior e Infraespinhal foram monitorados por eletromiografia (EMG) de superfície (2 kHz); o sinal mecanomiográfico (MMG) (2 kHz) foi coletado do Infraespinhal e os torques (2 kHz) explosivos isométricos de RM e RL do ombro foram coletados na posição do ombro de abdução e rotação lateral a 90° em um dinamômetro. Após uma avaliação funcional do membro superior, 18 indivíduos do sexo masculino, praticantes de atividade esportiva overhead, participaram do estudo, sendo nove com ombros saudáveis e nove com instabilidade glenoumeral anterior. Após a coleta e armazenamento dos sinais, esses foram filtrados e analisados. Os sinais EMG do peitoral maior e EMG e MMG do infraespinhal foram filtrados (EMG 5-500 Hz e MMG 4-400 Hz) e um envoltório linear foi calculado. O início dos sinais foi identificado usando-se o limiar de repouso + 3 desvios padrão para EMG e MMG e 2% do pico de torque para o limiar de força. Os limiares de ativação foram usados para calcular o início de cada sinal (EMG, MMG e Torque). Os intervalos de tempo entre os eventos foram mensurados e comparados entre os grupos (ombro instável, ombro contra-lateral e ombro saudável). Os picos de torque e taxa de produção do torque de RM e RL foram calculados para todos os grupos. Resultados: O REM do infraespinhal em ombros com instabilidade e nos ombros contralaterais ao instável foi menor do que nos ombros saudáveis. Pico de Torque, Taxa de Produção de Torque, atraso entre EMG do peitoral maior e EMG do infraespinhal e REM do peitoral maior não apresentaram diferenças significativas entre os grupos. Conclusão: Ombros instáveis e contralaterais aos instáveis apresentam adaptação crônica do manguito rotador com diminuição do REM. O REM está possivelmente associado ao aumento da rigidez dos elementos elásticos em série. O aumento da demanda pelos estabilizadores dinâmicos em decorrência da falência dos mecanismos estáticos de estabilização do ombro poderia explicar tal adaptação do infraespinhal. / Introduction: Acquired shoulder instabilities are a common upper limb injury in sports, mostly related to abduction and external rotation of glenohumeral joint during explosive contractions. Most of the dynamic stabilization of the shoulder joint is provided by the rotator cuff. In sports movements the stabilization must be quick to avoid humeral head excessive motion. The time between muscle activation and force production is named Electromechanical Delay (EMD), and is related to the speed of transmited tension to the joint/bone. Objetive: Evaluate the EMD in the infraspinatus muscle during External Rotation (ER), the EMD of Pectoralis Major during an Internal Rotation (IR) and the delay between Pectoralis Major and Infraspinatus activation during an IR and relate those mesurements to the shoulder stability/instability. The mechanical behaviour of the infraspinatus muscle was also assessed by mechanomyography, enabling to subdivide the EMD with respect to the electrical and mechanical events. Methods: Pectoralis Major and Infraspinatus muscles were monitored by surface Electromyography (EMG) (2kHz); the mechanomyographic (MMG) signal was collected from infraspinatus muscle (2kHz) and the isometric explosive IR and ER of shoulder were collected at 90° of abduction and external rotation on a dynamometer. After a functional evaluation of the shoulder, 18 male subjects, overhead sports participate in the study, nine with stable shoulders and nine with anterior shoulders instability. After data collection and storage, the signals were filtered and analysed. The EMG signals from Pectoralis Major and EMG and MMG from infraspinatus were filtered (EMG 5-500 Hz and MMG 4-400 Hz) and a linear envelope was calculated. The signal onset was identified using the threshold of resting signal plus 3 standart deviations for EMG and MMG and 2% of peak torque to torque threshold. The thresholds were used to calculate the beginning of each signal (EMG, MMG and Torque). The time delays between events were measured and compared between the groups (stable, unstable and contralateral to the unstable). Peak Torque and Rate of Torque Production of IR and ER were calculated to all groups. Results: The infraspinatus EMD in the unstable and contralateral to unstable shoulders were smaller than the healthy shoulders. Peak Torque, Rate of Torque Production, delay between pectoralis major EMG and infraspinatus EMG and pectoralis EMD were not different between the groups. Conclusions: Unstable and contralateral to unstable shoulders showed a chronic adaptation of rotator cuff with decrease in EMD. The EMD could be related to increase in stiffness of series elastic components. The increased demand for the dynamic stabilization caused by the loss of static stabilization mechanism could lead to the infraspinatus adaptation.
25

Instabilidade do ombro : variação do retardo eletromecânico em ombros saudáveis e instáveis

Von Kossel, Markus January 2013 (has links)
Introdução: Instabilidades adquiridas do ombro são uma afecção comum do membro superior na prática esportiva, ocasionadas particularmente pela posição de abdução e rotação lateral da articulação glenoumeral durante movimentos explosivos. O manguito rotador proporciona grande parte da estabilidade dinâmica do ombro, sendo que nos movimentos esportivos, a estabilização necessita ser rápida para evitar a movimentação excessiva da cabeça umeral. O tempo entre a ativação do músculo e a produção de tensão é conhecida como Retardo Eletromecânico (REM), podendo este estar associado à velocidade a qual um músculo transmite sua tensão à articulação. Objetivo: avaliar o REM do músculo infraespinhal durante a rotação lateral (RL), o REM do músculo Peitoral Maior durante a rotação medial (RM) e o atraso entre a ativação do Peitoral Maior e Infraespinhal durante uma RM e relacionar estes eventos com a presença ou não da instabilidade glenoumeral adquirida. O comportamento mecânico do infraespinhal foi avaliado também por meio de mecanomiografia, possibilitando subdividir o REM em relação aos eventos elétricos e mecânicos. Métodos: Os músculos Peitoral Maior e Infraespinhal foram monitorados por eletromiografia (EMG) de superfície (2 kHz); o sinal mecanomiográfico (MMG) (2 kHz) foi coletado do Infraespinhal e os torques (2 kHz) explosivos isométricos de RM e RL do ombro foram coletados na posição do ombro de abdução e rotação lateral a 90° em um dinamômetro. Após uma avaliação funcional do membro superior, 18 indivíduos do sexo masculino, praticantes de atividade esportiva overhead, participaram do estudo, sendo nove com ombros saudáveis e nove com instabilidade glenoumeral anterior. Após a coleta e armazenamento dos sinais, esses foram filtrados e analisados. Os sinais EMG do peitoral maior e EMG e MMG do infraespinhal foram filtrados (EMG 5-500 Hz e MMG 4-400 Hz) e um envoltório linear foi calculado. O início dos sinais foi identificado usando-se o limiar de repouso + 3 desvios padrão para EMG e MMG e 2% do pico de torque para o limiar de força. Os limiares de ativação foram usados para calcular o início de cada sinal (EMG, MMG e Torque). Os intervalos de tempo entre os eventos foram mensurados e comparados entre os grupos (ombro instável, ombro contra-lateral e ombro saudável). Os picos de torque e taxa de produção do torque de RM e RL foram calculados para todos os grupos. Resultados: O REM do infraespinhal em ombros com instabilidade e nos ombros contralaterais ao instável foi menor do que nos ombros saudáveis. Pico de Torque, Taxa de Produção de Torque, atraso entre EMG do peitoral maior e EMG do infraespinhal e REM do peitoral maior não apresentaram diferenças significativas entre os grupos. Conclusão: Ombros instáveis e contralaterais aos instáveis apresentam adaptação crônica do manguito rotador com diminuição do REM. O REM está possivelmente associado ao aumento da rigidez dos elementos elásticos em série. O aumento da demanda pelos estabilizadores dinâmicos em decorrência da falência dos mecanismos estáticos de estabilização do ombro poderia explicar tal adaptação do infraespinhal. / Introduction: Acquired shoulder instabilities are a common upper limb injury in sports, mostly related to abduction and external rotation of glenohumeral joint during explosive contractions. Most of the dynamic stabilization of the shoulder joint is provided by the rotator cuff. In sports movements the stabilization must be quick to avoid humeral head excessive motion. The time between muscle activation and force production is named Electromechanical Delay (EMD), and is related to the speed of transmited tension to the joint/bone. Objetive: Evaluate the EMD in the infraspinatus muscle during External Rotation (ER), the EMD of Pectoralis Major during an Internal Rotation (IR) and the delay between Pectoralis Major and Infraspinatus activation during an IR and relate those mesurements to the shoulder stability/instability. The mechanical behaviour of the infraspinatus muscle was also assessed by mechanomyography, enabling to subdivide the EMD with respect to the electrical and mechanical events. Methods: Pectoralis Major and Infraspinatus muscles were monitored by surface Electromyography (EMG) (2kHz); the mechanomyographic (MMG) signal was collected from infraspinatus muscle (2kHz) and the isometric explosive IR and ER of shoulder were collected at 90° of abduction and external rotation on a dynamometer. After a functional evaluation of the shoulder, 18 male subjects, overhead sports participate in the study, nine with stable shoulders and nine with anterior shoulders instability. After data collection and storage, the signals were filtered and analysed. The EMG signals from Pectoralis Major and EMG and MMG from infraspinatus were filtered (EMG 5-500 Hz and MMG 4-400 Hz) and a linear envelope was calculated. The signal onset was identified using the threshold of resting signal plus 3 standart deviations for EMG and MMG and 2% of peak torque to torque threshold. The thresholds were used to calculate the beginning of each signal (EMG, MMG and Torque). The time delays between events were measured and compared between the groups (stable, unstable and contralateral to the unstable). Peak Torque and Rate of Torque Production of IR and ER were calculated to all groups. Results: The infraspinatus EMD in the unstable and contralateral to unstable shoulders were smaller than the healthy shoulders. Peak Torque, Rate of Torque Production, delay between pectoralis major EMG and infraspinatus EMG and pectoralis EMD were not different between the groups. Conclusions: Unstable and contralateral to unstable shoulders showed a chronic adaptation of rotator cuff with decrease in EMD. The EMD could be related to increase in stiffness of series elastic components. The increased demand for the dynamic stabilization caused by the loss of static stabilization mechanism could lead to the infraspinatus adaptation.
26

Vascular Changes in the Supraspinatus Muscle and Association with Intramuscular Fat Accumulation: An Experimental Study in Rabbits

MacIntyre-Newell, Meaghan 10 July 2018 (has links)
Supraspinatus (SSP) tendon tear leads to intramuscular fat accumulation in the SSP muscle and the mechanisms are currently unknown. The purpose of this study was to investigate changes in vascularization of the SSP muscle and the relationship to intramuscular fat accumulation following SSP tendon detachment with or without reattachment. One hundred and six rabbits underwent SSP tendon detachment. In groups of ten, thirty rabbits were sacrificed 4, 8, and 12 weeks following detachment. Forty rabbits underwent detachment and immediate reattachment and were sacrificed in groups of ten following 0, 1, 2, and 6 weeks of healing. In groups of twelve, the remaining thirty-six rabbits underwent SSP tendon reattachment 4, 8, and 12 weeks after detachment and were sacrificed 12 weeks later. Vascularization was quantified in each specimen using CD31 immunohistochemistry. Four weeks after SSP tendon detachment, there was an increase in vascularization of the distal SSP muscle that reached significance after 12 weeks of detachment (p=0.024). We found that vascularization was positively correlated with intramuscular fat accumulation after detachment only (r=0.29; p=0.008). After SSP tendon reattachment, immediate or delayed, the correlation between vascularization and intramuscular fat accumulation was not observed. Microscopically, some SSP muscle vascular structures in the reattachment group had thicker vascular walls which were further quantified using αSMA immunohistochemistry. The delayed reattachment group showed an increase in vascular wall thickness in the distal portion of the SSP muscle at 4+12 (p=0.012) and 12+12 (p=0.012) weeks and in the proximal portion at 4+12 (p=0.024) weeks. Further investigation is required to demonstrate a cause/effect relationship between increased vascularization and intramuscular fat accumulation in the context of rotator cuff tear and success of surgical repair.
27

Instabilidade do ombro : variação do retardo eletromecânico em ombros saudáveis e instáveis

Von Kossel, Markus January 2013 (has links)
Introdução: Instabilidades adquiridas do ombro são uma afecção comum do membro superior na prática esportiva, ocasionadas particularmente pela posição de abdução e rotação lateral da articulação glenoumeral durante movimentos explosivos. O manguito rotador proporciona grande parte da estabilidade dinâmica do ombro, sendo que nos movimentos esportivos, a estabilização necessita ser rápida para evitar a movimentação excessiva da cabeça umeral. O tempo entre a ativação do músculo e a produção de tensão é conhecida como Retardo Eletromecânico (REM), podendo este estar associado à velocidade a qual um músculo transmite sua tensão à articulação. Objetivo: avaliar o REM do músculo infraespinhal durante a rotação lateral (RL), o REM do músculo Peitoral Maior durante a rotação medial (RM) e o atraso entre a ativação do Peitoral Maior e Infraespinhal durante uma RM e relacionar estes eventos com a presença ou não da instabilidade glenoumeral adquirida. O comportamento mecânico do infraespinhal foi avaliado também por meio de mecanomiografia, possibilitando subdividir o REM em relação aos eventos elétricos e mecânicos. Métodos: Os músculos Peitoral Maior e Infraespinhal foram monitorados por eletromiografia (EMG) de superfície (2 kHz); o sinal mecanomiográfico (MMG) (2 kHz) foi coletado do Infraespinhal e os torques (2 kHz) explosivos isométricos de RM e RL do ombro foram coletados na posição do ombro de abdução e rotação lateral a 90° em um dinamômetro. Após uma avaliação funcional do membro superior, 18 indivíduos do sexo masculino, praticantes de atividade esportiva overhead, participaram do estudo, sendo nove com ombros saudáveis e nove com instabilidade glenoumeral anterior. Após a coleta e armazenamento dos sinais, esses foram filtrados e analisados. Os sinais EMG do peitoral maior e EMG e MMG do infraespinhal foram filtrados (EMG 5-500 Hz e MMG 4-400 Hz) e um envoltório linear foi calculado. O início dos sinais foi identificado usando-se o limiar de repouso + 3 desvios padrão para EMG e MMG e 2% do pico de torque para o limiar de força. Os limiares de ativação foram usados para calcular o início de cada sinal (EMG, MMG e Torque). Os intervalos de tempo entre os eventos foram mensurados e comparados entre os grupos (ombro instável, ombro contra-lateral e ombro saudável). Os picos de torque e taxa de produção do torque de RM e RL foram calculados para todos os grupos. Resultados: O REM do infraespinhal em ombros com instabilidade e nos ombros contralaterais ao instável foi menor do que nos ombros saudáveis. Pico de Torque, Taxa de Produção de Torque, atraso entre EMG do peitoral maior e EMG do infraespinhal e REM do peitoral maior não apresentaram diferenças significativas entre os grupos. Conclusão: Ombros instáveis e contralaterais aos instáveis apresentam adaptação crônica do manguito rotador com diminuição do REM. O REM está possivelmente associado ao aumento da rigidez dos elementos elásticos em série. O aumento da demanda pelos estabilizadores dinâmicos em decorrência da falência dos mecanismos estáticos de estabilização do ombro poderia explicar tal adaptação do infraespinhal. / Introduction: Acquired shoulder instabilities are a common upper limb injury in sports, mostly related to abduction and external rotation of glenohumeral joint during explosive contractions. Most of the dynamic stabilization of the shoulder joint is provided by the rotator cuff. In sports movements the stabilization must be quick to avoid humeral head excessive motion. The time between muscle activation and force production is named Electromechanical Delay (EMD), and is related to the speed of transmited tension to the joint/bone. Objetive: Evaluate the EMD in the infraspinatus muscle during External Rotation (ER), the EMD of Pectoralis Major during an Internal Rotation (IR) and the delay between Pectoralis Major and Infraspinatus activation during an IR and relate those mesurements to the shoulder stability/instability. The mechanical behaviour of the infraspinatus muscle was also assessed by mechanomyography, enabling to subdivide the EMD with respect to the electrical and mechanical events. Methods: Pectoralis Major and Infraspinatus muscles were monitored by surface Electromyography (EMG) (2kHz); the mechanomyographic (MMG) signal was collected from infraspinatus muscle (2kHz) and the isometric explosive IR and ER of shoulder were collected at 90° of abduction and external rotation on a dynamometer. After a functional evaluation of the shoulder, 18 male subjects, overhead sports participate in the study, nine with stable shoulders and nine with anterior shoulders instability. After data collection and storage, the signals were filtered and analysed. The EMG signals from Pectoralis Major and EMG and MMG from infraspinatus were filtered (EMG 5-500 Hz and MMG 4-400 Hz) and a linear envelope was calculated. The signal onset was identified using the threshold of resting signal plus 3 standart deviations for EMG and MMG and 2% of peak torque to torque threshold. The thresholds were used to calculate the beginning of each signal (EMG, MMG and Torque). The time delays between events were measured and compared between the groups (stable, unstable and contralateral to the unstable). Peak Torque and Rate of Torque Production of IR and ER were calculated to all groups. Results: The infraspinatus EMD in the unstable and contralateral to unstable shoulders were smaller than the healthy shoulders. Peak Torque, Rate of Torque Production, delay between pectoralis major EMG and infraspinatus EMG and pectoralis EMD were not different between the groups. Conclusions: Unstable and contralateral to unstable shoulders showed a chronic adaptation of rotator cuff with decrease in EMD. The EMD could be related to increase in stiffness of series elastic components. The increased demand for the dynamic stabilization caused by the loss of static stabilization mechanism could lead to the infraspinatus adaptation.
28

The efficacy of shoulder adjustments on patients suffering from shoulder impingement syndrome

Munday, Sarah Louisa January 1999 (has links)
Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / Impingement syndrome of the shoulder is a very common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this investigation was to investigate the effectiveness of the chiropractic adjustment in order to determine whether or not it is an effective approach in the treatment of impingement syndrome / M
29

The Biomechanics of Reverse Shoulder Arthroplasty

Gutiérrez, Sergio 01 July 2009 (has links)
Rotator cuff deficiency with glenohumeral arthritis presents a unique challenge to the orthopaedic surgeon. Under these conditions, total shoulder replacement has yielded poor results as a result of eccentric loading of the glenoid leading to loosening and early failure. Multiple procedures have been recommended to resolve this problem including total shoulder arthroplasty, shoulder arthrodesis, and hemiarthroplasty. Hemiarthroplasty, the current standard of care for this condition, offers only limited goals for functional improvement and only a modest improvement in pain. Recently, there has been renewed interest in reverse shoulder arthroplasty. The main concept behind the reverse shoulder implant is the stabilization of the joint by replacing the head of the arm with a socket and placing a ball on the shoulder side. This "reverse" configuration creates a fixed fulcrum through which the deltoid can act more efficiently at raising the arm and thus increasing range of motion and returning the patient to a more normal level of function. This dissertation attempts to fill in some of the gaps in reverse basic science with six published studies. The important results found in these studies were: Implantation of the glenosphere with an inferior tilt reduces the incidence of mechanical failure of the baseplate. A positive linear correlation is present between abduction range of motion (ROM) and center of rotation offset (CORO). When comparing several factors affecting ROM and scapular impingement, CORO had the largest effect on ROM, followed by glenosphere position. Neck-shaft angle had the largest effect on inferior scapular impingement, followed by glenosphere position. Stability is determined primarily by increasing joint compressive forces and, to a lesser extent, by increasing humerosocket depth. There are three distinct classes of arc of motion relative to the articular constraint: I - arc of motion decreased with increased constraint, II - arc of motion with a complex relationship to constraint, and III - arc of motion increased with increased constraint. The information presented in this dissertation may be useful to the orthopaedic surgeon when deciding on an appropriate reverse implant and improving surgical technique, as well as aiding engineers in improving reverse implant design.
30

A novel approach to investigating the tendinous and capsular layers of the rotator cuff complex : A biomechanical study

Cronjé, Jessica Y. January 2019 (has links)
Rotator cuff (RC) muscle insertion was previously thought to consist of singular, individual tendons inserting onto predefined areas on the greater and lesser tuberosities. However, more recent publications describe the RC muscle tendons as forming a singular insertion across the tuberosities, consisting of both tendinous and capsular portions. Orthopaedic surgeons are now considering these two layers in their surgical approach and treatment plans; therefore this study aimed to test and compare the elastic modulus and maximum load to failure for both tendinous and capsular layers taken from supraspinatus (SS), infraspinatus (IS) and subscapularis (SC). Fourteen (n = 14) fresh/frozen arms were used in this study. Each RC muscle was reverse dissected and trimmed to a 2 x 2cm strip, which was separated into its two layers, still attached to the humerus. An Instron 1342 with a 1kN load cell was used to place the samples under tensile testing till failure (Newtons/N). Accompanying Integrated Design Tools (IDT) NX8-S2 cameras captured images for full-field strain measurements with the Image Systems TEMA software package through digital image correlation (DIC). SS, IS, and SC tendinous layers yielded higher average elastic moduli readings (72.34 MPa, 67.04 MPa, and 59.61 MPa respectively) compared to their capsular components (27.38 MPa, 32.45 MPa, and 41.49 MPa respectively). Likewise, the tendinous layers for SS, IS and SC all showed higher average loads to failure (252.74 N, 356.27 N and 385.94 N, respectively) when compared to the capsular layers (211.21 N, 168.54 N and 281.74 N, respectively). These biomechanical differences need to be taken into account during surgical repair owing to the fact that, should these layers be repaired as one singular structure, it may place the weaker less elastic, capsular layer under more strain, possibly leading to either re-tear complications or reduced postoperative healing and functionality. Thus, based on the results, it is recommended that surgeons consider and repair each layer independently for better postoperative biomechanical integrity. / Dissertation (MSc)--University of Pretoria, 2019. / Anatomy / MSc / Unrestricted

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