Rotatorenmanschettenrupturen (RM-Rupturen) haben eine hohe Prävalenz in der Bevölkerung und kommen mit zunehmendem Alter gehäuft vor (Ozaki et al. 1988, Milgrom et al.1995). Die operative Rekonstruktion der RM gilt als Goldstandard der Behandlung. Unbehandelt neigen RM-Rupturen zu Progression und zu fettiger Infiltration des Muskelbauchs und zu Abnahme der Sehnenqualität (Goutallier et al. 1994). Im weiteren Verlauf droht eine Defektarthropathie mit schmerzhafter Bewegungsseinschränkung und hochgradigem Funktionsverlust der Extremität. Eine zeitgerechte Rekonstruktion der RM kann diesen Verlauf günstig beeinflussen und die Funktion des Schultergelenkes signifikant verbessern (Deutsch et al. 1997, Gladstone et al. 2007). Mit zunehmendem Funktionsanspruch, auch noch im fortgeschrittenen Alter, gewinnt die Rekonstruktion der RM zunehmend an Bedeutung (Worland et al. 1999). Die Rerupturrate der operativen Rekonstruktion ist hoch und wird je nach Autor mit bis zu 94% angegeben (Boileau et al. 2005, Galatz et al. 2004). Uneinigkeit herrscht in der Literatur über die Art der Primärrefixation der Sehne im Knochen (Bishop et al. 2006, Boileau et al. 2005, Galatz et al. 2004). Mehrere Autoren berichten, dass die Nahtankerreparatur der transossären Refixation gleichwertig bzw. überlegen ist (Reed et al., 1996, Klinger et al. 2007). Des Weiteren wird die Anzahl und das Platzierungsmuster der Nahtanker, im Hinblick auf die Primärstabilität, kontrovers diskutiert (Apreleva et al. 2002, Craft et al. 1996, Rossouw et al. 1997). 52 Ziel des Schulterchirurgen sollte es sein, eine möglichst hohe Primärfestigkeit der Rekonstruktion zu erreichen, des Weiteren sollte die Refixationsmethode die spannungsfreie Einheilung der Sehne ermöglichen, den Patienten möglichst schnell einer aktiven Rehabilitation zuführen und die Rerupturrate möglichst gering halten (Kim et al. 2005). Ziel der Arbeit war es zu zeigen, ob eine weitere Reihe Nahtanker eine höhere Primärstabilität in Abhängigkeit des verwendeten Nahtmaterials bietet. Hierzu wurden 32 frische Schafsschultern in 4 Gruppen zu je 8 Präparaten aufgeteilt. Eine vollständige RM-Ruptur wurde simuliert und anschließend wurden die Rupturen entweder mit einer Einreihen-Nahtankerversorgung (single-row-Technik) oder mit einer Zweireihen-Nahtankerversorgung (double-row-Technik) refixiert. Dabei kamen 2 verschiedene Nahtmaterialien zum Einsatz (nicht resorbierbares Polyesterfadenmaterial (Ethibond®) und nicht resorbierbares Polyethylenfadenmaterial (HiFi®) der Stärke 2.0). Die Präparate wurden in einer Zugmaschine auf ihre Zugfestigkeit getestet. Die double-row-Technik in Kombination mit nicht-resorbierbarem Polyethylenfadenmaterial (HiFi®, Gruppe IV) erzielte hierbei eine signifikant höhere Ausreißfestigkeit als die anderen Versorgungen. Mehrere Fixationspunkte der Verbindung Knochen-Faden/Naht-Sehne bei der double- row-Technik erreichen so durch eine gleichmäßige Lastverteilung eine höhere Zugfestigkeit Inwieweit diese erhöhte Primärfestigkeit eine Verbesserung des klinischen Ergebnisses und eine Reduktion der Rerupturrate erbringen kann, muss durch zukünftige klinisch-prospektive Studien validiert werden. Der Einsatz dieser kostenintensiven und operativ anspruchsvollen Methode ist unseres Erachtens nur dann gerechtfertigt, wenn die Anzahl an Revisionseingriffen hierdurch signifikant gesenkt werden kann.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.

Tyrimo objektas: Peties sąnario judesių amplitudės, raumenų jėgos, skausmo ir funkcinio pajėgumo pokyčiai taikant pratimus ir peties sąnario mobilizaciją po peties sąnario sukamosios manžetės plyšimo operacijos. Temos aktualumas. Peties sąnario sukamosios manžetės plyšimai dažnai lemia peties sąnario skausmus ir įvairaus pobūdžio negalią vyresniame amžiuje (Khair & Gulotta, 2011). Šią traumą patiria apie 25,0 proc. vyresnių nei 60 m žmonių ir apie 20,0 proc. vyresnių nei 20 m žmonių (Itoj, 2013). Lietuvoje yra atlikta nedaug tyrimų apie peties sąnario sukamosios manžetės plyšimus. Užsienio autoriai daugiau tyrinėja peties sąnario mobilizacijos ir pasyvių techninkų efektyvumą sergant peties ankšumo sindromu, artritu, artroze ir kitomis ligomis. Ypač trūksta informacijos apie gydymą, kuris leistų pacientams išvengti operacijos. Daugelis autorių nurodo, jog reikalingi išsamesni tyrimai šioje srityje. Tyrimo tikslas: įvertinti peties sąnario mobilizacijos ir pratimų efektyvumą gydant peties sąnario sukamosios manžetės plyšimus. Tyrimo uždaviniai: 1. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos paties sąnario judesių amplitudę, raumenų jėgą, skausmą ir funkcinį pajėgumą prieš kineziterapiją. 2. Įvertinti peties sąnario mobilizacijos ir gydomųjų pratimų poveikį pacientų peties sąnario judesių amplitudei, raumenų jėgai, skausmui ir funkciniam pajėgumui po sukamosios manžetės plyšimo operacijos. 3. Įvertinti pacientų po sukamosios manžetės plyšimo operacijos judesių... [toliau žr. visą tekstą] / Object: The change of shoulder range of motion, muscle strength, pain and functional capacity after taking exercises and shoulder joint mobilization for patients after rotator cuff tear reconstruction surgery. Relevance of the topic. In elder age shoulder pain and various disabilities often occur because of the rotator cuff tears (Khair & Gulotta, 2011). 25,0 percent of population over 60 years and 20,0 percent of population over 20 years suffer from this injury (Itoj, 2013). Foreigner scientists more often make studies about the effectiveness of shoulder joint mobilization and other passive physical therapy techniques in curing other shoulder illnesses such as impingement syndrome, arthritis and ect. Especially there is lack of information about treatment that would prevent patients from surgery. Many scientists indicate that more studies are necessary about this topic. Task. The aim of this study was to evaluate the effectiveness of shoulder joint mobilization and therapeutic exercises curing rotator cuff tears. The main goals of this study were: 1. To evaluate range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear arthroscopic reconstruction surgery. 2. To evaluate effectiveness of shoulder joint mobilization and therapeutic exercises for range of motion, muscle strength, pain and functional capacity of operated shoulder for patients after rotator cuff tear reconstruction surgery. 3. To evaluate how shoulder... [to full text]

The purpose of the study was to investigate the static and dynamic architecture of supraspinatus throughout its volume in the normal and pathological state. The architecture was first investigated in cadaveric specimens free of any tendon pathology. Using a serial dissection and digitization method tailored for supraspinatus, the musculotendinous architecture was modeled in situ. The 3D model reconstructed in Autodesk MayaTM allowed for visualization and quantification of the fiber bundle architecture i.e. fiber bundle length (FBL), pennation angle (PA), muscle volume (MV) and tendon dimensions. Based on attachment sites and architectural parameters, the supraspinatus was found to have two architecturally distinct regions, anterior and posterior, each with three subdivisions. The findings from the cadaveric investigation served as a map and platform for the development of an ultrasound (US) protocol that allowed for the dynamic fiber bundle architecture to be quantified in vivo in normal subjects and subjects with a full-thickness supraspinatus tendon tear. The architecture was studied in the relaxed state and in three contracted states (60º abduction with either neutral rotation, 80º external rotation, or 80º internal rotation). The dynamic changes in the architecture within the distinct regions of the muscle were not uniform and varied as a function of joint position. Mean FBL in the anterior region shortened significantly with contraction (p<0.05) but not in the posterior. In the anterior region, mean PA was significantly smaller in the middle part compared to the deep (p<0.05). Comparison of the normal and pathological muscle found large differences in the percentage change of FBL and PA with contraction. The architectural parameter that showed the largest changes with tendon pathology was PA. In sum, the results showed that the static and dynamic fiber bundle architecture of supraspinatus is heterogeneous throughout the muscle volume and may influence tendon stresses. The architectural data collected in this study and the 3D muscle model can be used to develop future contractile models. The US protocol may serve as an assessment tool to predict the functional outcome of rehabilitative exercises and surgery.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.

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)

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.

Os músculos do manguito rotador são os responsáveis pelo movimento de rotação do ombro e representam sítio freqüente de processos patológicos.O desequilíbrio de forças do manguito rotador pode desencadear patologias distintas do ombro ou ser resultado destas. A quantificação da força muscular do manguito rotador com dados precisos, somente é possível com aparelhos de alto custo, longe do alcance da maioria dos profissionais envolvidos com o problema em nosso país. No presente estudo, um aparelho relativamente simples e de baixo custo, capaz de mensurar com precisão a força muscular isométrica de rotação interna e rotação externa do ombro, foi projetado e construído com materiais de fácil obtenção e preço acessível. Ele consiste basicamente de uma plataforma de medição do torque de rotação do ombro acoplada a uma cadeira e adaptável para avaliação bilateral. O aparelho foi projetado para que o indivíduo permaneça sentado durante o teste, com cotovelo fletido a 90 graus e o antebraço apoiado sobre uma superfície plana. Um torquímetro, devidamente calibrado, foi fixado na porção inferior da plataforma, no ponto correspondente ao centro de rotação do ombro. A mudança no comprimento do braço de alavanca foi permitida pela variação na posição de um manípulo para apoio da mão durante os esforços de rotação interna e de rotação externa do ombro. Variações no comprimento do braço de alavanca e na altura da plataforma foram projetadas para adaptarem-se aos braços e antebraços dos indivíduos. O aparelho foi testado em 20 indivíduos saudáveis e demonstrou ser completamente versátil para uso em diversas condições e confiável na produção de informações sobre o torque dos músculos rotadores do ombro. / The rotator cuff muscles are responsible for the rotation movements of the shoulder and frequent site of pathological processes. Rotator cuff muscle power imbalance may unchain or result from distinct shoulder diseases. To date precise quantification of rotator cuff muscle power is only possible with the use of expensive machines, far from the reach of most of the professionals involved with the problem in our country. In the present investigation, a relatively simple and low cost device, able to precisely measuring isometric internal and external rotator muscle power, was developed and built with easily obtainable and low cost materials. It consists basically of a platform for measuring the rotational torque of the shoulder adaptable to both sides of a chair for bilateral evaluation. It was designed for the individual to remain seated while in test, the elbow flexed at 90o and the forearm rested on a flat surface. A properly calibrated torquimeter was adapted to the bottom side of the platform in a point corresponding to the shoulder’s center of rotation. The moving lever was provided with a handle to be grasped by the individual while doing internal or external efforts with the shoulder. Both platform height and moving lever were made adaptable to individual arm and forearm lengths. The device was tested with 20 healthy individuals and demonstrated to be quite versatile for use in many different conditions and reliable in providing information on the torque of the rotator muscle of the shoulder.

Background Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. Objectives To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. Design A mixed methods design, using semi-structured interviews and validated outcome questionnaires. Method Five men and five women, aged 47–68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. Results/findings Four key themes emerged. The cause of pain, ‘Understanding the pain’, was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, ‘It affects everything’. Participants responded to their pain by adopting certain, ‘Pain-associated behaviours’ and sought information for diagnosis, general management and exercise prescription, ‘Emotional responses and the future’. Conclusions The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24541号 / 人健博第112号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM