Thesis (M.App.Sc. in Physiotherapy)--University of South Australia, 1996.

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1996

Thesis (M.S.)--University of Delaware, 2008. / Principal faculty advisors: James G. Richards, College of Health Sciences; and Susan J. Hall, Dept. of Health, Nutrition and Exercise Sciences. Includes bibliographical references.

This thesis presents a radiographic description of developmental morphology of the human scapula and a comprehensive morphological description of trabecular bone in the perinatal scapula. While the aim was originally to describe the changing trabecular morphology in the developing scapula, considerable thought has gone into the design, advancement and validity of the methodologies presented in this thesis. The work of previous studies has been considered and improved upon to take into account recent advances in software and hardware. Specifically, the introduction of MPR to the methodology has resulted in a more efficient and reliable technique that could allow future researchers to examine larger datasets in shorter periods of time. Additional anthropometric data were also gathered on the perinatal scapula, which was used to assist in the design of the multiplanar stereoscopic analysis. User error associated with threshold definition and VOI placement was also investigated and found to be negligible. With respect to development of the juvenile scapula, three distinct developmental phases, comprising eight separate groups, were identified from the radiographic study and anthropometric review study: pre-reboot (<0.5y), reboot (0.5-3y) and post-reboot (>3y). A clear pattern of regional organisation was visible at the earliest stages of development, echoing the findings of previous studies. It was suggested that the reboot phase represents a developmental period in which the scapula undergoes functional change under a two-tier mechanism, which influences its overall development. On one level the scapula appears constrained by a rigid template that controls macro- morphology in preparation for phylogenetically anticipated demands, which may, or may not, materialise; on a second tier is the adaptive micro-architecture that initially compliments the phylogenetic template, but retains the flexibility to respond to shifting ontogenetic demands. The trabecular architecture of the pre-reboot specimens was subsequently analysed in quantitative detail. A progressive radiating pattern, which originated from the approximate location of the primary ossification centre, was identified; it is suggested that a combination of radiating growth and internal vascular distribution are significant contributors to this pattern. This thesis provides a detailed account of the developmental morphology of the human scapula and contributes new elements to the evolving methodologies used in this field. The findings of this study also lay the foundation for further investigation of the radiating pattern of ossification and the potential for micro-architecture in developing bone to adapt to ontogenetic demands despite gross morphology that is phylogenetically constrained.

A thorough understanding of typical shoulder motion is desirable for both clinicians and shoulder researchers. With this knowledge, comparisons between normal and special populations (e.g. athletic, working, elderly, injured) are enabled and injury mechanisms for heightened or diminished performance may be identified. The purpose of this study was to generate a robust quantification of typical shoulder kinematic profiles during dynamic humeral elevation in six vertical movement planes, and to determine the influence of humeral movement plane, movement phase, gender, and humeral elevation angle on typical scapulothoracic (ST), glenohumeral (GH), acromioclavicular (AC), and sternoclavicular (SC) kinematics. Upper limb kinematic data were collected on 15 males and 14 females as they elevated and lowered their right humerus in six vertical movement planes with elbows fully extended. A total of 60 shoulder kinematic profiles were generated for both raising and lowering motion phases. Trial-to-trial repeatability of the measured rotations, as indicated by intra-class correlation coefficient was found to be moderate (0.658) to high (0.999). Overall, as the humerus was elevated, scapulothoracic (ST) upward rotation, ST posterior tilt, sternoclavicular (SC) elevation, SC retraction, acromioclavicular (AC) elevation and glenohumeral (GH) elevation all increased. However, ST protraction/retraction, GH internal/external rotation, GH anterior/posterior plane of elevation, and AC protraction/retraction responses were less consistent. There was a main effect of humeral movement plane and elevation angle (p < 0.001) identified for all measured joint rotations. A significant phase main effect was not found for right glenohumeral +anterior/-posterior plane of elevation (GAP), glenohumeral +medial/-lateral elevation (GLE), and acromioclavicular protraction/retraction (APR). At least one significant interaction of the main effects, including that of gender, was present for all rotations. The typical shoulder kinematic profiles provided in this investigation is the largest to date of its kind obtained using skin-mounted shoulder tracking techniques. Clinical scientists will find the profiles useful because they provide motion trends that can be compared to profiles from other segments of the population, including patients with specific shoulder injuries. This work supports the more ambitious future clinical goal of being able to identify people who are at risk for developing shoulder pathologies in clinical settings in a non-invasive manner.

A thorough understanding of typical shoulder motion is desirable for both clinicians and shoulder researchers. With this knowledge, comparisons between normal and special populations (e.g. athletic, working, elderly, injured) are enabled and injury mechanisms for heightened or diminished performance may be identified. The purpose of this study was to generate a robust quantification of typical shoulder kinematic profiles during dynamic humeral elevation in six vertical movement planes, and to determine the influence of humeral movement plane, movement phase, gender, and humeral elevation angle on typical scapulothoracic (ST), glenohumeral (GH), acromioclavicular (AC), and sternoclavicular (SC) kinematics. Upper limb kinematic data were collected on 15 males and 14 females as they elevated and lowered their right humerus in six vertical movement planes with elbows fully extended. A total of 60 shoulder kinematic profiles were generated for both raising and lowering motion phases. Trial-to-trial repeatability of the measured rotations, as indicated by intra-class correlation coefficient was found to be moderate (0.658) to high (0.999). Overall, as the humerus was elevated, scapulothoracic (ST) upward rotation, ST posterior tilt, sternoclavicular (SC) elevation, SC retraction, acromioclavicular (AC) elevation and glenohumeral (GH) elevation all increased. However, ST protraction/retraction, GH internal/external rotation, GH anterior/posterior plane of elevation, and AC protraction/retraction responses were less consistent. There was a main effect of humeral movement plane and elevation angle (p < 0.001) identified for all measured joint rotations. A significant phase main effect was not found for right glenohumeral +anterior/-posterior plane of elevation (GAP), glenohumeral +medial/-lateral elevation (GLE), and acromioclavicular protraction/retraction (APR). At least one significant interaction of the main effects, including that of gender, was present for all rotations. The typical shoulder kinematic profiles provided in this investigation is the largest to date of its kind obtained using skin-mounted shoulder tracking techniques. Clinical scientists will find the profiles useful because they provide motion trends that can be compared to profiles from other segments of the population, including patients with specific shoulder injuries. This work supports the more ambitious future clinical goal of being able to identify people who are at risk for developing shoulder pathologies in clinical settings in a non-invasive manner.

Thesis (MAppSc in Physiotherapy) -- University of South Australia, 1994

In the diagnosis and analysis of shoulder instability a precise determination of the location and orientation of the Glenohumeral joint is important. A better understanding of shoulder kinematics and kinetics will help clinicians and therapists in the diagnosis and treatment of shoulder pathologies. To-date, non-invasive skin-based methods are often either restricted to quasi-static measurements or are inaccurate during dynamic assessments at high humeral elevations as a result of soft skin artefact. Tracking the orientation of the scapula is difficult because it is surrounded by soft tissues, is held mainly by muscles and has only one direct point of attachment to the thorax. Instability of the glenohumeral joint generates poor functionality of the shoulder labrum and capsule as well as in the muscle and connective tissue structures that surround the shoulder. As the clinical phenomenon of shoulder instability is extremely complex, one of the priorities for the specialist in avoiding a faulty diagnosis is to recognise, identify and classify shoulder pathologies such as muscle patterning instability in the early stages of the investigation. A two stage methodology for non-invasive tracking of the scapula under dynamic conditions is presented in this work. The methodology provides scapula location by combining data from two surface mounted sensors using a regression-type equation formulated from quasi-static trials undertaken using a scapula locator and three IMUs (first stage). In the second stage, the least square fit is used to improve the scapular orientation by utilising data from only two IMUs (humerus and scapula) under dynamic conditions. Accuracy was assessed in an animal study by comparing results with those from a bone based method during quasi static and dynamic tests. Tests were also undertaken to investigate the errors induced by the soft tissue artefact in surface based scapula location measurement. In dynamic trials the methodology proved more accurate in determining scapula location than a standard skin-based approach, and showed that the greatest contribution to soft tissue artefact was from the epidermal, dermal and subcutaneous tissue layers as opposed to the muscle layer. We confirmed that, in cases where subjects have relatively small amounts of soft tissue surrounding the scapula, surface based methods could provide reasonable accuracy. Our methodology utilised subject-specific data to formulate a regression equation, and can be used to provide accurate, non-invasive tracking of the scapula under dynamic conditions in subjects regardless of individual body morphology. After the methodology validation, study tests were undertaken in a case study in order to estimate the scapula orientation under dynamic conditions in a human without symptoms of any shoulder pathologies and in one participant diagnosed with shoulder instability due to muscle patterning. The two stage methodology is proven to work in a healthy human participant in dynamic tests, in a person with no suspicion of shoulder instability. This methodology allows the error reduction generated by the soft tissues surrounded the scapula. The work presented here can be used as a framework for developing diagnosis protocols by using modern technology.

The term scapulohumeral rhythm is commonly used to describe the two dimensional rotation of the scapula accompanying motion of the arm. Despite the development of a variety of measurement techniques, including radiography, goniometry and three dimensional digitisation, the complete three dimensional kinematics of the scapula have never been presented. Nor have the effects of arm motions outside elevation in the coronal, sagittal or scapula planes been considered. Employing the Isotrak®" electromagnetic measurement system, this study has developed and validated a new method to simultaneously measure the three dimensional kinematics of the scapula and humerus. Euler angle rotations of the· scapu·lawere defined in a sequence approximately analogous to clinical definitions. For the first time, the three dimensional displacements of the scapula have also been determined. 950/0 confidence intervals for lateral rotation of the scapula during humeral elevation in the coronal plane have been calculated at under 4°, Significantly smaller than those presented by previous authors. A mathematical model of three dimensional scapulohumeral kinematics has been developed, capable of predicting the position and orientation of the scapula for a given orientation of the humerus over a wide range of humeral motion. Using this model system, the effects of humeral azimuth, elevation and rotation on the kinematics of the scapula have been investigated. Humeral elevation was seen to have the largest effect, causing the scapula to rotate laterally, retract and tip backwards. Humeral azimuth. has no noticeable effect on the lateral rotation of the scapula, although it causes the scapula to retract, and to tip backwards slightly. Rotation of the humerus has littre effect on the kinematics of the scapula. However, when approaching maximal internal rotation, the ligaments around the glenohumeral joint impose a kinematic constraint on the scapula, resulting in elevation of the scapula upon the thoracic cage.

Introduktion: Motorisk kontrollträning bygger på motorisk inlärningsteori och används för att korrigera rörelsemönster. Metoden har utvärderats för nack- och ländryggbesvär men ingen sammanställning har gjorts för skuldran. Syfte: Syftet med denna litteraturstudien var att undersöka vilket vetenskapligt stöd som motorisk kontrollträning har för skuldran och dess påverkan  på funktion, smärta och dyskinesi. Metod: Litteratursökningen gjordes i PubMed, Science Direct, Scopus, PEDro, SPORTDiscus och CINAHL. Sammanställning gjordes efter smärta, funktion och dyskinesi. Resultat: 13 studier inkluderades i denna sammanställning. Fem studier med RCT-design, tre tvärsnittsstudier och två case-studier, en A-B-A-design, en prospektiv single group pre-post design, en single-blind randomized controlled laboratory. Fyra studier hade ett interventionstillfälle och varade upp till en vecka. De övriga nio studierna varade 4-10 veckor. Nio studier identifierades för vardera utfallsmått. Smärta och funktion förbättrades i samtliga studier som undersökte de måtten efter intervention jämfört med baseline. Dyskinesi förbättrades i tre studier, en studie förblev oförändrad medan fem studier visade på blandade resultat för sina utfallsmått. Konklusion: Resultatet av denna litteraturstudie indikerar att motorisk kontrollträning har positiv påverkan på utfallsmåtten smärta och funktion. Gällande dyskinesi sågs positiva tendenser men ingen slutsats kan dras då det är en stor spridning gällande utfallsmått och resultat. Resultatet kan dock inte enbart tillskrivas motorisk kontrollträning. Standardiserade tester och utvärderingsinstrument för dyskinesi efterfrågas samt fler studier som undersöker utfallsmåtten smärta, funktion och dyskinesi tillsammans.