Orientador: João Eduardo Guarnetti dos Santos / Resumo: O ombro por ser uma articulação muito instável está mais vulnerável a lesões. Afim de proteger e imobilizar a articulação o tratamento é seguido com o uso de tipoia. No entanto, a imobilização deixa as articulações sob os efeitos deletérios do desuso, o que pode favorecer o surgimento de lesões secundárias como a capsulite adesiva. O design e a ergonomia são considerados disciplinas científicas capazes de desenvolver e ajustar produtos às necessidades e às capacidades humanas. O objetivo deste estudo foi gerar parâmetros para o design ergonômico de uma tipoia alternativa utilizando as tecnologias de manufatura aditiva, a fim de minimizar os desconfortos termofisiológicos e o índice de capsulite adesiva após imobilização. Nesse contexto, desenvolveu-se com o auxílio do design um modelo de tipoia mais confortável, adequado, funcional e que não favorece o surgimento de complicações após imobilização do ombro. Foi realizada uma coleta de dados com indivíduos adultos, de ambos os gêneros, entre 18 e 85 anos de idade, 71 voluntários, que fizeram uso de tipoia para lesão do ombro. Seguiu com uma investigação ergonômica dos modelos de tipoia disponíveis no mercado, para desenvolver um modelo alternativo com as devidas adequações ergonômicas. O projeto da tipoia foi modelado no software CAD SolidWorks e a impressão foi por FDM (Fusão por Deposição de Material), em uma impressora 3D Creality CR-10, com material PLA (Ácido Polilactico). Para testar a percepção do usuário frente aos mode... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The shoulder because it is a very unstable joint is more vulnerable to injury, in order to protect and immobilize the joint, treatment is followed with the use of a sling. However, immobilization leaves the joints under the harmful effects of disuse, which can favor the appearance of secondary lesions such as adhesive capsulitis. Design and ergonomics are considered scientific disciplines capable of developing and adjusting products to human needs and capacities. The aim of this study was to generate parameters for the ergonomic design of an alternative sling using additive manufacturing technologies, in order to minimize thermophysiological discomfort and the adhesive capsulitis index after immobilization. In this context, a more comfortable, adequate, functional tipoia of model was developed with the aid of design, which does not favor the appearance of complications after shoulder immobilization. A data collection was carried out with adult individuals, both genders, between 18 and 85 years of age, 71 volunteers, who made use of tipoia for shoulder injury. It continued with an ergonomic investigation of the sling models available on the market, to develop an alternative model with the appropriate ergonomic adaptations. The design of the tipoia was modeled in SolidWorks CAD software and the printing was by FDM (Melting by Deposition of Material) in a Creality CR-10 3D printer with PLA material (Polylactic Acid). To test the user's perception of sling models, a semantic diff... (Complete abstract click electronic access below) / Doutor

A "Job Coach" model was developed based on sports medicine and rehabilitation principles for athletes, and individual placement and supported employment for people with psychiatric disabilities. This is a biopsychosocial model, emphasising workplace-based intervention. / Background. Occupational musculoskeletal soft tissue injuries represent a major source of work disability. There has been a gradual rise in the occurrence of occupational musculoskeletal injuries of the upper extremity, including both acute injuries and more chronic health problems. Return to work following an occupational injury is a multifactoral process, although traditional clinic-based rehabilitation programmes do not appreciate the importance of contextual factors. / Conclusion. Workplace work hardening programmes are a further development of work rehabilitation programmes. The therapeutic use of actual work facilities and the work environment can effectively facilitate the successful return to work process of the injured worker. More importantly, many of the psychosocial problems associated with separation from the work routine, peer group and/or the employer are minimised by the presence of the Job Coach. The results of this study confirm that workplace-based rehabilitation intervention is more effective than conventional clinic-based rehabilitation programmes in terms of prevention of further work disability, improvement in functional capabilities and decrease in perceived pain and disability. / Keywords. Job coach, workplace-based rehabilitation, rotator cuff injury, work disability, return to work intervention. / Methodology. A randomised controlled trial was conducted on 94 workers recruited from Workers' Compensation insurers. These workers had all sustained occupational rotator cuff injury and had lost more than 90 workdays. The workers were randomly assigned into control or experimental groups. The control group received a traditional work hardening programme and the experimental group received a workplace work hardening programme using the Job Coach model. The return to work outcomes of the two groups were compared. Areas of comparison included return to work rate after training, job retention ability and impact on earning capacity. Other outcome measures included change in active range of motion of the shoulder joint, eight basic functional capacities and the worker's perception of shoulder pain and disability based on the Shoulder Pain and Disability Index (SPADI). / Results. After one-month of the training programme, a higher return to work rate was obtained in the experimental group compared to the control group (71.4% against 37%, chi2=11.095, p=0.001). For job retention ability, 93.5% of the workers in the experimental group were still at work compared to 72.9% of workers in the control group (chi 2=7.031, p=0.008). No obvious salary change was noted between the two groups. / The SPADI was statistically significantly lower in the experimental group than in the control group (p=0.032), meaning that workers in the experimental group had fewer shoulder problems after training. Other significant improvements were noted in active shoulder flexion (p=0.001), arm lift strength (p=0.01), high-near lift strength (p=0.014), dynamic carrying strength (p=0.007) and overhead work tolerance (p=0.032), all of which were found to be statistically significantly higher in the experimental group than in the control group. / Cheng Shu-kei. / "July 2006." / Adviser: Leung Kim Hung. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1568. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 216-238). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Sports scientists and trainers generally agree that the multidimensional training in tennis should start during early childhood in order to ultimately reach a professional playing standard. Evidence suggests that motor skills, including power, strength, agility, speed and explosive power, as well as mental strength and a highly developed neuromuscular coordinating ability are strongly correlated with the level of tournament performance. Turner&Dent (1996) found that 27% of all tennis injuries in junior players occur in the shoulder region. The shoulder girdle is prone to injury because of its ability to maximally accelerate and decelerate the arm while the arm maintains it maintains precise control over the racquet at ball contact. The purpose of this study was to determine whether the occurrence of shoulder injuries could be minimized in tennis players by following a specific exercise programme, focusing on the shoulder girdle. A total of 42 tennis players participated in this study. They were all aged between 14 and 18 years. Both males and females were used for the purpose of this study. All the players were training at the SA Tennis Performance Centre and the International Tennis Federation at the University of Pretoria. They were all elite tennis players practising daily and scheduled for standard major tournaments throughout the year. Each subject completed a questionnaire of his or her tennis and medical history. The players were then divided into a control group and an experimental group. Both groups completed a series of physical scientific tests, consisting of posture analysis, body composition, flexibility, functional strength of the upper body; and isokinetic power and endurance of the shoulder muscles. These tests were executed every 3 months over a 9-month period and the results of each battery of tests were used to adjust and upgrade the new programmes. The experimental group did specific preventative shoulder exercises 5 times a week in addition to their usual gymnasium programme twice a week, while the control group followed a normal strengthening programme twice a week. A medical doctor immediately evaluated any muscle stresses or pains throughout the year. At the end of the year the data was compared to determine the difference in injury occurrence between the two groups. There was a significant difference (p<0.05) in the distribution of the lean body mass with the Lean body mass at T1 being lower than the Lean body mass at T3 in the control group. In the experimental group the fat percentage showed a significant decrease (p<0.05) from T1 to T3. The distribution of the muscle percentage at T1 was significantly different (p<0.05) from the distribution of the muscle percentage at T3 in the experimental group with the muscle percentage at T1 being lower than the muscle percentage at T3. There was a significant difference between the control and experimental group for 1RM bench press (p<0.05) with the 1RM bench press measurements at T3 being lower for the control group than for the experimental group. Also, the 1RM bench press at T1 was lower than the 1RM bench press at T3 in the experimental group. The experimental group showed a significant increase from T1 to T3, peaking at T3 with the 1RM bench press. Results of the tests done to determine isokinetic muscle strength showed that a statistical significant correlation (p<0.05) was found with regard to the strength of the internal rotators of the non-dominant shoulder at T3, with the experimental group having a higher measurement than the control group. The internal rotators and external rotators of both the dominant and non-dominant shoulders were lower at T1 than at T3 in the experimental group (p<0.05). The external rotators of the non-dominant shoulder at T1 were lower than the external rotators of the non-dominant shoulder at T3 in the control group. Results of the tests done to determine flexibility showed a statistically significant difference with the internal rotators and external rotators of the dominant as well as the non-dominant shoulders being lower at T1 than at T3 in the experimental group. Also, the external rotators of the non-dominant shoulder of the control group were lower at T1 than at T3. Results of the tests done to determine posture showed that in the control group, 54.5% of the players had scoliosis at T1 as opposed to 40.9% at T3. In the experimental group 55% had scoliosis at T1 compared to the 30% at T3. In the experimental group, 55% of the players’ shoulder heights were not level at T1, compared to 30% at T3. 63.6% of the control group’s non-dominant shoulders were higher than the dominant shoulder at T1, compared to the 40.9% of subjects at T3. Among the subjects in the experimental group, 50% had a higher non-dominant shoulder and 5% a higher dominant shoulder at T1, compared to 25% and 5% respectively in the control group, at T3. Results of the tests done to determine the occurrence of injuries, showed that the subjects with no injuries in the control group stayed stable from T1 (54.5%) to T2 (54.5%) whereafter it increased to 59.1% at T3. The experimental group stayed stable from T1 (55.0%) to T2 (55.0%) where after it increased to 85% at T3. In the control group the percentage grade 1 and 2 injuries was 13.6% at T1, increasing to 18.2% at T2, and decreasing to 13.6% at T3. In the experimental group 15% of the subjects had grade 1 injuries at T1. This percentage increased to 30% at T2 where after it decreased to 15% at T3 again. The percentage of subjects with grade 2 injuries in the experimental group remained stable at 10.0% from T1 to T2. None of the subjects had grade 2 injuries at T3. In the control group 9% had grade 3 injuries at T1, with none at T2 and T3. In the experimental group the percentage of subjects with grade 3 injuries remained stable at 5.0% from T1 to T2. None of the subjects had grade 3 injuries at T3. In the control group 4.5% of subjects had grade 4 injuries at T1. This stayed more or less stable at T2 (4.6%) and increased to 9.1% at T3. In the experimental group 10.0% had grade 4 injuries at T1. None of the subjects had grade 4 injuries at either T2 or T3. In the control group 4.5% had grade 5 injuries at T1, none had it at T2, and 4.5% had it at T3. In the experimental group none of the subjects had grade 5 injuries at T1, T2 or T3. In the control group none of the subjects had grade 6 injuries at T1 or T3. At T2, however, 4.6% had grade 6 injuries. In the experimental group 5.0% of the subjects had grade 6 injuries at T1 and none had this type of injury at T2 or T3. In conclusion, the results indicate that a specifically designed exercise programme can help to diminish the risk of shoulder injuries in tennis players. It can also improve bi-lateral muscle strength in opposing muscle groups which are used in tennis. / Thesis (DPhil)--University of Pretoria, 2007. / Biokinetics, Sport and Leisure Sciences / unrestricted

Überkopfsportler*innen führen häufige Wurf- und Schlagbewegungen über Kopf bzw. der Horizontallinie aus und sind hohen Risiken für Verletzungen der Schultergelenke ausgesetzt. Die Identifikation von Risikofaktoren und adäquate Diagnostik sind für die Entwicklung gezielter präventiver und therapeutischer Interventionen essentiell. Die vorliegende Arbeit zielt darauf ab, Risikofaktoren für überlastungsbedingte Schulterbeschwerden bei Überkopfsportler*innen zu identifizieren sowie diagnostische Möglichkeiten zu erweitern und zu optimieren. Die Ergebnisse sollen Rückschlüsse auf grundlegende Verletzungsmechanismen der Schulter bei Überkopfsportler*innen liefern und zur Entwicklung und Verbesserung präventiver und therapeutischer Maßnahmen beitragen. Im Rahmen dieser Dissertation wurde der Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, ein Fragebogen zur patientenbezogenen Erfassung der Funktionsfähigkeit von Schulter und Ellenbogen bei Überkopfsportler*innen, ins Deutsche übersetzt, kulturell adaptiert und validiert. Des Weiteren wurden methodische Aspekte der ultraschallgestützten Untersuchung des subakromialen Raumes mittels der akromiohumeralen Distanz (AHD) untersucht, wobei die untersuchten Auswertemethoden eine ausgezeichnete Reliabilität aufwiesen. Darüber hinaus konnten Einflussfaktoren auf die AHD-Messung ermittelt werden, wobei eine erhöhte Aktivität der Schultermuskulatur zu größeren AHD-Reduktionen bei der Schulterabduktion führte. Außerdem zeigten sich kurzfristige Effekte handballspezifischer Belastung im Sinne einer Verringerung der AHD, welche durch Schulterabduktion sowie einer geringen Abduktionskraft verstärkt wurde und somit das Risiko für Schulterverletzungen erhöhen kann. Diese Arbeit liefert relevante Erkenntnisse über Risikofaktoren von Schulterverletzungen bei Überkopfsportler*innen und Einflussfaktoren der ultraschallgestützten AHD-Messung. Außerdem entstand der erste deutsche validierte Fragebogen für Überkopfsportler*innen. / Overhead athletes who perform frequent overhead throwing and striking movements as part of their sport-specific motions are at high risk for both acute and chronic overuse-related injuries of the shoulder joints. In order to develop specific therapeutic interventions and preventative measures, individualized diagnosis and risk factor identification are essential. The present work aims to identify risk factors for overuse-related shoulder symptoms in overhead athletes and to expand and optimize diagnostic capabilities. The results provide conclusions on basic injury mechanisms of the shoulder in overhead athletes and contribute to the development and improvement of preventive and therapeutic measures. In this dissertation, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, a questionnaire for patient-related assessment of functional capacity of the shoulder and elbow in overhead athletes, was translated into German, culturally adapted, and validated. Furthermore, methodological aspects of acromiohumeral distance (AHD) acquisition using diagnostic ultrasound were investigated. The optimal evaluation method of the AHD measurement showed excellent intra-rater and inter-rater reliability. Factors affecting the AHD measurement were also identified, with increased shoulder muscle activity resulting in greater AHD reductions in shoulder abduction. In addition, short-term effects of handball-specific loading on AHD were assessed. In response to loading, AHD decreased, with shoulder abduction enhancing this mechanism. Low abduction strength had a negative effect on AHD maintenance, which may increase the risk of shoulder injury. This work provides relevant knowledge about risk factors of shoulder injuries in overhead athletes as well as influencing factors in AHD measurement using ultrasonography. In addition, the first German validated questionnaire specifically tailored for the group of overhead athletes was developed.