Shoulder pain in elite swimmers is common and its cause is unknown. One hypothesis is that repetitive swimming leads to shoulder laxity, which in turn leads to impingement and shoulder pain. An observational cross-sectional study was designed to test this hypothesis. Eighty elite swimmers (13-25 years of age) completed questionnaires on their swimming training, pain and shoulder function. They were given a standardized clinical shoulder examination, and tested for inferior glenohumeral joint laxity using a noninvasive electronic laxometer designed for this study. Fifty-two swimmers also attended for a shoulder MRI. The laxometer had good-excellent reliability for inter-observer (Intra-class correlation coefficient, ICC = 0.74) and intra-observer (ICC = 0.76) assessments of joint laxity. The reliability of MRI-determined supraspinatus tendinosis was excellent with a single experienced musculoskeletal radiologist (intra-observer ICC = 0.85) and fair for an inter-observer assessment including less experienced radiologists (ICC = 0.55). MRIdetermined supraspinatus tendinosis was present in 36/52 (69%) swimmers, including four international-level athletes. A positive impingement sign correlated with supraspinatus tendinosis (r = 0.49, p = 0.0002). The impingement sign had 100% sensitivity and 65% specificity for diagnosing supraspinatus tendinopathy. Shoulder laxity correlated modestly with impingement (r = 0.23, p &lt 0.05). There was no association between shoulder laxity and supraspinatus tendinosis (r = 0.24, p = 0.08). The number of hours swum/week (r = 0.36, p = 0.01) and the weekly mileage (r = 0.34, p = 0.02) both correlated significantly with supraspinatus tendinopathy whereas swimming stroke preference did not. Multiple logistic regression analysis performed with supraspinatus tendinopathy as the dependent variable showed the combination of hours swum/week and weekly mileage correctly predicted tendinopathy in 85% of elite swimmers. These data indicate that: (1) supraspinatus tendinopathy is a major cause of shoulder pain in elite swimmers; and (2) this supraspinatus tendinopathy is induced by the volume/dose of swimming; and (3) shoulder laxity per se has only a minimal association with shoulder impingement in elite swimmers. These finding in humans are consistent with animal and tissue culture findings which support the hypothesis that tendinopathy is related to the dose and duration of load to tendon cells.

Thesis (M. Tech.(Chiropractic))--Technikon Witwatersrand, 2004. / Supervisor: Malany Moodley ; Co-supervisor: Neil De Villiers. Includes abstract. Includes bibliographical references (leaves 107-114). Also available via World Wide Web.

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1997

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2003. / Also held in print (117 leaves, ill., 30 cm.) in Akoranga Theses Collection. (T 617.572062 RYA)

Thesis (Ph. D.)--University of New South Wales, 2001. / Includes bibliographical references (leaves 178-200). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xii, [137] leaves / Musculoskeletal injuries in computer users are an increasing concern. The computer has become an essential working tool that is used throughout all levels of companies and organisations. Management and professional personnel are required to use computers, often without training in typing skills, this combined with higher stress and responsibility levels and lengthy work hours. Potentially this makes them a high-risk group for work related injury. Previous research has focused mainly on data entry and secretarial workers, who are often competent in typing and keyboard skills. There is an increasing body of literature that implicates a wide variety of factors responsible for computer and office related musculoskeletal injury, however there is still much conflict as to what factors play the most influential role in development of these disorders. Conflict largely remains over the role of individual and constitutional factors versus workplace factors such as ergonomic design and patterns of computer use. The aim of this study was therefore to determine the prevalence of and related risk factors associated with work related musculoskeletal injuries of the neck and shoulder in non-secretarial computer users within the South African context.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xii, [137] leaves / Musculoskeletal injuries in computer users are an increasing concern. The computer has become an essential working tool that is used throughout all levels of companies and organisations. Management and professional personnel are required to use computers, often without training in typing skills, this combined with higher stress and responsibility levels and lengthy work hours. Potentially this makes them a high-risk group for work related injury. Previous research has focused mainly on data entry and secretarial workers, who are often competent in typing and keyboard skills. There is an increasing body of literature that implicates a wide variety of factors responsible for computer and office related musculoskeletal injury, however there is still much conflict as to what factors play the most influential role in development of these disorders. Conflict largely remains over the role of individual and constitutional factors versus workplace factors such as ergonomic design and patterns of computer use. The aim of this study was therefore to determine the prevalence of and related risk factors associated with work related musculoskeletal injuries of the neck and shoulder in non-secretarial computer users within the South African context.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background The association between the radiographic and clinical findings of shoulder pain is unclear and it is not fully understood how plain film radiographs of the shoulder influence the suspected clinical diagnosis and conservative management of shoulder pain at the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT). Previous research at the CDC reported that plain film radiographs did not significantly influence the suspected clinical diagnosis and conservation management of the lumbar spine and knee conditions. This study was conducted in order to determine if a similar trend was observed for plain film radiographs of the shoulder and the suspected clinical diagnosis and conservative management of shoulder pain. Objectives Objective 1: To determine the association between the suspected clinical diagnosis and radiographic diagnosis of shoulder pain. Objective 2: To describe the type of incidental radiographic findings in the selected plain film radiographs of the shoulder. Objective 3: To determine the proportion of change in the suspected clinical diagnosis and the conservative management of shoulder after obtaining the radiographic report. Method The archives of the CDC at the Durban University of Technology were searched for plain film radiographs of the shoulder and corresponding patients’ records from 4 April 1992 to 19 September 2011. These were collected, examined and evaluated, and the relevant data was extracted. Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. The suspected clinical diagnoses were categorized into groups (trauma, mechanical conditions, muscular or tendon dysfunction, capsular syndromes, neurological conditions, arthritides and other). These were then constructed using two-by-two tables for the absence or presence of radiographic diagnoses versus the suspected clinical diagnosis. The McNemars chi square test was used to determine any association between the radiographic and suspected clinical diagnosis. Results The mean age of the patients whose clinical and plain film radiographic records were examined was 43.5 years, with 53.7% male and 46.3% female patients. It was not possible to find an association between the suspected clinical and radiographic diagnoses as the categories were too different for statistical testing to be done. Thirty one (57.4%) plain film radiographs were requested at the first consultation. In 53.7% (29/54 radiographs) of cases, no specific suspected clinical diagnosis was given and “suspected pathology” was the reason given for referral. Of the 54 patients, 21 had a change in the suspected clinical diagnosis; however, in many of these cases (13/21) it was not a direct result of the radiographic findings. A wide range of treatments were used both before and after plain film radiographs, including soft tissue therapy, manipulation and electrotherapy. There was no significant change in the frequency of use of any of the modalities post-radiographs. Conclusion The reasons provided for ordering plain film radiographs were sometimes vague or even invalid. Although there was a change in 21 of the 54 suspected clinical diagnoses it was not conclusively as a result of the radiographic findings. The management of shoulder complaints did not change appreciatively following plain film radiographs. These findings suggest that the current use of plain film radiographs in the clinical and management context at the CDC needs to be reviewed. / M

MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand / Introduction Disabled sport has become very popular over the last decade with a variety of sports now available for persons with disabilities to compete in. Wheelchair basketball is a fast growing sport in South Africa. However, it is also considered a high-risk sport with most reported injuries coming from participating in the game along with tennis, road racing, rugby and soccer (Nunome et al, 2002, Ferrara and Peterson, 2000 and Curtis, 1997). The sport is characterised by high intensity propulsion and manoeuvring as well as reaching overhead for shooting, passing and rebounding (Goosey-Tolfrey et al, 2002 and Curtis et al, 1999). The athletes are thus at risk of developing in particular shoulder injuries. This study aimed to establish the prevalence of shoulder pain in South African; Gauteng based professional male wheelchair basketball players. It aimed to highlight predisposing factors contributing to the prevalence of shoulder pain as well as establish whether there is a difference in shoulder pain between the wheelchair bound athletes vs. the otherwise ambulatory athletes. By quantifying the magnitude of the problem it was hoped that awareness would lead to measures taken to rectify any problems highlighted by the research. Methods Twenty-nine professional South African: Gauteng male wheelchair basketball players took part in a cross sectional descriptive survey based study. The researcher, following signed informed consent, administered a piloted valid and reliable questionnaire to gain information regarding demographics, medical history and lifestyle habits. Results were expressed in the form of tables and graphs with frequencies, percentages and averages used to describe findings. Results Prevalence of shoulder pain was found to be 72.4% with 21 of 29 participants having experienced shoulder pain since using a wheelchair and 11 of the 29 (37.9%) having current shoulder pain. The number of years using a wheelchair significantly influenced the prevalence iv of shoulder pain (p = 0.03). One hundred percent (nine out of nine) of participants who had been using a wheelchair for longer than 10 years had experienced the problem, while of those who had been using a wheelchair for less than 10 years, 57.14% (four out of seven) had experienced shoulder pain. Time spent at work was found to be significantly associated with the presence of shoulder pain. Of the 12 people who worked more than 30 hours per week, 12 (100%) had experienced shoulder pain (p = 0.05). In the comparison of the ambulatory vs non ambulatory athletes, the wheelchair bound participants tended to be more likely to experience shoulder pain with 12 out of 15 having shoulder problems and 7 of the 12 ambulatory participants having experienced shoulder pain. This was however not a significant finding (p = 0.22). Conclusion It was found that the prevalence of shoulder pain in professional wheelchair basketball athletes in Gauteng was 72.4%. This was significantly associated with hours spent at work as well as years spent using a wheelchair. There were no significant findings regarding shoulder pain prevalence in the otherwise ambulatory vs wheelchair bound wheelchair basketball athletes. Shoulder pain is an important problem in the wheelchair basketball athlete. More education is needed regarding prevention of shoulder problems in our athletes with an emphasis on posture and ergonomic handling.