Thesis (MAppSc in Physiotherapy)--University of South Australia, 1995

Background: Frozen shoulder or idiopathic adhesive capsulitis is an enigma of musculo-skeletal medicine. It is a difficult condition to treat and its etiology is still unknown. Aim: The aim of this study is to investigate whether acupuncture has a role in the management of frozen shoulder. Objectives: An in-depth literature review was conducted on all aspects related to the current concepts and treatments for frozen shoulder. Although there were discussions on associated conditions and possible causes of frozen shoulder, there is currently no consensus on its management. Acupuncture has been used successfully as a treatment for frozen shoulder by many eastern practitioners. Unfortunately, their claims could not be substantiated due to a lack of properly conducted clinical trials. An acupuncture treatment protocol for the management of frozen shoulder was designed based on both Traditional Chinese Medicine (TCM) and Anatomical principles. This protocol was then tested with a clinical trial. Methods: A pilot study, using a prospective case series of 20 patients suffering with the “adhesive phase” of frozen shoulder, was conducted to test the effectiveness of the acupuncture treatment protocol. This study included specific selection and exclusion criteria; an objective assessment of the range of movement and subjective assessments on the quality of life and pain. All data were collated and analysed with SPSS version 12. The pretreatment and post-treatment data were tested using both parametric paired sample t test and non-parametric Wilcoxon signed-rank test. Results: The patients’ profile confirmed the affected age group and gender distribution to be similar to those in the literature search. Unfortunately, due to the small sample size, there were no significant associated conditions demonstrated. There were twice as many cases of primary frozen shoulder than secondary frozen shoulder in this study. These analyses suggested that there were significant changes in all three areas of assessment – range of shoulder movement, quality of life and visual analogue pain scale (p&lt0.001). At completion of treatment, the result revealed that the acupuncture treatment protocol was successful in 60%, and moderately successful in 15%, of the 20 cases tested. This outcome was compared with the study by Omari and Bunker which showed only 12% success with conservative western medical treatments, suggesting that acupuncture may be better than conservative western medical treatments. Conclusion: Acupuncture treatment is less costly and has minimal side effects. It should be part of the non-procedural modalities offered to patients suffering with frozen shoulder. For patients who have failed western conservative managements, a trial of acupuncture treatment should be considered prior to embarking on the more invasive interventions..

Thesis (M.S.)--Michigan State University. Dept. of Kinesiology, 2007. / Includes bibliographical references (leaves 62-66).

Master's thesis - - State University of New York College at Cortland, 2006 - - Department of Exercise Science and Sport Studies. / Includes bibliographical references (p.33-5).

Thesis (M.S.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains x, 185 p. : col. ill. Includes abstract. Includes bibliographical references.

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Rotator cuff disorders encompass a range of impairments from tendinopathy to partialor full-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain. Rotator cuff tears, most of which are atraumatic, are common in adults with shoulder pain and are strongly associated with increasing age. Conservative treatment including physiotherapy is the first-line treatment, but some patients do not respond, and ultimately require surgery. Early predictions of response could allow individuals’ care pathways to be optimised, preventing unnecessary delays and suffering and benefiting patients and healthcare providers alike. My primary aim was to develop a prognostic model for the outcome of physiotherapy in adults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This was addressed by a prospective prognostic model study. The study was underpinned by a systematic review of prognostic models in adults undergoing physiotherapy for painful rotator cuff disorders and was further informed and complemented by the following work: the development and validation of the physiotherapy protocol for the prognostic study; the identification, selection and definition of the candidate prognostic factors for the prognostic study; the estimation of the Minimal Important Difference (MID) of the study’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC); and an exploratory responder analysis of the WORC outcome scores. The prognostic systematic review, prognostic study, MID analysis and responder analysis are original contributions to knowledge. The prognostic systematic review revealed important methodological deficiencies in the five included studies, and no clinically usable model. No study addressed a distinct PTT population. The process of identifying factors for my own prognostic model study revealed a lack of knowledge about the prognostic relevance of factors. All of the candidate models I explored in my prognostic study (n sample = 65, n analysed = 61) had low performance and precision. The estimated MID of the WORC was -300. The responder analysis resulted in different proportions of responders to treatment depending on the responder definition. My results highlight the difficulties involved in predicting outcomes in the field of shoulder pain and rotator cuff disorders, and the need for methodologically sound prognosis research.

Joint movements are essential for the function of human body during the activities of daily living and sports. The movement of human joints varies from normal to those which have an increased range of joint movement (gymnasts) to those with extreme disabling laxity in patients with a connective tissue disorder (Ehlers Danlos Syndrome). “Hypermobility" is most commonly used to describe excessive movement. Hypermobility was assessed by using the current criteria of the Beighton score for signs and the Brighton criteria for symptoms of hypermobility in a group of orthopaedic patients attending the specialist knee and shoulder injury clinics. The Beighton score was found to be higher in patients attending for primary ACL reconstruction (mean 2.9, p = 0.002) and revision ACL reconstruction (mean 4, p < 0.001) when compared with the control group. Hypermobility was a risk factor for the failure of ACL reconstruction (30% vs 0%). The mean Beighton score was higher in both the primary shoulder dislocation group (mean difference 1.8, p=0.001) and the recurrent shoulder dislocation group (mean difference 1.4, p=0.004). Bone defects were studied on the CT scan following shoulder dislocations. There was no correlation between hypermobility and the bone defects. The bone defect was a risk factor for recurrent shoulder instability (48% vs 16%). A material testing system was used to assess the tissue laxity of discarded hamstring tendon and shoulder capsule obtained during stabilisation procedures. The mean gradient of slope for both tendon and capsule graphs was 23.8 (range 3.08-52.63). The tissue laxity was compared to the Beighton score, however no correlation was detected between the Beighton score and the gradient of the tissue laxity. An electronic goniometer was used to measure the angle of the MCP joint of the little finger, whilst a force plate system simultaneously measured the force required to hyperextend the MCP joint. The little finger MCP joints of each hand were assessed in this manner in a group of patients undergoing primary ACL reconstruction or open shoulder stabilization. The mean force required to produce the 40 degrees angle at the little finger MCP joint was 0.04 kg with a range from 0-0.11 kg. There was a positive correlation between the gradient of tissue laxity and the force required to produce 40 degrees angle at the little finger of the dominant hand. The expression of Collagen V and Small leucine rich proteoglycans (Decorin and Biglycan) was studied in the skin, hamstring tendon and shoulder capsule of the patients described above attending with shoulder or knee instability. These patients had different levels of hypermobility (as assessed by the Beighton score) and symptoms of hypermobility (as assessed by the Brighton criteria to diagnose Benign Joint Hypermobility Syndrome). The weaker tendon group was found to have a lower mean Beighton score, while the weaker skin group had a higher mean Beighton score. Collagen V expression was higher in the skin dermal papillae of the weaker group. The Beighton Scores were higher in patients with ACL and shoulder injuries. Hypermobility was a risk factor for the failure of ACL reconstruction. There was no correlation between hypermobility and the bone defects on the CT scan following shoulder dislocation. Bone defects were a risk factor for recurrence. There was no correlation between the Beighton Score and the tissue laxity. There was a correlation between the tissue laxity and the clinical assessment of laxity at the little finger MCPJ by using a force- goniometer system. There was a correlation between the collagen V expression in the dermal papillae of the skin and the Beighton score.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-12-05T18:23:14Z No. of bitstreams: 1 Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5) / Made available in DSpace on 2012-12-05T18:23:14Z (GMT). No. of bitstreams: 1 Marcos Gomes da Silva A ultra sonografia... 2005.pdf: 32482863 bytes, checksum: 577d11de768274646dcc96446a704746 (MD5) Previous issue date: 2005 / Escola Bahiana de Medicina e Saúde Pública / Centro de Pesquisas Gonçalo Moniz / Com objetivo de estudar os possíveis achados uitra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avallados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluidos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipo de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador. / Seventy-seven patients with clinical diagnostic of painful shoulder sent to ultrasonographic investigation were assessed in order to study the possible ultrasonographic findings of the painful shoulder syndrome (PSS). Besides the image findings, we tried to identify clinical and epidemiological variables which could be associated to the presence of pathological disorders. Among the 77 patients included in the study, we found ultrasonographic abnormalities in 47 patients (61%). The most common finding among the abnormal exams was the lesion of the rotator cuff in 38 patients (80%), classified as tendinopathy, partial rupture or complete rupture. Nine patients (20%) with abnormal exams presented other lesions, such as bursitis (5 cases) and joint effusion (4 cases), without other associated alterations. Among the clinical and epidemiologic variables assessed, age over 51 years and the presence of joint disability were associated to abnormal ultrasound results for these patients. The rotator cuff lesion was associated to the presence of joint effusion and the need of the use of anti-infiammatory drugs. We have reached the conclusion that sonography is an important method of assessing patients with PSS. In this study, factors such as age and joint disability were associated with the presence of the rotator cuff lesion

Os acostamentos exercem funções importantes em uma rodovia, tanto em relação à melhoria das condições operacionais, tais como a capacidade e a segurança viárias, quanto ao desempenho dos pavimentos, protegendo a estrutura da pista principal, melhorando as condições de drenagem e de transferência de carga. Entretanto, os acostamentos têm sido suprimidos ou implantados de maneira incorreta por razões de economia. O presente trabalho reuniu critérios e recomendações existentes sobre a implantação de acostamentos no que diz respeito à sua influência na capacidade e na segurança viárias, às suas características geométricas, aos métodos para a definição do tipo, dimensionamento e sobre os defeitos encontrados nos pavimentos, tanto nos acostamentos quanto nas pistas. Também efetuou análises para mensurar a importância dos acostamentos no bom desempenho de uma rodovia, tanto em relação às condições operacionais, como do desempenho do pavimento. A partir destas análises verificou-se que a supressão de acostamentos em uma rodovia pode reduzir a sua capacidade em 7% e aumentar o índice de acidentes previstos em até 28%. Com relação ao desempenho dos pavimentos, a partir do levantamento das condições funcionais e estruturais dos pavimentos existentes na malha rodoviária pertencente à Divisão Regional DR-2 do Departamento de Estradas de Rodagem do Estado de São Paulo (DER/SP) efetuado em 2005, verificou-se que o Índice de Qualidade Final da malha composta por rodovias com acostamentos é superior ao da malha composta por rodovias sem acostamentos. Foram então realizadas análises que verificaram a influência dos acostamentos (i) na vida útil de pavimentos flexíveis e rígidos através da utilização do método de dimensionamento da AASHTO; (ii) na espessura das placas de concreto dos pavimentos rígidos através dos métodos de dimensionamento da AASHTO e da PCA; (iii) nas tensões atuantes nas placas de concreto dos pavimentos rígidos através da análise mecanicista com a utilização do programa EVERFE 2.24. Todas as análises mostraram que os acostamentos melhoram significativamente o desempenho do pavimento da pista principal, seja aumentando a sua vida útil de 100 a 400% ou reduzindo a espessura necessária do revestimento da pista principal em cerca de 25%. Realizou-se também uma análise de custo para orientar a definição do tráfego a ser considerado para o dimensionamento do pavimento dos acostamentos, onde se constatou que o valor de 5% do tráfego total considerado para a pista implica em aumento de apenas 2 a 3 % nos custos totais da pavimentação, sendo recomendável o seu uso. Por fim, propôs-se um Fluxograma para Projeto baseado nas análises realizadas e com o objetivo de orientar a decisão de implantar ou não os acostamentos, assim como fornecer recomendações a serem seguidas em ambos os casos. / Shoulders has important functions in a highway, so much in relation to the improvement of the operational conditions, such as the capacity and the road safety, as for the pavements performance, protecting the structure of the mainline, improving the drainage and load transfer conditions. However, the shoulders have been suppressed or implanted in incorrect way for economy reasons. The present work gathered criteria and existent recommendations on the implantation of shoulders related to its influence in the capacity and road safety, to their geometric characteristics, to the methods for the definition of the type, design method and failures in the pavements, in the shoulders and in the tracks. It also made analyses to measure the importance of the shoulders in the good performance of a highway, so much in relation to the operational conditions, as of the pavement performance. Starting from these analyses it was verified that the suppression of shoulders in a highway can reduce its capacity in 7% and to increase the predicted accidents index in up to 28%. Regarding the pavements performance, starting from the functional and structural conditions of the existent pavements in the road mesh belonging to the Regional Division DR-2 of the Department of Highways of the State of São Paulo (DER/SP) in 2005, it was verified that the value of Final Quality Index of the mesh composed by highways with shoulders is superior to the mesh composed by highways without shoulders. Then, analyses were made to verify the influence of the shoulders (i) in the flexible and rigid pavements life cycle through the use of the AASHTO design method; (ii) in the concrete thickness of the rigid pavements through the AASHTO and PCA design methods; (iii) in the stresses in the concrete plate of the rigid pavements through the analysis mechanic with the use of the software EVERFE 2.24. All of the analyses showed that the shoulders improve significantly the pavement performance of the mainline, increasing its life cycle from 100 to 400% or reducing the necessary thickness of the covering of the mainline in about 25%. It also took place a cost analysis to guide the definition of the traffic to be considered in the shoulders pavement design, where it was verified that the value of 5% of the total traffic considered for the mainline increases only 2 to 3% in the total costs of the paving, being advisable its use. Finally, it was proposed a Flowchart for Project based on the accomplished analyses and with the objective of guiding the decision of implanting or not the shoulders, as well as supplying recommendations to be following in both cases.