A dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Although studies of manipulation-induced peripheral changes in the muscles have been done, inconsistencies noted by the author’s call for further investigation into the reflex effects of manipulation. Additionally, according to the literature, no effective treatment protocol for the painful shoulder has been found. Therefore this research aimed at addressing these discrepancies by quantifying the immediate effect of cervical spine manipulation in terms of peak torque on rotator cuff musculature in asymptomatic patients with both a cervical spine dysfunction and without. And thus by investigating cervical manipulation to the C4-C7 spinal segment, as a possible added intervention for improving rotator cuff muscle peak torque, a more efficient and effective management protocol for the painful shoulder could be attained. Thus the aims for this study included: 1) To evaluate whether manipulation has an effect on rotator cuff peak torque or not, utilizing the Cybex Orthotron II Isokinetic Rehabilitation System; 2) To ascertain whether manipulation of the specific levels has an effect on the rotator cuff peak torque or not and 3) To ascertain whether the presence or absence / M

Abstrakt Bakgrund: Upprepade rörelser och hållning i dagliga aktiviteter, arbete eller idrott kan påverka det neuromuskuloskeletala systemet. Upprepade förändringar av hållning och rörelser kan ge upphov till lokaliserad stress på vävnaden. Inom tennis är axelleden väl studerad. I litteraturen ses adaptiva förändringar av axelrörlighet hos tennisspelare och andra kastidrottare. Bålens rörlighet och förhållandet mellan bål- och axelrörlighet är ej studerad. Syfte: Syftet med studien var att undersöka bålrotation, glenohumeralledsrotation och korrelation mellan bålrotation och glenohumeralledsrotation hos elitspelande tennisjuniorer 16-19 år samt att identifiera eventuella idrottsspecifika adaptationer avseende bålrotation och glenohumeralledsrotation. Metod: Passiv rotationsrörlighet i glenohumeralleden mättes med en clinometer på en smartphone samt aktiv bålrotation i sittande med en goniometer placerad vid T2. Deltagarna var 32 tennisjuniorer och kontrollgruppen bestod av 30 fotbollsjuniorer i ålder 16-19 år. Deskriptiv statistik för inåt- utåtrotation och bålrotation presenterades. Skillnader mellan tennis och kontrollgrupp analyserades. Korrelation mellan bålrotation och  inåt- samt utåtrotation analyserades. Resultat: Bålrotation mot icke dominant sida var lägre hos tennisspelarna jämfört med fotbollsspelarna. Ingen tydlig korrelation kunde ses mellan rotationsrörlighet i axeln och bålrotation. Tennisspelarna hade sämre inåtrotation och total rotationsrörlighet (TROM) i glenohumeralleden i dominant arm jämfört med fotbollsspelarna, dessutom minskar deras inåtrotation och TROM med stigande ålder. Konklusion: Det föreligger antydningar till adaptiva förändringar hos tennisspelare med minskad bålrotation åt icke dominant sida samt nedsatt inåtrotation på dominant axel. / Abstract Background: Repeated movements and sustained postures in daily activity, work and in sports can influence the neuromusculoskeletal system. Repeated changes in posture and movement might cause local stress in the tissue. Adaptive effects in the mobility of the shoulder in tennis players and other overhead athletes are well documented in the literature. Research of trunk mobility and its effect on the shoulder is limited. Aim: The aim of this study was to investigate trunk rotation, glenohumeral rotation and the correlation between trunk rotation and glenohumeral rotation in elite junior tennis players 16-19 years old. Secondly, to identify athletic adaptations in trunk rotation and glenohumeral rotation in elite junior tennis players. Methods: Range of motion in the glenohumeral joint for internal and external rotation was measured with a clinometer on a smartphone. Range of motion for trunk rotation was measured with seated rotation test with a goniometer placed at T2. The participants were 32 elite junior tennis players and the control group was 30 elite junior soccer players aged 16-19 years old. Descriptive statistics for range of motion in shoulder and trunk rotation was presented. Differences between tennis players and control group were analyzed. Correlation between trunk rotation and internal and external rotation was analyzed. Results: Trunk rotation to the non dominant side had lower scores in tennis players than in soccer players. No obvious correlation was detected between shoulder rotation and trunk rotation. Tennis players had less internal rotation and total rotation range of motion (TROM) in their dominant arm compared to the control group.  This reduction in internal rotation and TROM increased with age. Conclusion: There are some indications for adaptive changes in tennis players with reduced trunk rotation to the non dominant side and reduced internal rotation in the dominant shoulder.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / The purpose of this study was to determine whether dry needling of myofascial trigger points (TrP's), found in the shoulder rotator myotatic unit, had an effect on the peak torque and total work parameters of the shoulder myotatic unit and by inference, the relative external rotation strength deficit in over-head throwing athletes. Athletes who perform overhead throwing sports such as: baseball, javelin, swimming/waterpolo and tennis, are susceptible to sustaining a micro-traumatic injury of the rotator myotatic unit of the shoulder, owing to repetitive high velocity mechanical stress placed on the shoulder at the extreme ranges of motion. The inherent structure of the shoulder, with three external rotators and five internal rotators, causes a muscle imbalance before an activity, such as throwing occurs, and this can predispose an athlete to Repetitive Stress Injuries (RSI) as a result of overuse or overload. The incidence and activation of TrP's in shoulder muscles can be accounted for on the basis of mechanical stress such as overuse / overload and thus could change muscle fiber co-ordination (muscle activity) and precipitate a painful lesion. It can be seen in current literature that TrP's produce a number of signs and symptoms such as: spasm of other muscles, weakness of involved muscle function, loss of co-ordination and decreased work tolerance of the involved muscle . Therefore the TrP's present in the shoulder rotator unit could contribute to changes in internal/external rotation ratios in over head athletes, and thus by deactivating or eliminating these TrP's, it is possible that these ratios may be / M

Objectives: To examine the effects of posture on subacromial (SA) space with arm elevation in patients with rotator cuff disease (RCD) and healthy subjects. Background: Poor posture has been linked to altered scapular mechanics, theorized to lead to excessive SA space narrowing. However, no study has examined the direct effects of posture on SA space using ultrasonography. We hypothesize that when compared to a neutral posture, upright posture will increase SA space and slouched posture will decrease SA space. Methods: Subjects with painful RCD (n=31) and healthy (n=29) shoulders participated. SA space was measured on ultrasound generated images using the acromiohumeral distance (AHD), which is the shortest distance between acromion and the humerus. Two trials each were collected in three postures of normal, slouched and upright posture with the arm at two angles of rest (0° elevation) and 45° abduction. Results: Two RMANOVAs for each arm angle compared the AHD across postures and groups. There was no interaction between group and posture, and no significant main effect of group for AHD. Groups were collapsed for further analysis. There was a significant main effect of posture on AHD at the 45° abduction (p = 0.0002); AHD increased significantly from normal (AHD= 8.63mm) to upright (AHD= 9.76mm) posture. Conclusion: The effect of posture on SA space is minimal; only upright posture increasing AHD over normal posture by 1.13mm, at 45° abduction position. Research is needed to determine the effects of posture on shoulder pain and posture interventions.

Title: Function and mechanics of fascias focused to shoulder girdle Objectives: The main subject of the diploma thesis is the issue of fascial concatenation. The aim of the diploma thesis is a systematic study findings related to the selected issue and introduce concepts, that deal with the fascial concatenation. For a specific example of fascial concatenation was chosen from a practical standpoint shoulder girdle in relation to the entire upper limb. Methods: The thesis methodologically equivalent to a theoretical type of work - job search. Results: By processing the literature sources was created a comprehensive overview that relates to the topic of fascial concatenation. Attention was focused on the arrangement of fascial tissue, not only in terms of stratification, but also due to its layout. One of the chapters was focused on mechanical functions and models explaining changes in fascial tissue behavior during therapy. The thesis presented three general concepts dealing with fascial concatenation whose specific strings were introduced in the shoulder girdle in relation to the entire upper limb. Keywords: fascia, fascial chain, shoulder girdle

Name of the diploma thesis: Comparison in Frequency of Shoulder and Spine Injuries between 1st National Volleyball Men's and Women's League Players Goal of the diploma thesis: Goal of this thesis is to determine frequency of shoulder and spine injuries within men's category of professional volleyball. Thesis also surveys types of prevention and regeneration that players use, how long they warm up and how they compensate strain before training (match) and after training (match). At the end thesis compares men's results with women's that are based on survey from this thesis and from bachelor work (Vítová, 2012). Method: Required data was obtained by questionnaire in field. Acquired data was processed on the basis of perused Czech and foreign literature that is focused on injuries and prevention in sport. Results: Overview of frequency of shoulder and spine injuries within men's and women's volleyball. Key words: volleyball, injuries, shoulder, spine, prevention

Title: Evaluation of pain threshold by using the method of pressure algometry at selected muscular points in the area of shoulder girdle in karate practitioners. Objectives: The main objective of this thesis is to assess the pain threshold using the method of pressure algometry at selected muscle points while practising the technique choku-cuki in karate practitioners. Methods: The experiment is a pilot study which evaluates the pain threshold in m. latissimus dorzi, m. serratus anterior, m. trapezius pars descendent, ascendent and other selected muscles of both right and left shoulder girdles before exercising direct choku-cuki glow in the position of heiko-dachi stance and also controls the proper performance of given technique. Manual pressure algometer has been chosen as alternative objective method. Examined group consisted of ten male karate practitioners who had met the criteria specified for this study. Results: The results of measurements using pressure algometry in the muscles m. latissimus dorzi, m. serratus anterior, m. trapezius pars descendent, ascendent demonstrated that while practising the technique of the choku-cuki blow in the position of heiko-dachi stance, lowering of pain threshold in the contracted upper limb in comparison to the hitting one was observed. Keywords: pressure...

Title: Rehabilitation after the shoulder joint arthroplasty Objectives: Confirmation of the hypothesis that there is a correlation between success of the surgery and the type of indication, age of the patient and the dominance of the operated upper extremity. At the end is the comparation of our achievements with foreign studies. Method: The clinical part was processed using standardized questionnaire with 34 patients from the rehabilitation clinic Medicentrum at Praha. This part compares the data 3 months after total shoulder arthroplasty with preoperative condition obtained restrospective at the same time. Results: The results show influence of the indications, age of the patient and dominance of the operated upper extremity on the successfulness after total shoulder arthroplasty. Key words: arthroplasty, shoulder joint, rehabilitation

Objetivo: verificar se a associação entre disfunção da coluna cervical e disfunção do ombro em pacientes com sintomas crônicos de síndrome do impacto do ombro. Métodos: Foram avaliados indivíduos com e sem dor no ombro que foram divididos em dois grupos, sendo grupo dor no ombro (GDO) e grupo controle, sendo que nesse grupo os indivíduos não tinham dor no ombro e na coluna cervical. Os instrumentos utilizados foram o questionário Índice de dor e incapacidade do ombro (SPADI) para mensurar a incapacidade e dor no ombro e a Escala visual numérica para verificar a intensidade de dor no ombro e na região da coluna cervical. O grau de incapacidade da coluna cervical foi por meio do Neck Disability Index (NDI). O limiar de dor foi avaliado através das modalidades térmicas (estímulos de calor e frio) e de limiar de dor por pressão, por meio de um termostato e algômetro, respectivamente. Ambas as avaliações de sensibilidade foram avaliadas na área periarticular que representam o local afetado pela dor no ombro, a inserção do musculo deltoide. Na região da coluna cervical, foi o musculo trapézio superior (região occipital), trapézio médio (ponto médio entre a sétima vértebra cervical e a borda posterior do acrômio) e infraespinhal. Análise de regressão logística múltipla seguida de análise da curva de operação do receptor foi utilizada para determinar quais variáveis melhor diferenciavam a dor moderada / grave do ombro da dor leve no ombro. A curva Receiver Operating Characteristic foi usada para determinar os pontos de corte das medidas de resultado. Resultados: os dados demonstraram que houve relação entre o escore do SPADI com NDI. Além disso, o escore do SPADI teve relação com intensidade de dor na coluna cervical. A dor no pescoço e o SPADI total são capazes de prever a dor no ombro moderada / grave para aqueles que sofrem de baixa dor nesta região. O ponto de corte do escore total do SPADI para distinguir indivíduos com qualquer nível de intensidade de dor ou com dor intensa daqueles sem dor no ombro foi de 27 pontos (Sen = 100%, Spe = 100%). O ponto de corte do escore total do SPADI para diferenciar indivíduos com dor leve / moderada e sem dor no ombro foi de 29 pontos (Sen = 100%, Spe = 100%). As curvas ROC obtidas de todas as análises resultam em valores de AUC variando de 0,82 a 1,00 (p <0,05, Sen = 85 a 100%, Spe = 84 a 100%). Os pontos de corte das outras variáveis estudadas também foram gerados. Conclusão: os resultados demonstram que há uma associação entre a dor e incapacidade do ombro com a dor e incapacidade na coluna cervical em pacientes com sintomas de impacto subacromial. Além disso, nossos achados fornecem valores de corte ótimos para desfechos relacionados ao pescoço do ombro que serão úteis na prática clínica e na pesquisa que identifica pacientes com sintomas crônicos de síndrome do impacto do ombro e diferentes níveis de intensidade da dor / Objective: To verify the association between cervical spine dysfunction and shoulder dysfunction in patients with chronic symptoms of shoulder syndrome. Methods: Individuals with and without shoulder pain who were divided into two groups were evaluated: shoulder pain group (SPG) and control group, in which the individuals had no pain in the shoulder and neck. The instruments used were the Index of Pain and Shoulder Inability Index (SPADI) to measure the shoulder disability and pain and the Visual Numerical Scale to verify the intensity of pain in the shoulder and in the region of the cervical spine. The degree of disability of the cervical spine was through the Neck Disability Index (NDI). The pain threshold was evaluated through thermal modalities (heat and cold stimuli) and pain threshold by pressure, using a thermostat and algometer, respectively. Both sensitivity assessments were evaluated in the periarticular area that represent the site affected by shoulder pain, the insertion of the deltoid muscle. In the region of the cervical spine, it was the superior trapezius muscle (occipital region), medial trapezius (midpoint between the seventh cervical vertebra and the posterior rder of the acromion) and infraspinatus. Multiple logistic regression analysis followed by analysis of the receiver operating curve was used to determine which variables best differentiated moderate / severe shoulder pain from mild shoulder pain. The Receiver Operating Characteristic curve was used to determine the cutoff points of the outcome measures. Results: Data showed that there was a relationship between SPADI score and NDI. In addition, the SPADI score correlated with pain intensity in the cervical spine. Neck pain and total SPADI are able to predict moderate / severe shoulder pain for those suffering from low pain in this region. The cut-off point of the SPADI total score to distinguish individuals with any level of pain intensity or severe pain from those without shoulder pain was 27 points (Sen = 100%, Spe = 100%). The cut-off point of the SPADI total score to differentiate individuals with mild / moderate pain and no shoulder pain was 29 points (Sen = 100%, Spe = 100%). The ROC curves obtained from all analyzes resulted in AUC values ranging from 0.82 to 1.00 (p <0.05, Sen = 85 to 100%, Spe = 84 to 100%). The cut-off points of the other variables studied were also generated. Conclusion: The results demonstrate that there is an association between shoulder pain and disability with pain and disability in the cervical spine in patients with subacromial impingement symptoms. In addition, our findings provide optimal cutoff values for shoulder neck outcomes that will be useful in clinical practice and in research that identifies patients with chronic symptoms of shoulder impingement syndrome and different levels of pain intensity

O objetivo do presente trabalho foi o estudo artroscópico das articulações do ombro e do joelho no cão. Durante o exame artroscópico avaliou-se possibilidade de visibilização das estruturas intra-articulares, facilidades e dificuldades inerentes à técnica e complicações. Fez-se análise citológica de líquido sinovial e histopatológica de membrana sinovial da articulação do joelho. Realizou-se a artroscopia em 10 articulações (9 cães) do ombro portadoras de osteocondrite dissecante e em 53 articulações (50 cães) do joelho, as quais apresentaram ruptura de ligamento cruzado cranial total ou parcial associada ou não a lesão de menisco medial ou lateral e luxação medial de patela. Na articulação do ombro as complicações consistiram na dificuldade de confecção dos portais artroscópico e instrumental pela técnica de triangulação, lesão iatrogênica de cartilagem, deslocamento prematuro do artroscópio e acúmulo de fluído nos tecidos moles periarticulares. As estruturas observadas foram sulco intertubercular, tubérculo supraglenoidal, tendão do M. bíceps braquial, cartilagem da cabeça do úmero (cranial e caudal) e da cavidade glenoidal, ligamento glenoumeral medial, bolsa articular caudal e sinóvia. As lesões de cartilagem observadas durante estudo artroscópico destas articulações foram condromalácea, erosão, eburnação e fibrilação na cabeça do úmero e erosão na cavidade glenoidal, além de retalho de cartilagem livre (próximo ao defeito na cabeça do úmero, na bolsa articular caudal, próximo ao tendão do M. bíceps braquial e na porção medial da articulação) ou fixo junto ao defeito na cabeça do úmero. Em um animal o retalho de cartilagem foi removido via artroscopia e nos demais através de artrotomia. Durante exame artroscópico da articulação do joelho observou-se região suprapatelar, patela, tróclea, côndilo lateral e medial do fêmur, côndilo lateral e medial da tíbia, menisco lateral e medial, tendão do M. extensor digital longo, ligamento cruzado cranial e caudal, ligamento intermeniscal, ligamento mucoso e sinóvia. Complicações consistiram principalmente de infiltração de tecidos moles periarticulares e obstrução do campo de visão pelo coxim adiposo infrapatelar. Diferenças entre o diagnóstico artroscópico e a confirmação após artrotomia concentraram-se na diferenciação entre ruptura completa e parcial do ligamento cruzado cranial (n=3) e afecção de menisco (n=6). A artroscopia trouxe informações sobre a membrana sinovial, alteração em menisco lateral e ligamento cruzado caudal não perceptível durante artrotomia. O estudo citológico denotou processo não inflamatório na maioria das articulações estudadas. Em análise histopatológica obteve-se processo inflamatório crônico, agudo e uma articulação com sinovite linfocitica plasmocitica. A artroscopia é uma técnica endoscópica que demanda intenso treinamento para a sua realização; e, permite um exame rico em minúcias que traz informações significativas que poderão ajudar a elucidar as afecções articulares que acometem a espécie canina. / The aim of this approach is shoulder and knee arthroscopic study in the dog. During the arthroscopic exam it was analyzed the possibility to see the structures into the joint; facilities and difficulties concerning the technique and its complications. Cytological synovial fluid and histopathological synovial membrane studies of the knee joint were performed. The arthroscopy was carried out in ten shoulder joints (nine dogs) which had osteochondritis dissecans and in fifty-three knee joints (fifty dogs), which had complete or partial cranial cruciate ligament rupture associated or not with medial or lateral meniscal damage and medial patella luxation. In the shoulder joint the complications consisted of the difficulty in doing the arthroscopic and instrumental portal using the triangulation technique, iatrogenic lesion, premature removal of the arthroscopy and periarticular infiltration. The observed structures were intertubercular groo, supraglenoid tubercle, tendon of biceps brachii muscle, cartilage of the humeral head (cranial and caudal) and glenoid cavity, medial glenohumeral ligament, caudomedial gutter and synovium. The lesions of the articular cartilage observed during the exam in the shoulder joint were chondromalacia, erosion, eburnation, fibrillation in the humeral head and erosion of the glenoidal cavity besides joint mice (near the defect on the humeral head, on the caudomedial gutter, near the tendon of biceps brachii muscle and in the medial gutter) and flap in the caudomedial humeral head. In one animal the flap was removed by arthroscopy while in the others it was removed by arthrotomy. During the arthroscopic exam of the knee joint it was remarked suprapatellar joint pouch, patella, trochlea, lateral and medial femoral condyle, lateral and medial tibial condyle, lateral and medial meniscus, tendon of long digital extensor muscle, cranial and caudal cruciate ligament, intermeniscal ligament and synovium. The main complications consisted of periarticular infiltration and obstruction of the field of vision by the infrapatellar fat pad. The differences between the diagnostic after arthroscopy and confirmation by arthrotomy were the differentiation between complete and partial rupture of the cranial cruciate ligament (n=3) and meniscal lesion (n=6). The arthroscopy exam provides information about lateral meniscal and caudal cruciate ligament lesion which are not noticeable by arthrotomy. The cytological study showed no-inflammatory process in most of the joints. In the histopathological analysis the results were chronic and acute inflammatory process and one joint having plasmacytic lymphocytic synovitis. The arthroscopy is an endoscopic technique that requires continuous training to be achieved and gives a detailed exam with significant information which could help to explain a lot of diseases in joints of the canine species.