A relação entre dor no ombro e a discinese escapular (DE) é ainda incerta. Diferenças entre participantes com e sem DE têm sido demonstradas na literatura, com enfoque na quantidade de movimento escapular em graus específicos de elevação do úmero. No entanto, essa abordagem não considera a forma das séries temporais que representam os movimentos escapulares. A Análise de Componentes Principais (ACP) pode aprofundar o atual conhecimento dos padrões \"anormais\" da escápula por considerar a colinearidade e a variabilidade presentes nas séries temporais cinemáticas. Este estudo objetivou avaliar a cinemática escapular em pacientes com dor no ombro e participantes assintomáticos com e sem DE usando a ACP. Dados foram coletados em 98 participantes separados em quatro grupos: Dor+DE (n=24), Dor (n=25), Sem Dor+DE (n=24), e Sem dor (n=25). Os dados cinemáticos foram capturados por um sistema de captura de movimento eletromagnético durante as fases de elevação e abaixamento do braço. ACP e análise de variância foram utilizadas para comparar os grupos. O grupo Sem Dor+DE apresentou progressivo aumento da inclinação anterior ao longo da fase de elevação do braço comparado aos grupos sem DE, Dor (tamanho de efeito = 0.79) e Sem Dor (tamanho de efeito = 0.80). Durante a fase de abaixamento do braço, o grupo Dor+DE apresentou progressivo aumento da inclinação anterior ao longo da fase comparado ao grupo Sem Dor+DE (tamanho de efeito = 0.68). Assim, a ACP demonstrou diferenças no padrão da inclinação anterior da escápula relacionada a presença de DE e dor. A presença de DE revelou um padrão com progressivo aumento da inclinação anterior da escápula ao longo da fase de elevação. No entanto, durante a fase de abaixamento, participantes assintomáticos com DE modificaram seu padrão de movimento, diferente do grupo sintomático, reforçando a sugerida associação entre modificações no movimento escapular e sintomas no ombro. / The relationship between shoulder pain and scapular dyskinesis (SDK) is still unclear. Differences between participants with and without SDK have been demonstrated, focusing on the amount of scapular motion at specific degrees of humeral elevation. However, this approach does not consider the shape of the scapular motion temporal series. Principal Component Analysis (PCA) may advance current understanding of \'abnormal\' movement patterns by considering the collinearity and the variability present in the kinematic temporal series. This study aimed to evaluate the scapular kinematics in patients with shoulder pain and in asymptomatic participants with and without SDK using PCA. Data were collected in 98 participants separated in four groups: Pain+SDK (n=24), Pain (n=25), No Pain+SDK (n=24), and No Pain (n=25). Scapulothoracic kinematic data were measured with an electromagnetic tracking device during arm elevation and lowering phases. PCA and analysis of variance were used to compare the groups. The No Pain+SDK group had a progressive increasing in anterior tilt over the elevation phase compared to the Pain (effect size=0.79) and No Pain (effect size=0.80) groups. During the arm-lowering, the Pain+SDK group had a progressive increasing in anterior tilt over this phase in comparison to the No Pain+SDK group (effect size=0.68). Therefore, PCA demonstrated differences in the scapular anterior tilt related to SDK and shoulder pain. The presence of SDK revealed a scapular pattern with progressive increasing in anterior tilt over the elevation phase. However, during the arm-lowering phase, asymptomatic participants with SDK changed their motion pattern, unlike the symptomatic group, reinforcing the suggested association between scapular modifications and shoulder symptoms.

De acordo com o conceito de cadeia cinética, o controle da posição distal depende da estabilização dos segmentos proximais. Deste modo, a estabilização necessária para o controle e movimento dos membros superiores é proporcionada pelo tronco e pela pelve que servem como meio de transmissão de força e energia. O controle da postura e do movimento é realizado por mecanismos de feedback e feedforward definidos pela teoria do controle motor. O feedforward é descrito pelas atividades antecipatórias corporais a fim de neutralizar os efeitos perturbadores de determinada condição específica. O feedback é representado pelo uso do biofeedback (estímulo verbal, visual, auditivo ou cinestésico) com o objetivo de restaurar a coordenação e o controle muscular, e potencializar os mecanismos de feedforward muscular. Há poucas investigações de tais mecanismos de controle no complexo articular do ombro e estudos prévios demostram a influência de comandos verbais para a orientação escapular sobre os padrões de ativação muscular seletiva do ombro. Objetivo: verificar o efeito da instrução verbal para ativação consciente da musculatura abdominal, sobre a atividade dos músculos periescapulares em pacientes com sintomas da síndrome do impacto no ombro durante exercícios de força. Materiais e Métodos: 30 voluntários com condição dolorosa há pelo menos 4 semanas no ombro, de ambos os sexos ( 11 homens e 19 mulheres) com idade de 35 a 75 anos realizaram exercícios para o complexo sendo que o grupo controle apenas repetiu os exercícios já o outro grupo recebeu treinamento para adicionar a contração abdominal consciente referente a estímulo verbal e tátil durante os mesmos exercícios previamente realizados, assim o sinal eletromiográfico foi captado através do aparelho TrignoTM Wireless System (Delsys Inc. Boston, MA). Resultados: Durante os exercícios a comparação entre grupos com e sem instrução para contração abdominal no momento pré e pós apresentou diferença no modelo linear de efeitos mistos apenas para os músculos Trapézio Transverso durante o Full can (FC) para o lado sintomático (TE:0,92); Trapézio ascendente para o lado 10 sintomático durante (FC) (TE:-0,96) e para o lado assintomático durante External Rotation Kneeling (ERK) (TE:-0,81); já o Serrátil anterior quando exigido no exercício Knee Push (KP) o lado assintomático apresentou diferença entre os grupos (TE:-1,24) assim como no (ERK) com (TE: -2,09) para lado assintomático e no Wall Slide with Towel (WST) com (TE:1,03) também para o lado assintomático; Conclusão / According to the kinetic chain concept, the control of the distal position depends on the stabilization of the proximal segments. Thus, the stabilization necessary for the control and movement of the upper limbs is provided by the trunk and pelvis which serve as a means of transmitting force and energy. The control of posture and movement is performed by feedback and feedforward mechanisms defined by motor control theory. Feedforward is described by anticipatory body activities in order to counteract the disruptive effects of a particular condition. The feedback is represented by the use of biofeedback (verbal, visual, auditory or kinesthetic stimulus) with the objective of restoring coordination and muscular control, and potentiate the mechanisms of muscle feedforward. There are few investigations of such control mechanisms in the shoulder joint complex and previous studies demonstrate the influence of verbal commands on the scapular orientation on selective muscular activation patterns of the shoulder. Objective: To verify the effect of verbal instruction for conscious activation of the abdominal musculature on the activity of the periescapular muscles in patients with symptoms of shoulder impact syndrome during strength exercises. Materials and Methods: 30 volunteers with painful condition for at least 4 weeks on the shoulder, of both sexes (11 men and 19 women) aged 35 to 75 years performed exercises for the complex and the control group only repeated the exercises already the other group received training to add conscious abdominal contraction regarding verbal and tactile stimuli during the same exercises previously performed, so the electromyographic signal was captured through the TrignoTM Wireless System (Delsys Inc. Boston, MA). Results: During the exercises, the comparison between groups with and without instruction for abdominal contraction at the pre and post moments presented a difference in the linear mixed effects model only for Middle trapezoid muscles during Full can (FC) for the symptomatic side (TE: 0.92 ); trapeze lower to the symptomatic side during (FC) (TE: -0.96) and to the asymptomatic side during External Rotation Kneeling (TE: -0.81). The anterior serratus when required in the Knee Push exercise (KP), the asymptomatic side presented a difference between the groups (TE: -1.24) as well as in the (ERK) with (TE: -2.09) for asymptomatic side and Wall Slide with Towel (WST) with (TE: 1.03) also for the asymptomatic side; Conclusion:

A prevalência de dor no ombro em nadadores competitivos pode chegar a 91%. A articulação escapulotorácica (ET) tem papel central na funcionalidade do ombro atuando de forma coordenada com a articulação glenoumeral (GU), posicionando a cavidade glenóide para evitar impacto precoce do manguito rotador (MR) sob o arco coracoacromial. Um atleta de natação pode realizar até 2500 braçadas em apenas um dia de treinamento o que os torna susceptível a fadiga. O objetivo deste estudo foi analisar a cinemática da escápula e atividade eletromiográfica dos músculos trapézio ascendente (TA), trapézio transverso (TT), trapézio descendente (TD) e serrátil anterior (SA) em nadadores antes e após a realização de um teste de esforço máximo de 3 minutos. O estudo contou com 16 atletas entre 15 a 24 anos. Um sistema de 8 câmeras infravermelho foi utilizado para registrar a cinemática nos três planos de movimento antes e após o teste de esforço. Foi utilizado um eletromiógrafo com sensores wireless sincronizado ao sistema de câmeras. A análise estatística para comparação entre o pré e pós teste foi realizada pelo teste t pareado e a estimativa do tamanho do efeito (TE) foi calculada pelo d Cohen\'s. Foram realizadas regressões lineares para verificar a relação entre a variação cinemática e a variação eletromiográfica. Os resultados mostraram aumento da rotação interna da escápula em todas as angulações com TE pequeno, e aumento da inclinação anterior com 120° de elevação com TE pequeno. O SA apresentou diminuição da atividade eletromiográfica nos intervalos de 120-90° e 60-30° com TE moderado. Houve relação entre a variação da inclinação anterior da escápula e a variação da atividade muscular do TT, da rotação interna com a variação do TT e do SA. Concluiu-se que atletas de natação submetidos a um teste de esforço máximo exibem aumento da inclinação anterior, além de aumento da rotação interna durante toda a ADM. A atividade muscular do SA decaiu após o teste de esforço máximo. Por se tratar de um músculo atuante durante todo o gesto esportivo, estratégias preventivas e de tratamento devem focar no ganho de força e resistência deste músculo. / The prevalence of shoulder pain in competitive swimmers may reach 91%. The scapulothoracic joint (ST) plays a central role in shoulder function acting in a coordinated way with the glenohumeral joint (GU), avoiding the impact on the rotator cuff (MR) under the coracoacromial arch. A swimming athlete can perform up to 2.500 strokes in just one day of training which makes them susceptible to fatigue. The aim of this study was to analyze the scapular kinematics and the electromyographic activity of the upper trapezius (UT), medium trapezius (MT), lower trapezius (LT) and anterior serratus (AS) muscles in swimmers before and after a maximal effort in a 3 minutes test. The study included 16 athletes aged between 15 and 24 years. A system with 8 infrared camera was used to verify the kinematics in the three planes of motion before and after the effort test. A wireless electromyograph synchronized with the camera system was used. The statistical analysis for comparison between the pre and post test was performed by the paired T-test and the effect size calculation (ES) was performed by d Cohen\'s. Linear regressions were performed to verify the relationship between the kinematic variation and the electromyographic variation. The results showed increased scapular\'s internal rotation at all angles with small ES and anterior tilt increase at 120° elevation with small ES. The AS showed a decrease in electromyographic activity in the intervals of 120-90° and 60-30 ° with moderate ES. There was a relation between the variation of the anterior tilt of the scapula and the variation of the MT muscle activity, between the internal rotation with the MT and between the internal rotation with AS muscle variation. Was concluded that swimming athletes submitted to a maximal effort test showed an increase in anterior tilt, in addition to an increase in internal rotation throughout all the range of motion. The AS muscle activity declined after the maximal effort test. Because it is a active muscle throughout the stroke movement, preventive and treatment strategies should focus on the strength and endurance of this muscle.

De acordo com o conceito de cadeia cinética, o controle da posição distal depende da estabilização dos segmentos proximais. Deste modo, a estabilização necessária para o controle e movimento dos membros superiores é proporcionada pelo tronco e pela pelve que servem como meio de transmissão de força e energia. O controle da postura e do movimento é realizado por mecanismos de feedback e feedforward definidos pela teoria do controle motor. O feedforward é descrito pelas atividades antecipatórias corporais a fim de neutralizar os efeitos perturbadores de determinada condição específica. O feedback é representado pelo uso do biofeedback (estímulo verbal, visual, auditivo ou cinestésico) com o objetivo de restaurar a coordenação e o controle muscular, e potencializar os mecanismos de feedforward muscular. Há poucas investigações de tais mecanismos de controle no complexo articular do ombro e estudos prévios demostram a influência de comandos verbais para a orientação escapular sobre os padrões de ativação muscular seletiva do ombro. Objetivo: verificar o efeito da instrução verbal para ativação consciente da musculatura abdominal, sobre a atividade dos músculos periescapulares em pacientes com sintomas da síndrome do impacto no ombro durante exercícios de força. Materiais e Métodos: 30 voluntários com condição dolorosa há pelo menos 4 semanas no ombro, de ambos os sexos ( 11 homens e 19 mulheres) com idade de 35 a 75 anos realizaram exercícios para o complexo sendo que o grupo controle apenas repetiu os exercícios já o outro grupo recebeu treinamento para adicionar a contração abdominal consciente referente a estímulo verbal e tátil durante os mesmos exercícios previamente realizados, assim o sinal eletromiográfico foi captado através do aparelho TrignoTM Wireless System (Delsys Inc. Boston, MA). Resultados: Durante os exercícios a comparação entre grupos com e sem instrução para contração abdominal no momento pré e pós apresentou diferença no modelo linear de efeitos mistos apenas para os músculos Trapézio Transverso durante o Full can (FC) para o lado sintomático (TE:0,92); Trapézio ascendente para o lado 10 sintomático durante (FC) (TE:-0,96) e para o lado assintomático durante External Rotation Kneeling (ERK) (TE:-0,81); já o Serrátil anterior quando exigido no exercício Knee Push (KP) o lado assintomático apresentou diferença entre os grupos (TE:-1,24) assim como no (ERK) com (TE: -2,09) para lado assintomático e no Wall Slide with Towel (WST) com (TE:1,03) também para o lado assintomático; Conclusão / According to the kinetic chain concept, the control of the distal position depends on the stabilization of the proximal segments. Thus, the stabilization necessary for the control and movement of the upper limbs is provided by the trunk and pelvis which serve as a means of transmitting force and energy. The control of posture and movement is performed by feedback and feedforward mechanisms defined by motor control theory. Feedforward is described by anticipatory body activities in order to counteract the disruptive effects of a particular condition. The feedback is represented by the use of biofeedback (verbal, visual, auditory or kinesthetic stimulus) with the objective of restoring coordination and muscular control, and potentiate the mechanisms of muscle feedforward. There are few investigations of such control mechanisms in the shoulder joint complex and previous studies demonstrate the influence of verbal commands on the scapular orientation on selective muscular activation patterns of the shoulder. Objective: To verify the effect of verbal instruction for conscious activation of the abdominal musculature on the activity of the periescapular muscles in patients with symptoms of shoulder impact syndrome during strength exercises. Materials and Methods: 30 volunteers with painful condition for at least 4 weeks on the shoulder, of both sexes (11 men and 19 women) aged 35 to 75 years performed exercises for the complex and the control group only repeated the exercises already the other group received training to add conscious abdominal contraction regarding verbal and tactile stimuli during the same exercises previously performed, so the electromyographic signal was captured through the TrignoTM Wireless System (Delsys Inc. Boston, MA). Results: During the exercises, the comparison between groups with and without instruction for abdominal contraction at the pre and post moments presented a difference in the linear mixed effects model only for Middle trapezoid muscles during Full can (FC) for the symptomatic side (TE: 0.92 ); trapeze lower to the symptomatic side during (FC) (TE: -0.96) and to the asymptomatic side during External Rotation Kneeling (TE: -0.81). The anterior serratus when required in the Knee Push exercise (KP), the asymptomatic side presented a difference between the groups (TE: -1.24) as well as in the (ERK) with (TE: -2.09) for asymptomatic side and Wall Slide with Towel (WST) with (TE: 1.03) also for the asymptomatic side; Conclusion:

The glenohumeral joint has the largest range of motion in the body. This is due to its anatomy of the bony structure of the glenoid fossa providing a shallow socket with minimal constraint of the humeral head and the surrounding soft tissue structures serving as restraints to limit excessive humeral head translation. The bony and soft tissue structures function together with a delicate balance that when disrupted lead to several pathologies including degenerative osteoarthritis or glenohumeral instability, which are the focus of this research. For glenohumeral osteoarthritis, the gold standard treatment is total shoulder arthroplasty. Although the surgical success rate is reported at 95%, the long-term failure rate is as high as 30% and often caused by glenoid component failure. For glenohumeral instability, surgical capsular plication can significantly reduce recurrent dislocation rates, however, up to 70% of patients experience joint stiffness and a reduced range of motion. For these treatments, there is little consensus regarding what surgical parameters optimize functional recovery - consequently, several surgical techniques exist. Since long-term follow-ups are lacking and difficult to perform, basic science studies are needed to identify what surgical parameters are most likely to influence patient recovery. The objective of this research was to develop patient-specific computer models to create accurate representations of these pathologies and to investigate the effects of different surgical parameters in total shoulder arthroplasty and glenohumeral instability repair. A total shoulder arthroplasty computer model was developed to investigate the effect of surgical parameters of the glenoid implant component. An initial study performed a cadaveric validation of the methodology to simulate the reaming process for resurfacing the glenoid surface. This validated computer model was then used to investigate how the degree of correction of glenoid retroversion affects cement mantle stress and potential cement failure. The use of physiologic patient-specific bone models revealed that maintaining the cortical bone layer should take precedence over version correction when a high degree of glenoid deformity is encountered. A glenohumeral instability computer model was developed to investigate the effect of capsular repair on shoulder stability and joint range of motion. The computer model suggests that adding a plication of the posterior band of the inferior glenohumeral ligament offloads regions of high strain from the anterior region of the glenoid attachment site which may indicate a reduced risk of anterior capsular repair failure. An anisotropic hyperelastic material behavior was then incorporated to model the glenohumeral capsule by performing an inverse finite element analysis to obtain the optimized material parameters. The computer models developed in this research utilize radiographic patient images in order to replicate and investigate actual pathology. As a result, the studies performed provide a deeper understanding of the glenohumeral joint mechanics associated with the treatments of total shoulder arthroplasty and glenohumeral capsular plication. This information provides insight for the practicing shoulder surgeon in their pre-operative surgical planning to decide the optimal technique and approach for a patient with these challenging pathologies. Moreover, the methodologies developed for simulating these surgical techniques can have a wide application to advance the foundation of pre-surgical virtual simulation and provide critical data for computer aided surgical navigation of other joints and diseases.

by Choi Man. / Year shown on spine: 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 146-153). / Abstract --- p.1 / Chapter 1 --- Introduction --- p.3 / Chapter 1.1 --- Anatomy --- p.4 / Chapter 1.2 --- Kinematics of the overhead sports --- p.6 / Chapter 1.3 --- Isokinetics assessment of the shoulder rotators --- p.8 / Chapter 1.4 --- Objectives of the study --- p.10 / Chapter 1.5 --- Method of investigation --- p.11 / Chapter 1.5.1 --- Subject --- p.12 / Chapter 1.5.2 --- Equipment --- p.13 / Chapter 1.5.3 --- Protocol --- p.14 / Chapter 1.6 --- Data Management --- p.17 / Chapter 1.7 --- Clinical application --- p.18 / Chapter 1.8 --- Definition of terms --- p.18 / Chapter 2 --- Literture Review --- p.20 / Chapter 2.1 --- Anatomy --- p.20 / Chapter 2.1.1 --- Ligament --- p.21 / Chapter 2.1.2 --- Muscles --- p.24 / Chapter 2.2 --- Biomechanics of the overhead movement --- p.30 / Chapter 2.2.1 --- Wind up Phase --- p.32 / Chapter 2.2.2 --- Cocking Phase --- p.33 / Chapter 2.2.3 --- Acceleration Phase --- p.36 / Chapter 2.2.4 --- Deceleration Phase --- p.38 / Chapter 2.3 --- Eccentric contraction --- p.40 / Chapter 2.3.1 --- Physiology of eccentric contraction --- p.40 / Chapter 2.3.2 --- Mechanical trauma in eccentric contraction & DOMS --- p.41 / Chapter 2.3.3 --- Eccentric contraction in Plyometric --- p.43 / Chapter 2.3.4 --- Role of eccentric contraction in overhead sports --- p.44 / Chapter 2.3.5 --- Comparison with concentric contraction --- p.45 / Chapter 2.4 --- Isokinetics --- p.46 / Chapter 2.4.1 --- Introduction to isokinetics --- p.46 / Chapter 2.4.2 --- Reliability of isokinetic assessment on Shoulder rotator --- p.48 / Chapter 2.4.3 --- Agonist / Antagonist Ratio --- p.51 / Chapter 2.4.4 --- Variation of torques with testing protocols --- p.52 / Chapter 2.4.5 --- Comparison of muscle torques in different groups --- p.56 / Chapter 2.4.6 --- Isokinetic eccentric contraction of shoulder Rotators --- p.62 / Chapter 3 --- Method of Investigation --- p.63 / Chapter 3.1 --- Subject --- p.64 / Chapter 3.1.1 --- Part One --- p.64 / Chapter 3.1.2 --- Part Two --- p.65 / Chapter 3.1.3 --- Criteria of subject recruitment --- p.65 / Chapter 3.2 --- Equipment --- p.66 / Chapter 3.2.1 --- Collection of medical history and general informations --- p.66 / Chapter 3.2.2 --- Test for general laxity --- p.66 / Chapter 3.2.3 --- Test for shoulder impingement --- p.72 / Chapter 3.2.4 --- Test for shoulder instability --- p.73 / Chapter 3.2.5 --- Joint range measurement --- p.76 / Chapter 3.2.6 --- Isokinetic strength of shoulder rotators --- p.78 / Chapter 3.3 --- Calibration --- p.79 / Chapter 3.4 --- Testing procedure --- p.79 / Chapter 3.4.1 --- "Explanation,warning & consent" --- p.79 / Chapter 3.4.2 --- Warming up --- p.80 / Chapter 3.4.3 --- Screening --- p.81 / Chapter 3.4.4 --- Isokinetic testing of the rotational strength of both shoulders --- p.81 / Chapter 3.5 --- Operator --- p.87 / Chapter 3.6 --- Data Management --- p.88 / Chapter 3.6.1 --- Part One --- p.88 / Chapter 3.6.2 --- Part Two --- p.89 / Chapter 4 --- Result --- p.91 / Chapter 4.1 --- Part One --- p.89 / Chapter 4.1.1 --- Intra-class correlation coefficient --- p.90 / Chapter 4.1.2 --- Correlation between the PTR & the ASMSTR --- p.92 / Chapter 4.2 --- Part Two --- p.94 / Chapter 4.2.1 --- Comparison between the Members in the Hong Kong Badminton Team with the Non-athlete Subjects --- p.94 / Chapter 4.2.2 --- Comparison between the Badminton Players in the Hong Kong Team and the Hong Kong National Junior Team --- p.105 / Chapter 5 --- Discussion --- p.111 / Chapter 5.1 --- General discussion of the design of the study --- p.111 / Chapter 5.1.1 --- Subject --- p.111 / Chapter 5.1.2 --- Specific test --- p.112 / Chapter 5.1.3 --- Warming up --- p.112 / Chapter 5.1.4 --- Testing protocol --- p.113 / Chapter 5.2 --- Part One --- p.116 / Chapter 5.2.1 --- Test-retest reliability --- p.117 / Chapter 5.2.2 --- Correlation between the PTR and the ASMSTR --- p.120 / Chapter 5.3 --- Part two --- p.122 / Chapter 5.3.1 --- Comparison between the HKT and the non- athletes --- p.123 / Chapter 5.3.2 --- Presentation of torque ratio in the HKJ --- p.133 / Chapter 5.3.3 --- Performance in those with history of shoulder problem --- p.134 / Chapter 5.4 --- Clinical application and suggestion for further study --- p.139 / Chapter 6 --- Conclusion --- p.144 / Chapter 7 --- Reference --- p.146 / Chapter 8 --- Appendix

Este estudo teve como objetivo implementar um modelo biomecânico, de segmentos articulados, associado à solução inversa que permita a análise em três dimensões das forças de reação proximais e momentos proximais resultantes para diferentes gestos do membro superior. O modelo implementado é composto por cinco segmentos rígidos (mão, antebraço, braço, escápula e tronco) conectados. A resolução das equações de movimento de Newton-Euler é feita através da solução inversa. Para registro cinemático foram utilizadas cinco câmeras digitais, com freqüência de amostragem de 50 campos/seg. O modelo implementado foi avaliado de quatro formas: estimativa da acurácia da medida tridimensional obtida pela cinemetria, comparação quantitativa e qualitativa dos resultados parciais oferecidos pelo modelo implementado com resultados obtidos por instrumentos de mensuração direta (eletrogoniômetro e eletromiografia) e cálculo da propagação do erro nos valores de força de reação resultante e momento proximal líquido. Os resultados sugerem que o modelo apresenta resultados coerentes. A acurácia do sistema de videogrametria estimada foi, em média, de 1,7 (± 1,5) mm. As medidas angulares da cinemetria e eletrogoniometria divergiram em até 36°. O erro propagado no cálculo da força de reação proximal pode chegar até 25% e até 100% no cálculo do momento proximal. O sinal eletromiográfico e o momento proximal apresentaram sincronismo temporal. O modelo foi capaz de avaliar as forças de reação proximal resultantes e momentos proximais líquidos nos diferentes gestos. / The goal of this study was to implement a link segments biomechanical model, associate to the inverse solution for three dimensions analysis of proximal reaction force and proximal net moments during upper limb movement. The implemented model is composed by five connected rigid segments (hand, forearm, arm, scapula and trunk). The resolution of Newton-Euler movement equations is done through the inverse solution. For kinematics acquisition five digital cameras were used, with a frequency sample of 50 fields/sec. The implemented model was evaluated in four ways: accuracy estimation of the three-dimensional measurements, quantitative and qualitative comparison of the partial results offered by the implemented model with results obtained by instruments of direct measurements (electrogoniometer and electromyography) and calculation of the error propagation in proximal reaction force and proximal net moment values. The results suggest that the model presents coherent results. The estimated accuracy videogrammetry system was, on average, of 1.7 (± 1.5) mm. The joint angular values obtained by kinematics system and electrogoniometer diverged in 36°. The error propagation in proximal reaction force values can arrive up to 25% and up to 100% for proximal net moment. The electromyographic sign and the proximal moment presented temporary synchronism. The model was able to evaluate the proximal reaction force and proximal net moment during upper limb movement.

O crucifixo é um elemento chave na prova das argolas na Ginástica Artística Masculina. A posição anatômica durante a sua execução requer a abdução do ombro em 90° no plano frontal, o que provoca grande solicitação mecânica nas articulações do ombro. Em condição de treino, um aparelho modificado é mundialmente utilizado para diminuir as cargas no ombro e permitir maior numero de repetições do crucifixo. Estudos sugerem que há diferenças na ativação muscular no ombro entre a situação de treino e competição. Entretanto, ainda não há conhecimento sobre a especificidade dos aparelhos de treino no âmbito da biomecânica, considerando a cinemática, cinética e eletromiografia em bases individuais. O objetivo geral desta tese projeto é investigar a biomecânica do crucifixo com o uso das argolas de competição e de treinamento. Doze ginastas brasileiros de alto nível foram testados em dinamômetro isocinético para verificação de assimetria na força de ombros e eletromiografia. Após intervalo de uma semana, os participantes realizaram, em seus ginásios de treinamento, três crucifixos nas argolas de competição e no aparelho de treino em ordem aleatória. Foi utilizada uma câmera de vídeo digital, uma célula de carga acoplada em cada cabo das argolas e eletromiografia de superfície em nove músculos do membro superior. Os resultados foram comparados por testes paramétricos, não paramétricos e estatística descritiva. A assimetria nas forças de ombro foi de 9,9±6,4%. Os ângulos do ombro no aparelho de treino tiveram menor desvio da posição alvo com 90° de abdução do que nas argolas para o ombro direito e esquerdo, e menores valores de simetria. As forças nos cabos foram semelhantes em ambos os aparelhos, como também a simetria. Não houve diferença na eletromiografia de nove músculos e valores de co-contração entre os dois aparelhos. As argolas de treino permitiram aos ginastas um melhor desempenho do crucifixo sem alterar o padrão de ativação muscular do ombro das argolas de competição. A orientação individualizada é necessária para que os ginastas realizem o crucifixo no aparelho de treino da mesma maneira que realizam nas argolas de competição, para que as equivalentes características biomecânicas sejam mantidas / The cross is a key element in Male Artistic Gymnastics rings routines. The anatomical position during its execution requires 90° of shoulder abduction in frontal plane, which implies a large mechanical demand of shoulder joints. For training condition, a modified rings apparatus is worldwide used to decrease shoulder load and allow more repetitions of cross. Studies suggest that there is different shoulder muscle activation between training and competition conditions. However, is not clear the training apparatuses specificity regarding biomechanics, considering kinematics, kinetics and electromyography in an individual basis. The aim of this thesis is to investigate the biomechanics of the cross using training and competition rings devices. Twelve Brazilian elite gymnasts were tested on isokinetic dynamometer for shoulder strength asymmetry and electromyography assessment. Within one week interval, participants performed in their training place, three crosses in rings and in training apparatus randomly. One digital video camera, one strain gauge in each cable and surface electromyography of nine shoulder muscles were used. Statistical analyses were performed by parametric and non-parametric tests and descriptive statistics. Shoulder strength asymmetry RMS values were 9.9±6.4%. The asymmetry of shoulder strength and cross performance on rings had an individual basis relation. Shoulder angles on training device had less deviation from target 90° of abduction on training apparatus than on rings and smaller asymmetry value. Cable forces had similar values in both apparatuses, as the asymmetry values. Electromyography of nine muscles and co contraction values differences were not different between the types of rings. The training rings allowed the gymnasts to better perform the cross without changing shoulder muscle activation patterns. An individual orientation for gymnasts to perform the cross on training apparatus within the same way they perform in competition rings, it is necessary for the maintenance of equivalent biomechanical characteristics

A instabilidade do ombro é a incapacidade de manter a cabeça umeral centralizada na fossa glenóide. Os requisitos para o diagnóstico clínico incluem história clínica, exame físico geral e testes objetivos para avaliar a presença e o grau de instabilidade do ombro. O objetivo do presente trabalho é comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multislice com a artrorressonância magnética na avaliação da instabilidade do ombro correlacionando com os achados artroscópicos assim como verificar a eficácia da artrotomografia computadorizada multislice na avaliação das alterações anatômicas relacionadas com a instabilidade do ombro. Trata-se de um estudo prospectivo onde, inicialmente, 30 pacientes com o diagnóstico clínico de instabilidade do ombro foram submetidos à artrotomografia computadorizada com cortes de espessura de 0,5 mm e reconstrução a cada 3 mm e à artrorressonância magnética nas seqüências convencionais ponderadas em T1 e T2 com e sem saturação de gordura. Comparado com a artroscopia, a artrorressonância magnética mostrou uma sensibilidade de 93,33% para lesão labral superior, 96,30% para lesão labral anterior e 83,3% para lesão labral ântero-superior e a artrotomografia computadorizada multislice mostrou uma sensibilidade de 90%, 88,89% e 77,78%, respectivamente. A sensibilidade da artrorressonância magnética para lesão de cartilagem articular foi de 16,67% comparado com uma sensibilidade 33,30% da artrotomografia computadorizada multislice. A artrorressonância magnética e artrotomografia computadorizada multislice mostraram a mesma sensibilidade para detecção da lesão de Hill-Sachs (100%), lesão labral ântero-inferior (100%), anormalidades capsulares (88,89%) e lesões de Bankart ósseo (80%). Com base nos resultados, concluímos que a artrorressonância magnética é um método de acurácia superior à artroTCMS na avaliação das lesões labrais ântero-superior, superior e anterior e que a artrotomografia computadorizada multislice mostrou-se eficaz nas estruturas relacionadas à instabilidade, com resultados semelhantes à Artro- RM para o diagnóstico de lesões labrais ântero-inferiores (ALPSA e Bankart), lesões de Hill-Sachs, redundância capsular e Bankart ósseo, sendo superior à artro-RM no diagnóstico de lesões de cartilagem articular / Shoulder instability is characterized by the incapacity to keep the humeral head centered within the glenoid fossa. Clinical diagnosis should include a history of prior events, a complete physical examination, and a set of objective tests to evaluate the presence and extent of shoulder instability. This study aims to compare the imaging of anatomical deformities seen in shoulder instability by employing both multislice computerized tomography (MSCT) arthrography and magnetic resonance arthrography (MRA). A correlation between those images and the arthroscopic findings was important to determining the efficacy of MSCT arthrography in the assessment of shoulder instability. The 30 patients in this prospective study, who had had a previous clinical diagnosis of shoulder instability, underwent CT arthrography using 0.5 mm-thick slices with reconstructions every 3 mm, and T1- and T2-weighted sequential MR imaging arthrography with and without fat saturation. MRA was shown to be 93.33 % sensitive in detecting superior labral lesion, 96.30% in anterior labral lesion, and 83.3% sensitive in anterosuperior labral lesion, whereas the respective results for MSCT arthrography were 90%, 88.89%, and 77.78%. MRA and MSCT arthrography afforded 16.67% and 33.30% sensitivity for joint cartilage injury, respectively. Both techniques were equally sensitive in detecting Hill-Sachs lesion (100%), anteroinferior labral lesion (100%), capsular abnormalities (88.89%), and bony Bankart lesions (80%). The results herein led us to conclude that MRA is more accurate than MSCT arthrography in assessing anterosuperior, superior (SLAP) and anterior labral lesions and the MSCT arthrography had good results in the evaluation of the structures related to shoulder instability. Both methods yielded equivalent results for Hill-Sachs, ALPSA and Bankart lesions. The MSCT arthrography furnished better results than MRA in the diagnosis of articular cartilage lesions

INTRODUCTION: Arthrofibrosis, which occurs in a substantial portion of the population, is a pathologic accumulation of scar tissue that presents in patients as a painful decrease in joint range of motion. Since an individual’s quality of life can be significantly impacted by arthrofibrosis and because there are limitations in current treatments, this thesis focuses on examining the use of the hormone relaxin to alleviate shoulder arthrofibrosis. METHODS: A set of 20 Sprague Dawley rats were given secondary shoulder contractures and separated into groups to examine the efficacy of relaxin using intravenous delivery, intra-articular delivery, and different treatment frequencies. The differences across groups were examined through mechanical range of motion testing as well as histologic sampling. RESULTS: Multiple doses of intra-articular injections of relaxin showed a complete return to the normal range of motion (P < 0.01) when compared with the surgical control, whereas other delivery methods and frequencies failed to show meaningful improvements. This was further confirmed in histologic analysis through the lack of fibrotic adhesions within the capsular space after multiple intra-articular relaxin treatments when compared with the surgical control. DISCUSSION: Although significant improvements to range of motion were seen after multiple doses of intra-articular relaxin, potential tissue degradation was also observed within the joint space after histologic examination. Further research is necessary to fully understand the proper dosing needed to avoid potential negative side effects caused by excess use of relaxin.