Bakgrund: Smärta från axelleden är vanligt förekommande hos simmare, därav finns begreppet ”simmaraxel”. Etiologin till tillståndet och smärtan är dock ännu inte fastställd, flertalet studier visar på varierande orsaker och symtom. Den oklara etiologin, skapar delade meningar sett till lämplig behandling för simmaraxlar. Flera teorier finns kring den bästa behandlingsmetoden för axelsmärta hos simmare. Många olika studier har gjorts med syfte att undersöka sambandet mellan axelspecifik styrketräning på axelfunktion hos simmare med axelsmärta. Få studier har gjorts med syfte att undersöka effekten av axelspecifik styrketräning på just smärtan vid simmaraxlar. Syfte: Syftet med denna studie var att på individnivå undersöka hur axelspecifik styrketräning påverkar simmare med axelsmärta gällande smärta och funktion. Metod: Studien baseras på single-case experimentell design (SCED), med en AB-design. I studien medverkade tre deltagare från en simklubb i Stockholm. Deltagarna fick under totalt nio veckor skatta smärta via Numeric Rating Scale (NRS) och axelfunktion via Western Ontario Shoulder Instability Index (WOSI), för att undersöka förändringen på smärta och funktion över tid. Resultatsammanfattning: En deltagare uppnådde signifikant förbättring sett till självskattad smärta. Sett till självskattad funktion fanns signifikant försämring hos två deltagare. En deltagare uppnådde en stabil baslinje. Resterande två deltagare uppgav spridda värden under samtliga faser för NRS och WOSI.  Slutsats: Inga specifika slutsatser går att dras utifrån studiens resultat eftersom endast en deltagare uppnådde en stabil baslinje och på grund av oklarheten kring orsakerna till deltagarnas smärta. / Background: Pain originating from the shoulder joint is frequent among swimmers, therefore the term “swimmer’s shoulder” was constructed. However, the etiology of the condition has not yet been established and numerous studies indicate varying origins. Divided opinions have formed about effective interventions due to the confusion regarding swimmer’s shoulder. Several studies have investigated the interaction between various interventions and their effect on swimmer’s shoulders, however only a few have studied the effect strength training has on pain in the shoulder joint due to the condition.  Purpose: The aim of this study was to investigate at an individual level, how strength training of the shoulders affects active swimmers with shoulder pain, concerning pain and function. Method: This study is designed after a single-case experimental design (SCED), with an AB-design. Three swimmers from a swimming club in Stockholm participated. During a total of nine weeks, the participants had to assess pain via the numeric rating scale (NRS) and shoulder function via the Western Ontario Shoulder Instability Index (WOSI). Results: One participant acquired significant improvement in self-rated pain. Regarding self-rated function two participants showed significant impairment. One participant acquired a stable baseline. The remaining two participants reported scattered values during all phases for both NRS and WOSI.  Conclusion: No specific conclusions can be made based on the results of the study as only one participant achieved a stabile baseline, and there is ambiguity regarding the causes of pain among the swimmers.

La déchirure de la coiffe des rotateurs est une des causes les plus fréquentes de douleur et de dysfonctionnement de l'épaule. La réparation chirurgicale est couramment réalisée chez les patients symptomatiques et de nombreux efforts ont été faits pour améliorer les techniques chirurgicales. Cependant, le taux de re-déchirure est encore élevé ce qui affecte les stratégies de réhabilitation post-opératoire. Les recommandations post-chirurgicales doivent trouver un équilibre optimal entre le repos total afin de protéger le tendon réparé et les activités préconisées afin de restaurer l'amplitude articulaire et la force musculaire. Après une réparation de la coiffe, l'épaule est le plus souvent immobilisée grâce à une écharpe ou une orthèse. Cependant, cette immobilisation limite aussi la mobilité du coude et du poignet. Cette période qui peut durer de 4 à 6 semaines où seuls des mouvements passifs peuvent être réalisés. Ensuite, les patients sont incités à réaliser les exercices actifs assistés et des exercices actifs dans toute la mobilité articulaire pour récupérer respectivement l’amplitude complète de mouvement actif et se préparer aux exercices de résistance réalisés dans la phase suivante de la réadaptation. L’analyse électromyographique des muscles de l'épaule a fourni des évidences scientifiques pour la recommandation de beaucoup d'exercices de réadaptation au cours de cette période. Les activités sollicitant les muscles de la coiffe des rotateurs à moins de 20% de leur activation maximale volontaire sont considérés sécuritaires pour les premières phases de la réhabilitation. À partir de ce concept, l'objectif de cette thèse a été d'évaluer des activités musculaires de l'épaule pendant des mouvements et exercices qui peuvent théoriquement être effectués au cours des premières phases de la réhabilitation. Les trois questions principales de cette thèse sont : 1) Est-ce que la mobilisation du coude et du poignet produisent une grande activité des muscles de la coiffe? 2) Est-ce que les exercices de renforcement musculaire du bras, de l’avant-bras et du torse produisent une grande activité dans les muscles de la coiffe? 3) Au cours d'élévations actives du bras, est-ce que le plan d'élévation affecte l'activité de la coiffe des rotateurs? Dans notre première étude, nous avons évalué 15 muscles de l'épaule chez 14 sujets sains par électromyographie de surface et intramusculaire. Nos résultats ont montré qu’avec une orthèse d’épaule, les mouvements du coude et du poignet et même quelques exercices de renforcement impliquant ces deux articulations, activent de manière sécuritaire les muscles de ii la coiffe. Nous avons également introduit des tâches de la vie quotidienne qui peuvent être effectuées en toute sécurité pendant la période d'immobilisation. Ces résultats peuvent aider à modifier la conception d'orthèses de l’épaule. Dans notre deuxième étude, nous avons montré que l'adduction du bras réalisée contre une mousse à faible densité, positionnée pour remplacer le triangle d’une orthèse, produit des activations des muscles de la coiffe sécuritaires. Dans notre troisième étude, nous avons évalué l'électromyographie des muscles de l’épaule pendant les tâches d'élévation du bras chez 8 patients symptomatiques avec la déchirure de coiffe des rotateurs. Nous avons constaté que l'activité du supra-épineux était significativement plus élevée pendant l’abduction que pendant la scaption et la flexion. Ce résultat suggère une séquence de plan d’élévation active pendant la rééducation. Les résultats présentés dans cette thèse, suggèrent quelques modifications dans les protocoles de réadaptation de l’épaule pendant les 12 premières semaines après la réparation de la coiffe. Ces suggestions fournissent également des évidences scientifiques pour la production d'orthèses plus dynamiques et fonctionnelles à l’articulation de l’épaule. / Rotator cuff tear is one of the most common causes of shoulder pain and dysfunction. The operative repair has been widely performed for symptomatic patients and many efforts have been done to improve the surgical techniques. However, the re-tear rate is still high and this affects post-repair rehabilitation strategies. Post-surgical care should balance between the restriction imposed to protect the repaired tendon and the activities prescribed to restore range of motion and muscle strength. Frequently, early after rotator cuff repair, shoulder is immobilized in a sling or abduction orthosis, but this immobilization includes elbow and wrist joints as well. In this period that may last 4-6 weeks, only passive range of motion exercises are performed. After removing the immobilizer, patients are encouraged to do active assisted and active range of motion exercises respectively to regain the full active range of motion and be prepared for the resistance exercises in the following phase of rehabilitation. Electromyography of shoulder muscles has provided scientific basis for many of rehabilitation exercises during this period. Anecdotally, the activities of less than 20% of the maximal voluntary contraction of rotator cuff muscles are considered safe for the first phases of rehabilitation after rotator cuff repair. Using this concept, the aim of this dissertation is to evaluate the activity of shoulder musculature during some movements and exercises that can theoretically be performed during the early phases of rehabilitation. Three main questions of this thesis are: 1) Do elbow and wrist mobilizations highly activate rotator cuff muscles? 2) Do some resistance exercises of arm, forearm and chest muscles produce high activity in rotator cuff muscles? 3) During active arm elevation, does the plane of elevation affect rotator cuff activity? In our first study, we evaluated 15 shoulder muscles in 14 healthy subjects with both surface and indwelling EMG. Our results showed that while wearing a shoulder orthosis, elbow and wrist movements and even some resistance training involving these two joints, would minimally activate the rotator cuff muscles and can be considered safe. We also introduced some daily living tasks that can be performed safely during immobilization period. These findings may help to modify the design of current shoulder orthoses. In the second study, we also showed that resisted arm adduction against a low-density foam that replaced the hard wedge of orthosis would not highly activate the cuff muscles. In our final study, we evaluated the EMG of shoulder musculature during arm elevation tasks in 8 symptomatic patients with rotator cuff tears. We found that supraspinatus activity during arm elevation is significantly higher in abduction plane than in scaption and flexion planes in patients with rotator cuff tears. This suggested a plane sequences for active range of motion exercises during rehabilitation. The findings that are presented in this dissertation, suggest some modifications in the rehabilitation protocols during the first 12 weeks after rotator cuff repair. These suggestions also provide a scientific basis for producing more dynamic and functional shoulder orthoses.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Shoulder pain was constantly reported as a problematic symptom causing dysfunction and quality of life interference after neck dissection in head and neck cancer patients. Due to a lack of conceptual framework and inconsistency of instrument selection, a comparison among previous studies was almost impossible, making it difficult to understand the phenomenon. The current study applied the University of California, San Francisco School of Nursing Symptom Management Model. The purposes of the study were to (a) describe the symptom experience of shoulder pain at 1 month after neck dissection, (b) describe the relationships among symptom experience of shoulder pain, functional status, and quality of life, and (c) identify the contextual variables, concurrent symptoms, and/or adherence predicting symptom experience of shoulder pain, functional status, and/or quality of life. This was a descriptive study with a convenience sample of head and neck cancer patients. The data were collected via a medical record review, a self-administered survey, and a physical examination. The data from 29 patients were entered for descriptive statistics, Pearson correlations, and multiple regressions. At 1 month after surgery, 62% of patients reported they had shoulder pain at some point within a week. Their shoulder pain was from mild to moderate. Fifty-nine percent complained that shoulder pain bothered them about the moderated level. In the final model, symptom experience, shoulder pain, was significantly correlated with one outcome, active shoulder abduction, but not the other, total quality of life, generic quality of life, and head and neck quality of life. Active shoulder abduction was significantly correlated with three quality of life measures. Adding significant predictors of symptom experience and outcomes into the final model, there is a potential that the model would be useful to guide treatment strategies. Treatment for myofascial pain of the levator scapulae could relieve shoulder pain after neck dissection and improve head and neck quality of life. Those with level V dissection were high risk populations of developing shoulder pain. Risk factors of quality of life, which were depression, loss of sensation, and radiation would describe how an intervention could change or unchange the patient’s life.

RERUME: Les modèles personnalisés 3D sont de plus en plus demandés pour la planification chirurgicale et les recherches en biomécanique. L’objectif principal de cette thèse cotutelle était d’améliorer la méthode de reconstruction 3D à partir des images radiographies biplanes proposée par Lagacé, Ohl et al., afin que celle-ci puisse être plus facilement utilisée en clinique et qu’elle puisse permettre d’aider à la planification chirurgicale et/ou l’évaluation post-chirurgicale. Le système de radiographie biplane EOS à faible dose d’irradiation est le résultat d’une collaboration entre la société EOS imaging, l’institut biomécanique humaine Georges Charpak d’Arts et Métiers ParisTech, le laboratoire de recherche en imagerie et orthopédie (LIO) de l’école de technologie supérieure de Montréal, Georges Charpak, Jean Dubousset et Gabriel Kalifa (Dubousset et al. 2010). Le principe du détecteur de rayon X est basé sur les travaux développés par le Prof. Charpak, qui réduit significativement la dose de rayonnement comparé à la radiographie standard (Dubousset et al. 2010) Quatorze indices cliniques utilisés plus ou moins couramment en clinique pour le diagnostic et le suivi des pathologies de l’épaule et pour la planification chirurgicale et son évaluation post-opératoire ont été calculé. La justesse est acceptable (biais <1 mm sauf la distance sous acrominale) et une reproductibilité (2 fois écart-type inférieur à 5 mm ou 5° sauf 2 paramètres) qui est similaire à ce qui est présenté dans la littérature. L’approche proposée apporte sur une amélioration de la reconstruction dans un contexte où il serait intéressant qu’elle devienne utilisable en routine clinique. Bien que les améliorations soient encore nécessaires, cette contribution apporte une pierre à l’analyse de l’articulation intacte et pathologique et est prometteuse quant à la possibilité de son implantation dans la routine clinique pour évaluer les interventions chirurgicales en pré- et post-opératoire. / Three-dimensional subject-specific models are increasingly requested for surgical planning and research in biomechanics. The main objective of this cotutelle thesis was to improve the 3D reconstruction method using biplane radiography images proposed by Lagacé, Ohl et al., in order to facilitate its application in clinic, especially to assist surgical planning and/or post-surgical evaluation. The low-dose biplane radiography EOS was used and an improvement to the reconstruction method was proposed. Fourteen clinical indices used more or less routinely in clinical diagnosis for monitoring of shoulder disorders and for surgical planning and postoperative evaluation were calculated and evaluated. The accuracy is acceptable and reproducibility is similar to what is presented in the literature. The proposed approach brings an improvement of reconstruction in a context where it would be interesting for clinical routine use. Although improvements are required, this contribution brings a stone to the analysis of intact and pathological joint and is promising as to the possibility of its presence in the clinical routine for evaluating pre- and post-operative surgery.

Submitted in partial compliance with the requirements fo the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background Competitive swimming, as with most other sports that are participated in at more than a recreational level, involves a substantial amount of training. Training excessively results in the overuse of muscles. The overuse of muscles commonly causes the production of myofascial trigger points (MFTPs) within the overworked muscles. The presence of MFTPs is a condition known as myofascial pain syndrome (MPS). Myofascial trigger points may be active or latent. Either way, they produce a wide range of effects. This study focuses on the effect of reduced muscle strength. Muscle strength is essential to athletes as it determines performance. Swimmers with MFTPs will not perform at their full ability. Dry needling is an effective form of treatment for MFTPs as it produces immediate relief from the effects of MFTPs. There is not enough information on the immediate effects of dry needling on athlete performance. Since dry needling brings about the immediate relief of MFTPs, this study aims to restore a swimmer’s muscle power and hence improvement of their swimming performance post-intervention. Aim The aim of this study was to determine the immediate effect of dry needling common myofascial trigger points (MFTP) found in four muscles of the shoulder girdle on competitive swimmers’ 100m freestyle lap-times. Methods The design was a pre-test post-test quasi-experimental study. Thirty five competitive swimmers between the ages of 16 and 30 years old participated in this study. Each participant underwent one assessment. Participants’ lap-times were taken using a Sportline Econosport Stopwatch. The pre- and post-intervention lap-times were compared to each other using statistical analysis. The intervention for the purpose of the study was trigger point dry needling. Myofascial trigger points were assessed using manual palpation and the Myofascial Diagnostic Scale (MDS). Results The median lap time was slightly longer post intervention (0:01:16.10) than pre-intervention (0:01:16.03), and was highly statistically significant (p=0.001). The results of the study were inconclusive, however, as there were too many confounding variables (for example, fatigue due to repeatedly swimming laps, swimmers of a lower caliber and hence quicker fatigue rate being included in the study)which negated the effect of dry needling and so the poorer performance of the participants post-intervention could not be attributed entirely to the intervention. A small number of participant’s lap-times decreased post-intervention i.e. they performed better post-intervention. These individualswere predominantly sprint-swimmers. Conclusion Dry needling negatively affects immediate lap-time performance. Future studies should reduce the number of variables affecting the study, for example, having a sprinter versus long-distance swimmer group, testing the outcome of dry needling after the swimmer has had sufficient time (for example, a day) to rest post-intervention. / M

Introduction : Les travaux réalisés par Bascans ont permis de mieux comprendre la fonction des patients atteints d’une rupture de la coiffe des rotateurs au moment du diagnostic à l’aide de paramètres morphologiques osseux et musculaires intégrés dans un modèle de régression linéaire. Les paramètres osseux étudiés provenaient d’une méthode de reconstruction 3D de l’épaule à partir d’images EOS. Jusqu’à présent, aucune étude ne s’est intéressée à prédire l’évolution dans le temps des patients atteints d’une rupture de la coiffe des rotateurs à l’aide de ces paramètres ni à valider l’imagerie EOS pour l’évaluation de l’épaule. Objectif : Nous souhaitons prédire l’évolution de la fonction de l’épaule des patients atteints d’une rupture de la coiffe des rotateurs à partir de paramètres musculaires et de la morphologie osseuse. Ensuite, nous souhaitons comparer l’imagerie EOS à la radiographie standard de l’épaule pour l’évaluation des patients à la clinique externe d’orthopédie. Méthode : Dans un premier temps, 50 personnes ayant participé à une étude portant sur la fonction de l’épaule en 2009 furent réévaluées. Leur fonction mesurée fut corrélée à leur fonction prédite par le modèle de régression linéaire créé par Bascans. De nouveaux modèles ont ensuite été créés afin de mieux comprendre l’évolution de la douleur, de la force et de la fonction de leur épaule telle que mesurées par le score de Constant et le QuickDash. Dans un deuxième temps, 47 patients nécessitant une radiographie standard de l’épaule dans le cadre de leur consultation à la clinique externe d’orthopédie ont été recrutés. En plus de la radiographie standard, ils ont passé un examen radiographique EOS antéro-postérieur de leur épaule. Un comité d’expert formé de deux orthopédistes et d’une radiologiste a créé un questionnaire d’évaluation des images grâce à la méthode Delphi. Ces trois spécialistes ont ensuite analysé chaque image présentée dans un ordre aléatoire. Résultats : La majorité des participants atteints d’une rupture de la coiffe des rotateurs ont été opérés pendant le suivi. Nous ne pouvons donc pas prédire l’évolution naturelle de ces patients. Nous avons cependant produit des modèles de régression linéaire qui améliorent considérablement notre compréhension des paramètres ayant un impact sur la fonction initiale. Notamment, nos modèles expliquent 66,8% de la variabilité du score de Constant et 71,8% de celle du QuickDash pour les femmes. L’imagerie EOS antéro-postérieure de l’épaule permet d’obtenir des mesures de la distance sousacromiale et de l’espace acromio-claviculaire similaires à la radiographie standard, avec une différence moyenne de 1,4 mm entre les modes d’imagerie, ce qui n’est pas cliniquement significatif. L’imagerie EOS produit des images de qualité légèrement inférieure et pouvant présenter légèrement plus d’artéfacts de mouvement que la radiographie standard. Ces différences sont cependant mineures et ne semblent pas avoir d’impact sur la capacité des spécialistes à émettre avec confiance un diagnostic. Conclusions : Cette étude a permis de mieux comprendre les paramètres morphologiques ayant un impact sur la fonction de l’épaule des patients. Elle a également révélé que les paramètres corrélant avec le niveau fonctionnel ne sont pas les mêmes en fonction du sexe. Nous avons démontré que les images EOS sont légèrement inférieures à la radiographie standard, mais demeurent un mode d’imagerie adéquat et valide. L’imagerie EOS pourrait donc être utilisée en clinique externe d’orthopédie, ce qui diminuerait l’exposition aux radiations des patients et qui permettrait d’intégrer plus facilement en clinique les connaissances développées à partir de la reconstruction 3D de l’épaule. / Introduction : Bascans improved our understanding of shoulder function at diagnosis of rotator cuff tear using morphological bony and muscular paramaters in a linear regression model. The bony parameters were measured using a 3D reconstruction of the shoulder generated from EOS images. Up to now, no study tried to predict shoulder function of patients suffering from rotator cuff tear using these parameters. The EOS imaging system has not been compared to the standard X-rays for the evaluation of shoulders yet. Objectives : We aim to predict the evolution of shoulder function for patients with a rotator cuff tear using the same morphological parameters as Basacans. Our second objective is to compare the EOS imaging system to standard X-Rays for shoulder evaluation at the orthopedic outpatient clinic. Method : Fifty participants from a 2009 study on shoulder function were re-evaluated. Their measured shoulder function was correlated to their predicted shoulder function using a linear regression model. Moreover, new models were created to improve our understanding of pain, strength, and shoulder function as measured in the Constant Score and the QuickDash. Forty-seven other patients who needed to undergo shoulder X-Rays at the orthopeadic outpatient clinic were recruited. Besides their shoulder X-Rays, they underwent an anterioposterior EOS shoulder radiograph. An expert committee of two orthopedists and one radiologist created a shoulder radiographs’ evaluation survey using the Delphi methodology. The committee then evaluated each image in a random order. Results : The majority of participants who suffered from a rotator cuff tear have had a surgery since the first study. Therefore, we were not able to predict the natural evolution of these patients. However, we were able to produce linear regression models that considerably improve our understanding of the parameters that have an impact on shoulder function at diagnosis. Our regression models explain 66.8% of the variability of the Constant score and 71.8% of the variability of the QuickDash for female participants. The measure of the subacromial distance and the acromioclavicular space was similar in anteroposterior shoulder images from the EOS system and the standard X-rays, with a mean difference of 1.4 mm between the two imaging techniques, which is not clinically significant. EOS images are of slightly inferior quality than the standard X-rays. This difference remains minor and does not seem to have an impact on the specialists’ ability to make a confident diagnosis from these images. Conclusions : This study improves our understanding of the morphological parameters that have an impact on shoulder function. Moreover, it revealed that the parameters that have an impact on shoulder function are not the same depending on the patients’ sex. We demonstrated that shoulder EOS images are slightly inferior to standard X-Rays, but that they still produce images of a sufficient quality for diagnosis. Therefore, the EOS images could be used at the orthopedic outpatient clinic, which would reduce patients’ exposure to radiation and would facilitate the integration in the clinical setting of the research based on shoulder 3D reconstruction.

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

No / Objective To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection. Design Randomised controlled trial. Setting Two secondary care National Health Service trusts. Participants One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study. Intervention Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours. Outcome measures All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy – Breast). Results All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year. Conclusion A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic,Durban Institute of Technology, 2005 xxi, 132, 34 leaves ; ill. ; 30 cm / To assess and quantify the number, severity and specific location of myofascial trigger points within the shoulder rotator muscle group. To assess the internal/external ratio of the dominant shoulder in throwing athletes using a Cybex 700 dynamometer, after intervention and to establish a comparable clinical profile of the participants.