Background: Individuals with Subacromial Pain Syndrome (SPS) often present with a variety of contributing factors. It is possible that a subgroup exists within SPS that has primary impairments of scapular mobility and/or muscle strength. In an attempt to better identify scapular contributions in SPS, the Scapular Assistance Test (SAT) and Scapula Reposition Test (SRT) have been described. Additionally, thoracic spine thrust manipulation has been shown to be effective for shoulder pain. Problem Statement: It is currently unknown whether or not there are impairments in scapulothoracic muscle force generation or scapular mobility in individuals with SPS who have positive results on the SAT and SRT. It also remains unknown whether individuals with SPS respond differently in the immediate effects on scapular motion, scapulothoracic muscle force generation, pain, or function following different manipulation techniques. Methodology: Sixty subjects with shoulder pain were enrolled in the study. Baseline measures were obtained for scapular upward rotation and posterior tilt, scapulothoracic muscle force generation, pectoralis minor muscle length, pain, and function. Participants were randomized to receive a seated thrust manipulation, supine thrust manipulation, or sham manipulation. Measures were reassessed immediately after treatment and the Penn Shoulder Score (PSS) was reassessed at 48 hours. Results: The results indicated no significant differences in scapular upward rotation or posterior tilt, or muscle force generation based on the results of the SAT or SRT. There was a small but significant difference in pectoralis minor muscle length based on the result of the SAT. There were no significant between-group differences in scapular motion, muscle force generation, or pectoralis minor muscle length based on the treatment received. There were no significant differences in 48-hour improvement in pain, function, satisfaction, and total PSS scores. Small but significant within group changes existed on several measures. Discussion: The SAT and SRT may be ineffective in differentiating scapular movement associated impairments. Thoracic spine thrust manipulation resulted in no greater immediate improvements in scapular motion, strength, pectoralis minor muscle length, pain, or function compared to a sham treatment. The improvements in pain and function are likely not biomechanical in nature and are likely not derived from the manipulative thrust.

Background: Physical therapists regularly make decisions regarding intervention intensity based upon pathoanatomy and symptom irritability, but the reliability and validity of classifying patients by symptom irritability are unknown. Purpose: Examine the reliability and construct validity of the shoulder symptom irritability classification (SSIC) system for the purposes of determining an appropriate treatment intensity. Design: Prospective repeated-measures cross-sectional single-blinded design. Methods: 101 consecutive subjects with primary complaints of shoulder pain were assessed by a pair of blinded raters. Raters recorded the SSIC level and selected the appropriate intervention intensities for the subjects. Data Analysis: Prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS) and observed agreement were the primary measures of reliability. Analysis of variance (ANOVA) was used to compare functional disability across different levels of irritability. Receiver operating characteristic (ROC) curve analysis was utilized to derive cut-off scores for the patient-reported outcome (PRO) measures. Ordinal regression was utilized to compare the strength of patient-reported pain and disability in the determination of shoulder symptom irritability. Results: Inter-rater reliability (PABAK-OS) was 0.69 (95% Confidence Interval [CI] = 0.59, 0.78). ANOVA demonstrated significant differences in functional limitation between SSIC groups for all PRO measures. ROC curve analysis found significant cut-off scores for all PRO measures. Lastly, rater agreement between SSIC and treatment strategy was found to have PABAK-OS of 0.82 (95% CI 0.75, 0.88) with 80% agreement. Discussion: The inter-rater reliability of the SSIC system good and is not contingent upon experience or expertise. Despite lack of predominance of the function in the components of SSIC, functional limitation significantly influences SSIC along with aspects of pain that influence function. While the cut-off scores show promising results, further work is needed to validate the results. Ultimately, there appears to an excellent relationship between rater selected SSIC and treatment strategy demonstrating a foundation for construct validity of the SSIC. Therefore, the results of this study should serve as a foundation for future work for refinement of the SSIC as a component of the STAR-Shoulder diagnostic classification system. Clinical Significance: The shoulder symptom irritability classification scale is reliable and clinically useful for improvement of communication between medical providers.

No description available.

The problem of this study was to determine the relative contribution of the strength of shoulder internal rotators among various muscle groups to ball speed in the fastball pitch as exhibited by college pitchers. An objective of the study was to explain at least 40% of the contribution of ball speed. The literature appears to be somewhat inconclusive as to the quantification of component contributors of muscle groups m the upper extremity to ball speed. It appears in the literature that variables other than upper extremity strength account for approximately 50% of ball speed. Some research has indicated that strength of the shoulder internal rotators is a major contributor while most research of this type has either been inconclusive or qualitative m nature. Eighteen college pitchers were tested for upper extremity peak torque production on the Cybex II Isokinetic Dynamometer at speeds of 90 and 240 degrees/second. Fastball speed was measured with a hand held radar gun. Results of regression analyses performed on the data indicate a strong correlation between the internal rotators of the upper extremity and fastball speed. A regression equation using a hierarchical strategy to maximize R2 accounted for 40% of contribution to ball speed using independent variables of shoulder internal rotation at 90° /sec. (X1) and elbow flexion at 240°/sec. (X2); ie, Speed=62.861+245X1 +.39X2. The standardized beta weights for this equation indicate that the greater contributor to ball speed was Sho/Int/Rot-90 when the effects of Elb/Fl-240 are controlled. When elbow extension at 90° /sec. was added to the equation as X3 approximately 59% of ball speed is explained; ie, Speed=68.605 + 268X1 + 807 X2 - .430X3.

This thesis studied unpaved highway shoulders, and in particular shoulders of lower volume asphalt pavements being overlaid. The primary objective was to better understand how different shoulder aggregates perform on lower volume routes with asphalt surfaces and relatively narrow shoulders. A literature review and an evaluation of a full-scale test section containing five aggregate categories in nine test sections over a thirty-four-month period were the primary efforts performed to evaluate unpaved highway shoulders. The study concluded shoulder width measurements were not especially informative, and that California Bearing Ratio measurements were only modestly informative. Crushed concrete outperformed all other aggregates, though the remaining aggregate categories (gravel, limestone, steel slag, and reclaimed asphalt pavement) also had a reasonable case for being moved forward toward possible specification updates. The primary recommendation of this thesis is to use the data contained herein to further shoulder aggregate specifications for the Mississippi Department of Transportation.

Ergonomics software programs often use an independent axis approach (IAA) to calculate resultant shoulder strength to predict manual arm strength (MAS). The IAA treats strength about each joint axis (joint axis strengths: JAS) in the arm as independent motors, which all combine to complete an exertion. However, this form of modeling is not a true physiological representation of how the shoulder/arm function. The weighted average approach (WAA) was proposed, which combines the axes by weighting each strength based on its relative contribution to the resultant moment vector. The primary purpose of this thesis was to test the IAA using participant-specific JAS values, such that it afforded the IAA the best opportunity to predict MAS accurately. The secondary purpose was to test the WAA, to determine if it was a viable replacement for the IAA. Fifteen university age females completed two data collections. One tested the eight different JASs for the shoulder and elbow, and the other tested participant’s MASs in four hand locations and six exertion directions. The JAS force data, and postural kinematic data (from the MAS collection), were inputs into two models, which completed the MAS predictions. A 4 x 6 x 3 repeated measures ANOVA revealed a significant three-way interaction between hand location, exertion direction, and method of MAS estimation (p<0.0001) on MAS. The most important finding of the thesis was that both the IAA and WAA predictions were significantly different than the MAS values. The IAA and WAA explained only 17.9% & 19.1% of the variance with RMS errors of 74.5 N & 73.4 N, respectively. This indicated that ergonomics software programs, using the IAA, should not be used to make arm strength predictions by ergonomists, and that WAA was not a viable replacement for the IAA. / Thesis / Master of Science in Kinesiology

Ryggsäckar används vid mängder av aktiviteter och har många fördelar jämfört med andra väskor, särskilt när det kommer till att bära tungt. Emellertid blir dåligt utformade ryggsäckar med bristande hänsyn till ergonomiska faktorer obekväma och kan i värsta fall orsaka skador. Studier har visat att belastningen på axlar är den främst begränsande faktorn vid ryggsäcksbärande. Klättermusen har försökt lösa detta problem med innovationen Butterfly Bridge som är tänkt att fördela lasten över axeln på ett mer skonsamt sätt. Projektet genomfördes i syfte att bredda kunskapen kring ryggsäckars påverkan på kroppen samt bidra med information om Butterfly Bridges effekt till uppdragsgivaren. Mer specifikt var målet med projektet att utveckla lämplig metod för att mäta effekten och utvärdera huruvida Butterfly Bridge fungerar som beskrivet och har en mätbar effekt på tryckfördelning mellan ryggsäck och axel. Den inledande litteraturstudien visade på ett antal tillgängliga metoder för att mäta och bedöma en ryggsäcks påverkan på kroppen. För att utvärdera Butterfly Bridges effekt valdes en kvantitativ metod med experimentella tester på testdocka. Trycket mellan axelrem och dockan mättes med taktila trycksensorer från Tekscan. Mätningar gjordes med och utan Butterfly Bridge för två ryggsäckar från Klättermusen, Grip 60L och Ymer 65L. Resultaten visade inte på någon skillnad mellan att använda Butterfly Bridge eller inte. Tryckbilder från mätningarna visade inga synliga skillnader i tryckfördelning och det kan utifrån mätningarna i denna studie inte bevisas att Butterfly Bridge har någon effekt på tryckfördelningen. Slutsatsen är att Tekscan F-Scan kan användas för att mäta skillnader i tryck mellan olika ryggsäckar men metoden är på intet sätt felfri. Fler tester krävs för att bestämma Butterfly Bridges effekt. / <p>2022-07-01</p>

本研究の目的は，無症状の野球選手における肩甲骨の運動異常(SD)の発生状況とSDを有する野球選手における投球中の肩関節の運動学・動力学的な特徴を評価することとした．この結果，無症状の野球選手はSD type Ⅰ(肩甲骨後傾の低下)の発生割合が最も多かったこと，とくにSD type Ⅰを有する野球選手はSDを有さない野球選手と比較して，投球中のレイトコッキング期の肩甲上腕関節(GH)の外旋角度と前方間力が増加し，肩甲骨後傾が低下していることが明らかになった． / 博士(スポーツ健康科学) / Doctor of Philosophy in Health and Sports Science / 同志社大学 / Doshisha University

Statistical modelling has become a ubiquitous tool for analysing of morphological variation of bone structures in medical images. For radiological images, the shape, relative pose between the bone structures and the intensity distribution are key features often modelled separately. A wide range of research has reported methods that incorporate these features as priors for machine learning purposes. Statistical shape, appearance (intensity profile in images) and pose models are popular priors to explain variability across a sample population of rigid structures. However, a principled and robust way to combine shape, pose and intensity features has been elusive for four main reasons: 1) heterogeneity of the data (data with linear and non-linear natural variation across features); 2) sub-optimal representation of three-dimensional Euclidean motion; 3) artificial discretization of the models; and 4) lack of an efficient transfer learning process to project observations into the latent space. This work proposes a novel statistical modelling framework for multiple bone structures. The framework provides a latent space embedding shape, pose and intensity in a continuous domain allowing for new approaches to skeletal joint analysis from medical images. First, a robust registration method for multi-volumetric shapes is described. Both sampling and parametric based registration algorithms are proposed, which allow the establishment of dense correspondence across volumetric shapes (such as tetrahedral meshes) while preserving the spatial relationship between them. Next, the framework for developing statistical shape-kinematics models from in-correspondence multi-volumetric shapes embedding image intensity distribution, is presented. The framework incorporates principal geodesic analysis and a non-linear metric for modelling the spatial orientation of the structures. More importantly, as all the features are in a joint statistical space and in a continuous domain; this permits on-demand marginalisation to a region or feature of interest without training separate models. Thereafter, an automated prediction of the structures in images is facilitated by a model-fitting method leveraging the models as priors in a Markov chain Monte Carlo approach. The framework is validated using controlled experimental data and the results demonstrate superior performance in comparison with state-of-the-art methods. Finally, the application of the framework for analysing computed tomography images is presented. The analyses include estimation of shape, kinematic and intensity profiles of bone structures in the shoulder and hip joints. For both these datasets, the framework is demonstrated for segmentation, registration and reconstruction, including the recovery of patient-specific intensity profile. The presented framework realises a new paradigm in modelling multi-object shape structures, allowing for probabilistic modelling of not only shape, but also relative pose and intensity as well as the correlations that exist between them. Future work will aim to optimise the framework for clinical use in medical image analysis.

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session. Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach. Results: There were two over-arching key themes: firstly, ‘Participants’ Perspectives’ of the session generated four themes: Improved understanding of ‘the whole’; Mindful self-awareness; Taking charge; “The pain is still there”. Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, ‘Participants’ Recommendations’, had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education. Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.