Thesis title: Electromyographic Analysis of the Shoulder Girdle Muscles Inclusion of Volleyball Players Problem definition: Elite sport is very demanding, not only physically, but also mentally. The demands on the musculoskeletal system are often not compensated, especially in children and junior categories. The only targeted and regular compensation takes place at volleyball by the fitness training in the gym, but not always properly lead and adapted to the individual needs of athletes. The question is whether it is possible to prevent these problems. From my perspective, yes, the inclusion of appropriate compensation exercise in normal training session, which will require little equipment and time and to be functionally connected with volleyball technique that players do not lose the game performance. In the context of the thesis will be compared exercising of the second diagonal PNF for the upper extremity with an elastic resistance and simulated strike without the ball - volley lob, as an alternative fitness of exercises for volleyball players. Objectives: The aim of the dissertation is based on the available literature to outline the issues of kinesiological and biomechanical relationships of the shoulder girdle in sports especially in volleyball, which is a typical representative of the...

Progressive overload through the range of motion (ROM) is important for proper rehabilitation of muscle strength, yet varies across types of resistance for a given exercise. The purpose of this study was to compare strength curves (SC) for shoulder internal (IR) and external rotation (ER) with resistance curves (RC) for two application angles (A and B) of Thera-Band® resistance to determine which application angle best overloads IR and ER through the ROM. Thirty volunteer subjects participated in this study. SCs were obtained experimentally by measuring maximal isometric torque for IR and ER from 30° to 135°. RCs were calculated using regression equations from the literature. Significant differences (p < 0.05) were found between the SCs and RCs for both application angles during IR and ER. The findings of this study indicate that application angles A and B do not provide optimal loading when performing shoulder IR and ER exercises.

Studies of comparative morphology clearly distinguish the shoulder morphology of Homo from that of the other hominoids. While the shoulder morphology of non-human hominoids is thought to signal adaptations to arboreal locomotion, human shoulder morphology is understood to have lost this adaptation during hominin evolution. Ideas how non-human hominoid shoulder morphology is advantageous in an arboreal context suggest that the specific shoulder morphological traits enhance the arm-raising mechanism. However, this idea has not been biomechanically tested. This thesis constitutes the first analysis of the biomechanical consequences of two distinct shoulder morphologies within Hominoidea by comparing the glenohumeral muscle capabilities of Gorilla to Homo. The biomechanical capabilities are evaluated by constructing a computational musculoskeletal model of a gorilla thorax, shoulder girdle and upper arm, which is used to predict relevant biomechanical metrics such as muscle moments and moment arms. Muscle moments and moment arms are predicted for two important mechanisms, arm-raising and arm-lowering. The predictions are compared to those of an already existing human musculoskeletal model in order to evaluate differences in arm-raising and arm-lowering capability based on the two distinct thorax and shoulder girdle morphologies. The results of the biomechanical analyses show that the arm-lowering mechanism is enhanced in Gorilla compared to Homo, instead of the arm-raising mechanism. The enhanced arm-lowering mechanism is evident by greater moment capacities of two important arm-lowering muscles, pectoralis major and teres major. The greater moments are the result of greater muscle force capacities and greater moment arms, due to the beneficial musculoskeletal geometry of Gorilla. The results highlight that a more distal muscle insertion along the humerus has the greatest enhancing effect on the arm-lowering moment arms of teres major and pectoralis major. Furthermore, thorax and shoulder girdle morphological traits that are well known to distinguish non-human apes from humans were found to contribute to the enhancement of the arm-lowering mechanism. The more cranially oriented glenoid, obliquely oriented scapular spine and cranial scapula position on the thorax enabled certain muscles to act as arm-lowering muscles in Gorilla, contrary to the arm-raising action capability that is predicted for Homo. The enhanced arm-lowering capability is likely advantageous for the arboreal locomotion of apes. During hoisting behaviours that are known to occur during suspension and vertical climbing, arm-lowering is used to lift the heavy body of the apes upward. The results of this thesis in conjunction with earlier EMG studies suggest those muscles which are highly activated during these hoisting behaviours also have enhanced arm-lowering capacities in Gorilla and potentially other non-human hominoids compared to Homo. As such, the results highlight shoulder morphological traits that are biomechanically important for the arboreal locomotor behaviour of apes. By this, the thesis demonstrates a link between the conformation of shoulder morphological traits and their biomechanical capability, which will aid future functional interpretations of extant and extinct species.:Acknowledgements Bibliographische Darstellung Summary Zusammenfassung Chapter 1: Exploring the functional morphology of the Gorilla shoulder through musculoskeletal modelling Chapter 2: Comparison of the arm-lowering performance between Gorilla and Homo through musculoskeletal modeling Conclusion Appendix A: Supplementary Information for Chapter 1 Appendix B: Supplementary Information for Chapter 2 Appendix C: Curriculum Vitae Appendix D: Author Contributions

BACKGROUND: Shoulder girdle pain is a common disabling complaint with a high lifetime prevalence. Interventions aimed at decreasing shoulder pain without stressing shoulder girdle structures have the potential to improve participation in multimodal shoulder rehabilitation programs. HYPOTHESIS/PURPOSE: The aim of this study was to determine the acute effects of moderate intensity lower extremity exercise on mechanically induced shoulder pain in individuals without shoulder injury. It was hypothesized that participants would exhibit less shoulder pain, as indicated by increased pain thresholds, following lower extremity exercise. STUDY DESIGN: Repeated measures study. METHODS: Thirty (30) healthy participants were recruited to participate in this study. Pain pressure algometry was used to mechanically induce shoulder pain over the infraspinatus muscle belly. This was performed on the dominant shoulder before and immediately after performing 10 minutes of moderate intensity lower extremity exercise using a recumbent exercise machine. Heart rate and rate of perceived exertion were measured following exercise. Repeated measures ANOVA was used to compare pain pressure threshold scores between the baseline and post-exercise time points. Significance was set at p ≤ 0.05 . Effect size (ES) was calculated using Glass's Δ. RESULTS: Moderate intensity lower extremity aerobic exercise led to significantly (F = 8.471, p = 0.003) decreased evoked shoulder pain in healthy adults with moderate effect sizes (0.30-0.43). CONCLUSIONS: Lower extremity aerobic exercise significantly decreased pain of the infraspinatus in this sample of young healthy participants. Utilization of lower extremity exercise may be of benefit for younger patients to decreased acute shoulder pain. LEVEL OF EVIDENCE: 2b: individual cohort study.

The glenohumeral (GH) joint is the most mobile joint in the human body, but its mobility inherently increases the risk of instability. The humeral head sits in a shallow glenoid in the scapula like a golf ball sitting on a tee. The stability in this joint is provided by the rotator cuff muscles and tendons that actively pull the humerus back into the socket to prevent dislocation, especially during overhead motions. However, the rotator cuff is prone to tears, resulting in pain, loss of mobility, and recreational limitations. Surgical reattachment of the tendon to the bone is challenging due to the mechanical disparity between the two tissues, resulting in stress concentrations and a high risk of retear. Notably, the specialized tissue at the tendon-to-bone attachment, which facilitates stress transfer between tendon and bone in healthy joints, does not regenerate after surgical reattachment and healing, making tendon-to-bone repairs prone to re-tears. A comprehensive understanding of GH joint biomechanics is essential for developing early interventions to prevent rotator cuff injuries. Furthermore, improving tendon-to-bone fixation during rotator cuff repair is critical to improve post-surgery outcomes. In the last decade, bioinspired solutions have shown considerable promise for addressing several biomedical problems. This thesis draws bioinspiration from two animals that have evolved unique mechanical functions: (i) the bat shoulder joint, which facilitates repetitive overhead motions during flight and may offer insights into rotator cuff pathology and (ii) the curvature of python snake teeth, which enables secure grasping of prey without soft tissue tearing. In the first part of the thesis, the bat shoulder was studied for its unique characteristics relative to mice. Overhead motions in humans often lead to shoulder injuries, partly because the bony anatomy of the unstable GH joint places greater stress on the joint's surrounding soft tissues to stabilize these motions. Traditional animal models used to study shoulder pathology are quadrupeds, which lack the capacity for overhead motion. In contrast, bats consistently engage in overhead motion during flight, subjecting their shoulders to substantial loading throughout their relatively long lifespan. Remarkably, the biomechanical demands placed on a bat's shoulder are estimated to exceed those of a competitive swimmer’s by 45-fold, despite sharing similar coracoacromial arch anatomy with humans. We were inspired to study functional adaptations in the shoulders of bats that enable this overhead motion. We performed comparative anatomy studies of the shoulders of bats and mice, similarly-sized quadrupeds. By quantifying the constraints imposed by the bony anatomy, we identified adaptations of the shoulder, including the rotator cuff tendons, that allow bats to sustain overhead motion in a high stress, repeated loading environment, without injury. In the second part of the thesis, python teeth were used as inspiration to develop a repair device optimized to grasp the rotator cuff without tearing. Rotator cuff repair surgeries fail frequently, with 20-94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we examined the specialized teeth of snakes of the Pythonoidea superfamily, which effectively grasp soft tissues without tearing. To apply this non-damaging and effective gripping approach to the surgical repair of tendons, we developed and optimized a python-tooth inspired array as an adjunct to current rotator cuff suture repair, and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, and enabled optimization of a tooth array device to enhance rotator cuff repair to distribute stresses and increase tendon-bone contact. The efficacy of the approach was demonstrated via human cadaver tests, suggesting an alternative to traditional suturing paradigms that may reduce tendon re-tearing. Collectively, these studies contribute to a better understanding of the biomechanics of the GH joint and offer novel, bioinspired approaches for rotator cuff repair. The functional adaptations of bats provide insight into developing new approaches to treat GH joint instability, and a clinically relevant python-tooth inspired device can ultimately reduce the high rates of re-rupture currently observed in rotator cuff repair.

京都大学 / 新制・課程博士 / 博士(理学) / 甲第24181号 / 理博第4872号 / 新制||理||1697(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 中務 真人, 教授 森 哲, 准教授 森本 直記 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

This paper presents an intraoperative MRI-guided, patient-mounted robotic system for shoulder arthrography procedures in pediatric patients. The robot is designed to be compact and lightweight and is constructed with nonmagnetic materials for MRI safety. Our goal is to transform the current two-step arthrography procedure (CT/x-ray-guided needle insertion followed by diagnostic MRI) into a streamlined single-step ionizing radiation-free procedure under MRI guidance. The MR-conditional robot was evaluated in a Thiel embalmed cadaver study and healthy volunteer studies. The robot was attached to the shoulder using straps and ten locations in the shoulder joint space were selected as targets. For the first target, contrast agent (saline) was injected to complete the clinical workflow. After each targeting attempt, a confirmation scan was acquired to analyze the needle placement accuracy. During the volunteer studies, a more comfortable and ergonomic shoulder brace was used, and the complete clinical workflow was followed to measure the total procedure time. In the cadaver study, the needle was successfully placed in the shoulder joint space in all the targeting attempts with translational and rotational accuracy of 2.07 ± 1.22mm and 1.46 ± 1.06 degrees, respectively. The total time for the entire procedure was 94 min and the average time for each targeting attempt was 20 min in the cadaver study, while the average time for the entire workflow for the volunteer studies was 36 min. No image quality degradation due to the presence of the robot was detected. This Thiel-embalmed cadaver study along with the clinical workflow studies on human volunteers demonstrated the feasibility of using an MR-conditional, patient-mounted robotic system for MRI-guided shoulder arthrography procedure. Future work will be focused on moving the technology to clinical practice.

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