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The life expectancy of the elderly population is expected to increase with 22 % by 2050. As one grows older, the body starts to deteriorate, which can lead to a higher risk for diseases and accidents. During recent years shoulder surgeries have increased dramatically, and to assess the shoulder function the most common technique is the use of camera-based motion capture systems. However, this is very time consuming and does not completely represent the real shoulder performance. Therefore, this study was aimed to validate a new technique, the force range monitor (FRM). Thirteen volunteers participated in this study, which was divided into two sessions. Session one included abduction and flexion strength measurements using the FRM, as well as six mobility measurements with the inertial measurement unit (IMU) of the FRM. The second session was conducted in the same manner, with the addition of the Vicon system (motion capture system). In this study a control session for FRM and the Vicon system was also performed for abduction and flexion movements with two participants, where the placement of the IMU was modified. As indicated by the results, FRM and the Vicon system do not measure the same parameters. Even if the FRM does not measure the same shoulder joint angles as the Vicon System, the FRM can still be of clinical importance when evaluating position deviation during strength and mobility measurements. Moreover, the FRM had a high repeatability for a number of participants, and most of the mobility measurements presented a distinct patterns for various activities. Hence, it can be concluded that the FRM is a potential technique to evaluate shoulder strength and mobility.

Forty-five males volunteered to serve as subjects to investigate the effects of limb velocity and limb preference on peak torque/body weight (PTBW), torque acceleration energy (TAE), average power (AVP), and endurance ratio (ER) at isokinetic speeds of 60 and 300 degrees/second during internal and external rotation of the shoulder. Standard Cybex warm-up and test protocol were used for both test conditions. Test/retest reliability estimates ranges from r=.60- .70. Repeated Measures ANOVA revealed significant limb speed and limb preference effects on PTBW, TAE, and AVP in both exercise speed or limb preference. The data illustrate a need for an internal/external shoulder rotation normative profile specific to limb speed and limb preference. / Master of Science

During walking, arm swing helps maintain postural balance and stability, but it does not aid in body propulsion. Human bipedal locomotion makes the upper limbs passively swing without engaging much upper limb muscle force or effort. The central idea of this thesis is to capture the kinetic energy of the arm swing during walking and transfer it to the lower limbs via a wearable exosuit to reduce the lower limb muscle efforts during walking. The Arm-Leg Interactive Coupling Exosuit (ALICE) is designed with cable-pulley system to harness shoulder and elbow movements to support the hips and ankles during walking. ALICE employs two coupling methods, shoulder-hip coupling and elbow-ankle coupling. The shoulder is coupled with the hip contralaterally, while the elbow is coupled with the ankle ipsilaterally to match the natural walking pattern. Therefore, shoulder flexion results in hip flexion, and elbow flexion initiates plantarflexion of the ankle during toe-off. The proposed concept was validated through human subject experiments involving 15 healthy young adults who walked on a treadmill for 5 minutes with and without the device. Walking kinematics, muscle activity, foot pressure, and metabolic cost were recorded to compare differences in walking biomechanics and energetics between three conditions - BL, S1 (device worn but disengaged) and S2 (device worn and engaged). A repeated measures analysis of variance (ANOVA) followed by post hoc analysis was used to identify the effects of shoulder-hip coupling, elbow-ankle coupling, and their combined effects. The results indicate that the proposed concepts indeed generate the expected outcomes of reducing lower limb muscle activity in exchange for the increased effort of upper limb muscles.

Abstract Aim: The aim of this study was to investigate if treatment with “dry needling” in myofascial triggerpoints (MTrPs) in the rotatorcuff muscles may affect impingement symptoms such as pain during provocative tests, shoulder mobility, and function. The research questions were: Does the value of pain change on the Visual Analog Pain Scale (VAS) between before and after treatment? Do the positive provocative tests for impingement change between before and after treatment? Does the active shoulder mobility change between before and after treatment? Does the self-rated function change between before and after treatment? Method: The study was a prospective randomized intervention study and 19 persons with impingement symptoms (mean ± standard deviation; 58 ± 18 years, and shoulder pain duration 3.9 ± 1.6 months) were randomized into two groups. The groups were tested before, directly after and 3 weeks after treatment. The intervention group was treated twice, with a week in between, with “dry needling” in MTrPs. The control group was also treated on two occasions but was instead given a superficial needle in the infraspinatus muscle. All subjects were treated by the same physiotherapist. Pain was evaluated on the VAS when subjects performed active shoulder flexion before and after treatment. Provocative tests for shoulder impingement (Neer sign, Hawkins-Kennedy test and Jobe test) as well as range of motion tests were performed before, after and three weeks after treatment. The frequencies of positive/negative provocative tests were presented. Shoulder function was evaluated with the QuickDASH questionnaire. Significance level p≤0.05 was used in the study and a tendency was identified between 0.05 ≤ p &lt; 0.1. Results: There was a tendency (p=0.086) with decreased pain (VAS) in the intervention group after the treatment. Among the impingement tests only significant improved results was observed for Neer sign test three weeks after the treatment (p=0.025) No significant difference could be seen on the active shoulder mobility between before and after the treatment. The perceived function in the intervention group, measured with the Quick DASH questionnaire, showed a tendency (p=0.086) towards a better function. Conclusions: The study showed a tendency towards that”dry needling”  in MTrPs may affect impingement symptoms such as pain and function. The provocative tests for shoulder impingement, Neer sign, showed a significant decrease in pain after treatment. More studies with larger population is needed to make a statement about the effect of “dry needling” in MTrPs as a treatment for shoulder impingement symptoms. / Sammanfattning Syfte och frågeställningar: Syftet med studien var att undersöka om behandling med ”dry needling” (intramuskulär nålstimulering) i myofasciella triggerpunkter (MTrPs) i rotatorcuffmuskulaturen kan påverka impingementsymptom såsom smärta vid provokationstester, axelledsrörlighet och funktion. Frågeställningarna var: Förändras smärtskattning på visuell analog skala(VAS) vid aktiv axelflexion efter jämfört med före behandling? Förändras de positiva provokationstesterna för impingement efter jämfört med före behandling? Förändras den aktiva axelledsrörligheten efter jämfört med före behandling? Förändras den självskattade funktionen efter jämfört med före behandling? Metod: Studien var en prospektiv randomiserad interventionsstudie, 19 forskningspersoner (fp) med impingementsymptom, (medelålder 58 ± 18 år, besvärsdurationens medeltid 3.9 ± 1.6 mån), randomiserades till två grupper. Grupperna undersöktes före, direkt efter och tre veckor efter avslutad behandling. Interventionsgruppen behandlades vid två tillfällen, med en veckas mellanrum, med ”dry needling” i MTrPs medan kontrollgruppen vid två tillfällen istället fick en ytlig akupunkturnål i m infraspinatus. Behandlingen av alla fp utfördes av en och samma fysioterapeut. Smärta utvärderades med (VAS) vid aktiv axelflexion direkt före och efter behandling. Provokationstester (Neer sign, Hawkins-Kennedy test och Jobe test) samt rörlighetsmätning utfördes före, efter och tre veckor efter avslutad behandling. Frekvensen positiva/negativa provokationstesttest summerades. Funktionen utvärderades med frågeformuläret QuickDASH. Signifikansnivå p&lt; 0.05 används i studien och en tendens identifierades mellan 0.05 ≤ p &lt; 0.1. Resultat: Det fanns en tendens (p=0.086) till minskad smärta (VAS) i interventionsgruppen efter jämfört med före behandling. Bland impingementtesterna sågs enbart ett signifikant förbättrat resultat för Neers sign tre veckor efter avslutad behandling jämfört med före behandling (p=0.025). Ingen signifikant skillnad kunde ses gällande rörligheten före och efter behandling. Den upplevda funktionsförmågan mätt med frågeformuläret QuickDASH visade en tendens (p=0.086) mot bättre funktion i interventionsgruppen. Slutsats: Studien har visat tendenser på att ”dry needling” i MTrPs kan påverka impingementsymptom såsom minskad smärta och bättre självskattad funktion efter behandling jämfört med före. Impingementtestet Neer sign visade en signifikant minskad smärta efter behandling. Fler studier med större grupper, större ålderspann och längre behandlingstid behövs för att kunna uttala sig om effekten av ”dry needling” i MTrPs som behandlingsmetod vid impingementsymptom i axeln. / <p>Fristående kurs i Idrottsvetenskap inriktning idrottsmedicin 2013-2015</p>

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Although axillary artery injury occurs frequently with dislocations of the shoulder and fractures of the clavicle, it is rarely associated with fractures of the proximal humerus. If the axillary artery is damaged, prompt recognition and treatment are necessary to salvage the involved extremity.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Durban University of Technology, 2013. / Objectives: Myofascial pain dysfunction is a common musculoskeletal disorder, known to affect athletes. This research aimed to create a map of myofascial trigger points (MFTPs), to ascertain sport specific combinations. Design and Setting: This IRB approved study was a cross-sectional, observational study. Participants: Forty swimmers and forty non-swimmers (soccer players). Measurements : All participants underwent one assessment, non-intervention session where primary measures included: shoulder disability index (SDI), myofascial diagnostic scale (MDS), algometer and numerical pain rating scale (NRS). Manual palpation, the MDS and an algometer assessed MFTPs and the SDI overall function. SPSS version 20 (IBM) using Pearson’s chi square tests / Fisher’s exact tests compared MFTP locations between the groups, and non-parametric Mann-Whitney tests compared continuous measures (due to significant non-normal distribution), with a p-value <0.05 level of significance. Results: MFTP presence is very uncommon in swimmers, with associated pain and loss of function being very low on average. No evidence was found that swimmers were affected more than non swimmers by MFTPs related pain or loss of function, but has indicated that algometer measurements for infraspinatus MFTP 1, were significantly higher (p<0.027) (showing decreased tenderness) than the values in non swimmers. Conclusions: These results contradict the literature which suggests that unique activity specific patterns of MFTPs exist. This may be as a result of underlying systemic causes of MFTPs that obscured the pattern in this study. It is therefore suggested that larger trials with more participants per group be done in order to verify the results of this study.

Background: Insufficient exposure assessment is a suggested contributing factor to the current lack of clearly characterised relationships between occupational biomechanical risk factors and musculoskeletal disorders. Minimal attention has been paid to the potential bias of measurement tools from expected true values (i.e. accuracy) or between measurement tools, and empirical data on the magnitudes of variance contributed by methodological factors for measurement tool precision are lacking. Aim: The aim of this thesis was to quantify aspects of bias and precision in three commonly employed biomechanical risk factor assessment tools - inclinometry, observation, and electromyography (EMG) - and provide recommendations guiding their use. Methods: Upper arm elevation angles (UAEAs) were assessed using inclinometers (INC) and by computer-based posture-matching observation, and bias relative to true angles was calculated. Calibration models were developed for INC data, and their efficacy in correcting measurement bias was evaluated. The total variance of trapezius and erector spinae (ES) EMG recordings during cyclic occupational work was partitioned into biological and methodological sources, including the variance uniquely attributable to sub-maximal normalisation. Using algorithms to estimate the precision of a group mean, the efficacy of different trapezius EMG study designs was evaluated. Using precision criteria, the efficacy of different normalisation methods was assessed for ES EMG recordings. Results and Discussion: Inclinometer measured UAEAs were biased from true angles, with increasing bias at higher angles. In contrast, computer based posture-matching observations were not biased from true angles.  Calibration models proved effective at minimizing INC data bias. The dispersion of estimates between- and within- observers at any given set angle underlined the importance of repeated observations when estimating UAEAs.  For EMG, a unique but relatively small component of the total variance was attributable to the methodological process of normalisation. Performing three repeats of the trapezius EMG normalisation task proved optimal at minimizing variance for one-day EMG studies, while two repeats sufficed for multi-day EMG studies. A prone normalisation task proved superior for maximizing normalised lumbar ES EMG precision. Conclusion: Key aspects of measurement tool accuracy, bias between tools, and tool precision were quantified, and recommendations were made to guide future research study design.

Introduction: Baggage handling is considered to be a heavy manual handling job including biomechanical exposures suspected of increasing the risk for musculoskeletal disorders. Aims: To document low back pain (LBP), shoulder pain (SP), and physical and psychosocial factors in baggage handlers, and to evaluate the implementation of an ergonomic intervention aiming to increase the use of loading assist devices. Methods: A questionnaire was utilized to characterize pain and psychosocial work conditions in 525 baggage handlers. The postures of 55 baggage handlers during 114 shifts were measured using inclinometry, half shift video-recordings were made for subsequent task analysis, and the number of aircraft handled was registered. Associations for psychosocial and biomechanical exposures with pain were assessed using regression analyses. An ergonomic intervention was implemented and evaluated using questionnaires and repeated interviews. Feasibility, intermediate outcomes, barriers and facilitators were assessed. Results: The prevalence rates of reported LBP and SP were 70% and 60%, respectively. Pain interfering with work (LBP - 30% and SP - 18%) and high pain intensity (LBP - 34% and SP - 28%) were associated with poor psychosocial working conditions. Extreme postures with arms elevated &gt;60° occurred for 6.4% of the total time, and in trunk flexion &gt;60° for 2.1% total time. In contrast, 71% of the total time was spent in a neutral trunk posture. The 90th percentile trunk forward flexion was 34.1°.  Daily shoulder pain increased in approximately one-third of all shifts and was positively associated with extreme work posture and the number of aircraft handled; this association was modified by influence and support. The intervention was delivered as planned, and dose received and satisfaction were rated as high. Motivated trainees facilitated implementation while lack of manager support, opportunities to observe and practice behaviors, follow-up activities, staff reduction, and job insecurity were barriers. Conclusion: The high prevalence rates of LBP and SP in baggage handlers were associated with psychosocial exposures, and daily shoulder pain was associated with higher biomechanical exposure. Barriers to implementation can be minimized by recruiting motivated trainees, securing strong organizational support, and carrying out follow-up activities.