Thesis (doctoral)--Freie Universität Berlin, 1980.

Thesis (D.PT.)--Sage Colleges, 2009. / "May 2009." "A Capstone project for PTY 768 presented to the faculty of the Physical Therapy Department Sage Graduate School in partial fulfillment for the degree of Doctor of Physical Therapy." Includes bibliographical references.

The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons

No description available.

The purpose of this study was to examine the sensitivity of the kinesthetic system in active movement of the shoulder joint. Three movement amplitudes, 45°, 90° and 125° were studied under two classical psychophysical methods, the method of constant stimuli and the method of average error. Ten subjects were each given one hundred trials per standard for both methods. Results yielded difference limens ranging from 1.4° to 2.2° and constant errors ranging from -0.07° to 1.05°, for the three standards. However, no significant differences occurred among DLs within each method and thus Weber's Ratio was found not to be constant over the range of movement. In terms of constant errors there was only one significant difference among these errors within the two methods. Learning was found not to occur in the method of average error in that algebraic error, absolute error and within subject variability did not exhibit any tendency to become smaller. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

No description available.

No description available.

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Reverse total shoulder arthroplasty is used as the treatment for arthritic rotator cuff deficient shoulders. Some of the most common complications of a reverse shoulder arthroplasty are scapular notching, glenoid dissociations, glenohumeral dislocation, loosening or dissociation of the humeral component and nerve injury. Clinical outcomes are dependent on the preoperative diagnosis, the function of the deltoid and remaining rotator cuff muscles, biomechanical design of the prosthesis, and the orientation and placement of the reverse shoulder component. This study aims to optimize the patient-specific placement of a reverse shoulder component. A simulation software package was developed that can be used to determine the optimal placement of the reverse shoulder prosthesis for a specific patient. This is achieved by maximizing the humerothoracic range of motion and minimizing the adduction deficit. The motion of the simulation model is driven by shoulder complex motion equations adjusted for each patient. This data was obtained from literature with the motion of the arm fixed to the coronal, scapular and sagittal elevation planes. The influence of the various components of the Tornier Aequalis® - Reversed II system, together with changing the glenoid component inclination and humeral component retroversion, was investigated. This allowed the simulation software to be verified and validated, as well as applying the insight and knowledge gained to a case study. Further simulations evaluated a design change of the humeral component neck-shaft angle from the standard 155 ° to 145 ° or 165 °. The reverse shoulder simulation software provides accurate patient-specific Three Dimensional (3D) pre-operative planning and shoulder complex motion simulation. / AFRIKAANSE OPSOMMING: Omgekeerde volledige skouerartoplastie word as behandeling van ontsteking in gewrigsomhulsel-aangetaste skouers gebruik. Onder die algemeenste komplikasies van 'n omgekeerde skouergewrig-operasie is kepe in die skouerblad (skapulier), lostrekkings of onthegting van die gewrigskom (glenoïede), ontwrigting van die boarm/skouergewrig, die loskom of onthegting van die boarmbeen en beskadiging van senuwees. Mediese resultate is afhanklik van diagnose voor die operasie, die werking van die driehoekspier (deltoïede) en oorblywende draaispiere, die biomeganiese ontwerp van die prostese en die oriëntasie en plasing van die omgekeerde skouerkomponent. Hierdie studie is gemik op die beste pasiënt-spesifieke plasing van die omgekeerde skouerkomponent. Die simulasie-sagtewarepakket wat ontwikkel is, kan gebruik word om die optimale plasing van die omgekeerde skouerprostese in die geval van 'n spesifieke pasiënt te bepaal. Dit word gedoen deur die bewegingsvermoë van die bo-armbeen te maksimaliseer en die gebrekkige werking van die trekspiere te minimaliseer. Die werking van die simulasiemodel word gedryf deur die beweging van skouerkomponente te vergelyk, aangepas vir elke pasiënt. Hierdie data is verkry uit literatuur en die koppeling van die arm se beweging aan die belangrikste, skouerblad- en sagittale elevasievlakke. Die invloed van die onderskeie komponente van die Tornier Aequalis® - Reversed II-stelsel is saam met die verandering van die gewrigskom-komponent se helling en bo-armkomponent se terugstoting ondersoek. Sodoende kon die simulasie-sagteware nagegaan, bevestig en geldig verklaar word; en die insig en kennis wat verkry is op 'n gevallestudie toegepas word. Met verdere simulasies is 'n ontwerpwysiging ge- ëvalueer waar die skouerkomponent se beenpyphoek vanaf die standaard van 155° na 145° of 165° verander is. Die omgekeerde skouersimulasiesagteware maak akkurate pasiëntspesifieke driedimensionele (3D) beplanning voor 'n operasie en simulasie van die bewegings skouerdele moontlik.

Joint Position Sense (JPS) of the shoulder as determined by repeated repositioning tasks has been performed under different constrained testing conditions. The variability in the testing protocols for JPS testing of the gleno-humeral joint may incorporate different movement patterns, numbers of trials used to derived a specific JPS variable and range of motion. All of these aspects may play an important role in the assessment of G-H JPS testing. When using a new instrument for assessing JPS all of these issues need to be examined to document the optimal testing protocols for subsequent clinical assessments. By undertaking these studies future clinical trials may be more optimally assessed to determine if there are differences between dominant and non-dominant arms as well as the presence of JPS changes in performance associated with pathology and rehabilitation. This study used a 3-dimensional tracking system to examined gleno-humeral JPS using 2 open kinetic chain movement patterns. The 'conventional' 90 degree abducted, externally rotated movement was compared to the hypothetically more functional D2 movement pattern used in proprioceptive neuromuscular facilitatory techniques. These two patterns were tested at different ranges (low and high). Two cohorts (n=12, n=16) of normal healthy athletic males aged 17-35 years, performed matching tasks of both left and right arms. The second cohort (n=16) were assessed with and without strapping the gleno-humeral joint with sports tape. Accuracy (overall bias) and precision (variability) scores were determined for progressively greater numbers of trials. The findings of the study show that estimates of JPS accuracy and precision become more stable from data derived from 5 to 6 matching trials. There were no statistical differences between sides [95%CI ± 1.5cm]. The accuracy but not precision improved as subjects approximated the 'high' end of range in the 'conventional' or D2 pattern. Furthermore, no systematic differences were detected at different ranges of movement or movement patterns with or without the application of sports tape. These findings provide a guide to the number of trials that optimise the testing of the gleno-humeral joint and also suggest that in normal controls the magnitude of differences between sides and movement patterns is similar. These findings also iii indicate that sports tape applied to the shoulder may not significantly change the JPS performance in healthy, athletic males.

PURPOSE: To compare glenohumeral joint position sense (JPS), concentric internal (IR) and external rotation (ER) strength, functional ability, and level of satisfaction in patients who underwent three types of glenohumeral capsulorrhaphy with age-matched controls. RESEARCH DESIGN: Four 4x2 and two 4x3 ANOVAs were used to identify differences in JPS and concentric IR/ER strength between groups: Open Capsulorrhaphy (n=21), Thermal Capsulorrhaphy (n=16), Arthroscopic Capsulorrhaphy (n=14) and Controls (n=22). Pearson correlation analyses were performed to determine the relationship between objective American Shoulder and Elbow Surgeons (ASES) evaluations and subjective Shoulder Rating Questionnaire (SRQ) scores. Stepwise multiple regression analyses were performed to predict ASES and SRQ scores from various objective and subjective outcome measures. SUBJECTS: 73 adults (51 postsurgical patients, 22 healthy controls; mean age, 23.7 ± 6.8 yrs) participated in this retrospective study. The 51 patients who underwent capsulorrhaphy for recurrent, anterior glenohumeral instability were evaluated at an average of 32.1 months postsurgery. MEASUREMENTS: JPS was measured bilaterally using a reproduction of passive positioning protocol at 2 target angles: 60% and 90% of maximum passive external rotation (60% and 90% ER[subscript max]). Concentric IR and ER peak torques were measured bilaterally at 90°/sec, 180°/sec and 270°/sec. Objective postoperative function was quantified with the clinician-based ASES form, while functional status and patient satisfaction were assessed with the patient-based SRQ form. RESULTS: The accuracy of JPS in patients' surgical limbs was similar to that present in their contralateral, uninjured shoulders at both target angles. The Open group demonstrated significantly better involved-limb JPS acuity (4.2° ± 1.9°) than the Arthroscopic group (6.8° ± 3.2°) and Control group (6.6° ± 3.5°) (p<.05). However, the Open group had 31% less IR strength than Control subjects and 33% less than the Arthroscopic group, with IR peak torques significantly less in their postsurgical shoulders than their uninvolved limbs (p<.002). There was a strong, positive correlation (r =.64, p≤.001) between objective ASES and subjective SRQ scores. Patients' postoperative level of pain and ASES scores were significant predictors of their SRQ clinical scores (R=.81, p<.003). CONCLUSIONS: Glenohumeral JPS and rotator cuff strength were similar in both the postsurgical and uninvolved shoulders of the Arthroscopic and Thermal groups. Patients in the Open capsulorrhaphy group demonstrated significantly better involved-limb JPS than Arthroscopic and Control groups. The large strength deficits observed in the Open group, particularly in IR, were of significant concern. We observed a higher failure rate, more revision surgeries, and lower patient satisfaction with the Thermal capsulorrhaphy technique. Patient-based outcomes were significant predictors of operative success as measured by clinician-based evaluation. Prospective, randomized controlled studies are still needed to evaluate the outcomes of these glenohumeral capsulorrhaphy procedures over the longer term. / Graduation date: 2005