Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-termfollow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design. Case report. Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.

Shoulder impingement is the most common cause of shoulder pain. It is often described as mechanical irritation of the tendons of the rotator cuff or long head of the biceps due to compression against either the structures of the subacromial arch or the glenoid and glenoid labrum. Various treatment options exist to address impingement, and recent studies suggest thoracic spine manipulation may be a useful option. The purpose of this study was to assess changes in range of motion (ROM), pain and shoulder function both immediately post- and 7 to 10 days after receiving thoracic spine manipulations. We also attempted to identify changes in scapular kinematics and shoulder muscle activity associated with thoracic spine manipulation in subjects with shoulder impingement. Thirty subjects between the ages of 18 and 45 with signs of shoulder impingement participated in this repeated measures study. All subjects received both a mid-thoracic spine and a cervicothoracic junction manipulation. Changes in pain were assessed using an 11 point numeric pain rating scale. Subjects reported pain with performance of provocative testing (Jobes Empty Can, Hawkins-Kennedy and Neer's tests for impingement) as well as with performance of cervical rotation, thoracic spine flexion and extension and weighted humeral elevation. Shoulder elevation force production pre- and post- manipulation was assessed using hand-held dynamometry. Additionally, subjects completed the Penn Shoulder Score (PSS) and the Sports and Performing Arts Module of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to assess shoulder pain and function 7 to 10 days post thoracic spine manipulation. Electromagnetic sensors tracked three-dimensional scapular and clavicular kinematics as well as cervical, thoracic and humerothoracic ROM. Surface electromyography data were collected from the infraspinatus, serratus anterior, and the upper, middle and lower trapezius muscles with loaded humerothoracic elevation. A repeated measures analysis of variance (ANOVA) was used to compare scapular orientation and muscle activity at 30, 60, 90 ad 120 degrees of humerothoracic elevation before and after spinal manipulation. Paired t - tests revealed significant decreases in pain [(Jobes 2.6 ± 1.1, Neer's 2.6 ± 1.3, Hawkins-Kennedy 2.8 ± 1.3; p<0.001 for all three tests) (weighted shoulder elevation 2.0 ± 1.5, p<0.001; cervical rotation 0.4 ± .9, p=0.039)] as well as improvements in shoulder function (Force production 5.5±3.1, PSS 7.7 ± 9.4 and DASH 16.4 ± 13.2; p<0.001 for each). No significant changes in any of the ROM assessments were observed. No changes in scapular or clavicular kinematics were observed, with the exception of small decrease in scapular upward rotation (p = .04). A small but significant increase in middle trapezius activity (p = .03) was detected; however, no other significant differences in muscle activity were observed following manipulation. Moreover, paired t-tests revealed no significant differences in muscle onset times after manipulation. The findings of this study indicate that thoracic spine manipulation may be an effective intervention to treat pain associated with shoulder impingement; however, the improvements associated with thoracic spine manipulation are not likely explained by changes in scapular kinematics or shoulder muscle activity. Thoracic spine manipulation did not substantially alter scapular kinematics or motor control at the shoulder. / Physical Therapy

Title: Changes of trunk mobility in relation to postural stability Objectives: The main aim of this work was to quantitatively observe segmental trunk mobility in 3D space during flexion of arm and create coupled pattern phenomena of particular spine segments. Additional aim was to verify the effect of modification of the measurements on movement performance and to relate the given movement of the arm and the segmental trunk mobility to changes in the load of the lower extremities. Methods: The measurement itself was performed on 23 asymptomatic males aged 20 - 30. In 3 modifications of the motion measurement - no load, with load and with load and hold with arm forward, probands performed 5 repetitions of right arm flexion in the sagittal plane. The motion was scanned by system Qualisys markers while standing on 2 Kistler stabilometric platforms. Results: In most probands, the segmental movement of the spine was repeatable. It was possible to compare it between probands and create coupled pattern phenomena of the spine. The increased arm load and hold with arm forward caused an increase in the deflections of the particular spine segments in sagittal plane. Furthermore, the increase in load has led to demonstrably greater load changes in the lower extremities. The link between the segmental trunk...

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Background: Clinical ergonomic advice for sitting posture has been inferred from anthropometry theory and physiology studies. Qualitative observation of posture has been used to argue that postures are too flexed, too extended, too static, too mobile, require insufficient muscle activity or require too much. In other fields of healthcare, evidence is progressed from basic science to clinical trials before an intervention is prescribed, but postural advice has been prescribed from basic science without quantitative studies of postural behaviour. Spinal neuromuscular control can predict development of low back pain, it is affected by spinal pain, and can be trained, but studies examining these variables rarely measure the spinal position of their test subjects. There is a need for more detail of how spinal positions affect regional muscle activity. Study Objectives: The overall aims of this thesis were to quantify sagittal spinal postures in sitting for comparison within and between subjects and tasks, and to detail paraspinal and abdominal muscle activity associated with sitting postures. The studies quantified regional spinal curves in - Study I: typical posture behaviour during a computer task in comparison with standing, - Study II: postures that are achievable in sitting, - Study III: the regional muscle activity associated with sitting postures that have been clinically advocated as ‘ideal’, - Study IV: cohorts with and without a history of low back pain for comparison of regional muscle activity. Results and Conclusions: For clinical trials quantifying postural behaviour, the postural variation within subjects and task conditions in Study I demonstrated the importance of measurement over a prolonged period and subjects performing relevant tasks (as opposed to brief measures such as radiography that have been the standard for posture assessment). The use of surface tracking to quantify regional spinal curves and sagittal balance establish a foundation to investigate the effect of interventions on posture behaviour (eg. chair geometry, posture training, task variables and subject cohorts). Study I also showed that typical sitting posture for a computer task was more flexed at the thoracolumbar spinal region than when subjects deliberately ‘corrected’ their sitting posture, and both sitting postures were flexed at the lumbar region relative to standing. Study II showed that most subjects were unable to sit with spinal curves like those adopted in standing unless facilitation and feedback were provided, although these curves have been clinically advocated as ‘ideal’ posture. If clinical theories about ‘ideal’ sitting posture are correct, then teaching individuals the awareness of spinal position or skill to adopt these postures could be as important for workplace health and safety as other variables such as design and adjustment of office furniture. Study III showed three upright sitting postures that have been clinically advocated as ‘ideal’ were distinguished by incremental changes in activity of the lumbar multifidus muscles. In Study IV, individuals with a history of low back pain showed more incremental activity at the longissimus thoracis muscle to achieve the same sitting postures. If particular postures are shown to be ‘ideal’ in clinical trials, then training for these postures may need to focus on muscular strategies as well as spinal position. The distinct differences in regional muscle activity observed with spinal curves and subject cohorts (Studies III and IV) imply that studies of spinal neuromuscular control should measure or control spinal curves during testing. If spinal posture were controlled, the flat posture (flat surface from ~T5 to sacrum) would have the advantages of being achievable, commonly used in sitting and easily assessed. The flat posture also demonstrated the lowest muscle activity of the upright sitting postures examined, which may improve accuracy of determining muscle activity onset/offset used as an outcome measure for interventions, distinguishing cohorts or as a predictor for low back pain occurrence.

Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-termfollow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design. Case report. Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.

Title: Effect of Kinesio Taping on the functional condition of the musculoskeletal system The concept of the problem: The kinesiotaping method is currently very popular therapeutic method in sport as well as in physiotherapy. Although this method was primarily developed as therapeutic method, there is only a few studies, in which the kinesiotaping method is used on healthy individuals. Objective: The objective of this thesis is to evaluate the immediate effect of applied kinesio tape on changes in the range of motion of the thoracic spine in the sagittal plane on healthy individuals. Methods: The theoretical part deals with summary of the taping method as well as with anatomical and kinesiological aspects of flexion and extension of the thoracic spine. The practical part as an experiment (single blinded controlled trial) is dedicated to the application of kinesio and placebo tape, the way that both tapes were applied was specifically designed for the purpose of this thesis and for specifically selected individuals. For gathering the data and for the evaluation the changes in the range of motion, the index of thoracic spine mobility was used. Results: For experimental group - kinesio tape there were no statistically significant increase in the range of motion. Vice versa, according to the obtained...

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.

Bibliographical record DVOŘÁK, J. Physiological movements of the spine during locomotion. Prague: Charles University, 2nd Faculty of Medicine, Department of Rehabilitation and Sports Medicine 2021. 75 p. Thesis supervisor PhDr. Marcela Šafářová, Ph.D. Abstract The diploma thesis Physiological movements of the spine during locomotion deals with the relationship between locomotion, spatiotemporal properties of gait and spinal movements. The theoretical part of the work summarizes the knowledge about the phylogenetic and ontogenetic development of the spine. The paper discusses the influences that affect the motility of the spine from intrauterine development to old age. The main part of the theoretical part is devoted to an overview of studies examining the movements of the spine during human locomotion. The experimental part was performed by testing a group of younger (24.6 ± 3.6 years) and older adults (43.5 ± 4.6 years). Both groups consisted of 8 women and 8 men. A total of 32 volunteers were tested. Otto's spine distance, thoracic spine rotation, 95% COP standing, and spatiotemporal gait data were measured using a Zebris Rehawalk FDM-T. Thereafter, therapy was applied to the chest to affect the dynamics of movement. Finally, control measurements of all olunteers were performed. Statistical data...

EFFECTS OF THORACIC SPINAL MANIPULATIVE THERAPY ON THORACIC SPINE AND SHOULDER KINEMATICS, THORACIC SPINE FLEXION/EXTENSION EXCURSION, AND PRESSURE PAIN SENSITIVITY IN PATIENTS WITH SUBACROMIAL PAIN SYNDROME By Joseph R. Kardouni, Ph.D., PT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Lori A. Michener, PhD, PT, ATC, Professor, Department of Physical Therapy In patients with shoulder pain, the use of manual therapy directed at the spine and shoulder have been reported to provide superior outcomes to exercise based interventions or usual care without the use of manual therapy. Clinical trials have also reported improved pain and disability after thoracic spinal manipulative therapy (SMT) as a stand-alone treatment for shoulder pain. Although clinical efficacy is reported for the use of thoracic SMT for the treatment of shoulder pain, the mechanisms underlying the clinical benefits are not well understood. This limits the directed use of SMT. The benefits could be due to changes in spine or shoulder motion or neurophysiologic mechanisms of pain modulation. Elucidating the mechanism of manual therapy will aid the directed use of thoracic SMT for treating patients with shoulder pain. The research described in chapters 3 and 4 was performed to assess the effects of thoracic SMT in patients with subacromial pain syndrome with regard to biomechanical changes at the thoracic spine and shoulder and effects on central and peripheral pain sensitivity. Subjects with shoulder impingement pain symptoms were randomly assigned to receive 1 visit of thoracic SMT or sham SMT, applied to the lower, middle, and upper (cervicothoracic junction) thoracic spine. A 3-dimensional electromagnetic tracking system was used to measure thoracic and scapular kinematics during active arm elevation, and thoracic excursion at end-range of flexion and extension pre- post-treatment. Pressure pain threshold (PPT) was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. PPT measures at the painful shoulder were used to assess peripheral and/or central pain sensitivity, and PPT at unaffected regions measured central pain sensitivity. Patient-rated outcomes measures of pain (Numeric Pain Rating Scale-NPRS), function (Pennsylvania Shoulder Score-Penn), and global rating of change (GROC) were used to assess changes in clinical symptoms following treatment. No significant differences were found between treatment groups for the thoracic kinematics or excursion, shoulder kinematics, PPT measures, or patient-rated outcomes. No differences were noted pre- to post-treatment in either group for thoracic kinematics or excursion or PPT measures. In both groups, there was a decrease in mean scapular external rotation over time during ascending arm elevation, but the change was less than measurement error. Outcome measures of NPRS, Penn and GROC indicated clinical improvements in both groups following treatment, but there were no differences between the thoracic SMT or sham SMT groups. There were no meaningful correlations between thoracic and scapular kinematics or thoracic excursion with the outcome measures of NPRS, Penn, or GROC. There was a significant positive correlation (r=0.52 , p=0.009) between change in PPT at the lower trapezius on the unaffected side and baseline Penn scores. Biomechanically, thoracic spine extension and excursion did not change following thoracic SMT, and the SMT group had no greater changes in shoulder kinematics or patient-rated pain and function than the sham SMT group. Additionally, thoracic SMT did not improve peripheral or central pain sensitivity as measured by PPT. Furthermore, improvements in patient-rated outcomes were not found to be related to changes in thoracic spine mobility, or shoulder kinematics with SMT. The single correlation between change in PPT and baseline Penn may indicate a neurophyciologic effect of SMT in patients with higher baseline function scores, but the since no other significant relationships between PPT and outcome were seen, the implications of this finding are limited. Overall, alterations in thoracic spine mobility and pressure pain sensitivity do not appear to be responsible for improved outcomes in patients with subacromial pain syndrome. Future studies should explore the effects of SMT using other measures of thoracic spine motion and experimental pain modalities, as well as greater dosing of SMT over a longer follow-up.