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Sample records for subacromial space due

  1. Arthroscopic treatment of bony loose bodies in the subacromial space.

    Science.gov (United States)

    Li, Wei; Xiao, De-Ming; Jiang, Chang-Qing; Zhang, Wen-Tao; Lei, Ming

    2015-01-01

    Multiple bony loose bodies in the subacromial space caused form cartilage or bone cells and continue to grow. A 58-year-old man with two-year history of swelling and pain of the right shoulder. He had no history of tuberculosis and rheumatoid arthritis. Magnetic resonance (MR) images showed some bony loose bodies in the subacromial space. The removal of loose bodies and bursa debridement were performed arthroscopically. Histological diagnosis of them was synovitis with fibrous bodies. Extra-articular loose bodies is extremely rare, especially in the subacromial space, which maybe originated in the proliferative synovial bursa. Most authors recommend open removal to relive the pain, but there were choice to apply arthroscopy to remove them. The mechanism of formation of bony loose bodies is not clear, may be associated with synovial cartilage metaplasia. Arthroscopic removal of loose bodies and bursa debridement is a good option for treatment of the loose body in the subacromial space, which can receive good function. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Arthroscopic treatment of bony loose bodies in the subacromial space

    Directory of Open Access Journals (Sweden)

    Wei Li

    2015-01-01

    Conclusion: The mechanism of formation of bony loose bodies is not clear, may be associated with synovial cartilage metaplasia. Arthroscopic removal of loose bodies and bursa debridement is a good option for treatment of the loose body in the subacromial space, which can receive good function.

  3. Tendon vascularity in overhead athletes with subacromial pain syndrome and its correlation with the resting subacromial space.

    Science.gov (United States)

    Tsui, Sammi Sin Mei; Leong, Hio Teng; Leung, Vivian Yee Fong; Ying, Michael; Fu, Siu Ngor

    2017-05-01

    Supraspinatus tendinopathy is one of the common causes of subacromial pain syndrome (SAPS) in overhead athletes. Changes in tendon vascularity have been reported in painful tendons; however, the prevalence and distribution have not been investigated in young overhead athletes. We conducted a cross-sectional study of 47 overhead athletes (male, 31; female, 16) aged 18 to 36 years with SAPS for >3 months. A sonographer graded the severity of the tendinopathy and area of vascularization. Ultrasound imaging was used to measure supraspinatus tendon thickness, vascularity, and resting subacromial space. A self-written program was used to semiquantify the intensity of vascularity, expressed as the vascular index. The majority (87.2%) of the participants had signs of tendinopathy in the supraspinatus tendon, and 40 (85.1%) of the tendinopathic tendons had vascularity. The majority (66.0%) of the vascularized subjects presented with minimal increase in vascularity, and 19.1% had moderate to severe vascularization. Most (79.2%) of the vascularization was observed in the pericortical region. The vascular index was negatively correlated with the resting subacromial space in male athletes with a reduced subacromial space (ρ = -0.63; P = .038). Of overhead athletes with SAPS, 87.2% had supraspinatus tendinopathy with minimal to moderate vascularization, with the majority of vascularization occurring in the pericortical region. In male athletes with a reduced subacromial space, greater vascularity in the supraspinatus tendon was associated with a smaller resting subacromial space. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers.

    Science.gov (United States)

    Gumina, Stefano; Di Giorgio, Giantony; Postacchini, Franco; Postacchini, Roberto

    2008-02-01

    The assumption that subacromial space decreases in patients with thoracic hyperkyphosis arises from sporadic and personal observations. The purpose of this study was to compare width of subacromial space calculated on radiographs and CT scans of a high number of patients with thoracic hyperkyphosis that registered on exams of healthy volunteers. We measured the subacromial space, using Petersson's method, on radiographs of 47 patients with idiopathic or acquired thoracic hyperkyphosis and of 175 healthy shoulder volunteers. Both groups were further distinguished considering gender and age. Females with hyperkyphosis were also divided in two subgroups: those with a kyphotic curve of less (24 patients) or more (19 patients) than 50 degrees , respectively. Subacromial space of all patients and of 21 volunteers was also evaluated using CT. Acromio-humeral space was less wide in patients with hyperkyphosis with respect to coeval volunteers of the same gender; in females and in subjects older than 60. Subacromial width of females with hyperkyphosis whose curve was more than 50 degrees was significantly narrower (phyperkyphosis greater than 50 degrees had a subacromial space narrower than that measured in patients with a less severe kyphosis. This suggests that subacromial width is directly related to severity of thoracic kyphosis. Because hyperkyphosis of patients with osteoporotic vertebral fractures may worsen over the time, subacromial decompression could give only temporary shoulder pain relief.

  5. SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES

    Science.gov (United States)

    2011-01-01

    Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from glenohumeral instability and muscle imbalance. The purpose of this review is to describe the role of muscle imbalance in subacromial impingement in order to guide sports physical therapy evaluation and interventions. PMID:21655457

  6. Arthroscopic Finding of an Extra-Articular Loose Body in the Subacromial Space: Case Report Presentation and Literature Review.

    Science.gov (United States)

    Hartelius, Carl; Apostolopoulos, Alexandros P; Zaman, Tariq

    2016-01-01

    Loose bodies are pieces of soft tissue that run free within a body cavity, typically in the synovium; loose bodies outside of synovial cavities are very rare. This case study demonstrates such an instance occurring in the subacromial space, which is especially unusual. We report on it coupled with an analysis of the literature of known cases that have occurred previously. A 55-year old right-hand-dominant female patient presented with left shoulder pain. She had injured her left shoulder 7 yr previously and had achieved adequate pain and symptomatic control with physiotherapy. A magnetic resonance imaging scan demonstrated subacromial subdeltoid bursitis with a large subacromial spur, a bulky acromioclavicular (AC) joint, and a partial tear of the supraspinatous tendon. The patient subsequently underwent shoulder arthroscopy for subacromial decompression and AC joint excision. Arthroscopy demonstrated a suspected impingement of the rotator cuff in the subacromial space, bursitis, and a prominent acromion that limited the subacromial space (bigliani, type III), but during the procedure a detached white mass was discovered in the subacromial bursa. After histological analysis, the mass showed osteocartilagenous tissue, consistent with a loose body. Following the procedure, there were no complications, and the patient's symptoms gradually resolved. Extraarticular loose bodies are extremely rare, especially in the subacromial bursa. Reported cases have all been associated with either traumatic or degenerative shoulder pathology, and the diagnosis was commonly established incidentally on arthroscopy. Cases were managed with removal during the same procedure. Arthroscopic removal of loose bodies and bursa debridement, good options for treatment of loose bodies in the subacromial space, can result in good function.

  7. Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial space in primary shoulder arthroscopies.

    Science.gov (United States)

    Patzer, Thilo; Petersdorf, Sabine; Krauspe, Ruediger; Verde, Pablo Emilio; Henrich, Birgit; Hufeland, Martin

    2018-01-18

    We hypothesized that the prevalence of Propionibacterium acnes in patients undergoing primary shoulder arthroscopy is equal in the glenohumeral space compared with the subacromial space. Patients aged 18 years or older with shoulder arthroscopies were included. The exclusion criteria were prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, and antibiotic therapy within 14 days preoperatively. After standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen. Sample cultivation was conducted according to standardized criteria for bone and joint aspirate samples and incubated for 14 days. Matrix-assisted laser desorption-ionization time-of-flight spectrometry was used for specimen identification in positive culture results. The study prospectively included 115 consecutive patients with normal C-reactive protein levels prior to surgery (54.8% men; mean age, 47.2 ± 14.6 years). P acnes was detected on the skin after disinfection in 36.5% of patients, in the glenohumeral space in 18.9%, and in the subacromial space in 3.5% (P = .016). The prevalence of P acnes is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies. The results do not confirm the contamination theory but also cannot clarify whether P acnes is a commensal or enters the joint hematologically or even lymphatically or via an unknown pathway. Despite standardized surgical skin disinfection, P acnes can be detected in skin swab samples in more than one-third of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Effects of Repetitive Shoulder Activity on the Subacromial Space in Manual Wheelchair Users

    Directory of Open Access Journals (Sweden)

    Yen-Sheng Lin

    2014-01-01

    Full Text Available This study investigated (1 the effect of repetitive weight-relief raises (WR and shoulder external rotation (ER on the acromiohumeral distance (AHD among manual wheelchair users (MWUs and (2 the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P<0.01 occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P=0.008. Increased shoulder pain was associated with AHD percentage narrowing after ER (P≤0.007. The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.

  9. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it?

    Science.gov (United States)

    Mackenzie, Tanya Anne; Herrington, Lee; Horlsey, Ian; Cools, Ann

    2015-08-01

    Reduction of the subacromial space as a mechanism in the etiology of shoulder impingement syndromes is debated. Although a reduction in this space is associated with shoulder impingement syndromes, it is unclear if this observation is cause or consequence. The purposes of this descriptive review are to provide a broad perspective on the current perceptions with regard to the pathology and pathomechanics of subacromial and internal impingement syndromes, consider the role of the subacromial space in impingement syndromes, describe the intrinsic and extrinsic mechanisms considered to influence the subacromial space, and critique the level of evidence supporting these concepts. Based on the current evidence, the hypothesis that a reduction in subacromial space is an extrinsic cause of impingement syndromes is not conclusively established and the evidence permits no conclusion. If maintenance of the subacromial space is important in impingement syndromes regardless of whether it is a cause or consequence, research exploring the correlation between biomechanical factors and the subacromial space, using the later as the outcome measure, would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Subacromial lipoma causing shoulder impingement syndrome.

    Science.gov (United States)

    Sucuoglu, Hamza; Akgun, Kenan

    2017-01-01

    Subacromial lipoma represents a rare cause of subacromial impingement syndrome (SIS). A 49-year-old male patient presented to clinic with progressive right shoulder pain and limited movement, ongoing for approximately 1 month. Magnetic resonance imaging (MRI) revealed a lesion, compatible with lipoma, extending through subacromial space and pressing on supraspinatus muscle. After histopathological verification of lipoma, mass was excised. Postoperatively, patient completed 1 month physical therapy and rehabilitation program. Patient was free of pain at 4-month follow-up. Subacromial lipoma should be included in differential diagnosis of SIS for patients unresponsive to conservative treatment; MRI is very useful to determine precise etiology and inform surgical treatment.

  11. Differences in scapular orientation, subacromial space and shoulder pain between the full can and empty can tests.

    Science.gov (United States)

    Timmons, Mark K; Lopes-Albers, Andrea Diniz; Borgsmiller, Lindsey; Zirker, Catherine; Ericksen, Jeff; Michener, Lori A

    2013-04-01

    The empty and full can arm positions are used as diagnostic tests and in therapeutic exercise programs for patients with subacromial impingement syndrome. The adverse effects of these arm positions on the rotator cuff have not been fully described. The purpose of this investigation was to compare the acromio-humeral distance, three-dimensional scapular position, and shoulder pain during maximum isometric contractions in the empty and full can arm positions. Subjects with subacromial impingement syndrome (n=28) and a matched control group without shoulder pain (n=28) participated. Acromio-humeral distance, scapular/clavicular positions and shoulder pain were measured during maximal isometric contractions in each position. No difference was found in acromio-humeral distance (P=0.314) between the arm positions or between the groups (P=0.598). The empty can position resulted in greater scapular upward rotation (Ppain in the EC position might be due to the lack of an association amongst the scapular positions rather than the deficiency of a single scapular motion. Published by Elsevier Ltd.

  12. Subacromial impingement syndrome

    NARCIS (Netherlands)

    Umer, M.; Qadir, I.; Azam, M.

    2012-01-01

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a

  13. Subacromial impingement syndrome

    OpenAIRE

    Masood Umer; Irfan Qadir; Mohsin Azam

    2012-01-01

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patient...

  14. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

    Directory of Open Access Journals (Sweden)

    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  15. Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM)

    Science.gov (United States)

    2011-01-01

    Background The Subacromial Impingement Syndrome (SIS) is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology). Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology). Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%). We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion), a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma), or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes). We believe patients should be treated according to their predominant etiological mechanism(s). Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies. Methods In this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours); 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics); EMG (adductor co-activation) and dynamometry instrumented shoulder radiographs during arm tasks (force and muscle activation

  16. Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM

    Directory of Open Access Journals (Sweden)

    de Witte Pieter

    2011-12-01

    Full Text Available Abstract Background The Subacromial Impingement Syndrome (SIS is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology. Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology. Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%. We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion, a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma, or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes. We believe patients should be treated according to their predominant etiological mechanism(s. Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies. Methods In this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours; 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics; EMG (adductor co-activation and dynamometry instrumented shoulder radiographs during arm tasks (force and

  17. Subacromial impingement syndrome.

    Science.gov (United States)

    Umer, Masood; Qadir, Irfan; Azam, Mohsin

    2012-05-09

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality randomized controlled trials are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

  18. Subacromial impingement syndrome

    Directory of Open Access Journals (Sweden)

    Masood Umer

    2012-05-01

    Full Text Available Subacromial impingement syndrome (SAIS represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However the etiology is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality RCTs are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

  19. Case study of physiotherapy treatment of a patient after arthroscopic for subacromial decompression

    OpenAIRE

    Hiršová, Pavlína

    2013-01-01

    Title: Case study of physiotherapy treatment of a patient after arthroscopic for subacromial decompression The objective of this bachelor thesis is introduction with theme of physiotherapy of shoulder joint after arthroscopy for subacromial decompression. The thesis is divided in two main parts. The first (general) part describes anatomy, kinesiology and biomechanics of shoulder girdle briefly. There is also the reference of pathology in subacromial space and arthroscopic method description. ...

  20. Arthroscopic treatment for synovial chondromatosis of the subacromial bursa: a case report.

    Science.gov (United States)

    Park, Jung Ho; Noh, Haeng Kee; Bada, Leela P; Wang, Joon Ho; Park, Jong Woong

    2007-10-01

    Synovial chondromatosis of the subacromial bursa has been reported rarely. To the best of our knowledge, there was no case report of arthroscopic treatment for synovial chondromatosis of the subacromial bursa in English literature. The authors present a case of synovial chondromatosis of the subacromial space in a 45-year-old male, which was managed by arthroscopy. This rare condition can be well managed on similar lines as the other joints through arthroscopic surgery.

  1. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis.

    Science.gov (United States)

    Jowett, Sue; Crawshaw, Dickon P; Helliwell, Philip S; Hensor, Elizabeth M A; Hay, Elaine M; Conaghan, Philip G

    2013-08-01

    To perform a cost-effectiveness analysis of subacromial corticosteroid injection combined with exercise compared with exercise alone in patients with moderate to severe shoulder pain from subacromial impingement syndrome. A within-trial cost-effectiveness analysis with 232 patients randomized to physiotherapy-led injection combined with exercise (n = 115) or exercise alone (n = 117). The analysis was from a health care perspective with 24-week follow-up. Resource use information was collected from all patients on interventions, medication, primary and secondary care contacts, private health care use and over-the-counter purchases. The measure of outcome was quality-adjusted life years (QALYs), calculated from EQ-5D responses at baseline and three further time points. An incremental cost-effectiveness analysis was conducted. Mean per patient NHS costs (£255 vs £297) and overall health care costs (£261 vs £318) were lower in the injection plus exercise arm, but this difference was not statistically significant. Total QALYs gained were very similar in the two trial arms (0.3514 vs 0.3494 QALYs), although slightly higher in the injection plus exercise arm, indicating that injection plus exercise may be the dominant treatment option. At a willingness to pay of £20,000 per additional QALY gained, there was a 61% probability that injection plus exercise was the most cost-effective option. Injection plus exercise delivered by therapists may be a cost-effective use of resources compared with exercise alone and lead to lower health care costs and less time off work. International Standard Randomised Controlled Trial Number Register, http://www.controlled-trials.com/isrctn/, ISRCT 25817033.

  2. Accuracy of physical examination in subacromial impingement syndrome.

    Science.gov (United States)

    Silva, L; Andréu, J L; Muñoz, P; Pastrana, M; Millán, I; Sanz, J; Barbadillo, C; Fernández-Castro, M

    2008-05-01

    Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial-subdeltoid bursitis (SSB) confirmed by MRI. Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specificity, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2 x 2 table. Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specificity. Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specificity. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better define shoulder lesions.

  3. Intra-rater and inter-rater reliability of the standardized ultrasound protocol for assessing subacromial structures

    DEFF Research Database (Denmark)

    Hougs Kjær, Birgitte; Ellegaard, Karen; Wieland, Ina

    2017-01-01

    : To investigate the intra- and inter-rater reliability of the existing ultrasound (US) examinations of the subacromial space, the subacromial-subdeltoid bursa, and the supraspinatus tendon. METHOD: In a three-phased design, two physiotherapists using a standardized US protocol examined the thickness...

  4. Physiotherapy after subacromial decompression surgery

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Falla, Deborah; Frost, Poul

    2015-01-01

    This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop the in...... is currently being evaluated within the framework of the Shoulder Intervention Project (ISRCTN55768749).......This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop...

  5. Spontaneous Isolated Infection of the Subacromial Bursa

    Science.gov (United States)

    Al-Tawil, Karam

    2013-01-01

    Isolated infection of the subacromial bursa is a rare entity. We present the case of a previously fit man who was found to have staphylococcal infection of the sub-acromial bursa, without an obvious precipitant. Preoperative MRI scanning determined the specific locus of infection, and the patient was successfully treated with arthroscopic washout of the sub-acromial bursa followed by empirical antibiotic therapy. PMID:23984140

  6. Is Ultrasound-Guided Injection More Effective in Chronic Subacromial Bursitis?

    National Research Council Canada - National Science Library

    HSIEH, LIN-FEN; HSU, WEI-CHUN; LIN, YI-JIA; WU, SHIH-HUI; CHANG, KAE-CHWEN; CHANG, HSIAO-LAN

    2013-01-01

    .... Therefore, this study aimed to compare the efficacy of subacromial corticosteroid injection under US guidance with palpation-guided subacromial injection in patients with chronic subacromial bursitis...

  7. Augmented Fixation With Biodegradable Subacromial Spacer After Repair of Massive Rotator Cuff Tear.

    Science.gov (United States)

    Bozkurt, Murat; Akkaya, Mustafa; Gursoy, Safa; Isik, Cetin

    2015-10-01

    Unsuccessful outcomes after repair of massive rotator cuff ruptures accompanied by muscle atrophy and fatty degeneration are frequently associated with inadequate management and secondary tears. We report the functional differences after rotator cuff rupture repair with a biodegradable spacer application. In these patients, rotator cuff rupture repair should provide coverage of the humeral head. Subsequently, acromioplasty should be performed to allow adequate space for the subacromial spacer. Thereafter measurement of the intra-articular space required for application of the biodegradable spacer is performed. Using this method can decrease the rate of tears by providing a safe subacromial space in cases of massive rotator cuff rupture.

  8. Subacromial osteochondroma: A rare cause of impingement syndrome.

    Science.gov (United States)

    Çıtlak, Atilla; Akgün, Ulaş; Bulut, Tugrul; Aslan, Cihan; Mete, Berna Dirim; Şener, Muhittin

    2015-01-01

    Subacromial impingement syndrome is one of the most common disorders of shoulder. Scapula is a very rare site for osteochondromas, and osteochondromas arising under the acromion cause impingement syndrome. We presented 34-year old female patient with subacromial impingement syndrome secondary to osteochondroma. She had received conservative treatment several times in other clinics. The osteochondroma causing impingement was not diagnosed. Physical examination of the right shoulder revealed 90° flexion, 70° abduction, 20° external rotation and internal rotation to sacrum. X-ray, CT and MRI of the shoulder was obtained. Osteochondroma of the acromion (35×33×25mm) causing impingement was detected. The osteochondroma of acromion compressed, displaced and ruptured the supraspinatus tendon. Also an osseous prominence of glenoid was detected during shoulder arthroscopy, and it was removed arthroscopically. The giant osteochondroma of acromion could not remove arthroscopically due to the size of the lesion, and it was removed totally through a mini open approach. Histopathological examination confirmed the diagnosis of osteochondroma. Scapular, clavicular and humeral osteochondromas cause impingement syndrome. Osteochondroma should be treated with total excision. Recurrences can be seen due to insufficient removal of osteochondromas. We think that, total excision is important to prevent recurrence. Subacromial osteochondroma is a very rare cause of impingement syndrome, and if it isn't diagnosed early it limits shoulder movements, causes severe shoulder impingement and rotator cuff tear. The diagnosis of subacromial osteochondroma should be considered in any patient with shoulder impingement syndrome and good functional results can be expected following total excision. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Subacromial shoulder disorders among baggage handlers

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Mikkelsen, Sigurd; Pedersen, Ellen Bøtker

    2016-01-01

    PURPOSE: To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure. METHODS: This cohort study is based...... System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders. RESULTS: The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer...... increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders....

  10. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases).

    Science.gov (United States)

    Teoh, Kar H; Jones, Sian A; Gurunaidu, Subramaniam; Pritchard, Mark G

    2015-07-01

    Subacromial corticosteroid injections are frequently used for both diagnostic and therapeutic purposes in shoulder pain. Subacromial septic bursitis is a recognized but rare complication. There have been no reports of methicillin-resistant Staphylococcus aureus infections of the subacromial bursa after subacromial injections in the literature. We describe case reports of two patients who presented with subacromial methicillin-resistant Staphylococcus aureus septic bursitis following subacromial corticosteroid injections in the community and highlight the diagnostic and management challenges of this condition.

  11. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases)

    OpenAIRE

    Teoh, Kar. H.; Jones, Sian A; Gurunaidu, Subramaniam; Pritchard, Mark G.

    2014-01-01

    Subacromial corticosteroid injections are frequently used for both diagnostic and therapeutic purposes in shoulder pain. Subacromial septic bursitis is a recognized but rare complication. There have been no reports of methicillin-resistant Staphylococcus aureus infections of the subacromial bursa after subacromial injections in the literature. We describe case reports of two patients who presented with subacromial methicillin-resistant Staphylococcus aureus septic bursitis following subacromi...

  12. The effect of experimentally-induced subacromial pain on proprioception.

    Science.gov (United States)

    Sole, Gisela; Osborne, Hamish; Wassinger, Craig

    2015-02-01

    Shoulder injuries may be associated with proprioceptive deficits, however, it is unknown whether these changes are due to the experience of pain, tissue damage, or a combination of these. The aim of this study was to investigate the effect of experimentally-induced sub-acromial pain on proprioceptive variables. Sub-acromial pain was induced via hypertonic saline injection in 20 healthy participants. Passive joint replication (PJR) and threshold to detection of movement direction (TTDMD) were assessed with a Biodex System 3 Pro isokinetic dynamometer for baseline control, experimental pain and recovery control conditions with a starting position of 60° shoulder abduction. The target angle for PJR was 60° external rotation, starting from 40°. TTDMD was tested from a position of 20° external rotation. Repeated measures ANOVAs were used to determine differences between PJR absolute and variable errors and TTDMD for the control and experimental conditions. Pain was elicited with a median 7 on the Numeric Pain Rating Scale. TTDMD was significantly decreased for the experimental pain condition compared to baseline and recovery conditions (≈30%, P = 0.003). No significant differences were found for absolute (P = 0.152) and variable (P = 0.514) error for PJR. Movement sense was enhanced for the experimental sub-acromial pain condition, which may reflect protective effects of the central nervous system in response to the pain. Where decreased passive proprioception is observed in shoulders with injuries, these may be due to a combination of peripheral tissue injury and neural adaptations that differ from those due to acute pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided?

    NARCIS (Netherlands)

    Rutten, M.J.C.M.; Maresch, B.J.; Jager, G.J.; Waal Malefijt, M.C. de

    2007-01-01

    BACKGROUND: Blind injection of the subacromial-sub-deltoid bursa (SSB) for diagnostic purposes (Neer test) or therapeutic purposes (corticosteroid therapy) is frequently used. Poor response to previous blind injection or side effects may be due to a misplaced injection. It is assumed that ultrasound

  14. MR imaging after therapeutic injection of the subacromial bursa

    Energy Technology Data Exchange (ETDEWEB)

    Major, N.M. [Duke University Medical Center, Department of Radiology, Division Musculoskeletal, Durham, NC (United States)

    1999-11-01

    Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid. This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of a potential complication.Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection with 7 cm{sup 3} of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman; age range 27-36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging was performed up to 10 days after the injection in this patient.Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection prior to imaging is vital for accurate interpretation of MR shoulder examinations. (orig.)

  15. Space shuttle contamination due to backflow from control motor exhaust

    Science.gov (United States)

    Robertson, S. J.; Chan, S. T. K.; Lee, A. L.

    1976-01-01

    Spacecraft contamination of the space shuttle orbiter and accompanying Spacelab payloads is studied. The scattering of molecules from the vernier engines and flash evaporator nozzle after impingement on the orbiter wing surfaces, and the backflow of molecules out of the flash evaporator nozzle plume flow field due to intermolecular collisions in the plume are the problems discussed. A method was formulated for dealing with these problems, and detailed results are given.

  16. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

    OpenAIRE

    Jean-Christophe Murray; Stéphane Pelet

    2014-01-01

    Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right sh...

  17. In vivo temperature measurement in the subacromial bursa during arthroscopic subacromial decompression.

    Science.gov (United States)

    Barker, Scott L; Johnstone, Alan J; Kumar, Kapil

    2012-06-01

    The purpose of the study was to evaluate whether use of a bi-polar radiofrequency (RF) ablation wand would cause excess heating, which may lead to collateral damage to the surrounding tissues during arthroscopic subacromial decompression. Cadaveric studies have shown that high temperatures can potentially be reached when using RF ablation wands in arthroscopic shoulder surgery. Only 1 other published study assesses these temperature rises in the clinical setting. Fifteen patients were recruited to participate in the study. A standard arthroscopic subacromial decompression was performed using continuous flow irrigation, with intermittent use of the RF ablation wand for soft tissue debridement. The temperature of the irrigation fluid within the subacromial bursa and the outflow fluid from the suction port of the wand were measured during the procedure using fiber-optic thermometers. The mean peak temperature recorded in the subacromial bursa was 32.0°C (29.3-43.1°C), with a mean rise from baseline of 9.8°C. The mean peak temperature recorded from the outflow fluid from the wand was 71.6°C (65.6-77.6°C), with a mean rise from baseline of 49.4°C. High temperatures were noted in the outflow fluid from the wand; however, this was not evident in the subacromial bursa itself. Use of room temperature inflow fluid, maintenance of flow through the bursa, and avoidance of prolonged uninterrupted use of the wand all appear to ensure that safe temperatures are maintained in the subacromial bursa not only in the laboratory but also in a clinical setting. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  18. Guideline for diagnosis and treatment of subacromial pain syndrome

    NARCIS (Netherlands)

    Diercks, Ronald; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

  19. Adhesion of the subacromial bursa may cause subacromial impingement in patients with rotator cuff tears: pressure measurements in 18 patients.

    Science.gov (United States)

    Machida, Akitoshi; Sugamoto, Kazuomi; Miyamoto, Takashi; Inui, Hiroaki; Watanabe, Tetsu; Yoshikawa, Hideki

    2004-02-01

    In order to determine whether adhesion of the subacromial bursa leads to impingement, we measured the subacromial contact pressures before and after release of adhesion of this bursa. 18 shoulders with cuff tears and adhesion of the subacromial bursa were evaluated in 8 male and 10 female patients, of mean age 62 (53-71) years and who had no particular limitation of shoulder motion. We recorded subacromial pressures using a very sensitive film inserted under the acromion during surgery. In passive scapular plane elevation (scaption) at 100 degrees, the mean subacromial contact pressure and area declined from 1.43 (SD 0.23) MPa before release to 1.14 (SD 0.35) MPa after release (p bursa increases impingement between the acromion and the insertion of rotator cuff tendons.

  20. The molecular pathophysiology of subacromial bursitis in rotator cuff disease.

    Science.gov (United States)

    Blaine, Theodore A; Kim, Yang-Soo; Voloshin, Ilya; Chen, Darwin; Murakami, Koko; Chang, Seong-Sil; Winchester, Robert; Lee, Francis Y; O'keefe, Regis J; Bigliani, Louis U

    2005-01-01

    Little information exists on the molecular and biochemical pathophysiology of subacromial bursitis and rotator cuff disease. We investigated the pattern of expression of cytokines (interleukin [IL]-1beta, IL-1, IL-6, tumor necrosis factor [TNF] alpha, small inducible cytokines), metalloproteases, and cyclooxygenases in the subacromial bursa in patients with rotator cuff disease. Subacromial bursa specimens were prepared for molecular and biochemical analysis in patients undergoing shoulder surgery following an institutional review board-approved protocol. Specimens were analyzed for the presence of cytokines, metalloproteases, and cyclooxygenases by use of microarray for gene expression and immunohistocytochemistry. Microarray analysis for gene expression and immunohistochemistry demonstrated that the expression of several cytokine genes (TNF, IL-1alpha, IL-1beta, and IL-6) was increased in patients with subacromial bursitis compared with control specimens. Furthermore, the expression of metalloproteases (MMP-1 and MMP-9) and cyclooxygenases (COX-1 and COX-2) in the bursitis group was found to be increased as compared with controls. Although further investigation is required, these studies suggest that inflammation of the subacromial bursa does occur in patients with rotator cuff disease. These findings support the role of anti-inflammatory agents in the treatment of subacromial impingement and emphasize the importance of subacromial bursectomy to reduce inflammation in rotator cuff disease.

  1. Intra and inter-examiner reliability of the subacromial impingement index

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, Carlos Eduardo Sala; Ferreira, Felipe Varella; Carvalho Sposito, Guilherme de; Nogueira-Barbosa, Marcello Henrique; Oliveira, Anamaria Siriani de [University of Sao Paulo, Ribeirao Preto School of Medicine, Ribeirao Preto, SP (Brazil)

    2010-01-15

    The present study aimed to assess the reliability of intra and inter-examiner subacromial impingement index (SII) measures obtained from radiographs. Thirty-six individuals were enrolled and divided into two groups: control group, composed of 18 volunteers in good general health without shoulder problems, and a group of 18 patients with subacromial impingement syndrome (SIS). Radiographic images were taken with the dominant upper limb in neutral rotation, while the volunteers held their arm at 90 of abduction in the frontal plane. The beam of radiation at 30 craniocaudal inclination was used to provide an antero-posterior image view. Three blinded examiners each performed three measurements from the subacromial space (SS) and the anatomical neck of the humerus (NH). The SII was calculated as the ratio of the SS and the NH measures. The mean values of SII were compared using t-tests. The intra-class correlation coefficient (ICC) was used to assess intra- and inter-examiner reliability of the measures. The mean values of SII were greater for the control group (0.12) than for the SIS group (0.08; p = 0.0071). SII measurements showed excellent intra (0.96-0.99) and inter-examiner reliability (0.94) for both the control and SIS group. The results of this study show the potential use of the SII; a greater mean value for the control group compared to the SIS group and excellent reliability for intra- and inter-examiner measurement. Validation studies of the index should be conducted to correlate the index with clinical findings from subacromial impingement syndrome. (orig.)

  2. Subdeltoid lipoma: a case with symptoms mimicking glenohumeral instability and subacromial impingement.

    Science.gov (United States)

    Ui, Michimasa; Ogawa, Kiyohisa

    2010-06-09

    Lipoma is the most frequently occurring benign soft tissue tumor in the shoulder and the axillary region in middle-aged and older persons, yet few such lipoma cases have been associated with clinical symptoms. A 38-year-old right-handed man presented with an enlarged feeling and a painful back-and-forth popping in his left shoulder. Although moderate tenderness of the subacromial bursa and bicipital groove existed, an obvious impingement sign was absent. Also not evidenced were signs of neurological deficits, limited range of motion, or any physical findings suggestive of instability. Magnetic resonance imaging showed a homogenous tumor in the subdeltoid that was isointense relative to the subcutaneous fat and fluid collection in the hypertrophic subacromial bursa. As the tumor was considered from the clinical and imaging findings to be attributable to all clinical symptoms, it was resected en bloc with a satisfactory result. Histopathologically, the tumor showed typical features of a simple lipoma. To our knowledge, the present case is the first of a subdeltoid intermuscular lipoma of which mechanism developing symptoms was preoperatively surmised from imaging. The symptom-mimicking shoulder instability was assumed to be produced by the back-and-forth snapping of the lipoma beneath the deltoid muscle. The mechanism for developing the subacromial impingement-like symptom was surmised to derive from the middle deltoid fibers pressuring the lipoma to push up into the subacromial space. This case is presented to emphasize the careful reading of imaging in considering the pathomechanism of the attributing symptoms. Copyright 2010, SLACK Incorporated.

  3. Rehabilitation for Subacromial Impingement Starts at the Scapula

    Directory of Open Access Journals (Sweden)

    Peggy A. Houglum

    2013-12-01

    Full Text Available Subacromial impingement, especially secondary subacromial impingement, is a common malady of athletes and non-athletes alike. Although several pathologies may lead to impingement, they all relate back to poor posture. Over time, postural changes increase stress to soft tissue structures to change both alignment and performance. Injury results as low-level stresses impact weakening tissues to the point of overload. Crucial to effective treatment of secondary subacromial impingement is the identification and correction of all causes. Basic to successful treatment is correction of posture, including scapular posture and muscles which control, stabilize, and move the scapula. An evidence-based approach to not only identifying the causes but also creating a treatment regimen to effectively resolve secondary subacromial impingement is presented.

  4. Doses due to extra-vehicular activity on space stations

    Energy Technology Data Exchange (ETDEWEB)

    Deme, S.; Apathy, I.; Feher, I. [KFKI Atomic Energy Research Institute, Budapest (Hungary); Akatov, Y.; Arkhanguelski, V. [Institute of Biomedical Problems, State Scientific Center, Moscow (Russian Federation); Reitz, G. [DLR Institute of Aerospace Medicine, Cologne, Linder Hohe (Germany)

    2006-07-01

    One of the many risks of long duration space flight is the dose from cosmic radiation, especially during periods of intensive solar activity. At such times, particularly during extra-vehicular activity (E.V.A.), when the astronauts are not protected by the wall of the spacecraft, cosmic radiation is a potentially serious health threat. Accurate dose measurement becomes increasingly important during the assembly of large space objects. Passive integrating detector systems such as thermoluminescent dosimeters (TLDs) are commonly used for dosimetric mapping and personal dosimetry on space vehicles. K.F.K.I. Atomic Energy Research Institute has developed and manufactured a series of thermoluminescent dosimeter systems, called Pille, for measuring cosmic radiation doses in the 3 {mu}Gy to 10 Gy range, consisting of a set of CaSO{sub 4}:Dy bulb dosimeters and a small, compact, TLD reader suitable for on-board evaluation of the dosimeters. Such a system offers a solution for E.V.A. dosimetry as well. By means of such a system, highly accurate measurements were carried out on board the Salyut-6, -7 and Mir Space Stations, on the Space Shuttle, and most recently on several segments of the International Space Station (I.S.S.). The Pille system was used to make the first measurements of the radiation exposure of cosmonauts during E.V.A.. Such E.V.A. measurements were carried out twice (on June 12 and 16, 1987) by Y. Romanenko, the commander of the second crew of Mir. During the E.V.A. one of the dosimeters was fixed in a pocket on the outer surface of the left leg of his space-suit; a second dosimeter was located inside the station for reference measurements. The advanced TLD system Pille 96 was used during the Nasa-4 (1997) mission to monitor the cosmic radiation dose inside the Mir Space Station and to measure the exposure of two of the astronauts during their E.V.A. activities. The extra doses of two E.V.A. during the Euromir 95 and one E.V.A. during the Nasa4 experiment

  5. Subacromial osteochondroma: A rare cause of impingement syndrome

    OpenAIRE

    Çıtlak, Atilla; Akgün, Ulaş; Bulut, Tugrul; Aslan, Cihan; Mete, Berna Dirim; Şener, Muhittin

    2014-01-01

    Introduction Subacromial impingement syndrome is one of the most common disorders of shoulder. Scapula is a very rare site for osteochondromas, and osteochondromas arising under the acromion cause impingement syndrome. Presentation of case We presented 34-year old female patient with subacromial impingement syndrome secondary to osteochondroma. She had received conservative treatment several times in other clinics. The osteochondroma causing impingement was not diagnosed. Physical examination...

  6. Mycobacterium avium-intracellulare: a rare cause of subacromial bursitis.

    Science.gov (United States)

    Sinha, Raj; Tuckett, John; Hide, Geoff; Dildey, Petra; Karsandas, Alvin

    2015-01-01

    Septic subacromial bursitis is an uncommon disorder with only a few reported cases in the literature. The most common causative organism is Staphylococcus aureus. We report the case of a 61-year-old female with a septic subacromial bursitis where the causative organism was found to be Mycobacterium avium-intracellulare (MAI). The diagnosis was only made following a biopsy, and we use this case to highlight the importance of recognising the need to consider a biopsy and aspiration in atypical situations.

  7. Current UK practices in the management of subacromial impingement

    Science.gov (United States)

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  8. Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome.

    Science.gov (United States)

    Yu, Chung-Ming; Chen, Chih-Hwa; Liu, Hsien-Tao; Dai, Ming-Hsun; Wang, I-Chun; Wang, Kun-Chung

    2006-01-01

    Subacromial impingement syndrome, with pain and limited motion, is a common disease encountered daily in clinics. This study determined the efficacy of subacromial injections of corticosteroids and local anesthesia for treatment of painful subacromial impingement syndrome. A total of 238 shoulders in 209 patients, with regular follow-up, were enrolled in this study. Mean patient age was 51 years (range 31-72 years). Each patient complained of shoulder pain with progressive motion limitation present for more than one month, which was not relieved by various nonsurgical treatments. The mean duration of symptoms before injection was five months (range 1-12 months). Each patient had a positive Neer impingement sign, Hawkins impingement sign, painful tendon sign, limited range of motion and did not show clinical evidence of a rotator cuff tear. Each patient was administered an injection of 1 ml of 2% Xylocaine and 1 ml of Rinderon suspension. A second injection was administered one week later for patients without obvious improvement. Following injections, patients were instructed to perform a home rehabilitation program for four weeks. Follow-up examinations were scheduled for one, two and four weeks, and three, six, nine and 12 months after injection. Outcome measures included the Constant-Murley score and shoulder range of motion. At follow-up four weeks after the first injection, 216 shoulders (91%) had satisfactory improvement in amount of pain and range of motion: mean improvements in the active range of motion of forward elevation, abduction, internal rotation and external rotation were 56 degrees, 48 degrees, 18 degrees and 22 degrees, respectively. However, at the first year follow-up, the satisfaction rate was slightly down at 88%, and 19 shoulders (8%; 16 patients) had recurrent pain and motion limitation after an average of 5.4 months (range 3-12 months). Each of these patients received another injection. Surgery was recommended for 22 shoulders (9%; 18

  9. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  10. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review

    NARCIS (Netherlands)

    Dorrestijn, Oscar; Stevens, Martin; Winters, Jan C.; van der Meer, Klaas; Diercks, Ron L.

    2009-01-01

    Background: Patients with subacromial impingement syndrome are often operated on when conservative treatments fail. But does surgery really lead to better results than nonoperative measures? This systematic review compared effects of conservative and surgical treatment for subacromial impingement

  11. Subacromial impingement syndrome caused by a voluminous subdeltoid lipoma.

    Science.gov (United States)

    Murray, Jean-Christophe; Pelet, Stéphane

    2014-01-01

    Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.

  12. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

    Directory of Open Access Journals (Sweden)

    Jean-Christophe Murray

    2014-01-01

    Full Text Available Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.

  13. Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial.

    Science.gov (United States)

    Kromer, Thilo O; de Bie, Rob A; Bastiaenen, Caroline H G

    2010-06-09

    Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome. This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization. The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks. Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments

  14. Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    de Bie Rob A

    2010-06-01

    Full Text Available Abstract Background Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome. Methods/Design This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization. The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks. Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants

  15. Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study.

    Science.gov (United States)

    Lee, Doo-Hyung; Hong, Ji Yeon; Lee, Michael Young; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-05-01

    To evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. Prospective, longitudinal comparison study. University-affiliated tertiary care hospital. Patients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness 2mm and effusion thickness 2mm. A single subacromial injection with 20mg of triamcinolone acetonide. Visual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. There were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. A patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome.

    Science.gov (United States)

    Ettinger, Lucas R; Shapiro, Matthew; Karduna, Andrew

    2017-01-01

    Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS); however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance-matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS) was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P = .042) and elbow (5.6° difference, P = .001) than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater (P = .046) than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.

  17. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome

    Directory of Open Access Journals (Sweden)

    Lucas R Ettinger

    2017-06-01

    Full Text Available Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS; however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance–matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P  = .042 and elbow (5.6° difference, P  = .001 than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater ( P  = .046 than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.

  18. Subacromial bursitis related to HIV infection: case report.

    Science.gov (United States)

    Ejnisman, Benno; Figueiredo, Eduardo Antônio de; Terra, Bernardo Barcellos; Lima, Ana Lucia L Munhoz; Uip, David E

    2010-01-01

    Describe a subacromial bursitis at the right shoulder of a 45-year-old male subject. The patient has been living with HIV/AIDS for 22 years. The ultrasonography and the MRI revealed the presence of a pronounced subacromial effusion, with an inflammatory reaction of adjacent tissues. The tumoration was handled firstly with a needle-puncture aspiration, with a thick liquid outflow, followed by an open drainage. Histopathological evaluation showed no evidence of any AIDS defining disease. There was complete remission of the infection after five months thereafter the symptoms had started. After reviewing the scarce literature in the area, no reports of subacromial bursitis in HIV/AIDS patients were found. The authors point out that, although rare, this disease should be considered as differential diagnosis of shoulder diseases in HIV-infected subjects.

  19. Subacromial bursitis with rice bodies : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bong Soo; Joo, Kyung Bin; Park, Dong Woo; Lee, Hak Soo; Oh, Jae Cheon; Lee, Yong Joo; Lee, Won Mi [Hanyang Univ., Seoul (Korea, Republic of). Coll. of Medicine

    1998-04-01

    Multiple rice bodies in joints or bursae are rarely encountered in patients with rheumatoid arthritis. We report the radiologic findings of massive subacromial bursitis with innumerable rice bodies on the right shoulder of a 38-year-old man with rheumatoid arthritis. Subacromial bursography showed markedly distended bursa with multiple nodular filling defects. Precontrast CT scanning revealed well-demarcated hypodense lesion without calcification in subacromio-subdeltoid bursa. Multiple rice bodies showed slightly high signal intensity of T1WI and T2WI, and no enhancement after gadolinium injection. (author). 7 refs., 4 figs.

  20. Subdeltoid/subacromial bursitis associated with influenza vaccination

    OpenAIRE

    Cook, Ian F

    2013-01-01

    A 76-year-old male presented with subacromial/subdeltoid bursitis following influenza vaccine administration into the left deltoid muscle. This shoulder injury related to vaccine administration (SIRVA) could have been prevented by the use of a safe, evidence based protocol for the intramuscular injection of the deltoid muscle.

  1. Fewer rotator cuff tears fifteen years after arthroscopic subacromial decompression.

    Science.gov (United States)

    Björnsson, Hanna; Norlin, Rolf; Knutsson, Anders; Adolfsson, Lars

    2010-01-01

    A successful clinical result is reported in 75% to 85% of impingement patients after arthroscopic subacromial decompression. The result is maintained over time, but few studies have investigated the integrity of the rotator cuff in these patients. Using ultrasonography, we examined the integrity of the rotator cuff in 70 patients 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at the index procedure. Tendons were still intact in 57 patients (82%), 10 (14%) had partial-thickness tears, and 3 (4%) had full-thickness tears. The total number of 18% tears (partial and full thickness) in this study, including patients clinically diagnosed with subacromial impingement at a mean age of 60 years, is unexpectedly low compared with 40% degenerative tears reported in asymptomatic adults of the same age. Arthroscopic subacromial decompression seems to reduce the prevalence of rotator cuff tears in impingement patients. This appears attributable to elimination of extrinsic factors such as mechanical wear and bursitis. The potential effect of surgery on intrinsic cuff degeneration is unknown, but intrinsic factors may explain tears still developing despite decompression. Level III, therapeutic study.

  2. Subdeltoid/subacromial bursitis associated with influenza vaccination.

    Science.gov (United States)

    Cook, Ian F

    2014-01-01

    A 76-year-old male presented with subacromial/subdeltoid bursitis following influenza vaccine administration into the left deltoid muscle. This shoulder injury related to vaccine administration (SIRVA) could have been prevented by the use of a safe, evidence based protocol for the intramuscular injection of the deltoid muscle.

  3. "Pinching subacromial problems” - A clinical and biomechanical approach -

    NARCIS (Netherlands)

    Witte, Pieter Bas de

    2015-01-01

    The Subacromial Impingement Syndrome (SIS) is the most prevalent disorder of the shoulder in primary health care. Acromionplasty, as the main surgical treatment of SIS, is one of the most performed orthopedic surgeries. However, its results are highly variable. Possibly, there are different

  4. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Directory of Open Access Journals (Sweden)

    Siwei Sun

    2016-01-01

    Full Text Available Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients’ shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients and group B (33 patients in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38±3.56 versus 94.24±3.60, P>0.05. Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

  5. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Science.gov (United States)

    Sun, Siwei; Gan, Minfeng; Sun, Han; Wu, Guizhong; Yang, Huilin; Zhou, Feng

    2016-01-01

    To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients' shoulder function to judge if it has been affected by subacromial osteolysis. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38 ± 3.56 versus 94.24 ± 3.60, P > 0.05). The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

  6. The role of experimentally-induced subacromial pain on shoulder strength and throwing accuracy.

    Science.gov (United States)

    Wassinger, Craig A; Sole, Gisela; Osborne, Hamish

    2012-10-01

    Shoulder injuries often comprise two separate yet related components, structural tissue damage and pain. The role of each of these components on shoulder function is difficult to ascertain. Experimental pain models allow the assessment of consequences of localized pain when applied to healthy individuals. By understanding the role of pain on shoulder function, clinicians will be able to more efficiently assess and treat shoulder injuries. The objective of the study was to evaluate the role of experimentally-induced sub-acromial pain on shoulder isokinetic rotational strength and throwing accuracy. This was a block counterbalanced, crossover, repeated measures study design utilizing 20 individuals without self-reported shoulder or cervical pathology. Shoulder function was measured with and without experimental pain injection (2 mL of 5% hypertonic saline) in the sub-acromial space. Functional tasks consisted of shoulder rotational strength utilizing isokinetic testing and throwing accuracy via the functional throwing performance index. The hypertonic saline induced moderate pain levels in all participants (4.3-5.1/10). Normalized shoulder internal (t = 3.76, p = 0.001) and external (t = 3.12, p = 0.006) rotation strength were both diminished in the painful condition compared to the pain free condition. Throwing accuracy was also reduced while the participants experienced pain (t = 3.99, p = 0.001). Moderate levels of experimental shoulder pain were sufficient to negatively influence shoulder strength and throwing accuracy in participants without shoulder pathology. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Deformation of a layered half-space due to a very long tensile fault

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    . In a recent paper,. Wang et al (2003) gave FORTRAN programs for computation of deformation induced by earthquake sources in a multilayered half-space. The Airy stress function due to various two- dimensional sources in an unbounded ...

  8. Two-dimensional deformation of a uniform half-space due to non ...

    Indian Academy of Sciences (India)

    dimensional deformation of a uniform half-space due to non-uniform movement accompanying a long vertical tensile fracture. Sunita Rani Ram Chander Verma. Volume 122 Issue 4 August 2013 pp 1055-1063 ...

  9. Static deformation of two welded monoclinic elastic half-spaces due ...

    Indian Academy of Sciences (India)

    Static deformation of two monoclinic elastic half-spaces in welded contact due to a long inclined strike-slip fault situated in one of the half-spaces is studied analytically and numerically. Closedform algebraic expressions for the displacement at any point of the medium are obtained. The variation of the displacement at the ...

  10. Static deformation of two welded monoclinic elastic half-spaces due ...

    Indian Academy of Sciences (India)

    M. Senthilkumar (Newgen Imaging) 1461 1996 Oct 15 13:05:22

    Static deformation of two monoclinic elastic half-spaces in welded contact due to a long inclined strike-slip fault situated in one of the half-spaces is studied analytically and numerically. Closed- form algebraic expressions for the displacement at any point of the medium are obtained. The variation of the displacement at the ...

  11. Subacromial bursitis following human papilloma virus vaccine misinjection.

    Science.gov (United States)

    Uchida, Soshi; Sakai, Akinori; Nakamura, Toshitaka

    2012-12-17

    A patient presented at our clinic with severe subacromial bursitis, which persisted for several months following a third booster injection with Cervarix™. Chronic subacromial bursitis manifested itself in this patient after what appeared to be the misinjection of vaccine in close proximity to the acromion. This bursitis was resistant to conventional physiotherapy and to corticosteroid therapy, but was responsive to arthroscopic surgery. Since such patients may present to an arthroscopic surgeon only months after receiving a vaccine injection, this etiological link may not be fully appreciated by treating clinicians. Further, the accuracy of injection in the deltoid region also appears under appreciated, and this report highlights the importance of accurate injection to the deltoid region or in certain cases, the value of simply changing the injection site to another larger muscle. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Huge tumor-like subacromial bursitis associated with rheumatoid arthritis.

    Science.gov (United States)

    Yoneda, M; Wakitani, S; Yamamoto, T

    2001-09-01

    Abstract We report a rare case of a huge subacromial bursitis in rheumatoid arthritis. A solid tumor was initially suspected because it was very large with no apparent local sign of inflammation, and because no fluid retention was observed. We performed radiograms, a plain computed tomogram, a (99)mTc-MDP bone scintigram, a (67)Ga-citrate scintigram, and a digital subtraction arteriogram, which all indicated no evidence of tumor. Finally, a bursogram proved the mass to be a huge enlarged subacromial bursa. Surgical exploration revealed that the bursa contained 450 g of a yellowish, jelly-like substance, which was considered to be a thick collection of fibrin. No recurrence was noted at a follow-up 16 years after surgery.

  13. Deformation of a layered half-space due to a very long tensile fault

    Indian Academy of Sciences (India)

    The problem of the coseismic deformation of an earth model consisting of an elastic layer of uniform thickness overlying an elastic half-space due to a very long tensile fault in the layer is solved analytically. Integral expressions for the surface displacements are obtained for a vertical tensile fault and a horizontal tensile fault.

  14. Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Rasmussen, Lars; Aagaard, Per

    2006-01-01

    physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength......We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained...... (MVC). Electromyographic (EMG) activity was assessed using surface and intramuscular recordings from eight shoulder muscles. Force steadiness was impaired in SIS subjects during concentric contractions at the highest target force level only, with muscle activity largely unaffected. No between...

  15. An Explanation of Hubble Redshift due to the Global Non-Holonomity of Space

    Directory of Open Access Journals (Sweden)

    Rabounski D.

    2009-01-01

    Full Text Available In General Relativity, the change of the energy of a freely moving photon should be the solution to the scalar equation of the isotropic geodesic equations, which manifests the work produced on the photon being moved along the path. I solved the equation in terms of physical observables (Zelmanov, Physics Doklady , 1956, v. 1, 227–230, and in the large scale approximation, i.e. with gravitation and deformation neglected in the space, while supposing the isotropic space to be globally non-holonomic (the time lines are non-orthogonal to the spatial section, a condition manifested by the rotation of the space. The solution is E = E 0 exp( at=c , where is the angular velocity of the space (it meets the Hubble constant H 0 = c=a = 2 : 3 10 H 0 = c=a = 2 : 3 10 is the radius of the Universe, t = r=c is the time of the photon’s travel. So a photon loses energy with distance due to the work against the field of the space non-holonomity. According to the solution, the redshift should be z = exp( H 0 r=c This solution explains both the redshift z = H 0 r=c observed at small distances and the non-linearity of the empirical Hubble law due to the exponent (at large r . The ultimate redshift, according to the theory, should be z = exp( = 22.14.

  16. Hubble Refshift due to the Global Non-Holonomity of Space

    Science.gov (United States)

    Rabounski, Dmitri

    2009-05-01

    In General Relativity, the change of the energy of a freely moving photon should be the solution to the scalar equation of the isotropic geodesic equations, which manifests the work produced on the photon being moved along the path. I solved the equation in terms of physical observables (Zelmanov, Phys. Doklady, 1956, v.1, 227), and in the large scale approximation, i.e. with gravitation and deformation neglected in the space, while supposing the isotropic space to be globally non-holonomic (the time lines are non-orthogonal to the spatial section, a condition manifested by the rotation of the space). The solution is E=E0exp(-H^2AT/c), where H is the angular velocity of the space (it meets the Hubble constant H0=c/A=2.3x10-18s-1), A is the radius of the Universe, T=L/c is the time of the photon's travel. So a photon loses energy with distance due to the work against the field of the space non-holonomity. According to the solution, the redshift should be z=exp(H0L/c)-1 H0L/c. This solution explains both the redshift z=H0L/c observed at small distances and the non-linearity of the empirical Hubble law due to the exponent (at large L). The ultimate redshift, according to the theory, should be z=exp(π)-1=22.14.

  17. Quantifying the daily economic impact of extreme space weather due to failure in electricity transmission infrastructure

    Science.gov (United States)

    Oughton, Edward J.; Skelton, Andrew; Horne, Richard B.; Thomson, Alan W. P.; Gaunt, Charles T.

    2017-01-01

    Extreme space weather due to coronal mass ejections has the potential to cause considerable disruption to the global economy by damaging the transformers required to operate electricity transmission infrastructure. However, expert opinion is split between the potential outcome being one of a temporary regional blackout and of a more prolonged event. The temporary blackout scenario proposed by some is expected to last the length of the disturbance, with normal operations resuming after a couple of days. On the other hand, others have predicted widespread equipment damage with blackout scenarios lasting months. In this paper we explore the potential costs associated with failure in the electricity transmission infrastructure in the U.S. due to extreme space weather, focusing on daily economic loss. This provides insight into the direct and indirect economic consequences of how an extreme space weather event may affect domestic production, as well as other nations, via supply chain linkages. By exploring the sensitivity of the blackout zone, we show that on average the direct economic cost incurred from disruption to electricity represents only 49% of the total potential macroeconomic cost. Therefore, if indirect supply chain costs are not considered when undertaking cost-benefit analysis of space weather forecasting and mitigation investment, the total potential macroeconomic cost is not correctly represented. The paper contributes to our understanding of the economic impact of space weather, as well as making a number of key methodological contributions relevant for future work. Further economic impact assessment of this threat must consider multiday, multiregional events.

  18. [Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement].

    Science.gov (United States)

    Águila-Ledesma, I R; Córdova-Fonseca, J L; Medina-Pontaza, O; Núñez-Gómez, D A; Calvache-García, C; Pérez-Atanasio, J M; Torres-González, R

    2017-01-01

    Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle > 35°), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

  19. The simulation of radiation effects to astronauts due to solar energetic particles in deep space

    Science.gov (United States)

    Gang, Bao

    2012-02-01

    The exposure to interplanetary radiation poses a serious health risk to astronauts, especially for long-term missions. Protecting the astronauts from these particles has been the key issue to the manned space mission. High-energy space particles can penetrate the protective layer of a spacecraft, and probably cause deleterious effects to the astronauts. To estimate the size of these effects, a credible simulation of radioprotection is required. Using the Geant4 software toolkit, we have modeled the interaction processes and predicted the total energy deposit in a phantom (astronaut) as well as the similar information associated with secondary effects, due to Solar Energetic Particles (SEPs) at ∼1 AU caused by the large SEPs events in October 1989 and August 1972. In addition, we compared the characteristics of the energy deposit due to SEPs and Galactic Cosmic Rays (GCRs) and explained the differences between them by physical mechanism analysis.

  20. Arthroscopic subacromial decompression is effective in selected patients with shoulder impingement syndrome.

    Science.gov (United States)

    Magaji, S A; Singh, H P; Pandey, R K

    2012-08-01

    A total of 92 patients with symptoms for over six months due to subacromial impingement of the shoulder, who were being treated with physiotherapy, were included in this study. While continuing with physiotherapy they waited a further six months for surgery. They were divided into three groups based on the following four clinical and radiological criteria: temporary benefit following steroid injection, pain in the mid-arc of abduction, a consistently positive Hawkins test and radiological evidence of impingement. Group A fulfilled all four criteria, group B three criteria and group C two criteria. A total of nine patients improved while waiting for surgery and were excluded, leaving 83 who underwent arthroscopic subacromial decompression (SAD). The new Oxford shoulder score was recorded pre-operatively and at three and 12 months post-operatively. A total of 51 patients (group A) had a significant improvement in the mean shoulder score from 18 (13 to 22) pre-operatively to 38 (35 to 42) at three months (p < 0.001). The mean score in this group was significantly better than in group B (21 patients) and C (11 patients) at this time. At one year patients in all groups showed improvement in scores, but patients in group A had a higher mean score (p = 0.01). At one year patients in groups A and B did better than those in group C (p = 0.01). Arthroscopic SAD is a beneficial intervention in selected patients. The four criteria could help identify patients in whom it is likely to be most effective.

  1. An Explanation of Hubble Redshift due to the Global Non-Holonomity of Space

    Directory of Open Access Journals (Sweden)

    Rabounski D.

    2009-01-01

    Full Text Available In General Relativity, the change of the energy of a freely moving photon should be the solution to the scalar equation of the isotropic geodesic equations, which manifests the work produced on the photon being moved along the path. I solved the equation in terms of physical observables (Zelmanov, Physics Doklady, 1956, v.1, 227-230, and in the large scale approximation, i.e. with gravitation and deformation neglected in the space, while supposing the isotropic space to be globally non-holonomic (the time lines are non-orthogonal to the spatial section, a condition manifested by the rotation of the space. The solution is $E = E_{0} exp(-Omega^{2} at/c$, where $Omega$ is the angular velocity of the space (it meets the Hubble constant $H_{0} = c/a = 2.3 imes 10^{-18}$ s$^{-1}$, $a$ is the radius of the Universe, $t = r/c$ is the time of the photon's travel. So a photon loses energy with distance due to the work against the field of the space non-holonomity. According to the solution, the redshift should be $z = exp(H_{0} r/c - 1 = H_{0} r/c$. This solution explains both the redshift $z = H_{0} r/c$ observed at small distances and the non-linearity of the empirical Hubble law due to the exponent (at large $r$. The ultimate redshift, according to the theory, should be $z = exp(pi - 1 = 22.14$.

  2. Is ultrasound-guided injection more effective in chronic subacromial bursitis?

    Science.gov (United States)

    Hsieh, Lin-Fen; Hsu, Wei-Chun; Lin, Yi-Jia; Wu, Shih-Hui; Chang, Kae-Chwen; Chang, Hsiao-Lan

    2013-12-01

    Although ultrasound (US)-guided subacromial injection has shown increased accuracy in needle placement, whether US-guided injection produces better clinical outcome is still controversial. Therefore, this study aimed to compare the efficacy of subacromial corticosteroid injection under US guidance with palpation-guided subacromial injection in patients with chronic subacromial bursitis. Patients with chronic subacromial bursitis were randomized to a US-guided injection group and a palpation-guided injection group. The subjects in each group were injected with a mixture of 0.5 mL dexamethasone suspension and 3 mL lidocaine into the subacromial bursa. The primary outcome measures were the visual analog scale for pain and active and passive ranges of motion of the affected shoulder. Secondary outcome measures were the Shoulder Pain and Disability Index, the Shoulder Disability Questionnaire, and the 36-item Short-Form Health Survey (SF-36). The primary outcome measures were evaluated before, immediately, 1 wk, and 1 month after the injection; the secondary outcome measures were evaluated before, 1 wk, and 1 month after the injection. Of the 145 subjects screened, 46 in each group completed the study. Significantly greater improvement in passive shoulder abduction and in physical functioning and vitality scores on the SF-36 were observed in the US-guided group. The pre- and postinjection within-group comparison revealed significant improvement in the visual analog scale for pain and range of motion, as well as in the Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, and SF-36 scores, in both groups. The US-guided subacromial injection technique produced significantly greater improvements in passive shoulder abduction and in some items of the SF-36. US is effective in guiding the needle into the subacromial bursa in patients with chronic subacromial bursitis.

  3. Alternativas terapéuticas en el manejo del Síndrome Subacromial: Cross Taping

    OpenAIRE

    Dizy-Friera, Eduardo

    2015-01-01

    El síndrome subacromial, también conocido como síndrome de pinzamiento del hombro, es un trastorno muy prevalente en nuestra sociedad que genera un alto coste socioeconómico y una elevada discapacidad. El síndrome subacromial supone un desafío terapéutico para los fisioterapeutas. Existen múltiples formas de tratamiento, sin embargo la evidencia científica que las apoya es escasa. El propósito de este estudio es evaluar la efectividad del cross taping en el síndrome subacromial, incluyendo...

  4. The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis.

    Science.gov (United States)

    Awerbuch, Mark S

    2008-01-07

    Periarticular shoulder disorders are common in clinical practice, and diagnosis is often difficult. Medicare statistics indicate that between 2001 and 2006 the use of diagnostic shoulder ultrasonography increased significantly. Rotator cuff disease, shoulder impingement syndrome and subacromial bursitis are among the most common diagnoses reported on shoulder ultrasonography. Shoulder ultrasonography is useful in the diagnosis of full thickness tears, but its utility for other rotator cuff disorders, shoulder impingement syndrome and subacromial bursitis is less well established.

  5. Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders

    OpenAIRE

    Ke-Vin Chang; Wei-Ting Wu; Levent Özçakar

    2016-01-01

    Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and can be related to various shoulder ultrasonographic findings. Since the association of BPE with subacromial impingement is unclear, our study aimed to explore its association with the dynamic subacromial impingement test during ultrasound (US) imaging. We included 337 shoulders referred for US examinations and quantified the amount of BPE. Effusion more than 1?mm in thickness was considered a positive find...

  6. Synovial osteochondromatosis in the subacromial bursa mimicking calcific tendinitis: sonographic diagnosis.

    Science.gov (United States)

    Kim, Tae-Kwon; Lee, Dae-Hee; Park, Jong-Hoon; Kim, Chul-Hwan; Jeong, Woong-Kyo

    2014-05-01

    Synovial osteochondromatosis is an idiopathic benign metaplasia of the synovial membrane rarely found in an extra-articular bursa. We describe the case of a 55-year-old woman with synovial osteochondromatosis in the subacromial bursa mimicking calcific tendinitis. Plain radiographs showed a radiopaque mass over the middle facet of the greater tuberosity, suggesting calcific tendinitis. Sonography, however, showed a loose body in the subacromial bursa, and no evidence of calcification inside the rotator cuff. Copyright © 2013 Wiley Periodicals, Inc.

  7. Interleukin-1β stimulates stromal-derived factor-1α expression in human subacromial bursa.

    Science.gov (United States)

    Blaine, Theodore A; Cote, Mindy A; Proto, Al; Mulcahey, Mary; Lee, Francis Y; Bigliani, Louis U

    2011-11-01

    Chemokines produced by synoviocytes of the subacromial bursa are up-regulated in subacromial bursitis and rotator cuff disease. We hypothesized that SDF-1α production in bursal synoviocytes may be induced by local cytokines such as interleukin IL-1β and IL-6. Subacromial bursa specimens were obtained from patients undergoing shoulder surgery. Bursal specimens were stained with anti-human antibodies to IL-1, IL-6, and SDF-1α by immunohistochemistry and compared to normal and rheumatoid controls. Bursal cells were also isolated from specimens and cultured. Early passaged cells were then treated with cytokines (IL-1β and IL-6) and SDF-1α expression was measured by ELISA and RT-PCR. SDF-1α, IL-1β, and IL-6 were expressed at high levels in bursitis specimens from human subacromial bursa compared to normal controls. In cultured bursal synoviocytes, there was a dose-dependent increase in SDF-1α production in the supernatants of cells treated with IL-1β. SDF-1α mRNA expression was also increased in bursal cells treated with IL-1β. IL-6 caused a minimal but not statistically significant increase in SDF-1α expression. SDF-1α, IL-1β, and IL-6 are expressed in the inflamed human subacromial bursal tissues in patients with subacromial bursitis. In cultured bursal synoviocytes, SDF-1α gene expression and protein production are stimulated by IL-1β. IL-1β produced by bursal syvoviocytes and inflammatory cells in the human subacromial bursa is an important signal in the inflammatory response that occurs in subacromial bursitis and rotator cuff disease. Copyright © 2011 Orthopaedic Research Society.

  8. Stresses due to vertical subsurface loading for an inhomogeneous cross-anisotropic half-space

    Science.gov (United States)

    Wang, Cheng-Der; Pan, Ernian

    2004-10-01

    In this article, we present the solutions for the stresses induced by four different loads associated with an axially loaded pile in a continuously inhomogeneous cross-anisotropic half-space. The planes of cross-anisotropy are parallel to the horizontal surface of the half-space, and the Young's and shear moduli are assumed to vary exponentially with depth. The four loading types are: an embedded point load for an end-bearing pile, uniform skin friction, linear variation of skin friction, and non-linear parabolic variation of skin friction for a friction pile. The solutions for the stresses due to the pile load are expressed in terms of the Hankel integral and are obtained from the point load solutions of the same inhomogeneous cross-anisotropic half-space which were derived recently by the authors (Int. J. Rock Mech. Min. Sci. 2003; 40(5):667-685). A numerical procedure is proposed to carry out the integral. For the special case of homogeneous isotropic and cross-anisotropic half-space, the stresses predicted by the numerical procedure agree well with the solutions of Geddes and Wang (Geotechnique 1966; 16(3):231-255; Soils Found. 2003; 43(5):41-52). An illustrative example is also given to investigate the effect of soil inhomogeneity, the type and degree of soil anisotropy, and the four different loading types on the vertical normal stress. The presented solutions are more realistic in simulating the actual stratum of loading problem in many areas of engineering practice. Copyright

  9. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases.

    Science.gov (United States)

    Gotoh, M; Hamada, K; Yamakawa, H; Inoue, A; Fukuda, H

    1998-09-01

    The subacromial bursa is recognized as a site associated with the shoulder pain caused by rotator cuff disease in the middle-aged and elderly. Substance P is contained in primary afferent nerves, and its quantity increases during chronic pain. The amount of substance P in the subacromial bursa of patients with rotator cuff disease was examined. Radioimmunoassay and immunohistochemistry were employed to quantify and localize substance P. The preoperative pain level was measured with a visual analogue scale with 0 as no pain, 5 as moderate, and 10 as severe. Thirty-seven patients that had undergone operation were divided into two groups: one composed of 19 patients with subacromial bursitis and a partial-thickness tear of the rotator cuff (nonperforated cuff) and the other composed of 18 patients with a full-thickness tear (perforated cuff). Subacromial bursae obtained from seven fresh cadavers with no shoulder pain before death were used as controls. The visual analogue scale showed significantly greater pain in the group with the nonperforated rotator cuff than in the group with the perforated cuff. Consistent with these results, the amount of substance P in the subacromial bursa was significantly greater in the former group than in the latter. Nerve fibers immunoreactive to substance P were localized around the vessels, with a larger number of fibers in the group with the nonperforated rotator cuff. Therefore, an increased amount of substance P in the subacromial bursa appears to correlate with the pain caused by rotator cuff disease.

  10. Axisymmetric deformation of a poroelastic layer overlying an elastic half-space due to surface loading

    Science.gov (United States)

    Rani, Sunita; Rani, Sunita

    2017-11-01

    The axisymmetric deformation of a homogeneous, isotropic, poroelastic layer of uniform thickness overlying a homogeneous, isotropic, elastic half-space due to surface loads has been obtained. The fluid and the solid constituents of the porous layer are compressible and the permeability in vertical direction is different from its permeability in horizontal direction. The displacements and pore-pressure are taken as basic state variables. An analytical solution for the pore-pressure, displacements and stresses has been obtained using the Laplace-Hankel transform technique. The case of normal disc loading is discussed in detail. Diffusion of pore-pressure is obtained in the space-time domain. The Laplace inversion is evaluated using the fixed Talbot algorithm and the Hankel inversion using the extended Simpson's rule. Two different models of the Earth have been considered: continental crust model and oceanic crust model. For continental crust model, the layer is assumed to be of Westerly Granite and for the oceanic crust model of Hanford Basalt. The effect of the compressibilities of the fluid as well as solid constituents and anisotropy in permeability has been studied on the diffusion of pore-pressure. Contour maps have been plotted for the diffusion of pore-pressure for both models. It is observed that the pore-pressure changes to compression for the continental crust model with time, which is not true for the oceanic crust.

  11. The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Frich, Lars Henrik

    2016-01-01

    BACKGROUND: Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). OBJECTIVE: We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment...... and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. METHODS: Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1-75.9, 1 July 2007...... to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. RESULTS: Within...

  12. Shoulder abduction torque steadiness is preserved in subacromial impingement syndrome.

    Science.gov (United States)

    Camargo, Paula Rezende; Avila, Mariana Arias; de Oliveira, Ana Beatriz; Asso, Naoe Aline; Benze, Benedito Galvão; de Fátima Salvini, Tania

    2009-06-01

    This study compared peak torque and torque steadiness during isometric abduction in subjects with subacromial impingement syndrome (SIS) and those with no upper limb disorders. The SIS group consisted of 27 subjects (33.48 +/- 9.94 years) with unilateral SIS. The control group consisted of 23 healthy and active subjects (32.26 +/- 9.04 years). Peak torque and torque steadiness were measured during isometric abduction (80 masculine in the scapular plane) of the shoulder. Standard deviation, coefficient of variation, stability time, median frequency, and relative power were measured from the steadiness trials. There were neither significant interactions between group and side (P > 0.05), nor were there significant main effects of group and side (P > 0.05) for all variables analyzed. The results of this study showed that steadiness is preserved by SIS during isometric abduction of the shoulder.

  13. Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.

    Science.gov (United States)

    Gebremariam, Lukas; Hay, Elaine M; van der Sande, Renske; Rinkel, Willem D; Koes, Bart W; Huisstede, Bionka M A

    2014-08-01

    The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy. The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results. Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found. Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Distances to the subacromial bursa from 3 different injection sites as measured arthroscopically.

    Science.gov (United States)

    Sardelli, Matthew; Burks, Robert T

    2008-09-01

    The purpose of this study was to assess the distance for a standard needle to reach the subacromial bursa through 3 commonly used approaches. Thirty patients without associated rotator cuff tears underwent arthroscopic evaluation of the shoulder. The bursa was entered without shaving or altering of the bursa. By use of standard arthroscopic portals, a spinal needle was inserted from an anterior, lateral, and posterior position and measured to define the distance to the subacromial bursa from the skin. The mean distance with anterior needle placement was 2.9 +/- 0.6 cm. The mean distance with lateral needle placement was 2.9 +/- 0.7 cm. The mean distance with posterior needle placement was 5.2 +/- 1.1 cm. The mean body mass index for the group of patients was 27.5. The minimum was 18.7, and the maximum was 42.8. The distance to the subacromial bursa from the anterior and lateral approaches appears to be consistent and within reach of a standard 22- or 25-gauge needle. The distance to the subacromial bursa from a posterior approach appears to be almost double that of the anterior and lateral approaches and may not be reachable by standard 22- and 25-gauge needles in all patients. There appears to be no correlation between distances to the subacromial bursa from the anterior, lateral, or posterior approaches and the patient's body mass index. Given the relative distances measured to the subacromial bursa from the anterior, lateral, and posterior positions, clinicians may choose a longer needle to improve the accuracy of placement when approaching the subacromial bursa from a posterior position. Use of a standard-length needle will provide reasonable accuracy from the anterior and lateral positions.

  15. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome : a randomized controlled trial

    NARCIS (Netherlands)

    Dorrestijn, Oscar; Stevens, Martin; Diercks, Ron L.; van der Meer, Klaas; Winters, Jan C.

    2007-01-01

    Background: Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have

  16. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association

    NARCIS (Netherlands)

    Diercks, R.; Bron, C.; Dorrestijn, O.; Meskers, C.; Naber, R.; Ruiter, T. de; Willems, J.; Winters, J.; Woude, H.J. van der; et al.,

    2014-01-01

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

  17. Emittance growth due to static and radiative space charge forces in an electron bunch compressor

    Directory of Open Access Journals (Sweden)

    Richard Talman

    2009-01-01

    2004 FEL Conference, pp. 18–21, MOCOS05, available at http://www.JACoW.org], a code with similar capabilities. For this comparison an appropriately new, 50 MeV, “standard chicane” is introduced. Unlike CSRTrack (which neglects vertical forces the present simulation shows substantial growth of vertical emittance. But “turning off” vertical forces in the UAL code (to match the CSRTrack treatment brings the two codes into excellent agreement. (iii Results are also obtained for 5 GeV electrons passing through a previously introduced “standard chicane” [Coherent Synchrotron Radiation, CSR Workshop, Berlin 2002, http://www.desy.de/csr] [of the sort needed for linear colliders and free electron lasers (FEL’s currently under design or construction]. Relatively little emittance growth is predicted for typical bunch parameters at such high electron energy. Results are obtained for both round beams and ribbon beams (like those actually needed in practice. Little or no excess emittance growth is found for ribbon bunches compared to round bunches of the same charge and bunch width. The UAL string space charge formulation (like TraFic4 and CSRTrack avoids the regularization step (subtracting the free-space space charge force which is required (to remove divergence in some methods. Also, by avoiding the need to calculate a retarded-time, four-dimensional field history, the computation time needed for realistic bunch evolution calculations is modest. Some theories of bunch dilution, because they ascribe emittance growth entirely to CSR, break down at low energy. In the present treatment, as well as CSR, all free-space Coulomb and magnetic space charge forces (but not image forces, and also the centrifugal space charge force (CSCF are included. Charge-dependent beam steering due to CSCF, as observed recently by Beutner et al. [B. Beutner et al., in Proceedings of FEL Conference, BESSY, Berlin, Germany, 2006, MOPPH009], is also investigated.

  18. Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome.

    Science.gov (United States)

    Bandholm, Thomas; Rasmussen, Lars; Aagaard, Per; Jensen, Bente Rona; Diederichsen, Louise

    2006-11-01

    We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength (MVC). Electromyographic (EMG) activity was assessed using surface and intramuscular recordings from eight shoulder muscles. Force steadiness was impaired in SIS subjects during concentric contractions at the highest target force level only, with muscle activity largely unaffected. No between-group differences in shoulder MVC were observed. The present data suggest that shoulder sensory-motor control is only mildly impaired in subjects with SIS who are able to continue with upper body physical activity in spite of shoulder pain. Thus, physical activity should be continued by patients with SIS, if possible, to avoid the loss in neural and muscle functions associated with inactivity.

  19. Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders.

    Science.gov (United States)

    Chang, Ke-Vin; Wu, Wei-Ting; Özçakar, Levent

    2016-12-12

    Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and can be related to various shoulder ultrasonographic findings. Since the association of BPE with subacromial impingement is unclear, our study aimed to explore its association with the dynamic subacromial impingement test during ultrasound (US) imaging. We included 337 shoulders referred for US examinations and quantified the amount of BPE. Effusion more than 1 mm in thickness was considered a positive finding. A comparison of three grades of subacromial impingement, adjusted by patient demographics, static sonographic shoulder pathology, and physical findings, by using multivariate regression models revealed that the odds ratio of subacromial impingement (with 95% confidence intervals) in the presence of BPE was 6.54 (3.21-13.32) in grade 1, 6.93 (3.05-15.76) in grade 2 and 3.18 (1.48-6.80) in grade 3. An increase in age, subdeltoid bursitis, full-thickness supraspinatus tendon tear, and shoulder stiffness were also associated with BPE. Since our study demonstrated a positive association of BPE with all grades of impingement, a US dynamic subacromial impingement test is suggested when BPE is present. Future prospective studies are needed to identify changes in BPE after treatment.

  20. Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease.

    Science.gov (United States)

    Voloshin, Ilya; Gelinas, Jill; Maloney, Michael D; O'Keefe, Regis J; Bigliani, Louis U; Blaine, Theodore A

    2005-09-01

    The pathophysiology of subacromial impingement syndrome is poorly understood. We investigated the expression of inflammatory cytokines, metalloproteases, and the cyclooxygenases in the subacromial bursa in control patients and in patients with rotator cuff tear. Basic science evaluation. Eighteen patients undergoing shoulder surgery had a subacromial bursa biopsy examination. Patients were divided into 2 groups. Group I (study group) had 10 patients with a full-thickness rotator cuff tear (RCT). Group II (control group) had 8 patients. Seven of 8 underwent shoulder arthroscopy with anterior capsular reconstruction for instability; 1 of 8 underwent open reduction internal fixation for acute proximal humerus fracture. None of the patients in group II had any history of symptoms or signs consistent with subacromial impingement. H&E and immunohistochemical antibody (MMP-1, MMP-9, IL-1, IL-6, TNF-alpha, COX-1, and COX-2) stained specimens were examined by 2 blinded observers using a histologic scale (grade 0 = no staining to grade 4 = intense staining). Histologic evidence of inflammation was present in all patients with RCT (group I). No or mild inflammation was noted in group II. The average staining grade for inflammatory cytokines (IL-1, IL-6, TNF-alpha) and proteinases (MMP-1 and MMP-9) was significantly more pronounced in the RCT group (P bursa of patients with rotator cuff tear. These findings support the role of nonsteroidal anti-inflammatory drugs and corticosteroids in RCT treatment, and emphasize the importance of subacromial bursectomy to reduce inflammation in RCT surgery.

  1. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome.

    Science.gov (United States)

    Tsai, Yao-Hung; Huang, Tsung-Jen; Hsu, Wei-Hsiu; Huang, Kuo-Chin; Li, Yen-Yao; Peng, Kuo-Ti; Hsu, Robert Wen-Wei

    2007-01-01

    Normally, the subacromial-subdeltoid bursa is thinner than 2 mm using ultrasound examination. The subtle thickening of the bursa could be an early sign of subacromial impingement and possibly a rotator cuff tear. The aim of this study was to compare the thickness of subacromial bursa measured using ultrasonography in the painful shoulder with normal side, and also to differentiate Neer stages I and II impingements in patients with unilateral shoulder pain. We performed bilateral shoulder sonography in 268 consecutive patients with unilateral shoulder pain and clinical suggestion of rotator cuff pathology. The study group consisted of 102 cases of Neer stage I and 166 cases of Neer stage II impingement syndrome. The bursa thickness was calculated from the superficial peribursal fat to the upper margin of the supraspinatus. A statistically significant association was detected (p bursa in patients with Neer stage I impingement had no statistically important link the results of the patients with Neer stage II impingement. Increased bursa thickness in the symptomatic side may be an alternative sonographic indicator of subacromial bursitis and partial-thickness rotator cuff tears, even when measured to be less than 2 mm. Sonographic examination of subacromial bursa thickness is not an appropriate technique to differentiate the Neer stages I and II impingement. Further study is needed to quantify the echogenicity of the supraspinatus tendon and to show a level of accuracy in patients with rotator cuff tendinosis or partial tears.

  2. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder.

    Science.gov (United States)

    Lho, Yun-Mee; Ha, Eunyoung; Cho, Chul-Hyun; Song, Kwang-Soon; Min, Byung-Woo; Bae, Ki-Cheor; Lee, Kyung-Jae; Hwang, Ilseon; Park, Hyung-Bin

    2013-05-01

    Frozen shoulder is a debilitating condition characterized by gradual loss of glenohumeral motion with chronic inflammation and capsular fibrosis. Yet its pathogenesis remains largely unknown. We hypothesized that the subacromial bursa may be responsible for the pathogenesis of frozen shoulder by producing inflammatory cytokines. We obtained joint capsules and subacromial bursae from 14 patients with idiopathic frozen shoulder and from 7 control subjects to determine the expression levels of interleukin (IL) 1α, IL-1β, IL-6, tumor necrosis factor α (TNF-α), cyclooxygenase (COX) 1, and COX-2 by real-time reverse transcriptase-polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay. IL-1α, IL-1β, TNF-α, COX-1, and COX-2 were expressed at significantly high levels in the joint capsules of the frozen shoulder group compared with those of the control group. Intriguingly, IL-1α, TNF-α, and COX-2 were also expressed at significantly high levels in the subacromial bursae of the frozen shoulder group compared with those of the control group. Immunohistochemical analysis showed increased expression of COX-2 in both the joint capsules and subacromial bursae of the frozen shoulder group. These findings imply that elevated levels of inflammatory cytokines in the subacromial bursa may be associated with the pathogenesis of inflammation evolving into fibrosis. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  3. Evaluation of SPACE code for simulation of reactor scram due to unplanned loss of RCP power in OPR 1000

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seyun; Lee, Dong Hyuk; Kim, Yo Han; Ha, Sang Jun [KHNP Central Research Institute, Daejeon (Korea, Republic of)

    2012-10-15

    SPACE (Safety and Performance Analysis Code for Nuclear Power Plants) has been developing by KHNP with the cooperation with KEPCO E and C and KAERI. SPACE code is expected to be applied to the safety analysis for LOCA (Loss of Coolant Accident) and Non LOCA scenarios. SPACE code solves two fluid, three field governing equations and programmed with C++ computer language using object oriented concepts. To evaluate the analysis capability for the transient phenomena in the actual nuclear power plant, the reactor trip accident due to the loss of RCP power in OPR1000 (Ulchin unit 4) was simulated with SPACE code.

  4. Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff.

    Science.gov (United States)

    Tillander, B; Franzén, L E; Nilsson, E; Norlin, R

    2001-05-01

    This study was designed to investigate the histologic expression of the rat's supra- and infraspinatus tendons in carrageenan-induced subacromial bursitis. Thirty-two rats received subacromial injections with carrageenan (n = 28) or saline (n = 4). The tendons were analysed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and immunofluorescent staining of fibronectin and fibrinogen. In the controls (saline x 10) and group A (carrageenan x 5) there were no changes in the tendons. In group B (carrageenan x 10) 3/8 rats showed macrophages between the collagen fibres and an increased staining of fibronectin. In group C (double dosis carrageenan) all rats had signs of fibrocartilaginous metaplasia in the supraspinatus tendon. In eight of these specimens even bony metaplasia was seen. The infraspinatus tendon showed fibrosis but no fibrocartilaginous metaplasia. The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.

  5. Effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome.

    Science.gov (United States)

    Aydin, Ali; Yildiz, Vahit; Topal, Murat; Tuncer, Kutsi; Köse, Mehmet; Şenocak, Eyüp

    2014-01-01

    To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study. We divided these patients into 2 groups, whereby 32 (47%) patients received conservative therapy before arthroscopic subacromial decompression and 36 (53%) patients did not receive conservative therapy. We compared both groups in terms of the the Constant, UCLA, and VAS scores for shoulder pain before and after arthroscopic subacromial decompression. Constant, UCLA, and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression (P 0.05). Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression.

  6. Deformation of two welded elastic half-spaces due to a long inclined ...

    Indian Academy of Sciences (India)

    inclined shear fault in two welded half-spaces is well known. The purpose of this note is to present the corresponding solution for a tensile fault. Closed-form analytical expressions for the. Airy stress function for a tensile line source in two welded half-spaces are first obtained. These expressions are then integrated ...

  7. Association between kyphosis and subacromial impingement syndrome: LOHAS study.

    Science.gov (United States)

    Otoshi, Kenichi; Takegami, Misa; Sekiguchi, Miho; Onishi, Yoshihiro; Yamazaki, Shin; Otani, Koji; Shishido, Hiroaki; Kikuchi, Shinichi; Konno, Shinichi

    2014-12-01

    Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). The study enrolled 2144 participants who were older than 40 years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong [Pusan National Univ. Yangsan Hospital, Yangsan (Korea, Republic of); Lee, In Sook; Lee, Seung Jun [Pusan National Univ. Hospital, Busan (Korea, Republic of)

    2012-09-15

    To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images.

  9. Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-07-01

    Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

  10. Subacromial bursitis with giant rice bodies as initial presentation of rheumatoid arthritis.

    Science.gov (United States)

    Subramaniam, Ramesh; Tan, Justina Wei Lyn; Chau, Cora Yuk Ping; Lee, Keng Thiam

    2012-10-01

    Rice body formation is a nonspecific response to chronic synovial inflammation associated with tuberculous arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, seronegative inflammatory arthritis, and even osteoarthritis. Such bodies were termed rice bodies because of their close resemblance to grains of polished white rice. We present a case report of a middle-aged woman with right shoulder subacromial/subdeltoid bursitis with giant rice body formation as her initial presentation of rheumatoid arthritis. Her right shoulder symptoms resolved after subacromial and subdeltoid bursectomy and removal of the rice bodies. She subsequently developed inflammatory arthritis of other joints, met the criteria for rheumatoid arthritis, and has been treated medically.

  11. Dynamic enhanced MRI of the subacromial bursa: correlation with arthroscopic and histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Matsuzaki, S. [Dept. of Radiology, Osaka Kosei-nenkin Hospital (Japan); Yoneda, M. [Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, Osaka City, Osaka (Japan); Kobayashi, Y. [Dept. of Pathology, Osaka Kosei-nenkin Hospital (Japan); Fukushima, S. [Dept. of Orthopaedic Surgery, Sapporo Tokeidai Hospital, Osaka (Japan); Wakitani, S. [Dept. of Orthopaedic Surgery, Shinsyu Univ., Matsumato (Japan)

    2003-09-01

    Objective: To assess dynamic MRI with Gd-DTPA enhancement for evaluating inflammatory changes in the subacromial bursa. Design and patients: We detected the signal intensity changes in dynamic MRI of the subacromial bursa, and confirmed these macroscopically by arthroscopy and histologically. The signal intensity was measured using built-in software, and the enhancement ratio (E ratio) was calculated from dynamic MR images. In addition, as a parameter of the rate of the increase in the signal intensity from 0 to 80 s, the mean increase per second in the E ratio was obtained as the coefficient of enhancement (CE). The correlation was studied of the E ratio and CE with the arthroscopic findings (redness, villous formation, thickening and adhesion), and of the E ratio and CE with the histological findings (capillary proliferation, papillary hyperplasia, fibrosis and inflammatory cell infiltration) of the subacromial bursa. Of patients with shoulder pain, this study included those with rotator cuff injury; patients with rheumatoid arthritis or pitching shoulder disorders were excluded. There were 27 patients (15 men, 12 women) ranging in age from 25 to 73 years (mean 49.1 years). Dynamic MRI of the shoulder was also performed on the healthy side of 10 patients and in five normal young volunteers. Results and conclusions: Changes in signal intensity on dynamic MRI were measured in the subacromial bursa. The E ratio (80 s) and CE (0-80 s) were significantly correlated with redness and villous formation as arthroscopic findings, positively correlated with capillary proliferation and papillary hyperplasia as histological findings (p < 0.05), and negatively correlated with fibrosis as a histological finding (p < 0.05) in the subacromial bursa. The patterns of dynamic curves were well correlated with the bursoscopic and histological findings of the synovium of the subacromial bursa. Dynamic MRI appears to correlate with inflammatory activity of synovium of the subacromial

  12. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome.

    Science.gov (United States)

    Radnovich, Richard; Trudeau, Jeremiah; Gammaitoni, Arnold R

    2014-01-01

    Treatment for pain due to shoulder impingement syndrome (SIS) typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT) patch has been reported to reduce SIS pain in a small case series. This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0-10 scale (0= no pain, 10= worst pain) were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg). Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily) during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0-10 scale). Sixty patients enrolled in the study (average age =51 years, range 18-75, n=21 female). Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, Pwork, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. These results suggest that short-term, noninvasive treatment with the HLT patch has similar efficacy to subacromial corticosteroid injections for the treatment of pain associated with SIS.

  13. 2-D Deformation analysis of a half-space due to a long dip-slip fault ...

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    Closed form analytical expressions of stresses and displacements at any field point due to a very long dip-slip fault of finite width buried in a homogeneous, isotropic elastic half-space, are presented. Airy stress function is used to derive the expressions of stresses and displacements which depend on the dip angle and ...

  14. Shoulder proprioception in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Sahin, Ebru; Dilek, Banu; Baydar, Meltem; Gundogdu, Mehtap; Ergin, Burcu; Manisali, Metin; Akalin, Elif; Gulbahar, Selmin

    2017-01-01

    Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. To investigate the shoulder proprioception in patients with SIS. Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.

  15. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series.

    Science.gov (United States)

    Chae, John; Jedlicka, Lynn

    2009-03-01

    To assess the effectiveness of subacromial corticosteroid injections for poststroke shoulder pain. Exploratory, prospective case series. Ambulatory setting, university-affiliated hospital. Stroke survivors (N=10) with pain in the hemiparetic shoulder. Consecutive stroke survivors with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis received subacromial corticosteroid injections. The primary outcome measure was the Brief Pain Inventory (BPI) question 12 (BPI 12), which assesses "worst pain" in the previous 7 days. Secondary measures included BPI question 15, which assesses present pain and BPI question 23 (BPI 23), which assesses pain interference with 7 daily activities. Outcomes were assessed at baseline, weekly for the first 4 weeks and then at 8 and 12 weeks postinjection. Repeated measure analysis of variance revealed significant within group time effect for BPI 12 (F=7.7, PSubacromial corticosteroid injection is associated with significant reduction in poststroke shoulder pain in patients with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis. However, there is a gradual loss of effect with time. Controlled trials are needed to show a cause and effect relationship.

  16. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis.

    Science.gov (United States)

    Chen, Max J L; Lew, Henry L; Hsu, Tsz-Ching; Tsai, Wen-Chung; Lin, Wei-Ching; Tang, Simon F T; Lee, Ya-Chen; Hsu, Rex C H; Chen, Carl P C

    2006-01-01

    To investigate the treatment effectiveness between ultrasound-guided and blind injection techniques in the treatment of subacromial bursitis. A total of 40 patients with sonographic confirmation of subacromial bursitis were recruited into this study. These patients were divided into blind and ultrasound-guided injection groups. The shoulder abduction range of motion was compared before injections and 1 wk after the completion of injections in both groups. The shoulder abduction range of motion before injection in the blind injection group was 71.03 +/- 12.38 degrees and improved to 100 +/- 18.18 degrees 1 wk after the injection treatments. However, the improvement did not reveal significant statistical differences (P > 0.05). The shoulder abduction range of motion before injection in the ultrasound-guided injection group was 69.05 +/- 14.72 degrees and improved to 139.29 +/- 20.14 degrees 1 wk after the injection treatments (P subacromial bursa. The ultrasound-guided injection technique can result in significant improvement in shoulder abduction range of motion as compared with the blind injection technique in treating patients with subacromial bursitis.

  17. Multiple rice body formation in chronic subacromial/subdeltoid bursitis: MR appearances.

    Science.gov (United States)

    Griffith, J F; Peh, W C; Evans, N S; Smallman, L A; Wong, R W; Thomas, A M

    1996-07-01

    Multiple rice body formation is an unusual complication of chronic bursitis. Clinically and macroscopically, it can resemble synovial osteochondromatosis. Radiographic and MR appearances, however, may allow an accurate pre-operative diagnosis. The imaging features of two middle-aged women with multiple subacromial/subdeltoid bursa rice bodies are described.

  18. Septic subacromial bursitis caused by Mycobacterium kansasii in an immunocompromised host.

    Science.gov (United States)

    Mathew, Stephanie D; Tully, Charla C; Borra, Himabindu; Berven, Michael D; Arroyo, Ramon

    2012-05-01

    Mycobacterium kansasii is a common cause of pulmonary infection as a result of nontuberculous mycobacteria, but is less commonly described as a cause of an orthopedic infection. We present the first case of M. kansasii subacromial septic bursitis in an immunocompromised host. This case demonstrates the diagnostic and treatment challenges associated with orthopedic infections caused by M. kansasii.

  19. Bilateral subacromial bursitis with macroscopic rice bodies: Ultrasound, CT and MR appearance

    Energy Technology Data Exchange (ETDEWEB)

    Law, T.C.; Chong, S.F.; Lu, P.P. [Kwong Wah Hospital (Hong Kong). Department of Radiology; Mak, K.H. [Kwong Wah Hospital (Hong Kong). Department of Orthopaedics and Traumatology

    1998-05-01

    The radiological findings of ultrasound, CT and MR of a case of bilateral subacromial bursitis with macroscopic rice bodies is described. MRI is the investigation of choice and the intravenous gadolinium-enhanced usefulness was noted. The previous literature is also reviewed. Copyright (1998) Blackwell Science Pty Ltd 5 refs., 1 tab., 4 figs.

  20. Case reports: ossified mass of the rotator cuff tendon in the subacromial bursa.

    Science.gov (United States)

    Matsumoto, Isshin; Ito, Yoichi; Tomo, Hiroyasu; Nakao, Yoshihiro; Takaoka, Kunio

    2005-08-01

    Unlike calcification, ossification is infrequent in the rotator cuff. We describe the clinical, radiographic, and pathologic findings in 64-year-old man with an ossified mass arising from a calcified portion of the rotator cuff tendon within the subacromial bursa. Mechanical stress and ischemic events are possible causes of cartilage formation followed by endochondral ossification, producing a mass causing outlet impingement.

  1. Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie

    Dansk resuméSubacromial Impingement Syndrom (SIS), som er karakteriseret ved både skuldersmerte ogfunktionsnedsættelse, er en af de hyppigst rapporterede skulderlidelser i primærsektoren. SIS relateres ofte tilen ubalance mellem de skapula-stabiliserende muskler. Indenfor udvalgte specielle popul...

  2. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation.

    Science.gov (United States)

    Lin, Hsin-Yu; Wong, Poo-Kuang; Ho, Wei-Pin; Chuang, Tai-Yuan; Liao, Yi-Shyan; Wong, Chin-Chean

    2014-02-06

    Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.

  3. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion - dynamic sonographic evaluation

    Science.gov (United States)

    2014-01-01

    Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved. PMID:24502688

  4. Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side.

    Science.gov (United States)

    Põldoja, Elle; Rahu, Madis; Kask, Kristo; Weyers, Imke; Kolts, Ivo

    2017-07-01

    Vascularity of the subacromial bursa and rotator cuff tendons is key factors in the pathogenesis of subacromial bursitis and impingement syndrome, rotator cuff tendinitis, and rotator cuff tears. The purpose of this study was to investigate and describe blood supply to the cranial and caudal parts of the subacromial bursa and the vascularity of the rotator cuff tendons on the bursal side. Fourteen fresh cadaveric shoulders from six females and eight males with a mean age of 71.7 (±10.8) years were studied. Before dissection, an arterial injection of 10% aqueous dispersion of latex was administered. Post-injection, the shoulders were fixed in an alcohol-formalin-glycerol solution. The cranial and caudal bursa of all specimens was mainly supplied by the thoracoacromial, suprascapular, and anterior and posterior circumflex humeral arteries. The cranial part of the bursa was supplied anteriorly by the thoracoacromial artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third. The caudal part received arterial blood anteriorly from the anterior circumflex humeral artery, and posteriorly and medially by the posterior circumflex humeral artery as far as the medial third of the caudal bursa. In addition, the suprascapular artery branched at the upper surface of the coracohumeral ligament, and the subcoracoid artery branched at the under surface of the same ligament. The subacromial bursa appears well vascularized. The results of the present investigation showed that blood supply to the subacromial bursa at the caudal part and rotator cuff tendons on the bursal side was linked to the same arteries. The subcoracoid artery supplied interval rotator structures close to the caudal bursa. It is the wish of the authors that this meticulous anatomical work will help surgeons in their day-to-day clinical work, e.g. to minimize the risk of complications such as perioperative bleeding.

  5. Arthroscopic subacromial decompression results in normal shoulder function after two years in less than 50% of patients

    DEFF Research Database (Denmark)

    Konradsen, Lars Aage Glud; Jensen, Claus Hjorth

    2015-01-01

    INTRODUCTION: The aim of this study was to evaluate the outcome two years after arthroscopic subacromial decompression using the Western Ontario Rotator-Cuff (WORC) index and a diagram-based questionnaire to self-assess active shoulder range of motion (ROM). METHODS: Outcomes in 80 patients...... with impingement of the shoulder undergoing arthroscopic subacromial decompression were prospectively assessed preoperatively, at three months and at two years post-operatively using the WORC index. All patients had received non-operative treatment for at least six months before undergoing surgery. Active range......, but only 45% reported near normal or normal WORC scores, and 56% presented with a reduced active ROM at two years. CONCLUSION: Arthroscopic subacromial decompression -appears effective in alleviating symptoms in patients with subacromial impingement who are resistant to conservative treatment, but can only...

  6. Degradation of signal to noise ratio in optical free space data links due to background illumination.

    Science.gov (United States)

    Leeb, W R

    1989-08-15

    In free space optical data transmission systems illumination of the receiver antenna by background radiation will decrease the signal to noise ratio. We derive expressions for that degradation both for direct and for heterodyne/homodyne receivers. Examples are given for cases where the sun, the moon, the earth, and Venus illuminate earth orbiting receivers operating at wavelengths of 0.85 microm, 1.3 microm, and 10.6 microm. Direct detection receivers will typically suffer a degradation of between 5 and 15 dB at lambda = 0.85 microm and lambda = 1.3 microm when illuminated by the sun. Heterodyne/homodyne receivers at 10.6 microm degrade more with sun radiation (typically 4 dB) than at the smaller wavelengths ( approximately 0.3 dB). The moon, earth, and Venus cause negligible reduction of signal to noise ratio.

  7. Possible lack of low-mass meteoroids in the Earth's meteoroid flux due to space erosion?

    Science.gov (United States)

    Rubincam, David Parry

    2018-01-01

    The Earth's cumulative meteoroid flux, as found by Halliday et al. (1996), may have a shallower slope for meteoroid masses in the range 0.1-2.5 kg compared to those with masses greater than 2.5 kg when plotted on a log flux vs. log mass graph. This would indicate a lack of low-mass objects. While others such as Ceplecha (1992) find no shallow slope, there may be a reason for a lack of 0.1-2.5 kg meteoroids which supports Halliday et al.'s finding. Simple models show that a few centimeters of space erosion in stony meteoroids can reproduce the bend in Halliday et al.'s curve at ∼2.5 kg and give the shallower slope.

  8. Numerical Calculation of Electric Fields in Housing Spaces Due to Electromagnetic Radiation from Antennas for Mobile Communication

    Directory of Open Access Journals (Sweden)

    H.-P. Geromiller

    2003-01-01

    Full Text Available The influence of electromagnetic radiation from mobile antennas on humans is under discussion in va'rious groups ofscientists, This paper deals with the impact ofelectromagnetic radiation in a housing space. The space is assumedto be bordered by 5 walls of ferroconcrete and a door-window combination on the 6th side, the latter to be electromagnetically transparent. The transparent side of the housing is exposed to an electromagnetic wave. As the source ofradiation is considered to be far away from the housing, the radiation is regarded to be from a plane wave. Due to the high signal frequency and ferroconcrete walls, 5 sides ofthe housing space are considered to be perfect conductors. The electric field inside the housing is calculated numerically by the method of finite differences for different angles of incidence of the radiated electromagnetic wave. The maximum value of the calculated electric field is outlined in a diagram.

  9. Numerical Calculation of Electric Fields in Housing Spaces due to Electromagnetic Radiation from Antennas for Mobile Communication

    Directory of Open Access Journals (Sweden)

    H.-P. Geromiller

    2004-01-01

    Full Text Available The influence of electromagnetic radiation from mobile antennas on humans is under discussion in various group of scientists. This paper deals with the impact of electromagnetic radiation in housing spaces. The space is assumed to be bordered by 5 walls of ferroconcrete and a door-window combination on the 6th side, the latter to be electromagnetic transparent. The transparent side of the housing is exposed to an electromagnetic wave. As the source of radiation is considered to be far away from the housing, the radiation is regarded as a plane wave. Due to the high signal frequency and the ferroconcrete walls, 5 sides of the housing space are considered to be perfect conductors. The electric field inside the housing is calculated numerically by the method of finite differences for different angles of incidence of the radiated electromagnetic wave. The maximum value of the calculated electric field is outlined in a diagram.

  10. [Vacuum-assisted Closure Therapy for Residual Space after Open Window Thoracotomy for Pleural Empyema due to Bronchopleural Fistula].

    Science.gov (United States)

    Togo, Takeo; Hasumi, Tohru; Hoshi, Fumihiko; Hoshikawa, Yasushi; Okada, Yoshinori; Saito, Yasuki

    2016-05-01

    A 73-year-old man underwent right middle-lower bilobectomy for lung adenocarcinoma. He suffered from pneumonia followed by empyema due to bronchopleural fistula. On day 19 after the operation, an open window thoracostomy was created. Then the pleural space was treated conservatively with saline irrigation and petrolatum gauze packing. Progressive formation of healthy granulation tissue was observed around the bronchopleural fistula and the adjacent pulmonary artery, resulting in a complete closure of the bronchopleural fistula. And then we applied vacuum-assisted closure (VAC) therapy to the residual pleural cavity. At 4 weeks after the initiation of VAC therapy, the pleural cavity was completely filled with granulation tissue and re-expanded residual lung. In conclusion, VAC therapy is a safe and effective treatment for residual space after open window thoracostomy for empyema due to bronchopleural fistula, if it is applied after closure of bronchopleural fistula and adequate granulation tissue formation on the great vessels.

  11. Fading Losses on the LCRD Free-Space Optical Link Due to Channel Turbulence

    Science.gov (United States)

    Moision, Bruce; Piazzolla, Sabino; Hamkins, Jon

    2013-01-01

    The Laser Communications Relay Demonstration (LCRD) will implement an optical communications link between a pair of Earth terminals via an Earth-orbiting satellite relay. Clear air turbulence over the communication paths will cause random fluctuations, or fading, in the received signal irradiance. In this paper we characterize losses due to fading caused by clear air turbulence. We illustrate the performance of a representative relay link, utilizing a channel interleaver and error-correction-code to mitigate fading, and provide a method to quickly determine the link performance.

  12. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up

    DEFF Research Database (Denmark)

    Haahr, J. P.; Ostergaard, S.; Dalsgaard, J.

    2005-01-01

    OBJECTIVES: To compare the effect of graded physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement. METHODS: Randomised controlled trial with 12 months' follow up in a hospital setting. Ninety consecutive patients aged...... 18 to 55 years were enrolled. Symptom duration was between six months and three years. All fulfilled a set of diagnostic criteria for rotator cuff disease, including a positive impingement sign. Patients were randomised either to arthroscopic subacromial decompression, or to physiotherapy...

  13. Emittance growth due to static and radiative space charge forces in an electron bunch compressor

    CERN Document Server

    Talman, Richard; Stulle, Frank

    2009-01-01

    Evolution of short intense electron bunches passing through bunch-compressing beam lines is studied using the UAL (Unified Accelerator Libraries) string space charge formulation [R. Talman, Phys. Rev. ST Accel. Beams 7, 100701 (2004); N. Malitsky and R. Talman, in Proceedings of the 9th European Particle Accelerator Conference, Lucerne, 2004 (EPS-AG, Lucerne, 2004); R. Talman, Accelerator X-Ray Sources (Wiley-VCH, Weinheim, 2006), Chap. 13]. Three major configurations are studied, with the first most important and studied in greatest detail (because actual experimental results are available and the same results have been simulated with other codes): (i) Experimental bunch compression results were obtained at CTF-II, the CERN test facility for the “Compact Linear Collider” using electrons of about 40 MeV. Previous simulations of these results have been performed (using trafic4* [A. Kabel et al., Nucl. Instrum. Methods Phys. Res., Sect. A 455, 185 (2000)] and elegant [M. Borland, Argonne National Laboratory...

  14. Comparison of subacromial tenoxicam and steroid injections in the treatment of impingement syndrome.

    Science.gov (United States)

    Çift, Hakan; Özkan, Feyza Ünlü; Tolu, Sena; Şeker, Ali; Mahiroğulları, Mahir

    2015-01-01

    This study aims to assess and compare the efficacy of subacromial tenoxicam and steroid injections in treating patients with shoulder impingement syndrome. Forty patients having shoulder impingement syndrome with findings of rotator cuff tendinitis or subacromial bursitis on magnetic resonance imaging were included in the study. Patients were randomized into two subacromial injection groups: patients in the first group (10 males, 10 females; mean age 45.3 years; range 32 to 67 years) were administered 20 mg tenoxicam three times by weekly intervals, and patients in the second group (8 males, 12 females; mean age 46.5 years; range 29 to 73 years) were administered 40 mg methylprednisolone acetate just for once. Visual analog scale (VAS), active range of motion (ROM) of the shoulder joint, and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire scores were evaluated at baseline, six weeks after treatment, and first year. Visual analog scale, DASH, and active ROM scores in both groups were statistically significantly improved. No statistically significant difference was detected between subacromial tenoxicam and steroid injections in terms of post-treatment VAS, DASH, and active ROM scores. Mean pre- and post-treatment VAS scores in tenoxicam group were 7.8 (range, 3-9) and 2.6 (range, 2-4), respectively. Mean pre- and post-treatment VAS scores in steroid group were 6.2 (range, 3-10) and 3.6 (range, 0-7), respectively. Mean pre- and post-treatment DASH scores in tenoxicam group were 59.4 (range, 45-80) and 14.7 (range, 8.3-25.8), respectively. Mean pre- and post-treatment DASH scores in steroid group were 56.7 (range, 33.3-85.8) and 18.1 (range, 0-69.2), respectively. Although the improvement in active ROM was higher in the steroid group, difference between two groups was not statistically significant. Both subacromial tenoxicam and steroid injections may be successfully used in the treatment of patients with impingement syndrome. Subacromial tenoxicam

  15. Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial).

    Science.gov (United States)

    Roddy, Edward; Zwierska, Irena; Hay, Elaine M; Jowett, Sue; Lewis, Martyn; Stevenson, Kay; van der Windt, Danielle; Foster, Nadine E

    2014-03-14

    Subacromial impingement syndrome is the most frequent cause of shoulder problems which themselves affect 1 in 3 adults. Management commonly includes exercise and corticosteroid injection. However, the few existing trials of exercise or corticosteroid injection for subacromial impingement syndrome are mostly small, of poor quality, and focus only on short-term results. Exercise packages tend to be standardised rather than individualised and progressed. There has been much recent interest in improving outcome from corticosteroid injections by using musculoskeletal ultrasound to guide injections. However, there are no high-quality trials comparing ultrasound-guided and blind corticosteroid injection in subacromial impingement syndrome. This trial will investigate how to optimise the outcome of subacromial impingement syndrome from exercise (standardised advice and information leaflet versus physiotherapist-led exercise) and from subacromial corticosteroid injection (blind versus ultrasound-guided), and provide long-term follow-up data on clinical and cost-effectiveness. The study design is a 2x2 factorial randomised controlled trial. 252 adults with subacromial impingement syndrome will be recruited from two musculoskeletal Clinical Assessment and Treatment Services at the primary-secondary care interface in Staffordshire, UK. Participants will be randomised on a 1:1:1:1 basis to one of four treatment groups: (1) ultrasound-guided subacromial corticosteroid injection and a physiotherapist-led exercise programme, (2) ultrasound-guided subacromial corticosteroid injection and an advice and exercise leaflet, (3) blind subacromial corticosteroid injection and a physiotherapist-led exercise programme, or (4) blind subacromial corticosteroid injection and an advice and exercise leaflet. The primary intention-to-treat analysis will be the mean differences in Shoulder Pain and Disability Index (SPADI) scores at 6 weeks for the comparison between injection interventions and at

  16. Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study

    DEFF Research Database (Denmark)

    Haahr, J. P.; Andersen, JH

    2006-01-01

    not differ between treatment groups. Self-reported outcomes after 4-8 years did not differ between treatment groups. CONCLUSION: The results of surgical decompression were equal to those of conservative treatment, and the surgery group had more income transferrals during the first year of follow-up...... with graded physiotherapy and exercises or arthroscopic subacromial decompression. Outcomes were proportion of time per year with income transfers (indexed 0-1), including total transfers (marginalization), sick leave and disability pension obtained from the registry at the Ministry of Work. Self...

  17. Synovial chondromatosis of the subacromial bursa causing a bursal-sided rotator cuff tear.

    Science.gov (United States)

    Neumann, Julie A; Garrigues, Grant E

    2015-01-01

    Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up.

  18. Specific or general exercise strategy for subacromial impingement syndrome-does it matter?

    DEFF Research Database (Denmark)

    Shire, Alison R; Stæhr, Thor A B; Overby, Jesper B

    2017-01-01

    strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more......, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations...... was SMD −0.19 (95% CI −0.61, 0.22) and SMD 0.30 (95% CI −0.16, 0.76) for function. Conclusions There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed...

  19. Exercise therapy after ultrasound-guided corticosteroid injections in patients with subacromial pain syndrome

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Christensen, Robin; Rosager, Sara

    2016-01-01

    BACKGROUND: Subacromial pain syndrome (SAPS) accounts for around 50 % of all cases of shoulder pain. The most commonly used treatments are glucocorticosteroid (steroid) injections and exercise therapy; however, despite treatment SAPS patients often experience relapse of their symptoms. Therefore...... the clinical effect of combining steroid and exercise therapy is highly relevant to clarify. The aim of this randomized controlled trial was to investigate if exercise therapy added to steroid injection in patients with SAPS will improve the effect of the injection therapy on shoulder pain. METHODS......: In this two-arm randomized trial running over 26 weeks, patients with unilateral shoulder pain (> 4 weeks) and thickened subacromial bursa (> 2 mm on US) were included. At baseline all participants received two steroid injections into the painful shoulder with an interval of one week. Subsequently they were...

  20. Efetividade da Terapia Manual na Síndrome de Conflito Subacromial

    OpenAIRE

    Silva, Sónia Isabel Oliveira da

    2015-01-01

    Introdução: A síndrome do conflito subacromial representa uma das causas mais comuns de dor no ombro. Neste tipo de conflito existe comprometimento do espaço subacromial, na maioria das vezes provocada pela compressão mecânica da coifa dos rotadores, especialmente da inserção do tendão do músculo supra-espinhoso, contra a superfície antero-inferior do acrómio. A etiologia desta condição tem sido debatida ao longo dos anos e muitos autores defendem que a sua causa é multi-fatorial. Estudos ass...

  1. Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Shin, Sang-Jin; Do, Nam-Hoon; Lee, Juyeob; Ko, Young-Won

    2016-09-01

    Corticosteroid injections have been widely used for reducing shoulder pain. However, catastrophic complications induced by corticosteroid such as infections and tendon degeneration have made surgeons hesitant to use a corticosteroid injection as a pain control modality, especially during the postoperative recovery phase. To determine the effectiveness and safety of a subacromial corticosteroid injection for persistent pain control during the recovery period and to analyze the factors causing persistent pain after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. A total of 458 patients who underwent arthroscopic rotator cuff repair were included in this study. Patient-specific parameters, tear size and pattern, and pain intensity were reviewed. Seventy-two patients were administered a postoperative subacromial corticosteroid injection under ultrasound guidance. The corticosteroid injection was administered to patients who awakened overnight because of constant severe shoulder pain or whose pain was exacerbated at the time of rehabilitation exercises within 8 weeks after surgery. Pain intensity, patient satisfaction, and functional outcomes using the American Shoulder and Elbow Surgeons (ASES) and Constant scores were compared between the patients with and without a subacromial corticosteroid injection. The retear rate was evaluated with magnetic resonance imaging at 6 months postoperatively. In patients with an injection, the mean (±SD) visual analog scale for pain (pVAS) score was 7.7 ± 1.2 at the time of the injection. This significantly decreased to 2.3 ± 1.4 at the end of the first month after the injection, demonstrating a 70.2% reduction in pain (P rotator cuff tears (41.8%) showed a higher occurrence of severe postoperative persistent pain. Preoperative shoulder stiffness was revealed as a predisposing factor for persistent pain (odds ratio, 0.2; P = .04). A subacromial corticosteroid injection can be considered as a useful and safe

  2. Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients.

    Science.gov (United States)

    Bouju, Y; Bouilleau, L; Dubois de Montmarin, G; Bacle, G; Favard, L

    2014-12-01

    Ultrasonography has become an investigation of choice in the management of shoulder pain. The objective of this study was to determine whether the efficacy of subacromial-subdeltoid bursa injection correlated with the ultrasound findings. We prospectively recruited patients who were seen between November 2012 and November 2013 for subacromial pain and whose rotator cuff was either intact or showed a full-thickness tear less than 1cm in length. A standardised physical examination of the shoulder was followed immediately by static and dynamic ultrasonography, intra-bursal injection of lidocaine, and a repetition of the same physical examination. Recorded ultrasonography features were the appearance of the bursa, shape of the coraco-acromial ligament, and bursal deformation induced by passage under the coraco-acromial ligament during dynamic imaging. A response to the injection was defined as greater than 75% improvements in at least three of the physical examination parameters. We included 39 patients with a mean age of 56.7 years. Ultrasonography showed abnormalities of the bursa in 30 patients, including 1 with an intra-bursal effusion, 10 with thickening, and 19 with both. Deformation of the bursa under the coraco-acromial ligament was noted in 26 patients. The proportions of patients with bursal effusion and with bursal thickening were similar in the 20 responders and 19 non-responders. Neither were any significant differences found for coraco-acromial ligament shape or bursal deformation under the ligament. No correlation was found between ultrasonography findings and the efficacy of a local anaesthetic injection into the subacromial bursa. These findings suggest that ultrasound abnormalities may constitute mere physiological changes, in keeping with earlier studies in asymptomatic individuals. Thus, subacromial impingement may be currently overdiagnosed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Distinguishing multiple rice body formation in chronic subacromial-subdeltoid bursitis from synovial chondromatosis.

    Science.gov (United States)

    Chen, Albert; Wong, Lun-Yick; Sheu, Chin-Yin; Chen, Be-Fong

    2002-02-01

    Multiple rice body formation is a complication of chronic bursitis. Although it resembles synovial chondromatosis clinically and on imaging, the literature suggests that analysis of radiographic and MR appearances should allow discrimination. We report the imaging findings in a 41-year-old man presenting with rice body formation in chronic subacromial-subdeltoid bursitis. We found that the signal intensity of the rice bodies is helpful in making the diagnosis.

  4. Distinguishing multiple rice body formation in chronic subacromial-subdeltoid bursitis from synovial chondromatosis

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Albert; Wong, Lun-Yick; Sheu, Chin-Yin [Department of Radiology, Mackay Memorial Hospital, Taipei (Taiwan); Chen, Be-Fong [Department of Pathology, Mackay Memorial Hospital, Taipei (Taiwan)

    2002-02-01

    Multiple rice body formation is a complication of chronic bursitis. Although it resembles synovial chondromatosis clinically and on imaging, the literature suggests that analysis of radiographic and MR appearances should allow discrimination. We report the imaging findings in a 41-year-old man presenting with rice body formation in chronic subacromial-subdeltoid bursitis. We found that the signal intensity of the rice bodies is helpful in making the diagnosis. (orig.)

  5. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    OpenAIRE

    José L. Arias-Buría; Sebastián Truyols-Domínguez; Raquel Valero-Alcaide; Jaime Salom-Moreno; María A. Atín-Arratibel; César Fernández-de-las-Peñas

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous ele...

  6. RIGID TAPE VERSUS KINESIO TAPE ON SCAPULAR ROTATION AND FORWARD HEAD ANGLE IN SUBACROMIAL IMPINGEMENT SYNDROME

    OpenAIRE

    Eman A. Embaby; Eman M.A. Abdalgwad

    2016-01-01

    Background: Rigid and kinesio taping is commonly used in the rehabilitation and prevention of subacromial impingement syndrome (SIS). It is proposed to have positive effects on shoulder function and scapular kinematics. However, there is a paucity of literature regarding the effectiveness of rigid versus elastic taping on scapular upward rotation and forward head posture (FHP), which is commonly adopted in SIS. Purpose: This study was designed to investigate the effect of taping with post...

  7. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van der Meer Klaas

    2007-02-01

    Full Text Available Abstract Background Subacromial impingement syndrome (SIS is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT, which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery. Methods/Design The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT. Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group or continuation of usual medical care (control group. The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses. Discussion The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial

  8. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs.

    Science.gov (United States)

    MacDonald, P B; Clark, P; Sutherland, K

    2000-01-01

    The purpose of this study was to assess the diagnostic accuracy of the Neer and Hawkins impingement signs for the diagnosis of subacromial bursitis or rotator cuff pathosis. Eighty-five consecutive patients undergoing shoulder arthroscopy by a single surgeon were documented prospectively for the positive and negative clinical and arthroscopic pathologic findings. The Neer sign was found to have a sensitivity of 75% for the appearance suggestive of subacromial bursitis; this compared with 92% for the Hawkins sign. For rotator cuff tearing, the sensitivity of the Neer sign was 85% and the sensitivity of the Hawkins sign was 88%. Specificity and positive predictive values for the two tests were low, being not much higher than pretest probability. The two tests had a high negative predictive value (96% for bursitis, 90% for rotator cuff tearing) when they were combined. The results are compared with those reported in the literature. We conclude that the Neer and Hawkins signs are sensitive for appearances suggestive of subacromial bursitis and rotator cuff partial or complete tearing with a high negative predictive value. However, they lack specificity in comparison with arthroscopic findings.

  9. Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders

    Science.gov (United States)

    Byun, Seung Deuk; Choi, Won Duck; Lee, Zee Ihn

    2011-01-01

    Objective To investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders. Method This prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1st injection (= 2 weeks after 3rd injection). Results (1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1st, 2nd, and 4th week after the first injection in both groups (pbursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation. PMID:22506189

  10. Subacromial impingement in patients with whiplash injury to the cervical spine

    Directory of Open Access Journals (Sweden)

    Giddins Grey E

    2008-06-01

    Full Text Available Abstract Background Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. Methods and results We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26% had developed shoulder pain following the injury; of these, 11/220 (5% had clinical evidence of impingement syndrome. Only 3/11 patients (27% had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p Conclusion After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

  11. Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections.

    Science.gov (United States)

    Chang, Ke-Vin; Wu, Wei-Ting; Han, Der-Sheng; Özçakar, Levent

    2017-10-01

    To explore factors contributing to initial effectiveness and recurrence after ultrasound (US)-guided subacromial corticosteroid injections by assessing clinical measurements and static and dynamic shoulder US images. Retrospective cohort study. Rehabilitation outpatient clinic. Adults with shoulder pain referred for injection therapy (N=164). US-guided subacromial corticosteroid injection. The association of initial effectiveness (defined as >50% decrease in any of the 3 pain subdomains after the first injection) and recurrent shoulder pain that required repeated intervention with record-based clinical measurements and static/dynamic shoulder US. This study included 164 patients, 106 of whom were responsive to a first injection. Among the 106 participants, 42 received a second injection because of recurrent shoulder pain. By using the multivariate logistic regression analysis, initial effectiveness was positively associated with right handedness, grade 2 subacromial impingement during the dynamic US examination, and bicipital groove tenderness. However, these patients had a negative association with subdeltoid bursitis, grade 3 subacromial impingement, and shoulder stiffness. Subdeltoid bursitis and a positive painful arc test were predictors of recurrent shoulder pain that necessitated a repeated injection in the Cox proportional hazards model. The initial effectiveness and recurrence after US-guided subacromial corticosteroid injection were associated with certain clinical measurements and static and dynamic shoulder US, which should be carefully evaluated (and can be used) to guide the best treatment outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome

    Directory of Open Access Journals (Sweden)

    Radnovich R

    2014-12-01

    Full Text Available Richard Radnovich,1 Jeremiah Trudeau,2 Arnold R Gammaitoni3 1Injury Care Medical Center, Boise, ID, USA; 2Analgesic Solutions, Natick, MA, USA; 3Nuvo Research Inc., West Chester, PA, USA Background: Treatment for pain due to shoulder impingement syndrome (SIS typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT patch has been reported to reduce SIS pain in a small case series. Methods: This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0–10 scale (0= no pain, 10= worst pain were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg. Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0–10 scale. Results: Sixty patients enrolled in the study (average age =51 years, range 18–75, n=21 female. Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, P<0.001 and from 5.6±1.2 to 3.2±2.6 in the injection group (n=31, P<0.001. Similar improvements were seen in each group for worst pain; pain interference with general activity, work, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. Conclusion: These results suggest that short-term, noninvasive treatment

  13. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome

    Science.gov (United States)

    Radnovich, Richard; Trudeau, Jeremiah; Gammaitoni, Arnold R

    2014-01-01

    Background Treatment for pain due to shoulder impingement syndrome (SIS) typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT) patch has been reported to reduce SIS pain in a small case series. Methods This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0–10 scale (0= no pain, 10= worst pain) were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg). Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily) during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0–10 scale). Results Sixty patients enrolled in the study (average age =51 years, range 18–75, n=21 female). Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, P<0.001) and from 5.6±1.2 to 3.2±2.6 in the injection group (n=31, P<0.001). Similar improvements were seen in each group for worst pain; pain interference with general activity, work, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. Conclusion These results suggest that short-term, noninvasive treatment with the HLT patch has similar efficacy to subacromial corticosteroid injections for the treatment of pain associated with SIS. PMID:25525385

  14. Solving Component Structural Dynamic Failures Due to Extremely High Frequency Structural Response on the Space Shuttle Program

    Science.gov (United States)

    Frady, Greg; Nesman, Thomas; Zoladz, Thomas; Szabo, Roland

    2010-01-01

    For many years, the capabilities to determine the root-cause failure of component failures have been limited to the analytical tools and the state of the art data acquisition systems. With this limited capability, many anomalies have been resolved by adding material to the design to increase robustness without the ability to determine if the design solution was satisfactory until after a series of expensive test programs were complete. The risk of failure and multiple design, test, and redesign cycles were high. During the Space Shuttle Program, many crack investigations in high energy density turbomachines, like the SSME turbopumps and high energy flows in the main propulsion system, have led to the discovery of numerous root-cause failures and anomalies due to the coexistences of acoustic forcing functions, structural natural modes, and a high energy excitation, such as an edge tone or shedding flow, leading the technical community to understand many of the primary contributors to extremely high frequency high cycle fatique fluid-structure interaction anomalies. These contributors have been identified using advanced analysis tools and verified using component and system tests during component ground tests, systems tests, and flight. The structural dynamics and fluid dynamics communities have developed a special sensitivity to the fluid-structure interaction problems and have been able to adjust and solve these problems in a time effective manner to meet budget and schedule deadlines of operational vehicle programs, such as the Space Shuttle Program over the years.

  15. Increased IL-1beta expression and myofibroblast recruitment in subacromial bursa is associated with rotator cuff lesions with shoulder stiffness.

    Science.gov (United States)

    Ko, Jih-Yang; Wang, Feng-Sheng; Huang, Hsuan-Ying; Wang, Ching-Jen; Tseng, Shin-Ling; Hsu, Chin

    2008-08-01

    We evaluated whether proinflammatory cytokine expression and myofibroblast recruitment in subacromial bursa was linked to rotator cuff lesions with shoulder stiffness. We analyzed expressions of IL-1beta, IL-6, and TNF-alpha in subacromial bursa and joint fluid collected from 14 patients with cuff tears with stiffness as a study group (Group I) and 14 patients with rotator cuff tears without shoulder stiffness as a control group (Group II) using real-time RT-PCR, immunohistochemistry, and ELISA. Myofibroblast apoptosis in subacromial bursa was analyzed using terminal deoxynucleotidyl transferase -mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) and alpha-smooth muscle actin immunofluorescence staining. Shoulder function was evaluated using the Constant score. Group I had higher mRNA expression (p bursa and IL-1beta levels in joint fluid were correlated with a preoperative deficit in shoulder motion (p bursa in rotator cuff lesions are linked to shoulder stiffness.

  16. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis.

    Science.gov (United States)

    Ottenheijm, Ramon P; Jansen, Mariëtte J; Staal, J Bart; van den Bruel, Ann; Weijers, René E; de Bie, Rob A; Dinant, Geert-Jan

    2010-10-01

    To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings. Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included articles were searched to identify relevant studies. Two reviewers independently selected the articles evaluating the accuracy of ultrasound for detecting subacromial disorders from the title and abstracts retrieved by the literature search. Selection criteria were ultrasound frequency greater than or equal to 7.5MHz as index test, surgery, magnetic resonance imaging and/or radiography as reference standards, and subacromial disorders as target conditions. Two reviewers independently extracted the data on study characteristics and results to construct 2 by 2 tables and performed a methodologic quality assessment. Twenty-three studies were included: 22 reported on full-thickness rotator cuff tears, 15 on partial-thickness tears, 3 on subacromial bursitis, 2 on tendinopathy, and 2 on calcifying tendonitis, respectively. For full-thickness tears, pooled sensitivity of ultrasound was .95 (95% confidence interval, .90-.97), and specificity .96 (.93-.98). For partial-thickness tears, pooled sensitivity was .72 (.58-.83), and specificity .93 (.89-.96). Statistical pooling was not possible for the other disorders. For subacromial bursitis, sensitivity ranged from .79 to .81, and specificity from .94 to .98. For tendinopathy, sensitivity ranged from .67 to .93, specificity from .88 to 1.00. Sensitivity for calcifying tendonitis was 1.00 in both studies, with specificity ranging from .85 to .98. We strongly recommend ultrasound in patients for whom conservative treatment fails, to rule in or out full-thickness tears, to rule in partial-thickness tears, and to a lesser extent to diagnose tendinopathy, subacromial bursitis, and calcifying tendonitis. These results can help physicians tailor treatment

  17. Fisioterapia en el síndrome subacromial del hombro. Revisión sistemática cualitativa.

    OpenAIRE

    Zhou, Yanxiang

    2014-01-01

    Trabajo Fin de Grado (TFG) Antecedentes: El dolor de hombro es un problema muy frecuente, se estima que un tercio de la población sufre o sufrirá a lo largo de la vida dolor de hombro en alguna ocasión. El síndrome subacromial es la causa más común. La fisioterapia es la terapia de elección frente al síndrome subacromial, con una gran variedad abordajes fisioterapéuticos como los ejercicios terapéuticos, la terapia manual, el ultrasonido, la acupuntura, etc. Objetivo: El objetivo de est...

  18. Shoulder function and work disability after decompression surgery for subacromial impingement syndrome: a randomised controlled trial of physiotherapy exercises and occupational medical assistance.

    Science.gov (United States)

    Svendsen, Susanne W; Christiansen, David H; Haahr, Jens Peder; Andrea, Linda C; Frost, Poul

    2014-06-21

    Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function. A recent Danish study showed that 10% of a nationwide cohort of patients retired prematurely within two years after surgery. Few studies have compared effects of different postoperative exercise programmes on shoulder function, and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability. This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression. The study is a mainly pragmatic multicentre randomised controlled trial. The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region. Patients aged ≥18-≤63 years, who still have shoulder symptoms 8-12 weeks after surgery, constitute the study population. Around 130 participants are allocated to: 1) physiotherapy exercises, 2) occupational medical assistance, 3) physiotherapy exercises and occupational medical assistance, and 4) usual care. Intervention manuals allow individual tailoring. Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder. Randomisation is computerised with allocation concealment by randomly permuted block sizes. Statistical analyses will primarily be performed according to the intention-to-treat principle. The paper presents the rationale, design, methods, and operational aspects of the Shoulder Intervention Project (SIP). SIP evaluates a new rehabilitation approach, where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care. If successful, the project may serve as a model for rehabilitation of surgical shoulder

  19. Visual scapular dyskinesis: kinematics and muscle activity alterations in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Lopes, Andrea Diniz; Timmons, Mark K; Grover, Molly; Ciconelli, Rozana Mesquita; Michener, Lori A

    2015-02-01

    To characterize scapular kinematics and shoulder muscle activity in patients with subacromial impingement syndrome, with and without visually identified scapular dyskinesis. Cross-sectional study. Laboratory. Participants with subacromial impingement syndrome (N=38) were visually classified using a scapular dyskinesis test with obvious scapular dyskinesis (n=19) or normal scapular motion (n=19). Not applicable. An electromagnetic motion capture system measured 3-dimensional kinematics of the thorax, humerus, and scapula. Simultaneously, surface electromyography was used to measure muscle activity of the upper, middle, and lower trapezius; serratus anterior; and infraspinatus during ascending and descending phases of weighted shoulder flexion. Separate mixed-model analyses of variance for the ascending and descending phases of shoulder flexion compared kinematics and muscle activity between the 2 groups. Shoulder disability was assessed with the Pennsylvania Shoulder Score (Penn). The group with obvious dyskinesis reported 6 points lower on Penn shoulder function (0-60 points), exhibited a main group effect of less scapular external rotation of 2.1° during ascent and 2.5° during descent, and had 12.0% higher upper trapezius muscle activity during ascent in the 30° to 60° interval. Patients with obvious dyskinesis and subacromial impingement syndrome have reduced scapular external rotation and increased upper trapezius muscle activity, along with a greater loss of shoulder function compared with those without dyskinesis. These biomechanical alterations can lead to or be caused by scapular dyskinesis. Future studies should determine if correction of these deficits will eliminate scapular dyskinesis and improve patient-rated shoulder use. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears

    Science.gov (United States)

    Hodgson, R J; O'Connor, P J; Hensor, E M A; Barron, D; Robinson, P

    2012-01-01

    Objective Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear. PMID:23091289

  1. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain.

    Directory of Open Access Journals (Sweden)

    Angela Cadogan

    Full Text Available The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP.In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity. A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100; LR+ 6.2; 95% CI 1.5, 25.7. Imaging did not improve the ability to rule-out a PAR.Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

  2. Inter-examiner reproducibility of clinical tests and criteria to identify subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Vind, Mikkel; Bogh, Søren Bie; Larsen, Camilla Marie

    2011-01-01

    Abstract Introduction A specific algorithm has been proposed for classifying impingement related shoulder pain in athletes with overhead activity. Data on the inter-examiner reproducibility of the suggested clinical tests and criteria and their mutual dependencies for identifying subacromial...... was followed, consisting of a training, an overall agreement and a study phase. To proceed to the study phase, an overall agreement of 0.80 was required. In total 10, 20 and 44 subjects were included in the three phases, respectively. The case prevalence in the study phase was 50%. The inclusion criterion...... reproducibility in clinical practice, as well as the validity of the tests and criteria for SIS....

  3. Two Cases of Subacromial Bursitis with Many Loose Bodies as a Cause of Rheumatoid Arthritis

    OpenAIRE

    砂川, 融; 杉村, 功; 堀, 司郎; 村岡, 博; 有田, 淳

    1989-01-01

    Rice bodies caused by T.B. and R.A. in joints are relatively common and reported, but in bursa are rare. We experienced two cases of subacromial bursitis with many rice bodies :one is a 53-year-old female and the other is a 62-year-old male. They were suffering from rheumatoid arthritis for years, and complained of swelling of the shoulder joint, but had no pain and no remarkable limitation of range of motion of the shoulder joint. We resected the bursa containing a lot of rice bodies operati...

  4. Arthroscopic treatment for synovial chondromatosis of the subacromial bursa associated with partial rotator cuff tear.

    Science.gov (United States)

    Xu, Caiqi; Yang, Xingguang; Zhao, Jinzhong

    2015-02-01

    Synovial chondromatosis is characterized by benign synovial proliferation that leads to chondral or osteochondral foci formation. In this case report, a right-handed female suffered from progressively worsening pain and limited mobility of forward elevation, abduction and external rotation in her right shoulder. A shoulder arthroscopy was conducted, during which, thickened bursal synovium and several loose bodies were observed, associated with bursal side tear of rotator cuff. A thorough synovectomy, subacromial debridement and acromioplasty were conducted. The pathological findings were consistent with synovial chondromatosis. After systematic rehabilitation, the patient had relief of shoulder pain and full range of motions in 14-months follow-up. Case report, Level IV.

  5. Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial

    Directory of Open Access Journals (Sweden)

    Fredrik Granviken

    2015-07-01

    Full Text Available Question: Are there different effects of home exercises and supervised exercises on pain and disability for people with subacromial impingement? Design: Randomised trial with two treatment arms, concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis. Participants: Forty-six patients with subacromial impingement were recruited from an interdisciplinary outpatient clinic of physical medicine and rehabilitation at a university hospital in Norway. Intervention: The home exercise group had one supervised exercise treatment followed by exercises at home for 6 weeks. The supervised exercise group had up to 10 supervised exercise treatments in addition to home exercises for 6 weeks. Outcome measures: The primary outcome was the Shoulder Pain and Disability Index (SPADI. Secondary outcome variables were: average pain during the past week, the Fear Avoidance Beliefs Questionnaire, participant satisfaction with treatment, active range of motion, work status and clinical shoulder tests. Pain was assessed weekly and all outcomes were assessed at 6 weeks. Participants were free to seek ongoing treatment of their choice until 26 weeks, when the SPADI was assessed again. Results: While both groups improved considerably, the groups did not differ significantly on the SPADI after the intervention at 6 weeks (0 points, 95% CI –14 to 14 or when followed up at 26 weeks (–2 points, 95% CI –21 to 17. There were no between-group differences for pain at any time. The remaining outcomes also did not differ significantly, except for the clinical tests of shoulder impingement. In the supervised exercise group, 11 out of 23 participants had two or more positive tests, compared to 18 out of 21 in the home exercise group. Conclusion: Supervision of more than the first session of a 6-week exercise regimen did not cause significant differences in pain and disability in people with subacromial impingement. Trial registration: NCT01257113

  6. Efectos del uso de acupuntura en el síndrome subacromial

    OpenAIRE

    Rueda Garrido, Juan Carlos

    2014-01-01

    Antecedentes: El hombro doloroso u omalgia, es una de las principales causas de dolor osteoarticular que se presentan en la práctica clínica diaria, y a menudo provoca discapacidad funcional considerable. La causa más frecuente de dolor de hombro es el síndrome subacromial. Objetivo: Conseguir una disminución de la intensidad del dolor a corto y medio plazo con el uso de acupuntura en el hombro lesionado. Método: Estudio controlado y aleatorizado, en el que participan dos grupos: uno qu...

  7. Expression of bioactive bone morphogenetic proteins in the subacromial bursa of patients with chronic degeneration of the rotator cuff.

    Science.gov (United States)

    Neuwirth, Jana; Fuhrmann, Renée A E; Veit, Amanda; Aurich, Matthias; Stonâns, Ilmars; Trommer, Tilo; Hortschansky, Peter; Chubinskaya, Susanna; Mollenhauer, Juergen A

    2006-01-01

    Degeneration of the rotator cuff is often associated with inflammation of the subacromial bursa and focal mineralization of the supraspinatus tendon. Portions of the supraspinatus tendon distant from the insertion site could transform into fibrous cartilage, causing rotator-cuff tears owing to mechanical instability. Indirect evidence is presented to link this pathology to ectopic production and secretion of bioactive bone morphogenetic proteins (BMPs) from sites within the subacromial bursa. Surgically removed specimens of subacromial bursa tissue from patients with chronic tears of the rotator cuff were analyzed by immunohistochemistry and reverse transcription-PCR. Bioactive BMP was detected in bursa extracts by a bioassay based on induction of alkaline phosphatase in the osteogenic/myogenic cell line C2C12. Topical and differential expression of BMP-2/4 and BMP-7 mRNA and protein was found in bursa tissue. The bioassay of C2C12 cells revealed amounts of active BMP high enough to induce osteogenic cell types, and blocking BMP with specific antibodies or soluble BMP receptors Alk-3 and Alk-6 abolished the inductive properties of the extract. Sufficient information was gathered to explain how ectopic expression of BMP might induce tissue transformation into ectopic bone/cartilage and, therefore, promote structural degeneration of the rotator cuff. Early surgical removal of the subacromial bursa might present an option to interrupt disease progression.

  8. [Isolated synovial chondromatosis of the subacromial bursa: report of a new case and review of the literature].

    Science.gov (United States)

    Bouhaouala, M H; Saïd, W; Salah, M Haj; Bouaziz, N; Mourali, S; Chaabane, S

    2006-01-01

    Synovial chondromatosis is a rare metaplasia of the synovium of unknown etiology that may involve occasionally the subacromial bursa. We report a new case diagnosed by ultrasound in a 30-year-old man and we present pathogenetic, diagnostic and therapeutic features of this disease with a literature review.

  9. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis.

    NARCIS (Netherlands)

    Ottenheijm, R.P.; Jansen, M.J.; Staal, J.B.; Bruel, A. van den; Weijers, R.E.; Bie, R.A. de; Dinant, G.J.

    2010-01-01

    OBJECTIVE: To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings. DATA SOURCES: Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included

  10. Current Status of Open Surgical Treatment Protocols for Subacromial Impingement Syndrome Associated with Rotator Tear

    Directory of Open Access Journals (Sweden)

    Oktay Gazi

    2012-06-01

    Full Text Available Objective: The aim of this study was to evaluate the recent treatment protocols for Neer stage III subacromial impingement syndrome with open anterior acromioplasty and rotator cuff repair. Material and Methods: Twenty-two patients (8 males, 14 females; mean age: 52.9±10.2 who were diagnosed with a rotator cuff tear based on clinical and radiological findings between 2009 and 2010 participated in the study.. We used the open surgical decompression technique which was previously described by Neer. The ruptured tendon ends were isolated and were fixed to the bones with appropriate suture anchors and transosseoz sutures. Preoperative, postoperative and the final follow-up Constant and UCLA shoulder scores were evaluated. Results: The mean preoperative Constant score was 34.4±6.6 and UCLA score was 13.8±3.3. The mean postoperative Constant score was 73±7.6 and UCLA score was 31.7±3.3. Significant improvement was observed in postoperative shoulder scores (p<0.01 and postoperative shoulder range of motion in all patients (p<0.01. Conclusion: Currently, clinical and functional results of open and arthroscopic subacromial rotator cuff decompression are similar. However, many surgeons prefer the open method and achieve successful results. (The Me di cal Bul le tin of Ha se ki 2012; 50: 59-63

  11. Is there evidence in favor of surgical interventions for the subacromial impingement syndrome?

    Science.gov (United States)

    Tashjian, Robert Z

    2013-09-01

    To investigate the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome (SIS). Using terms including randomized controlled trial (RCT), shoulder impingement syndrome, rotator cuff impingement, and interventions, the Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched up to February 2009. Relevant systematic reviews and RCTs in any language that included patients with SIS that was not caused by systemic disease or acute trauma; that evaluated surgical or postsurgical treatment for SIS; that reported outcomes of pain, function, or recovery; and that had a follow-up of ≥ 2 weeks, were selected by 2 independent reviewers and confirmed by consensus. Data on the study population, interventions, outcome measures, and length of follow-up (6 months) were extracted. Two reviewers assessed the methods of the RCTs that were included in reviews other than Cochrane reviews and in RCTs published more recently, rating RCTs that met 6 of 12 Furlan criteria as high quality. The effectiveness of the intervention was rated as moderate, limited, or no evidence, depending on the consistency and quality of the evidence. The included studies were 11 RCTs from a Cochrane review, an additional 2 RCTs that reported on the effectiveness of surgery for SIS, and 3 further RCTs that reported on postsurgical interventions. The quality of the studies was generally poor (10/11 RCTs in the Cochrane review had a high risk of bias; and 3 of the additional RCTs were rated moderate to low quality). Arthroscopic or open subacromial decompression compared with physiotherapy or exercise was investigated in 3 trials. No evidence for differences between the treatments in pain, function, or time to recovery was found in the short, medium, or long term. Five comparisons of arthroscopic versus open subacromial decompression showed no differences in pain or shoulder function scores at any follow-up assessment. One study found no difference in short- or

  12. Rigid shoulder taping with physiotherapy in patients with subacromial pain syndrome: A randomized controlled trial.

    Science.gov (United States)

    Apeldoorn, Adri T; Kamper, Steven J; Kalter, Joeri; Knol, Dirk L; van Tulder, Maurits W; Ostelo, Raymond W

    2017-04-06

    To assess the effectiveness of individualized physiotherapy in combination with rigid taping compared with individualized physiotherapy alone in patients with subacromial pain syndrome. A prospective randomized trial with concealed allocation. A total of 140 patients between 18 and 65 years of age from primary physiotherapy settings. The intervention group received individualized physiotherapy and shoulder taping. The control group received individualized physiotherapy only. Primary outcomes were: pain intensit (numerical rating scale) and functioning (Simple Shoulder Test). Secondary outcomes were: global perceived effect and patient-specific complaints. Data were collected at baseline, and at 4, 12 and 26 weeks' follow-up. During the 6-month follow-up period multilevel analysis showed a significant difference between groups favouring the control group on pain intensity (p = 0.02), but not on functioning. Regarding secondary outcomes, a significant difference between groups was found favouring the intervention group for global perceived effect (p = 0.02), but not for patient-specific complaints. Rigid shoulder taping, as used in this study, cannot be recommended for improving physiotherapy outcomes in people with subacromial pain syndrome.

  13. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Science.gov (United States)

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  14. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    Science.gov (United States)

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  15. Neuromuscular control of scapula muscles during a voluntary task in subjects with Subacromial Impingement Syndrome

    DEFF Research Database (Denmark)

    Larsen, C M; Søgaard, Karen; Chreiteh, S S

    2013-01-01

    Imbalance of neuromuscular activity in the scapula stabilizers in subjects with Subacromial Impingement Syndrome (SIS) is described in restricted tasks and specific populations. Our aim was to compare the scapular muscle activity during a voluntary movement task in a general population with and w......Imbalance of neuromuscular activity in the scapula stabilizers in subjects with Subacromial Impingement Syndrome (SIS) is described in restricted tasks and specific populations. Our aim was to compare the scapular muscle activity during a voluntary movement task in a general population...... with and without SIS (n=16, No-SIS=15). Surface electromyography was measured from Serratus anterior (SA) and Trapezius during bilateral arm elevation (no-load, 1kg, 3kg). Mean relative muscle activity was calculated for SA and the upper (UT) and lower part of trapezius (LWT), in addition to activation ratio...... and time to activity onset. In spite of a tendency to higher activity among SIS 0.10-0.30 between-group differences were not significant neither in ratio of muscle activation 0.80-0.98 nor time to activity onset 0.53-0.98. The hypothesized between-group differences in neuromuscular activity of Trapezius...

  16. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    José L. Arias-Buría

    2015-01-01

    Full Text Available Objective. To compare effects of ultrasound- (US- guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n=17 group or exercise (n=19 group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions. Shoulder pain (NPRS and disability (DASH were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P<0.01: individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  17. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis.

    Science.gov (United States)

    Shire, Alison R; Stæhr, Thor A B; Overby, Jesper B; Bastholm Dahl, Mathias; Sandell Jacobsen, Julie; Høyrup Christiansen, David

    2017-04-17

    Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function. There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the

  18. Targeted knockout of TNF-α by injection of lentivirus-mediated siRNA into the subacromial bursa for the treatment of subacromial bursitis in rats.

    Science.gov (United States)

    Wang, Yi; Li, Quan; Wei, Xianzhao; Xu, Jie; Chen, Qi; Song, Shuang; Lu, Zhe; Wang, Zimin

    2015-09-01

    Subacromial bursitis (SAB) is the major source of pain in rotator cuff disease. Although multiple investigations have provided support for the role of inflammatory cytokines in SAB, few have focussed on the use these cytokines in the treatment of SAB. The aim of the present study was to observe the therapeutic efficacy of lentivirus‑mediated RNA interference (RNAi) on carrageenan‑induced SAB by injecting lentivirus‑tumor necrosis factor (TNF)‑α‑RNAi expressing TNF‑α small interfering (si)RNA. Using screened siRNA segments, an siRNA was designed. A lentivirus vector expressing siRNA was established and packed as lentivirus particles. A lentivirus that expressed the negative sequence was used as a lentivirus‑negative control (NC). The carrageenan‑induced SAB model was established in 32 male Sprague‑Dawley rats. The modeled rats were randomly assigned to four groups: Lentivirus‑RNAi treatment group, lentivirus‑NC group, SAB group and phosphate‑buffered saline (PBS) blank control group. The lentivirus was injected (1x10(7) transducing units) into the subacromial bursa of the rats in the lentivirus‑RNAi group and lentivirus‑NC group, whereas 100 µl PBS was injected at the same site in the SAB group and the PBS blank control group. At 5 weeks following injection, the animals were sacrificed and venous blood was obtained. The effect of TNF‑α interference and the expression of inflammatory cytokines were determined by reverse transcription‑quantitative polymerase chain reaction, western blotting, hematoxylin and eosin staining, Van Gieson's staining and immunofluorescence. The expression of TNF‑α was decreased in the lentivirus‑TNF‑α‑RNAi group compared with that in the SAB group. Morphological observations revealed that the number of inflammatory cells were reduced and damage to tendon fibers was attenuated in this group, suggesting that the downregulation of the protein expression levels of TNF‑α‑associated nuclear

  19. Upper Incisor Changes Due to Modifying the Point of Application of Forces during Space Closure in MBT Technique

    National Research Council Canada - National Science Library

    H. Ravanmehr; F. Abdolhosseini

    2004-01-01

    .... Although this technique has many advantages, in space closure stage causes up righting problem in upper incisors, which should be adjusted by applying additional torque in anterior region.Purpose...

  20. Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

    Science.gov (United States)

    Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

    2016-08-01

    The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate

  1. Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Arias-Buría, José L; Fernández-de-Las-Peñas, César; Palacios-Ceña, María; Koppenhaver, Shane L; Salom-Moreno, Jaime

    2017-01-01

    This randomized clinical trial investigated the effectiveness of exercise versus exercise plus trigger point (TrP) dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise plus TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise plus TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the second and fourth sessions. The primary outcome was pain-related disability assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcomes included mean current pain and the worst pain experienced in the shoulder during the previous week. They were assessed at baseline, 1 week, and 3, 6, and 12 months after the end of treatment. Analysis was according to intention to treat with mixed analysis of covariance adjusted for baseline outcomes. At 12 months, 47 patients (94%) completed follow-up. Statistically larger improvements (all, P < .01) in shoulder disability was found for the exercise plus TrP-DN group at all follow-up periods (post: Δ -20.6 [95% confidence interval (CI) -23.8 to -17.4]; 3 months: Δ -23.2 [95% CI -28.3 to -18.1)]; 6 months: Δ -23.6 [95% CI -28.9 to -18.3]; 12 months: Δ -13.9 [95% CI -17.5 to -10.3]). Both groups exhibited similar improvements in shoulder pain outcomes at all follow-up periods. The inclusion of TrP-DN with an exercise program was effective for improving disability in subacromial pain syndrome. No greater improvements in shoulder pain were observed. This study found that the inclusion of 2 sessions of TrP-DN into an exercise program was effective for improving shoulder pain-related disability at short-, medium-, and long-term; however, no greater

  2. Arthroscopic treatment of a case with concomitant subacromial and subdeltoid synovial chondromatosis and labrum tear.

    Science.gov (United States)

    Aydogan, Nevres Hurriyet; Kocadal, Onur; Ozmeric, Ahmet; Aktekin, Cem Nuri

    2013-01-01

    Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

  3. Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis.

    Science.gov (United States)

    Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y

    2016-05-01

    Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.

  4. The activity pattern of shoulder muscles in subjects with and without subacromial impingement

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Nørregaard, Jesper; Dyhre-Poulsen, Poul

    2009-01-01

    Altered shoulder muscle activity is frequently believed to be a pathogenetic factor of subacromial impingement (SI) and therapeutic interventions have been directed towards restoring normal motor patterns. Still, there is a lack of scientific evidence regarding the changes in muscle activity...... in patients with SI. The aim of the study was to determine and compare the activity pattern of the shoulder muscles in subjects with and without SI. Twenty-one subjects with SI and 20 healthy controls were included. Electromyography (EMG) was assessed from eight shoulder muscles from both shoulders during...... and serratus anterior muscles on the symptomatic side compared to the healthy subjects. On the asymptomatic side, the groups showed different muscle activity during external rotation. Our findings of an altered shoulder muscle activity pattern on both the symptomatic and asymptomatic side in patients indicate...

  5. Pathological Fracture of Clavicle Following Sub-Acromial Decompression-Infraclavicular Compartment Syndrome?

    Directory of Open Access Journals (Sweden)

    S Mukhopadhyay

    2009-11-01

    Full Text Available A 34-year-old factory worker presented with pain and weakness of the left shoulder following a fall on ice on her left shoulder. An ultrasound scan of the shoulder taken 4 months after injury showed small partial articular surface tear of the supraspinatus tendon. Ten days following subacromial decompression she suffered a pathological fracture of her left clavicle. MRI, CT, and isotope bone scans showed no evidence of malignancy or infection but a collection of fluid was noted underlying the clavicle communicating to the acromioclavicular joint. Ultrasound scan guided aspiration of 20 millilitres of bloodstained fluid underlying the clavicle resulted in gradual recovery and adequate healing of the fracture.

  6. Arthroscopic Treatment of a Case with Concomitant Subacromial and Subdeltoid Synovial Chondromatosis and Labrum Tear

    Directory of Open Access Journals (Sweden)

    Nevres Hurriyet Aydogan

    2013-01-01

    Full Text Available Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

  7. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Monu, J.U.V. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pruett, S. [Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Vanarthos, W.J. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pope, T.L. Jr. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States)

    1994-10-01

    Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenbid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery. (orig.)

  8. Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Lund, Hans; Juul-Kristensen, Birgit

    Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics Larsen CM1, Juul-Kristensen B1,2 Holtermann A3, Lund H1,2, Søgaard K1 1University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, DK 2Institute...... patient sample with SIS, and to assess the clinimetric properties of clinical assessment methods of scapular kinematics as important aspects for optimising effect measures of treatment in order to improve clinical guidelines in this area. METHODS: Scapular muscle activity was examined, 1) during...... a voluntary arm movement task and 2) selective activation tasks during sessions with and without on-line biofeedback, in a general population consisting of 16 SIS patients and 15 controls (No-SIS). Furthermore, 3) a systematic review was conducted of all available clinical scapular assessment methods...

  9. 2-D deformation of two welded half-spaces due to a blind dip-slip fault

    Indian Academy of Sciences (India)

    The solution of two-dimensional problem of an interface breaking long inclined dip-slip fault in two welded half-spaces is well known. The purpose of this note is to obtain the corresponding solution for a blind fault. The solution is valid for arbitrary values of the fault-depth and the dip angle. Graphs showing the variation of ...

  10. Taping patients with clinical signs of subacromial impingement syndrome: the design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Knol Dirk L

    2011-08-01

    Full Text Available Abstract Background Shoulder problems are a common complaint of the musculoskeletal system. Physical therapists treat these patients with different modalities such as exercise, massage, and shoulder taping. Although different techniques have been described, the effectiveness of taping has not yet been established. The aim of this study is to assess the effectiveness and cost-effectiveness of usual physical therapy care in combination with a particular tape technique for subacromial impingement syndrome of the shoulder compared to usual physical therapy care without this tape technique in a primary healthcare setting. Methods and design An economic evaluation alongside a randomized controlled trial will be conducted. A sample of 140 patients between 18 and 65 years of age with a diagnosis of subacromial impingement syndrome (SAIS as assessed by physical therapists will be recruited. Eligible patients will be randomized to either the intervention group (usual care in combination with the particular tape technique or the control group (usual care without this tape technique. In both groups, usual care will consist of individualized physical therapy care. The primary outcomes will be shoulder-specific function (the Simple Shoulder Test and pain severity (11-point numerical rating scale. The economic evaluation will be performed using a societal perspective. All relevant costs will be registered using cost diaries. Utilities (Quality Adjusted Life Years will be measured using the EuroQol. The data will be collected at baseline, and 4, 12, and 26 weeks follow-up. Discussion This pragmatic study will provide information about the effectiveness and cost-effectiveness of taping in patients presenting with clinical signs of SAIS. Trial registration Trial registration number: NTR2575

  11. A specific exercise strategy reduced the need for surgery in subacromial pain patients.

    Science.gov (United States)

    Hallgren, Hanna C Björnsson; Holmgren, Theresa; Oberg, Birgitta; Johansson, Kajsa; Adolfsson, Lars E

    2014-10-01

    A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome. 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion. All patients had improved significantly (p<0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons. The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome. Clinical trials NCT01037673. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. A relativistic self-consistent model for studying enhancement of space charge limited emission due to counter-streaming ions

    Science.gov (United States)

    Lin, M. C.; Verboncoeur, J.

    2016-10-01

    A maximum electron current transmitted through a planar diode gap is limited by space charge of electrons dwelling across the gap region, the so called space charge limited (SCL) emission. By introducing a counter-streaming ion flow to neutralize the electron charge density, the SCL emission can be dramatically raised, so electron current transmission gets enhanced. In this work, we have developed a relativistic self-consistent model for studying the enhancement of maximum transmission by a counter-streaming ion current. The maximum enhancement is found when the ion effect is saturated, as shown analytically. The solutions in non-relativistic, intermediate, and ultra-relativistic regimes are obtained and verified with 1-D particle-in-cell simulations. This self-consistent model is general and can also serve as a comparison for verification of simulation codes, as well as extension to higher dimensions.

  13. Phase-space holes due to electron and ion beams accelerated by a current-driven potential ramp

    Directory of Open Access Journals (Sweden)

    M. V. Goldman

    2003-01-01

    Full Text Available One-dimensional open-boundary simulations have been carried out in a current-carrying plasma seeded with a neutral density depression and with no initial electric field. These simulations show the development of a variety of nonlinear localized electric field structures: double layers (unipolar localized fields, fast electron phase-space holes (bipolar fields moving in the direction of electrons accelerated by the double layer and trains of slow alternating electron and ion phase-space holes (wave-like fields moving in the direction of ions accelerated by the double layer. The principal new result in this paper is to show by means of a linear stability analysis that the slow-moving trains of electron and ion holes are likely to be the result of saturation via trapping of a kinetic-Buneman instability driven by the interaction of accelerated ions with unaccelerated electrons.

  14. 2-D deformation of two welded half-spaces due to a blind dip-slip fault

    Indian Academy of Sciences (India)

    The solution of two-dimensional problem of an interface breaking long inclined dip-slip fault in two welded half-spaces is well known.The purpose of this note is to obtain the corresponding solution for a blind fault.The solution is valid for arbitrary values of the fault-depth and the dip angle.Graphs showing the variation of the ...

  15. Upper Incisor Changes Due to Modifying the Point of Application of Forces during Space Closure in MBT Technique

    OpenAIRE

    H. Ravanmehr; F. Abdolhosseini

    2004-01-01

    Statement of Problem: A recent technique (MBT) has been introduced for easy and efficient orthodontic treatment by means of straight wire fixed appliances. Although this technique has many advantages, in space closure stage causes up righting problem in upper incisors, which should be adjusted by applying additional torque in anterior region.Purpose: The purpose of this clinical trial was to determine whether there is a significant difference in final incisor inclination (torque) of two group...

  16. Upper Incisor Changes Due to Modifying the Point of Application of Forces during Space Closure in MBT Technique

    Directory of Open Access Journals (Sweden)

    H. Ravanmehr

    2004-06-01

    Full Text Available Statement of Problem: A recent technique (MBT has been introduced for easy and efficient orthodontic treatment by means of straight wire fixed appliances. Although this technique has many advantages, in space closure stage causes up righting problem in upper incisors, which should be adjusted by applying additional torque in anterior region.Purpose: The purpose of this clinical trial was to determine whether there is a significant difference in final incisor inclination (torque of two groups one treated with MBT technique and the other by changing the point of application of the closing force (in anterior region.Materials and Methods: Twelve patients (8 girls, 4 boys with Cl I malocclusion and crowding, whom were candidate for first premolars extraction, were selected.For space closure, 6 anterior teeth (canine to canine in upper and lower jaws ligated and the applied force was from the hooks on canines to hooks on the first molars.After space closure the results compared with the results of a previous study which treatment plan was according to original MBT technique (anterior hooks soldered to arch wire. Forces applied randomly among quadrants by NiTi coil spring (American Orthodontics Co. or active tie backs with elastic modules (Dentaurum Co.Results: The results showed a statistically significant difference between final torques of two techniques (P=0.0001. Also, the rate of space closure with NiTi coils was significantly greater than active tie back (P=0.0001.Conclusion: Anchorage loss in two groups compared and the results indicated significantly lower anchorage loss in NiTi coil spring group (P=0.035.

  17. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects.

    Science.gov (United States)

    Zanetti, M; Jost, B; Hodler, J; Gerber, C

    2000-06-01

    To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27-53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined. Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6-11 mm) than in the symptomatic group (mean 32 mm, range 7-50 mm) (t-test, P = 0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P > 0.05) between asymptomatic (mean 28 x 3 mm) and symptomatic patients (mean 32 x 3 mm). Small residual defects or retears (Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant.

  18. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects

    Energy Technology Data Exchange (ETDEWEB)

    Zanetti, M.; Hodler, J. [Dept. of Radiology, University Hospital Balgrist, Zurich (Switzerland); Jost, B.; Gerber, C. [Dept. of Orthopedic Surgery, University Hospital Balgrist, Zurich (Switzerland)

    2000-06-01

    Objective. To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings.Design and patients. Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27-53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined.Results. Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6-11 mm) than in the symptomatic group (mean 32 mm, range 7-50 mm) (t-test, P=0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P>0.05) between asymptomatic (mean 28 x 3 mm) and symptomatic patients (mean 32 x 3 mm).Conclusion. Small residual defects or retears (<1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant. (orig.)

  19. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association.

    Science.gov (United States)

    Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

    2014-06-01

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears.

  20. The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study.

    Science.gov (United States)

    Chillemi, Claudio; Petrozza, Vincenzo; Franceschini, Vincenzo; Garro, Luca; Pacchiarotti, Alberto; Porta, Natale; Cirenza, Mirko; Salate Santone, Francesco; Castagna, Alessandro

    2016-12-01

    To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P bursa were directly associated with pain (P bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. IV.

  1. Effect of dynamic humeral centring (DHC) treatment on painful active elevation of the arm in subacromial impingement syndrome. Secondary analysis of data from an RCT.

    Science.gov (United States)

    Beaudreuil, Johann; Lasbleiz, Sandra; Aout, Mounir; Vicaut, Eric; Yelnik, Alain; Bardin, Thomas; Orcel, Philippe

    2015-03-01

    The physiotherapy dynamic humeral centring (DHC) aims to prevent subacromial impingement of rotator cuff tendons during elevation of the arm. The objective of the study was to determine whether DHC acts via an effect on subacromial impingement mechanism by assessing its effect on painful elevation of the arm in subacromial impingement syndrome. This is a secondary analysis of results of a randomised controlled trial of the effectiveness of DHC. Sixty-nine patients with subacromial impingement syndrome were prospectively included. Patients and the assessor were blinded to the study hypothesis and treatment, respectively. Patients underwent DHC or non-specific mobilisation as a control for 6 weeks in 15 supervised individual outpatient sessions with home exercises. Outcomes were pain-free range of motion and presence of painful arc of the shoulder, both in active flexion and abduction of the arm at 3 months. At 3 months, pain-free range of motion, both flexion and abduction, was greater in the DHC group than in the mobilisation group. The number of patients with painful arc during flexion was decreased in the DHC group. DHC improves painful active elevation of the arm. We suggest that DHC may act via a specific effect on subacromial impingement mechanism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Decrease in the numbers of dendritic cells and CD4+ T cells in cerebral perivascular spaces due to natalizumab.

    Science.gov (United States)

    del Pilar Martin, Maria; Cravens, Petra D; Winger, Ryan; Frohman, Elliot M; Racke, Michael K; Eagar, Todd N; Zamvil, Scott S; Weber, Martin S; Hemmer, Bernhard; Karandikar, Nitin J; Kleinschmidt-DeMasters, B K; Stüve, Olaf

    2008-12-01

    To extend our studies on the prolonged and differential effect of natalizumab on T lymphocyte numbers in the cerebrospinal fluid, we investigated the number and phenotypes of leukocytes and the expression of major histocompatibility complex (MHC) classes I and II in cerebral perivascular spaces (CPVS). We hypothesized that natalizumab reduces the number of antigen presenting cells in CPVS. A case-control study in which inflammatory cell numbers in the CPVS of cerebral tissue were assessed by immunohistochemical staining. A patient with multiple sclerosis (MS) who developed progressive multifocal leukoencephalopathy (PML) during natalizumab therapy. Controls included location-matched cerebral autopsy material of patients without disease of the central nervous system, patients with MS not treated with natalizumab, and patients with PML not associated with natalizumab therapy. The absolute number of CPVS in the patient with MS treated with natalizumab was significantly lower than in the control groups owing to extensive destruction of the tissue architecture. The expression of MHC class II molecules and the number of CD209+ dendritic cells were significantly decreased in the CPVS of the patient with MS treated with natalizumab. No CD4+ T cells were detectable. Our observations may explain the differential and prolonged effects of natalizumab therapy on leukocyte numbers in the cerebrospinal fluid.

  3. A Theory of the Podkletnov Effect based on General Relativity: Anti-Gravity Force due to the Perturbed Non-Holonomic Background of Space

    Directory of Open Access Journals (Sweden)

    Rabounski D.

    2007-07-01

    Full Text Available We consider the Podkletnov effect — the weight loss of an object located over a superconducting disc in air due to support by an alternating magnetic field. We consider this problem using the mathematical methods of General Relativity. We show via Einstein’s equations and the geodesic equations in a space perturbed by a disc undergoing oscillatory bounces orthogonal to its own plane, that there is no r ˆ ole of superconductivity; the Podkletnov effect is due to the fact that the field of the background space non-holonomity (the basic non-othogonality of time lines to the spatial section, being perturbed by such an oscillating disc produces energy and momentum flow in order to compensate the perturbation in itself. Such a momentum flow is directed above the disc in Podkletnov’s experiment, so it works like negative gravity (anti-gravity. We propose a simple mechanical system which, simulating the Podkletnov effect, is an experimental test of the whole theory. The theory allows for other “anti-gravity devices”, which simulate the Podkletnov effect without use of very costly superconductor technology. Such devices could be applied to be used as a cheap source of new energy, and could have implications to air and space travel.

  4. Shoulder Retractor Strengthening Exercise to Minimize Rhomboid Muscle Activity and Subacromial Impingement

    Science.gov (United States)

    Fennell, Jeremy; Mochizuki, George; Ismail, Farooq; Boulias, Chris

    2016-01-01

    Purpose: We investigated the best position for shoulder retractor strengthening exercise to maximize middle trapezius activity and minimize rhomboid major activity. Although both trapezius and rhomboids are scapular retractors, rhomboids also act as downward rotators of the scapula, which can worsen subacromial impingement. Methods: Twelve healthy participants (age 30 [SD 6] y) with no history of shoulder pain were recruited for this study, which used fine-wire electromyography to examine maximal muscle activation of the middle trapezius and rhomboid major muscle fibres in four different positions: with the shoulder in 90° abduction with elbow completely extended and (1) shoulder internal rotation, (2) shoulder neutral rotation, (3) shoulder external rotation, and (4) rowing (shoulder neutral rotation and elbow flexed 90°). The ratio of trapezius to rhomboid muscles was compared with Wilcoxon signed-rank tests. Results: Muscle activation ratio during shoulder retraction exercise was significantly lower by 22% (i.e., rhomboid was more active than middle trapezius) when performed with the shoulder in rowing position (elbow flexed) than with the shoulder in external rotation (elbow extended) position (p=0.031). All four positions produced coactivation of trapezius and rhomboids. Discussion: Rowing position may not be the best position for shoulder retractor strengthening in patients with impingement syndrome. The preferable position for maximizing middle trapezius activity and minimizing rhomboid activity may be shoulder external rotation with elbow extended. PMID:27504044

  5. Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: biomechanical studies in rats.

    Science.gov (United States)

    Dolkart, Oleg; Chechik, Ofir; Bivas, Assaf; Brosh, Tamar; Drexler, Michael; Weinerman, Zachary; Maman, Eran

    2017-10-01

    Arthroscopic rotator cuff (RC) repair incorporates suture anchors to secure torn RC tendons to the greater tuberosity (GT) bone. RC repair strength depends on the anchor-bone interface and on the quality of the GT. We evaluated the effect of single and multiple corticosteroid injections on the pullout strength of suture anchors. Fifty rats were divided into those receiving saline solution injection (control group), a single methylprednisolone acetate (MTA) injection (MTA1 group), or 3 once-weekly MTA injections (MTA3 group). Rats were killed humanely at 1 or 4 weeks after the last injection. A mini-suture anchor was inserted into the humeral head through the GT. Specimens were tested biomechanically. At 1 week after the last injection, the mean maximal pullout strength was significantly reduced in the MTA1 group (63.5%) and MTA3 group (56%) compared with the control group (P suture anchor at 1 week. However, this effect was transient and resolved within a relatively short period. These findings indicate that a waiting period is required between subacromial corticosteroid injection and RC repair surgery that involves the use of suture anchors. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study.

    Science.gov (United States)

    Draghi, Ferdinando; Scudeller, Luigia; Draghi, Anna Guja; Bortolotto, Chandra

    2015-06-01

    The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01. Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.

  7. Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie

    Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics Larsen CM1, Juul-Kristensen B1,2 Holtermann A3, Lund H1,2, Søgaard K1 1University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, DK 2Institute of Oc...... benefit from biofeedback training. Lastly, these results indicate that very few clinical assessment methods have sufficient clinimetric properties that can be recommended for clinical use....... a voluntary arm movement task and 2) selective activation tasks during sessions with and without on-line biofeedback, in a general population consisting of 16 SIS patients and 15 controls (No-SIS). Furthermore, 3) a systematic review was conducted of all available clinical scapular assessment methods...... parts were below 1.5% activity or (ii) an activation ratio above 95% of the total activity of all muscles, significantly fewer SIS subjects than No-SIS subjects achieved selective activation of individual scapular muscle compartments without on-line biofeedback of muscle activity from each muscle...

  8. Relationship between acromial morphological variation and subacromial impingement: A three-dimensional analysis.

    Science.gov (United States)

    Li, Xinyu; Xu, Wei; Hu, Ning; Liang, Xi; Huang, Wei; Jiang, Dianming; Chen, Hong

    2017-01-01

    To evaluate the association of acromial morphology and subacromial impingement. Bilateral shoulder computed tomography was performed in 138 patients who received shoulder arthroscopy. Measured parameters included: acromial tilt (AT), modified acromial tilt (mAT), acromial slope (AS), acromiohumeral interval (AHI), lateral acromial angle (LAA), acromial index (AI), critical shoulder angle (CSA), acromial anterior protrusion (AAP), and acromial inferior protrusion (AIP). Acromial morphological characteristics were compared between groups. Side-to-side differences were assessed between affected and non-affected shoulders. Intra- and inter-observer agreements for each parameter were calculated. AT (25.90 vs. 29.41°), mAT (18.88 vs. 22.64°), and AHI (5.46 vs. 6.47 mm) were significantly smaller in impinged patients. The impingement group demonstrated significantly larger AI (63.50 vs. 59.84%), CSA (31.78 vs. 28.74°), AAP (7.13 vs. 5.32 mm), and AIP (5.51 vs. 4.04 mm). Regarding side-to-side comparison, the acromial morphology was significantly different between the affected and non-affected shoulders in impinged patients, while the difference was slight and insignificant in control patients. All, except AS and LAA, measured parameters demonstrated good intra- and inter-observer agreements. Three-dimensional reconstructed CT scan is a reliable method to measure shoulder morphology. The acromial morphological variation is related with sub acromial impingement, however, the causal relationship of them should be further explored.

  9. Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue.

    Science.gov (United States)

    Alizadehkhaiyat, Omid; Roebuck, Margaret M; Makki, Ahmed T; Frostick, Simon P

    2018-02-01

    Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome.

    Science.gov (United States)

    Ribeiro, I L; Camargo, P R; Alburquerque-Sendín, F; Madeleine, P; Fernández-de-las-Peñas, C; Salvini, T F

    2016-02-01

    Topographical pain maps (TPM) are useful tools to assess deep tissue sensitivity in musculoskeletal pain conditions. There is evidence suggesting bilateral sensitivity in subacromial pain syndrome (SAPS), although it is not widely accepted. No previous study has investigated TPM of the shoulder in SAPS. To investigate whether differences for TPM of the shoulder are evident among patients with unilateral SAPS and controls. Pressure pain thresholds (PPTs) were assessed 3 times at each point and there was a 20 s rest period between each one. The TPM were calculated using 29 pre-determined points on both shoulders in all groups by inverse distance weighted interpolation of PPT data. Multivariate Analysis of Covariance was applied to detect differences in PPTs between groups, sides, points (gender as covariate). The results revealed significant differences between points and genders (both, P shoulder. Women exhibited bilateral lower PPTs in all points than men in both groups (all, P shoulder. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Stromal cell-derived factor 1 (SDF-1, CXCL12) is increased in subacromial bursitis and downregulated by steroid and nonsteroidal anti-inflammatory agents.

    Science.gov (United States)

    Kim, Yang-Soo; Bigliani, Louis U; Fujisawa, Motoyuki; Murakami, Koko; Chang, Seong-Sil; Lee, Hahn-Jun; Lee, Francis Y; Blaine, Theodore A

    2006-08-01

    Several studies have demonstrated that inflammation in the subacromial bursa is an important component in the pathogenesis of impingement syndrome. We have demonstrated in a previous study that many inflammatory cytokines, including stromal cell-derived factor 1 (SDF-1, CXCL12), are increased in the subacromial bursa [Blaine et al. 2005. J Shoulder Elbow Surg 14(Suppl 1):84S-89S]. SDF-1 is a potent chemotactic and angiogenic factor that stimulates recruitment of inflammatory cells. In the current study, we proposed that the resident cells in subacromial bursal tissue produce SDF-1, which can play a role in the inflammatory reponse of bursal tissue, and that this chemokine can be regulated by steroid (dexamethasone) and nonsteroidal anti-inflammatory medications (NSAIDs). Twenty-two subacromial bursa tissues (18 bursitis and 4 normal bursa) were obtained intraoperatively from patients during shoulder surgery and analyzed using the cDNA Array technique in accordance with an IRB approved protocol. cDNA array results were confirmed with real-time reverse transcription-polymerase chain reaction (RT-PCR). Bursal cells (from 4 normal bursa, 3 bursitis) and two normal bone marrow with whole tissue explants were cultured for one passage. Cell culture supernatants were collected and SDF-1 protein was detected with enzyme-linked immunosorbent assay (ELISA). Cultured bursal cells were treated with a COX-2 inhibitor and dexamethasone, and cells was harvested at 1-day and 4-day intervals. SDF-1 expression was evaluated by real-time RT-PCR and ELISA. cDNA Array analysis demonstrated that the gene expression of SDF-1 was increased in patients with subacromial bursitis compared to controls (p bursitis tissue is increased 10-fold over control tissue. While the normal bursal cells produced negligible amounts of SDF-1 protein, cultured cells derived from bursitis lesion released as much SDF-1 protein (235 pg/100,000 cells) as normal bone marrow stromal cells (283 pg/100,000 cells) as

  12. Efectividad del tratamiento invasivo de los puntos gatillo miofasciales en la mejora del dolor y el ROM en pacientes diagnosticados de síndrome de pinzamiento subacromial.

    OpenAIRE

    Ropero Tena, Eric

    2015-01-01

    ¿Es el tratamiento invasivo de punción seca una intervención eficaz en el síndrome de pinzamiento subacromial para disminuir el dolor y aumentar el rango de movilidad articular? Objetivos: Valorar la efectividad a corto y largo plazo del tratamiento invasivo de los PGM en pacientes diagnosticados de síndrome de pinzamiento subacromial con más de 6 meses de persistencia de los síntomas. Metodología: Se realizará un estudio experimental de tipo ensayo clínico aleatorio controlado y de cie...

  13. Estudio sobre la eficacia de la educación y los ejercicios terapéuticos en el tratamiento del síndrome subacromial.

    OpenAIRE

    Vidal Prat, Núria

    2014-01-01

    OBJETIVO: Valorar la eficacia de la educación y los ejercicios terapéuticos en el síndrome subacromial. MATERIAL Y METODOS: Se realizará un estudio en sujetos diagnosticados de síndrome subacromial entre 35 y 70 años de edad, derivados al servicio de rehabilitación del Hospital Santa Maria de Lleida. Ensayo controlado aleatorio, con muestreo consecutivo de duración de 6 meses. El programa de intervención con un periodo de duración de 3 semanas, estará compuesto por un grupo control que per...

  14. Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome.

    Science.gov (United States)

    Koppenhaver, Shane; Embry, Robin; Ciccarello, John; Waltrip, Justin; Pike, Rachel; Walker, Michael; Fernández-de-Las-Peñas, Cesar; Croy, Theodore; Flynn, Timothy

    2016-12-01

    Initial reports suggest that treating myofascial trigger points in the infraspinatus with dry needling may be effective in treating patients with shoulder pain. However, to date, high quality clinical trials and thorough knowledge of the physiologic mechanisms involved is lacking. To examine the effect of dry needling to the infraspinatus muscle on muscle function, nociceptive sensitivity, and shoulder range of motion (ROM) in the symptomatic and asymptomatic shoulders of individuals with unilateral subacromial pain syndrome. Within-subjects controlled trial. Fifty-seven volunteers with unilateral subacromial pain syndrome underwent one session of dry needling to bilateral infraspinatus muscles. Outcome assessments, including ultrasonic measures of infraspinatus muscle thickness, pressure algometry, shoulder internal rotation and horizontal adduction ROM, and questionnaires regarding pain and related disability were taken at baseline, immediately after dry needling, and 3-4 days later. Participants experienced statistically significant and clinically relevant changes in all self-report measures. Pressure pain threshold and ROM significantly increased 3-4 days, but not immediately after dry needling only in the symptomatic shoulder [Pressure pain threshold: 5.1 (2.2, 8.0) N/cm(2), internal rotation ROM: 9.6 (5.0, 14.1) degrees, horizontal adduction ROM: 5.9 (2.5, 9.4) degrees]. No significant changes occurred in resting or contracted infraspinatus muscle thickness in either shoulder. This study found changes in shoulder ROM and pain sensitivity, but not in muscle function, after dry needling to the infraspinatus muscle in participants with unilateral subacromial pain syndrome. These changes generally occurred 3-4 days after dry needling and only in the symptomatic shoulders. Published by Elsevier Ltd.

  15. Risk of Impaired Control of Spacecraft/Associated Systems and Decreased Mobility Due to Vestibular/Sensorimotor Alterations Associated with Space flight

    Science.gov (United States)

    Bloomberg, Jacob J.; Reschke, Millard F.; Clement, Gilles R.; Mulavara, Ajitkumar P.; Taylor, Laura C..

    2015-01-01

    Control of vehicles and other complex systems is a high-level integrative function of the central nervous system (CNS). It requires well-functioning subsystem performance, including good visual acuity, eye-hand coordination, spatial and geographic orientation perception, and cognitive function. Evidence from space flight research demonstrates that the function of each of these subsystems is altered by removing gravity, a fundamental orientation reference, which is sensed by vestibular, proprioceptive, and haptic receptors and used by the CNS for spatial orientation, posture, navigation, and coordination of movements. The available evidence also shows that the degree of alteration of each subsystem depends on a number of crew- and mission-related factors. There is only limited operational evidence that these alterations cause functional impacts on mission-critical vehicle (or complex system) control capabilities. Furthermore, while much of the operational performance data collected during space flight has not been available for independent analysis, those that have been reviewed are somewhat equivocal owing to uncontrolled (and/or unmeasured) environmental and/or engineering factors. Whether this can be improved by further analysis of previously inaccessible operational data or by development of new operational research protocols remains to be seen. The true operational risks will be estimable only after we have filled the knowledge gaps and when we can accurately assess integrated performance in off-nominal operational settings (Paloski et al. 2008). Thus, our current understanding of the Risk of Impaired Control of Spacecraft/Associated Systems and Decreased Mobility Due to Vestibular/Sensorimotor Alterations Associated with Space flight is limited primarily to extrapolation of scientific research findings, and, since there are limited ground-based analogs of the sensorimotor and vestibular changes associated with space flight, observation of their functional

  16. Evaluation of the effectiveness of three physiotherapeutic treatments for subacromial impingement syndrome: a randomised clinical trial.

    Science.gov (United States)

    Pérez-Merino, L; Casajuana, M C; Bernal, G; Faba, J; Astilleros, A E; González, R; Giralt, M; Romeu, M; Nogués, M R

    2016-03-01

    To determine whether dexketoprofen administered by phonophoresis or iontophoresis is more effective for the treatment of subacromial impingement syndrome (SIS) than conventional ultrasound therapy. Randomised clinical trial. University hospital. Ninety-nine participants with SIS without a complete tear of the rotator cuff were assigned at random to three intervention groups. Participants received ultrasound (n=32), phonophoresis with dexketoprofen (50mg/session) (n=33) or iontophoresis with dexketoprofen (50mg/session) (n=34). All participants completed 20 treatment sessions plus exercise therapy and cryotherapy. A visual analogue scale (VAS), the Constant-Murley Scale (CMS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were administered pre-treatment (baseline), post-treatment and 1 month post-treatment. At baseline, there were no differences between the groups. Post-treatment, VAS score improved by -1.2 points and CMS score improved by 8.9 points in the ultrasound group compared with the iontophoresis group [95% confidence interval (CI) -0.2 to -2.2 and 95% CI 17.0 to 0.7, respectively]. CMS score improved by 7.1 points in the phonophoresis group compared with the iontophoresis group (95% CI 14.8 to -0.7). At 1 month post-treatment, no significant differences were detected between the groups. VAS, CMS and DASH scores of all groups improved post-treatment and at 1 month post-treatment. Ultrasound, iontophoresis with dexketoprofen and phonophoresis with dexketoprofen can improve pain, shoulder function, and physical functioning and symptoms in the upper limb in patients with SIS without a complete tear of the rotator cuff. CLINICAL TRIALS. NCT01748188. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  17. Involvement of the anterior portion of the subacromial-subdeltoid bursa in the painful shoulder.

    Science.gov (United States)

    Stallenberg, Bernard; Destate, Nathalie; Feipel, Véronique; Gevenois, Pierre Alain

    2006-10-01

    The purpose of our study was to verify that increased widening of the anterior portion of the subacromial-subdeltoid bursa is associated with anteromedial shoulder pain. Bursography, sonography, and CT were performed in six cadaver shoulders and compared with anatomic sections in neutral position and while the humerus was extended and internally rotated. For the clinical study, the width of the anterior portion of the bursa was measured in both positions in both shoulders of 27 patients referred because of shoulder pain and in eight asymptomatic volunteers. Pain was coded as absent, experienced in the anteromedial portion of the shoulder, or experienced elsewhere but not anteromedially, and we compared the pain scores between shoulder positions. In all cadaver shoulders, when compared with CT scans and anatomic sections, sonography showed the morphology of the bursa, its relationships with surrounding structures, and morphologic changes associated with position. In volunteers, the mean width of the bursa was 0.74 +/- 0.05 and 0.93 +/- 0.09 mm (p = 0.013), respectively, in neutral and stress position. In patients, the same values were 0.70 +/- 0.07 and 0.81 +/- 0.14 mm (p = 0.286) in the asymptomatic side and 1.20 +/- 0.11 and 1.75 +/- 0.23 mm (p bursa was wider in patients experiencing pain anteromedially than in those who experienced pain elsewhere and volunteers (p = 0.002 and bursa was wider in symptomatic shoulders than in asymptomatic shoulders (p bursa is associated with anteromedial shoulder pain and the clinical syndrome of coracoid impingement.

  18. Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

    Science.gov (United States)

    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2014-11-01

    The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Clinical anatomy of the subacromial and related shoulder bursae: A review of the literature.

    Science.gov (United States)

    Kennedy, Marion S; Nicholson, Helen D; Woodley, Stephanie J

    2017-03-01

    The subacromial bursa (SAB) is the main bursa of the shoulder. It facilitates normal movement and is also commonly involved in shoulder disorders. Other shoulder bursae have been described but their anatomy has not been well studied. Anatomical variation of shoulder bursae has been suggested and this has implications for clinical practice. This article reviews current knowledge of the normal anatomy of the SAB and related shoulder bursae. A systematic review of the English and German literature was conducted using databases and a hand search of reference lists focusing on the clinical anatomy of the SAB, coracobrachial and subcoracoid bursae and subtendinous bursa of subscapularis. Twenty-four original sources and 13 textbooks were identified. Fifteen studies described the general morphology of the shoulder bursae using cadaveric specimens, eight examined innervation, and one provided information about the blood supply of the SAB. The literature agrees that the SAB is consistent and well innervated with a lateral subdeltoid part and a variable subcoracoid portion. There is variability regarding the consistency, location, and communications of the coracobrachial and subcoracoid bursae and the superior part of the subtendinous bursa of subscapularis, and little information on their nerve and blood supply. Several bursae are present around the shoulder joint. Further research is warranted to understand the precise attachments, dimensions, and communications of the bursae, as well as their nerve and blood supply. This information will improve understanding of the clinical relevance of these bursae and inform appropriate assessment and treatment. Clin. Anat. 30:213-226, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  20. Inter- and intrarater reliability of goniometry and hand held dynamometry for patients with subacromial impingement syndrome.

    Science.gov (United States)

    Fieseler, Georg; Laudner, Kevin G; Irlenbusch, Lars; Meyer, Henrike; Schulze, Stephan; Delank, Karl-Stefan; Hermassi, Souhail; Bartels, Thomas; Schwesig, René

    2017-12-01

    The purpose of this study was to examine the intra- and interrater reliability of measuring shoulder range of motion (ROM) and strength among patients diagnosed with subacromial impingement syndrome (SAIS). Twenty-five patients (14 female patients; mean age, 60.4± 7.84 years) diagnosed with SAIS were assessed to determine the intrarater reliability for glenohumeral ROM. Twenty-five patients (16 female patients; mean age, 60.4± 7.80 years) and 76 asymptomatic volunteers (52 female volunteers; mean age, 29.4± 14.1 years) were assessed for interrater reliability. Dependent variables were active shoulder ROM and isometric strength. Intrarater reliability was fair-to-excellent for the SAIS patients (intraclass correlation coefficient [ICC], 0.52-0.97; standard error of measurement [SEM], 4.4°-9.9° N; coefficient of variation [CV], 7.1%-44.9%). Based on the ICC, 11 of 12 parameters (92%) displayed an excellent reliability (ICC> 0.75). The interrater reliability showed fair-to-excellent results (SAIS patients: ICC, 0.13-0.98; SEM, 2.3°-8.8°; CV, 3.6%-37.0%; controls: ICC, 0.11-0.96; SEM, 3.0°-35.4°; CV, 5.6%-26.4%). In accordance with the intrarater reliability, glenohumeral adduction ROM was the only parameter with an ICC below 0.75 for both samples. Painful shoulder ROM in the SAIS patients showed no influence on the quality of reliability for measurement. Therefore, these protocols should be considered reliable assessment techniques in the prevention, diagnosis, and treatment of painful shoulder conditions such as SAIS.

  1. The Relationship between the Mean Platelet Volume and Subacromial Impingement Syndrome

    Directory of Open Access Journals (Sweden)

    Yalkın Çalık

    2015-04-01

    Full Text Available Objective: Subacromial impingement syndrome (SIS characterized by inflammation of supraspinatus tendon is one of the most common causes of the shoulder pain. In some studies, platelet activity has been shown as a marker to indicate the inflammation associated with the disease. The mean platelet volume (MPV shows platelet function and activation. The aim of this study was to investigate the relationship between MPV and SIS. Materials and Methods: Eighty seven inpatients (female/male: 55/32, mean age: 56.34±7.53 years diagnosed with SIS according to physical examination and MR findings in Bolu Physical Therapy and Rehabilitation Hospital between January 2014- June 2014 constituted the case group, 87 outpatients (female/male 61/26, mean age: 52.97±8.48 years not diagnosed with SIS constituted the control group. MPV values between case and control group that were similar in terms of age and gender were compared. Results: In case group MPV (8.36±0.73*** was lower than that of the control group (8.44±1.02**** and platelet count (253.75±50.17*** was higher than that of the control group (244.79±56.19***. Both were not statistically significant (p>0.05. Significant negative correlation was found between MPV and platelet level in case group (r=-0.240, p<0.05. Conclusion: These findings present that there is no relationship between MPV and SIS. New prospective studies are needed on this subject. (Turkish Journal of Osteoporosis 2015;21: 15-8

  2. Effects of Low-Load Exercise on Post-needling Induced Pain After Dry Needling of Active Trigger Point in Individuals with Subacromial Pain Syndrome.

    OpenAIRE

    Salom Moreno, Jaime; Jiménez Gómez, Laura; Gómez Ahufinger, Victoria; Palacios Ceña, María; Arias Buría, José Luis; Koppenhaver, Shane L.; Fernández de las Peñas, César

    2017-01-01

    Background: Application of dry needling is usually associated to post-needling induced pain. Development of post-needling intervention targeting to reduce this adverse event is needed. Objective: To determine the effectiveness of low-load exercise on reducing post-needling induced-pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome.

  3. The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study

    Directory of Open Access Journals (Sweden)

    Sebnem Koldas Dogan

    2010-01-01

    Full Text Available OBJECTIVES: Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders. The aim of this study was to investigate the effectiveness of 850-nm gallium arsenide aluminum (Ga-As-Al laser therapy on pain, range of motion and disability in subacromial impingement syndrome. METHODS: A total of 52 patients (33 females and 19 males with a mean age of 53.59±11.34 years with subacromial impingement syndrome were included. The patients were randomly assigned into two groups. Group I (n = 30, laser group received laser therapy (5 joule/cm² at each point over maximum 5-6 painful points for 1 minute. Group II (n = 22, placebo laser group received placebo laser therapy. Initially cold pack (10 minutes was applied to all of the patients. Also patients were given an exercise program including range of motion, stretching and progressive resistive exercises. The therapy program was applied 5 times a week for 14 sessions. Pain severity was assessed by using visual analogue scale. Range of motion was measured by goniometer. Disability was evaluated by using Shoulder Pain and Disability Index. RESULTS: In group I, statistically significant improvements in pain severity, range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy (p0.05. CONCLUSIONS: The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability.

  4. Clinical effectiveness of botulinum toxin type B in the treatment of subacromial bursitis or shoulder impingement syndrome.

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho; Song, Sun Hong

    2011-01-01

    Subacromial steroid injections are used as a treatment method in subacromial bursitis (SB) or shoulder impingement syndrome (SIS). However, the steroid effect is relatively restricted to the short-term and repeated injections are frequently required, which contributes to unwanted side effects. As an alternative, botulinum toxin (BT) has recently been used for pain relief. This study aimed to investigate the clinical effectiveness of BT type B and to compare this with the effectiveness of steroids. Sixty-one patients diagnosed with SB or SIS were divided into 2 groups and treated with BT type B (BT group) and trimacinolone injection (TA group) under ultrasound guidance, respectively. Numeric Rating Scale (NRS), active shoulder abduction angle, and the Korean version of the score on the Disability of Arm, Shoulder, and Hand (DASH) were measured before the treatment, and at 1 and 3 months after the treatment. Both groups obtained a significant improvement of NRS, DASH, and active shoulder abduction at 1 and 3 months follow-up. BT group showed significantly better outcomes in terms of reduction of NRS and DASH at 3 months than TA group. BT group showed strong trend toward the larger degree of active shoulder abduction than the TA group at 3 months follow-up, as well. Whereas, no significant difference was found in NRS, DASH, and active shoulder abduction between the 2 groups at 1 month follow-up. BT type B can be a useful strategy and has great potential for replacing steroids as a treatment for SB or SIS.

  5. Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon.

    Science.gov (United States)

    Nasu, H; Nimura, A; Yamaguchi, K; Akita, K

    2015-09-01

    Patients with a shoulder disorder often complain of pain on the anterior or lateral aspect of the shoulder. Such pain has been thought to originate from the suprascapular nerve. However, taking into consideration the distinctive course of the axillary nerve, the axillary nerve is likely to supply branches to the structure around the shoulder joint. This study was conducted to clarify the division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint. The division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint were examined macroscopically by dissecting 20 shoulders of 10 adult Japanese cadavers. The thin branches from the anterior branch of the axillary nerve were distributed to the subacromial bursa and the area around the long head of the biceps tendon. The branches from the main trunk of the axillary nerve or the branch to the teres minor muscle were distributed to the infero-posterior part of the shoulder joint. The pain on the anterior or lateral aspect of the shoulder, which has been thought to originate from the suprascapular nerve, might be related to the thin branches which originate from the axillary nerve and innervate the subacromial bursa and the area around the long head of the biceps tendon. These results would be useful to consider the cause of the shoulder pain or to prevent the residual pain after the biceps tenodesis.

  6. Efficacy of Proprioceptive Exercises in Patients with Subacromial Impingement Syndrome: A Single-Blinded Randomized Controlled Study.

    Science.gov (United States)

    Dilek, Banu; Gulbahar, Selmin; Gundogdu, Mehtap; Ergin, Burcu; Manisali, Metin; Ozkan, Mustafa; Akalin, Elif

    2016-03-01

    The objective of this study was to evaluate the effectiveness of proprioceptive exercises on shoulder proprioception, range of motion, pain, muscle strength, and function in patients with subacromial impingement syndrome. Sixty-one patients with subacromial impingement syndrome participated in this prospective, single-blind randomized controlled trial. All patients were randomly divided into two groups: control group (conventional physiotherapy, n = 30) and intervention group (proprioceptive exercise and conventional physiotherapy, n = 31). The primary outcome measures were sense of kinesthesia and active and passive repositioning for proprioception at 0 degrees and 10 degrees external rotation at 12 wks. The secondary outcome measures were pain at rest, at night, and during activities of daily living with the visual analog scale (0-10 cm), the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons index, range of motion, and isometric muscle strength at both 6 and 12 wks. After treatment, significant improvement was found in range of motion, pain, isometric muscle strength, kinesthesia at 0 degrees external rotation, and functional tests in both groups. The intervention group showed a significant improvement in kinesthesia at 10 degrees external rotation and active and passive repositioning at 10 degrees external rotation. When groups were compared, there were no statistically significant differences in any of the parameters at 12 wks. Although proprioceptive exercises may provide better proprioceptive acuity, no additional positive effect on other clinical parameters was observed.

  7. Single-lead percutaneous peripheral nerve stimulation for the treatment of shoulder pain from subacromial impingement syndrome.

    Science.gov (United States)

    Wilson, Richard D; Harris, Michael A; Bennett, Maria E; Chae, John

    2012-08-01

    This case report demonstrates the feasibility of a single-lead peripheral nerve stimulation system for the treatment of pain secondary to chronic subacromial impingement syndrome. The participant was a 57-year-old man who experienced persistent pain from subacromial impingement syndrome for 20 months despite having undergone conservative therapy of steroid injection and physical therapy. After study enrollment, a single intramuscular lead was placed percutaneously into the deltoid muscle of the affected shoulder. He was treated 6 hours per day for 3 weeks and the lead was removed. The primary outcome measure was the Brief Pain Inventory (Short-form) Question 3 (BPI 3), which queries the worst pain in the last week on a 0-10 numerical rating scale. At baseline, BPI 3 was an 8. At the end of treatment and at 4 and 12 weeks after treatment, BPI 3 scores were 2, 0, and 0, respectively. Substantial improvements in shoulder impairment, quality of life, and shoulder disability measures were also observed. Additional studies are needed to further demonstrate safety and efficacy, determine optimal dose, define optimal prescriptive parameters, expand clinical indications, and demonstrate long-term effect. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Effect of subacromial sodium hyaluronate injection on rotator cuff disease: A double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Moghtaderi, Alireza; Sajadiyeh, Sepideh; Khosrawi, Saeid; Dehghan, Farnaz; Bateni, Vahid

    2013-01-01

    Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingment syndrome without rotator cuff complete tear. This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: Case group by 20 mg of sodium hyaluronate (Fermathron™) and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t-test. In both groups mean VAS has decreased, but more significantly in case group (P hyaluronate are effective in treating rotator cuff disease without complete tears.

  9. Prediction of post-operative pain following arthroscopic subacromial decompression surgery: an observational study [v1; ref status: indexed, http://f1000r.es/9s

    Directory of Open Access Journals (Sweden)

    Anthony Davis

    2013-02-01

    Full Text Available Background: Arthroscopic shoulder surgery is increasingly performed as a day case procedure. Optimal post-operative pain relief remains a challenge due to considerable variations in the level of pain experienced between individuals. Our aim was to examine whether the preoperative electrical pain threshold was a strong predictor of elevated postoperative pain levels following arthroscopic subacromial decompression (ASD surgery. Methods: Forty consenting patients with American Society of Anesthesiologists (ASA grade 1-2 presenting for elective ASD surgery were recruited. Patients’ electrical pain thresholds were measured preoperatively using a PainMatcher® (Cefar Medical AB, Lund, Sweden device. Following surgery under general anaesthesia, the maximum pain experienced at rest and movement was recorded using a visual analogue scale until the end of postoperative day four. Results: In univariate analyses (t-test, the postoperative pain experienced (Area Under Curve was significantly greater in patients with a low pain threshold as compared with a high pain threshold at both rest (mean 12.5, S.E. 1.7 v mean 6.5, S.E.1.2. P=0.008 and on movement (mean 18.7, S.E. 1.5 v mean 14.1, S.E.1.4. P=0.031. In multivariate analyses, adjusting for additional extra analgesia, the pain experienced postoperatively was significantly greater in the low pain threshold group both at rest (mean difference 4.9, 95% CI 1.5 to 8.4, P=0.007 and on movement (mean difference 4.1, 95%CI 0.03 to 8.2, P=0.049. Conclusions: Preoperative pain threshold can predict postoperative pain level following ASD of the shoulder. Trial registration: Clinicaltrials.gov identifier: NCT01351363 Level of Evidence: II

  10. Spaces

    Directory of Open Access Journals (Sweden)

    Maziar Nekovee

    2010-01-01

    Full Text Available Cognitive radio is being intensively researched as the enabling technology for license-exempt access to the so-called TV White Spaces (TVWS, large portions of spectrum in the UHF/VHF bands which become available on a geographical basis after digital switchover. Both in the US, and more recently, in the UK the regulators have given conditional endorsement to this new mode of access. This paper reviews the state-of-the-art in technology, regulation, and standardisation of cognitive access to TVWS. It examines the spectrum opportunity and commercial use cases associated with this form of secondary access.

  11. Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome.

    Science.gov (United States)

    Paavola, Mika; Malmivaara, Antti; Taimela, Simo; Kanto, Kari; Järvinen, Teppo Ln

    2017-06-06

    Arthroscopic subacromial decompression (ASD) is the most commonly performed surgical intervention for shoulder pain, yet evidence on its efficacy is limited. The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage. The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy (DA) in patients with shoulder impingement syndrome (SIS), where DA differs only by the lack of subacromial decompression. A third group of supervised progressive exercise therapy (ET) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies. Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre, three-group randomised controlled study. We performed two-fold concealed allocation, first by randomising patients to surgical (ASD or DA) or conservative (ET) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio. Our two primary outcomes are pain at rest and at arm activity, assessed using visual analogue scale (VAS). We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95% CI at 24 months. Our secondary outcomes are functional assessment (Constant score and Simple shoulder test), quality of life (15D and SF-36), patient satisfaction, proportions of responders and non-responders, reoperations/treatment conversions, all at 2 years post-randomisation, as well as adverse effects and complications. We recruited a total of 210 patients from three tertiary referral centres. We will conduct the primary analysis on the intention-to-treat basis. The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and

  12. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series.

    Science.gov (United States)

    Tate, Angela R; McClure, Philip W; Young, Ian A; Salvatori, Renata; Michener, Lori A

    2010-08-01

    Case series. Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional

  13. Effectiveness of Standardized Physiotherapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2016-01-01

    was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. DESIGN: A multicenter randomized controlled trial was conducted. SETTING......: The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. PATIENTS: One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow...... outcome measures. LIMITATIONS: The nature of the exercise intervention did not allow blinding of patients and care providers. CONCLUSION: The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12...

  14. Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Akkaya, Nuray; Akkaya, Semih; Gungor, Harun R; Yaşar, Gokce; Atalay, Nilgun Simsir; Sahin, Fusun

    2017-01-01

    Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.

  15. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.

    Science.gov (United States)

    Shams, Ahmed; El-Sayed, Mohamed; Gamal, Osama; Ewes, Waled

    2016-12-01

    Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0-5 scale. Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in

  16. Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Bell Simon N

    2008-04-01

    Full Text Available Abstract Background Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other methods of post-operative pain management. Methods/Design This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo arthroscopic subacromial decompression with or without rotator cuff repair, all operations performed by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. All participants will receive a pre-incision bolus injection of 20 mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40 mg. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75% or placebo (normal saline administered continuously into the subacromial space by an elastomeric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively. The primary end point will be average pain at rest over the first 12-hour post-operative period on a verbal analogue pain score. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient stay and incidence of post-operative adhesive capsulitis. Discussion The results of this trial will

  17. Migration of calcium deposits into subacromial-subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging.

    Science.gov (United States)

    Della Valle, Valeria; Bassi, Emilio Maria; Calliada, Fabrizio

    2015-09-01

    Calcifying tendinitis of the shoulder is a common condition characterized by the deposition of calcium, predominantly hydroxyapatite crystals, in the rotator cuff. A rare complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa or into the humeral greater tuberosity. These complications are responsible for intense acute shoulder pain and functional disability. Patient anamnesis and clinical symptoms must be considered to make the diagnosis, but imaging, particularly sonography, is often necessary, showing a typical presentation related to the locations of calcium deposits. We present sonographic and other imaging features of subacromial-subdeltoid bursitis and humeral osteitis related to the migration of calcium.

  18. Injection of the subacromial bursa in patients with rotator cuff syndrome: a prospective, randomized study comparing the effectiveness of different routes.

    Science.gov (United States)

    Marder, Richard A; Kim, Sunny H; Labson, Jerry D; Hunter, John C

    2012-08-15

    Rotator cuff syndrome is often treated with subacromial injection of corticosteroid and local anesthetic. It has not been established if the common injection routes of the bursa are equally accurate. We conducted a prospective clinical trial involving seventy-five shoulders in seventy-five patients who were randomly assigned to receive a subacromial injection through an anterior, lateral, or posterior route with respect to the acromion. An experienced physician performed the injections, which contained radiopaque contrast medium, corticosteroid, and local anesthetic. After the injection, a musculoskeletal radiologist, blinded to the injection route, interpreted all of the radiographs. The rate of accuracy varied with the route of injection, with a rate of 56% for the posterior route, 84% for the anterior route, and 92% for the lateral route (p = 0.006; chi-square test). The accuracy of injection through the posterior route was significantly lower than that through either the anterior or the lateral route (p bursa in females.

  19. Effects of Proprioceptive Neuromuscular Facilitation and Mulligan Concepts on the Pain, Functional Level and Quality of Life on Subacromial Impingement Syndrome

    OpenAIRE

    Karaku?, Sinem; Gelecek, Nihal; Ye?ilyaprak, Sevgi Sevi

    2014-01-01

    Objectives: The purpose of the study was to investigate the effects of Proprioceptif Neuromuscular Facilitation (PNF) and Mulligan concepts on the pain, functional level and quality of life in the patients with subacromial impingement syndrome (SIS). Methods: This study was carried out on 40 patients (26 females, 14 males), mean age 50,3?1,13 years, who had been diagnosed as SIS admitted to the physical therapy and rehabilitation clinic. Before the beginning measurements all the patients were...

  20. Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial.

    Science.gov (United States)

    Rabini, Alessia; Piazzini, Diana B; Bertolini, Carlo; Deriu, Laura; Saccomanno, Maristella F; Santagada, Domenico A; Sgadari, Antonio; Bernabei, Roberto; Fabbriciani, Carlo; Marzetti, Emanuele; Milano, Giuseppe

    2012-04-01

    Single-blind randomized clinical trial, with a follow-up of 24 weeks. To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.

  1. Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression.

    Science.gov (United States)

    Kraeutler, Matthew J; Reynolds, Kirk A; Long, Cyndi; McCarty, Eric C

    2015-06-01

    The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: a preliminary trial.

    Science.gov (United States)

    Kaya, Derya Ozer; Baltaci, Gul; Toprak, Ugur; Atay, Ahmet Ozgur

    2014-01-01

    The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05). For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  3. Three-dimensional volume rendering of tibiofibular joint space and quantitative analysis of change in volume due to tibiofibular syndesmosis diastases

    Energy Technology Data Exchange (ETDEWEB)

    Taser, F.; Shafiq, Q.; Ebraheim, N.A. [Medical University of Ohio, Orthopaedic Surgery Department, Toledo, OH (United States)

    2006-12-15

    The diagnosis of ankle syndesmosis injuries is made by various imaging techniques. The present study was undertaken to examine whether the three-dimensional reconstruction of axial CT images and calculation of the volume of tibiofibular joint space enhances the sensitivity of diastases diagnoses or not. Six adult cadaveric ankle specimens were used for spiral CT-scan assessment of tibiofibular syndesmosis. After the specimens were dissected, external fixation was performed and diastases of 1, 2, and 3 mm was simulated by a precalibrated device. Helical CT scans were obtained with 1.0-mm slice thickness. The data was transferred to the computer software AcquariusNET. Then the contours of the tibiofibular syndesmosis joint space were outlined on each axial CT slice and the collection of these slices were stacked using the computer software AutoCAD 2005, according to the spatial arrangement and geometrical coordinates between each slice, to produce a three-dimensional reconstruction of the joint space. The area of each slice and the volume of the entire tibiofibular joint space were calculated. The tibiofibular joint space at the 10th-mm slice level was also measured on axial CT scan images at normal, 1, 2 and 3-mm joint space diastases. The three-dimensional volume-rendering of the tibiofibular syndesmosis joint space from the spiral CT data demonstrated the shape of the joint space and has been found to be a sensitive method for calculating joint space volume. We found that, from normal to 1 mm, a 1-mm diastasis increases approximately 43% of the joint space volume, while from 1 to 3 mm, there is about a 20% increase for each 1-mm increase. Volume calculation using this method can be performed in cases of syndesmotic instability after ankle injuries and for preoperative and postoperative evaluation of the integrity of the tibiofibular syndesmosis. (orig.)

  4. Trunk stabilization during sagittal pelvic tilt: from trunk-on-pelvis to trunk-in-space due to vestibular and visual feedback.

    Science.gov (United States)

    van Drunen, Paul; van der Helm, Frans C T; van Dieën, Jaap H; Happee, Riender

    2016-03-01

    The goal of this study was to investigate the human ability to stabilize the trunk in space during pelvic tilt. Upper body sway was evoked in kneeling-seated healthy subjects by angular platform perturbations with a rotation around a virtual low-back pivot point between the L4 and L5 vertebrae. To investigate motor control modulation, variations in task instruction (balance naturally or minimize trunk sway), vision (eyes open or closed), and perturbation bandwidth (from 0.2 up to 1, 3, or 10 Hz) were applied. Cocontraction and proprioceptive muscle spindle feedback were associated with minimizing low-back flexion/extension (trunk-on-pelvis stabilization), while vestibular and visual feedback were supposed to contribute to trunk-in-space stabilization. Trunk-in-space stabilization was only observed with the minimize trunk sway task instruction, while the task instruction to balance naturally led to trunk-on-pelvis stabilization with trunk rotations even exceeding the perturbations. This indicates that vestibular feedback is used when minimizing trunk sway but has only a minor contribution during natural trunk stabilization in the sagittal plane. The eyes open condition resulted in reduced global trunk rotations and increased global trunk reflexive responses, demonstrating effective visual contributions to trunk-in-space stabilization. On the other hand, increasing perturbation bandwidth caused a decreased feedback contribution leading to deteriorated trunk-in-space stabilization. Copyright © 2016 the American Physiological Society.

  5. Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study.

    Science.gov (United States)

    Kvalvaag, Elisabeth; Anvar, Masoud; Karlberg, Anna Cecilia; Brox, Jens Ivar; Engebretsen, Kaia Beck; Soberg, Helene Lundgaard; Juel, Niels Gunnar; Bautz-Holter, Erik; Sandvik, Leiv; Roe, Cecilie

    2017-11-21

    Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)). A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up. There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = -3.1, with 95% CI -5.9 to -0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to -3.8; p bursitis (p = 0.04) were associated with a poorer outcome after one year. In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI. Clinicaltrials.gov no NCT01441830

  6. Due antichi quartieri romani sotto la lente di ingrandimento: un’analisi space syntax dei quartieri delle città antiche e della loro vita sociale

    Directory of Open Access Journals (Sweden)

    Stöger, Hanna

    2015-12-01

    Full Text Available Neighbourhoods and the social use of space are areas of growing interest. By combining archaeological methods and space syntax, the article offers new insights into the physical environment of daily life in the Roman city. The detailed examination of two city blocks from Ostia (Rome’s imperial port-town, allows the authors to identify spaces which fostered social cohesion and community building. The shared courtyards and passage spaces of Block IV ii suggest continued community focus (2nd - 5th centuries AD. In contrast, Block IV iv lacks common spaces and revealed self-contained buildings centred on individual access to public space. Block IV ii enjoyed shared spaces within its own perimeter, while Block IV iv looks toward external community building, with activities centred on the street confining the block. The results show the flexibility of Roman urban structures and allow for suggestive glimpses into the community that sustained the city in the long-term.El estudio de los vecindarios y el uso social del espacio habitado son temas de interés creciente. Mediante la combinación de métodos arqueológicos y space syntax, este artículo ofrece nuevas formas de analizar el entorno físico de la vida cotidiana en las ciudades romanas. El examen detallado de dos bloques urbanos en Ostia (la ciudad portuaria de Roma en época imperial nos ha permitido identificar espacios que fomentan la cohesión social y la vida en comunidad. El uso común de patios y pasillos en el Bloque IV ii sugiere un uso comunal continuado desde el siglo II hasta el siglo V d. C. En claro contraste con este sector, el Bloque IV iv no tiene espacios comunes y muestra edificios aislados con accesos individuales al espacio público. El Bloque IV ii disfruta de espacios compartidos dentro de su propio perímetro, mientras que el Bloque IV iv parece estar orientado por el interés de comunidades externas con actividades desarrolladas hacia la calle creando cierto aislamiento

  7. Shifts in the climate space of temperate cyprinid fishes due to climate change are coupled with altered body sizes and growth rates.

    Science.gov (United States)

    Ruiz-Navarro, Ana; Gillingham, Phillipa K; Britton, J Robert

    2016-09-01

    Predictions of species responses to climate change often focus on distribution shifts, although responses can also include shifts in body sizes and population demographics. Here, shifts in the distributional ranges ('climate space'), body sizes (as maximum theoretical body sizes, L∞) and growth rates (as rate at which L∞ is reached, K) were predicted for five fishes of the Cyprinidae family in a temperate region over eight climate change projections. Great Britain was the model area, and the model species were Rutilus rutilus, Leuciscus leuciscus, Squalius cephalus, Gobio gobio and Abramis brama. Ensemble models predicted that the species' climate spaces would shift in all modelled projections, with the most drastic changes occurring under high emissions; all range centroids shifted in a north-westerly direction. Predicted climate space expanded for R. rutilus and A. brama, contracted for S. cephalus, and for L. leuciscus and G. gobio, expanded under low-emission scenarios but contracted under high emissions, suggesting the presence of some climate-distribution thresholds. For R. rutilus, A. brama, S. cephalus and G. gobio, shifts in their climate space were coupled with predicted shifts to significantly smaller maximum body sizes and/or faster growth rates, aligning strongly to aspects of temperature-body size theory. These predicted shifts in L∞ and K had considerable consequences for size-at-age per species, suggesting substantial alterations in population age structures and abundances. Thus, when predicting climate change outcomes for species, outputs that couple shifts in climate space with altered body sizes and growth rates provide considerable insights into the population and community consequences, especially for species that cannot easily track their thermal niches. © 2016 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

  8. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies

    Directory of Open Access Journals (Sweden)

    Smith Toby O

    2010-03-01

    Full Text Available Abstract Background Subacromial impingement syndrome (SIS is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG activity of the shoulder complex exists between people with SIS and healthy controls. Methods Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate. Results Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls. Conclusions A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.

  9. Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

    Science.gov (United States)

    Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

    2012-05-01

    The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

  10. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review.

    Science.gov (United States)

    Kinsella, Rita; Pizzari, Tania

    2017-04-01

    Subacromial pain syndrome (SPS) is a common cause of shoulder pain and muscle activity deficits are postulated to contribute to the development and progression of the disorder. The purpose of this systematic review was to definitively determine whether evidence exists of differences in electromyography (EMG) characteristics between subjects with and without SPS. Six key databases were searched: MEDLINE, EMBASE, CINAHL, SPORTdiscus, PEDro and The Cochrane Library (inception to May 2016). The search yielded 1414 records using terms relating to shoulder impingement, EMG, scapular and rotator cuff muscles. Twenty-two papers remained once duplicates were removed and selection criteria applied. Data extraction, quality assessment and data synthesis were performed. Effect sizes and 95% confidence intervals were calculated. There was limited evidence that serratus anterior has lower amplitude, delayed activation and earlier termination in SPS participants. For the majority of muscles, regardless of task, load or arm position, significant differences were not demonstrated or results were contradictory. The understanding of SPS is changing and EMG appears unable to capture the complexities associated with this condition. Addressing aberrant movement patterns and facilitating balanced activation of all shoulder muscles may be a more appropriate treatment direction for the future.

  11. Predicting Response to Subacromial Injections and Lidocaine/Tetracaine Patch from Pretreatment Pain Quality in Patients with Shoulder Impingement Syndrome.

    Science.gov (United States)

    Gammaitoni, Arnold R; Trudeau, Jeremiah J; Radnovich, Richard; Galer, Bradley S; Jensen, Mark P

    2015-07-01

    No existing pain treatment is effective for all pain problems, and response to pain treatment is highly variable. Knowledge regarding the patient factors that predict response to different treatments could benefit patients by providing an empirical foundation for patient-treatment matching. This study sought to test the hypothesis that improvements following two treatments thought to operate via similar mechanisms would be predicted by similar baseline pain qualities. Prospective prediction analysis using data from a previously published open label trial comparing a heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain in individuals with shoulder impingement syndrome. Consistent with the study hypothesis, the response to the two treatments were predicted by similar baseline pain qualities; specifically, higher baseline levels of unpleasant, electric, and sensitive pain predicted subsequent improvements in sleep interference, work/activity interference, and patient global ratings of improvement, respectively. The findings are consistent with the combined ideas that (1) those who have the most to gain (i.e., those reporting the highest levels of various pain qualities) can expect the best response to effective treatments and (2) different pain qualities may be associated with different types of outcomes. The findings support further research to examine how pain quality measures may be used to improve patient-treatment matching, and therefore, ultimately improve the efficiency, efficacy, and overall benefit-risk of pain treatment. Wiley Periodicals, Inc.

  12. Kinesio taping or just taping in shoulder subacromial impingement syndrome? A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Kocyigit, Figen; Acar, Merve; Turkmen, Mehmet Besir; Kose, Tugce; Guldane, Nezahat; Kuyucu, Ersin

    2016-10-01

    To verify effects of kinesio taping (KT) in shoulder subacromial impingement syndrome (SIS) when compared to sham taping applied in the same way with KT. Patients were randomized as group 1 (n = 21) KT group and group 2 (n = 20) sham-taping group. Taping was applied every three days, three times during the study period. We assessed all the patients at baseline, at the end of the taping period (12th day), and at one-month post-intervention. We assessed pain on the 100 mm visual analog scale (VAS). Shoulder range of motion (ROM), Constant Scores, and Nottingham Health Profile (NHP) scores were evaluated. Of the 41 participants, 13 were males (32%) and 28 were females (68%). The mean age was 45 ± 15 years (range 20-65 years). We documented a significant decrease in VAS for nocturnal pain, and Constant Score in both groups. The KT group showed additional significant change in NHP pain and physical activity scores. KT and sham taping generated similar results regarding pain and Constant Scores.

  13. Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

    Science.gov (United States)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

    2016-06-01

    Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and

  14. The effects on the characteristics of urban storm runoff due to the space allocation of design rainfall and the partition of the subbasin

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Lee, Sang Tae [Kyonggi University, Suwon (Korea, Republic of)

    1997-04-30

    The influences of the space allocation of design rainfall and partition of the subbasin on the characteristics of urban storm runoff was investigated for the 6 drainage basins by applying SWMM model. It shows the deviation of -54.68{approx}+18.77% in the peak discharge when we applied the composed HUFF quantities to the two zones which are divided by upper and lower region of the basin. Then it is compared with the value for the case of using uniform rainfall distribution all over the drainage. Therefore, it would be helpful to decrease the flood risk when we adopt the space distribution of the design rainfall. The effects of the partitioning the drainage on the computing result shows various responses because of the surface characteristics of the each basin such as slope, imperviousness ratio, but we can get closer result to the measured value as we make the subbasin detailed. If we use the concept of the skewness and area ratio when we determine the width of subbasin, we can improve the computed result even with fewer number of subbasins. We expect reasonable results which close into the measured results in the range of relative error, 25%, when we divide the basin into more than 3 subbasins and the total urban drainage area is less than 10 km{sup 2}. (author). 25 refs., 8 tabs., 7 figs.

  15. Selective activation of intra-muscular compartments within the trapezius muscle in subjects with Subacromial Impingement Syndrome. A case-control study

    DEFF Research Database (Denmark)

    Larsen, C M; Juul-Kristensen, B; Olsen, H B

    2014-01-01

    Neuromuscular control of the scapular muscles is important in the etiology of shoulder pain. Electromyographical (EMG) biofeedback in healthy people has been shown to support a selective activation of the lower compartment of the trapezius muscle, specifically. The aim of the present paper...... that individuals with SIS may benefit from biofeedback training to gain control of the neuromuscular function of the scapular muscle....... was to investigate whether patients with Subacromial Impingement Syndrome (SIS) were able to selectively activate the individual compartments within the trapezius muscle, with and without EMG biofeedback to the same extent as healthy controls (No-SIS). Fifteen SIS and 15 No-SIS participated in the study. Sessions...

  16. Functional thoracic hyperkyphosis model for chronic subacromial impingement syndrome: an insight on evidence based "treat the cause" concept--a case study and literature review.

    Science.gov (United States)

    Nagarajan, M; Vijayakumar, P

    2013-01-01

    Recent evidences suggest functional thoracic hyperkyphosis (FTH) could be a different approach in the management of subacromial impingement syndrome (SIS). This case study aims firstly with the development of evidence informed FTH model for SIS. Secondly this study aimed to develop well defined multimodal physical therapy intervention for FTH and its related mechanical consequences in elderly patient with chronic SIS. As a result, Level IV positive evidence was found in both the short and long-term pain and disability of chronic SIS, using FTH model with 26 months of follow-up.

  17. A mechanism leading to q-power law distribution due to the inhomogeneity of phase space in the self-gravitational system

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Yahui, E-mail: zhengyahui1979@yahoo.com.cn; Li, Jianjun

    2013-07-15

    One mechanism leading to the q-power law distribution has been proposed in the self-gravitational system. The friction force in the stochastic process may be nonlinearly relevant to the momentum of particle, whose friction coefficient can be expressed as the function of the kinetic energy of the particle. The correlation strength of noises is inhomogeneous in the such system, maybe due to the strength of gravitational field. This implies that the gradient of correlation strength is the function of gravitational force. With the Taylor's low order approximation, the stationary solution of the two-vector variable Fokker–Planck equation is the power law form in self-gravitational system. This Letter also verifies that the neutrino flux deviation from the theory value in the solar core is due to the same mechanism.

  18. A due

    DEFF Research Database (Denmark)

    to acknowledge the excellence of these two scholars by a double Festschrift, "A due". Both have been working at the Music Department of the University of Copenhagen and have collaborated with The Royal Library on various projects. This publication contains contributions from 44 colleagues, who thus - in topics...

  19. Space space space

    CERN Document Server

    Trembach, Vera

    2014-01-01

    Space is an introduction to the mysteries of the Universe. Included are Task Cards for independent learning, Journal Word Cards for creative writing, and Hands-On Activities for reinforcing skills in Math and Language Arts. Space is a perfect introduction to further research of the Solar System.

  20. Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression.

    Science.gov (United States)

    Jaeger, Moritz; Berndt, Thomas; Rühmann, Oliver; Lerch, Solveig

    2016-03-01

    To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years. We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery. Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate. Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  1. Rilonacept in the treatment of subacromial bursitis: A randomized, non-inferiority, unblinded study versus triamcinolone acetonide.

    Science.gov (United States)

    Carroll, Matthew B; Motley, Spencer A; Wohlford, Susanna; Ramsey, Bryan C

    2015-12-01

    Subacromial bursitis is caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament and acromion. While multiple cytokines are implicated, interleukin-1 beta appears to play a prominent role. Rilonacept, an interleukin-1 trap, may be an alternative to corticosteroid injection for the management of this condition. This single center, randomized, non-inferiority, unblinded study recruited 33 subjects over 9 months. Twenty subjects received 160mg intrabursal injection of rilonacept and 13 received a 6mL mixture of lidocaine, bupivacaine, and 80mg triamcinolone acetonide. QuickDASH, subject reported pain, and adverse events were recorded at time of injection, 2 days later, 2 weeks later, and 4 weeks later. Primary outcome was improvement in QuickDASH 4 weeks post-injection. Secondary outcomes were improvement in subject reported pain and occurrence of adverse events at 4 weeks. Both study groups were equally matched for age, gender, ethnicity, and site of bursa injection. Both medications demonstrated a statistically significant improvement in QuickDASH 4 weeks post-injection, but triamcinolone acetonide injection offered greater improvement (P=0.004). Both medications demonstrated improvement in subject reported pain but between group comparison at 4 weeks showed that triamcinolone was superior (P=0.044). No statistically significant differences in adverse events were noted between groups, but subjects who received rilonacept experienced more episodes of diarrhea and headache. While improvement in QuickDASH and pain was noted with a single intrabursal injection of rilonacept at 4 weeks, injection with triamcinolone acetonide was more efficacious. This trial was registered with www.clinicaltrials.gov (NCT01830699). Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  2. The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors

    Science.gov (United States)

    Christiansen, David Høyrup; Frost, Poul; Frich, Lars Henrik; Falla, Deborah; Svendsen, Susanne Wulff

    2016-01-01

    Background Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). Objective We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. Methods Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1–75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. Results Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery. Conclusion In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited. PMID:26954692

  3. Dynamic ultrasound of the subacromial-subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers.

    Science.gov (United States)

    Daghir, Ahmed A; Sookur, Paul A; Shah, Sachit; Watson, Martin

    2012-09-01

    The purpose of the study was to determine if the thickness of the subacromial-subdeltoid (SASD) bursa during dynamic ultrasound and on static views differs between patients with shoulder impingement syndrome and healthy volunteers. Twenty-two patients with a clinical diagnosis of shoulder impingement syndrome and 23 healthy volunteers were recruited. A subset of patients showing an immediate symptom response following intrabursal injection was identified as "injection responders". Ultrasound of the shoulder was performed on all participants using three standard static views and two dynamic views (before and after arm abduction). The thickness of both the intrabursal fluid and the superficial peribursal fat was measured on all views. The bursal thickness measurements in the two groups were compared using a t test for significance. The mean increase in SASD bursal fluid thickness following arm abduction was not statistically different among all patients (0.39 ± 0.41 mm) and controls (0.35 ± 0.32 mm), p = 0.72. The same was true comparing injection responders (0.46 ± 0.49 mm) with controls, p = 0.41. On static views, greater bursal fluid thickness was found in patients (1.01 ± 0.48 mm) compared with controls (0.67 ± 0.32 mm) when using the short axis view of the supraspinatus, p = 0.006. No statistically significant difference was found between injection responders and controls when measuring peribursal fat thickness on any view. Gathering of the SASD bursa demonstrated during dynamic ultrasound does not necessarily indicate painful impingement of the bursa as it is found to a similar degree in patients with a clinical diagnosis of impingement and healthy volunteers.

  4. The relationship between subacromial bursa thickness on ultrasound and shoulder pain in open water endurance swimmers over time.

    Science.gov (United States)

    Couanis, G; Breidahl, W; Burnham, S

    2015-07-01

    To help clinicians understand the clinical relevance of subacromial bursa (SAB) thickness on ultrasound investigations in marathon swimmers. A prospective, observational cohort study. Twenty two open-water marathon swimmers entered in a 19.7km open-water event received comprehensive, bilateral, shoulder ultrasounds on three occasions: 4 months prior to the race, 2 weeks prior to the race and within 1 week after the race. The SAB thickness was measured in the longitudinal plane of supraspinatus, with other abnormailities also recorded. The swimmers completed questionnaires detailing presence and severity of shoulder pain, volume of swimming completed that week and their breathing pattern. SAB thickness increased with season progression: mean of 1.55 (± 0.68) 4 months prior to the race, 1.63 (± 0.68) 2 weeks prior to the race and 1.86 (± 0.69) 1 week after the race. SAB thickness is significantly (p=0.05) correlated (β=0.11) with kilometres swum in the pool in the preceding week. SAB thickness was not significantly correlated with pain when measured prior to the race. However, at 1 week post race, SAB thickness of shoulders with pain were significantly greater than those without pain, p-value=0.032. SAB thickness increases with increasing swimming training. Commonly, this increase is not correlated to pain, suggestive of a painless adaptive process. The significant correlation between pain and SAB thickness soon after an exacerbating event suggests that painful acute SAB thickening is a different entity to chronic, painless adaptive SAB thickening. These two entities can only be differentiated by clinical history and examination. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  5. Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study.

    Science.gov (United States)

    Hanratty, Catherine E; Kerr, Daniel P; Wilson, Iseult M; McCracken, Martin; Sim, Julius; Basford, Jeffrey R; McVeigh, Joseph G

    2016-09-01

    Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor response to treatment. There is little research exploring physical therapists' perspectives on the management of the syndrome. The study objective was to investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. This was a qualitative focus group study. Three 60- to 90-minute focus group sessions containing 6 to 8 experienced musculoskeletal physical therapists (total number=20) were conducted. Thematic content analysis was used to analyze transcripts and develop core themes and categories. Exercise was seen as key in the management of SAIS. The overarching theme was the need to "gain buy-in to exercise" at an early stage. The main subtheme was patient education. Therapists identified the need to use education about SAIS etiology to foster buy-in and "sell" self-management through exercise to the patient. They consistently mentioned achieving education and buy-in using visual tools, postural advice, and sometimes a "quick fix" of pain control. Furthermore, experienced practitioners reported including educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises, including: scapular stabilization; rotator cuff, lower trapezius, and serratus anterior muscle strengthening; and anterior shoulder and pectoralis minor muscle stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patients performed. Expanding the geographical area over which the focus groups were conducted and including therapists with less than 5 years of postgraduate experience may have strengthened the findings of this study. Experienced musculoskeletal physical therapists believe that exercise is central in treating patients with SAIS and that gaining patient buy-in to its

  6. Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows.

    Science.gov (United States)

    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2017-08-20

    We aimed to identify intensities of occupational mechanical exposures (force, arm elevation and repetition) that do not entail an increased risk of surgery for subacromial impingement syndrome (SIS) even after prolonged durations of exposure. Additionally, we wanted to evaluate if exposure to hand-arm vibration (HAV) is an independent risk factor. We used data from a register-based cohort study of the entire Danish working population (n=2 374 403). During follow-up (2003-2008), 14 118 first-time events of surgery for SIS occurred. For each person, we linked register-based occupational codes (1993-2007) to a general population job exposure matrix to obtain year-by-year exposure intensities on measurement scales for force, upper arm elevation >90° and repetition and expert rated intensities of exposure to HAV. For 10-year exposure time windows, we calculated the duration of exposure at specific intensities above minimal (low, medium and high). We used a logistic regression technique equivalent to discrete survival analysis adjusting for cumulative effects of other mechanical exposures. We found indications of safe exposure intensities for repetition (median angular velocity 90° >2 min/day implied an increased risk reaching ORs of 1.7 and 1.5 after 10 years at low intensities. No associations were found for HAV. We found indications of safe exposure intensities for repetition. Any intensities of force and upper arm elevation >90° above minimal implied an increased risk across 10-year exposure time windows. No independent associations were found for HAV. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Haik, M N; Alburquerque-Sendín, F; Moreira, R F C; Pires, E D; Camargo, P R

    2016-09-01

    To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS). Systematic review. PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases. Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included. 64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet. Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging.

    Science.gov (United States)

    Park, In; Lee, Hyo-Jin; Kim, Sung-Eun; Bae, Sung-Ho; Byun, Chu-Hwan; Kim, Yang-Soo

    2015-11-01

    Subacromial impingement is a common cause of shoulder pain and one cause of rotator cuff disease. We aimed to identify which shoulder motions cause subacromial impingement by measuring the vertical displacement and peak strain of the coracoacromial ligament using ultrasound speckle tracking imaging. Sixteen shoulders without shoulder disability were enrolled. All subjects were men, and the average age was 28.6 years. The vertical displacement and peak strain of the coracoacromial ligament were analyzed by the motion tracing program during the following active assisted motions (active motion controlled by the examiner): (1) forward flexion in the scapular plane, (2) horizontal abduction in the axial plane, (3) external rotation with the arm at 0° abduction (ER0), (4) internal rotation with the arm at 0° abduction (IR0), (5) internal rotation with the arm at 90° abduction (IR90), and (6) internal rotation at the back (IRB). The mean vertical displacement of the coracoacromial ligament during forward flexion (2.2 mm), horizontal abduction (2.2 mm), and IR90 (2.4 mm) was significantly greater than that during the other motions (ER0, -0.7 mm; IR0, 0.5 mm; IRB, 1.0 mm; P impingement. It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    Yilmaz Kaysin, Meryem; Akpinar, Pinar; Aktas, Ilknur; Unlü Ozkan, Feyza; Silte Karamanlioglu, Duygu; Cagliyan Hartevioglu, Hulya; Vural, Nazan

    2017-09-06

    The aim of this study was to investigate the effectiveness of short wave diathermy (SWD) in patients with subacromial impingement syndrome. In this double-blinded, randomized, placebo-controlled trial, 57 patients (aged 35-65 yrs) were classified into night pain positive (NP[+]) (n = 28) and night pain negative (NP[-]) (n = 29) groups. Both groups were randomly assigned to SWD (NP[+], n = 14; NP[-], n = 14) and sham (NP[+], n = 15; NP[-], n = 14) subgroups. Visual analog scale, Constant-Murley Scale (CS), and Shoulder Disability Questionnaire (SDQ) scores were used for evaluation. There was only a significant difference in pain with activity at 1-mo (mean difference [MD], -1.65; 95% confidence interval, -3.01 to -0.28]) and 2-mo evaluations (MD, -2.1; 95% confidence interval, -3.51 to -0.69) between SWD versus sham groups. In the NP(+) SWD group, the CS pain score was significantly higher than in the NP(+) sham group at all evaluations after treatment. At 1 mo, the NP(-) SWD group showed significantly better pain, strength, total CS, and SDQ scores than the NP(-) sham group. At 2 mos, the pain, range of motion, strength, and total CS and SDQ scores were better in the NP(-) SWD group than in the NP(-) sham group (P diathermy is more effective in subacromial impingement syndrome without NP.

  10. Crystalline arrays of pairs of molecular rotors: correlated motion, rotational barriers, and space-inversion symmetry breaking due to conformational mutations.

    Science.gov (United States)

    Lemouchi, Cyprien; Iliopoulos, Konstantinos; Zorina, Leokadiya; Simonov, Sergey; Wzietek, Pawel; Cauchy, Thomas; Rodríguez-Fortea, Antonio; Canadell, Enric; Kaleta, Jiří; Michl, Josef; Gindre, Denis; Chrysos, Michael; Batail, Patrick

    2013-06-26

    The rod-like molecule bis((4-(4-pyridyl)ethynyl)bicyclo[2.2.2]oct-1-yl)buta-1,3-diyne, 1, contains two 1,4-bis(ethynyl)bicyclo[2.2.2]octane (BCO) chiral rotators linked by a diyne fragment and self-assembles in a one-dimensional, monoclinic C2/c centrosymmetric structure where two equilibrium positions with large occupancy imbalance (88% versus 12%) are identified on a single rotor site. Combining variable-temperature (70-300 K) proton spin-lattice relaxation, (1)H T1(-1), at two different (1)H Larmor frequencies (55 and 210 MHz) and DFT calculations of rotational barriers, we were able to assign two types of Brownian rotators with different activation energies, 1.85 and 6.1 kcal mol(-1), to the two (1)H spin-lattice relaxation processes on the single rotor site. On the basis of DFT calculations, the low-energy process has been assigned to adjacent rotors in a well-correlated synchronous motion, whereas the high-energy process is the manifestation of an abrupt change in their kinematics once two blades of adjacent rotors are seen to rub together. Although crystals of 1 should be second harmonic inactive, a large second-order optical response is recorded when the electric field oscillates in a direction parallel to the unique rotor axle director. We conclude that conformational mutations by torsional interconversion of the three blades of the BCO units break space-inversion symmetry in sequences of mutamers in dynamic equilibrium in the crystal in domains at a mesoscopic scale comparable with the wavelength of light used. A control experiment was performed with a crystalline film of a similar tetrayne molecule, 1,4-bis(3-((trimethylsilyl)ethynyl)bicyclo[1.1.1]pent-1-yl)buta-1,3-diyne, whose bicyclopentane units can rotate but are achiral and produce no second-order optical response.

  11. Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

    Science.gov (United States)

    Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

    2012-09-01

    Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

  12. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study.

    Science.gov (United States)

    Walther, Markus; Werner, Andreas; Stahlschmidt, Theresa; Woelfel, Rainer; Gohlke, Frank

    2004-01-01

    This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.

  13. LIPOMA ARBORESCENS: RARE CASE OF ROTATOR CUFF TEAR ASSOCIATED WITH THE PRESENCE OF LIPOMA ARBORESCENS IN THE SUBACROMIAL-SUBDELTOID AND GLENOHUMERAL BURSA.

    Science.gov (United States)

    Benegas, Eduardo; Neto, Arnaldo Amado Ferreiro; Teodoro, Daniel Sabatini; da Silva, Marcos Vinícius Muriano; de Oliveira, Augusto Medaglia; Filippi, Renée Zon; de Santis Prada, Flávia

    2012-01-01

    Lipoma arborescens is a rare intra-articular disease that is usually monoarticular and is characterized by extensive proliferation of the synovial villi and hyperplasia of the subsynovial fat. The synovial tissue is progressively replaced by mature fat cells in the synovial membrane. The present study reports a case of a rare condition of lipoma arborescens that was simultaneously intra-articular (glenohumeral joint) and in the subacromial-subdeltoid bursa, in association with a torn supraspinatus tendon. The clinical, histological and radiographic presentations and treatment are discussed here. The description of this case includes radiographic and magnetic resonance evaluations and pathological examination. Although lipoma arborescens is a rare condition, it should be taken into consideration in cases presenting synovial hyperproliferation and synovial fat replacement.

  14. Uso del taping en el manejo clínico de sujetos con pinzamiento sub-acromial: revisión sistemática

    OpenAIRE

    R. A. Aguilera Eguía; E. O. Zafra Santos; F. A. Araya Quintanilla; L. E. Gómez Carreño; J. X. Soto Aliaga; A. Vargas Varga; C. J. Cofré Bolados; A. R. Espinoza Salinas; G. A. Pavez von Martens; T. Aguilera Eguía; M. Di Santo

    2014-01-01

    El pinzamiento sub-acromial (SPS) es el trastorno músculo-esquelético más frecuente de las patologías de hombro. El taping se ha transformado en una indicación relativamente nueva y bastante común en los últimos años. Se realizará una síntesis de la evidencia a través de una revisión sistemática (RS) de ensayos clínicos aleatorizados que hayan comparado el uso del taping para el manejo de estos pacientes. El objetivo de esta revisión es determinar el efecto del taping sobre el dolor en sujeto...

  15. Efectividad del kinesiotape como tratamiento complementario a un programa de ejercicio físico en el Síndrome del pinzamiento subacromial secundario a discinesias escapulares

    OpenAIRE

    Nadal Zuferri, Marcos

    2016-01-01

    Aquest projecte té com a objectiu valorar l'efectivitat del kinesiotape com una tècnica complementària dins d’un programa d'exercici físic, en la funcionalitat dels treballadors, que utilitzen els seus braços per sobre del cap, d'entre 18-65 anys diagnosticats de síndrome del pinçament subacromial secundari a discinèsies escapulars. Per l’assoliment d’aquest objectiu es realitzarà un estudi multicèntric controlat i aleatoritzat amb doble cec sobre una mostra de 225 subjectes. En l'estudi hi h...

  16. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

    DEFF Research Database (Denmark)

    Clausen, M B; Witten, A; Holm, K

    2017-01-01

    BACKGROUND: Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments...... diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during...... testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score...

  17. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome.

    Science.gov (United States)

    Min, Kyong Su; St Pierre, Patrick; Ryan, Paul M; Marchant, Bryant G; Wilson, Christopher J; Arrington, Edward D

    2013-05-01

    The objective of this study was to compare the efficacy of subacromial injection of triamcinolone compared to injection of ketorolac in the treatment of external shoulder impingement syndrome. Thirty-two patients diagnosed with external shoulder impingement syndrome were included in this double-blinded randomized controlled clinical trial. Each patient was randomized into the steroid group or nonsteroidal anti-inflammatory drugs (NSAID) group. The steroid syringe contained 40 mg triamcinolone; and the NSAID syringe contained 60 mg ketorolac. Each patient was evaluated in terms of arc of motion, visual analog scale (VAS) for evaluating pain, and the UCLA (The University of California at Los Angeles) shoulder rating scale. At 1 month follow-up, both treatment arms resulted in increased range of motion and decreased pain. The steroid group decreased in active abduction while the NSAID group increased (steroid: 134°, NSAID: 151°, P = .03). The mean improvement in the UCLA shoulder rating scale at 4 weeks was 7.15 for the NSAID group and 2.13 for the steroid group (P = .03). Subgroup analysis of the UCLA scale demonstrated an increase in both forward flexion strength (P = .04) and patient satisfaction (P = .03) in the NSAID group. No significant difference could be seen in all other outcome measures. In this study, an injection of ketorolac resulted in greater improvements in the UCLA shoulder rating scale than an injection of triamcinolone at 4 weeks follow-up. While both triamcinolone and ketorolac are effective in the treatment of isolated subacromial impingement, ketorolac appears to have equivalent if not superior efficacy; all the while decreasing patient exposure to the potential side-effects of corticosteroids. Published by Mosby, Inc.

  18. Development and delivery of a physiotherapist-led exercise intervention in a randomised controlled trial for subacromial impingement syndrome (the SUPPORT trial).

    Science.gov (United States)

    Stevenson, Kay; Jackson, Sue; Shufflebotham, Julie; Roddy, Edward; Foster, Nadine E

    2017-03-24

    This paper describes the development, content and delivery of a physiotherapist- led individualised, supervised and progressed exercise programme for use in a factorial randomised controlled trial testing treatments for subacromial impingement syndrome. To develop the intervention, a survey of community physiotherapists and national guidelines provided the basis for a consensus workshop through which a protocol was developed for the SUPPORT trial physiotherapist-led exercise programme (SUPPORT: SUbacromial impingement syndrome and Pain: a randomised controlled trial Of exeRcise and injection). The protocol included three stages of exercise progression: (1) scapular stability and active exercise with no resistance (2) range of motion exercise with scapular control, isometrics and stretches, and (3) through range resistance exercise. A two day training programme was developed for physiotherapists which included the trial background, current evidence and strategies to improve exercise adherence. Twenty physiotherapists were trained to deliver the exercise intervention. In the SUPPORT trial, 128 participants were randomised to physiotherapist-led exercise. Ninety nine (81%) participants had their first physiotherapy session within 2 to 3 weeks and 71 (56%) received six to eight treatment sessions. Frequently-used exercises were: stage 1 scapular setting with glenohumeral joint (GHJ) flexion to 90°, stage 2 GHJ medial rotation stretch, stage 3 scapular setting through lateral rotation, with resistance bands. We combined clinical and research expertise with national guidance in order to develop a physiotherapist-led, individualised, progressed and supervised exercise intervention for use within a randomised trial. The effectiveness of the intervention is being evaluated within the SUPPORT trial. Trial registration number ISRCTN 42399123. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis.

    Science.gov (United States)

    Wu, Tao; Song, Hai Xin; Dong, Yan; Li, Jian Hua

    2015-12-01

    This systematic review and meta-analysis aimed to assess the effectiveness of ultrasound-guided (USG) versus blind (landmark-guided, LMG) corticosteroid subacromial-subdeltoid bursa injection in adults with shoulder pain. The searches were performed on PubMed, Ovid MEDLINE, Ovid EMBASE, Ovid CochraneCENTRAL, Web of Science, Google Scholar, and Scopus from database inception through March 27, 2015. Studies were included trials comparing USG versus LSG injections for the treatment of adults with subacromial-subdeltoid bursitis. Two reviewers independently performed data extraction and appraisal of the studies. The outcome measures collected were the decreased VAS and SDQ scores, the increased shoulder function scores and shoulder abduction motion range, and the effective rate at 6 weeks after injection. Seven papers including 445 patients were reviewed; 224 received LMG injections and 221 received USG injections. There was a statistically significant difference in favor of USG for pain score [MD = 1.19, 95% CI (0.39, 1.98), P = 0.003] and SDQ score [MD = 5.01, 95% CI (1.82, 8.19), P = 0.02] at 6 weeks after injection. Also there was a statistically significant difference between the groups, with greater improvement reported of shoulder function scores [SMD = 0.89, 95% CI (0.56, 1.23), P < 0.001] and shoulder abduction motion range [MD 32.69, 95% CI (14.82, 50.56), P < 0.001] in the USG group. More effective rate was also reported with USG group and the difference was statistically significant [risk ratio = 1.6, 95% CI (1.02, 2.50), P = 0.04]. Ultrasound-guided corticosteroid injections potentially offer a significantly greater clinical improvement over blind SASD bursitis injections in adults with shoulder pain. Copyright © 2015. Published by Elsevier Inc.

  20. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Marlette Burger

    2016-02-01

    Full Text Available Background: Subacromial impingement syndrome (SIS is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs compared to physiotherapy in the management of SIS.Objective: To critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM and shoulder function in patients with SIS.Methodology:  Seven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots.Results: The PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6–7 weeks follow-up (p < 0.0001, no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1–3 months, mid- (6 months and long term (12 months.Conclusion: In patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.

  1. The effect of interferential current therapy on patients with subacromial impingement syndrome: a randomized, double-blind, sham-controlled study.

    Science.gov (United States)

    Nazligul, Tuba; Akpinar, Pinar; Aktas, Ilknur; Unlu Ozkan, Feyza; Cagliyan Hartevioglu, Hulya

    2017-09-11

    Although interferential current (IFC) is a common electrotherapeutic modality used to treat musculoskeletal pain, there is not any randomized controlled trial investigating its clinical efficacy in subacromial impingement syndrome (SAIS). Investigation of effectiveness of IFC treatment in patients with SAIS. Randomized, double-blind, sham-controlled study. Physical medicine and rehabilitation outpatient clinic. Patients (n=65) between 25 and 65 years of age, with a diagnosis of SAIS according to clinical evaluation and subacromial injection test. Patients were randomly distributed into two groups: 1) active IFC group (n=33); 2) sham IFC group (n=32). Exercise, cryotherapy, and a non-steroidal anti-inflammatory drug (NSAID) were given to both groups. Ten sessions of IFC with bipolar method were applied to the active IFC group daily 20 minutes per session, 5 days per week, for 2 weeks while sham IFC was applied to the sham IFC group with the same protocol. Visual analog scale (VAS), Constant scores, and Shoulder Disability Questionnaire (SDQ) were used for evaluation at baseline, immediately post-treatment, and 1 month post-treatment. Both the patients and the researcher who assessed the outcomes were blinded to the treatment protocol throughout the study period. Sixty of the 65 patients (active IFC group n=30, sham IFC group n=30) completed the study, 3 patients from active IFC, 2 from sham IFC group dropped during the follow up period. Statistically significant improvement was observed in all parameters of both groups immediately and 1 month post-treatment (p0.05). Our results demonstrated that IFC therapy does not provide additional benefit to NSAID, cryotherapy, and exercise program in treatment of SAIS. Our study responds to the needs of the lack of evidence in the field of rehabilitation. IFC therapy does not provide additional benefit for the treatment of SAIS.

  2. Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.

    Science.gov (United States)

    Kardouni, Joseph R; Shaffer, Scott W; Pidcoe, Peter E; Finucane, Sheryl D; Cheatham, Seth A; Michener, Lori A

    2015-08-01

    Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. Randomized Controlled Study. Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale - NPRS), function (Pennsylvania Shoulder Score - Penn), and global rating of change (GROC). There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574). There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups. Published by Elsevier Ltd.

  3. SHORT‐TERM EFFECTS OF INSTRUMENT‐ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME

    Science.gov (United States)

    Coviello, Joseph Paul; Reynolds, Timothy James

    2017-01-01

    Background and Purpose While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument‐Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Case Description Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain‐free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. Outcomes The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post‐IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. Discussion IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi‐modal treatment approach. Level of Evidence 5 PMID:28217425

  4. SHORT-TERM EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME.

    Science.gov (United States)

    Coviello, Joseph Paul; Kakar, Rumit Singh; Reynolds, Timothy James

    2017-02-01

    While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument-Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain-free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post-IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi-modal treatment approach. 5.

  5. Effects of Low-Load Exercise on Postneedling-Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome.

    Science.gov (United States)

    Salom-Moreno, Jaime; Jiménez-Gómez, Laura; Gómez-Ahufinger, Victoria; Palacios-Ceña, María; Arias-Buría, José L; Koppenhaver, Shane L; Fernández-de-Las-Peñas, César

    2017-05-05

    The application of dry needling usually is associated with postneedling-induced pain. A postneedling intervention reduce this adverse event is needed. To determine the effectiveness of low-load exercise on reducing postneedling-induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. A 72-hour follow-up, single-blind randomized controlled trial. Urban hospitals. Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low-load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. Numerical Pain Rating Scale (0-10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0-10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling-induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P needling, irrespective of the treatment group. Low-load exercise was effective for reducing postneedling-induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short-term pain and disability changes. To be determined. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc

  6. Conservative treatment for patients with subacromial impingement: Changes in clinical core outcomes and their relation to specific rehabilitation parameters

    Directory of Open Access Journals (Sweden)

    Mikkel B. Clausen

    2018-02-01

    Full Text Available Background Impaired patient-reported shoulder function and pain, external-rotation strength, abduction strength, and abduction range-of-motion (ROM is reported in patients with subacromial impingement (SIS. However, it is unknown how much strength and ROM improves in real-life practice settings with current care. Furthermore, outcomes of treatment might depend on specific rehabilitation parameters, such as the time spent on exercises (exercise-time, number of physiotherapy sessions (physio-sessions and number of corticosteroid injections, respectively. However, this has not previously been investigated. The purpose of this study was to describe changes in shoulder strength, ROM, patient-reported function and pain, in real-life practice settings, and explore the association between changes in clinical core outcomes and specific rehabilitation parameters. Methods Patients diagnosed with SIS at initial assessment at an outpatient hospital clinic using predefined criteria’s, who had not undergone surgery after 6 months, were included in this prospective cohort study. After initial assessment (baseline, all patients underwent treatment as usual, with no interference from the investigators. The outcomes Shoulder Pain and Disability Index (SPADI:0–100, average pain (NRS:0–10, external rotation strength, abduction strength and abduction ROM, pain during each test (NRS:0–10, were collected at baseline and at six month follow-up. Amount of exercise-time, physio-sessions and steroid-injections was recorded at follow-up. Changes in outcomes were analyzed using Wilcoxon Signed-Rank test, and the corresponding effect sizes (ES were estimated. The associations between changes in outcomes and rehabilitation parameters were explored using multiple regression analyses. Results Sixty-three patients completed both baseline and follow-up testing. Significant improvements were seen in SPADI (19 points, ES:0.53, p  0.2. A higher number of physio-sessions was

  7. Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Abdulla, Sean Y; Southerst, Danielle; Côté, Pierre; Shearer, Heather M; Sutton, Deborah; Randhawa, Kristi; Varatharajan, Sharanya; Wong, Jessica J; Yu, Hainan; Marchand, Andrée-Anne; Chrobak, Karen; Woitzik, Erin; Shergill, Yaadwinder; Ferguson, Brad; Stupar, Maja; Nordin, Margareta; Jacobs, Craig; Mior, Silvano; Carroll, Linda J; van der Velde, Gabrielle; Taylor-Vaisey, Anne

    2015-10-01

    Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear. Determine the effectiveness of exercise for shoulder pain. We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology. We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care. The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care. CRD42013003928. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Coracoid impingement syndrome due to intensive rock climbing training.

    Science.gov (United States)

    Schöffl, Volker; Schneider, Hans; Küpper, Thomas

    2011-06-01

    Overuse and acute injuries to the upper body are common in rock climbing. Such injuries primarily affect the fingers; but shoulder problems are increasingly common, especially among more experienced and older climbers who climb at a high ability level. Such shoulder problems are often due to subacromial impingement, shoulder dislocations with bankart lesions, hyperlaxity, SLAP lesions or irritations of the long biceps tendon. In contrast to these known conditions, we describe a case of an ambitious female rock climber who trained intensively and developed a coracoid impingement caused by hypertrophied subscapularis tendon and muscle following sport-specific training. Diagnosis was made through clinical evaluation and confirmed by magnetic resonance tomography. Coracoid impingement syndrome is a less common cause of shoulder pain and occurs when the subscapularis tendon impinges between the coracoid and the lesser tuberosity of the humerus. The patient was treated successfully with a conservative therapy and returned to full activity within 6 weeks. Copyright © 2011 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  9. Lipoma arborescens: caso raro de ruptura do manguito rotador associado à presença de lipoma arborescens na bursa subacromial-subdeltoidea e glenoumeral Lipoma arborescens: rare case of rotator cuff tear associated with the presence of lipoma arborescens in the subacromial-subdeltoid and glenohumeral bursa

    Directory of Open Access Journals (Sweden)

    Eduardo Benegas

    2012-01-01

    Full Text Available Lipoma arborescens é uma condição rara de moléstia intra-articular, usualmente monoarticular, caracterizada por extensa proliferação dos vilos sinoviais e hiperplasia da gordura subsinovial. O tecido sinovial é progressivamente substituído por células maduras de gordura na membrana sinovial. O presente trabalho é o relato de caso de uma condição rara de lipoma arborescens tanto intra-articular (glenoumeral como da bursa subacromial-subdeltoide além de ruptura do tendão do supraespinhoso. As apresentações clínicas, histológicas e radiográficas assim como o tratamento são discutidos no presente estudo. A apresentação do caso contempla também a avaliação radiográfica, ressonância magnética e exame patológico. Apesar do lipoma arborescens ser uma condição rara, tal hipótese deve ser considerada frente a um caso com hiperproliferação sinovial e lipossubstituição da sinovial.Lipoma arborescens is a rare intra-articular disease that is usually monoarticular and is characterized by extensive proliferation of the synovial villi and hyperplasia of the subsynovial fat. The synovial tissue is progressively replaced by mature fat cells in the synovial membrane. The present study reports a case of a rare condition of lipoma arborescens that was simultaneously intra-articular (glenohumeral joint and in the subacromial-subdeltoid bursa, in association with a torn supraspinatus tendon. The clinical, histological and radiographic presentations and treatment are discussed here. The description of this case includes radiographic and magnetic resonance evaluations and pathological examination. Although lipoma arborescens is a rare condition, it should be taken into consideration in cases presenting synovial hyperproliferation and synovial fat replacement.

  10. Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with Subacromial Impingement Syndrome.

    Science.gov (United States)

    Keenan, Karen A; Akins, Jonathan S; Varnell, Michelle; Abt, John; Lovalekar, Mita; Lephart, Scott; Sell, Timothy C

    2017-03-01

    To examine the effect of kinesiology tape (KT) on shoulder strength, proprioception, and scapular kinematics in healthy and Subacromial Impingement Syndrome (SAIS) subjects. Placebo-controlled quasi-experimental study. Research laboratory. A total of 30 physically active subjects participated. Ten healthy subjects with no previous history of shoulder pathology received KT on the dominant shoulder. Twenty subjects with shoulder pain for a minimum of two weeks and presenting with clinical signs of impingement were allotted to receive KT (n = 10) or placebo taping (PT, n = 10) on the involved shoulder. All participants were tested pre- and post-application. Shoulder internal/external rotation (IR/ER) strength was assessed with isokinetic dynamometry (average peak torque/body weight). Shoulder IR/ER proprioception was assessed through threshold to detect passive motion (mean absolute error in degrees). Scapular position at 90° and 120° of shoulder abduction during arm raising/lowering were assessed using a 3D motion analysis system. No significant within group or between group differences were demonstrated for any measure. Taping does not appear to aid/impair shoulder strength, shoulder proprioception, or scapular kinematics. Future research should explore if the effects of KT are time-dependent and similar in other pathologies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. [Influence of Operative and Conservative Therapy on the Ability to Work of Patients With Subacromial Impingement: A Prospective Clinical Comparative Study].

    Science.gov (United States)

    Schulze, Christoph; Köhler, Hans Christian; Kaltenborn, Alexander; Gutcke, André; Tischer, Thomas

    2017-08-01

    Background Subacromial impingement is a common reason for pain in the shoulder. Treatment is difficult and patients are not able to work for a long time. An increasing number of operative treatments can be observed although conservative treatment is effective, too. There is no study that observed how operative and conservative treatment influence ability to work. Methods 86 persons were included in this prospective study. Surgery was performed with an arthroscopy of the shoulder. Conservative treatment was carried out by a physiotherapist under control of the physician. Reevaluation was conducted 3 and 6 months after the initial contact. Here we observed the time the participant was not able to work, Constant Score and pain on the numeric rating scale. Results Both therapies were able to improve pain and function. During conservative treatment, improvement was faster than under operative care. Time without ability to work was 7 ± 5 weeks longer after operative treatment than under conservative therapy (p Bursitis subacromialis detected in the MRI was a predictor of faster recovery. Conclusion Conservative and operative treatment improved pain and function significantly. Properly carried out conservative therapy enables patients to get back to work earlier. Georg Thieme Verlag KG Stuttgart · New York.

  12. Responsiveness and minimal important change of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in patients with subacromial pain syndrome.

    Science.gov (United States)

    Rysstad, Tarjei; Røe, Yngve; Haldorsen, Benjamin; Svege, Ida; Strand, Liv Inger

    2017-06-08

    The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) is a valid and reliable patient-reported outcome measure (PROM). It was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity, and is one of the most commonly used PROMs for patients with shoulder pain. The aim of this study was to examine responsiveness, the smallest detectable change (SDC) and the minimal important change (MIC) of the DASH, in line with international (COSMIN) recommendations. The study sample consisted of 50 patients with subacromial pain syndrome, undergoing physical therapy for 3-4 months. Responsiveness to change was examined by calculating area under the receiver operating characteristic curves (AUC) and testing a priori-formulated hypothesis regarding correlations with changes in other instruments that measuring the same construct. The SDC was calculated using a test re-test protocol, and the MIC was calculated by the anchor-based MIC distribution. MIC values for patients with low and high baseline scores were also calculated. DASH appeared to be responsive, as it was able to distinguish patients who reported to be improved from those unchanged (AUC 0.77). All of the hypotheses were accepted. The SDC was 11.8, and the MIC was 4.4. This study shows that the Norwegian version of the DASH has good responsiveness to change and may thus be recommended to measure outcome in patients with shoulder pain in Norway.

  13. Internal- and External-Rotation Peak Toque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training.

    Science.gov (United States)

    Lee, Dong-Rour; Kim, Laurentius Jongsoon

    2016-08-01

    Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain. To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players. Single-group pretest, posttest. Biomechanics laboratory. 23 Little League Baseball players with subacromial impingement syndrome. The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk. The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s. The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s. CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

  14. Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study.

    Science.gov (United States)

    Akyol, Yesim; Ulus, Yasemin; Durmus, Dilek; Canturk, Ferhan; Bilgici, Ayhan; Kuru, Omer; Bek, Yuksel

    2012-10-01

    The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

  15. Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect.

    Science.gov (United States)

    Pekyavas, Nihan Ozunlu; Ergun, Nevin

    2017-05-01

    The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Intensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level I, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  16. Short-term effects of high-intensity laser therapy, manual therapy, and Kinesio taping in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Pekyavas, Nihan Ozunlu; Baltaci, Gul

    2016-08-01

    Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n = 15), KT + EX (n = 20), MT + KT + EX (n = 16), and MT + KT + HILT + EX (n = 19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT + KT + EX and HILT + MT + KT + EX groups (p effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.

  17. PERBANDINGAN ANTARA KOMBINASI LATIHAN STABILISASI BAHU DAN TRAKSI HUMERUS KE INFERIOR DENGAN KOMBINASI LATIHAN FUNGSIONAL BAHU DAN TRAKSI HUMERUS KE INFERIOR DALAM MENURUNKAN DISABILITAS BAHU DAN LENGAN PADA SUBACROMIAL IMPINGEMENT SYNDROME MAHASISWA AKAD

    Directory of Open Access Journals (Sweden)

    Mawaddah -

    2015-08-01

    Full Text Available Shoulder impingement causing interference on the motion of the shoulder joint activities and result in functional activity disorder. These injuries usually are caused by faulty movement, overuse, poor posture, occupational factors and trauma. This will cause a burden on one part of the body and cause imbalances in anatomy, which will eventually lead to disruption of the body that experienced work. This study aimed to investigate the effect of functional shoulder exercise and traction humerus to inferior with shoulder stabilization exercises and traction humerus to inferior to the decline in the shoulder and arm disabilities in subacromial impingement syndrome. This research method was experimental clinical trials with pre test and post test group design. Population student Academy Physiotherapy Widya Husada Semarang, which consists of 3 men and 12 women, aged between 18-21 years, divided into two groups. Group I was given Shoulder Stabilization exercises and Traction humerus to Inferior (n=7 and group II Functional Shoulder Exercise and Traction humerus to Inferior (n=8. This research was conducted for 3 weeks. Measurement of the value of disability shoulder and arm by using the Shoulder Pain and Disability Index (SPADI. The test results on the group I average value pre 34.17, SB = 6.31, and the average value of post 11.54, SB = 4.02, p = 0.001 found significant differences obtained test results paired sample t-test, and testing group II average value pre 40.18, SB = 3.53, and the average value of post 7.82, SB = 1.57, p = 0.001 found significant differences obtained test results paired sample t-test. Comparison of Group I and II, p = 0.005 there were significant differences, test results obtained independent sample t-test. Conclusions: The combination of shoulder stabilization exercises and traction humerus to inferior can reduce disability shoulder and arm on subacromial impingement syndrome. The combination functional shoulder exercise and

  18. Tratamiento del hombro doloroso en un servicio de rehabilitación y medicina física : estudio sobre los efectos de las ondas de choque y los ultrasonidos en el tratamiento del síndrome subacromial.

    OpenAIRE

    Fernández Fernández, Juan Reyes

    2013-01-01

    Objetivos del estudio: establecer los efectos de ultrasonidos y ondas de choque radiales en el síndrome subacromial, determinar la posible influencia del sexo y analizar la rentabilidad de ambas técnicas. Realizamos un estudio en veinticuatro pacientes repartidos en dos grupos: un grupo recibió ondas de choque y el otro ultrasonidos. Los pacientes fueron evaluados mediante la escala DASH, Constant&Murley, UCLA, SF-36 y EVA, antes del tratamiento, al mes, a los tres meses y a los seis...

  19. Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome.

    Science.gov (United States)

    Nörenberg, Dominik; Armbruster, Marco; Bender, Yi-Na; Walter, Thula; Ebersberger, Hans U; Diederichs, Gerd; Hamm, Bernd; Ockert, Ben; Makowski, Marcus R

    2017-03-01

    To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (pStandard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R2=0.75;pstandard MRI (R2=0.24;psuperior to standard MR-sequences using radiography as goldstandard. • SWMR has the potential to reliably identify sub-coracoacromial spurs without radiation exposure. • SWMR provides comparable detection rates to conventional radiography for sub-coracoacromial spur formation. • SWMR yields higher detection rates compared to standard-MR regarding sub-coracoacromial spur formation. • SWMR can be implemented in routine shoulder MRI protocols.

  20. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial.

    Science.gov (United States)

    Rhon, Daniel I; Boyles, Robert B; Cleland, Joshua A

    2014-08-05

    Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. To compare the effectiveness of 2 common nonsurgical treatments for SIS. Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891). Military hospital-based outpatient clinic in the United States. 104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012. Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy. The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use. Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported. The study occurred at 1 center with patients referred to physical therapy. Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group. Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.

  1. Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study.

    Science.gov (United States)

    Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, Johan Hviid; Thomsen, Jane Frølund; Frost, Poul

    2013-11-01

    The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. The study was based on the Musculoskeletal Research Database at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from a job exposure matrix based on expert judgment. We applied multivariable Cox regression. During 280 125 person-years of follow-up among 37 402 persons, 557 first-time operations for SIS occurred. Crude surgery rates increased from 1.1 to 2.5 per 1000 person-years with increasing shoulder load. Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR(adj)) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load showed an HR(adj) of 4.52 (95% CI 2.87-7.13). Subanalyses based on 18 856 persons showed an HR(adj) of 5.40 (95% CI 2.88-10.11) for complaints located specifically in the shoulder in combination with high shoulder load. Based on these findings, persons with neck-shoulder and especially shoulder complaints in combination with high shoulder load seem an obvious target group for interventions aimed at reducing exposures to prevent surgery for SIS.

  2. Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome

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    Noerenberg, Dominik; Armbruster, Marco [Munich University Hospitals Campus Grosshadern, Department of Clinical Radiology, Munich (Germany); Bender, Yi-Na; Walter, Thula; Diederichs, Gerd; Hamm, Bernd [Charite - University Medicine Berlin, Department of Radiology, Berlin (Germany); Ebersberger, Hans U. [Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany); Ockert, Ben [Munich University Hospitals Campus Grosshadern, Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service, Munich (Germany); Makowski, Marcus R. [Charite - University Medicine Berlin, Department of Radiology, Berlin (Germany); King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom)

    2017-03-15

    To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (p<0.001). SWMR demonstrated a sensitivity of 97.7 % (CI=0.92-1) and a specificity of 91.3 % (CI=0.788-1) for the identification of spurs. Standard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R{sup 2}=0.75;p<0.0001), while overestimating lesion size (5.7±1.2 mm; 4.3±1.3 mm;p<0.0001). Interobserver-agreement for spurs was high on SWMR (R{sup 2}=0.74;p<0.0001), but low on standard MRI (R{sup 2}=0.24;p<0.0001). SWMR allows a reliable detection of sub-coracoacromial spur formation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard. (orig.)

  3. Short-Term Effectiveness of Precut Kinesiology Tape Versus an NSAID as Adjuvant Treatment to Exercise for Subacromial Impingement: A Randomized Controlled Trial.

    Science.gov (United States)

    Devereaux, Moira; Velanoski, Kinny Quan; Pennings, Amanda; Elmaraghy, Amr

    2016-01-01

    To compare the short-term effectiveness of precut kinesiology tape (PCT) to a nonsteroidal anti-inflammatory drug (NSAID) as adjuvant treatment to exercise physiotherapy in improving pain and function in patients with shoulder impingement. Randomized, controlled assessor-blind parallel-design trial with 3 groups. Academic-community hospital. One hundred patients (mean age: 48 ± 12.3, 61 men, 39 women) with a diagnosis of subacromial impingement (SAI) syndrome were randomized to a treatment group from October 2009 to June 2012. Eighty-one patients completed the study. Patients were randomized to one of the 3 treatment groups: PCT and Exercise (n = 33), NSAID and Exercise (n = 29), or Exercise only (n = 38) for a 4 session 2-week intervention with a registered physiotherapist. Numeric pain rating scales for pain at rest and pain with arm elevation, the Simple Shoulder Test (SST), and the Constant Score were assessed pretreatment and post-treatment. A statistically significant reduction in pain at rest and pain with arm elevation, as well as improvement in SST and Constant Score were observed in all 3 treatment groups, with minimal clinically important differences shown on pain with elevation and SST scores. Between-group differences on all outcome measures were not statistically significant or clinically meaningful. The improvements in pain and function observed with an NSAID or PCT as adjuvant treatments were no greater than with rehabilitation exercise alone. If adjuvant treatment is desired, PCT seems to be better tolerated than an NSAID, although the difference did not reach significance. The routine addition of adjuvant treatment is not supported by the results of this study. As adjuvant therapy, PCT seems to be better tolerated than an NSAID. If desired, clinicians may consider incorporating PCT along with an exercise component in the conservative treatment of SAI syndrome.

  4. EFFECT OF POSTURAL CORRECTION WITH DIFFERENT TAPING MATERIALS ON SCAPULAR KINEMATICS AND MYOELECTRIC ACTIVITIES OF SCAPULAR ROTATORS IN SUBACROMIAL IMPINGEMENT SYNDROME A RANDOMIZED PLACEBO-CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Eman Mohamad Abd Al-Gawad

    2016-06-01

    Full Text Available Background: Rigid and kinesio tapings are commonly used in the rehabilitation of subacromial impingement syndrome (SIS. Yet; the effect of postural correction with the two taping materials in SIS has not been extensively studied. The purpose of the study is to examine the effect of postural correction with two different taping materials on scapular kinematics and electromyography of scapular upward rotators in patients with SIS. Methods: Twenty female patients with SIS participated in this study. Their age ranged from 30-60 years. Participants were randomly assigned into: Group I (Kinesio tape, n=10 and Group II (rigid tape, n=10. Thoracic and scapular taping with posture correction was applied to both groups. Scapular upward rotation at 0˚, 60˚, 90˚ and 120˚ of shoulder elevation and the activity level of the upper fibers of trapezius (UT, lower fibers of trapezius (LT and serratus anterior (SA muscles were measured before and immediately after taping application. Results: Both taping materials significantly increased scapular upward rotation at 60°, 90° and 120° angles (P =.004,.002 and .047 respectively after the application of tape as compared to the before. In addition, significantly greater muscle activity of the LT and SA muscles (P =.027 and 0.05 respectively were demonstrated by the kinesio-taping group as compared to rigid taping group during real taping condition. Conclusion: Both taping materials are effective in restoring scapular kinematics. Furthermore, kinesio taping has a facilitatory effect on the LT and SA muscles. Kinesio taping may be considered an alternative to rigid taping in patients with SIS.

  5. Subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder manual therapy plus exercise intervention in individuals with subacromial impingement syndrome: a prospective, randomized controlled clinical trial pilot study.

    Science.gov (United States)

    Wright, Alexis A; Donaldson, Megan; Wassinger, Craig A; Emerson-Kavchak, Alicia J

    2017-09-01

    To determine the subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder non-thrust plus exercise in patients with subacromial pathology. This was a randomized, single blinded controlled trial pilot study. This trial was registered at ClinicalTrials.gov (NCT01753271) and reported according to Consolidated Standards of Reporting Trials requirements. Patients were randomly assigned to either shoulder treatment plus cervicothoracic spinal thrust/non-thrust or shoulder treatment-only group. Primary outcomes were average pain intensity (Numeric Pain Rating Scale) and physical function (Shoulder Pain and Disability Index) at 2 weeks, 4 weeks, and patient discharge. 18 patients, mean age 43.1(15.8) years satisfied the eligibility criteria and were analyzed for follow-up data. Both groups showed statistically significant improvements in both pain and function at 2 weeks, 4 weeks, and discharge. The between-group differences for changes in pain or physical function were not significant at any time point. The addition of cervicothoracic spinal thrust/non-thrust to the shoulder treatment-only group did not significantly alter improvement in pain or function in patients with subacromial pathology. Both approaches appeared to provide an equally notable benefit. Both groups improved on all outcomes and met the criteria for clinical relevance for both pain and function. 2b.

  6. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index.

    Science.gov (United States)

    Clausen, M B; Witten, A; Holm, K; Christensen, K B; Attrup, M L; Hölmich, P; Thorborg, K

    2017-07-17

    Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines. The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function. Cross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia. Significant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29-33% deficits), and less for scapulothoracic strength and internal

  7. Surgery for subacromial impingement syndrome in relation to occupational exposures, lifestyle factors and diabetes mellitus: a nationwide nested case-control study.

    Science.gov (United States)

    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2017-10-01

    To estimate the risk of surgery for subacromial impingement syndrome (SIS) in relation to occupational exposures, lifestyle factors and diabetes mellitus. We conducted a case-control study nested in a register-based cohort study of the Danish working population. For each of 3000 first-time cases of surgery for SIS, two age-matched and sex-matched controls were drawn. Cases and controls received a questionnaire on job history and other factors. Job histories were combined with a psychosocial job exposure matrix (JEM) and the updated Shoulder JEM, which provided exposure intensities on measurement scales. Ten-year cumulative exposures to upper arm elevation >90°, repetitive shoulder movements, forceful shoulder exertions and hand-arm vibrations (HAVs) were estimated. We used conditional logistic regression. There were 5396 persons (60%) who answered the questionnaire. For occupational mechanical exposures, the adjusted OR (ORadj) ranged from 1.9 (95% CI 1.5 to 2.5 for HAVs) to 2.5 (95% CI 1.9 to 3.5 for force) among men and 1.7 (95% CI 1.2 to 2.5 for HAVs) to 2.0 (95% CI 1.3 to 2.9 for force) among women. No statistically significant associations were found for occupational psychosocial factors. Body mass index (BMI) and pack-years of smoking showed ORadj up to 2.0. Diabetes mellitus showed ORadj of 1.5 (95% CI 1.1 to 2.2) for men and 2.2 (95% CI 1.4 to 3.4) for women. Our findings add to the evidence of an increased risk of surgery for SIS in relation to occupational cumulative mechanical exposures, even when an increased risk in relation to BMI, smoking and diabetes mellitus is taken into account. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Poisoning due to pyrethroids.

    Science.gov (United States)

    Bradberry, Sally M; Cage, Sarah A; Proudfoot, Alex T; Vale, J Allister

    2005-01-01

    current') ensues which, if it is sufficiently large and/or long, lowers the action potential threshold and causes repetitive firing; this may be the mechanism causing paraesthesiae. At high pyrethroid concentrations, the sodium tail current may be sufficiently great to prevent further action potential generation and 'conduction block' ensues. Only low pyrethroid concentrations are necessary to modify sensory neurone function. Type II pyrethroids also decrease chloride currents through voltage-dependent chloride channels and this action probably contributes the most to the features of poisoning with type II pyrethroids. At relatively high concentrations, pyrethroids can also act on GABA-gated chloride channels, which may be responsible for the seizures seen with severe type II poisoning. Despite their extensive world-wide use, there are relatively few reports of human pyrethroid poisoning. Less than ten deaths have been reported from ingestion or following occupational exposure. Occupationally, the main route of pyrethroid absorption is through the skin. Inhalation is much less important but increases when pyrethroids are used in confined spaces. The main adverse effect of dermal exposure is paraesthesiae, presumably due to hyperactivity of cutaneous sensory nerve fibres. The face is affected most commonly and the paraesthesiae are exacerbated by sensory stimulation such as heat, sunlight, scratching, sweating or the application of water. Pyrethroid ingestion gives rise within minutes to a sore throat, nausea, vomiting and abdominal pain. There may be mouth ulceration, increased secretions and/or dysphagia. Systemic effects occur 4-48 hours after exposure. Dizziness, headache and fatigue are common, and palpitations, chest tightness and blurred vision less frequent. Coma and convulsions are the principal life-threatening features. Most patients recover within 6 days, although there were seven fatalities among 573 cases in one series and one among 48 cases in another

  9. Urticaria due to antihistamines

    National Research Council Canada - National Science Library

    Sánchez Morillas, L; Rojas Pérez-Ezquerra, P; Reaño Martos, M; Sanz, M L; Laguna Martínez, J J

    2011-01-01

    .... We report a patient with urticaria due to ingestion of ebastine and fexofenadine. Skin prick tests, patch tests, and basophil activation tests with the implicated drugs and antihistamines from other families were negative...

  10. Intuitionistic fuzzy metric spaces

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Han E-mail: jihpark@pknu.ac.kr

    2004-12-01

    Using the idea of intuitionistic fuzzy set due to Atanassov [Intuitionistic fuzzy sets. in: V. Sgurev (Ed.), VII ITKR's Session, Sofia June, 1983; Fuzzy Sets Syst. 20 (1986) 87], we define the notion of intuitionistic fuzzy metric spaces as a natural generalization of fuzzy metric spaces due to George and Veeramani [Fuzzy Sets Syst. 64 (1994) 395] and prove some known results of metric spaces including Baire's theorem and the Uniform limit theorem for intuitionistic fuzzy metric spaces.

  11. Metrizability of Cone Metric Spaces Via Renorming the Banach Spaces

    Directory of Open Access Journals (Sweden)

    Hossein Soleimani

    2012-09-01

    Full Text Available In this paper we show that by renorming an ordered Banach space, every cone $P$ can be converted to a normal cone with constant $K=1$ and consequently due to this approach every cone metric space is really a metric one and every theorem in metric space is valid for cone metric space automatically.

  12. Is radial Extracorporeal Shock Wave Therapy (rEWST) combined with supervised exercises (SE) more effective than sham rESWT and SE in patients with subacromial shoulder pain? Study protocol for a double-blind randomised, sham-controlled trial.

    Science.gov (United States)

    Kvalvaag, Elisabeth; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene Lundgaard; Bautz-Holter, Erik; Røe, Cecilie

    2015-09-11

    Subacromial shoulder pain is a common complaint. Radial Extracorporeal Shock Wave Therapy (rESWT) has being increasingly used to treat calcific and non-calcific tendinosis, although there is no evidence of the effectiveness of rESWT in non-calcific tendinosis of the rotator cuff. A randomised single blind study showed that the short-term effect of supervised exercises (SE) was significantly better than rESWT on subacromial shoulder pain, but both groups improved. In a clinical trial on achilles tendinopathy rESWT improved the effectiveness of treatment with eccentric loading. The objective of this present study is to evaluate if rESWT in addition to SE is more effective in improving shoulder pain and function compared with sham rESWT and SE in patients with subacromial shoulder pain. This is a double blind, randomised sham-controlled trial which is performed at the shoulder clinic at the Department of Physical Medicine and Rehabilitation in Oslo University Hospital, Norway. One-hundred-forty-four patients with subacromial shoulder pain lasting at least 3 months, age from 25 to 70 years old are included in the trial. Patients are randomly allocated in 1:1 ratio to receive either rESWT or sham rESWT once a week in addition to SE once a week for the initial 4 weeks. Subsequently SE are provided twice a week for 8 weeks. The primary outcome measure is a change in the Shoulder Pain and Disability Index (SPADI) at 24 weeks follow-up. Secondary outcomes include return to work, pain at rest and on activity, function, and health related quality of life. The patients, the physiotherapist providing the exercise regimen and the outcome assessor are blinded to group assignment. The physiotherapist providing the rESWT is not blinded. Because of the extensive use of rESWT in the treatment of subacromial shoulder pain the results of this trial will be of importance and have impact on clinical practice. ClinicalTrials.gov NCT01441830.

  13. Death due to asthma

    Directory of Open Access Journals (Sweden)

    Albert L. Sheffer

    1996-01-01

    Full Text Available The prevalence and fatality rate of asthma have increased worldwide. Underdiagnosis and undertreatment of asthma are central to the occurrence of fatal asthma. Atopy is the principal risk factor associated with asthma. However, consideration of the epidemiologic, physiologic, pharmacologic, pathologic and clinical parameters of asthma assessment may provide valuable insight into death due to asthma. Psychologic and socioeconomic factors may further aggravate the asthma status. Ethnic minorities are at increased risk of asthma. The perception of dyspnea may be blunted in asthma sufferers. Slow-onset fatal asthma may be associated with submucosal eosinophilic, whereas sudden-onset may be associated with submucosal neutrophilia. Fatal asthma occurs in patients abusing regular |32-agonist therapy. Peak flow assessment often provides insight into asthma deterioration prior to signs of respiratory distress. Markers of risk of death due to asthma further identify the fatality-prone asthma patient.

  14. Death due to asthma

    OpenAIRE

    Sheffer, Albert L.

    1996-01-01

    The prevalence and fatality rate of asthma have increased worldwide. Underdiagnosis and undertreatment of asthma are central to the occurrence of fatal asthma. Atopy is the principal risk factor associated with asthma. However, consideration of the epidemiologic, physiologic, pharmacologic, pathologic and clinical parameters of asthma assessment may provide valuable insight into death due to asthma. Psychologic and socioeconomic factors may further aggravate the asthma status. Ethnic minoriti...

  15. Human due diligence.

    Science.gov (United States)

    Harding, David; Rouse, Ted

    2007-04-01

    Most companies do a thorough job of financial due diligence when they acquire other companies. But all too often, deal makers simply ignore or underestimate the significance of people issues in mergers and acquisitions. The consequences are severe. Most obviously, there's a high degree of talent loss after a deal's announcement. To make matters worse, differences in decision-making styles lead to infighting; integration stalls; and productivity declines. The good news is that human due diligence can help companies avoid these problems. Done early enough, it helps acquirers decide whether to embrace or kill a deal and determine the price they are willing to pay. It also lays the groundwork for smooth integration. When acquirers have done their homework, they can uncover capability gaps, points of friction, and differences in decision making. Even more important, they can make the critical "people" decisions-who stays, who goes, who runs the combined business, what to do with the rank and file-at the time the deal is announced or shortly thereafter. Making such decisions within the first 30 days is critical to the success of a deal. Hostile situations clearly make things more difficult, but companies can and must still do a certain amount of human due diligence to reduce the inevitable fallout from the acquisition process and smooth the integration. This article details the steps involved in conducting human due diligence. The approach is structured around answering five basic questions: Who is the cultural acquirer? What kind of organization do you want? Will the two cultures mesh? Who are the people you most want to retain? And how will rank-and-file employees react to the deal? Unless an acquiring company has answered these questions to its satisfaction, the acquisition it is making will be very likely to end badly.

  16. AU-18 Space Primer

    Science.gov (United States)

    2009-09-01

    munications satellites are particularly vulnerable to intermittent signal loss due to scin- tillation. In fact, during the Persian Gulf War, allied...JSpOC.8 The GEODSS system can track objects as small as a basketball more than 20,000 miles in space. Moron Optical Space Surveillance. The Moron

  17. Limitations on space flight due to cosmic radiations.

    Science.gov (United States)

    CURTIS, H J

    1961-02-03

    These conclusions (10) may be summarized as follows: 1) Flight below the Van Allen belts seems reasonably safe without radiation shielding. 2) It is probably impractical to shield a rocket sufficiently to permit a man to remain in the inner Van Allen belt for more than about an hour, but it should be possible for him to go through it without serious harm. 3) Shielding for the outer Van Allen belt is possible but would have to be quite heavy if a stay of more than a few hours were contemplated. 4) The primary cosmic radiation is not intense enough to deliver a serious radiation dose, even for exposures of a few weeks, and the heavy cosmic ray primaries do not seem to present an unusual hazard.

  18. [Onychomycoses due to molds].

    Science.gov (United States)

    Chabasse, D; Pihet, M

    2014-12-01

    Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium... These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Aggradation in rivers due to overloading

    NARCIS (Netherlands)

    Ribberink, J.S.; Van der Sande, J.T.M.

    1984-01-01

    The problem of aggradation in a river due to overloading is tackled with a mathematical model consisting of a set of one-dimensional (in space) basic equations in which the water motion is assumed to be quasi-steady and the sediment transport is determined by local conditions. Analytical solutions

  20. Credit where due.

    Science.gov (United States)

    Friedman, Steven G

    2016-08-01

    The history of medicine is filled with stories of tireless researchers who failed to get credit for their hard work. Examples of this include Rosalind Franklin, who helped to elucidate the structure of DNA; Frederick Banting, who helped to discover insulin; and Jay McLean, who discovered heparin. The founding of the field of vascular surgery provides one of the most vivid examples of uncredited work. Even though Alexis Carrel was an unpaid, untitled assistant in Charles Guthrie's laboratory, it was Carrel alone who received a Nobel Prize for their work. In an attempt to give credit where due, the reasons for this injustice are described. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Microsystems for Space Applications

    Directory of Open Access Journals (Sweden)

    B. Palán

    2000-01-01

    Full Text Available Recent progress in microsystems technologies make them suitable for the space research and development due to their low volume, low mass, low power consumption, leading to reduced mission cost. The most interesting approach is using standard technologies with additional post-processing steps to realize sensors and actuators together with signal processing circuits. This paper summarises some aspects and difficulties of the space environment. The radiation effects in space are described and damage on CMOS structures are explained. Design methodologies for hardening microsystems and MOS based circuits against these effects are presented. Some examples of microsystems examples for space applications fabricated by researches world-wide are given.

  2. Analgesia para a sutura artroscópica do manguito rotador: estudo comparativo entre o bloqueio interescalênico do plexo braquial e o bloqueio da bursa subacromial contínuo Management of pain after the rotator cuff arthroscopic suture: comparative study among the interescalenic blockade and the continuous intrabursal infusion

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2007-10-01

    analyzed. Group I comprised patients who received interescalenic blockade with 0.75% ropivacaine. In group II, the same blockade was added with 150 µg of clonidine. In group III, a 30 ml bolus of 0.75% ropivacaine was administered to infiltrate the arthroscopic portals and directly in the subacromial space, followed by a continuous infusion of 0.2% ropivacaine with an infusion pump. The patients were submitted to the medication of the EAV analogue-visual scale 24 hours after the procedure. The variables studied were EAV, gender, size of the lesion, need of internal capsulotomy, and prevalence of side effects. The study evaluated 196 patients, 51 of whom were excluded, thus giving a total " n" = 145 patients. The total of patients in group I was 65, in group II, 19, and in group III, 61. RESULTS: The mean EAV index found for group I was 3.88 ± 1,737 (3; in group II, it was 3.8 ± 1.6 (3, and in group III, 1.95 ± 1.6 (2. There was a significant difference when comparing group I to group III (p < 0.001 and when comparing group II to group III (p < 0.001 suggesting less pain felt by patients in group III. There was no pain perception difference between genders (p = 0.700 and among the different sizes of rotator cuff lesion (p = 0.546. There was a pain perception difference between patients that were and those that were not submitted to internal capsulotomy (p = 0.038. There was reduced prevalence of nausea and/or vomiting (p = 0.089 and of pruritus (p = 0.092 in group III as compared to groups I and II. CONCLUSIONS: The protocol of postoperative analgesia with continuous infusion of ropivacaine showed that it is better than the protocols using morphine after the end of the interescalenic blockade effects. There was no difference in pain perception between the genders and according to different sizes of sutured lesions. There was a difference in pain perception by the patients who had and those who have not had internal capsulotomy. The rate of side effects was similar among

  3. [Keratitis due to Acanthamoeba].

    Science.gov (United States)

    Pérez-Irezábal, Julio; Martínez, Inés; Isasa, Patricia; Barrón, Jorge

    2006-10-01

    Free-living amebae appertaining to the genus Acanthamoeba, Naegleria and Balamuthia are the most prevalent protozoa found in the environment. These amebae have a cosmopolitan distribution in soil, air and water, providing multiple opportunities for contacts with humans and animals, although they only occasionally cause disease. Acanthamoeba spp. are the causative agent of granulomatous amebic encephalitis, a rare and often fatal disease of the central nervous system, and amebic keratitis, a painful disease of the eyes. Keratitis usually follows a chronic course due to the delay in diagnosis and subsequent treatment. The clear increase in Acanthamoeba keratitis in the last 20 years is related to the use and deficient maintenance of contact lenses, and to swimming while wearing them. The expected incidence is one case per 30,000 contact lens wearers per year, with 88% of cases occurring in persons wearing hydrogel lenses. This review presents information on the morphology, life-cycle and epidemiology of Acanthamoeba, as well as on diagnostic procedures (culture), appropriate antimicrobial therapy, and prevention measures.

  4. The “Hoover” (vacuum cleaner) technique for calcifying tendonitis deposits excision and removal of the calcific debris

    Science.gov (United States)

    Ehud, Atoun; Ehud, Rath; Alexander, Van Tongel; Ali, Narvani; Giusseppe, Sforza; Ofer, Levy

    2012-01-01

    A new technical tip for the improvement of the arthroscopic treatment of symptomatic calcifying tendinitis is described. Arthroscopic excision of calcifying tendonitis may result with multiple minute calcific debris in the subacromial bursa, causing severe post operative pain due to chemical irritation of the bursa. We suggest the use of a bladeless shaver barrel as a “Hoover” (vacuum cleaner) for arthroscopic clearance of these miniature calcific debris from the subacromial space after resection of the major deposits. The use of this technique resulted in good clinical outcome with improved post operative pain. PMID:23204765

  5. The "Hoover" (vacuum cleaner) technique for calcifying tendonitis deposits excision and removal of the calcific debris.

    Science.gov (United States)

    Ehud, Atoun; Ehud, Rath; Alexander, Van Tongel; Ali, Narvani; Giusseppe, Sforza; Ofer, Levy

    2012-07-01

    A new technical tip for the improvement of the arthroscopic treatment of symptomatic calcifying tendinitis is described. Arthroscopic excision of calcifying tendonitis may result with multiple minute calcific debris in the subacromial bursa, causing severe post operative pain due to chemical irritation of the bursa. We suggest the use of a bladeless shaver barrel as a "Hoover" (vacuum cleaner) for arthroscopic clearance of these miniature calcific debris from the subacromial space after resection of the major deposits. The use of this technique resulted in good clinical outcome with improved post operative pain.

  6. Sacred Space.

    Science.gov (United States)

    Adelstein, Pamela

    2018-01-01

    A space can be sacred, providing those who inhabit a particular space with sense of transcendence-being connected to something greater than oneself. The sacredness may be inherent in the space, as for a religious institution or a serene place outdoors. Alternatively, a space may be made sacred by the people within it and events that occur there. As medical providers, we have the opportunity to create sacred space in our examination rooms and with our patient interactions. This sacred space can be healing to our patients and can bring us providers opportunities for increased connection, joy, and gratitude in our daily work.

  7. Space Curves

    CERN Document Server

    Peskine, Christian; Sernesi, Edoardo

    1987-01-01

    The main topics of the conference on "Curves in Projective Space" were good and bad families of projective curves, postulation of projective space curves and classical problems in enumerative geometry.

  8. Cyclic universe due to phantom and quintessence

    OpenAIRE

    Gao, Changjun; Lu, Youjun; Shen, You-Gen

    2014-01-01

    We explore a cyclic universe due to phantom and quintessence fields. We find that, in every cycle of the evolution of the universe, the phantom dominates the cosmic early history and quintessence dominates the cosmic far future. In this model of universe, there are infinite cycles of expansion and contraction. Different from the inflationary universe, the corresponding cosmic space-time is geodesically complete and quantum stable. But similar to the Cyclic Model, the flatness problem, the hor...

  9. Space trophy nominations sought

    Science.gov (United States)

    Showstack, Randy

    2011-10-01

    The Rotary National Award for Space Achievement (RNASA) Foundation is soliciting nominations for its 2012 trophy. The trophy recognizes an outstanding American who has made major contributions to the U.S. space program. Previous awardees include astronaut Neil Armstrong and President George H. W. Bush. Nominations are due by 6 November 2011. For more information, see http://www.rnasa.org/trophy.html or contact chairman@rnasa.org.

  10. Space Microbiology

    OpenAIRE

    Horneck, Gerda; Klaus, David M.; Mancinelli, Rocco L

    2010-01-01

    Summary: The responses of microorganisms (viruses, bacterial cells, bacterial and fungal spores, and lichens) to selected factors of space (microgravity, galactic cosmic radiation, solar UV radiation, and space vacuum) were determined in space and laboratory simulation experiments. In general, microorganisms tend to thrive in the space flight environment in terms of enhanced growth parameters and a demonstrated ability to proliferate in the presence of normally inhibitory levels of antibiotic...

  11. Koszul spaces

    DEFF Research Database (Denmark)

    Berglund, Alexander

    2014-01-01

    We prove that a nilpotent space is both formal and coformal if and only if it is rationally homotopy equivalent to the derived spatial realization of a graded commutative Koszul algebra. We call such spaces Koszul spaces and show that the rational homotopy groups and the rational homology of iter...

  12. Space administration

    OpenAIRE

    Worthington, Scott; Worthington, Scott

    2015-01-01

    My dissertation consists of two parts. The larger portion is an hour-long piece for double bass, electronics, and projected text called Space Administration. The second portion, this essay, discusses my musical background leading up to Space Administration, details of the composition itself, and what new directions I see in my work that in part stem from creating the piece Space Administration

  13. Space Charge Effects

    CERN Document Server

    Ferrario, M.; Palumbo, L.

    2014-12-19

    The space charge forces are those generated directly by the charge distribution, with the inclusion of the image charges and currents due to the interaction of the beam with a perfectly conducting smooth pipe. Space charge forces are responsible for several unwanted phenomena related to beam dynamics, such as energy loss, shift of the synchronous phase and frequency , shift of the betatron frequencies, and instabilities. We will discuss in this lecture the main feature of space charge effects in high-energy storage rings as well as in low-energy linacs and transport lines.

  14. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years' follow-up.

    Science.gov (United States)

    Kolk, Arjen; Thomassen, Bregje J W; Hund, Hajo; de Witte, Pieter Bas; Henkus, Hans-Erik; Wassenaar, Willem G; van Arkel, Ewoud R A; Nelissen, Rob G H H

    2017-08-01

    The treatment effect of acromioplasty for chronic subacromial pain syndrome (SAPS) on long-term shoulder function and rotator cuff deterioration has still to be determined. This study aimed to determine the long-term clinical and radiologic treatment effect of arthroscopic acromioplasty in patients with chronic SAPS. In this double-blind, randomized clinical trial, 56 patients with chronic SAPS (median age, 47 years; age range, 31-60 years) were randomly allocated to arthroscopic bursectomy alone or to bursectomy combined with acromioplasty and were followed up for a median of 12 years. The primary outcome was the Constant score. Secondary outcomes included the Simple Shoulder Test, visual analog scale (VAS) for pain, VAS for shoulder functionality, and rotator cuff integrity assessed with magnetic resonance imaging or ultrasound. A total of 43 patients (77%) were examined at a median of 12 years' follow-up. Intention-to-treat analysis at 12 years' follow-up did not show a significant additional treatment effect of acromioplasty on bursectomy alone in improvement in Constant score (5 points; 95% confidence interval, -5.1 to 15.6), Simple Shoulder Test score, VAS score for pain, or VAS score for shoulder function. The prevalence of rotator cuff tears was not significantly different between the bursectomy group (17%) and acromioplasty group (10%). There were no relevant additional effects of arthroscopic acromioplasty on bursectomy alone with respect to clinical outcomes and rotator cuff integrity at 12 years' follow-up. These findings bring the effectiveness of acromioplasty into question and may support the idea of a more conservative approach in the initial treatment of SAPS. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Design spaces

    DEFF Research Database (Denmark)

    2005-01-01

    Digital technologies and media are becoming increasingly embodied and entangled in the spaces and places at work and at home. However, our material environment is more than a geometric abstractions of space: it contains familiar places, social arenas for human action. For designers, the integration...... of digital technology with space poses new challenges that call for new approaches. Creative alternatives to traditional systems methodologies are called for when designers use digital media to create new possibilities for action in space. Design Spaces explores how design and media art can provide creative...... alternatives for integrating digital technology with space. Connecting practical design work with conceptual development and theorizing, art with technology, and usesr-centered methods with social sciences, Design Spaces provides a useful research paradigm for designing ubiquitous computing. This book...

  16. Space suit

    Science.gov (United States)

    Shepard, L. F.; Durney, G. P.; Case, M. C.; Kenneway, A. J., III; Wise, R. C.; Rinehart, D.; Bessette, R. J.; Pulling, R. C. (Inventor)

    1973-01-01

    A pressure suit for high altitude flights, particularly space missions is reported. The suit is designed for astronauts in the Apollo space program and may be worn both inside and outside a space vehicle, as well as on the lunar surface. It comprises an integrated assembly of inner comfort liner, intermediate pressure garment, and outer thermal protective garment with removable helmet, and gloves. The pressure garment comprises an inner convoluted sealing bladder and outer fabric restraint to which are attached a plurality of cable restraint assemblies. It provides versitility in combination with improved sealing and increased mobility for internal pressures suitable for life support in the near vacuum of outer space.

  17. Morrey spaces

    CERN Document Server

    Adams, David R

    2015-01-01

    In this set of lecture notes, the author includes some of the latest research on the theory of Morrey Spaces associated with Harmonic Analysis. There are three main claims concerning these spaces that are covered: determining the integrability classes of the trace of Riesz potentials of an arbitrary Morrey function; determining the dimensions of singular sets of weak solutions of PDE (e.g. The Meyers-Elcart System); and determining whether there are any “full” interpolation results for linear operators between Morrey spaces. This book will serve as a useful reference to graduate students and researchers interested in Potential Theory, Harmonic Analysis, PDE, and/or Morrey Space Theory. .

  18. Space colonization

    National Research Council Canada - National Science Library

    Anita Gale; Narayanan Ramachandran

    2009-01-01

      Progress toward future space settlement is measured in small ways, mostly as incremental changes in perception and advances in targeted applied engineering that supports infrastructure development...

  19. Learning Spaces

    CERN Document Server

    Falmagne, Jean-Claude

    2011-01-01

    Learning spaces offer a rigorous mathematical foundation for practical systems of educational technology. Learning spaces generalize partially ordered sets and are special cases of knowledge spaces. The various structures are investigated from the standpoints of combinatorial properties and stochastic processes. Leaning spaces have become the essential structures to be used in assessing students' competence of various topics. A practical example is offered by ALEKS, a Web-based, artificially intelligent assessment and learning system in mathematics and other scholarly fields. At the heart of A

  20. Space psychology

    Science.gov (United States)

    Parin, V. V.; Gorbov, F. D.; Kosmolinskiy, F. P.

    1974-01-01

    Psychological selection of astronauts considers mental responses and adaptation to the following space flight stress factors: (1) confinement in a small space; (2) changes in three dimensional orientation; (3) effects of altered gravity and weightlessness; (4) decrease in afferent nerve pulses; (5) a sensation of novelty and danger; and (6) a sense of separation from earth.

  1. Borel Spaces

    CERN Document Server

    Berberian, S K

    2002-01-01

    A detailed exposition of G.W. Mackey's theory of Borel spaces (standard, substandard, analytic), based on results in Chapter 9 of Bourbaki's General Topology. Appended are five informal lectures on the subject (given at the CIMPA/ICPAM Summer School, Nice, 1986), sketching the connection between Borel spaces and representations of operator algebras.

  2. Space Telescope.

    Science.gov (United States)

    National Aeronautics and Space Administration, Huntsville, AL. George C. Marshall Space Flight Center.

    This pamphlet describes the Space Telescope, an unmanned multi-purpose telescope observatory planned for launch into orbit by the Space Shuttle in the 1980s. The unique capabilities of this telescope are detailed, the major elements of the telescope are described, and its proposed mission operations are outlined. (CS)

  3. Space microbiology.

    Science.gov (United States)

    Horneck, Gerda; Klaus, David M; Mancinelli, Rocco L

    2010-03-01

    The responses of microorganisms (viruses, bacterial cells, bacterial and fungal spores, and lichens) to selected factors of space (microgravity, galactic cosmic radiation, solar UV radiation, and space vacuum) were determined in space and laboratory simulation experiments. In general, microorganisms tend to thrive in the space flight environment in terms of enhanced growth parameters and a demonstrated ability to proliferate in the presence of normally inhibitory levels of antibiotics. The mechanisms responsible for the observed biological responses, however, are not yet fully understood. A hypothesized interaction of microgravity with radiation-induced DNA repair processes was experimentally refuted. The survival of microorganisms in outer space was investigated to tackle questions on the upper boundary of the biosphere and on the likelihood of interplanetary transport of microorganisms. It was found that extraterrestrial solar UV radiation was the most deleterious factor of space. Among all organisms tested, only lichens (Rhizocarpon geographicum and Xanthoria elegans) maintained full viability after 2 weeks in outer space, whereas all other test systems were inactivated by orders of magnitude. Using optical filters and spores of Bacillus subtilis as a biological UV dosimeter, it was found that the current ozone layer reduces the biological effectiveness of solar UV by 3 orders of magnitude. If shielded against solar UV, spores of B. subtilis were capable of surviving in space for up to 6 years, especially if embedded in clay or meteorite powder (artificial meteorites). The data support the likelihood of interplanetary transfer of microorganisms within meteorites, the so-called lithopanspermia hypothesis.

  4. Space Robotics

    Directory of Open Access Journals (Sweden)

    Alex Ellery

    2004-09-01

    Full Text Available In this second of three short papers, I introduce some of the basic concepts of space robotics with an emphasis on some specific challenging areas of research that are peculiar to the application of robotics to space infrastructure development. The style of these short papers is pedagogical and the concepts in this paper are developed from fundamental manipulator robotics. This second paper considers the application of space manipulators to on-orbit servicing (OOS, an application which has considerable commercial application. I provide some background to the notion of robotic on-orbit servicing and explore how manipulator control algorithms may be modified to accommodate space manipulators which operate in the micro-gravity of space.

  5. Knowledge spaces

    CERN Document Server

    Doignon, Jean-Paul

    1999-01-01

    Knowledge spaces offer a rigorous mathematical foundation for various practical systems of knowledge assessment. An example is offered by the ALEKS system (Assessment and LEarning in Knowledge Spaces), a software for the assessment of mathematical knowledge. From a mathematical standpoint, knowledge spaces generalize partially ordered sets. They are investigated both from a combinatorial and a stochastic viewpoint. The results are applied to real and simulated data. The book gives a systematic presentation of research and extends the results to new situations. It is of interest to mathematically oriented readers in education, computer science and combinatorics at research and graduate levels. The text contains numerous examples and exercises and an extensive bibliography.

  6. Space Bugz!

    DEFF Research Database (Denmark)

    Birke, Alexander; Schoenau-Fog, Henrik; Reng, Lars

    2012-01-01

    This paper presents Space Bugz! - a novel crowd game for large venues or cinemas that utilises the audience's smartphones as controllers for the game. This paper explains what crowd gaming is and describes how the approach used in Space Bugz! enables more advanced gameplay concepts and individual...... player control than current technologies allow. The gameplay of Space Bugz! is then explained along with the technical architecture of the game. After this, the iterative design process used to create the game is described together with future perspectives. The article concludes with links to a video...

  7. Space colonization

    National Research Council Canada - National Science Library

    Ram Ramachandran; Anita Gale

    2010-01-01

    .... government trying to reinvent the human space program priorities and approaches. Russia, ESA, Japan, China, and India all have proposed ambitious missions, including manned missions, to the Moon and planets...

  8. Space exploration

    National Research Council Canada - National Science Library

    Chris Moore

    2012-01-01

      Here, Moore presents a year in review on space exploration programs. This 2012 NASA's strategy of stimulating the development of commercial capabilities to launch crew and cargo to the ISS began to pay off...

  9. SHIMMERING SPACE

    Directory of Open Access Journals (Sweden)

    Grazielle Katyane dos Santos Silva

    2009-04-01

    Full Text Available This article presents an analysis of spatiality in the book Os guarda-chuvas cintilantes (Shimmering Umbrellas, 1984, written by the Portuguese writer Teolinda Gersão. The book makes us question the journal genre. However, the text itself questions the traditional notions of narrative, which are particular to the journal genre. In Os guarda-chuvas cintilantes there is the attempt to destroy linear temporality and create a new temporal measure, based on ludic themes, is also important in the book. The configuration of spatiality crosses time, becoming, therefore, mobile and unstable. There are in the book multiples spaces: a dream space, a material space and a symbolic space.

  10. Making space

    International Development Research Centre (IDRC) Digital Library (Canada)

    Karen Kershaw

    Making space an enquiry into women's participation in local politics in Rajasthan. Alice Albin Morris, Geeta Sharma and Arun Kumar. UNNATI Organisation for Development Education. India. Parallel Sessions II - Session B ...

  11. Riesz spaces

    CERN Document Server

    Zaanen, A C

    1983-01-01

    While Volume I (by W.A.J. Luxemburg and A.C. Zaanen, NHML Volume 1, 1971) is devoted to the algebraic aspects of the theory, this volume emphasizes the analytical theory of Riesz spaces and operators between these spaces. Though the numbering of chapters continues on from the first volume, this does not imply that everything covered in Volume I is required for this volume, however the two volumes are to some extent complementary.

  12. Space Rescue

    Science.gov (United States)

    Muratore, John F.

    2007-01-01

    Space Rescue has been a topic of speculation for a wide community of people for decades. Astronauts, aerospace engineers, diplomats, medical and rescue professionals, inventors and science fiction writers have all speculated on this problem. Martin Caidin's 1964 novel Marooned dealt with the problems of rescuing a crew stranded in low earth orbit. Legend at the Johnson Space Center says that Caidin's portrayal of a Russian attempt to save the American crew played a pivotal role in convincing the Russians to join the real joint Apollo-Soyuz mission. Space Rescue has been a staple in science fiction television and movies portrayed in programs such as Star Trek, Stargate-SG1 and Space 1999 and movies such as Mission To Mars and Red Planet. As dramatic and as difficult as rescue appears in fictional accounts, in the real world it has even greater drama and greater difficulty. Space rescue is still in its infancy as a discipline and the purpose of this chapter is to describe the issues associated with space rescue and the work done so far in this field. For the purposes of this chapter, the term space rescue will refer to any system which allows for rescue or escape of personnel from situations which endanger human life in a spaceflight operation. This will span the period from crew ingress prior to flight through crew egress postlanding. For the purposes of this chapter, the term primary system will refer to the spacecraft system that a crew is either attempting to escape from or from which an attempt is being made to rescue the crew.

  13. public spaces

    Directory of Open Access Journals (Sweden)

    Elena Grigoryeva

    2013-01-01

    Full Text Available The topic of this issue is PUBLIC SPACES. It is familiar and clear to every citizen. The streets and courtyards as childhood experiences remain with us forever. And these are the places where we come with our parents at weekends, where we meet friends, where we have dates and where we already come for a walk with our children.The history of public spaces is long and captivating. It was the main city squares where the most important events took place in history. The Agoras of Ancient Greece and the Roman Forums, the squares of Vatican, Paris and London, Moscow and Saint Petersburg… Greve, Trafalgar, Senate, Palace, Red, Bolotnaya – behind every name there is life of capitals, countries and nations.Public spaces, their shapes, image and development greatly influence the perception of the city as a whole. Both visitors and inhabitants can see in public spaces not only the visage but the heart, the soul and the mind of the city.Unfortunately, sometimes we have to prove the value of public spaces and defend them from those who consider them nothing but a blank space, nobody’s land destined for barbarous development.What should happen to make citizens perceive public spaces as their own and to make authorities consider development and maintenance of squares and parks their priority task against the  background of increasing competition between cities and the fight for human capital? Lately they more often say about “a high-quality human capital”. And now, when they say “the city should be liveable” they add “for all groups of citizens, including the creative class”.

  14. Underground spaces/cybernetic spaces

    Directory of Open Access Journals (Sweden)

    Tomaž Novljan

    2000-01-01

    Full Text Available A modern city space is a space where in the vertical and horizontal direction dynamic, non-linear processes exist, similar as in nature. Alongside the “common” city surface, cities have underground spaces as well that are increasingly affecting the functioning of the former. It is the space of material and cybernetic communication/transport. The psychophysical specifics of using underground places have an important role in their conceptualisation. The most evident facts being their limited volume and often limited connections to the surface and increased level of potential dangers of all kinds. An efficient mode for alleviating the effects of these specific features are artistic interventions, such as: shape, colour, lighting, all applications of the basic principles of fractal theory.

  15. Metric spaces with unique pretangent spaces

    OpenAIRE

    Dovgoshey, Oleksiy; Abdullayev, Fahreddin; Kuchukaslan, Mehmet

    2009-01-01

    We find necessary and sufficient conditions under which an arbitrary metric space $X$ has a unique pretangent space at the marked point $a\\in X$. Key words: Metric spaces; Tangent spaces to metric spaces; Uniqueness of tangent metric spaces; Tangent space to the Cantor set.

  16. Space Robotics

    Directory of Open Access Journals (Sweden)

    Alex Ellery

    2004-06-01

    Full Text Available In this first of three short papers, I introduce some of the basic concepts of space engineering with an emphasis on some specific challenging areas of research that are peculiar to the application of robotics to space development and exploration. The style of these short papers is pedagogical and this paper stresses the unique constraints that space application imposes. This first paper is thus a general introduction to the nature of spacecraft engineering and its application to robotic spacecraft. I consider the constraints and metrics used by spacecraft engineers in the design of spacecraft and how these constraints impose challenges to the roboticist. The following two papers consider specific robotics issues in more detail.

  17. Environmental spaces

    DEFF Research Database (Denmark)

    Larsen, Henrik Gutzon

    Using the development of intergovernmental environmental cooperation in the Baltic Sea area as a concrete example, the aim of this study is to explore how the 'environment' in situations of environmental interdependence is identified and institutionalised as political-geographical objects....... 'Environmental interdependence' is to this end conceptualised as a tension between 'political spaces' of discrete state territories and 'environmental spaces' of spatially nested ecosystems. This tension between geographies of political separateness and environmental wholeness is the implicit or explicit basis...... for a large and varied literature. But in both its critical and problemsolving manifestations, this literature tends to naturalise the spatiality of environmental concerns: environmental spaces are generally taken for granted. On the suggestion that there is a subtle politics to the specification...

  18. Tsirelson's space

    CERN Document Server

    Casazza, Peter G

    1989-01-01

    This monograph provides a structure theory for the increasingly important Banach space discovered by B.S. Tsirelson. The basic construction should be accessible to graduate students of functional analysis with a knowledge of the theory of Schauder bases, while topics of a more advanced nature are presented for the specialist. Bounded linear operators are studied through the use of finite-dimensional decompositions, and complemented subspaces are studied at length. A myriad of variant constructions are presented and explored, while open questions are broached in almost every chapter. Two appendices are attached: one dealing with a computer program which computes norms of finitely-supported vectors, while the other surveys recent work on weak Hilbert spaces (where a Tsirelson-type space provides an example).

  19. Space Telescopes

    Science.gov (United States)

    Rigby, Jane R.

    2011-01-01

    The science of astronomy depends on modern-day temples called telescopes. Astronomers make pilgrimages to remote mountaintops where these large, intricate, precise machines gather light that rains down from the Universe. Bit, since Earth is a bright, turbulent planet, our finest telescopes are those that have been launched into the dark stillness of space. These space telescopes, named after heroes of astronomy (Hubble, Chandra, Spitzer, Herschel), are some of the best ideas our species has ever had. They show us, over 13 billion years of cosmic history, how galaxies and quasars evolve. They study planets orbiting other stars. They've helped us determine that 95% of the Universe is of unknown composition. In short, they tell us about our place in the Universe. The next step in this journey is the James Webb Space Telescope, being built by NASA, Europe, and Canada for a 2018 launch; Webb will reveal the first galaxies that ever formed.

  20. Einstein spaces

    CERN Document Server

    Petrov, Aleksej Z

    1969-01-01

    Einstein Spaces presents the mathematical basis of the theory of gravitation and discusses the various spaces that form the basis of the theory of relativity. This book examines the contemporary development of the theory of relativity, leading to the study of such problems as gravitational radiation, the interaction of fields, and the behavior of elementary particles in a gravitational field. Organized into nine chapters, this book starts with an overview of the principles of the special theory of relativity, with emphasis on the mathematical aspects. This text then discusses the need for a ge

  1. Performative Spaces

    DEFF Research Database (Denmark)

    Svaneklink, Annette

    2009-01-01

    that can be related to traditional architectural concepts in terms of dealing with space, body, time and movement. The paper considers this performativity and dual spatiality as being a processual architecture, constantly reconfiguring new hybrids between space, image and user. This dual spatiality raises......Performative aspects of architecture seem to be constituted as a series of actions between place and non-place as well as between place and user. The performative action raises a dual spatiality that relates physical, extended spatiality to temporality. The paper argues that this is a topic...

  2. Game Spaces

    DEFF Research Database (Denmark)

    Kristiansen, Erik

    2015-01-01

    or she suddenly finds himself in another world, where artefacts are given new meaning and where other rules apply. This makes sense, but also demands that play and non-play can be easily separated. Even so, the concept of the magic circle has never been analysed with respect to the spatial configuration......, called “pervasive games.” These are games that are based on computer technology, but use a physical space as the game space as opposed to video games. Coupling spatial configuration with performance theory of rituals as liminal phenomena, I put forward a model and a new understanding of the magic circle...

  3. Entering Space

    Science.gov (United States)

    Zubrin, Robert

    The authors is giving a classification of civilisations depending on the degree of colonisation of the Earth, Solar System and Our Galaxy. The problems of: History of geographic discoveries (The great geographical discoveries during the Middle Age, the concurence of Chinnese and Europeans in this Area); The Astrophysics, such as: Asteroids, Water and Atmosphere on outer planets, Planet Mars Planet, Agriculture on outer planets, Minerals on outer planets; Cosmic flights: Fuels, Robotics, Moon (as an intermediary basis for interplanetary flights), Mars colonisation; Interstellar flights, Space research costs, strategy and tactics of the space colonisation; Policy: War and Peace, International Collaboration are discussed.

  4. Transit space

    DEFF Research Database (Denmark)

    Raahauge, Kirsten Marie

    2008-01-01

    This article deals with representations of one specific city, Århus, Denmark, especially its central district. The analysis is based on anthropological fieldwork conducted in Skåde Bakker and Fedet, two well-off neighborhoods. The overall purpose of the project is to study perceptions of space...... and the interaction of cultural, social, and spatial organizations, as seen from the point of view of people living in Skåde Bakker and Fedet. The focus is on the city dwellers’ representations of the central district of Århus with specific reference to the concept of transit space. When applied to various Århusian...

  5. A calculation of confusion noise due to infrared cirrus

    Science.gov (United States)

    Gautier, T. N., III; Boulanger, Francois; Perault, M.; Puget, J. L.

    1992-01-01

    General expressions are developed for the statistical errors to be expected in photometric measurements due to confusion in a background of fluctuating surface brightness. Backgrounds actually observed in the far IR by the IRAS satellite are used to calculate tables of these error expressions for two simple measurement techniques. The confusion-noise-limited sensitivities for NASA's planned Space IR Telescope Facility and the ESA's IR Space Observatory are estimated at a wavelength of 100 microns from these tables.

  6. Trading Spaces

    Science.gov (United States)

    Cort, Cliff

    2006-01-01

    Education administrators face the dual dilemma of crowded, aging facilities and tightening capital budgets. The challenge is to build the necessary classroom, laboratory and activity space while minimizing the length and expense of the construction process. One solution that offers an affordable alternative is modular construction, a method that…

  7. Space Conquest

    CERN Multimedia

    2005-01-01

    An old water tank from the time of the ISR is being converted into a temporary store for ATLAS muon chambers. This is the last chapter in the big programme by the PH Department to make better use of space at CERN.

  8. Rich Design Research Space

    Directory of Open Access Journals (Sweden)

    Birger Sevaldson

    2008-10-01

    Full Text Available This paper introduces and discusses a Rich Research Space as an inclusive methodological framework and scaffold for research-by-design. The Rich Research Space especially addresses the issue of richness in design processes and design-led research. There is a general trend towards increased complexity in design processes, caused on one hand by the increasing depth and width in the use of design media and methods, and on the other hand by the increasing complexity and interdependency of society due to globalisation. These issues confront the designer-researcher with new challenges. This paper formulates a research strategy for research-by-design in fields that have a high degree of richness in the use of media, the amount of information, and the methods involved. The Rich Research Space concept proposed takes into account the physical, social, and cultural spaces, and the virtual and visual media spaces in which the research-by-design takes place. The concept takes the form of a specific integral approach to design, and a holistic theoretical mindset. It embraces many types of investigation, from analytical to intuitive. The Rich Research Space provides a flexible framework within which the complexity of research-by-design can be interrelated, discussed, and reflected upon. Potentially, it can create a more involved role for the designer-researcher, a role that allows contributions towards the resolution of ever more pressing issues in our society. This approach is currently one of a limited number of possible frameworks that the design professions can utilize in order to make a difference in a world of at times overwhelming complexity. The concept of the Rich Research Space is discussed with reference to an art installation called Barely.Keywords: Research by design, collaborative design, complexity, creativity, research methods.

  9. Women in Space

    Science.gov (United States)

    Mukai, Chiaki

    Since 1963 women have successfully flown and worked in space so much so that having a female aboard the shuttle, on Soyuz or on the International Space Station is considered commonplace. We do know that women have historically been virturally equal in capabilities and performance with their male counterparts. For example, there have been superb shuttle pilots, shuttle commanders, EVA participants as well as mission specialists and payload specialists. Thus, gender is not an issue within the ranks, rather a simple fact. In addition, there is a positive psychological factor that has been noted in that a mixed crew seems to have better intercommunications dynamics. JAXA has conducted the experiments on 7 subjects on bone mineral density in short duration of space flight and noticed a slight decrease in that density in both male and female. Lean body mass was also examined and found to be reduced by 3.0 % on average. There was no significant difference between male and female subjects in short duration of space flight. Unfortunately, only 1 of the 7 subjects was a woman. In fact, only 48 women have flown in total, some more than once, and science is still discovering the effects of the space experience. This is due to the limited exposure on orbit and in microgravity and the limited number of potential subjects. Time in space is beginning to increase with the continued progress of the ISS, thereby creating a demand for more knowledge on what effects long term exposure will have on the female of the species. The presentation will address these and other concerns involved with women in space from the perspective of a female scientist and an astronaut.

  10. 2013 Space Radiation Standing Review Panel Status Review for: The Risk of Acute and Late Central Nervous System Effects from Radiation Exposure, The Risk of Acute Radiation Syndromes Due to Solar Particle Events (SPEs), The Risk Of Degenerative Tissue Or Other Health Effects From Radiation Exposure, and The Risk of Radiation Carcinogenesis

    Science.gov (United States)

    2014-01-01

    The Space Radiation Standing Review Panel (from here on referred to as the SRP) was impressed with the strong research program presented by the scientists and staff associated with NASA's Space Radiation Program Element and National Space Biomedical Research Institute (NSBRI). The presentations given on-site and the reports of ongoing research that were provided in advance indicated the potential Risk of Acute and Late Central Nervous System Effects from Radiation Exposure (CNS) and were extensively discussed by the SRP. This new data leads the SRP to recommend that a higher priority should be placed on research designed to identify and understand these risks at the mechanistic level. To support this effort the SRP feels that a shift of emphasis from Acute Radiation Syndromes (ARS) and carcinogenesis to CNS-related endpoints is justified at this point. However, these research efforts need to focus on mechanisms, should follow pace with advances in the field of CNS in general and should consider the specific comments and suggestions made by the SRP as outlined below. The SRP further recommends that the Space Radiation Program Element continue with its efforts to fill the vacant positions (Element Scientist, CNS Risk Discipline Lead) as soon as possible. The SRP also strongly recommends that NASA should continue the NASA Space Radiation Summer School. In addition to these broad recommendations, there are specific comments/recommendations noted for each risk, described in detail below.

  11. Noncommutative phase spaces on Aristotle group

    Directory of Open Access Journals (Sweden)

    Ancille Ngendakumana

    2012-03-01

    Full Text Available We realize noncommutative phase spaces as coadjoint orbits of extensions of the Aristotle group in a two dimensional space. Through these constructions the momenta of the phase spaces do not commute due to the presence of a naturally introduced magnetic eld. These cases correspond to the minimal coupling of the momentum with a magnetic potential.

  12. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial.

    Science.gov (United States)

    Kinsella, Rita; Cowan, Sallie M; Watson, Lyn; Pizzari, Tania

    2017-01-01

    Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening-isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1-6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6-12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an

  13. Ratchet due to broken friction symmetry

    DEFF Research Database (Denmark)

    Norden, Bengt; Zolotaryuk, Yaroslav; Christiansen, Peter Leth

    2002-01-01

    with it have been carried out. In this device, an asymmetry of friction dependence on an applied force appears, resulting in rectification of rotary motion, In experiments, our setup is observed to rotate only in one direction, which is in accordance with given theoretical arguments, Despite the setup being...... three dimensional, the ratchet rotary motion is proved to be described by one dynamical equation. This kind of motion is a result of the interplay of friction and inertia. We also consider a case with viscous friction, which is irrelevant to this gadget, but it can be a possible mechanism of rotary......A ratchet mechanism that occurs due to asymmetric dependence of the friction of a moving system on its velocity or a driving force is reported. For this kind of ratchet, instead of a particle moving in a periodic potential, the dynamics of which have broken space-time symmetry, the system must...

  14. Space Toxicology

    Science.gov (United States)

    James, John T.

    2011-01-01

    Safe breathing air for space faring crews is essential whether they are inside an Extravehicular Mobility Suit (EMU), a small capsule such as Soyuz, or the expansive International Space Station (ISS). Sources of air pollution can include entry of propellants, excess offgassing from polymeric materials, leakage of systems compounds, escape of payload compounds, over-use of utility compounds, microbial metabolism, and human metabolism. The toxicological risk posed by a compound is comprised of the probability of escaping to cause air pollution and the magnitude of adverse effects on human health if escape occurs. The risk from highly toxic compounds is controlled by requiring multiple levels of containment to greatly reduce the probability of escape; whereas compounds that are virtually non-toxic may require little or no containment. The potential for toxicity is determined by the inherent toxicity of the compound and the amount that could potentially escape into the breathing air.

  15. Communication spaces.

    Science.gov (United States)

    Coiera, Enrico

    2014-01-01

    Annotations to physical workspaces such as signs and notes are ubiquitous. When densely annotated, work areas become communication spaces. This study aims to characterize the types and purpose of such annotations. A qualitative observational study was undertaken in two wards and the radiology department of a 440-bed metropolitan teaching hospital. Images were purposefully sampled; 39 were analyzed after excluding inferior images. Annotation functions included signaling identity, location, capability, status, availability, and operation. They encoded data, rules or procedural descriptions. Most aggregated into groups that either created a workflow by referencing each other, supported a common workflow without reference to each other, or were heterogeneous, referring to many workflows. Higher-level assemblies of such groupings were also observed. Annotations make visible the gap between work done and the capability of a space to support work. Annotations are repairs of an environment, improving fitness for purpose, fixing inadequacy in design, or meeting emergent needs. Annotations thus record the missing information needed to undertake tasks, typically added post-implemented. Measuring annotation levels post-implementation could help assess the fit of technology to task. Physical and digital spaces could meet broader user needs by formally supporting user customization, 'programming through annotation'. Augmented reality systems could also directly support annotation, addressing existing information gaps, and enhancing work with context sensitive annotation. Communication spaces offer a model of how work unfolds. Annotations make visible local adaptation that makes technology fit for purpose post-implementation and suggest an important role for annotatable information systems and digital augmentation of the physical environment.

  16. Space Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Corliss, William R.

    1968-01-01

    This booklet discusses three kinds of space radiation, cosmic rays, Van Allen Belts, and solar plasma. Cosmic rays are penetrating particles that we cannot see, hear or feel, which come from distant stars. Van Allen Belts, named after their discoverer are great belts of protons and electrons that the earth has captured in its magnetic trap. Solar plasma is a gaseous, electrically neutral mixture of positive and negative ions that the sun spews out from convulsed regions on its surface.

  17. Space Nutrition

    Science.gov (United States)

    Smith, Scott M.

    2009-01-01

    Optimal nutrition will be critical for crew members who embark on space exploration missions. Nutritional assessment provides an opportunity to ensure that crewmembers begin their missions in optimal nutritional status, to document changes during a mission and, if necessary, to provide intervention to maintain that status throughout the mission, and to assesses changes after landing in order to facilitate the return to their normal status as soon as possible after landing. We report here the findings from our nutritional assessment of astronauts who participated in the International Space Station (ISS) missions, along with flight and ground-based research findings. We also present ongoing and planned nutrition research activities. These studies provide evidence that bone loss, compromised vitamin status, and oxidative damage are the critical nutritional concerns for space travelers. Other nutrient issues exist, including concerns about the stability of nutrients in the food system, which are exposed to longterm storage and radiation during flight. Defining nutrient requirements, and being able to provide and maintain those nutrients on exploration missions, will be critical for maintaining crew member health.

  18. Autoerotic death due to electrocution

    Directory of Open Access Journals (Sweden)

    Piotr Arkuszewski

    2014-08-01

    Full Text Available Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area.

  19. Endocarditis due to Chryseobacterium meningosepticum

    Directory of Open Access Journals (Sweden)

    Bomb K

    2007-01-01

    Full Text Available Chryseobacterium meningosepticum is a gram negative rod widely distributed in nature. It is known to cause meningitis in neonates and premature infants. Adult infections are not common and are usually nosocomially acquired. We report an unusual case of native valve endocarditis in a 58-year-old man due to this organism. A high degree of suspicion and correct identification and sensitivity testing is required to diagnose infections by this rare isolate.

  20. Cervical myelopathy due to degenerative spondylolisthesis.

    Science.gov (United States)

    Koakutsu, Tomoaki; Nakajo, Junko; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin

    2011-05-01

    To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL). A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs. Disc levels of DSL were C3/4 in 6 cases and C4/5 in 16 cases. Distance of anterior slippage was 2 to 5 mm (average 2.9 mm) in flexion position. Space available for the spinal cord (SAC) was 11 to 15 mm (average 12.8 mm) in flexion position and 11 to 18 mm (average 14.6 mm) in extension position; 11 cases were reducible and 11 cases were irreducible in extension position. Myelograms demonstrated compression of spinal cord by the ligamentum flavum in extension position. Compression of spinal cord was not demonstrated in flexion position. C5-7 lordosis angle was lower than control. C5-7 range of motion (ROM) was reduced compared to controls. These alterations were statistically significant. DSL occurs in the mid-cervical spine. Lower cervical spine demonstrated restricted ROM and lower lordosis angle. Pathogenesis of cervical myelopathy due to DSL is compression of spinal cord by the ligamentum flavum in extension position and not by reduced SAC in flexion position.

  1. Space Detectives

    Science.gov (United States)

    Tyszka, Steph; Saraiva, Jose; Doran, Rosa

    2017-04-01

    NUCLIO is a Portuguese non-profit organization with a strong record of investing in science education and outreach. We have developed and implemented many activities mostly directed to a young audience, in a bid to awaken and reinforce the interest that young people devote to Astronomy and all things spatial. In this framework, we have created a week-long program called Space Detectives, supported by the Municipality of Cascais, based on a story-line that provided a number of challenges and opportunities for learning matters as diverse as the electro-magnetic spectrum, means of communication, space travel, the martian environment, coding and robotics. We report on the first session that took place in December 2016. We had as participants several kids aged 9 to 12, with a mixed background in terms of interest in the sciences. Their response varied from enthusiastic to somewhat less interested, depending on the nature of the subject and the way it was presented - a reaction not necessarily related to its complexity. This week was taken as something of a trial run, in preparation for the European Commission- funded project "Stories of Tomorrow", to be implemented in schools. The individual activities and the way they were related to the story-line, as well as the smooth transition from one to the next, were subject to an analysis that will allow for improvements in the next installments of this program. We believe this is an excellent approach to the goals of using Space and Astronomy as an anchor for generating and keeping interest in the scientific areas, and of finding new and richer ways of learning.

  2. Space Pharmacology

    CERN Document Server

    Wotring, Virginia E

    2012-01-01

    Space Pharmacology” is a review of the current knowledge regarding the use of pharmaceuticals during spaceflights. It is a comprehensive review of the literature, addressing each area of pharmacokinetics and each major physiological system in turn. Every section begins with a topic overview, and is followed by a discussion of published data from spaceflight, and from ground experiments meant to model the spaceflight situation. Includes a discussion looking forward to the new medical challenges we are likely to face on longer duration exploration missions. This book is a snapshot of our current knowledge that also highlights areas of unknown.

  3. Unliveable Spaces

    DEFF Research Database (Denmark)

    Johannessen, Runa

    The thesis is concerned with spatial practices of resistance employed in Palestinian struggles against Israel’s violent dispossession of Palestinian land through half a century of occupation. In the political configuration of the built space of the West Bank, architecture appears as a tactically......, fundamentally, who has the right to a future in this land. By viewing architecture in its dual dimension of praxis and object, built structures are investigated as agents that induce and manifest territorial struggles. The spatial instrumentalisation of architecture is effected by Israel through commonplace...

  4. Space exploration

    CERN Document Server

    2009-01-01

    Space Exploration, is one book in the Britannica Illustrated Science Library Series that is correlated to the science curriculum in grades 5-8. The Britannica Illustrated Science Library is a visually compelling set that covers earth science, life science, and physical science in 16 volumes.  Created for ages 10 and up, each volume provides an overview on a subject and thoroughly explains it through detailed and powerful graphics-more than 1,000 per volume-that turn complex subjects into information that students can grasp.  Each volume contains a glossary with full definitions for vocabulary help and an index.

  5. Space Food

    Science.gov (United States)

    1994-01-01

    In planning for the long duration Apollo missions, NASA conducted extensive research into space food. One of the techniques developed was freeze drying. Action Products commercialized this technique, concentrating on snack food including the first freeze-dried ice cream. The foods are cooked, quickly frozen and then slowly heated in a vacuum chamber to remove the ice crystals formed by the freezing process. The final product retains 98 percent of its nutrition and weighs only 20 percent of its original weight. Action snacks are sold at museums, NASA facilities and are exported to a number of foreign countries. Sales run to several million dollars annually.

  6. Maculopathy due to drug inhalation.

    Science.gov (United States)

    Asensio-Sánchez, V M; Gonzalez-Buendia, L; Marcos-Fernández, M

    2014-08-01

    A case of maculopathy due to "poppers" is described. Poppers is a drug composed of various forms of alkyl nitrite. A 39 year-old man, who had been using poppers for years, was seen in the clinic with phosphenes, reduced visual acuity and central scotoma. The SD-OCT in the right eye showed disruption at the level of the IS/OS junction line. The SD-OCT scan in the left eye showed an outer rectangular retinal hole and an outer retinal cyst. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  7. Physiotherapy intervention in subacromial impingement syndrome

    OpenAIRE

    Cardoso, Ricardo Manuel Tavares; Leite, Marcelo Soares Oliveira

    2013-01-01

    INTRODUÇÃO: Os problemas do ombro são responsáveis por cerca de 10% de todos os encaminhamentos para os fisioterapeutas, sendo a síndrome de colisão do ombro o diagnóstico mais comum entre as patologias do ombro, representando 44 a 65%. Contudo, a efectividade da fisioterapia nesta patologia continua a ser um tema em discussão. OBJECTIVO: Determinar a efectividade da fisioterapia no tratamento de pacientes com síndrome de colisão do ombro. METODOLOGIA: Pesquisa computadorizada nas bases de da...

  8. Application of GIS on Environmental Degradation Due to the ...

    African Journals Online (AJOL)

    Application of GIS on Environmental Degradation Due to the Offshoots of Highway Development Projects: Central Ethiopian Highlands. ... space and time and to increase its infiltration instead of directing it straight onto unprotected slopes. Key words: Gully erosion Risk, catchment area, Road design, Ecological destructions ...

  9. Space charge

    CERN Document Server

    Schindl, Karlheinz

    2005-01-01

    The Coulomb forces between the charged particles of a high-intensity beam in an accelerator create a self-field which acts on the particles inside the beam like a distributed lens, defocusing in both transverse planes. A beam moving with speed n is accompanied by a magnetic field which partially cancels the electrostatic defocusing effect, with complete cancellation at c, the speed of light. The effect of this 'direct space charge' is evaluated for transport lines and synchrotrons where the number of betatron oscillations per machine turn, Q, is reduced by DQ. In a real accelerator, the beam is also influenced by the environment (beam pipe, magnets, etc.) which generates 'indirect' space charge effects. For a smooth and perfectly conducting wall, they can easily be evaluated by introducing image charges and currents. These 'image effects' do not cancel when n approaches c, thus they become dominant for high-energy synchrotrons. Each particle in the beam has its particular incoherent tune Q and incoherent tune...

  10. Space to Space Advanced EMU Radio

    Science.gov (United States)

    Maicke, Andrew

    2016-01-01

    The main task for this project was the development of a prototype for the Space to Space Advanced EMU Radio (SSAER). The SSAER is an updated version of the Space to Space EMU Radio (SSER), which is the current radio used by EMUs (Extravehicular Mobility Unit) for communication between suits and with the ISS. The SSER was developed in 1999, and it was desired to update the design used in the system. Importantly, besides replacing out-of-production parts it was necessary to decrease the size of the radio due to increased volume constraints with the updated Portable Life Support System (PLSS) 2.5, which will be attached on future space suits. In particular, it was desired to fabricate a PCB for the front-end of the prototype SSAER system. Once this board was manufactured and all parts assembled, it could then be tested for quality of operation as well as compliancy with the SSER required specifications. Upon arrival, a small outline of the target system was provided, and it was my responsibility to take that outline to a finished, testable board. This board would include several stages, including frequency mixing, amplification, modulation, demodulation, and handled both the transmit and receive lines of the radio. I developed a new design based on the old SSER system and the outline provided to me, and found parts to fit the tasks in my design. It was also important to consider the specifications of the SSER, which included the system noise figure, gain, and power consumption. Further, all parts needed to be impedance matched, and spurious signals needed to be avoided. In order to fulfill these two requirements, it was necessary to perform some calculations using a Smith Chart and excel analysis. Once all parts were selected, I drew the schematics for the system in Altium Designer. This included developing schematic symbols, as well as layout. Once the schematic was finished, it was then necessary to lay the parts out onto a PCB using Altium. Similar to the schematic

  11. [Infections due to Mycobacterium simiae].

    Science.gov (United States)

    García-Martos, Pedro; García-Agudo, Lidia; González-Moya, Enrique; Galán, Fátima; Rodríguez-Iglesias, Manuel

    2015-10-01

    Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  12. APPENDICULAR INVAGINATION DUE TO ENDOMETRIOSIS

    Directory of Open Access Journals (Sweden)

    Vasja Kruh

    2003-12-01

    Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.

  13. Space platforms

    Science.gov (United States)

    1983-04-01

    The expanded scientific capabilities available by interfacing an orbital, free-flying experiments platform with Shuttle tending are outlined. The platform would be lifted to orbit by the Shuttle, and modularly increased in size on subsequent flights. Science packages could be left on the 26,000 lb space platform for up to six months. Component sections would include electrical and thermal control systems, berthing ports for payloads and an Orbiter, and an attitude control, communications, and data handling subsection. A 12 kW solar array would furnish power, and interconnect with Spacelab would further enhance the operations range. All berthed science packages would have individual pointing ability and grapples for the Orbiter RMS. Eventual evolution to include facilities for a human crew and a 25 kW solar array is projected.

  14. Teleprogramming a cooperative space robotic workcell for space station

    Science.gov (United States)

    Haule, Damian D.; Noorhosseini, S. M.; Malowany, Alfred S.

    1992-11-01

    The growing insight into the complexity and cost of in-orbit operations of future space missions strengthens the belief that a significant amount of automation will be needed to operate the orbital laboratories in a safe, efficient, and economic way. Thus, Automation & Robotics (A&R) technology is vital for unmanned exploration missions to comets and planets. While part of the space worksite may be structured, the space environment is generally unstructured. By `structured,' we mean environments that are designed and engineered to somehow `cooperate' with the machine. In addition, the structured part of the space worksite may be damaged or in an unknown condition. This lack of structure, as well as the non- repetitive nature of the tasks, require constant adaptation to the space environment by the robot. This is the motivation for increased space robot autonomy. However, complete autonomy is still beyond the scope of today's state-of-the-art in the case of a system executing a complete mission in a hazardous environment such as space. A systematic approach for the development of A&R technologies will reduce the lead-times and costs of facilities for recurrent basic tasks. A space robotic workcell (SRW) is a collection of robots, sensors, and other industrial equipment grouped in a cooperative environment to perform various complex tasks in space. Due to their distributed nature, the control and programming of SRWs is often a difficult task. The issues involved in order to design a real-time teleprogrammable SRW system that performs intervention tasks at remote unstructured sites are summarized. The concept of `remotely operated autonomous robots' (i.e., robots teleprogrammed and telesupervised at the task level while at a space worksite) is also developed via telepresence for human-machine interface and voice/speech programming. This paper makes an assessment of the role that teleprogramming may have in furthering the automation capabilities of space teleoperated

  15. Pulmonary Complications due to Esophagectomy.

    Science.gov (United States)

    Shirinzadeh, Abulfazl; Talebi, Yashar

    2011-01-01

    Esophageal carcinoma is the scourge of human beings. Pulmonary complications in patients who have undergone operation are common (20-30% of cases) and there are no suitable tools and ways to predict these complications. During a period of 10 years, from March 1998 to February 2007, 200 patients (150 male and 50 female) underwent Esophagectomy due to esophageal carcinoma in thoracic surgery ward retrospectively. Complications include the length of hospitalization, mechanical ventilation, morbidity and mortality. Patients' risk factors include age, preoperative chemo-radiotherapy, stage of the disease and preoperative spirometry condition. WE GROUPED OUR PATIENTS INTO THREE CATEGORIES: Normal (FEV1 ≥ 80% predicted), mildly impaired (FEV1 65% to 79% predicted), more severely impaired (FEV1 atelectasia in 160 patients (80%). 24 patients needed chest-tube insertion. 20 patients (10%) developed ARDS. 14 patients (7%) developed chylothorax. 20 patients (10%) of patients died during their postoperative hospital stay. 30 patients (15%) required mechanical ventilation for greater than 48 hours. We reviewed a number of preoperative clinical variables to determine whether they contributed to postoperative pulmonary complications as well as other outcomes. In general, age, impaired pulmonary function especially in those patients with FEV1 less than 65% predicted was associated with prolonged hospital length of stay (LOS). In fact pulmonary complications rate after Esophagectomy are high and there was associated mortality and morbidity.

  16. Transient hypofibrinogenemia due to allopurinol

    Directory of Open Access Journals (Sweden)

    Yin ZQ

    2014-09-01

    Full Text Available ZhiQiang Yin,1,* JiaLi Xu,2,* YongQiang Li,3,* JiPing Xia,1 Dan Luo1 1Department of Dermatology, 2Department of Oncology, 3Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China *These authors contributed equally to this work Abstract: This study reports a case of an 80-year-old male who suffered from drug eruption due to oral allopurinol for the treatment of gout. This patient complained of widespread erythema and maculopapule with itch, and small quantities of purplish-red rash with diffused distribution on four limbs were noted. After he was hospitalized, the area with purpuric rash increased in size, and hypofibrinogenemia was found. After treatment with intravenous infusion of fibrinogen and cryoprecipitate, and continued treatment with high-dose methylprednisolone, the skin rash gradually went away. This is the first report of purpura and hypofibrinogenemia induced by allopurinol and the pathophysiology underlying this reaction remained unknown. Keywords: purpura, fibrinogen, drug eruption, gout

  17. [Organ alterations due to aging].

    Science.gov (United States)

    Wieczorowska-Tobis, Katarzyna

    2008-01-01

    Aging defined as progressive organ dysfunction which makes keeping homeostasis more difficult starts at the age of 30-40. However, due to difficulties with the distinction between aging and disease processes, changes previously believed to be caused by aging are often recognized as the effect of pathologies when new data is presented. According to current knowledge, cardio-vascular aging includes decreased elasticity of main arteries, decreased ability of left ventricule to relaxate, diminished function of sino-atrial node and decreased effect of beta-adrenergic stimulation. Aging in the respiratory system is attributed to increased size of alveoli and alveolar ducts (which easier collapse), a decrease in the gase exchange area, a decrease in respiratory volumes (both static and dynamic) and a severe decrease in maximal oxygen consumption. In aging kidneys both renal blood flow and glomerular filtration are decreased. As the result of tubular alterations the kidney ability to conserve and dilute urine, and its capability to regulate the pH and serum sodium level diminish. Less dramatic changes are seen in the gastrointestinal tract. According to available data, high prevalence of gastric atrophy and hypochlorhydria are a consequence of Helicobacter pylori infection. Also, constipation is attributed much more to sedative life style and diet than to aging itself. In summary, none of the presented alterations is severe enough to cause the disease, but all of them increase the risk of pathology and thus pave the way for the disease even in healthy elderly subjects.

  18. The DUE Globwetland-2 Project

    Science.gov (United States)

    Paganini, Marc; Weise, Kathrin; Fitoka, Eleni; Hansen, Herbert; Fernandez, Diego; Arino, Olivier

    2010-12-01

    The overall objective of the Ramsar convention is the conservation and wise use of wetlands by national actions and international cooperation as a means to achieving sustainable development. This complex and challenging task requires national, local and international bodies involved in the implementation of the convention to rely on suitable geo-information in order to better understand wetland areas, complete national inventories, perform monitoring activities, carry out assessments and put in practice suitable management plans based on up to date and reliable information. In the recent years, the use of satellite earth observations (EO) within innovative geo-spatial analysis has revealed to be a key tool and unique information source to support the environmental community in different application domains, including wetlands conservation and management. The paper presents the main results and findings of the GlobWetland I project, providing an overview of the current capabilities and limits of EO technology as a tool to support the implementation of the Ramsar convention. It also summarises the major recommendations of the GlobWetland symposium "GlobWetland: Looking at Wetlands from Space" which principal aim was to strengthen the links between the different actors involved in the implementation of the Ramsar convention, and the earth observation community, in order to review the state of the art in the use of EO technology for wetlands management. Finally it presents the objective and scope of the GlobWetland II project, which will contribute to the establishment of a Global Wetlands Observing System (G-WOS) in accordance with the Strategic Plan 2009-2015 of the Ramsar convention on wetlands adopted as the last Conference of the Parties. The GlobWetland II project aims principally at developing a G-WOS pilot information system for the production of a number of wetland related geo-information maps and indicators, over 200 wetland sites and surrounding areas

  19. Empty Spaces.

    Science.gov (United States)

    Hulkower, Adira

    2017-09-01

    "I'm Jewish, you know, and my mother said, 'Always trust the rabbis.'" I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility-white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces-the absence of his voice, the too-large bed for his shrinking frame, the always-empty chair by his bedside, and most of all, the myriad gaps in his life story. He was what in hospitals is often called a "patient alone": someone who lacks decisional capacity and has no surrogate to make medical decisions for him. Mr. Weisman's aloneness prompted his primary team to consult our bioethics service in order to formulate goals of care for him, including the possibility of hospice care. © 2017 The Hastings Center.

  20. Otomycosis due to filamentous fungi.

    Science.gov (United States)

    García-Agudo, Lidia; Aznar-Marín, Pilar; Galán-Sánchez, Fátima; García-Martos, Pedro; Marín-Casanova, Pilar; Rodríguez-Iglesias, Manuel

    2011-10-01

    Otomycosis is common throughout the world but barely studied in Spain. Our objective was to determine the microbiological and epidemiological characteristics of this pathology in Cadiz (Spain) between 2005 and 2010. Samples from patients with suspicion of otomycosis underwent a direct microscopic examination and culture on different media for fungi and bacteria. Mycological cultures were incubated at 30°C for at least seven days. Identification of fungi was based on colonial morphology and microscopic examination of fungal structure. From a total of 2,633 samples, microbial growth was present in 1,375 (52.2%) and fungal isolation in 390 (28.4%). We identified 228 yeasts and 184 filamentous fungi (13.4% of positive cultures and 47.2% of otomycosis), associated with yeasts in 22 cases (5.6%). The most frequent species were Aspergillus flavus (42.4%), A. niger (35.9%), A. fumigatus (12.5%), A. candidus (7.1%), A. terreus (1.6%), and Paecilomyces variotii (0.5%). Infection was predominant in men (54.9%) and patients beyond 55 years old (46.8%). The most common clinical symptoms were itching (98.9%), otalgia (59.3%), and hypoacusis (56.0%). Fall season reported the lowest number of cases (20.1%). Incidence of otomycosis and fungi producing otomycosis vary within the distinct geographical areas. In Cadiz, this infection is endemic due to warm temperatures, high humidity, sea bathing, and wind, which contributes to disseminate the conidia. Despite Aspergillus niger has been reported as the main causative agent, A. flavus is predominant in Cadiz. Although infection is usually detected in warm months, we observed a homogeneous occurrence of otomycosis in almost all the seasons.

  1. Drug Information in Space Medicine

    Science.gov (United States)

    Bayuse, Tina M.

    2009-01-01

    Published drug information is widely available for terrestrial conditions. However, information on dosing, administration, drug interactions, stability, and side effects is scant as it relates to use in Space Medicine. Multinational crews on board the International Space Station present additional challenges for drug information because medication nomenclature, information available for the drug as well as the intended use for the drug is not standard across countries. This presentation will look at unique needs for drug information and how the information is managed in Space Medicine. A review was conducted of the drug information requests submitted to the Johnson Space Center Pharmacy by Space Medicine practitioners, astronaut crewmembers and researchers. The information requested was defined and cataloged. A list of references used was maintained. The wide range of information was identified. Due to the information needs for the medications in the on-board medical kits, the Drug Monograph Project was created. A standard method for answering specific drug information questions was generated and maintained by the Johnson Space Center Pharmacy. The Drug Monograph Project will be presented. Topic-centered requests, including multinational drug information, drug-induced adverse reactions, and medication events due to the environment will be highlighted. Information management of the drug information will be explained. Future considerations for drug information needs will be outlined.

  2. Space Science in Action: Space Exploration [Videotape].

    Science.gov (United States)

    1999

    In this videotape recording, students learn about the human quest to discover what is out in space. Students see the challenges and benefits of space exploration including the development of rocket science, a look back at the space race, and a history of manned space travel. A special section on the Saturn V rocket gives students insight into the…

  3. Space teleoperations technology for Space Station evolution

    Science.gov (United States)

    Reuter, Gerald J.

    1990-01-01

    Viewgraphs on space teleoperations technology for space station evolution are presented. Topics covered include: shuttle remote manipulator system; mobile servicing center functions; mobile servicing center technology; flight telerobotic servicer-telerobot; flight telerobotic servicer technology; technologies required for space station assembly; teleoperation applications; and technology needs for space station evolution.

  4. COMPARISON OF 3 STRETCHING PROTOCOLS FOR POSTERIOR SHOULDER TIGHTNESS IN THROWERS

    OpenAIRE

    M. Seshagiri Rao; Swathi Tejitha

    2016-01-01

    Background and Purpose: Posterior shoulder tightness (PST) can result due to abnormal humeral head motion which decreases subacromial space during overhead activities leading to compression of tissues causing limited shoulder flexion, internal rotation and horizontal adduction. Recently, some authors have expressed belief about cross body stretch and sleeper stretch. The need of this study is to know the effectiveness between three stretching protocols in PST. Materials and Methods: 45 PST...

  5. Recurrent Incisional Hernia due to Pseudomyxoma Peritonei

    Directory of Open Access Journals (Sweden)

    Zafer Ergul

    2011-01-01

    Full Text Available Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30×30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months.

  6. Septic arthritis due to Streptococcus sanguis.

    Science.gov (United States)

    Mandac, Inga; Prkacin, Ingrid; Matovinović, Mirjana Sabljar; Sustercić, Dunja

    2010-06-01

    Septic arthritis may represent a direct invasion of joint space by various microorganisms, including bacteria, viruses and fungi. Although any infectious agent may cause bacterial arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. We present a case of septic arthritis in a 56-year old male patient due to Streptococcus viridans which is member of the viridans group streptococci. Patient was admitted to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body weight during couple of months, and anemia of chronic disease as paraneoplastic process. He had long history of arterial hypertension and stroke. There was swelling and pain of the right sternoclavicular joint and precordial systolic murmur in physical status. A large diagnostic panel has been made, computerized tomography (CT) of right sternoclavicular joint showed widening of periarticular soft tissue and loss of clavicular corticalis. Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes. There were no crystals on microscopic examination and Gram stain of fluid was negative. Blood cultures were positive for S. sanguis and there was a consideration about possible periodontal disease. Stomatologic examination verified periapical ostitis and extraction of potential cause of infection has been done. Therapy with benzilpenicilline was followed by the gradual improvement of clinical and laboratory parameters. Although viridans group streptococci and Streptococcus sanguis in particular are rare causes of septic arthritis in native joints, they should be considered in the differential diagnosis of periodontal disease.

  7. 46 CFR 168.15-35 - Hospital space.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Hospital space. 168.15-35 Section 168.15-35 Shipping... VESSELS Accommodations § 168.15-35 Hospital space. (a) Each vessel must be provided with a hospital space. This space must be situated with due regard for the comfort of the sick so that they may receive proper...

  8. 46 CFR 72.20-35 - Hospital space.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Hospital space. 72.20-35 Section 72.20-35 Shipping COAST... Accommodations for Officers and Crew § 72.20-35 Hospital space. (a) Each vessel which in the ordinary course of... more, must be provided with a hospital space. This space must be situated with due regard to the...

  9. 46 CFR 92.20-35 - Hospital space.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Hospital space. 92.20-35 Section 92.20-35 Shipping COAST... ARRANGEMENT Accommodations for Officers and Crew § 92.20-35 Hospital space. (a) Each vessel which in the... crew of 12 or more, must be provided with a hospital space. This space must be situated with due regard...

  10. Preparing future space leaders - International Space University

    Science.gov (United States)

    Stone, Barbara A.; Van Reeth, George P.

    1992-01-01

    The International Space University (ISU) concept of developing a cadre of space professionals that will lead the universities and industries into space is discussed. ISU is an innovative, permanent worldwide organization for training and academic instruction in all aspects of space studies. ISU's major goal is to provide the young professional academic instruction in technical and nontechnical areas of modern space exploration and research, and a forum to exchange ideas and develop both personal and professional ties at an international level.

  11. Space Biosciences, Space-X, and the International Space Station

    Science.gov (United States)

    Wigley, Cecilia

    2014-01-01

    Space Biosciences Research on the International Space Station uses living organisms to study a variety of research questions. To enhance our understanding of fundamental biological processes. To develop the fundations for a safe, productive human exploration of space. To improve the quality of life on earth.

  12. Active Space Debris Removal System

    Directory of Open Access Journals (Sweden)

    Gabriele GUERRA

    2017-06-01

    Full Text Available Since the start of the space era, more than 5000 launches have been carried out, each carrying satellites for many disparate uses, such as Earth observation or communication. Thus, the space environment has become congested and the problem of space debris is now generating some concerns in the space community due to our long-lived belief that “space is big”. In the last few years, solutions to this problem have been proposed, one of those is Active Space Debris Removal: this method will reduce the increasing debris growth and permit future sustainable space activities. The main idea of the method proposed below is a drag augmentation system: use a system capable of putting an expanded foam on a debris which will increase the area-to-mass ratio to increase the natural atmospheric drag and solar pressure. The drag augmentation system proposed here requires a docking system; the debris will be pushed to its release height and then, after un-docking, an uncontrolled re-entry takes place ending with a burn up of the object and the foam in the atmosphere within a given time frame. The method requires an efficient way to change the orbit between two debris. The present paper analyses such a system in combination with an Electric Propulsion system, and emphasizes the choice of using two satellites to remove five effective rockets bodies debris within a year.

  13. Minimizing downstream scour due to submerged hydraulic jump using corrugated

    Directory of Open Access Journals (Sweden)

    Hossam Mohamed Ali

    2014-12-01

    Full Text Available Local scour downstream of hydraulic structures due to hydraulic jump is considered one of the tedious and complicated problems facing their stability. Throughout this paper, an experimental study was conducted to study the effect of using different spaced corrugated aprons on the downstream local scour due to submerged jump. Sixty runs were carried out in a horizontal rectangular flume to determine the optimal corrugation wavelength which minimizing the scour. A case of flat apron included to estimate the influence of corrugated aprons on scour holes dimensions. Two types of non-cohesive soil were used. Experiments were performed for a range of Froude numbers between 1.68 and 9.29. The results showed that using spaced triangular corrugated aprons minimize the scour depth and length of fine sand by average percentage of 63.4% and 30.2%, respectively and for coarse sand by 44.2% and 20.6% in comparing with classical jump.

  14. Coulomb's law in maximally symmetric spaces

    OpenAIRE

    Vakili, B.; Gorji, M. A.

    2012-01-01

    We study the modifications to the Coulomb's law when the background geometry is a $n$-dimensional maximally symmetric space, by using of the $n$-dimensional version of the Gauss' theorem. It is shown that some extra terms are added to the usual expression of the Coulomb electric field due to the curvature of the background space. Also, we consider the problem of existence of magnetic monopoles in such spaces and present analytical expressions for the corresponding magnetic fields and vector p...

  15. Quadrilateral space syndrome: findings at MR imaging.

    Science.gov (United States)

    Linker, C S; Helms, C A; Fritz, R C

    1993-09-01

    Shoulder pain due to compression of the axillary nerve by fibrous bands in the quadrilateral space has been termed the quadrilateral space syndrome. Selective atrophy of the teres minor muscle, which is innervated by the axillary nerve, was demonstrated at magnetic resonance imaging in three patients with clinical findings of the syndrome. This finding, in the appropriate clinical setting, is highly suggestive of the quadrilateral space syndrome, which is a potentially reversible cause of shoulder pain.

  16. Nice surjections on spaces of operators

    Indian Academy of Sciences (India)

    Abstract. A bounded linear operator is said to be nice if its adjoint preserves extreme points of the dual unit ball. Motivated by a description due to Labuschagne and Mas- cioni [9] of such maps for the space of compact operators on a Hilbert space, in this article we consider a description of nice surjections on K(X, Y ) for ...

  17. Nice surjections on spaces of operators

    Indian Academy of Sciences (India)

    A bounded linear operator is said to be nice if its adjoint preserves extreme points of the dual unit ball. Motivated by a description due to Labuschagne and Mascioni [9] of such maps for the space of compact operators on a Hilbert space, in this article we consider a description of nice surjections on K ( X , Y ) for Banach ...

  18. Collaborative Commercial Space Situational Awareness

    Science.gov (United States)

    Kelso, T. S.; Hendrix, D.; Sibert, D.; Hall, R. A.; Therien, W.

    2013-09-01

    There is an increasing recognition by commercial and civil space operators of the need for space situational awareness (SSA) data to support ongoing conjunction analysis, maneuver planning, and radio frequency interference mitigation as part of daily operations. While some SSA data is available from the Joint Space Operations Center via the Space Track web site, access to raw observations and photometric data is limited due to national security considerations. These data, however, are of significant value in calibrating intra- and inter-operator orbit determination results, determining inter-system biases, and assessing operating profiles in the geostationary orbit. This paper details an ongoing collaborative effort to collect and process optical observations and photometric data using a network of low-cost telescope installations and shows how these data are being used to support ongoing operations in the Space Data Center. This presentation will demonstrate how by leveraging advance photometric processing algorithms developed for Missile Defense Agency and the Ballistic Missile Defense (BMD) mission ExoAnalytic and AGI have been able to provide actionable SSA for satellite operators from small telescopes in less than optimal viewing conditions. Space has become an increasingly cluttered environment requiring satellite operators to remain forever vigilant in order to prevent collisions to preserve their assets and prevent further cluttering the space environment. The Joint Space Operations Center (JSpOC), which tracks all objects in earth orbit, reports possible upcoming conjunctions to operators by providing Conjunction Summary Messages (CSMs). However due to large positional uncertainties in the forward predicted position of space objects at the time closest approach the volume of CSMs is excessive to the point that maneuvers in response to CSMs without additional screening is cost prohibitive. CSSI and the Space Data Association have been able to screen most

  19. Atmosphere and Ambient Space

    DEFF Research Database (Denmark)

    Schmidt, Ulrik

    Atmosphere and Ambient Space This paper explores the relation between atmosphere and ambient space. Atmosphere and ambient space share many salient properties. They are both ontologically indeterminate, constantly varying and formally diffuse and they are both experienced as a subtle, non......-signifying property of a given space. But from a certain point of view, the two concepts also designate quite dissimilar experiences of space. To be ’ambient’ means to surround. Accordingly, ambient space is that space, which surrounds something or somebody. (Gibson 1987: 65) Since space is essentially...... of a surrounding character, all space can thus be described as having a fundamentally ambient character. So what precisely is an ambient space, then? As I will argue in my presentation, ambient space is a sensory effect of spatiality when a space is experienced as being particularly surrounding: a ‘space effect...

  20. Continuum of haptic space

    NARCIS (Netherlands)

    Kappers, A.M.L.; Koenderink, J.J.

    2002-01-01

    The structure of haptic space has first received serious attention in 1937 by Blumenfeld. Haptic space, as used in this chapter and indeed also by Blumenfeld, involves the space around us which we can reach by touch from a fixed position. How this space is related to the space through which we

  1. Space history, space policy, and executive leadership

    Science.gov (United States)

    Kraemer, Sylvia K.

    1993-01-01

    A lecture that attempts to establish the role of space historians in formulating space policy is presented. The discussion focusses on two adages and their relevance to space policy. The adages are as follows: 'write about what you know;' and 'good managers do things right; good executives do the right things.'

  2. Fundamental space radiobiology

    Science.gov (United States)

    Nelson, Gregory A.

    2003-01-01

    The unique feature of the space radiation environment is the dominance of high-energy charged particles (HZE or high LET radiation) emitted by the Sun and galactic sources, or trapped in the Van Allen radiation belts. These charged particles present a significant hazard to space flight crews, and accelerator-based experiments are underway to quantify the health risks due to unavoidable radiation exposure. There are three principal properties of charged particles that distinguish them from conventional radiation, i.e. gamma rays and x-rays. First, they have a defined range in matter rather than an exponential absorption profile. Second, they undergo nuclear reactions to produce secondary particles. Third, and most important, they deposit their energy along well-defined linear paths or tracks rather than diffuse fields. The structured energy deposition pattern interacts on multiple scales with the biological structures of DNA, cells and tissues to produce correlated patterns of damage that evade repair systems. Traditional concepts of dose and its associated normalization parameter, RBE (relative biological effectiveness), break down under experimental scrutiny, and probabilistic models of risk based on the number of particle traversals per cell may be more appropriate. Unique patterns of DNA damage, gene expression, mobilization of repair proteins, activation of cytokines and remodeling of cellular microenvironment are observed following exposure to high LET radiation. At low levels of exposure the communication of bioactive substances from irradiated to unirradiated "bystander" cells can amplify the damage and cause a significant deviation from linearity in dose vs. response relations. Under some circumstances, there is even a multigenerational delay in the expression of radiation-induced genetic damage (genomic instability) which is not strictly dose dependent. These issues and the experimental evidence derived from ground based experiments at particle

  3. NEW SPACE MECCA

    National Research Council Canada - National Science Library

    Mark Williamson

    2016-01-01

      Five years ago, when the National Aeronautics and Space Administration (NASA) retired the space shuttle fleet and shipped the orbiters to museums across the nation, it seemed that the Kennedy Space Center (KSC...

  4. Fuzzy Hypervector Spaces

    Directory of Open Access Journals (Sweden)

    R. Ameri

    2008-01-01

    Full Text Available The aim of this paper is the generalization of the notion of fuzzy vector spaces to fuzzy hypervector spaces. In this regard, by considering the notion of fuzzy hypervector spaces, we characterized a fuzzy hypervector space based on its level sub-hyperspace. The algebraic nature of fuzzy hypervector space under transformations is studied. Certain conditions are obtained under which a given fuzzy hypervector space can or cannot be realized as a union of two fuzzy hypervector spaces such that none is contained in the other. The construction of a fuzzy hypervector space generated by a given fuzzy subset of a hypervector space is given. The set of all fuzzy cosets of a fuzzy hypervector space is shown to be a hypervector space. Finally, a fuzzy quotient hypervector space is defined and an analogue of a consequence of the “fundamental theorem of homomorphisms” is obtained.

  5. Space Probe Launch

    Science.gov (United States)

    1970-01-01

    Managed by Marshall Space Flight Center, the Space Tug was a reusable multipurpose space vehicle designed to transport payloads to different orbital inclinations. Utilizing mission-specific combinations of its three primary modules (crew, propulsion, and cargo) and a variety of supplementary kits, the Space Tug was capable of numerous space applications. This 1970 artist's concept depicts the Tug's propulsion module launching a space probe into lunar orbit.

  6. Static deformation due to a long buried dip-slip fault in an isotropic ...

    Indian Academy of Sciences (India)

    Static deformation due to a long buried dip-slip fault in an isotropic half-space welded with an orthotropic half-space. NEERU BALA and SUNITA RANI. ∗. Department of Mathematics, Guru Jambheshwar University of Science and. Technology, Hisar 125 001 e-mail: s−b−rani@rediffmail.com. MS received 29 April 2008; ...

  7. Static deformation due to a long buried dip-slip fault in an isotropic ...

    Indian Academy of Sciences (India)

    Closed-form analytical expressions for the displacements and the stresses at any point of a two-phase medium consisting of a homogeneous, isotropic, perfectly elastic half-space in welded contact with a homogeneous, orthotropic, perfectly elastic half-space due to a dip-slip fault of finite width located at an arbitrary ...

  8. CT findings of diffus pneumocephalus due to bacterial meningitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Seok, Ji Yeon; Kim, Hyun Sook; Bae, Hee Joon; Chung, Hwa Ryung; Kim, Dae Hong; Yoon, Yong Kyu [Eulji Univ. School of Medicine, Seoul (Korea, Republic of)

    2001-01-01

    We report a case of diffuse pneumocephalus due to infection. Brian CT revealed diffuse brian swelling and diffuse pneumocephalus in the ventricular system, subarachnoid space, subdural/epidural space and superior sagittal sinus. CSF disclosed the presence of a yellowwish-green pus-like liquid. Polymerase chain reaction was positive for Haemophilus influenza Ag.

  9. Biotechnological experiments in space flights on board of space stations

    Science.gov (United States)

    Nechitailo, Galina S.

    2012-07-01

    Space flight conditions are stressful for any plant and cause structural-functional transition due to mobiliation of adaptivity. In space flight experiments with pea tissue, wheat and arabidopsis we found anatomical-morphological transformations and biochemistry of plants. In following experiments, tissue of stevia (Stevia rebaudiana), potato (Solanum tuberosum), callus culture and culture and bulbs of suffron (Crocus sativus), callus culture of ginseng (Panax ginseng) were investigated. Experiments with stevia carried out in special chambers. The duration of experiment was 8-14 days. Board lamp was used for illumination of the plants. After experiment the plants grew in the same chamber and after 50 days the plants were moved into artificial ionexchange soil. The biochemical analysis of plants was done. The total concentration of glycozides and ratio of stevioside and rebauside were found different in space and ground plants. In following generations of stevia after flight the total concentration of stevioside and rebauside remains higher than in ground plants. Experiments with callus culture of suffron carried out in tubes. Duration of space flight experiment was 8-167 days. Board lamp was used for illumination of the plants. We found picrocitina pigment in the space plants but not in ground plants. Tissue culture of ginseng was grown in special container in thermostate under stable temperature of 22 ± 0,5 C. Duration of space experiment was from 8 to 167 days. Biological activity of space flight culutre was in 5 times higher than the ground culture. This difference was observed after recultivation of space flight samples on Earth during year after flight. Callus tissue of potato was grown in tubes in thermostate under stable temperature of 22 ± 0,5 C. Duration of space experiment was from 8 to 14 days. Concentration of regenerates in flight samples was in 5 times higher than in ground samples. The space flight experiments show, that microgravity and other

  10. Space Biophysics: Accomplishments, Trends, Challenges

    Science.gov (United States)

    Smith, Jeffrey D.

    2015-01-01

    Physics and biology are inextricably linked. All the chemical and biological processes of life are dutifully bound to follow the rules and laws of physics. In space, these physical laws seem to turn on their head and biological systems, from microbes to humans, adapt and evolve in myriad ways to cope with the changed physical influences of the space environment. Gravity is the most prominent change in space that influences biology. In microgravity, the physical processes of sedimentation, density-driven convective flow, influence of surface tension and fluid pressure profoundly influence biology at the molecular and cellular level as well as at the whole-body level. Gravity sensing mechanisms are altered, structural and functional components of biology (such as bone and muscle) are reduced and changes in the way fluids and gasses behave also drive the way microbial systems and biofilms grow as well as the way plants and animals adapt. The radiation environment also effects life in space. Solar particle events and high energy cosmic radiation can cause serious damage to DNA and other biomolecules. The results can cause mutation, cellular damage or death, leading to health consequences of acute radiation damage or long-term health consequences such as increased cancer risk. Space Biophysics is the study and utilization of physical changes in space that cause changes in biological systems. The unique physical environment in space has been used successfully to grow high-quality protein crystals and 3D tissue cultures that could not be grown in the presence of unidirectional gravitational acceleration here on Earth. All biological processes that change in space have their root in a biophysical alteration due to microgravity and/or the radiation environment of space. In order to fully-understand the risks to human health in space and to fully-understand how humans, plants, animals and microbes can safely and effectively travel and eventually live for long periods beyond

  11. Space Mission Human Reliability Analysis (HRA) Project

    Science.gov (United States)

    Boyer, Roger

    2014-01-01

    The purpose of the Space Mission Human Reliability Analysis (HRA) Project is to extend current ground-based HRA risk prediction techniques to a long-duration, space-based tool. Ground-based HRA methodology has been shown to be a reasonable tool for short-duration space missions, such as Space Shuttle and lunar fly-bys. However, longer-duration deep-space missions, such as asteroid and Mars missions, will require the crew to be in space for as long as 400 to 900 day missions with periods of extended autonomy and self-sufficiency. Current indications show higher risk due to fatigue, physiological effects due to extended low gravity environments, and others, may impact HRA predictions. For this project, Safety & Mission Assurance (S&MA) will work with Human Health & Performance (HH&P) to establish what is currently used to assess human reliabiilty for human space programs, identify human performance factors that may be sensitive to long duration space flight, collect available historical data, and update current tools to account for performance shaping factors believed to be important to such missions. This effort will also contribute data to the Human Performance Data Repository and influence the Space Human Factors Engineering research risks and gaps (part of the HRP Program). An accurate risk predictor mitigates Loss of Crew (LOC) and Loss of Mission (LOM).The end result will be an updated HRA model that can effectively predict risk on long-duration missions.

  12. 34 CFR 602.25 - Due process.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Due process. 602.25 Section 602.25 Education... Required Operating Policies and Procedures § 602.25 Due process. The agency must demonstrate that the procedures it uses throughout the accrediting process satisfy due process. The agency meets this requirement...

  13. Space Toxicology: Human Health during Space Operations

    Science.gov (United States)

    Khan-Mayberry, Noreen; James, John T.; Tyl, ROchelle; Lam, Chiu-Wing

    2010-01-01

    Space Toxicology is a unique and targeted discipline for spaceflight, space habitation and occupation of celestial bodies including planets, moons and asteroids. Astronaut explorers face distinctive health challenges and limited resources for rescue and medical care during space operation. A central goal of space toxicology is to protect the health of the astronaut by assessing potential chemical exposures during spaceflight and setting safe limits that will protect the astronaut against chemical exposures, in a physiologically altered state. In order to maintain sustained occupation in space on the International Space Station (ISS), toxicological risks must be assessed and managed within the context of isolation continuous exposures, reuse of air and water, limited rescue options, and the need to use highly toxic compounds for propulsion. As we begin to explore other celestial bodies in situ toxicological risks, such as inhalation of reactive mineral dusts, must also be managed.

  14. Space weather: European Space Agency perspectives

    Science.gov (United States)

    Daly, E. J.; Hilgers, A.

    Spacecraft and payloads have become steadily more sophisticated and therefore more susceptible to space weather effects. ESA has long been active in applying models and tools to the problems associated with such effects on its spacecraft. In parallel, ESA and European agencies have built a highly successful solar-terrestrial physics capability. ESA is now investigating the marriage of these technological and scientific capabilities to address perceived user needs for space weather products and services. Two major ESA-sponsored studies are laying the groundwork for a possible operational European space weather service. The wide-ranging activities of ESA in the Space Weather/Space Environment domain are summarized and recent important examples of space weather concerns given.

  15. Fake weighted projective spaces

    OpenAIRE

    Buczynska, Weronika

    2008-01-01

    We define fake weighted projective spaces as a generalisation of weighted projective spaces. We introduce the notions of fundamental group in codimension 1 and of universal covering in codimension 1. We prove that for every fake weighted projective space its universal cover in codimension 1 is a weighted projective space.

  16. Organic chemistry in space

    Science.gov (United States)

    Johnson, R. D.

    1977-01-01

    Organic cosmochemistry, organic materials in space exploration, and biochemistry of man in space are briefly surveyed. A model of Jupiter's atmosphere is considered, and the search for organic molecules in the solar system and in interstellar space is discussed. Materials and analytical techniques relevant to space exploration are indicated, and the blood and urine analyses performed on Skylab are described.

  17. Space Guidelines for Libraries.

    Science.gov (United States)

    Wisconsin Coordinating Committee for Higher Education, Madison.

    The following guidelines are recommended: stack space--for each 10 volumes, one square foot of space; reading room--25 square feet per station x 20% of the total undergraduate population; carrel space--25% of the graduate enrollment x 45 square feet; office and auxilliary space--135 square feet x full time equivalent staff. (NI)

  18. Neutrosophic triplet normed space

    Science.gov (United States)

    Şahin, Mehmet; Kargın, Abdullah

    2017-11-01

    In this paper; new properties for neutrosophic triplet groups are introduced. A notion of neutrosophic triplet metric space is given and properties of neutrosophic triplet metric spaces are studied. Neutrosophic triplet vector space and neutrosophic triplet normed space are also studied and some of their properties are given. Furthermore, we also show that these neutrosophic triplet notionsare different from the classical notions.

  19. Budgeting Academic Space

    Science.gov (United States)

    Harris, Watson

    2011-01-01

    There are many articles about space management, including those that discuss space calculations, metrics, and categories. Fewer articles discuss the space budgeting processes used by administrators to allocate space. The author attempts to fill this void by discussing her administrative experiences with Middle Tennessee State University's (MTSU)…

  20. Space Physiology and Operational Space Medicine

    Science.gov (United States)

    Scheuring, Richard A.

    2009-01-01

    The objectives of this slide presentation are to teach a level of familiarity with: the effects of short and long duration space flight on the human body, the major medical concerns regarding future long duration missions, the environmental issues that have potential medical impact on the crew, the role and capabilities of the Space Medicine Flight Surgeon and the environmental impacts experienced by the Apollo crews. The main physiological effects of space flight on the human body reviewed in this presentation are: space motion sickness (SMS), neurovestibular, cardiovascular, musculoskeletal, immune/hematopoietic system and behavioral/psycho-social. Some countermeasures are discussed to these effects.

  1. Theory of function spaces

    CERN Document Server

    Triebel, Hans

    1983-01-01

    The book deals with the two scales Bsp,q and Fsp,q of spaces of distributions, where -8spaces, such as Hölder spaces, Zygmund classes, Sobolev spaces, Besov spaces, Bessel-potential spaces, Hardy spaces and spaces of BMO-type. It is the main aim of this book to give a unified treatment of the corresponding spaces on the Euclidean n-space Rn in the framework of Fourier analysis, which is based on the technique of maximal functions, Fourier multipliers and interpolation assertions. These topics are treated in Chapter 2, which is the heart

  2. Mitigation of Space Radiation Effects

    Science.gov (United States)

    Atwell, William

    2012-02-01

    During low earth orbit and deep space missions, humans and spacecraft systems are exposed to high energy particles emanating from basically three sources: geomagnetically-trapped protons and electrons (Van Allen Belts), extremely high energy galactic cosmic radiation (GCR), and solar proton events (SPEs). The particles can have deleterious effects if not properly shielded. For humans, there can be a multitude of harmful effects depending on the degree of exposure. For spacecraft systems, especially electronics, the effects can range from single event upsets (SEUs) to catastrophic effects such as latchup and burnout. In addition, some materials, radio-sensitive experiments, and scientific payloads are subject to harmful effects. To date, other methods have been proposed such as electrostatic and electromagnetic shielding, but these approaches have not proven feasible due to cost, weight, and safety issues. The only method that has merit and has been effective is bulk or parasitic shielding. In this paper, we discuss in detail the sources of the space radiation environment, spacecraft, human, and onboard systems modeling methodologies, transport of these particles through shielding materials, and the calculation of the dose effects. In addition, a review of the space missions to date and a discussion of the space radiation mitigation challenges for lunar and deep space missions such as lunar outposts and human missions to Mars are presented.

  3. Measuring space radiation shielding effectiveness

    Science.gov (United States)

    Bahadori, Amir; Semones, Edward; Ewert, Michael; Broyan, James; Walker, Steven

    2017-09-01

    Passive radiation shielding is one strategy to mitigate the problem of space radiation exposure. While space vehicles are constructed largely of aluminum, polyethylene has been demonstrated to have superior shielding characteristics for both galactic cosmic rays and solar particle events due to the high hydrogen content. A method to calculate the shielding effectiveness of a material relative to reference material from Bragg peak measurements performed using energetic heavy charged particles is described. Using accelerated alpha particles at the National Aeronautics and Space Administration Space Radiation Laboratory at Brookhaven National Laboratory, the method is applied to sample tiles from the Heat Melt Compactor, which were created by melting material from a simulated astronaut waste stream, consisting of materials such as trash and unconsumed food. The shielding effectiveness calculated from measurements of the Heat Melt Compactor sample tiles is about 10% less than the shielding effectiveness of polyethylene. Shielding material produced from the astronaut waste stream in the form of Heat Melt Compactor tiles is therefore found to be an attractive solution for protection against space radiation.

  4. Measuring space radiation shielding effectiveness

    Directory of Open Access Journals (Sweden)

    Bahadori Amir

    2017-01-01

    Full Text Available Passive radiation shielding is one strategy to mitigate the problem of space radiation exposure. While space vehicles are constructed largely of aluminum, polyethylene has been demonstrated to have superior shielding characteristics for both galactic cosmic rays and solar particle events due to the high hydrogen content. A method to calculate the shielding effectiveness of a material relative to reference material from Bragg peak measurements performed using energetic heavy charged particles is described. Using accelerated alpha particles at the National Aeronautics and Space Administration Space Radiation Laboratory at Brookhaven National Laboratory, the method is applied to sample tiles from the Heat Melt Compactor, which were created by melting material from a simulated astronaut waste stream, consisting of materials such as trash and unconsumed food. The shielding effectiveness calculated from measurements of the Heat Melt Compactor sample tiles is about 10% less than the shielding effectiveness of polyethylene. Shielding material produced from the astronaut waste stream in the form of Heat Melt Compactor tiles is therefore found to be an attractive solution for protection against space radiation.

  5. The modular sequence space of $\\chi^{2}$

    Directory of Open Access Journals (Sweden)

    N. Subramanian

    2014-01-01

    Full Text Available In this paper we introduce the modular sequence space of $\\chi^{2}$ and examine some topological properties of these space also establish some duals results among them. Lindenstrauss and Tzafriri [7] used the idea of Orlicz function to define the sequence space $\\ell_{M}$ which is called an Orlicz sequence space. Another generalization of Orlicz sequence spaces is due to Woo [9]. We define the sequence spaces $\\chi^{2}_{f\\lambda}$ and $\\chi^{2\\lambda}_{g},$ where $f=\\left(f_{mn}\\right$ and $g=\\left(g_{mn}\\right$ are sequences of modulus functions such that $f_{mn}$ and $g_{mn}$ be mutually complementary for each $m,n.$

  6. Historical aspects of human presence in Space

    Science.gov (United States)

    Harsch, V.

    2007-02-01

    Purpose: This paper presents the development of human presence in Space from its beginnings. Study hypotheses were based on historical findings on scientific, medical, cultural, and political aspects of manned Space flight due to the different attitudes of Space minded nations and organizations. Impacts of aerospace medicine on the advances of biomedical sciences will be touched upon, as well as the historical development of aviation and Space medical achievements which are described briefly and visions for future developments are given. Methods: An overview was gained by literature-study, archives research and oral history taking. Results: Aviation Medicine evolved parallel to Man's ability to fly. War-triggered advancements in aviation brought mankind to the edge of space-equivalent conditions within a few decades of the first motor-flight, which took place in the USA in 1903 [V. Harsch, Aerospace medicine in Germany: from the very beginnings, Aviation and Space Environment Medicine 71 (2000) 447-450 [1

  7. In-Space Manufacturing Baseline Property Development

    Science.gov (United States)

    Stockman, Tom; Schneider, Judith; Prater, Tracie; Bean, Quincy; Werkheiser, Nicki

    2016-01-01

    The In-Space Manufacturing (ISM) project at NASA Marshall Space Flight Center currently operates a 3D FDM (fused deposition modeling) printer onboard the International Space Station. In order to enable utilization of this capability by designer, the project needs to establish characteristic material properties for materials produced using the process. This is difficult for additive manufacturing since standards and specifications do not yet exist for these technologies. Due to availability of crew time, there are limitations to the sample size which in turn limits the application of the traditional design allowables approaches to develop a materials property database for designers. In this study, various approaches to development of material databases were evaluated for use by designers of space systems who wish to leverage in-space manufacturing capabilities. This study focuses on alternative statistical techniques for baseline property development to support in-space manufacturing.

  8. New solutions for the space debris problem

    CERN Document Server

    Pelton, Joseph N

    2015-01-01

    Addressing a pressing issue in space policy, Pelton explores the new forms of technology that are being developed to actively remove the defunct space objects from orbit and analyzes their implications in the existing regime of international space law and public international law. This authoritative review covers the due diligence guidelines that nations are using to minimize the generation of new debris, mandates to de-orbit satellites at end of life, and innovative endeavours to remove non-functional satellites, upper stage rockets and other large debris from orbit under new institutional, financial and regulatory guidelines.  Commercial space services currently exceed 100 billion USD business per annum, but the alarming proliferation in the population of orbital debris in low, medium and geosynchronous satellite orbits poses a serious threat to all kinds of space assets and applications. There is a graver concern that the existing space debris will begin to collide in a cascading manner, generating furth...

  9. A New Essential Norm Estimate of Composition Operators from Weighted Bloch Space into -Bloch Spaces

    Directory of Open Access Journals (Sweden)

    René E. Castillo

    2013-01-01

    Full Text Available Let be any weight function defined on the unit disk and let be an analytic self-map of . In the present paper, we show that the essential norm of composition operator mapping from the weighted Bloch space to -Bloch space is comparable to where for ,   is a certain special function in the weighted Bloch space. As a consequence of our estimate, we extend the results about the compactness of composition operators due to Tjani (2003.

  10. Redistribution of energy flow in a material due to damping.

    Science.gov (United States)

    Li, Xin; Pierce, Donna M; Arnoldus, Henk F

    2011-02-01

    The field lines of energy flow of the radiation emitted by a linear dipole in free space are straight lines, running radially outward from the source. When the dipole is embedded in a medium, the field lines are curves when the imaginary part of the relative permittivity is finite. It is shown that due to the damping in the material all radiation is emitted in directions perpendicular to the dipole axis, whereas for a dipole in free space the radiation is emitted in all directions except along the dipole axis. It is also shown that some field lines in the near field form semiloops. Energy flowing along these semiloops is absorbed by the material and does not contribute to the radiative power in the far field.

  11. National Space Agencies vs. Commercial Space: Towards Improved Space Safety

    Science.gov (United States)

    Pelton, J.

    2013-09-01

    Traditional space policies as developed at the national level includes many elements but they are most typically driven by economic and political objectives. Legislatively administered programs apportion limited public funds to achieve "gains" that can involve employment, stimulus to the economy, national defense or other advancements. Yet political advantage is seldom far from the picture.Within the context of traditional space policies, safety issues cannot truly be described as "afterthoughts", but they are usually, at best, a secondary or even tertiary consideration. "Space safety" is often simply assumed to be "in there" somewhere. The current key question is can "safety and risk minimization", within new commercial space programs actually be elevated in importance and effectively be "designed in" at the outset. This has long been the case with commercial aviation and there is at least reasonable hope that this could also be the case for the commercial space industry in coming years. The cooperative role that the insurance industry has now played for centuries in the shipping industry and for decades in aviation can perhaps now play a constructive role in risk minimization in the commercial space domain as well. This paper begins by examining two historical case studies in the context of traditional national space policy development to see how major space policy decisions involving "manned space programs" have given undue primacy to "political considerations" over "safety" and other factors. The specific case histories examined here include first the decision to undertake the Space Shuttle Program (i.e. 1970-1972) and the second is the International Space Station. In both cases the key and overarching decisions were driven by political, schedule and cost considerations, and safety seems absence as a prime consideration. In publicly funded space programs—whether in the United States, Europe, Russia, Japan, China, India or elsewhere—it seems realistic to

  12. Space Sciences Focus Area

    Energy Technology Data Exchange (ETDEWEB)

    Reeves, Geoffrey D. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-08-10

    To advance our understanding of the space environment (from the Sun to the Earth and beyond) and to advance our ability to operate systems in space that protect life and society. Space Science is distinct from other field, such as astrophysics or cosmology, in that Space Science utilizes in-situ measurements from high altitude rockets, balloons and spacecraft or ground-based measurements of objects and conditions in space.

  13. Space in Space: Designing for Privacy in the Workplace

    Science.gov (United States)

    Akin, Jonie

    2015-01-01

    Privacy is cultural, socially embedded in the spatial, temporal, and material aspects of the lived experience. Definitions of privacy are as varied among scholars as they are among those who fight for their personal rights in the home and the workplace. Privacy in the workplace has become a topic of interest in recent years, as evident in discussions on Big Data as well as the shrinking office spaces in which people work. An article in The New York Times published in February of this year noted that "many companies are looking to cut costs, and one way to do that is by trimming personal space". Increasingly, organizations ranging from tech start-ups to large corporations are downsizing square footage and opting for open-office floorplans hoping to trim the budget and spark creative, productive communication among their employees. The question of how much is too much to trim when it comes to privacy, is one that is being actively addressed by the National Aeronautics and Space Administration (NASA) as they explore habitat designs for future space missions. NASA recognizes privacy as a design-related stressor impacting human health and performance. Given the challenges of sustaining life in an isolated, confined, and extreme environment such as Mars, NASA deems it necessary to determine the acceptable minimal amount for habitable volume for activities requiring at least some level of privacy in order to support optimal crew performance. Ethnographic research was conducted in 2013 to explore perceptions of privacy and privacy needs among astronauts living and working in space as part of a long-distance, long-duration mission. The allocation of space, or habitable volume, becomes an increasingly complex issue in outer space due to the costs associated with maintaining an artificial, confined environment bounded by limitations of mass while located in an extreme environment. Privacy in space, or space in space, provides a unique case study of the complex notions of

  14. Immune responses in space flight

    Science.gov (United States)

    Sonnenfeld, G.

    1998-01-01

    significance of space flight-induced changes in immune parameters remains to be established; however, as duration of flights increases, the potential for difficulties due to impaired immune responses also increases.

  15. SpaceTech—Postgraduate space education

    Science.gov (United States)

    de Bruijn, Ferdi J.; Ashford, Edward W.; Larson, Wiley J.

    2008-07-01

    SpaceTech is a postgraduate program geared primarily for mid-career space professionals seeking to gain or improve their expertise in space systems engineering and in business engineering. SpaceTech provides a lifelong impact on its participants by broadening their capabilities, encouraging systematic "end-to-end" thinking and preparing them for any technical or business-related engineering challenges they may encounter. This flexible 1-year program offers high competency gain and increased business skills. It is held in attractive locations in a flexible, multi-cultural environment. SpaceTech is a highly effective master's program certified by the esteemed Technical University of Delft (TUD), Netherlands. SpaceTech provides expert instructors who place no barriers between themselves and participants. The program combines innovative and flexible new approaches with time-tested methods to give participants the skills required for future missions and new business, while allowing participants to meet their work commitments at the same time as they study for their master's degree. The SpaceTech program is conducted in separate sessions, generally each of 2-week duration, separated by periods of some 6-8 weeks, during which time participants may return to their normal jobs. It also includes introductory online course material that the participants can study at their leisure. The first session is held at the TUD, with subsequent sessions held at strategic space agency locations. By participating at two or more of these sessions, attendees can earn certificates of satisfactory completion from TU Delft. By participating in all of the sessions, as well as taking part in the companion Central Case Project (CCP), participants earn an accredited and highly respected master's degree in Space Systems Engineering from the TUD. Seven distinct SpaceTech modules are provided during these sessions: Space Mission Analysis and Design, Systems Engineering, Business Engineering

  16. Products of straight spaces with compact spaces

    Directory of Open Access Journals (Sweden)

    Kusuo Nishijima

    2007-10-01

    Full Text Available A metric space X is called straight if any continuous real-valued function which is uniformly continuous on each set of a finite cover of X by closed sets, is itself uniformly continuous. Let C be the convergent sequence {1/n : n ϵ N} with its limit 0 in the real line with the usual metric. In this paper, we show that for a straight space X, X × C is straight if and only if X × K is straight for any compact metric space K. Furthermore, we show that for a straight space X, if X × C is straight, then X is precompact. Note that the notion of straightness depends on the metric on X. Indeed, since the real line R with the usual metric is not precompact, R×C is not straight. On the other hand, we show that the product space of an open interval and C is straight.

  17. Section 2: The Space of Media Space

    Science.gov (United States)

    Harrison, Steve

    We began our study of media space with the social aspects of mediated communication because many in the computer-supported cooperative work (CSCW) realm are familiar with models, theories, frameworks, issues, and design approaches related to sociality. But the first media space research came from another set of traditions — the ordering of space and the making of place. Formally, these are the professional and intellectual provinces of architecture, which are probably remote from the disciplinary backgrounds of most readers. However, remoteness in terms of rhetoric and training does not prevent proximity to everyday human experience. The meaning of media space with respect to human experience is the focus of the articles in this section. The spaces are designed to have meaning, and the meaning of the design derives from spatial experience.

  18. Function valued metric spaces

    Directory of Open Access Journals (Sweden)

    Madjid Mirzavaziri

    2010-11-01

    Full Text Available In this paper we introduce the notion of an ℱ-metric, as a function valued distance mapping, on a set X and we investigate the theory of ℱ-metrics paces. We show that every metric space may be viewed as an F-metric space and every ℱ-metric space (X,δ can be regarded as a topological space (X,τδ. In addition, we prove that the category of the so-called extended F-metric spaces properly contains the category of metric spaces. We also introduce the concept of an `ℱ-metric space as a completion of an ℱ-metric space and, as an application to topology, we prove that each normal topological space is `ℱ-metrizable.

  19. Pacemaker Lead Endocarditis Due to Trichosporon Species.

    Science.gov (United States)

    Rath, Pratap Chandra; Purohit, Bharat Vijay; Agrawal, Binod; Reddy, Krupal; Nutankavala, Lavanya; Narreddy, Suneetha; Reddy, Mallikkarjun; Abu Salim, Md

    2015-04-01

    Pacemaker-related fungal endocarditis is an uncommon and unexpected complication. It is associated with high mortality rates. Due to nonspecific clinical symptoms, negative blood culture and delays in obtaining appropriate imaging studies; late diagnosis is common with fungal endocarditis. Hereby we are reporting a rare case of pacemaker lead endocarditis due to Trichosporon species. In literature we did not find any case of pacemaker-related endocarditis due to Trichosporon species.

  20. Due Diligence and "Reasonable Man," Offshore

    National Research Council Canada - National Science Library

    Bill Maurer

    2005-01-01

    In the wake of an international crackdown against preferential tax regimes, Caribbean tax havens and other jurisdictions have adopted "due diligence" procedures to manage financial and reputational risk...

  1. Emergency thyroidectomy: Due to acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Zulfu Bayhan

    2014-01-01

    CONCLUSION: Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.

  2. Universal Disorder in Organic Semiconductors Due to Fluctuations in Space Charge

    Science.gov (United States)

    Wu, Tzu-Cheng

    This thesis concerns the study of charge transport in organic semiconductors. These materials are widely used as thin-film photoconductors in copiers and laser printers, and for their electroluminescent properties in organic light-emitting diodes. Much contemporary research is directed towards improving the efficiency of organic photovoltaic devices, which is limited to a large extent by the spatial and energetic disorder that hinders the charge mobility. One contribution to energetic disorder arises from the strong Coulomb interactions between injected charges with one another, but to date this has been largely ignored. We present a mean-field model for the effect of mutual interactions between injected charges hopping from site to site in an organic semiconductor. Our starting point is a modified Fröhlich Hamiltonian in which the charge is linearly coupled to the amplitudes of a wide band of dispersionless plasma modes having a Lorentzian distribution of frequencies. We show that in most applications of interest the hopping rates are fast enough while the plasma frequencies are low enough that random thermal fluctuations in the plasma density give rise to an energetically disordered landscape that is effectively stationary for many thousands of hops. Moreover, the distribution of site energies is Gaussian, and the energy-energy correlation function decays inversely with distance; as such, it can be argued that this disorder contributes to the Poole-Frenkel field dependence seen in a wide variety of experiments. Remarkably, the energetic disorder is universal; although it is caused by the fluctuations in the charge density, it is independent of the charge concentration.

  3. An assessment of radiation damage in space-based germanium detectors due to solar proton events

    NARCIS (Netherlands)

    Owens, Alan; Brandenburg, S.; Buis, E. -J.; Kliewiet, H.; Kraft, S.; Ostendorf, R. W.; Peacock, A.; Quarati, F.; Quirin, P.

    2007-01-01

    Radiation effects caused by solar proton events will be a common problem for many types of sensors on missions to the inner solar system because of the long cruise phases coupled with the inverse square scaling of solar particle events. As part of a study in support of the BepiColombo mission to

  4. Two-dimensional deformation of a uniform half-space due to non ...

    Indian Academy of Sciences (India)

    Stephan and Wendland (1986) pre- sented a solution for the three-dimensional crack problems using the calculus of pseudo-differential operators. Niu et al. .... 2.3 Parabolic case. Let the movement on the fracture be given by b(h) = b0. (. 1 − h2. L2. ) , (0 ≤ h ≤ L). (11). The expressions for the displacements obtained.

  5. OneSpace

    DEFF Research Database (Denmark)

    Ledo, David; Aseniero, Bon Adriel; Greenberg, Saul

    2013-01-01

    Video conferencing commonly employs a video portal metaphor to connect individuals from remote spaces. In this work, we explore an alternate metaphor, a shared depth-mirror, where video images of two spaces are fused into a single shared, depth-corrected video space. We realize this metaphor in One......Space, where the space respects virtual spatial relationships between people and objects as if all parties were looking at a mirror together. We report preliminary observations of OneSpace's use, noting that it encourages cross-site, full-body interactions, and that participants employed the depth cues...

  6. Free topological vector spaces

    OpenAIRE

    Gabriyelyan, Saak S.; Morris, Sidney A.

    2016-01-01

    We define and study the free topological vector space $\\mathbb{V}(X)$ over a Tychonoff space $X$. We prove that $\\mathbb{V}(X)$ is a $k_\\omega$-space if and only if $X$ is a $k_\\omega$-space. If $X$ is infinite, then $\\mathbb{V}(X)$ contains a closed vector subspace which is topologically isomorphic to $\\mathbb{V}(\\mathbb{N})$. It is proved that if $X$ is a $k$-space, then $\\mathbb{V}(X)$ is locally convex if and only if $X$ is discrete and countable. If $X$ is a metrizable space it is shown ...

  7. Elements of linear space

    CERN Document Server

    Amir-Moez, A R; Sneddon, I N

    1962-01-01

    Elements of Linear Space is a detailed treatment of the elements of linear spaces, including real spaces with no more than three dimensions and complex n-dimensional spaces. The geometry of conic sections and quadric surfaces is considered, along with algebraic structures, especially vector spaces and transformations. Problems drawn from various branches of geometry are given.Comprised of 12 chapters, this volume begins with an introduction to real Euclidean space, followed by a discussion on linear transformations and matrices. The addition and multiplication of transformations and matrices a

  8. [Reflections on physical spaces and mental spaces].

    Science.gov (United States)

    Chen, Hung-Yi

    2013-08-01

    This article analyzes certain reciprocal impacts from physical spaces to mental spaces. If the epistemological construction and the spatial imagination from the subject of cogito or the social collectivities are able to influence the construction and creation of the physical spaces of that subject, then the context of that physical space may also affect the cognitive or social subject's mental cognition. This article applies the methodology of iconology from art history (E. Panofsky) and sociology (P. Bourdieu) to explore correlations between the creation of imaginative and physical spaces from the collective consciousness and mental cognition. The author uses Gilles Deleuses's opinion regarding the 17th-century Baroque style and contemporary social collective symptoms as an explanation. From these theoretical studies, the author analyzes the differences of spatial epistemology generated by Taiwan's special geological text. Finally, the author applies Michel Foucault's studies on spatial context to assess the possible application of this thesis of reciprocal impacts from mental spaces to physical spaces in a nursing context.

  9. Isometries on Banach spaces function spaces

    CERN Document Server

    Fleming, Richard J

    2002-01-01

    Fundamental to the study of any mathematical structure is an understanding of its symmetries. In the class of Banach spaces, this leads naturally to a study of isometries-the linear transformations that preserve distances. In his foundational treatise, Banach showed that every linear isometry on the space of continuous functions on a compact metric space must transform a continuous function x into a continuous function y satisfying y(t) = h(t)x(p(t)), where p is a homeomorphism and |h| is identically one.Isometries on Banach Spaces: Function Spaces is the first of two planned volumes that survey investigations of Banach-space isometries. This volume emphasizes the characterization of isometries and focuses on establishing the type of explicit, canonical form given above in a variety of settings. After an introductory discussion of isometries in general, four chapters are devoted to describing the isometries on classical function spaces. The final chapter explores isometries on Banach algebras.This treatment p...

  10. 5 CFR 732.301 - Due process.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Due process. 732.301 Section 732.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED... any determination. (b) Comply with all applicable administrative due process requirements, as provided...

  11. Peritoneal tuberculosis due to Mycobacterium caprae

    Directory of Open Access Journals (Sweden)

    T. Nebreda

    2016-01-01

    Full Text Available The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.

  12. NUMERICAL SOLUTIONS OF SOME PARAMETRIC EFFECTS DUE ...

    African Journals Online (AJOL)

    Dr A.B.Ahmed

    ISSN 1597-6343. Numerical Solutions of Some Parametric Effects Due to Electromagnetic Wave. Scattering by an Infinite Circular Cylinder. NUMERICAL SOLUTIONS OF SOME PARAMETRIC EFFECTS DUE. TO ELECTROMAGNETIC WAVE SCATTERING BY AN INFINITE. CIRCULAR CYLINDER. *1 Suleiman A. B. and 1 ...

  13. Unwanted effects due to cosmetics - a review

    NARCIS (Netherlands)

    Schnuch, A.

    2007-01-01

    Cosmetics are a heterogeneous group of products, consisting of products abundantly used as shampoos or cleansing agents on the one hand, and of products not so frequently used as those applied for decorative purposes such as nail cosmetics. Due to a differing frequency of use and due to differing

  14. Omicron space habitat—research stage II

    Science.gov (United States)

    Doule, Ondřej; Šálený, Vratislav; Hérin, Benoît; Rousek, Tomáš

    2012-01-01

    The design presented in this paper is in response to the revolution in private space activities, the increasing public interest in commercial flights to space and the utilization of structures such as space hotels or private orbital habitats. The baseline for the Omicron design concept is the Russian Salyut derived space station module. Salyut was the first space station to orbit the Earth. Its unique design and technical features were what made the development of space stations Salyut 1-7, MIR and the International Space Station (ISS) Zwezda service module possible. Due to its versatility and the reliable operating launch vehicle Proton, this space module series has the potential to be adapted for space hotel development. This paper proposes a conceptual design of the space habitat called Omicron, with particular focus on interior design for the microgravity environment. The Omicron concepts address the needs of space tourism with a strong emphasis on the safety and comfort of the spaceflight participants. The Omicron habitat supports three inhabitants in nominal conditions (e.g., two passengers and one astronaut). The habitat provides a flexible interior, facilities and spaces dynamically transforming in order to accommodate various types of activities, which will be performed in an organically formed interior supporting spatial orientation and movement in microgravity. The future development potential of Omicron is also considered. The baseline version is composed solely of one rigid module with an inverted cupola for observations. An alternative version offers more space using an inflatable structure. Finally, a combination of multiple Omicron modules enables the creation of a larger orbital habitat. The Omicron's subsystems support a few days visit by trained passengers. The transport to the habitat would be provided e.g., by the Soyuz TMA spacecraft carried by the Soyuz launch vehicle in the early stage of Omicron's development, before a fully reusable

  15. Role of the Space Station in Private Development of Space

    Science.gov (United States)

    Uhran, M. L.

    2002-01-01

    by the ISS partnership today will effect the later outcome. This paper reviews the range of activities underway in the U.S., as well those being pursued on a multilateral basis across the partnership. It will report on the status of NASA planning for establishment of a non-governmental organization (NGO) to manage the U.S. share of ISS user resources and accommodations. This initiative is unprecedented for a human-rated space craft of ISS magnitude and represents an extraordinarily complex undertaking due to the multi-mission, multi-partner nature of the program. Nonetheless, major advances are scheduled for 2002, as a new NASA Administrator takes the helm and declares the study phase is over. On the global front, the ISS Partners have formed a Multilateral Commercialization Group (MCG) charged to develop Recommended Guidelines for ISS Commercial Activities. Areas such as advertising, merchandising, entertainment, and sponsorship are actively under consideration with plans to advance to the long-awaited decision phase. In conjunction with this project, the challenging issue of how to create, protect, and potentially market the ISS brand to the benefit of the Partners, as well as the scientific, technological and commercial users of the station, is approaching resolution. In the area of space product development, the NASA Commercial Space Centers are entering the era of the space station with new operating principles and practices that promise a focused and sustainable research and development program. This portfolio of seventeen cooperative agreements spans applications in biotechnology, agriculture, remote sensing, and advanced materials. The rate-limiting step has long been access to space and we now stand ready to seize the opportunities afforded by a continuously operating, full-service laboratory in orbit. Each of these initiatives will have a marked effect on evolution of the space station program from a commercial development perspective and each offers the

  16. Causal symmetric spaces

    CERN Document Server

    Olafsson, Gestur; Helgason, Sigurdur

    1996-01-01

    This book is intended to introduce researchers and graduate students to the concepts of causal symmetric spaces. To date, results of recent studies considered standard by specialists have not been widely published. This book seeks to bring this information to students and researchers in geometry and analysis on causal symmetric spaces.Includes the newest results in harmonic analysis including Spherical functions on ordered symmetric space and the holmorphic discrete series and Hardy spaces on compactly casual symmetric spacesDeals with the infinitesimal situation, coverings of symmetric spaces, classification of causal symmetric pairs and invariant cone fieldsPresents basic geometric properties of semi-simple symmetric spacesIncludes appendices on Lie algebras and Lie groups, Bounded symmetric domains (Cayley transforms), Antiholomorphic Involutions on Bounded Domains and Para-Hermitian Symmetric Spaces

  17. 2001 Industry Studies: Space

    National Research Council Canada - National Science Library

    Argodale, John

    2001-01-01

    The U.S. space industry faces significant challenges in the 21st century. Although the U.S. dominates space in terms of investment and capabilities, commercial competition from Europe is formidable and growing...

  18. Beyond the Space Cadre

    National Research Council Canada - National Science Library

    Phillips, Bradley W

    2008-01-01

    The Marine Corps must develop an expeditionary trained and equipped core of space professionals who can provide the commander with integrated space analysis, products, and expertise during the Marine...

  19. Probabilistic metric spaces

    CERN Document Server

    Schweizer, B

    2005-01-01

    Topics include special classes of probabilistic metric spaces, topologies, and several related structures, such as probabilistic normed and inner-product spaces. 1983 edition, updated with 3 new appendixes. Includes 17 illustrations.

  20. Occupational Space Medicine

    Science.gov (United States)

    Tarver, William J.

    2012-01-01

    Learning Objectives are: (1) Understand the unique work environment of astronauts. (2) Understand the effect microgravity has on human physiology (3) Understand how NASA Space Medicine Division is mitigating the health risks of space missions.

  1. The space gravity environment

    NARCIS (Netherlands)

    Beysens, D.A.; van Loon, J.J.W.A.; Beysens, D.A.; van Loon, J.J.W.A.

    2015-01-01

    It is generally thought that gravity is zero on an object travelling at constant velocity in space. This is not exactly so. We detail in the following those causes that make space gravity not strictly zero.

  2. Stereotype locally convex spaces

    Energy Technology Data Exchange (ETDEWEB)

    Akbarov, S S

    2000-08-31

    We give complete proofs of some previously announced results in the theory of stereotype (that is, reflexive in the sense of Pontryagin duality) locally convex spaces. These spaces have important applications in topological algebra and functional analysis.

  3. Stereotype locally convex spaces

    Science.gov (United States)

    Akbarov, S. S.

    2000-08-01

    We give complete proofs of some previously announced results in the theory of stereotype (that is, reflexive in the sense of Pontryagin duality) locally convex spaces. These spaces have important applications in topological algebra and functional analysis.

  4. Space Physics Data Facility

    Data.gov (United States)

    National Aeronautics and Space Administration — The SPDF is a project of the Heliospheric Science Division (HSD) at NASA's Goddard Space Flight Center. SPDF consists of web-based services for survey and high...

  5. Space Environment Modeling

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes presentation materials and outputs from operational space environment models produced by the NOAA Space Weather Prediction Center (SWPC) and...

  6. Space, time, matter

    CERN Document Server

    Weyl, Hermann

    1999-01-01

    Excellent introduction probes deeply into Euclidean space, Riemann's space, Einstein's general relativity, gravitational waves and energy, and laws of conservation. "A classic of physics." - British Journal for Philosophy and Science.

  7. Space Power Facility (SPF)

    Data.gov (United States)

    Federal Laboratory Consortium — The Space Power Facility (SPF) houses the world's largest space environment simulation chamber, measuring 100 ft. in diameter by 122 ft. high. In this chamber, large...

  8. Inform@ed space

    DEFF Research Database (Denmark)

    Bjerrum, Peter; Olsen, Kasper Nefer

    2001-01-01

    Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001.......Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001....

  9. NASA Space Sounds API

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA has released a series of space sounds via sound cloud. We have abstracted away some of the hassle in accessing these sounds, so that developers can play with...

  10. Hubble Space Telescope-Space Shuttle interface dynamic verification test

    Science.gov (United States)

    Blair, Mark A.; Vadlamudi, Nagarjuna

    1989-01-01

    A test program has been developed for the interface between the Space Shuttle Orbiter and the Hubble Space Telescope which couples a standard modal test for a simple suspended structure with a novel, 'interface verification' test. While the free-free modal test is used to verify the high loads generating structural modes due to the interaction of internal components of the structure with the rest of the structure, the interface verification test verifies the character of the high-loading generating modes in which the structure reacts against the booster interface. The novel method excites the structure at a single payload-booster interface DOF, while all other interfaces are left free to move.

  11. Construction in Occupied Spaces

    Science.gov (United States)

    Ward, Andrew E.; Azhar, Salman; Khalfan, Malik

    2017-06-01

    Conducting construction activities in occupied environments presents a great challenge due to the additional logistical requirements and the presence of the building occupants. The aim of this research is to gather and evaluate the means and methods to successfully plan, manage, and execute construction activities in occupied spaces in an effort to provide consolidated industry tools and strategies for maintaining a schedule and minimizing the impact on the occupants. The methodology of the research utilizes an exploratory approach to gather qualitative data. The data was collected through interviews with industry professionals to identify industry best practices. The semi-structured interviews provided a platform for the documents, lessons learned, and the techniques and strategies used for occupied construction by the construction industry. The information obtained in the interview process identified six themes that are critical to achieving and maintaining quality in occupied construction. These themes of the schedule, cost, customer satisfaction, planning, fire/life safety and utilities, and contractor management are reviewed in detail, and the paper discusses how to manage each element. The analysis and extracted management techniques, procedures and strategies can be used by the construction industry for future projects by focusing on the critical aspects of occupied construction and the manner in which to succeed with it.

  12. Construction in Occupied Spaces

    Directory of Open Access Journals (Sweden)

    Ward Andrew E.

    2017-06-01

    Full Text Available Conducting construction activities in occupied environments presents a great challenge due to the additional logistical requirements and the presence of the building occupants. The aim of this research is to gather and evaluate the means and methods to successfully plan, manage, and execute construction activities in occupied spaces in an effort to provide consolidated industry tools and strategies for maintaining a schedule and minimizing the impact on the occupants. The methodology of the research utilizes an exploratory approach to gather qualitative data. The data was collected through interviews with industry professionals to identify industry best practices. The semi-structured interviews provided a platform for the documents, lessons learned, and the techniques and strategies used for occupied construction by the construction industry. The information obtained in the interview process identified six themes that are critical to achieving and maintaining quality in occupied construction. These themes of the schedule, cost, customer satisfaction, planning, fire/life safety and utilities, and contractor management are reviewed in detail, and the paper discusses how to manage each element. The analysis and extracted management techniques, procedures and strategies can be used by the construction industry for future projects by focusing on the critical aspects of occupied construction and the manner in which to succeed with it.

  13. Man's future in space

    Science.gov (United States)

    Freitag, R. F.

    1975-01-01

    Studies evaluating potential operational and commercial uses of space are being conducted, taking into account astronomy, astrophysics, manned bases and laboratories in earth orbit, space colonization, terrestrial communications, space processing and manufacturing, interstellar probes, planetary exploration, and the use of space for terrestrial energy supply. The present status in the exploration of the solar system is examined, giving attention to Jupiter, Venus, Mars, and Mercury. A brief outline of the development of human colonies on Mars is presented.

  14. Clinical Space Medicine Panel

    Science.gov (United States)

    Baisden, Denise L.; Billica, Roger (Technical Monitor)

    2000-01-01

    The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

  15. Metric 1-spaces

    OpenAIRE

    Weiss, Ittay

    2012-01-01

    A generalization of metric space is presented which is shown to admit a theory strongly related to that of ordinary metric spaces. To avoid the topological effects related to dropping any of the axioms of metric space, first a new, and equivalent, axiomatization of metric space is given which is then generalized from a fresh point of view. Naturally arising examples from metric geometry are presented.

  16. A Conceptual Space Logic

    DEFF Research Database (Denmark)

    Nilsson, Jørgen Fischer

    1999-01-01

    Conceptual spaces have been proposed as topological or geometric means for establishing conceptual structures and models. This paper, after briey reviewing conceptual spaces, focusses on the relationship between conceptual spaces and logical concept languages with operations for combining concepts...... to form concepts. Speci cally is introduced an algebraic concept logic, for which conceptual spaces are installed as semantic domain as replacement for, or enrichment of, the traditional....

  17. FROM SPACE FLIGHTS TO OSTEOPOROSIS

    Directory of Open Access Journals (Sweden)

    Giancarlo Bilancio

    2012-06-01

    Full Text Available Space missions (microgravity alter the balance between bone formation/resorption and induce bone loss. This effect represents a major limiting step in the realization of long-term space missions. A similar picture is induced by prolonged immobilization at bed (bed rest. The Osteoporosis and Muscular Atrophy project (OSMA was a research program sponsored by the Italian Space Agency which included 35-day bed rest experiments in healthy young men. Anthropometric data of these experiments indicated the expected bone mass reduction in some segments of the leg and body weight redistribution from non-fat mass to fat mass. According to the current view, the bone mass reduction due to microgravity/bed rest is associated with the release of calcium from the bone into the bloodstream (hypercalcemia which, in turn, lowers the secretion of parathyroid hormone and increases urinary calcium excretion. One of the main unsolved points in this view is that hypercalcemia is mild and transient during microgravity/bed rest whereas parathyroid hormone reduction is sustained. The analyses of the OSMA bed-rest will focus on the possible differences between early changes and later changes in indices of calcium homeostasis and bone metabolism during bed rest. The research on the mechanisms underlying bone mass loss during microgravity/ bed rest could be of help not only to space medicine but hopefully also for prevention and control of bone ageing and osteoporosis.

  18. Beyond spaces of counselling

    DEFF Research Database (Denmark)

    Bank, Mads; Nissen, Morten

    2017-01-01

    The article articulates experiments with spatial constructions in two Danish social work agencies, basing on (a) a sketchy genealogical reconstruction of conceptualisations and uses of space in social work and counselling, (b) a search for theoretical resources to articulate new spaces, and (c...... spaces are forms of spatialisations which might be taken as prototypical in attempts to develop social work and counselling...

  19. Function spaces, 1

    CERN Document Server

    Pick, Luboš; John, Oldrich; Fucík, Svatopluk

    2012-01-01

    This is the first part of the second revised and extended edition of a well established monograph. It is an introduction to function spaces defined in terms of differentiability and integrability classes. It provides a catalogue of various spaces and benefits as a handbook for those who use function spaces to study other topics such as partial differential equations. Volum

  20. Symmetric Spaces in Supergravity

    CERN Document Server

    Ferrara, Sergio

    2008-01-01

    We exploit the relation among irreducible Riemannian globally symmetric spaces (IRGS) and supergravity theories in 3, 4 and 5 space-time dimensions. IRGS appear as scalar manifolds of the theories, as well as moduli spaces of the various classes of solutions to the classical extremal black hole Attractor Equations. Relations with Jordan algebras of degree three and four are also outlined.