The Surfer's Shoulder: A Systematic Review of Current Literature and Potential Pathophysiological Explanations of Chronic Shoulder Complaints in Wave Surfers.

BACKGROUND: Wave surfing will debut in the next Olympic Games and is increasingly popular as a sport. Chronic shoulder complaints are frequently reported amongst surfers, though literature researching its pathophysiology and prevention is scarce. This article provides an overview of the current literature, proposes a potential pathogenesis and a potential physiotherapeutic prevention program for surf-induced shoulder complaints. METHODS: A systematic review was performed considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles regarding kinematic analysis of the surf paddling movement. Data sources were Embase, MEDLINE (PubMed) and Research gate. We included case series and cohort studies that originally studied or described the paddle movement made by wave surfers, studies that reported on kinesiologic analysis with nerve conduction studies and studies on 3D motion analysis of the shoulder while paddling. RESULTS: Eight original articles were included that analysed the shoulder movement in paddling surfers. Muscles that are active during paddling are mainly internal rotators and muscles that are involved in shoulder flexion. Internal rotators are active in propelling the surfer through the water, though external rotator strength is only used while the arm is out of the water. DISCUSSION: In surfers with shoulder complaints, external rotation range of motion and external rotation strength are impaired. Scapulothoracic dyskinesis may occur and subacromial pain syndrome may coincide. Further research should address potential pectoralis minor shortening, which may lead to aberrant scapular tilt and lateral rotation of the scapula. The surfer's shoulder is characterised by external rotation deficit, as opposed to internal rotation deficit in the thrower's shoulder, and it differs substantially from shoulder complaints in swimmers. Therefore, a specific prevention or rehabilitation protocol for surfers is required. Decreased thoracic extension may thereby alter the risk of scapular dyskinesis and hence increase the risk of impingement around the shoulder joint. A potential physiotherapeutic prevention programme should address all these aspects, with the main goal being to increase external rotator strength and to stretch the internal rotators. CONCLUSION: There is a high incidence of chronic surf-induced shoulder complaints in surfers. Symptoms may arise due to imbalanced training or scapular dyskinesis, which may subsequently trigger subacromial pain. Physiotherapeutic prevention should include stretching of the internal rotators, external rotator training and optimisation of thoracic extension and scapulothoracic movement.

La reestenosis en el stent depende del daño vascular inducido. ¿Son válidos los modelos experimentales actuales de análisis de los stents farmacoactivos? / Instent restenosis related to vessel injury score degree. Are current experimental models valid for drug-eluting stents analysis?

Introducción y objetivos. Los stents farmacoactivos son una herramienta útil para prevenir la reestenosis, pero los mecanismos involucrados en la respuesta proliferativa tras su implante aún no son conocidos en su totalidad. El objetivo de este estudio es comparar la histomorfometría vascular coronaria tras el implante de stents sin recubrir o stents farmacoactivos en un modelo porcino. Métodos. En 20 hembras de cerdos de la raza Large White de 2 meses de edad se implantó de forma aleatoria un total de 60 stents distribuidos en dos grupos: convencionales (n=20) y farmacoactivos (paclitaxel) (n=40). A los 28 días se procedió a eutanasia y análisis histomorfométrico. Se clasificó el grado de daño vascular en función de integridad o rotura de la túnica limitante elástica interna. Resultados. En el grupo de integridad de lámina elástica interna no se encontraron diferencias significativas entre stents farmacoactivos y stents convencionales para las variables área de neoíntima y porcentaje de reestenosis (1,3 [1,1-2,2] frente a 2 [1,3-2,5] mm2; p=0,6; y 14 [12,1-20,8] frente a 22,2 [14,1-23,3] %; p=0,5). En cambio, en el grupo de rotura de la lámina elástica interna sí se encontraron diferencias significativas (área de neoíntima, 1,2 [0,8-2] frente a 2,9 [2,3-3,7] mm2; p=0,001 y porcentaje de reestenosis, 16,63 [11,2-23,5] frente a 30,4 [26,4-45,7] %; p=0,001). Conclusiones. En el modelo porcino de coronarias sanas, la integridad de la lámina elástica interna no permite apreciar diferencias en la respuesta proliferativa entre stent farmacoactivo y convencional; la diferencia se establece sólo cuando el daño vascular es más profundo (AU)

Introduction and objectives. Drug-eluting stents are useful for preventing restenosis, but the patho-physiological processes involved in the proliferative response after implantation are still not known in detail. The aim of this study is to compare the coronary vascular histomorphometry after implanting drug-eluting stents and bare metal stents in a swine model. Methods. Sixty stents were randomly implanted in 20 Large White female pigs with a ratio of baremetal/drug-eluting stents of 1:2. After 28 days, euthanasia and histomorphometry were performed. We defined the vessel injury score in accordance to whether the internal elastic lamina was intact or ruptured. Results. There were no differences between drug-eluting stents and bare metal stents in the intact internal elastic lamina group regarding neointimal area or % restenosis (1.3 [1.1-2.2]) vs 2.0 [1.3-2.5] mm2; P=.6; and 14.0 [12.1-20.8] vs 22.2 [14.1-23.3] %; P=.5). We assessed statistically significant differences for the ruptured internal elastic lamina group, (neointimal area 1.2 [0.8-2.0] vs 2.9 [2.3-3.7] mm2; P=.001 and % restenosis 16.63 [11.2-23.5] vs 30.4 [26.4-45.7] %; P=.001). Conclusions. In our swine model, we did not find any differences between proliferative response of drug-eluting stents and bare metal stents when the internal elastic lamina is intact; differences are only found when vascular injury is deeper (AU)

Somatização em migrantes de baixa renda no Brasil / Somatization in Brazil's low-income migrants

Este artigo tem por objetivo compreender o entrelaçamento da cultura com reações psicológicas de indivíduos expostos ao processo de migração e estabelecer relações entre o fenômeno da migração e adoecimento psicossomático. O enfoque metodológico é essencialmente qualitativo, baseado em representações sociais de pacientes migrantes e da equipe de funcionários e profissionais de um centro de saúde do município próximo de Campinas. A análise demonstrou que a migração era percebida negativamente, como uma causadora de doenças quando havia perda do emprego/renda e fragmentação de laços familiares e comunitários. Se tais elementos estavam estabilizados, fatores estressantes do cotidiano permaneciam mascarados (mantidos fora da consciência) e a piora da saúde não era atribuída à migração ou à qualidade de vida. O problema da migração e doença, pela perspectiva do centro de saúde, incluía abordagem terapêutica exclusivamente biológica sem outra perspectiva que contribuísse para os sujeitos assimilarem as novas condições de vida num novo ambiente sócio-cultural.

This paper aims to debate relations between culture and psychological reactions of individuals exposed to the process of migration and to establish relations between migration and psychosomatic sickening. The methodological approach is essentially qualitative and based on social representations of migrant patients, staff and professionals of a public health unit near Campinas. The analysis demonstrated that migration was negatively experienced as producing ailments when loss of job/income, break of family/community ties was involved. When these elements were stabilized, stressful factors of daily life remained covered (out of conscience) and worsening in health condition was attributed neither to migration nor to life quality. The problem of migration and ailments, from the health center perspective, involved merely biological procedures and did not include additional perspectives to help patients to assimilate their new life conditions in a new social environment.

Somatização em migrantes de baixa renda no Brasil / Somatization in Brazil's low-income migrants

Este artigo tem por objetivo compreender o entrelaçamento da cultura com reações psicológicas de indivíduos expostos ao processo de migração e estabelecer relações entre o fenômeno da migração e adoecimento psicossomático. O enfoque metodológico é essencialmente qualitativo, baseado em representações sociais de pacientes migrantes e da equipe de funcionários e profissionais de um centro de saúde do município próximo de Campinas. A análise demonstrou que a migração era percebida negativamente, como uma causadora de doenças quando havia perda do emprego/renda e fragmentação de laços familiares e comunitários. Se tais elementos estavam estabilizados, fatores estressantes do cotidiano permaneciam mascarados (mantidos fora da consciência) e a piora da saúde não era atribuída à migração ou à qualidade de vida. O problema da migração e doença, pela perspectiva do centro de saúde, incluía abordagem terapêutica exclusivamente biológica sem outra perspectiva que contribuísse para os sujeitos assimilarem as novas condições de vida num novo ambiente sócio-cultural(AU)