'Early bird registration is open'
hope.ac.uk/hopesr/
Jo Gibson Dr Ian Horsley Mike Stewart ann cools Val jones Edel Fanning PhD Fredrik Johansson Roger Kerry Uzo Ehiogu Ritchie Barber PLY Caroline White Nigel Jones Simon Booker Liam Owens Kevin Kuppens

Rotator cuff tendinopathy

Tendon👉⤵️ stiffness/increased thickness/ collagen disorganisation

Neuromuscular👉altered kinematics/muscle activation/force

Psychosocial👉depression/anxiety/pain catastrophizing

CNS👉altered pain/sensorimotor processing

journals.sagepub.com/doi/10.1177/17…

Exercise induced adaptation on skeletal muscle

Ageing👉🏾muscle fiber atrophy, ⤵️satellite cells (SC) & mitochondrial (Mt) number

Exercise👉🏾reverse negative effects of ageing, muscle fiber hypertrophy, ⤴️ cross section area (CSA), ⤴️SC & Mt number

#muscle
mdpi.com/2073-4409/7/12…

Tendon

a|Tendon👉links muscle to bone via enthesis
b|Type I collagen👉tendon's major structural component
c|Electron microscopy of tendon (mouse tail)
d|Histological staining of tendon fibre (mouse tail)
e|Stained tendon section (mouse Achilles tendon)

nature.com/articles/nrrhe…

Tennis Elbow

▶️Overuse tendinopathy
▶️Annual incidence 👉🏾1%-3%
▶️Most patients in 30s & 40s
▶️maximal tenderness ~1cm distal to epicondyle at origin of extensor carpi radialis brevis
▶️Pain & ⤵️strength with resisted gripping, wrist supination/extension

aafp.org/pubs/afp/issue…

“Serratus Anterior” muscle

▪️origin👉upper eight ribs
▪️insertion👉medial border of scapula
▪️nerve supply👉lateral & superior thoracic
▪️blood supply👉 thoracodorsal arteries
▪️main action👉protraction of the scapula

#shoulder #scapula ncbi.nlm.nih.gov/books/NBK53145…

Muscle fibre adaptation to exercise

a/Muscle growth with high or low load training

b/Muscle growth👉epigenetic changes👉muscle memory👉facilitate re-growth

c/Muscle fibre types👉slow/oxidative to fast/glycolytic shift depending on type of training

portlandpress.com/biochemist/art…

Tendinopathy (risk factors)

Mechanical👉excessive loading/muscle imbalance, misalignment/training errors

Intrinsic👉past injury/aging/genetics/weight/ hormones/health conditions

Extrinsic👉environmental factors/malnutrition, smoking/alcohol
#tendon

mdpi.com/1422-0067/21/3…

'Brachial Plexus': Anatomical course in the shoulder, neck & upper arm

C5/C6 injury👉impaired shoulder & elbow flexion, abduction, external rotation
C7 injury👉compromised dexterity in the hands
C8/T1' injury👉impaired hand/wrist function

#nerve

frontiersin.org/journals/neuro…

Phases of skeletal muscle repair👇

Regeneration/Proinflammatory phase👉infiltration of injury site by immune cells to clear damaged fibres

Restorative phases👉proliferation of multiple cell types & formation/growth of new fibres

#muscle #healing

nature.com/articles/s4153…

Normal elbow range of movement 👇🏼

flexion 👉🏾 ~150°
extension 👉🏾 0°
pronation 👉🏾 90°,
supination 👉🏾 90°
hyperextension 👉🏾 10° -15°

#elbow #joint

sciencedirect.com/science/articl…

Check out conference programme and Ann’s course overview 👇🏼

Jo Gibson Dr Ian Horsley

Simplified Shoulder Anatomy (Anterior View)

LHBT: Long head of biceps tendon

SGHL: Superior glenohumeral ligament

#shoulder #anatomy

semanticscholar.org/paper/Shoulder…

The anatomy of tendons & ligaments:

a👉🏼tendon structure at the bone insertion
b👉🏼tendon structure at tissue & molecular levels
c👉🏼anatomy of ligaments (intervertebral disc)

#tendon #ligament #arthritis #anatomy

nature.com/articles/s4158…

Muscle Cramp (MC)

MC👉a hyper-excitable neurologic phenomena of excessive, involuntary muscle contractions

Common causes👉Physiologic/Metabolic/ Medications/Neuromuscular Disorders/Neurologic Diseases

Pathophysiology underlying neurogenic MC👇

practicalneurology.com/articles/2019-…

Frozen Shoulder: molecular pathophysiology

Systemic/Extrinsic/Intrinsic trigger
⬇️
Pro-inflammatory/Pro-fibrotic Environment
⬇️
Substance P/ Cytokines/ Growth Factors
⬇️
Fibroblast Trans-differentiation to Myofibroblasts
⬇️
Tissue Fibrosis & Contracture

nature.com/articles/s4157…

Three phases of muscle repair following injury👇🏼

1. Degeneration phase
2. Regeneration phase
3. Remodelling phase

#muscle #injury #repair

link.springer.com/article/10.100…

Planes of movements of the shoulder joint👇

▪️Abduction - Adduction
▪️Flexion - Extension
▪️Internal Rotation - External Rotation
▪️Horizontal Adduction - Horizontal Abduction

#anatomy #shoulder

nature.com/articles/s4157…

'Non-orthopaedic causes/origins of shoulder pain'

Some examples:
- Aortic Dissection
- Phrenic Nerve
- Cardiac Pain
- Gallstones
- Parsonage-Turner syndrome
- Pulmonary embolism

#shoulder #pain #systemicdiseases #differentialdiagnosis

link.springer.com/chapter/10.100…

Continuum model of Tendinopathy

Healthy Tendon
⬇️
Reactive Tendinopathy (⤴️cellularity, rounded tendon cells, altered gene expression)
⬇️
Tendon Dysrepair (vascular infiltration, collagen disarray)
⬇️
Degenerative Tendinopathy (severe collagen disarray)

ncbi.nlm.nih.gov/pmc/articles/P…