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Lefèvre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V, Poiraudeau S, Roby-Brami A, Roren A. Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications. Ann Phys Rehabil Med 2018; 61:46-53. [PMID: 28987866 DOI: 10.1016/j.rehab.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints. METHODS This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. RESULTS For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation. CONCLUSION The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
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Affiliation(s)
- Marie-Martine Lefèvre-Colau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Christelle Nguyen
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Clemence Palazzo
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Srour
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Guillaume Paris
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Valerie Vuillemin
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Poiraudeau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Agnes Roby-Brami
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandra Roren
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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252
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Hainline B. Peripheral nerve injury in sport: an overview. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:381-384. [PMID: 30482366 DOI: 10.1016/b978-0-444-63954-7.00036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Peripheral nerve injury in sport results from acute trauma or repetitive overuse. Repetitive overuse injuries must be assessed with the broad context of tissue overload, kinetic chain continuum, periodization, recovery, equipment, and sport-specific biomechanics. Simply diagnosing the anatomic location and extent of nerve injury is inadequate. Management must consider all contributors to nerve injury. This chapter provides an overview of emerging information for assessing and managing peripheral nerve injury in sport.
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Affiliation(s)
- Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN, United States.
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253
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Ben Kibler W, Ellenbecker T, Sciascia A. Neuromuscular adaptations in shoulder function and dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:385-400. [PMID: 30482367 DOI: 10.1016/b978-0-444-63954-7.00037-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation stiffness. They may be based on inherent neuromuscular architecture, but are commonly affected by positive or negative adaptations to imposed functional demands. Positive neuromuscular adaptations improve the efficiency of performing the task, which can result in less energy expenditure, maximum force delivered to the task, and protection of involved joints from excessive loads/motions, and improve the effectiveness of task performance. They frequently result from specific training in task mechanics and optimal conditioning of the neuromuscular structures involved in the task. Negative neuromuscular maladaptations can affect the efficiency of performing the task, increase energy expenditure and loads, decrease the effectiveness of task performance, and can be associated with clinical presentation of injury symptoms. They can result from overload, injury, and/or limited recovery. This chapter will focus specifically on shoulder joint function to provide examples of positive adaptations and negative maladaptations. It will then provide guidelines for clinical evaluation, treatment of clinical injury, and training/conditioning, based on understanding the neuromuscular activation.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, KY, United States
| | - Todd Ellenbecker
- Rehab Plus Sports Therapy and ATP World Tour, Scottsdale, AZ, United States.
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, KY, United States
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254
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Michielsen M, Vaughan-Graham J, Holland A, Magri A, Suzuki M. The Bobath concept - a model to illustrate clinical practice. Disabil Rehabil 2017; 41:2080-2092. [PMID: 29250987 DOI: 10.1080/09638288.2017.1417496] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background and purpose: The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath concept in terms of contemporary neurological rehabilitation. The utilisation of a framework to illustrate the clinical application of the Bobath concept provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The development process culminating in the model of Bobath clinical practice is described. Case description: The use of the model in clinical practice is illustrated using two cases: a client with a chronic incomplete spinal cord injury and a client with a stroke. Discussion: This article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice. Facilitation, a key aspect of Bobath clinical practice, was utilised to positively affect motor control and perception in two clients with impairment-related movement problems due to neurological pathology and associated activity limitations and participation restrictions - the outcome measures used to reflect the individual clinical presentation. Implications for Rehabilitation The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath-concept. The model of Bobath clinical practice provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The clinical application of the Bobath-concept highlights the integration of posture and movement with respect to the quality of task performance. Facilitation, a key aspect of Bobath clinical practice, positively affects motor control, and perception.
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Affiliation(s)
| | | | - Ann Holland
- c Neurorehabilitation and Therapy Services , University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Alba Magri
- d Studio Erre - Physiotherapy Clinic , Brescia , Italy
| | - Mitsuo Suzuki
- e Department of Rehabilitation , Bobath Memorial Hospital , Osaka , Japan
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255
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Wochatz M, Rabe S, Wolter M, Engel T, Mueller S, Mayer F. Muscle activity of upper and lower trapezius and serratus anterior during unloaded and maximal loaded shoulder flexion and extension. Int Biomech 2017. [PMCID: PMC7857459 DOI: 10.1080/23335432.2017.1364668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Altered scapular muscle activity is mostly described under unloaded and submaximal loaded conditions in impingement patients. However, there is no clear evidence on muscle activity with respect to movement phases under maximum load in healthy subjects. Therefore, this study aimed to investigate scapular muscle activity under unloaded and maximum loaded isokinetic shoulder flexion and extension in regard to the movement phase. Fourteen adults performed unloaded (continuous passive motion [CPM]) as well as maximum loaded (concentric [CON], eccentric [ECC]) isokinetic shoulder flexion (Flex) and extension (Ext). Simultaneously, scapular muscle activity was measured by EMG. Root mean square was calculated for the whole ROM and four movement phases. Data were analyzed descriptively and by two-way repeated measures ANOVA. CPMFlex resulted in a linear increase of muscle activity for all muscles. Muscle activity during CONFlex and ECCFlex resulted in either constant activity levels or in an initial increase followed by a plateau in the second half of movement. CPMExt decreased with the progression of movement, whereas CONExt and ECCExt initially decreased and either levelled off or increased in the second half of movement. Scapular muscle activity of unloaded shoulder flexion and extension changed under maximum load showing increased activity levels and an altered pattern over the course of movement.
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Affiliation(s)
- Monique Wochatz
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Sophie Rabe
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Martin Wolter
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Steffen Mueller
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
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256
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Sohns S, Schnieder K, Licht G, von Piekartz H. [Manual trigger point therapy of shoulder pain : Randomized controlled study of effectiveness]. Schmerz 2017; 30:549-559. [PMID: 27295296 DOI: 10.1007/s00482-016-0113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although chronic shoulder pain is highly prevalent and myofascial trigger points (mTrP) are thought to be found in the majority of patients with shoulder complaints, the influence on the pain mechanism remains unclear. There are only very few controlled clinical studies on the effects of manual trigger point compression therapy. OBJECTIVE This randomized controlled trial (RCT) compared the short-term effects of manual trigger point compression therapy (n = 6) with manual sham therapy (n = 6) in patients with unilateral shoulder pain due to myofascial syndrome (MFS). MATERIAL AND METHODS The measurement data were collected before and after two sessions of therapy. Pressure pain thresholds (PPT) of mTrP and symmetrically located points on the asymptomatic side were measured together with neutral points in order to detect a potential unilateral or generalized hyperalgesia. Additionally, the pain was assessed on a visual analog scale (VAS) at rest and during movement and the neck disability index (NDI) and disabilities of the arm, shoulder and hand (DASH) questionnaires were also completed and evaluated. RESULTS Both treatment modalities led to a significant improvement; however, the manual trigger point compression therapy was significantly more effective in comparison to sham therapy, as measured by different parameters. CONCLUSION The significant improvement of PPT values in the interventional group even at sites that were not directly treated, indicates central mechanisms in pain threshold modulation induced by manual compression therapy. The weaker but still measurable effects of sham therapy might be explained by the sham modality being a hands on technique or by sufficient stimulation of the trigger point region during the diagnostics and PPT measurements.
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Affiliation(s)
- S Sohns
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - K Schnieder
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - G Licht
- FORBs Facharztzentrum für Orthopädie und Rehabilitation des Bewegungssystems, Osnabrück, Deutschland
| | - H von Piekartz
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland.
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257
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Nodehi Moghadam A, Abdi K, Shati M, Noorizadeh Dehkordi S, Keshtkar AA, Mosallanezhad Z. The Effectiveness of Exercise Therapy on Scapular Position and Motion in Individuals With Scapular Dyskinesis: Systematic Review Protocol. JMIR Res Protoc 2017; 6:e240. [PMID: 29237578 PMCID: PMC5745349 DOI: 10.2196/resprot.8011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapular stabilizing muscles contributes to impingement syndrome. Scapular muscle exercises are included in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis because the muscular system is one of the major contributors of scapular positioning both at rest and during shoulder movement, but there is considerable uncertainty relating to the relative effectiveness of such approaches on changing scapular position and motion. Objective The aim of this systematic review protocol is to evaluate the effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis. Methods A systematic review will be conducted using PubMed, Scopus, Web of Science, Elsevier, Ovid, ProQuest, Physiotherapy Evidence Database, and Cochrane Library. The reference lists of articles, other reviews, gray literature, and key journals will be searched for relevant articles. Clinical trials reporting the effect of therapeutic exercises (scapular strengthening exercise, scapular stabilization exercise, scapular muscle stretching) with the aims of changing scapular position and motion in individuals with scapular dyskinesis will be included. Two independent reviewers will select studies, extract data, and assess the quality of primary studies. Any disagreement during the selection of studies will be discussed and decided by the whole team. Results This systematic review began in December 2016 and is currently in progress. The findings will be synthesized to determine the effectiveness of recommended therapeutic exercise on scapular position and motion in individuals with scapular dyskinesis. Conclusions This is the first systematic review protocol aiming to assess the effectiveness of exercise therapy in individuals with scapular dyskinesis. The systematic review doesn’t require ethics approval because all data used will be provided from published documents. The results of this study will be published in a peer-reviewed journal. Trial Registration PROSPERO CRD42017053923; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53923 (Archived by WebCite at http://www.webcitation.org/6uzq32T02)
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Affiliation(s)
- Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Mohsen Shati
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
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258
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Du WY, Huang TS, Hsu KC, Lin JJ. Measurement of scapular medial border and inferior angle prominence using a novel scapulometer: A reliability and validity study. Musculoskelet Sci Pract 2017; 32:120-126. [PMID: 28827031 DOI: 10.1016/j.msksp.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous studies have proposed various ways to assess scapular dyskinesis. In clinic, assessment tools designed to measure the posterior displacement of the inferior angle of the scapula with reference to the posterior thoracic cage are needed. OBJECTIVES A novel scapulometer was developed to measure scapular medial border and inferior angle prominence. METHODS A novel scapulometer was designed to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall in 29 participants with scapular dyskinesis bilaterally. Two raters measured the ROS and INF distance of the scapula 3 times bilaterally. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to determine the inter-rater and intra-rater reliability. Validity was based on correlations (convergent: ROS and internal/external rotation, and INF and tilt; divergent: ROS/INF and upward rotation of the scapula) using a FASTRAK Polhemus 3-D motion tracking system assessing scapular tilt, internal/external rotation, and upward/downward rotation. RESULTS The average ROS and INF displacements were 13.7 ± 5.0 mm and 12.5 ± 6.3 mm, respectively. The results showed excellent intra-rater and inter-rater reliability, with ICC = 0.88-0.99 and 0.95-0.99 (SEM = 0.7-0.8 mm), respectively. Correlations were 0.35/0.19 (convergent validity) and 0.07/0.09 (divergent validity). CONCLUSIONS The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended.
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Affiliation(s)
- Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan
| | - Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan
| | - Kai-Chieh Hsu
- Department of Mechanical Engineering, College of Engineering, National Taiwan University, 100 Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.
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259
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The Effect of Shoulder Muscle Fatigue on Acromiohumeral Distance and Scapular Dyskinesis in Women With Generalized Joint Hypermobility. J Appl Biomech 2017; 33:424-430. [DOI: 10.1123/jab.2016-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Muscle fatigue is considered to be one cause of shoulder pain, and subjects with generalized joint hypermobility (GJH) are affected more by shoulder pain. The purpose of this study was to examine the effects of muscle fatigue on acromiohumeral distance (AHD) and scapular dyskinesis in women with GJH. Thirty-six asymptomatic participants were assigned to either a GJH (n = 20) or control group (n = 16) using the Beighton scale. Before and after elevation fatigue trials, AHD was measured with ultrasonography at rest and when the arm was in 90° active elevation. A scapular dyskinesis test was used to visually observe alterations in scapular movement. Our results showed that in both groups, the fatigue reduced AHD in the 90° elevation position and increased the presence of scapular dyskinesis; however, no differences were found between the two groups. Although GJH has been identified as a factor for developing musculoskeletal disorders, generalized joint hypermobility did not result in changes to scapular dyskinesis or AHD, even after an elevation fatigue task. More studies are needed to evaluate the effects of muscle fatigue in subjects with GJH and a history of shoulder instability.
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260
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Jaggi A, Alexander S. Rehabilitation for Shoulder Instability - Current Approaches. Open Orthop J 2017; 11:957-971. [PMID: 28979601 PMCID: PMC5611703 DOI: 10.2174/1874325001711010957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Background: The shoulder relies predominantly on dynamic muscular control to provide stability. Successful treatment is highly dependent upon the correct clinical diagnosis, identification of anatomical structural defects and abnormal movement patterns so that rehabilitation programs can be designed accordingly and individualised to the patient. Method: A systematic outline is provided to guide the clinician on how to identify muscular insufficiencies both local to the shoulder joint and global muscles that can influence shoulder instability. Management is based on expert experience and current literature. Results: The Stanmore classification helps to correctly diagnose the type of instability and prioritise management. Symptom modification tests can help to guide management, however assessing individual muscle groups local to glenohumeral control is also recommended. Conclusion: Physical and psychosocial factors can influence motor control in the presence of pain and injury. A multi-disciplinary approach is required to avoid recurrence of symptoms with rehabilitation focusing on kinetic chain, scapular and gleno-humeral control.
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Affiliation(s)
- Anju Jaggi
- RNOHT - Therapies Dept Brockley Hill Stanmore Middlesex Stanmore HA7 4LP United Kingdom
| | - Susan Alexander
- RNOHT - Therapies Dept Brockley Hill Stanmore Middlesex Stanmore HA7 4LP United Kingdom
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261
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Lefèvre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V, Poiraudeau S, Roby-Brami A, Roren A. Recent advances in kinematics of the shoulder complex in healthy people. Ann Phys Rehabil Med 2017; 61:56-59. [PMID: 28964876 DOI: 10.1016/j.rehab.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marie-Martine Lefèvre-Colau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Christelle Nguyen
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Clemence Palazzo
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Srour
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Guillaume Paris
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Valerie Vuillemin
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Poiraudeau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Agnes Roby-Brami
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandra Roren
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, hôpital Cochin, université Paris Descartes, PRES Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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262
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Lawrence RL, Schlangen DM, Schneider KA, Schoenecker J, Senger AL, Starr WC, Staker JL, Ellermann JM, Braman JP, Ludewig PM. Effect of glenohumeral elevation on subacromial supraspinatus compression risk during simulated reaching. J Orthop Res 2017; 35:2329-2337. [PMID: 28071815 PMCID: PMC5503805 DOI: 10.1002/jor.23515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
Mechanical subacromial rotator cuff compression is one theoretical mechanism in the pathogenesis of rotator cuff disease. However, the relationship between shoulder kinematics and mechanical subacromial rotator cuff compression across the range of humeral elevation motion is not well understood. The purpose of this study was to investigate the effect of humeral elevation on subacromial compression risk of the supraspinatus during a simulated functional reaching task. Three-dimensional anatomical models were reconstructed from shoulder magnetic resonance images acquired from 20 subjects (10 asymptomatic, 10 symptomatic). Standardized glenohumeral kinematics from a simulated reaching task were imposed on the anatomic models and analyzed at 0, 30, 60, and 90° humerothoracic elevation. Five magnitudes of humeral retroversion were also imposed on the models at each angle of humerothoracic elevation to investigate the impact of retroversion on subacromial proximities. The minimum distance between the coracoacromial arch and supraspinatus tendon and footprint were quantified. When contact occurred, the magnitude of the intersecting volume between the supraspinatus tendon and coracoacromial arch was also quantified. The smallest minimum distance from the coracoacromial arch to the supraspinatus footprint occurred between 30 and 90°, while the smallest minimum distance to the supraspinatus tendon occurred between 0 and 60°. The magnitude of humeral retroversion did not significantly affect minimum distance to the supraspinatus tendon except at 60 or 90° humerothoracic elevation. The results of this study provide support for mechanical rotator cuff compression as a potential mechanism for the development of rotator cuff disease. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2329-2337, 2017.
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263
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Ruiz Ibán MA, Díaz Heredia J, García Navlet M, Serrano F, Santos Oliete M. Multidirectional Shoulder Instability: Treatment. Open Orthop J 2017; 11:812-825. [PMID: 28979595 PMCID: PMC5611704 DOI: 10.2174/1874325001711010812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background: The treatment of multidirectional instability of the shoulder is complex. The surgeon should have a clear understanding of the role of hiperlaxity, anatomical variations, muscle misbalance and possible traumatic incidents in each patient. Methods: A review of the relevant literature was performed including indexed journals in English and Spanish. The review was focused in both surgical and conservative management of multidirectional shoulder instability. Results: Most patients with multidirectional instability will be best served with a period of conservative management with physical therapy; this should focus in restoring strength and balance of the dynamic stabilizers of the shoulder. The presence of a significant traumatic incident, anatomic alterations and psychological problems are widely considered to be poor prognostic factors for conservative treatment. Patients who do not show a favorable response after 3 months of conservative treatment seem to get no benefit from further physical therapy. When conservative treatment fails, a surgical intervention is warranted. Both open capsular shift and arthroscopic capsular plication are considered to be the treatment of choice in these patients and have similar outcomes. Thermal or laser capsuloraphy is no longer recommended. Conclusion: Multidirectional instability is a complex problem. Conservative management with focus on strengthening and balancing of the dynamic shoulder stabilizers is the first alternative. Some patients will fare poorly and require either open or arthroscopic capsular plication.
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Affiliation(s)
| | - Jorge Díaz Heredia
- Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain
| | - Miguel García Navlet
- Hospital Asepeyo Coslada, Calle de Joaquín de Cárdenas, 2, 28823 Coslada, Madrid, Spain
| | - Francisco Serrano
- Hospital Asepeyo Coslada, Calle de Joaquín de Cárdenas, 2, 28823 Coslada, Madrid, Spain
| | - María Santos Oliete
- Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain
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264
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Navlet MG, Asenjo-Gismero CV. Multidirectional Instability: Natural History and Evaluation. Open Orthop J 2017; 11:861-874. [PMID: 29081865 PMCID: PMC5633721 DOI: 10.2174/1874325001711010861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Multidirectional instability (MDI) represents a great challenge to the orthopedic surgeon. When treating these patients we must be aware that instability refers to a symptomatic situation, thus multidirectional instability is defined as symptomatic involuntary instability in two or more directions, and should be clearly differentiated from asymptomatic hyperlaxity. It may be associated with hyperlaxity, either congenital or acquired following repetitive stress, but also may be present without hyperlaxity, which is rare. Methods: We searched in the online data bases and reviewed the relevant published literature available. Results: Many differences can be seen in the current literature when identifying these patients, unclear definitions and criteria to be included in this patient group are common. Conclusion: Understanding the complex shoulder biomechanics as well as being aware of the typical clinical features and the key examination signs, which we review in this article, is of paramount importance in order to identify and classify these patients, allowing the best treatment option to be offered to each patient.
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Affiliation(s)
- Miguel García Navlet
- Shoulder and Elbow Unit, Upper extremity department at ASEPEYO Hospital Coslada, Madrid, Spain
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265
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Sanchez G, Ferrari MB, Sanchez A, Kennedy NI, Provencher MT. Pectoralis Major Transfer for Treatment of Serratus Anterior Dysfunction in the Setting of Long Thoracic Nerve Palsy. Arthrosc Tech 2017; 6:e1347-e1353. [PMID: 29354439 PMCID: PMC5622283 DOI: 10.1016/j.eats.2017.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/19/2017] [Indexed: 02/03/2023] Open
Abstract
Symptomatic scapular winging resulting in scapular dyskinesia leads to a wide spectrum of clinical complaints, most notably periscapular pain. The malpositioning of the scapula, termed through use of the acronym SICK (scapular malposition, inferior-medial border prominence, coracoid pain and malposition, and dyskinesia of scapular movement), is due to the irregular activity of one or more of the periscapular muscles. In particular, the serratus anterior, innervated by the long thoracic nerve, is a key muscle that stabilizes the scapula and provides coordinated scapulohumeral rhythm. If the long thoracic nerve is injured, this results in significant shoulder dysfunction and scapular winging that may require surgical intervention. The purpose of this Technical Note is to present our preferred technique to treat symptomatic scapular winging due to long thoracic nerve palsy through transfer of the pectoralis major with its bone insertion to the inferior edge of the scapula.
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Affiliation(s)
- George Sanchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Matthew T. Provencher, M.D., M.C., U.S.N.R., Steadman Philippon Research Institute, 181 W Meadow Dr, Ste 1000, Vail, CO 81657, U.S.A.Steadman Philippon Research Institute181 W Meadow DrSte 1000VailCO81657U.S.A.
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266
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Andersson SH, Bahr R, Clarsen B, Myklebust G. Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed. Br J Sports Med 2017; 52:1191-1198. [DOI: 10.1136/bjsports-2017-097648] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2017] [Indexed: 11/04/2022]
Abstract
BackgroundShoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players.AimTo assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players.Methods329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014–2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players’ questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury.ResultsNo significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury.ConclusionNone of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players.
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267
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Observational Scapular Dyskinesis: Known-Groups Validity in Patients With and Without Shoulder Pain. J Orthop Sports Phys Ther 2017; 47:530-537. [PMID: 28683230 DOI: 10.2519/jospt.2017.7268] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional. Background The scapular dyskinesis test (SDT) has demonstrated reliability and validity, but its utility for clinical decision making is unclear. Objectives To characterize the prevalence of scapular dyskinesis in participants with and without shoulder pain, and to determine the influence of blinding to the presence of shoulder pain on prevalence of scapular dyskinesis. Methods Participants (n = 135), 67 with shoulder pain and 68 healthy controls, were included in this study. The SDT was performed by 2 examiners, from a total of 21 physical therapists. The second examiner was blinded to the participant's presence of shoulder pain. The SDT involved participants performing 5 repetitions of shoulder flexion and abduction, while the clinician observed for scapular dyskinesis, as characterized by scapular winging or dysrhythmia. Dyskinesis was rated as normal, subtle, or obvious. Ratings were collapsed into 2 groups, dyskinesis (subtle and obvious) and no dyskinesis (normal), as recommended by expert consensus. Results There were no significant differences for scapular dyskinesis prevalence between the shoulder pain group and control group during the SDT in abduction (shoulder pain, 67.2%; 95% confidence interval [CI]: 0.55, 0.77 and control group, 52.9%; 95% CI: 0.41, 0.64; P = .09) or flexion (shoulder pain, 67.2%; 95% CI: 0.55, 0.77 and control group, 61.8%; 95% CI: 0.50, 0.72; P = .51). There were significant differences (P ≤001) between the examiners' SDT ratings in the shoulder pain group. The unblinded examiner reported a higher prevalence when testing the involved shoulder for dyskinesis in flexion (blinded, 67.7%; 95% CI: 0.56, 0.78 and unblinded, 80%; 95% CI: 0.69, 0.88) and during abduction (blinded, 66.2%; 95% CI: 0.54, 0.76 and unblinded, 78.5%; 95% CI: 0.67, 0.87). Conclusion Scapular dyskinesis as assessed with the SDT is not more prevalent in those with shoulder pain. Rating was influenced by an examiner's knowledge of shoulder pain presence. Scapular dyskinesis may represent normal movement variability. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2017;47(8):530-537. Epub 6 Jul 2017. doi:10.2519/jospt.2017.7268.
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Rossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS One 2017; 12:e0181518. [PMID: 28749966 PMCID: PMC5531566 DOI: 10.1371/journal.pone.0181518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8-10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.
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Affiliation(s)
- Denise Martineli Rossi
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristiane Rodrigues Pedroni
- Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, São Paulo, Brazil
| | - Jaqueline Martins
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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269
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Movement Pattern of Scapular Dyskinesis in Symptomatic Overhead Athletes. Sci Rep 2017; 7:6621. [PMID: 28747702 PMCID: PMC5529546 DOI: 10.1038/s41598-017-06779-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/16/2017] [Indexed: 01/01/2023] Open
Abstract
This study investigated the characteristics of arm elevation via principal component analysis in symptomatic overhead athletes with scapular dyskinesis. One hundred-thirty-four overhead athletes with scapular dyskinesis [24: inferior angle prominence (pattern I); 46: medial border prominence (pattern II), 64: pattern I + II] were evaluated by three-dimensional electromagnetic motion and electromyography to record the scapular kinematics (upward rotation/posterior tipping/exterior rotation) and muscle activation (upper trapezius: UT; middle trapezius: MT; lower trapezius: LT; serratus anterior: SA) during lowering phase of arm elevation. The results showed: (1) for pattern I and II, the first 3 principal component (PCs) explained 41.4% and 42.6% of total variance of movement; (2) the first PCs were correlated with MT, LT activity (r = 0.41~0.61) and upward rotation, posterior tipping (r = −0.59~−0.33) in pattern I, and UT, MT, SA (r = 0.30~0.70) activity in pattern II; (3) contour plots of muscle activity demonstrated that muscle activities varied with dyskinesis patterns. In summary, for the pattern I, the major characteristics are coactivation of MT and LT and corresponding scapular posterior tipping and upward rotation. For the pattern II, the major characteristics are coactivation of UT, MT and SA without corresponding scapular external rotation.
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270
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Gane EM, O’Leary SP, Hatton AL, Panizza BJ, McPhail SM. Neck and Upper Limb Dysfunction in Patients following Neck Dissection: Looking beyond the Shoulder. Otolaryngol Head Neck Surg 2017; 157:631-640. [DOI: 10.1177/0194599817721164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function. Study Design Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Inclusion criteria: patients treated with neck dissection (2009-2014). Exclusion criteria: aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function. Results Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98). Conclusion Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.
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Affiliation(s)
- Elise M. Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
| | - Shaun P. O’Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Anna L. Hatton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Benedict J. Panizza
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Otolaryngology–Head and Neck Surgery Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Steven M. McPhail
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- School of Public Health and Social Work and the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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271
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Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med 2017; 52:102-110. [DOI: 10.1136/bjsports-2017-097559] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 11/04/2022]
Abstract
BackgroundIt is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.ObjectivesTo determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.MethodsA systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.ResultsFive studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).ConclusionsAthletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.
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272
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McKenna LJ, de Ronde M, Le M, Burke W, Graves A, Williams SA. Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain. J Sci Med Sport 2017; 21:129-133. [PMID: 28778823 DOI: 10.1016/j.jsams.2017.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. DESIGN A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. METHODS Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. RESULTS There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. CONCLUSIONS There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.
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Affiliation(s)
- Leanda J McKenna
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia.
| | - Mandy de Ronde
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia
| | - Minyang Le
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia
| | - William Burke
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia
| | - Anna Graves
- Department of Medical Radiation Sciences, Faculty of Science and Engineering, Curtin University, Australia
| | - Sian A Williams
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia
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Lange T, Struyf F, Schmitt J, Lützner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review. Phys Ther Sport 2017; 26:64-89. [DOI: 10.1016/j.ptsp.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/01/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022]
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274
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Dejaco B, Habets B, van Loon C, van Grinsven S, van Cingel R. Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single blinded, clinical trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2051-2059. [PMID: 27351548 DOI: 10.1007/s00167-016-4223-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/16/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the effectiveness of isolated eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy. METHODS Thirty-six patients with rotator cuff tendinopathy, diagnosed by an orthopaedic surgeon, were included and randomly allocated to an isolated eccentric exercise (EE) group (n = 20, mean age = 50.2 ± 10.8 years) or a conventional exercise (CG) group (n = 16, mean age = 48.6 ± 12.3 years). Both groups fulfilled a 12-week daily home-based exercise programme and received a total amount of nine treatment sessions. The Constant Murley score was used to evaluate both objective (e.g. range of motion and strength) and subjective measures (e.g. pain and activities of daily living). A visual analogue scale (VAS) was used to evaluate pain during daily activities. As secondary outcomes, shoulder range of motion and isometric abduction strength in 45° in the scapular plane were evaluated. All measurements were taken at baseline, at 6, 12 and 26 weeks. RESULTS After 26 weeks, both groups showed a significant increase in the Constant Murley score and a significant decrease in VAS scores. No difference was found between the groups, for any of the evaluated outcome measures. CONCLUSION A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy. However, it is no more beneficial than a conventional exercise programme for the rotator cuff and scapular muscles. Based on the results, clinicians should take into account that performing two eccentric exercises twice a day is as effective as performing six concentric/eccentric exercises once a day in patients with rotator cuff tendinopathy.
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Affiliation(s)
- Beate Dejaco
- Sports Medical Center Papendal, Papendallaan 7, 6814 GN, Arnhem, The Netherlands.
| | - Bas Habets
- Sports Medical Center Papendal, Papendallaan 7, 6814 GN, Arnhem, The Netherlands
| | - Corné van Loon
- Department of Orthopaedic Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Susan van Grinsven
- Department of Orthopaedic Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Robert van Cingel
- Sports Medical Center Papendal, Papendallaan 7, 6814 GN, Arnhem, The Netherlands.,HAN University of Applied Sciences Research Group Musculoskeletal Rehabilitation, Nijmegen, The Netherlands
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Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle. J Shoulder Elbow Surg 2017; 26:1159-1165. [PMID: 28169137 DOI: 10.1016/j.jse.2016.12.074] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/30/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stretching maneuvers for the pectoralis minor muscle, which involve shoulder horizontal abduction or scapular retraction, are performed in clinical and sports settings because the tightness of this muscle may contribute to scapular dyskinesis. The effectiveness of stretching maneuvers for the pectoralis minor muscle is unclear in vivo. The purpose of this study was to verify the effectiveness of stretching maneuvers for the pectoralis minor muscle in vivo using ultrasonic shear wave elastography. METHODS Eighteen healthy men participated in this study. Elongation of the pectoralis minor muscle was measured for 3 stretching maneuvers (shoulder flexion, shoulder horizontal abduction, and scapular retraction) at 3 shoulder elevation angles (30°, 90°, and 150°). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the 9 aforementioned stretching maneuver-angle combinations. RESULTS The shear elastic modulus was highest in horizontal abduction at 150°, followed by horizontal abduction at 90°, horizontal abduction at 30°, scapular retraction at 30°, scapular retraction at 90°, scapular retraction at 150°, flexion at 150°, flexion at 90°, and flexion at 30°. The shear elastic moduli of horizontal abduction at 90° and horizontal abduction at 150° were significantly higher than those of other stretching maneuvers. There was no significant difference between horizontal abduction at 90° and horizontal abduction at 150°. CONCLUSIONS This study determined that shoulder horizontal abduction at an elevation of 90° and horizontal abduction at an elevation of 150° were the most effective stretching maneuvers for the pectoralis minor muscle in vivo.
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276
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Scapular dyskinesis among competitive swimmers. J Bodyw Mov Ther 2017; 21:633-636. [DOI: 10.1016/j.jbmt.2016.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/19/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
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277
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Calé-Benzoor M, Maenhout A, Arnon M, Tenenbaum G, Werrin M, Cools A. Quality assessment of shoulder plyometric exercises: Examining the relationship to scapular muscle activity. Phys Ther Sport 2017. [PMID: 28645094 DOI: 10.1016/j.ptsp.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of the study was to evaluate performance quality of shoulder plyometric exercises, and examine the relationship to scapular muscle activation during an intense exercise bout. DESIGN Observational study. SETTING University laboratory. PARTICIPANTS 32 healthy university students (male/female: 14/18) volunteers. MAIN OUTCOME MEASURES Subjects performed 10 plyometric exercises. Surface EMG of upper (UT), middle (MT) and lower (LT) trapezius and serratus anterior (SA) was registered. A quality assessment questionnaire was administered at the beginning and end of the exercise bout. Muscle activation at the beginning and end was evaluated by t-test. Mixed repeated measures ANOVA was conducted to test the effects of criterion-quality, time, muscles, exercises, and their interactions. RESULTS Increased EMG activation was noted in 34/40 cases, (21/40 significant (p < 0.05) changes). Quality assessment revealed a decline in the ability to maintain initial position (43% of subjects), failure to keep a consistent and symmetrical arc of motion (62% of subjects), and performance with trick movements (48% of subjects). Inability to keep a consistent arc of motion was significant in 4 exercises. CONCLUSIONS The novel questionnaire may aid quality assessment during plyometric exercises. Ability to keep a consistent arc of motion was the most sensitive marker of decline of performance quality.
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Affiliation(s)
- Maya Calé-Benzoor
- Ribstein Center for Sports Medicine and Research, Wingate Institute, 42902 Israel; Physical Therapy Department, Faculty of Social Welfare and Health Sciences, Abba Hushi 199, Mount Carmel, University of Haifa, 3498838, Israel.
| | - Annelies Maenhout
- Ghent University, Department of Rehabilitation Medicine and Physiotherapy, Campus Heymans, De Pintelaan 185, 9000 Ghent, Belgium
| | - Michal Arnon
- Zinman College of Physical Education and Sport Sciences at the Wingate Institute, 42902 Netanya, Israel
| | - Gershon Tenenbaum
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL 32306, USA
| | - Mia Werrin
- Ghent University, Department of Rehabilitation Medicine and Physiotherapy, Campus Heymans, De Pintelaan 185, 9000 Ghent, Belgium
| | - Ann Cools
- Ghent University, Department of Rehabilitation Medicine and Physiotherapy, Campus Heymans, De Pintelaan 185, 9000 Ghent, Belgium
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278
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Baumer TG, Dischler J, Mende V, Zauel R, van Holsbeeck M, Siegal DS, Divine G, Moutzouros V, Bey MJ. Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes. J Shoulder Elbow Surg 2017; 26:1064-1072. [PMID: 28131679 PMCID: PMC5438772 DOI: 10.1016/j.jse.2016.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of asymptomatic rotator cuff tears has been reported to range from 15% to 39%, but the influence of asymptomatic rotator cuff pathology on shoulder function is not well understood. This study assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. METHODS A clinical ultrasound examination was performed in 46 asymptomatic volunteers (age: 60.3 ± 7.5 years) with normal shoulder function to document the condition of their rotator cuff. The ultrasound imaging identified the participants as healthy (n = 14) or pathologic (n = 32). Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex (Biodex Medical Systems, Inc., Shirley, NY, USA), and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores. RESULTS Compared with healthy volunteers, those with rotator cuff pathology had significantly less abduction (P = .050) and elevation (P = .041) strength, their humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). No significant differences were detected in the Western Ontario Rotator Cuff Index, visual analog scale, range of motion, or acromiohumeral distance. CONCLUSIONS The differences observed between the healthy volunteers and those with asymptomatic rotator cuff pathology lend insight into the changes in joint mechanics, shoulder strength, and conventional clinical outcomes associated with the early stages of rotator cuff pathology. Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology.
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Affiliation(s)
- Timothy G Baumer
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA.
| | - Jack Dischler
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Veronica Mende
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Daniel S Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
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279
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Navarro-Ledesma S, Struyf F, Labajos-Manzanares MT, Fernandez-Sanchez M, Morales-Asencio JM, Luque-Suarez A. Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain? Musculoskelet Sci Pract 2017; 29:38-42. [PMID: 28315580 DOI: 10.1016/j.msksp.2017.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND/HYPOTHESIS The relation between acromiohumeral distance (AHD) and severity of pain, disability and range of movement (ROM) in patients with chronic rotator cuff related shoulder pain (RCRSP) has not been reported. OBJECTIVES The aim of this study was to investigate the level of association between AHD measured by ultrasonography and pain-disability and shoulder range of movement (ROM), in patients suffering from chronic RCRSP. As a secondary objective, the determination of the intrarater reliability of AHD at both 0 and 60 degrees of shoulder elevation was carried out. DESIGN This was a cross-sectional study. METHOD A sample comprised of 97 patients with chronic RCSRP symptoms was recruited from three different primary care centres. Acromio-humeral distance (AHD) measured by ultrasonography at 0 and 60 degrees of shoulder elevation, shoulder pain-function (SPADI) and range of movement (ROM) were taken. RESULTS There was no correlation between AHD at 0° (-0,215), and at 60° (-0,148), with SPADI. No correlations were found with AHD and shoulder ROM at both 0 and 60°. Intrarater reliability was excellent for AHD at 0 and 60°. CONCLUSIONS There was a small association between AHD and shoulder pain and function, as well as with shoulder ROM, in patients with chronic RCRSP. Hence, clinicians should consider other possibilities rather than focusing their therapies only in increasing AHD when patients with chronic RCRSP are treated.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
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280
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Sohns S, Schnieder K, Licht G, von Piekartz H. Manuelle Triggerpunkttherapie bei Schulterschmerzen. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-017-0263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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281
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Kinematic analysis of the shoulder complex after anatomic and reverse total shoulder arthroplasty: A cross-sectional study. Musculoskelet Sci Pract 2017; 29:84-90. [PMID: 28347934 DOI: 10.1016/j.msksp.2017.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The movement of the arm relative to the trunk results from coordinated 3D glenohumeral and scapulothoracic movements. Changes in scapula kinematics may occur after total shoulder arthroplasty and could affect clinical and functional outcomes. OBJECTIVES To assess the 3D movement of the scapula during arm elevation after anatomic and reverse total shoulder arthroplasty. DESIGN/METHODS This was a single-centre, non-randomized, controlled cross-sectional study. Patients with anatomic (n = 14) and reverse total shoulder arthroplasty (n = 9) were prospectively enrolled and were compared to age-matched asymptomatic controls (n = 23). 3D scapular kinematics were assessed by a non-invasive, electromagnetic method during arm abduction and flexion. 3D scapular rotations and 3D linear displacements of the barycentre (geometrical centre) at rest and at 30°, 60° and 90° arm elevation; as well as scapulohumeral rhythm were analysed. Participant groups were compared using one-way ANOVA and Bonferroni post-hoc testing for normally distributed data, and Mann-Whitney U test for non-normally distributed data. RESULTS/FINDINGS Total range of scapular lateral rotation and barycentre displacement were increased, and scapulohumeral rhythm was reduced, in patients with anatomic and reverse total shoulder arthroplasty compared with age-matched controls; however, the global scapular kinematic pattern was preserved. CONCLUSION/INTERPRETATION For patients after total shoulder arthroplasty, the increased contribution of the scapula to arm elevation is consistent with a compensatory mechanism for the reduced glenohumeral mobility. The stability of the global scapula kinematic pattern reflects its mechanical and neuromotor strength.
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282
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de Araújo RC, Pirauá ALT, Beltrão NB, Pitangui ACR. Activity of periscapular muscles and its correlation with external oblique during push-up: Does scapular dyskinesis change the electromyographic response? J Sports Sci 2017; 36:571-577. [DOI: 10.1080/02640414.2017.1324205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - André Luiz Torres Pirauá
- Department of Physical Education, Tabosa de Almeida University Center - Asces Unita, Caruaru, Brazil
| | - Natália Barros Beltrão
- Department of Physical Education, Federal Rural University of Pernambuco, Recife, Brazil
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283
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Living status, economic hardship and sleep disturbance were associated with subjective shoulder pain in survivors of the Great East Japan Earthquake: A cross sectional study. J Orthop Sci 2017; 22:442-446. [PMID: 28118947 DOI: 10.1016/j.jos.2016.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 12/01/2016] [Accepted: 12/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Great East Japan Earthquake and devastating Tsunami hit hard everything on the northeastern coast of Japan. This study aimed to determine socio-psychological factors for "subjective shoulder pain" of the survivors at 2 years evaluated by a self-report questionnaire. METHODS Between November 2012 to February 2013, survivors replied to the self-report questionnaire, and 2275 people consented to join this study. Living status was divided into 5 categories (1. same house as before the earthquake (reference group), 2. temporary small house, 3. apartment, 4. house of relatives or acquaintance, 5. new house) and economic hardship was divided into 4 categories (1. normal (reference group), 2. a little bit hard, 3. hard, 4. very hard). Gender, age, body mass index, living areas, smoking and drinking habits, complications of diabetes mellitus and cerebral stroke, working status, and walking time were considered as the confounding factors. Kessler Psychological Distress Scale of ≥10/24 and Athens Insomnia Scale of ≥6/24 points were defined as a presence of psychological distress and sleep disturbance, respectively. We used multiple logistic regression analysis to examine the association of shoulder pain with living environment, economic hardship, psychological distress, and sleep disturbance at 2 years after the earthquake. RESULTS There were significant differences in the risk of having shoulder pain in those with "apartment" (OR = 1.74, 95% CI = 1.03-2.96), "house of relatives or acquaintance" (OR = 2.98, 95% CI = 1.42-6.25), economic hardship of "hard" (OR = 1.71, 95% CI = 1.08-2.7) and "very hard" (OR = 2.51, 95% CI = 1.47-4.29), and sleep disturbance (OR = 2.96, 95% CI = 2.05-4.27). CONCLUSIONS Living status of "apartment" and "house of relatives or acquaintance", economic hardship of "hard" and "very hard", and "sleep disturbance" were significantly associated with shoulder pain.
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284
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Pekyavas NO, Ergun N. Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:238-242. [PMID: 28446376 PMCID: PMC6197467 DOI: 10.1016/j.aott.2017.03.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
Abstract
Objective 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). Methods 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)). Results 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). Conclusion Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level of Evidence Level I, Therapeutic study.
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Affiliation(s)
| | - Nevin Ergun
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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285
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Shire AR, Stæhr TAB, Overby JB, Bastholm Dahl M, Sandell Jacobsen J, Høyrup Christiansen D. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis. BMC Musculoskelet Disord 2017; 18:158. [PMID: 28416022 PMCID: PMC5393017 DOI: 10.1186/s12891-017-1518-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background 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. Methods 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. Results 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. 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 to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1518-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison R Shire
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark.
| | - Thor A B Stæhr
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | - Jesper B Overby
- Department of Physiotherapy, VIA University College, Hedeager 2, Aarhus N, Denmark
| | | | | | - David Høyrup Christiansen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
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286
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Moroder P, Minkus M, Böhm E, Danzinger V, Gerhardt C, Scheibel M. Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept. ACTA ACUST UNITED AC 2017; 12:103-108. [PMID: 28868087 PMCID: PMC5578354 DOI: 10.1007/s11678-017-0399-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/17/2017] [Indexed: 12/04/2022]
Abstract
Background Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well. Objectives The aim was to investigate the effectiveness of a “shoulder pacemaker” device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability. Patients and methods Three patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off. Results No changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed. Conclusion The electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application. Video online The online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: “The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern”. Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universitätsmedizin Berlin 2017, all rights reserved
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Affiliation(s)
- Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Elisabeth Böhm
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Victor Danzinger
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Gerhardt
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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287
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Kinsella R, Pizzari T. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review. Shoulder Elbow 2017; 9:112-126. [PMID: 28405223 PMCID: PMC5384534 DOI: 10.1177/1758573216660038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/27/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Rita Kinsella
- Rita Kinsella, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia.
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288
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Kibler WB, Sciascia AD, Morris BJ, Dome DC. Treatment of Symptomatic Acromioclavicular Joint Instability by a Docking Technique: Clinical Indications, Surgical Technique, and Outcomes. Arthroscopy 2017; 33:696-708.e2. [PMID: 27866794 DOI: 10.1016/j.arthro.2016.08.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/03/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To report functional and objective outcomes resulting from surgical treatment of patients with symptomatic type III through V acromioclavicular (AC) joint injury by use of a modification of the anatomic AC joint reconstruction developed by Carofino and Mazzocca. METHODS The study included all patients treated in 2009-2014 who presented with a history of direct trauma to the shoulder; deformity of the AC joint on clinical examination; radiographic findings that would classify the injury as a Rockwood type III, IV, or V injury; AC joint instability on clinical examination; and self-reported deficits of arm function on initial presentation, in whom a comprehensive and directed nonoperative program failed. The surgical procedure used an allograft with reinforcing internal sutures passed around the coracoid and through anatomically positioned clavicular holes for the coracoclavicular (CC) ligaments, used a docking technique for reconstruction of the superior AC ligaments, and included repair of the native AC ligaments. Outcomes were reported for patients with a minimum follow-up period of 1.5 years. Outcome measurements included dynamic-static stability evaluation and Disabilities of the Arm, Shoulder and Hand (DASH) scores. RESULTS The study included 15 patients with 15 affected shoulders. The postsurgical follow-up period averaged 3 years (range, 1.5-5 years). Postoperatively, one patient showed loss of reduction after a fall. All others showed 2-dimensional radiographic stability and 3-dimensional dynamic clinical stability. Static radiographic measurement of the CC distance at discharge averaged 0.93 cm compared with 2.7 cm on initial examination (P < .0001). Patient-reported outcomes at an average of 3 years' follow-up showed a DASH score of 13 compared with a preoperative DASH score of 51 (P < .0001). CONCLUSIONS This study confirms that anatomic CC ligament reconstruction and repair or reconstruction of the AC ligaments help restore arm function as shown by the patient-specific and clinical outcome metrics. These results were achieved by correction of the deformity, which in turn allowed for the obtainment of static and dynamic stability. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A
| | | | | | - David C Dome
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A
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289
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Saulle M, Gellhorn AC. Approach to the diagnosis of shoulder pain using physical exam and ultrasound: an evidence-based approach. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0149-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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290
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Krzesniak-Swinarska M, Caress JB, Cartwright MS. Neuromuscular ultrasound for evaluation of scapular winging. Muscle Nerve 2017; 56:7-14. [PMID: 28006862 DOI: 10.1002/mus.25533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clinicians who treat nerve and muscle disorders may be asked to evaluate patients who have unilateral or bilateral scapular winging. Traditionally, this evaluation has relied upon a thorough history, physical examination, and electrodiagnostic testing to localize the cause of winging and detect the underlying neuromuscular pathology. Neuromuscular ultrasound has emerged as a non-invasive technique that can be used for structural evaluation of nerve and muscle abnormalities. METHODS Previous studies of imaging in scapular winging and experiences from our diagnostic laboratory are reviewed. RESULTS Four standard and 4 ancillary ultrasound views are described for evaluation of scapular winging. CONCLUSION Ultrasound is a non-invasive, painless, and radiation-free technology that can be used to evaluate scapular winging. Muscle Nerve 56: 7-14, 2017.
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Affiliation(s)
- Monika Krzesniak-Swinarska
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
| | - James B Caress
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Main Floor Reynolds Tower, Winston-Salem, North Carolina, 27157, USA
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291
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Rizzo JR, Thai P, Li EJ, Tung T, Hudson TE, Herrera J, Raghavan P. Structured Wii protocol for rehabilitation of shoulder impingement syndrome: A pilot study. Ann Phys Rehabil Med 2017; 60:363-370. [PMID: 28330586 DOI: 10.1016/j.rehab.2016.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the feasibility and efficacy of using a structured Nintendo Wii protocol to improve range of motion, strength, and quality of life in patients with shoulder impingement syndrome. METHODS A total of 14 patients with shoulder pain were randomized to perform a structured Wii protocol (n=8) or conventional therapy (n=6). Pain-free shoulder range of motion, strength, shoulder pain and disability, and quality of life were assessed pre- and post-treatment. RESULTS All 8 patients completed the Wii protocol, and 3 completed conventional therapy. The Wii protocol conferred significant improvements in shoulder range of motion, pain and disability, and quality of life but not strength, whereas conventional therapy conferred a significant improvement in strength. CONCLUSIONS As compared to conventional treatment, the structured Wii protocol implemented in this pilot study was a viable adjunct to therapy for shoulder impingement syndrome. Gaming may have a supplemental benefit by increasing motivation, pleasure, and/or adherence. Further investigation in larger cohorts is warranted.
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Affiliation(s)
- John-Ross Rizzo
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Neurology, New York University School of Medicine, New York University, New York, USA; Department of Psychology and Center for Neural Science, New York University, New York, USA
| | - Peter Thai
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; College of Medicine, SUNY Upstate Medical University, New York, USA
| | - Edward J Li
- Mount Sinai School of Medicine, New York, USA
| | - Terence Tung
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA
| | - Todd E Hudson
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Neurology, New York University School of Medicine, New York University, New York, USA
| | | | - Preeti Raghavan
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, USA.
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292
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Zappala J, Orrego C, Boe E, Fechner H, Salminen D, Cipriani DJ. Influence of Posture-Cuing Shirt on Tennis Serve Kinematics in Division III Tennis Players. J Chiropr Med 2017; 16:49-53. [PMID: 28228697 DOI: 10.1016/j.jcm.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/22/2016] [Accepted: 05/26/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the influence of a posture-cuing shirt on internal rotation velocity of the shoulder during a tennis swing and to determine this influence on shoulder external rotation position. METHODS Nine healthy competitive college tennis players from a Division III college participated in this study. High-speed motion capture allowed for 3-dimensional analysis of shoulder kinematics during a tennis serve. Two conditions were evaluated while the athletes performed a high-velocity tennis serve: a standard tennis shirt and a posture-cuing shirt. RESULTS Shoulder internal rotation velocity increased when wearing the posture-cuing shirt. Peak internal rotation velocity increased from 960.61°/s ± 93.24°/s to 1217.96°/s ± 155.01°/s (t = -1.76, P = .058). Internal rotation velocity at the time of impact increased from 765.18°/s ± 95.48°/s to 900.54°/s ± 105.33°/s (t = -1.50, P = .086). Shoulder maximum external rotation did not differ between the 2 conditions, at 172.00° ± 2.92° and 170.89° ± 3.70° (t = 0.325, P = .754). CONCLUSIONS Wearing a posture-cuing shirt may possibly alter shoulder kinematics during an overhead sport activity such as tennis. Internal rotation velocity seemed to improve while wearing this shirt, although shoulder external rotation position did not change. It is not known if these improvements can influence injury risk.
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293
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Struyf F, Tate A, Kuppens K, Feijen S, Michener LA. Musculoskeletal dysfunctions associated with swimmers’ shoulder. Br J Sports Med 2017; 51:775-780. [DOI: 10.1136/bjsports-2016-096847] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/04/2022]
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294
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Gillet B, Begon M, Sevrez V, Berger-Vachon C, Rogowski I. Adaptive Alterations in Shoulder Range of Motion and Strength in Young Tennis Players. J Athl Train 2017; 52:137-144. [PMID: 28145740 DOI: 10.4085/1062-6050.52.1.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Playing tennis requires unilateral and intensive movement of the upper limb, which may lead to functional adaptations of the shoulder and an increased injury risk. Identifying which athletes will be future elite tennis players starts at 5 to 6 years of age. Therefore, highly skilled players practice intensively in their childhood. However, whether these functional changes occur during the prepubertal years has not been established. OBJECTIVES To assess changes in glenohumeral-joint-rotation range of motion and strength of the shoulder-complex muscles in prepubertal elite tennis players. DESIGN Cross-sectional study. SETTING Tennis training sports facilities. PATIENTS OR OTHER PARTICIPANTS Sixty-seven male tennis players (age range = 7-13 years) selected by a regional tennis center of excellence were divided into 3 biological age groups relative to their predicted age at peak height velocity: greater than 4 (n = 26; age = 8.7 ± 0.7 years, height = 132.4 ± 12.9 cm, mass = 27.8 ± 3.8 kg), 3 to 4 (n = 21; age = 10.3 ± 0.6 years, height = 144.9 ± 5.7 cm, mass = 34.7 ± 4.0 kg), and 2 (n = 20; age = 12.8 ± 1.4 years, height = 158.5 ± 8.7 cm, mass = 43.0 ± 8.2 kg) years before their age at peak height velocity. MAIN OUTCOME MEASURES(S) We measured the internal- and external-rotation ranges of motion of the glenohumeral joint using a goniometer and calculated the total arc of motion. Maximal isometric strength of 8 shoulder muscles was measured using a handheld dynamometer. Strength values were normalized to body weight and used to calculate 4 agonist-to-antagonist strength ratios. RESULTS The total arc of motion of the glenohumeral joint decreased gradually with biological age (P ≤ .01) due to the decrease in internal-rotation range of motion (P < .001). Absolute strength increased gradually with biological age (P < .001), but the relative strengths and ratios remained similar. CONCLUSIONS Functional adaptations of the shoulder seen in adolescent and adult tennis players were observed in healthy prepubertal players. This knowledge could help clinicians and coaches more effectively monitor shoulder adaptations to tennis practice during the prepubertal years.
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Affiliation(s)
- Benoit Gillet
- Université de Lyon, France.,Université Claude Bernard Lyon 1 Laboratoire Interuniversitaire de Biologie de la Motricité, Villeurbanne Cedex, France.,Laboratoire de Simulation et de Modélisation du Mouvement (S2M), Département de Kinésiologie, Université de Montréal, Laval, QC, Canada
| | - Mickaël Begon
- Université Claude Bernard Lyon 1 Laboratoire Interuniversitaire de Biologie de la Motricité, Villeurbanne Cedex, France.,Centre de Réadaptation Marie-Enfant-Centre Hospitalier d'Université Sainte Justine, Montréal, QC, Canada
| | - Violaine Sevrez
- Aix-Marseille Université, Institut des Sciences du Mouvement Etienne-Jules Marey, Marseille, France
| | - Christian Berger-Vachon
- Université de Lyon, France.,IFSTTAR, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France.,Ligue du Lyonnais de Tennis, Bron, France
| | - Isabelle Rogowski
- Université de Lyon, France.,Université Claude Bernard Lyon 1 Laboratoire Interuniversitaire de Biologie de la Motricité, Villeurbanne Cedex, France
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295
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Morita W, Nozaki T, Tasaki A. MRI for the diagnosis of scapular dyskinesis: a report of two cases. Skeletal Radiol 2017; 46:249-252. [PMID: 27832291 DOI: 10.1007/s00256-016-2528-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/03/2016] [Accepted: 10/30/2016] [Indexed: 02/02/2023]
Abstract
Scapular dyskinesis describes the altered position of the scapula and/or abnormal movements of the scapulothoracic joint. It is caused by bony anatomical variations, bursitis, tumors, and muscular pathological conditions including loss of innervation and fibrosis. Scapular dyskinesis is just as often subclinical as it is symptomatic, and as the periscapular anatomical changes may not result in patient symptoms, a precise diagnosis of the etiology and pathophysiology has been a challenge. Scapular bony prominence is a common etiology of scapular dyskinesis, but does not always result in morbidity. We report a case of a 39-year-old man in whom an extensive MRI with fluid-sensitive imaging sequences covering the whole of the scapula was beneficial in diagnosing the inflammation adjacent to the bony deformity, which confirmed the etiology of scapular dyskinesis. Furthermore, in a 41-year old man without any anatomical variances, a similar MRI showed inflammation at the subscapular fossa that suggested altered scapular kinematics. An arthroscopic debridement of the lesion improved the symptoms. MRI in conjunction with plain radiographs, CT and physical examination enabled a precise diagnosis of the etiology. Fluid-sensitive MR images are important in defining the presence of inflammation, and are beneficial in determining the pathological significance of findings through other diagnostic measures.
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Affiliation(s)
- Wataru Morita
- Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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296
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Abstract
Upper extremity tennis injuries are most commonly characterized as overuse injuries to the wrist, elbow, and shoulder. The complex anatomy of these structures and their interaction with biomechanical properties of tennis strokes contributes to the diagnostic challenges. A thorough understanding of tennis kinetics, in combination with the current literature surrounding diagnostic and treatment methods, will improve clinical decision-making.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
| | - Meghan E Lark
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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297
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Chu SK, Jayabalan P, Kibler WB, Press J. The Kinetic Chain Revisited: New Concepts on Throwing Mechanics and Injury. PM R 2017; 8:S69-77. [PMID: 26972269 DOI: 10.1016/j.pmrj.2015.11.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/06/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022]
Abstract
The overhead throwing motion is a complex activity that is achieved through activation of the kinetic chain. The kinetic chain refers to the linkage of multiple segments of the body that allows for transfer of forces and motion. The lower extremities and core provide a base of support, generating energy that is transferred eventually through the throwing arm and hand, resulting in release of the ball. The kinetic chain requires optimal anatomy, physiology, and mechanics and is involved in all 6 phases of overhead throwing: windup, stride, arm cocking, acceleration, deceleration, and follow-through. Breaks or deficits in the kinetic chain can lead to injury or decreased performance. Through an understanding of the mechanics and pathomechanics seen in each phase of throwing, the clinician can better evaluate and screen for potential kinetic chain deficits in the overhead throwing athlete. The purpose of this article is to review the biomechanics of the overhead throwing motion, the role of the kinetic chain in throwing, and the clinical evaluation and management of abnormal throwing mechanics and related injuries.
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Affiliation(s)
- Samuel K Chu
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, and Rehabilitation Institute of Chicago, 1030 N Clark St, Suite 500, Chicago, IL 60611(∗).
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, and Rehabilitation Institute of Chicago, Chicago, IL(†)
| | | | - Joel Press
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, and Rehabilitation Institute of Chicago, Chicago, IL(¶)
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298
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Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review. Phys Ther 2017; 97:124-144. [PMID: 27587801 DOI: 10.2522/ptj.20160088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. PURPOSE The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. DATA SOURCES The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. STUDY SELECTION Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. DATA EXTRACTION Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. DATA SYNTHESIS Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. LIMITATIONS All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. CONCLUSIONS High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar tests was present, and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently, these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinically meaningful context of movement into clinical tests is warranted.
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299
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Deng S, Chen K, Ma Y, Chen J, Huang M. The Influence of Test Positions on Clinical Assessment for Scapular Dyskinesis. PM R 2016; 9:761-766. [PMID: 27916706 DOI: 10.1016/j.pmrj.2016.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Appropriate evaluation of scapular dyskinesis is essential for therapeutic strategies. Although the current visual-based assessment is rapid and practical, the reliability of this method is unsatisfactory. It is necessary to adequately understand the conditions of assessment to maximize the benefit of therapeutic interventions. OBJECTIVE To explore the influence of different test positions on clinical assessment for scapular dyskinesis. DESIGN Observational study. SETTING University rehabilitation department. PATIENTS A total of 102 subjects diagnosed with unilateral shoulder disorder were recruited from among rehabilitation outpatients from November 2015 to February 2016. METHODS Two experienced raters categorized the subjects' scapular movement pattern according to Kibler et al classification by the vision-palpation method at 4 test positions (at rest, and the end range of elevation in the sagittal, scapular, and coronal planes). MAIN OUTCOME MEASUREMENTS The overall prevalence of scapular dyskinesis, the distribution of types, and the reproducibility of types at the 4 test positions were analyzed. RESULTS The overall prevalence of scapular dyskinesis was 90.08%, and the highest frequency was found at the resting position. Type III was the most common type in our sample. In reproducibility analysis, 21.57% of subjects presented with the same type at any position, and 75.49% of subjects presented with 2 types. CONCLUSIONS Scapular dyskinesis in individuals with shoulder disorder showed a high prevalence, especially at the resting position. More than 1 type of scapular pattern would be present if assessed at different positions. This study indicates that test positions can affect the results of scapular dyskinesis assessment, and that the resting position should primarily be applied. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Simin Deng
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China(∗)
| | - Kang Chen
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China(†)
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China(‡).
| | - Juan Chen
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China(§)
| | - Mi Huang
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China(‖)
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300
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Mine K, Nakayama T, Milanese S, Grimmer K. The effectiveness of conservative management for disabled throwing shoulder in baseball: a systematic review of Japanese-language primary studies. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2016.1262108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Koya Mine
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Takashi Nakayama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Steve Milanese
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Karen Grimmer
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
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