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Fox JA, Luther L, Epner E, LeClere L. Shoulder Proprioception: A Review. J Clin Med 2024; 13:2077. [PMID: 38610841 PMCID: PMC11012644 DOI: 10.3390/jcm13072077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed and Medline, published between 1906 and 2021. The development of digital/smart phone goniometers can improve shoulder joint range of motion (ROM) measurements and demonstrate comparable measurement accuracy to the universal standard goniometer. The inclinometer offers a portable and cost-effective method for measuring shoulder joint angles and arcs of motion in the vertical plane. Two types of dynamometers, the computerized isokinetic machine and the handheld hydraulic dynamometer, are reliable tools for objective shoulder rotator cuff strength assessment. Motion analysis systems are highly advanced modalities that create three-dimensional models of motion arcs using a series of cameras and reflective beads, offering unparalleled precision in shoulder proprioception measurement; however, they require time-consuming calibration and skilled operators. Advancements in wearable devices and compact mobile technology such as iPhone applications may make three-dimensional motion analysis more affordable and practical for outpatient settings in the future. The complex interplay between proprioception and shoulder dysfunction is not fully understood; however, shoulder proprioception can likely both contribute to and be caused by shoulder pathology. In patients with rotator cuff tears, glenohumeral osteoarthritis, and shoulder instability, clinicians can track proprioception to understand a patient's disease progression or response to treatment. Finally, rehabilitation programs targeting shoulder proprioception have shown promising initial results in restoring function and returning athletes to play.
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Affiliation(s)
| | | | - Eden Epner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S Ste 3200, Nashville, TN 37232, USA; (J.A.F.); (L.L.); (L.L.)
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Ager AL, Roy JS, Dubé MO, Cools AM, Borms D. Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain. J Hand Ther 2024; 37:224-233. [PMID: 38350810 DOI: 10.1016/j.jht.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood. PURPOSE This study aimed to investigate the relationship between shoulder pain and proprioception. STUDY DESIGN This was a cross-sectional comparative study. METHODS Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations. RESULTS Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = -0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = -0.31 [-0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]). CONCLUSIONS Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.
| | - Marc-Olivier Dubé
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Ager AL, Roy JS, Hébert LJ, Roos M, Borms D, Cools AM. Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test. Musculoskelet Sci Pract 2023; 66:102829. [PMID: 37473497 DOI: 10.1016/j.msksp.2023.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic. OBJECTIVE To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability. DESIGN Cross-sectional measurement study. METHODS Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability). RESULTS The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC95 values (3.9-5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P < .05). CONCLUSIONS The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations. LEVEL OF EVIDENCE Level III cross-sectional study.
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Affiliation(s)
- Amanda L Ager
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Jean-Sébastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Luc J Hébert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Departments of Rehabilitation and Radiology/Nuclear Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Marianne Roos
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Abass MY, Shendy W, Samir H, Sweif RE, Ahmed MA, Awad A. Assessment of shoulder proprioception in patients with chronic mechanical cervical pain: A comparative study. J Back Musculoskelet Rehabil 2023; 36:1285-1293. [PMID: 37092213 DOI: 10.3233/bmr-220173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Chronic mechanical cervical pain (CMCP) is a common disabling problem worldwide, interfering with upper extremities function. However studying the impact of CMCP on shoulder proprioception is still lacking. OBJECTIVE To investigate the impact of CMCP on shoulder proprioception in young adults compared with normal control (NC) individuals. METHODS A comparative study was conducted between two groups; 40 patients with CMCP (mean age 32.28 ± 6.586) and 40 age and sex matched NC (mean age 33.43 ± 9.021). The Biodex isokinetic dynamometer was used to assess shoulder active sense of position at 30∘ external and internal rotations. The absolute angular error was calculated for the dominant and non-dominant shoulders. RESULTS The absolute angular error was significantly increased only in the CMCP at both rotation angles for both shoulders, showing a remarkable increase on the dominant shoulder and in the external rotation range compared with NC. CONCLUSIONS CMCP can significantly impair shoulder proprioception, particularly on the dominant side and in external rotation range. This could emphasize the careful examination of shoulder proprioception for the early detection of shoulders at risk, to eliminate the possibility of shoulder instability and/or injury in young adults with CMCP.
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Affiliation(s)
- Mohamed Yassen Abass
- Department of Physical Therapy for Neurological Disorders, Kasr Al-Ainy Educational Hospital, Cairo, Egypt
| | - Wael Shendy
- Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Hatem Samir
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Radwa E Sweif
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mai A Ahmed
- Department for Woman and Child Health, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
| | - Amina Awad
- Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Güler Y, Keskin A, Mıhlayanlar F, Atar S, Karslıoğlu B, İmren Y, Dedeoğlu SS. Shoulder Proprioception Following Reverse Total Shoulder Arthroplasty for Unreconstructable Upper Third Fractures of the Humerus: 2-Year Outcomes. Indian J Orthop 2022; 56:2245-2252. [PMID: 36507205 PMCID: PMC9705661 DOI: 10.1007/s43465-022-00769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Background Proximal humerus fractures may be comminuted in the elderly or after injury with high-energy mechanisms. Reverse total shoulder arthroplasty that may affect shoulder proprioception (rTSA) has also begun to play a part in treating acute proximal humeral fractures. In this study, the authors aimed to evaluate joint position sense (JPS) after rTSA. Methods Humac Norm II isokinetic device was used to evaluate the joint position sense. A joint angle was determined and the ability of the patient to create the same value of the angle by the active movement was evaluated. The difference between the pre-determined angle and the patient's measured angle was recorded. For proprioceptive sense, the initial position was 0° and the determination position was 30°, 60°, and 90° for flexion and abduction, and 15° and 30° for internal rotation and external rotation. Results While both the mean Constant and ADLEIR scores did not differ between non-operated and operated sides, the mean proprioception differences in all flexion (30°, 60°, and 90°), abduction (30°, 60°, and 90°), internal rotation (15° and 30°), and external rotation (15° and 30°) were significantly higher in the operated side than that in non-operated side (p < 0.01 for each pairwise comparison). Conclusion Reverse total shoulder arthroplasty (rTSA) treatment, which has increasingly become a surgical option in un-reconstructable proximal humeral fractures has significant adverse effects on proprioception on the operated side and may pose a risk for long-term instability, premature loosening, and prosthesis mechanical complications, in this context, well-designed prospective controlled studies are required.
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Affiliation(s)
- Yasin Güler
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
| | - Ahmet Keskin
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
| | - Fethi Mıhlayanlar
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Bülent Karslıoğlu
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
| | - Yunus İmren
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey
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Wawrzyniak A, Lubiatowski P, Kordasiewicz B, Brzóska R, Laprus H. Shoulder arthropathy secondary to syringomyelia: case series of 10 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1275-1281. [PMID: 34430987 DOI: 10.1007/s00590-021-03102-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Neuroarthropathy is a progressive joint degeneration secondary to neurological diseases. In the upper extremity, the shoulder is the most exposed, and it is mainly caused by syringomyelia. This condition is rare; therefore, the literature has documented only a few case reports or case series of small groups of patients. METHODS We collected data about patients with shoulder arthropathy due to syringomyelia who were treated in our two institutes and collected among members of the Polish Shoulder and Elbow Society. Our analysis was based on epidemiological data, symptoms, and clinical examinations. We also examined the results of diagnostic tests, including-spinal cord MRI and shoulder X-ray, and treatment methods and their effectiveness. RESULTS The examined group included 10 women with an average age of 63 years. Of these, nine patients reported pain, seven reported-swelling, and nine reported-weakness. In every patient, diagnosis was confirmed by X-ray of the shoulder with joint degeneration and MRI of the spinal cord with syrinx. Two patients were operated with reverse shoulder arthroplasty; the first one had excellent result-significant active range of motion improvement and reduction of symptoms, and the second one had a good result-pain relief and moderate range of motion improvement. Other patients were conservatively treated, resulting in total or partial symptoms relief but without significant range of motion improvement. CONCLUSION Charcot shoulder secondary to syringomyelia was mainly manifested by range of motion limitation, swelling, and pain. Both conservative and surgical treatments could be a good solution. However, if reverse arthroplasty is technically possible, it seems to be the most promising treatment for recovering function.
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Affiliation(s)
| | - Przemysław Lubiatowski
- Rehasport Clinic, Poznań, Poland
- Sport Traumatology and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Bartosz Kordasiewicz
- Trauma and Orthopedics Department, Centre of Postgraduate Medical Education, SPSK Im. A. Grucy, Otwock, Warsaw, Poland
- Idea Ortopedia, Warsaw, Poland
| | - Roman Brzóska
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
| | - Hubert Laprus
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
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