The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability

Effects of post-exercise cold-water immersion on performance and perceptive outcomes of competitive adolescent swimmers

PURPOSE

To evaluate the effects of repeated use of cold-water immersion (CWI) during a training week on performance and perceptive outcomes in competitive adolescent swimmers.

METHODS

This randomized-crossover study included 20 athletes, who received each intervention [CWI (14 ± 1 °C), thermoneutral water immersion (TWI) (27 ± 1 °C) as placebo, and passive recovery (PAS)] three times a week between the land-based resistance training and swim training. The interventions were performed in a randomized order with a 1-week wash-out period. We tested athletes before and after each intervention week regarding swim (100 m freestyle sprints) and functional performance (flexibility, upper and lower body power, and shoulder proprioception). We monitored athlete's perceptions (well-being, heaviness, tiredness, discomfort and pain) during testing sessions using a 5-item questionnaire. Athlete preferences regarding the interventions were assessed at the end of the study. We used generalized linear mixed models and generalized estimating equations for continuous and categorical variables, respectively (intervention x time).

RESULTS

We found a time effect for swim performance (p = .01) in which, regardless the intervention, all athletes improved sprint time at post-intervention compared to baseline. There was an intervention effect for pain (p = .04) and tiredness (p = .04), but with no significant post-hoc comparisons. We found no significant effects for other outcomes. All athletes reported a preference for CWI or TWI in relation to PAS.

CONCLUSION

The repeated use of CWI throughout a training week did not impact functional or swim performance outcomes of competitive adolescent swimmers. Perceptive outcomes were also similar across interventions; however, athletes indicated a preference for both CWI and TWI.

Shoulder proprioception changes in postmastectomy patients: an observational study

PURPOSE

Breast cancer surgery can cause changes in the anatomical structure of the shoulder and in shoulder mobility, leading to the increased possibility of long-term arm morbidity such as lymphedema. This study aims to evaluate the active shoulder joint position sense (AJPS) with and without lymphedema in postmastectomy patients.

METHODS

A total of 66 women, including 22 patients with lymphedema, 22 patients without lymphedema, and 22 healthy controls, were enrolled in the study. Pain severity was evaluated with the Numeric Pain Scale and edema severity was measured with circumferentially at 10 cm intervals. The normal range of motion of the shoulder joint was evaluated with the universal goniometer and the AJPS was assessed by active position repetition testing at 55°, 90°, and 125° shoulder flexion targets using the smartphone application "Clinometer."

RESULTS

AJPS at 55°, 90°, and 125° shoulder flexion target angles with and without lymphedema were different in all target angles compared to healthy controls (p < 0.01). There was a difference between the absolute error value of AJPS at 55° flexion (p < 0.05), and no difference at 90° and 125° flexion between the with and without lymphedema groups (p > 0.05).

CONCLUSION

This study shows that the AJPS was negatively affected in with and without lymphedema postmastectomy patients compared to healthy controls. This result emphasizes the importance of adding personalized methods for the restoration of joint position sense in addition to rehabilitation programs generally applied to the patient group.

Reduced shoulder proprioception due to fatigue after repeated handball throws and evaluation of test-retest reliability of a clinical shoulder joint position test

Background

Proprioception is vital for motor control and can be disturbed, for example, due to fatigue or injury. Clinical feasible, reliable and valid tests of shoulder proprioception are warranted. The aim was to investigate the effects of local fatigue on shoulder proprioception and the reliability of a feasible joint position sense test using an experimental repeated measures design.

Method

Forty participants repeated a shoulder joint position sense test to assess test-retest reliability. The test was then utilized on a subgroup of handball players who were subjected to five bouts of a repeated throwing task with the dominant hand. The effect of local fatigue was investigated by comparing the fatigued with the non-fatigued shoulder.

Results

There was a significant interaction for the arm × bout (p = 0.028, ηp2 = 0.20) and a significant effect for the arm (p = 0.034, ηp2 = 0.35) with a significant decrease in joint position sense for the throwing arm compared to the non-throwing arm. The intraclass correlation coefficient was 0.78 (95% CI = [0.57; 0.89]). The standard error of measurement between trials was 0.70° (range: 0.57°-0.90°).

Discussion

The results indicate that repeated throwing to fatigue disturbs shoulder joint position sense. Assessment with the modified test showed acceptable reliability and can be a valuable assessment tool in the clinic.

Changes in proprioception at different time points following anterior cruciate ligament injury or reconstruction

PURPOSE

To investigate the changes in 30° and 60° position sense in patients with anterior cruciate ligament (ACL) injury at different time points after injury and reconstruction.

METHODS

Patients were divided into six groups according to time after ACL injury and reconstruction: group A (ACL injury 1.5-6 months), group B (ACL injury 6-12 months), group C (ACL injury > 12 months), group D (postoperative ACL reconstruction 1-6 months), group E (postoperative ACL reconstruction > 6 months), and group F consisting of 14 healthy adults (control group). The ability of the affected leg to reproduce the same joint position during knee flexion was tested using active joint position sense assays to assess proprioception in both the lower extremities of the patient or between groups.

RESULTS

Proprioception decreased rapidly during the early stages of ACL injury. Significant difference in the affected side at 30° compared to the healthy side (Group A: 4.70 (4.78, 9.00) vs 4.15 (3.35, 6.13), P = 0.03; Group B: 2.90 (0.48, 4.56) vs 8.30 (4.18, 10.43), P = 0.001; Group E: 6.25 (2.55, 11.60) vs 9.60 (3.90, 12.73), P = 0.009). However, no significant differences were detected for a double lower limb contrast of 60° (Group A: 5.1 (1.00, 8.00) vs 3.00 (0.75, 3.55), P = 0.044). Finally, the affected side of patients in groups C, D and E had significant differences in position perception at 30° compared with healthy subjects (P < 0.01), and the affected side of patients in groups C and E had significant differences in position sense at 60° compared with healthy subjects (P < 0.01).

CONCLUSION

ACL injury had a greater impact on the patient's 30° position sense, with only a small impact for 60°. Further, the early and middle proprioception recovery stages after ACL injury were the best before surgery. Finally, proprioception recovery training should be performed soon after injury.

A comparison of functional vestibulo-ocular reflex and proprioception in athletes of combat sports and ball sports

Background

The contribution and role of sensory systems in providing postural control may vary depending on the condition or activity. Vestibulo-ocular reflex (VOR) and proprioception might be affected by the type of sport.

Objective

This study aimed to compare athletes engaged in combat sports and ball sports in terms of functional VOR and proprioception.

Design

This study is a cross-sectional, comperative research.

Method

Twenty-four athletes engaged in combat sports and 20 in ball sports were included in the study. Functional examination of VOR in athletes was performed with a novel Functional Head Impulse Test (fHIT). Proprioception analysis was evaluated using Laser Pointer Assisted Angle Reproduction Test (LPA-ART) in 90° shoulder flexion and abduction.

Results

fHIT lateral and posterior % Correct Answer (CA) values and anterior SCC 6000°/s² values of athletes engaged in ball sports were found to be statistically significantly higher than athletes in combat sports (p < 0.05). Except for anterior SCC 4000°/s² value, scores of the ball players in all accelerations and directions were higher than combat sports athletes, although it was not statistically significant. The 90° shoulder flexion and abduction angle deviation values obtained from the LI-ATT were statistically lower in those who played ball sports (p < 0.05).

Conclusions

Participation in sports branches played with the ball is expected to provide gains for athletes who want to reach high-level performance in proprioceptive and vestibular functioning and those with vestibular/proprioceptive pathology. Maintaining clear vision in dynamic sports branches can be improved by training VOR function.

Repeated Massage Improves Swimmers' Perceptions during Training Sessions but Not Sprint and Functional Performance: A Randomized Controlled Trial

This study aimed to investigate the effects of repeated massage adjusted for swimmers' training on the perceptive, functional, and performance outcomes of a sprint. We also investigated the effects of a single short massage on swimmers' self-reported perceptions after resistance training. This cross-over randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis included 19 male and female competitive swimmers between 12 and 20 years old. Participants were subjected to three 12-min interventions over a week between resistance and swim training and monitored regarding training load and perceptions. After the intervention week we assessed: perceptive (well-being, heaviness, tiredness, discomfort, and pain), performance (sprint time, FINA points, and stroke characteristics), and functional outcomes (flexibility, squat jump, bench press, proprioception), in addition to athlete beliefs and preferences. A massage was defined as consisting of sliding movements on the arms, back, and anterior thigh, with metronomic rhythm control (1:1), and was divided into two protocols: superficial massage (SM) (light touch) and deep massage (DM) (light, moderate, intense effleurage) while the control (CON) rested. After repeated massage (SM and SM), participants had less chances to report tiredness, and they also maintained perceptions of well-being while CON got worse throughout the week. However, we found evidence of worsening of the perceptions of heaviness and pain at the main stages of the swim training for the massage groups. SM and DM had no effects over sprint and functional performance. Our results suggest that the swimmers were able to train harder with no harm to recovery.

Role of active joint position sense on the upper extremity functional performance tests in college volleyball players

Background

It has been well established that proprioception plays a decisive role in shoulder stability and sport performance. Notwithstanding, there is a lack of clear association between active joint position sense (AJPS) and the performance of upper-extremity functional performance tests. The aim of this study was to determine whether the AJPS of the shoulder complex is associated with the performance of college volleyball players with the following functional tests: Y-Balance Test-Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). The secondary aim was to investigate whether the magnitude of the proprioception error through the AJPS had the ability to act as a predictor for functional test scores.

Methods

Cross-sectional study with a convenience sampling. Healthy college volleyball players (≥12 h of training/week), 30 males and 22 females, between 18 and 26 years of age were included. AJPS of the shoulder (90° of flexion (90°Flex), 90° of internal rotation at 90° of abduction (90°IR/ABD), 90° of external rotation at 90° of abduction (90°ER/ABD)) and three upper-extremity functional performance tests (YBT-UQ, CKCUEST and SMBT) were assessed. A Pearson's test and a stepwise multiple linear regression analysis were used to determine possible associations and relationships between outcome measures, respectively.

Results

The analysis revealed that AJPS at 90°IR/ABD and 90°ER/ABD were the only proprioceptive variables with an association to the YBT-UQ and SMBT. Despite these relationships, only the AJPS at 90°IR/ABD was associated with the performance of the YBT-UQ in; superolateral direction (β = -0.7; 95% CI [-1.3 to 0.1]; p = 0.025); inferolateral direction (β = -1.5; 95% CI [-2.1 to -0.8]; p = 0.001); and composite score (β = -0.8; 95% CI [-1.3 to -0.3]; p = 0.002). From these, AJPS at 90°IR/ABD mainly explained the variability of YBT-UQ (inferolateral direction) performance (R² = 0.32; %R² = 0.32). Our findings allow for a possible expanded role for proprioception as a contributing factor in upper limb motor control during functional movements. Further research is required to explore and distinguish the associations between proprioception, motor control and sport performance involving the upper limbs.

Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome

INTRODUCTION

The proprioception plays an important role in the stability of the shoulder joint. However, clinical practice lacks reliable and user-friendly tools.

OBJECTIVES

To evaluate the intra- and inter-rater reliability of the Laser-Pointer assisted Angle Reproduction Test (LP-ART), to analyze the difference in proprioception between the symptomatic and asymptomatic shoulders, and to investigate if there is a correlation between the LP-ART and the pain intensity assessed by 11-point Numerical Rating Pain Scale (NRPS) and the level of shoulder disability and pain assessed by the Disability Index and Shoulder Pain (SPADI - BR).

METHODS

Fifty patients (age = 56.2 ± 10.4 years) performed the LP-ART at 90° of shoulder flexion.

RESULTS

The intra and interrater reliability of the LP-ART measurements was moderate (Intraclass Correlation Coefficient_2,3 = 0.41 to 0.65) for both shoulders, symptomatic and asymptomatic. There was no difference in the absolute angular deviation between shoulders (mean difference of 0.4°, P = .581). The absolute angular deviation was not significantly correlated with the pain intensity (rs = 0.007, P = .962) and the SPADI - BR (r_s = 0.022, P = .881).

CONCLUSION

The LP-ART measurement showed moderate reliability in participants with subacromial pain syndrome. The active joint position sense was not different between symptomatic and asymptomatic shoulders, and there was no correlation between proprioception and the pain intensity and shoulder pain and disability level.

Effects of a Novel Rotator Cuff Rehabilitation Device on Shoulder Strength and Function

ABSTRACT

Savitzky, JA, Abrams, LR, Galluzzo, NA, Ostrow, SP, Protosow, TJ, Liu, SA, Handrakis, JP, and Friel, K. Effects of a novel rotator cuff rehabilitation device on shoulder strength and function. J Strength Cond Res 35(12): 3355-3363, 2021-The glenohumeral joint, a multiaxial ball and socket joint, has inherent instability counterbalanced by the muscular stability of the rotator cuff (RC) and connective tissue. Exercise has been shown to alleviate pain and disability arising from degenerative changes of the RC due to overuse, trauma, or poor posture. This study compared the training effects of ShoulderSphere (SS), an innovative device that uses resistance to centrifugal force, to TheraBand (TB), a traditional device that uses resistance to elasticity. Thirty-five healthy male and female adults (24.2 ± 2.4 years) were randomized into 3 groups: SS, TB, and control. Five outcomes were assessed before and after the twice-weekly, 6-week intervention phase: strength (shoulder flexion [Fx], extension [Ext], external rotation [ER], and internal rotation [IR]), proprioception (6 positions), posterior shoulder endurance (ShEnd), stability (Upper Quarter Y-Balance Test [YBal] (superolateral [YBalSup], medial [YBalMed], and inferolateral [YBalInf]), and power (seated shot put [ShtPt]). Data were analyzed using a 3 (group: SS, TB, and control) × 2 (time: pre and post) generalized estimating equation. Analyses demonstrated a main effect of time for all strength motions (p < 0.01): YBalInf (p < 0.0001), ShtPt (p < 0.05), and ShEnd (p < 0.0001) but no interaction effects of group × time. There were no main or interaction effects for proprioception. Both SS and TB groups had significant within-group increases in Ext, IR, YBalInf, and ShEnd. Only the SS group had significant increases in ER, Fx, and ShtPt. ShoulderSphere demonstrated comparable conditioning effects with TB and may afford additional strength gains in Fx and ER, and power. ShoulderSphere should be considered a viable alternative in RC conditioning.

The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception

BACKGROUND

Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm.

OBJECTIVE

This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception.

METHODS

Hundred and twenty-two patients with hemiplegia were included in this study. The patients' shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n = 76) and group without HSP (Group 2, n = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion.

RESULTS

Upper extremity motor function and shoulder's proprioceptive sense at each angles of group 1 were found significantly worse than group 2's (p≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p < 0.005).

CONCLUSIONS

Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity.

A comparison of physical characteristics, functions and quality of life between breast cancer survivor women who had a mastectomy and healthy women

BACKGROUND

The quality of life of breast cancer survivors who had a mastectomy may decrease due to potential physical problems and reduced upper extremity functions.

OBJECTIVE

This study aimed to compare the physical characteristics, upper extremity functions and quality of life of breast cancer survivors and healthy women.

METHODS

A total of 66 women participated in this study: breast cancer survivors (n= 33) and healthy counterparts (n= 33) participated in this study. The Lateral Scapular Dyskinesia Slide Test was used to evaluate scapular dyskinesia, the hand-held dynamometer was used to measure upper extremity muscular strength, the Angle Reproduction Test was used to measure upper extremity position sense, the Disabilities of the Arm, Shoulder and Hand questionnaire was used to assess upper extremity functions, and the Short Form-36 was used to assess the quality of life.

RESULTS

The findings showed that the prevalence of scapular dyskinesia was higher, whereas upper extremity muscle strength, shoulder joint position sense, upper extremity functions and many sub-dimensions of quality of life were reduced in breast cancer survivor women compared to the healthy women (p< 0.05).

CONCLUSIONS

Several physical characteristics, upper extremity functions and quality of life of breast cancer survivor women who had a mastectomy were affected more in comparison to healthy women. Thus, these parameters should be included in physiotherapy assessment and treatment programs.

Acute effect of flexible bar exercise on scapulothoracic muscles activation, on isometric shoulder abduction force and proprioception of the shoulder of individuals with and without subacromial pain syndrome

BACKGROUND

There is currently no evidence about the effects of neuromuscular facilitation after the use of a flexible bar on scapulothoracic muscle activity in individuals with subacromial pain syndrome. The study aimed to assess the acute effect of flexible bar exercise and subjective fatigue on scapulothoracic muscle activity, shoulder proprioception, and shoulder abduction force of subjects with and without symptoms of subacromial pain syndrome.

METHOD

Fifty subjects with subacromial pain syndrome and 50 asymptomatic subjects were recruited. A short-term flexible bar exercise was performed to assess the vibratory stimulus effects on scapulothoracic muscle activity, shoulder proprioception, and shoulder abduction force, and the same exercise was performed on a long-term basis to assess the effects of subjective fatigue. The activities of the serratus anterior and three portions of the trapezius muscle were investigated using surface electromyography during arm elevation. The active joint position sense error was assessed to determine shoulder proprioception using a laser pointer. A hand-held dynamometer was used to assess isometric shoulder abduction force.

FINDINGS

No significant intra-group differences were found in scapulothoracic muscle activity, as well as in active joint position sense error and isometric shoulder abduction force in either group (p >0.05).

INTERPRETATION

The acute effects of flexible bar exercise and subjective fatigue were unable to influence scapulothoracic muscle activation, shoulder joint position sense, and isometric shoulder abduction force in subacromial pain syndrome.

Variability of shoulder girdle proprioception in 44 healthy volunteers

BACKGROUND

Improved knowledge of normal shoulder girdle proprioception should benefit the treatment and rehabilitation of shoulder disorders. Whereas many of the available methods for assessing joint position sense (JPS) are costly and complex, Balke et al. have described a simple test. The primary objective of this study was to use this test to identify factors that influence shoulder-girdle JPS evaluation in healthy individuals. The secondary objective was to determine reference values based on the values obtained and on the factors associated with their variability.

HYPOTHESIS

Age and dominant limb influence the results of shoulder girdle JPS evaluation, creating a need for reference values that take these factors in account.

PATIENTS AND METHODS

A single-centre prospective study of healthy volunteers was performed between September 2012 and January 2013. In each volunteer, shoulder repositioning accuracy was assessed bilaterally as described by Balke et al. A line was drawn on the floor parallel to and 1 metre away from a wall. A target on the wall showed marks corresponding to three angles of arm elevation: 55°, 90°, and 125°. The volunteer was asked to raise the arm to the three positions, in abduction and in flexion, while memorising the joint positions, then to replicate the same positions with the eyes closed. The absolute differences between the replicated positions and the reference positions, designated angle deviations, were measured in degrees. Age, sex, and dominant upper limb were recorded.

RESULTS

The 88 shoulders of 44 healthy volunteers were studied. No significant difference was found between males and females (p>0.05). The only significant difference between sides was better replication by the dominant arm of flexion at 55° (p=0.03). By univariate analysis, age was the only factor significantly associated with repositioning errors (p=0.003); neither dominant limb nor sex were significant (p=0.29 and p=0.59, respectively). In flexion, the angle deviation increased significantly with movement amplitude. The measurements were used to create a chart of expected angle deviations in healthy individuals according to age and to plane and amplitude of movement.

DISCUSSION

The test described by Balke et al. is simple and feasible in everyday practice. Age, dominance, and plane of movement should be considered when evaluating abnormal shoulders. Further studies in larger numbers of individuals are needed to better define normal angle deviations related to these factors.

LEVEL OF EVIDENCE

IV.

Shoulder proprioception: How is it measured and is it reliable? A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION

Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder.

PURPOSE OF THE STUDY

To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols.

METHODS

A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale.

RESULTS

Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies.

CONCLUSION

Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed.

LEVEL OF EVIDENCE

Level 1a: systematic review.

Errors in Shoulder Joint Position Sense Mainly Come from the Glenohumeral Joint

While synchronous movement of the glenohumeral and scapulothoracic joints has been emphasized in previous kinematics studies, most investigations of shoulder joint position sense have treated the shoulder complex as a single joint. The purposes of this study were to investigate the joint position sense errors of the humerothoracic, glenohumeral, and scapulothoracic joints at different elevation angles and to examine whether the errors of the glenohumeral and scapulothoracic joints contribute to the errors of the humerothoracic joint. Fifty-one subjects with healthy shoulders were recruited. Active joint position sense of the humerothoracic, glenohumeral, and scapulothoracic joints was measured at 50°, 70°, and 90° of humerothoracic elevation in the scapular plane. The results showed that while scapulothoracic joint position sense errors were not affected by target angles, there was an angle effect on humerothoracic and glenohumeral errors, with errors decreasing as the target angles approached 90° of elevation. The results of a multiple regression analysis revealed that glenohumeral errors explained most of the variance of the humerothoracic errors and that scapulothoracic errors had a weaker predictive relationship with humerothoracic errors. Therefore, it may be necessary to test scapular joint position sense separately in addition to the assessment of the overall shoulder joint position sense.

Joint position sense - There׳s an app for that

Traditionally, proprioception has been assessed with a passive model, in which an external apparatus moves a body segment. Recently, protocols have been developed based on active movements, which are more representative of functional activities. However, even these approaches require expensive testing equipment and the necessity of a visit to a research lab, as there are no commercially available mobile instruments that allow for the assessment of proprioception outside of a laboratory setting. The objective of this study was to demonstrate the validity and feasibility of using a mobile device (iPod Touch) to assess joint position. We conducted a concurrent validity study in the lab (n=9) and a field based study (n=79). The field based study was conducted at the 2012 American Society of Biomechanics meeting in Gainesville, Florida. The results of both studies demonstrate good agreement with our established protocol using a magnetic tracking device, with angular errors decreasing with increasing shoulder flexion angles. The studies demonstrate the validity and feasibility of using mobile devices for assessing motion-based parameters, both inside and outside of a laboratory setting.

Upper limb joint position sense during shoulder flexion in healthy individuals: a pilot study to develop a new assessment method

BACKGROUND

Altered shoulder joint position sense (JPS) following shoulder injury has been demonstrated in the literature and may increase the risk of injury. A JPS assessment targeting the shoulder will provide the clinician with an objective marker. The present study aimed to develop an assessment method of JPS using an active relocation test (ART).

METHODS

In total, 40 healthy participants were recruited. A laser-pointer attached to the index finger during an ART allowed measurement (mm) of JPS by measuring the distance between the target and relocated position. Participants were blindfolded and stood an arm's length (approximately 1 m) away from the wall. Whilst keeping the wrist in neutral and elbow extended, the participant actively moved to the target position (90° glenohumeral flexion), held for 5 seconds, returned their arm to their side and actively returned to the target position. A mean was calculated from three trials to provide an ART score.

RESULTS

The mean (SD) dominant and nondominant ART score was 89.2 (SD 35.5) mm (95% confidence interval = 77.87 mm to 100.5 mm) and 94.1 (34.5) mm (95% confidence interval = 83.1 mm to 105.2 mm), respectively. Arm dominance did not significantly affect ART scores.

CONCLUSIONS

No significant difference was demonstrated between the dominant and nondominant arm using an ART assessing JPS acuity. Further studies are needed to establish inter-rater and intra-rater reliability.

Mobile Phone-Based Joint Angle Measurement for Functional Assessment and Rehabilitation of Proprioception

Assessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM). Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS). Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home.

Upper limb kinematics after arthroscopic and open shoulder stabilization

BACKGROUND

Shoulder joint stability mediated by proprioception is often quantified by arm repositioning tests (i.e., static end-position accuracy), overlooking ongoing movement quality. This study assessed movement quality by adopting smoothness-related kinematic descriptors. We compared performance of healthy controls with that of patients in arthroscopic shoulder stabilization and open shoulder stabilization groups. We hypothesized that arm kinematics after arthroscopic intervention would more closely resemble healthy movements compared with patients after open shoulder stabilization surgery.

METHODS

Healthy controls (N = 14) were compared with patients after arthroscopic shoulder stabilization (N = 10) and open shoulder stabilization (N = 12). Right-hand dominant subjects (the affected side in patients) performed 135 unconstrained 3-dimensional pointing movements toward visual targets (seen through pinhole goggles; i.e., no arm vision). Arm kinematic data were recorded and offline analyzed to obtain hand tangential velocity profiles further used to compute the acceleration-to-movement time ratio, peak-to-mean velocity ratio, and number of velocity peaks ("symmetry," "proportion," and "fragmentation" features, respectively). Parametric and nonparametric statistics were used for comparisons (P ≤ .05).

RESULTS

Control and arthroscopic shoulder stabilization groups presented similar acceleration-to-movement time ratio and peak-to-mean velocity ratio. Both groups differed from the open shoulder stabilization group (P = .001). Distributions of velocity peaks for control and arthroscopic shoulder stabilization groups were similar, whereas open shoulder stabilization and control subjects differed significantly (P = .028).

CONCLUSIONS

Movement quality mediated by proprioception in arthroscopic shoulder stabilization patients matches that of healthy controls, whereas performance in open shoulder stabilization patients seems inferior compared with that in healthy controls, as assessed by smoothness-related measures (less symmetrical, more fragmented movements).

Interest of emergency arthroscopic stabilization in primary shoulder dislocation in young athletes

INTRODUCTION

The recurrence rate after primary shoulder dislocation in young subjects with high functional demand is close to 75%. The present study assessed the interest of emergency arthroscopic stabilization in this specific population.

MATERIAL AND METHODS

A non-randomized prospective study included 31 athletes under 30 years of age with primary anterior shoulder dislocation. Fifteen were offered emergency stabilization; after informed consent, 14 were enrolled in the "emergency stabilization" group. This was compared to a group matched for age, sport and lesion, managed 1 year previously by "non-operative" treatment (n=17), divided into 2 subgroups: "immobilization" and "secondary stabilization". Continuous prospective assessment of recurrence, return to sport and function (QuickDASH, QDsport, Duplay and Rowe scores) enabled comparison between the 3 groups.

RESULTS

Mean follow-up was 19 months for the "emergency stabilization" group and 25 months for the "non-operative" group. There were no failures in the "emergency stabilization" group, compared to a 77% rate in the "non-operative" group with onset at a mean 7.5 months and a mean 2.6 episodes of recurrence. Seven (54%) of the failures of non-operative treatment required secondary stabilization. Ninety-three percent of the "emergency stabilization" group, 44% of the "immobilization" group and 71% of the "secondary stabilization" group resumed sport at least at their pre-dislocation level. Mean Quick DASH was 1.46 in the "emergency stabilization" group, versus 15.28 the "immobilization" group (P<0.05) and 16.96 in the "secondary stabilization" group. Mean Duplay and Rowe scores were respectively 92.9 and 95 in the "emergency stabilization" group, versus 59.44 and 61.1 in the "immobilization" group (P<0.05) and 85 and 93.57 in the "secondary stabilization" group.

DISCUSSION

Emergency arthroscopic stabilization limits recurrence (Kirkley et al.), with better functional results than for secondary stabilization, lesion "freshness" providing a more favorable environment for labral and ligamentary healing. These encouraging results need confirmation over longer follow-up.