Effect of flexibility deficit on scapular asymmetry in individuals with and without shoulder pain

The Pericoracoid Tissue Release in Children With Brachial Plexus Birth Injury

PURPOSE

In brachial plexus birth injury (BPBI), children with upper trunk injuries have multidirectional movement deficits, including global abduction and hand-to-neck, hand-to-abdomen, and hand-to-spine movements. The aim of this study was to evaluate the results of pericoracoid tissue release and postoperative structured physiotherapy as a first-step intervention to reduce the multidirectional movement deficit in children with BPBI.

METHODS

Thirty-four children with BPBI underwent pericoracoid tissue release, including coracohumeral and coracoacromial ligament release, pectoralis minor release, and coracoid process osteotomy. Patients were followed up with regular physiotherapy and a home exercise program for 1 year after surgery. Before surgery and at 3 and 12 months after surgery, upper-extremity function was measured using the modified Mallet classification and Active Movement Scale, passive shoulder and elbow joint movements were measured using goniometry, and the difference in the distance between the treatment table and the acromion was measured.

RESULTS

There was an improvement in all movement tasks evaluated with modified Mallet classification, and there was increased shoulder flexion, abduction, and external and internal rotation movements as evaluated with Active Movement Scale. Increased passive joint movements were noted in abduction, external rotation, and internal rotation movements with the arm next to the body and with the limb in 90° abduction. There was a decrease in the distance difference between the acromion and the treatment table between both sides.

CONCLUSIONS

Pericoracoid tissue release provided multidirectional improvement in shoulder joint movements in children with BPBI.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Pragmatic posterior capsular stretch and its effects on shoulder joint range of motion

OBJECTIVE

To evaluate the immediate effects of pragmatic posterior capsular stretch (PPCS) on shoulder joint range of motion (ROM).

METHOD

A quasi-experimental design was used to recruit healthy subjects of age 21.43 (±1.960) years, height 165.8 (±2.1069) cm and weight 63.90 (±13.187) kg. Inclusion criteria were grade 1 and grade 2 of the shoulder mobility test of functional movement screening. Preintervention and postintervention measurement of flexion, abduction, internal rotation (IR), external rotation (ER), reaching up behind the back (RUBTB) and reaching down behind the neck (RDBTN) were compared. A therapist-administered PPCS was the only intervention applied.

RESULTS

Paired t-test statistics showed improvement (mean°±SD) in shoulder flexion (13.5°±8.11), abduction (11°±8.35), IR (8.5°±10.27), ER (7.83°±7.15), RUBTB (17.34°±13.81) inches and RDBTN (2.93±1.52) inches. The changes in these ROM and functional movements were statistically significant (p<0.05).

CONCLUSION

PPCS can effectively improve the functional movement of RUBTB and shoulder ROM in healthy subjects. It is recommended for the trials on prevention and rehabilitation of shoulder pathologies.

TRIAL REGISTRATION NUMBER

NCT04242888.

The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity

Background

Post-stroke scapular dyskinesia is a predisposing factor for the affection of motor and somatosensory functions of the hemiparetic upper extremity.

Objective

The purpose of the study was to investigate the effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity.

Subjects and methods

Sixty patients with spasticity post-stroke participated in this study. The patients were assigned to one of the two groups as determined by the lateral scapular slide test (LSST) using the palpation meter (PALM); group A with scapular dyskinesia and group B stroke patients without scapular dyskinesia. The scapular position was determined by a measurement of scapular balance angle (SBA), and the upper extremity sensorimotor function was evaluated using Fugl-Meyer Assessment upper extremity (FMAUE) scale. The scapular balance angle and Fugl-Meyer upper extremity scores were compared between groups.

Results

There was a significant increase in the scapular balance angle of group A compared with that of group B (p < 0.001). Also, there was a significant decrease in sensory and motor functions of group A as measured by Fugl-Meyer upper extremity compared with that of group B (p < 0.001).

Conclusion

Scapular dyskinesia had a significant effect on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Management of scapular dyskinesia should be emphasized in the rehabilitation program for stroke patients with spasticity.

Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators

BACKGROUND

Modifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine-shoulder and spine-pelvis relationships suggest that the pelvis may influence shoulder posture.

OBJECTIVE

To investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm.

METHODS

Thirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed.

RESULTS

Paired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=-2.79 to -1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=-0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=-2.79 to -0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=-3.36 to 9.87).

CONCLUSION

The influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.