1
|
Tudini F, Jordon M, Levine D, Healy M, Cathey S, Chui K. Evaluating the effects of two different kinesiology taping techniques on shoulder range of motion and proprioception in patients with hypermobile Ehlers-Danlos syndrome: a randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1383551. [PMID: 38836006 PMCID: PMC11148207 DOI: 10.3389/fresc.2024.1383551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
Background Ehlers-Danlos syndrome (EDS) is a common group of inherited connective tissue disorders with a prevalence as high as 0.75%-2% of the population. Physical manifestations include pain and decreased proprioception, especially in more mobile joints, such as the shoulder. The kinesiology tape (K-Tape) is often used to treat patients with shoulder dysfunction. The effectiveness of the K-Tape is uncertain, and there is a lack of studies specifically studying the K-Tape in an EDS population. Purpose The purpose of this study was to compare the short-term effects of two different K-Tape procedures on shoulder active joint reposition (AJR) and active range of motion (AROM) in patients with hypermobile EDS (hEDS) and shoulder pain. Methods All participants were recruited from the EDS support groups and presented with shoulder pain. Baseline demographic information was obtained for each participant, after which AROM and AJR were assessed. The participants were randomized to receive one of two K-Tape procedures. Testing was repeated immediately post-taping and 48 h post-taping. Results Significant improvements in shoulder external (F = 10.917, p < 0.001) and internal (F = 11.736, p < 0.001) rotations were seen from baseline to immediately post-taping and baseline to 48 h post-taping in the experimental K-Tape group. There were no significant differences in the shoulder rotation in the control K-Tape group and no significant differences in either group for shoulder flexion or AJR at any time point (p > 0.05). Conclusion K-Tape may offer short-term improvements in shoulder rotation AROM in patients with hEDS and shoulder pain.
Collapse
Affiliation(s)
- Frank Tudini
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Max Jordon
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - David Levine
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Michael Healy
- Healy Physical Therapy and Sports Medicine, East Providence, RI, United States
| | - Sarah Cathey
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Roanoke, VA, United States
| |
Collapse
|
2
|
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.
Collapse
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.)
| | | |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Malmberg C, Andreasen KR, Bencke J, Kjær BH, Hølmich P, Barfod KW. Biomechanical and neuromuscular characteristics in patients with traumatic anterior shoulder instability undergoing arthroscopic Bankart repair: a clinical prospective cohort study protocol. BMJ Open 2024; 14:e078376. [PMID: 38431300 PMCID: PMC10910411 DOI: 10.1136/bmjopen-2023-078376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Traumatic shoulder dislocation is a common shoulder injury, especially among the young and active population. More than 95% of dislocations are anterior, in which the humeral head is forced beyond the anterior glenoid rim. The injury leads to increased joint laxity and recurrence rates are high. There is evidence that the shoulder biomechanics and neuromuscular control change following dislocation, but the existing literature is scarce, and it remains to be established if and how these parameters are useful in the clinical setting. The aim of this exploratory prospective cohort study is to investigate biomechanical and neuromuscular outcomes in patients with traumatic anterior shoulder instability undergoing arthroscopic Bankart repair, to test the hypothesis that examinations of these characteristics are applicable in the clinical setting to assess shoulder instability. METHODS AND ANALYSIS This is a prospective multicentre cohort study with repeated measures of 30 patients undergoing arthroscopic Bankart repair. With carefully selected and completely non-invasive examination methods, we will investigate biomechanical and neuromuscular outcomes in the affected shoulders once presurgically and twice post surgically at 6 and 12 months. Patients' contralateral shoulders are investigated once to establish a preinjury level. ETHICS AND DISSEMINATION The study was approved by the Capital Region Ethics Committee (journal-no: H-21027799) and the Capital Region Knowledge Center for Data Reviews (journal-no: P-2021-842) before patient recruitment began. The study results will be published in international peer-reviewed journals, online and in other relevant media, presented at medical conventions and disseminated to clinicians and patients as appropriate. TRIAL REGISTRATION NUMBER NCT05250388.
Collapse
Affiliation(s)
- Catarina Malmberg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristine Rask Andreasen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Institute of Sports Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Per Hølmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - K W Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
5
|
Sayyadi P, Minoonejad H, Seidi F, Shikhhoseini R, Arghadeh R. The effectiveness of fatigue on repositioning sense of lower extremities: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2024; 16:35. [PMID: 38311746 PMCID: PMC10840207 DOI: 10.1186/s13102-024-00820-w] [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: 01/18/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION An injury can significantly harm both individual and team performance. One of the most important risk factors for sports-related injuries, especially non-collision injuries, is fatigue. It seems that poor proprioception may play an essential role to impose athletes to further injuries. This systematic review and meta-analysis aimed to examine the effectiveness of fatigue on the repositioning sense of the lower extremity joints. METHOD The electronic databases, including PubMed, Web of Science, Scopus, and Google Scholar were systematically searched from inception to 11January 2024. The obtained records were exported to the EndNote Software version 8. Then, two investigators examined the records independently to find eligible studies based on the inclusion/exclusion criteria. In the case of disagreements, a consequence method was utilized. The quality of the eligible studies was evaluated using the Downs and Black checklist. Comprehensive Meta-Analysis (CMA) software ver. 3 software was used for statistical analysis. Q-test and I2 were employed to examine the data homogeneity. In addition, considering the risk of bias, the Funnel Plot and trim-and-fill method were used. RESULTS After reviewing the titles and abstracts of 3883 studies found in the selected databases, 43 articles were found to be eligible to include in meta-analyses. The results showed that fatigue led to a significant increase in the active absolute error of the knee (SDM = 0.524, 95% CI = 0.406-0.841), ankle in the horizontal plane (SDM = 0.541, 95% CI = 0.367-0.715), ankle in the sagittal plane (SDM = 0.443, 95% CI = 0.088-0.798), and hip (SDM = 0.988, 95% CI = 0.135-1.841). However, fatigue had no significant effects on the passive absolute error of the knee and ankle in horizontal plane and relative angular error of the knee. CONCLUSION Fatigue can diminish the active joint position sense of the lower extremities and thus may increase the risk of injury by reducing proprioception. Therefore, future research could be conducted to investigate the potential impact of integrated fatigue-mitigating exercises into athletes' training programs, with the aim of reducing the incidence of sports-related injuries.
Collapse
Affiliation(s)
- Parisa Sayyadi
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Iran, Tehran, Iran.
| | - Foad Seidi
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Iran, Tehran, Iran
| | - Rahman Shikhhoseini
- Department of Corrective Exercise and Sports Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ramin Arghadeh
- Department of Sports injury and biomechanics, Faculty of Sport Sciences and health, University of Tehran, Tehran, Iran
| |
Collapse
|
6
|
Rawal A, Eckers F, Lee OSH, Hochreiter B, Wang KK, Ek ET. Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population. J Clin Med 2024; 13:724. [PMID: 38337418 PMCID: PMC10856087 DOI: 10.3390/jcm13030724] [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: 11/18/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control.
Collapse
Affiliation(s)
- Aziz Rawal
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
| | - Franziska Eckers
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Orthopädie und Traumatologie, Universitätsspital Basel, 4031 Basel, Switzerland
| | - Olivia S. H. Lee
- Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Bettina Hochreiter
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8006 Zürich, Switzerland
| | - Kemble K. Wang
- Department of Orthopaedic Surgery, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia; (A.R.); (F.E.)
- Department of Surgery, Monash University, Melbourne, VIC 3800, Australia
| |
Collapse
|
7
|
Alfaya FF, Reddy RS, Alkhamis BA, Kandakurti PK, Mukherjee D. Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study. Diagnostics (Basel) 2023; 13:2099. [PMID: 37370994 DOI: 10.3390/diagnostics13122099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Subacromial Impingement Syndrome (SAIS) is a common shoulder condition characterized by pain and functional impairment. Proprioception, the sense of joint position and movement, is crucial in maintaining joint stability and coordinating movements. The relationship between shoulder proprioception, pain intensity, and functional disability in individuals with SAIS remains unclear, with conflicting findings in the literature. This cross-sectional study aimed to evaluate shoulder proprioception, examine its correlation with pain intensity and functional disability, and contribute to our understanding of the clinical implications of proprioceptive deficits in individuals with SAIS. Forty-two individuals were diagnosed with SAIS, and an equal number of asymptomatic controls were recruited. Shoulder proprioception was assessed using a digital inclinometer, measuring joint position sense at various angles of flexion and rotation. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Shoulder Pain and Disability Index (SPADI). Results: Individuals with SAIS exhibited significantly higher joint position error (JPE) values compared to asymptomatic controls in all measured angles of flexion and rotation (p < 0.001). Strong positive correlations were observed between JPE and pain intensity (r = 0.61 to 0.71, p < 0.01) and disability (r = 0.56 to 0.68, p < 0.01). These findings suggest impaired shoulder proprioception is associated with higher pain intensity and functional disability in SAIS. This study provides evidence of impaired shoulder proprioception in individuals with SAIS and its correlation with pain intensity and functional disability. The results highlight the clinical relevance of proprioceptive deficits in SAIS and emphasize the importance of incorporating proprioceptive assessment and targeted rehabilitation interventions into managing this condition. Future research should focus on longitudinal studies with larger and more diverse samples to further understand the underlying mechanisms and evaluate the effectiveness of proprioceptive interventions in improving outcomes for individuals with SAIS.
Collapse
Affiliation(s)
- Fareed F Alfaya
- Department of Orthopaedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Batool Abdulelah Alkhamis
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | | | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| |
Collapse
|
8
|
Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord 2023; 24:232. [PMID: 36978047 PMCID: PMC10044783 DOI: 10.1186/s12891-023-06346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. METHODS PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. RESULTS 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep's role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy's limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. CONCLUSIONS The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. PRE-REGISTRATION OSF: https://osf.io/erh9m.
Collapse
Affiliation(s)
- Brendan Diplock
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Darryn Marks
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| |
Collapse
|
9
|
ARSLAN S, YAPALI G. THE INTER-RATER AND INTRA-RATER RELIABILITY OF GLENOHUMERAL JOINT POSITION AND MOVEMENT SENSE TESTS APPLIED USING AN ISOKINETIC DYNAMOMETER. TÜRK FIZYOTERAPI VE REHABILITASYON DERGISI 2022. [DOI: 10.21653/tjpr.997172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: The aim of this study was to test the inter-rater and intra-rater reliability of glenohumeral joint (GHJ) position and movement sense tests of an isokinetic dynamometer in healthy individuals.
Methods: The study included 17 healthy subjects. GHJ position and movement sense tests were applied with an isokinetic dynamometer to the dominant extremity.
Results: The different error types calculated for position sense were in the range of mean 0.02±1.62 - 5.42±1.74. The ICC value for the different error types was determined in the range of 0.038 - 0.657 for the intra-rater tests, and 0.095 - 0.779 for the inter-rater tests. The movement sense test results for different directions and angles ranged from 9.61±2.61 to 11.18±2.89. The ICC values for movemeent sense were in the range of 0.687 – 0.912 for the intra-rater tests, and 0.844 - 0.925 for the inter-rater tests.
Conclusion: The isokinetic dynamometer showed moderate-good intra-rater and inter-rater test reliability in the measurement of the GHJ internal rotation movement sense. The intra-rater test reliability was poor in external rotation but the inter-rater test reliability was moderate-good. However in the measurement of movement sense, the isokinetic dynamometer showed intra-rater and inter-rater test reliability at an excellent level. The conformity of both the position and the movement sense tests, and therefore, the repeatability, was extremely good.
Collapse
|
10
|
Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091248. [PMID: 36143925 PMCID: PMC9505091 DOI: 10.3390/medicina58091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.
Collapse
|
11
|
Effects of Adding Aquatic-to-Land-Based Physiotherapy Programs for Shoulder Joint Position Sense Rehabilitation. Healthcare (Basel) 2022; 10:healthcare10020332. [PMID: 35206946 PMCID: PMC8871719 DOI: 10.3390/healthcare10020332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
There is limited evidence regarding the effects of aquatic-based physiotherapy on shoulder proprioception following post-traumatic injury to the joint. The main aim of this study was to investigate the effects of additional aquatic-based rehabilitation to a land-based physiotherapy program on shoulder joint position sense (JPS) rehabilitation. Forty-four individuals (mean age 44.50 ± 10.11) who had suffered a post-traumatic shoulder injury less than five months previously were pseudo-randomly allocated equally into a control group (9 females, 13 males) and experimental group (6 females, 16 males). Both groups received individualized standard land-based physiotherapy on average for 50 min per session, with five sessions per week for four consecutive weeks. The experimental group received an additional 30 min of personalized aquatic-based therapy during each session. Shoulder JPS was assessed by flexion (60°), extension (25°), abduction (60°), internal rotation (35°) and external rotation (35°) positions prior, halfway through, and after the intervention. Shoulder JPS improved significantly for all positions for both the control group (p < 0.03) and the experimental group (p < 0.01). No significant differences between the control group and the experimental group were found for change in shoulder JPS over time. Our results indicate that shoulder JPS can be significantly improved among individuals with post-traumatic injury to the joint through four weeks of personalized physiotherapy. The addition of aquatic-based exercises to standard land-based therapy did not, however, show significant benefits, and thus cannot be recommended for the improvement of shoulder JPS based on our findings.
Collapse
|
12
|
Forcin Favaro I, Martins J, Rossi DM, de Lima Boarati E, Felippe de Morais M, Oliveira AS. Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome. Physiother Theory Pract 2022; 39:1287-1296. [PMID: 35135433 DOI: 10.1080/09593985.2022.2035031] [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
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 Coefficient2,3 = 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 (rs = 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.
Collapse
Affiliation(s)
- Isabela Forcin Favaro
- Physiotherapy Graduate Program of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Denise Martineli Rossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo de Lima Boarati
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Mayra Felippe de Morais
- Physiotherapy Graduate Program of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anamaria Siriani Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Chen Z. Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries. HAND THERAPY 2021; 26:123-133. [PMID: 37904835 PMCID: PMC10584051 DOI: 10.1177/17589983211033313] [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: 10/12/2020] [Accepted: 06/30/2021] [Indexed: 11/01/2023]
Abstract
Introduction Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Methods Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the 'push-off' test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Results Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen's D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. Discussion WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.
Collapse
Affiliation(s)
- Zhiqing Chen
- Occupational Therapy Department, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
14
|
Proprioception: How is it affected by shoulder pain? A systematic review. J Hand Ther 2021; 33:507-516. [PMID: 31481340 DOI: 10.1016/j.jht.2019.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proprioception encompasses the submodalities of joint position sense (JPS), kinesthesia, sense of force, and velocity. Owing to the vast mobility of the shoulder, it heavily relies on an intact sense of proprioception. Moreover, shoulder injuries are associated with a decreased sense of proprioception. What remains unclear is how shoulder proprioception is affected by pain and competing nociceptive senses. PURPOSE OF THE STUDY To summarize the literature evaluating the relationship between pain and shoulder proprioception. METHODS A literature review was conducted from inception until 22 October 2018, using electronic databases (PubMed, Web of Science, Scopus, EBSCO, CINAHL, and Embase). Retrieved citations were screened for eligibility, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Eleven studies were included (n = 447 participants with shoulder pain, n = 20 with experimentally induced pain [EIP]/n = 600 painful shoulders and n = 20 [EIP]). The mean methodological quality of the studies was good (76%). Five studies investigated active JPS, four investigated passive JPS, six investigated kinesthesia, sense of force was measured in one study, and no study investigated sense of velocity. There is moderate evidence for impaired kinesthesia and low evidence for reduced sense of force among painful shoulders. Conflicting evidence is seen for the other proprioceptive submodalities. CONCLUSION The overall impact of pain on shoulder JPS remains unclear, while moderate evidence for an affected sense of kinesthesia is possible. There is low evidence for an impaired sense of force among painful shoulders. Standardization between studies is lacking, limiting the range of our conclusions. Further investigation is required into well-controlled and pain-induced studies to better understand the influence of pain on shoulder proprioception.
Collapse
|
15
|
Zarei M, Eshghi S, Hosseinzadeh M. The effect of a shoulder injury prevention programme on proprioception and dynamic stability of young volleyball players; a randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:71. [PMID: 34193267 PMCID: PMC8246688 DOI: 10.1186/s13102-021-00300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The "FIFA 11 + Shoulder" programme has been reported to reduce the incidence of upper extremity injuries among soccer goalkeepers. It has also been recommended for overhead sports. The purpose of this study was therefore to investigate the effect of an 8-week "FIFA 11 + shoulder" (11 + S) programme on shoulder joint position sense (JPS), threshold to detect passive motion (TTDPM) and upper quarter Y Balance Test in young male volleyball players. METHODS Thirty-two healthy young elite male volleyball players (17.49 ± 1.47 years) participated in this quasi-experimental study. Participants, recruited from two clubs participating in Iranian premier league, were randomly assigned into two groups; (1) the intervention group who performed the "FIFA 11 + shoulder" programme as their warm up protocol, three times per week, and (2) the control group who kept their routine warm up protocol meanwhile. Proprioception tests including JPS and TTDPM of internal and external rotator muscles of the dominant shoulder were recorded via the isokinetic system pro 4. The upper quarter Y Balance Test determined the shoulder dynamic stability. RESULTS No statistically significant differences were observed for JPS and TTDPM of shoulder internal and external rotator muscles; shoulder stability however significantly increased only in the intervention group (p = 0.03, ηp2=0.02). CONCLUSION Upper quarter dynamic stability improvement due to the 11+S programme leads to volleyball players' performance and may therefore contribute to a reduction in risk of sustaining injury if applied long-term. TRIAL REGISTRATION The trial was retrospectively registered atIranian Registry of Clinical Trials with the number of IRCT20201030049193N1 at 04/12/2020.
Collapse
Affiliation(s)
- Mostafa Zarei
- Sport Rehabilitation and Health Department, Faculty of Sports Sciences and Health, Shahid Beheshti University, Velenjak Square, Evin, 1983963113 Tehran, Iran
| | - Saeed Eshghi
- Sport Rehabilitation and Health Department, Faculty of Sports Sciences and Health, Shahid Beheshti University, Velenjak Square, Evin, 1983963113 Tehran, Iran
| | - Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| |
Collapse
|
16
|
Upper limb active joint repositioning during a multijoint task in participants with and without rotator cuff tendinopathy and effect of a rehabilitation program. J Hand Ther 2021; 33:73-79. [PMID: 30857891 DOI: 10.1016/j.jht.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional and longitudinal (exploratory) studies. INTRODUCTION Rotator cuff (RC) tendinopathy is the most prevalent shoulder diagnosis, and proprioception deficits are often observed in individuals with RC tendinopathy. PURPOSE OF THE STUDY This study aimed to evaluate upper limb proprioception during a multijoint task in participants with and without RC tendinopathy and to determine if symptoms, functional limitations, and proprioception are improved after a rehabilitation program. METHODS Twenty participants with and 20 without RC tendinopathy were recruited for the cross-sectional study, and 23 participants with RC tendinopathy were recruited for the longitudinal study. Proprioception was evaluated by an active joint-repositioning task: The upper limb was passively moved to a predetermined position, and the participant was asked to actively replicate the movement. The difference between the predetermined position and the replicated position was measured. The mean errors in positions of lateral, medial, and neutral rotation of the shoulder and the global mean error were reported. In addition to the active-repositioning assessment in the longitudinal study, symptoms and functional limitations were evaluated by the Disability of the Arm Shoulder and Hand questionnaire. RESULTS Significant deficits in active repositioning (p < .01), independent of the position, were observed in participants with RC tendinopathy compared with controls. The DASH score was improved after rehabilitation intervention (p < .001), and patients with active-repositioning deficits at baseline had reduced repositioning error (p < .05). CONCLUSIONS Upper limb active joint repositioning was impaired in participants with RC tendinopathy. Symptoms and functional limitations and active joint repositioning in participants with RC tendinopathy and initial deficits were improved after a 6-week global rehabilitation program.
Collapse
|
17
|
Nishigami T, Watanabe A, Maitani T, Shigetoh H, Mibu A, Wand BM, Catley MJ, Stanton TR, Moseley GL. Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain. BMC Musculoskelet Disord 2021; 22:98. [PMID: 33478446 PMCID: PMC7819341 DOI: 10.1186/s12891-021-03944-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 01/02/2021] [Indexed: 12/17/2022] Open
Abstract
Background There is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain. Methods The Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis. Results The FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization. Conclusions The FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.
Collapse
Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1, Gakuen-chou, Mihara, Hiroshima, 723-0053, Japan.
| | - Akihisa Watanabe
- Department of Rehabilitation, Machida Orthopaedics, Kochi, Japan
| | - Toshiki Maitani
- Department of Rehabilitation, Utsumi Orthopaedics Clinic, Kagawa, Japan
| | - Hayato Shigetoh
- Department of Rehabilitation, Miura internal Medicine Michiko Pediatrics Clinic, Kagawa, Japan
| | - Akira Mibu
- Department of Nursing and Physical Therapy, Konan Woman's University, Kobe, Hyogo, Japan
| | - Benedict Martin Wand
- The School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Mark J Catley
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University of South Australia, Adelaide, SA, Australia
| | - Tasha R Stanton
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University of South Australia, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - G Lorimer Moseley
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University of South Australia, Adelaide, SA, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| |
Collapse
|
18
|
Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
Collapse
Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| |
Collapse
|
19
|
Overbeek CL, Gacaferi H, Schoones JW, Jayakumar P, Vermeulen HM, de Groot JH, Nelissen RGHH, Nagels J. The effect of conservative therapies on proprioception in subacromial pain syndrome: a narrative synthesis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1787511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Celeste L. Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Hamez Gacaferi
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands
| | - Prakash Jayakumar
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henricus M. Vermeulen
- Department of Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
20
|
Mohamed AA, Jan YK, El Sayed WH, Wanis MEA, Yamany AA. Dynamic scapular recognition exercise improves scapular upward rotation and shoulder pain and disability in patients with adhesive capsulitis: a randomized controlled trial. J Man Manip Ther 2020; 28:146-158. [PMID: 31200629 PMCID: PMC7480516 DOI: 10.1080/10669817.2019.1622896] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Examine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis of the shoulder. METHODS A test-retest randomized controlled study design was used. A total of sixty-six patients with unilateral adhesive capsulitis were equally divided into two groups. The study group received a dynamic scapular recognition exercise using a wireless biofeedback system, while the control group received placebo treatment in the form of active range-of-motion (ROM) exercises of the sound upper limb. A digital inclinometer was used to measure the scapular upward rotation and ROM of the shoulder joint, and the Shoulder Pain and Disability Index (SPADI) was used to measure the shoulder pain and disability. RESULTS Study results showed that after two weeks, there were statistically significant differences between the study and control groups in scapular upward rotation and shoulder flexion and abduction (P < .05) and nonsignificant differences in shoulder external rotation and SPADI (P > .05). After two and six months, there were statistically significant differences between study and control groups in scapular upward rotation; shoulder flexion, abduction and external rotation; and SPADI scores (P < .05). CONCLUSION This study showed that a dynamic scapular recognition exercise significantly improves scapular upward rotation and the ROM of shoulder flexion and abduction after two weeks. At two and six months, this exercise improves scapular upward rotation; ROM of shoulder flexion, abduction, and external rotation; and SPADI scores. These improvements persisted for six months after the performance of this exercise.
Collapse
Affiliation(s)
- Ayman A. Mohamed
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Department of Basic Science and Biomechanics, Faculty of Physical Therapy, Beni-Suef University, Beni-SuefEgypt
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Wadida H. El Sayed
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, GizaEgypt
| | | | - Abeer A. Yamany
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, GizaEgypt
| |
Collapse
|
21
|
Chen Z. A novel staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex injury: A case report. J Hand Ther 2020; 32:525-534. [PMID: 30017412 DOI: 10.1016/j.jht.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/07/2018] [Accepted: 04/01/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Studies have highlighted the sensory innervations and stabilizing role of forearm muscles on wrist joint and implications to wrist sensorimotor rehabilitation. This case explored the novel incorporation of dart-throwing motion and proprioceptive neuromuscular facilitation in wrist sensorimotor rehabilitation. PURPOSE OF THE STUDY To describe and evaluate a staged wrist sensorimotor rehabilitation program for a patient with triangular fibrocartilage complex (TFCC) injury. METHODS The patient participated in the staged program for 9 sessions over a 3-month period. Treatment involved neuromuscular strengthening at the wrist and movement normalization of the upper extremity. Outcome measures were grip strength, visual analog scale, joint position sense, Quick Disabilities of the Arm, Shoulder and Hand, and patient-rated wrist evaluation. RESULTS The patient showed improvement in all outcome measures. Most outcomes exceeded the established minimal clinically important difference values. DISCUSSION The results suggest that dart-throwing motion and proprioceptive neuromuscular facilitation are beneficial in rehabilitation of TFCC injury. CONCLUSIONS This is the first study that incorporated dart-throwing motion and proprioceptive neuromuscular facilitation in the sensorimotor rehabilitation of TFCC injury and yielded promising results. There is a need to further evaluate the program in prospective randomized controlled trial recruiting a larger group of patients with TFCC injury.
Collapse
Affiliation(s)
- Zhiqing Chen
- Occupational Therapy Department, Singapore General Hospital, Singapore.
| |
Collapse
|
22
|
Dube MO, Roy JS. Effect of fatigue and the absence of visual feedback on shoulder motor control in an healthy population during a reaching task. Gait Posture 2019; 74:135-141. [PMID: 31522106 DOI: 10.1016/j.gaitpost.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main role of the upper limb is to position the hand in order to carry out varied activities requiring coordinated multi-joint movement, which requires mobility and stability at the glenohumeral joint. This is made possible by the interaction between active and passive structures as well as the integration of information coming from multiple systems. This interaction can be compromised by factors such as muscle fatigue and lack of visual feedback, leading to decreased performance. Several studies have investigated their isolated effect without looking at their combined effect. OBJECTIVE To measure the specific and the combined effects of shoulder muscles fatigue and of lack of visual feedback on shoulder motor control during a reaching task with the arm in an elevated position. METHODS 60 healthy participants were randomly assigned to one of four experimental groups: 1) control with visual feedback; 2) control without visual feedback; 3) fatigue with visual feedback; 4) fatigue without visual feedback. Subjects had to perform 10 trials of a reaching task in the KINARM robotic arm. Kinematic variables of interest were time taken to complete the task, final error, initial angle of deviation and area under curve. Non-parametric ANOVAs were used. RESULTS Analyses showed that there were statistically significant differences (p < 0,01) for the time taken to complete the task (1.15 s compared to 0.70 s), the area under the curve (0.015m2 compared to 0.009m2) and the final error (0.025 m compared to 0,011 m) between those who had visual feedback and those who did not. No statistically significant fatigue or feedback X fatigue interaction effects were found for all kinematic variables. CONCLUSION Findings show that lack of visual feedback had an impact on the reaching task performance while fatigue did not. In addition, fatigue did not increase the effect of the lack of visual feedback.
Collapse
Affiliation(s)
- Marc-Olivier Dube
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, G1M 2S8, Canada.
| | - Jean-Sebastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, G1R 1P5, Canada.
| |
Collapse
|
23
|
Hams AH, Evans K, Adams R, Waddington G, Witchalls J. Throwing performance in water polo is related to in-water shoulder proprioception. J Sports Sci 2019; 37:2588-2595. [PMID: 31352872 DOI: 10.1080/02640414.2019.1648987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Water polo players require a high level of upper-extremity strength, flexibility and coordination to achieve a peak level of throwing performance. Increased levels of shoulder proprioceptive acuity, strength and range of motion (ROM) have been previously associated with higher sporting performance. A coach-rating scale, used to quantify an athlete's kicking proficiency in soccer; was adapted in the current study to measure each coach's subjective expert opinion regarding athletes' throwing mechanics, velocity, and accuracy. To examine this hypothesis shoulder proprioception acuity of 18 water polo players was measured both in-water and on-land using an AMEDA apparatus and correlated with coach-rated throwing performance and clinical measures of shoulder strength and ROM. There was a moderate positive correlation between the in-water and the on-land proprioception acuity (r = 0.47, p < 0.05). The in-water score showing a strong positive correlation with coach rated throwing mechanics (r = 0.68, p < 0.05) and velocity (r = 0.75, p = 0.02), suggesting that superior proprioception acuity contributed to fast, mechanically-efficient throwing. These findings support the notion that in-water proprioceptive acuity is an important determinant of the throwing performance achieved by water polo athletes and its measurement may be a valuable adjunct to current athlete screening.
Collapse
Affiliation(s)
- Andrea H Hams
- Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia.,Sport Performance Innovation and Knowledge Excellence unit, Queensland Academy of Sports , Brisbane , Queensland , Australia.,School of Allied Health Sciences, Griffith University , Gold Coast , Queensland , Australia
| | - Kerrie Evans
- School of Allied Health Sciences, Griffith University , Gold Coast , Queensland , Australia.,Faculty of Health Sciences, The University of Sydney , Sydney , New South Wales , Australia.,Healthia Ltd , Brisbane , Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
| |
Collapse
|
24
|
Ramos MM, Carnaz L, Mattiello SM, Karduna AR, Zanca GG. Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability. Phys Ther Sport 2019; 37:157-163. [PMID: 30978602 DOI: 10.1016/j.ptsp.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN Reliability study. SETTING Clinical measurement. PARTICIPANTS Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.
Collapse
Affiliation(s)
- Marieli M Ramos
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | - Letícia Carnaz
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | - Stela M Mattiello
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Andrew R Karduna
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Gisele G Zanca
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil.
| |
Collapse
|
25
|
Lubiatowski P, Ogrodowicz P, Wojtaszek M, Romanowski L. Bilateral shoulder proprioception deficit in unilateral anterior shoulder instability. J Shoulder Elbow Surg 2019; 28:561-569. [PMID: 30502033 DOI: 10.1016/j.jse.2018.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Proprioception is an important element of shoulder dynamic stability. It has been shown to be affected in cases of capsular or labral injuries of the glenohumeral joint. Therefore, this study was conducted to investigate bilateral shoulder proprioception by active reproduction of joint position both in patients with post-traumatic recurrent unilateral shoulder instability and in normal healthy volunteers. METHODS We compared 41 patients, comprising 11 female and 30 male patients with an average age of 25.6 years (range, 18-39 years), with post-traumatic unilateral anterior shoulder instability with a control group of 27 healthy volunteers with no history of shoulder problems and with normal shoulder function during examination. All patients were examined using a high-accuracy computer-controlled electronic goniometer (Propriometer). The error of active reproduction of joint position (EARJP) was measured in abduction, flexion, external rotation, and internal rotation in both shoulders. RESULTS We observed a significant deficit in the EARJP in the unstable shoulders within the instability group. Surprisingly, similar results were recorded for the contralateral, unaffected shoulders within this group of patients compared with the control group. Joint acuity increased with higher elevation of the arm position. CONCLUSION Unilateral shoulder injuries, resulting in instability, affect proprioception in both shoulders, as demonstrated by an increased EARJP. This is the first report of unilateral shoulder instability coexisting with inferior proprioception in both shoulders.
Collapse
Affiliation(s)
- Przemysław Lubiatowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland; Rehasport Clinic, Poznań, Poland.
| | - Piotr Ogrodowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland; Rehasport Clinic, Poznań, Poland
| | - Marcin Wojtaszek
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland
| |
Collapse
|
26
|
Langer L, Osborne R, Rowe RH, Beneciuk JM. Laser testing for upper extremity proprioceptive deficits following rotator cuff injury: two case reports. Physiother Theory Pract 2019; 36:1493-1501. [PMID: 30676184 DOI: 10.1080/09593985.2019.1571141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Rotator cuff (RTC) dysfunction incidence ranges from 7% to 25% in the general population with a high recurrence rate. RTC musculature plays a significant role in dynamic stability of the glenohumeral joint with damage to these structures associated with proprioceptive impairments. Impaired proprioception has been linked to increased injury risk in other body regions; however, similar relationships with the upper extremity have not been extensively evaluated. The purpose of this case report is to present a preliminary, yet clinically feasible approach for using a laser for proprioceptive assessment and treatment in patients with RTC dysfunction. Case description: Patient 1 was a 21-year-old female with right shoulder pain from injury at work as a waitress where she lifted a heavy tray of plates. Patient 2 was a 48-year-old male with gradual and insidious onset of right shoulder pain during recreational baseball. Examination findings indicated contractile tissue involvement in both patients. Reaching and throwing tasks requiring accurate proprioceptive function were essential for return of each patient to their functional tasks. Laser proprioception testing was performed every 2 weeks with proprioceptive training provided as a supplement to other interventions. Outcomes: Over 4 weeks, improvements in objective laser proprioceptive test results were observed for both patients (Patient 1 = 6.0 cm; Patient 2 = 5.5 cm) in conjunction with active range-of-motion and self-report measures for pain intensity and function. Discussion: This case report describes a clinically feasible approach to testing and treating upper extremity proprioceptive deficits after RTC injury. Future research is required to establish reliability and validity of these methods.
Collapse
Affiliation(s)
| | - Raine Osborne
- Brooks Rehabilitation , Jacksonville, FL, USA.,Department of Physical Therapy, University of North Florida, Brooks College of Health , Jacksonville, FL, USA
| | | | - Jason M Beneciuk
- Brooks Rehabilitation , Jacksonville, FL, USA.,Department of Physical Therapy, University of Florida, College of Public Health & Health Professions , Gainesville, FL, USA
| |
Collapse
|
27
|
Gomes BSQ, Coelho VK, Terra BS, Bunn PS, Saragiotto BT, Ferreira AS, Nogueira LAC. Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study. PM R 2019; 11:972-978. [PMID: 30609221 DOI: 10.1002/pmrj.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood. OBJECTIVE To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls. STUDY DESIGN Matched case-control study. SETTING Physical Functional Rehabilitation Service of an outpatient clinic. PARTICIPANTS A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness. INTERVENTIONS All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index. MAIN OUTCOME MEASUREMENTS The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS). RESULTS The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS. CONCLUSIONS Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Bruno S Q Gomes
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Vanessa K Coelho
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Bruno S Terra
- B.S.T. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Priscila S Bunn
- P.S.B. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil and Exercise and Sport Sciences Department, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Bruno T Saragiotto
- B.T.S. Musculoskeletal Division, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Arthur S Ferreira
- A.S.F. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro A C Nogueira
- L.A.C.N. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
28
|
Lädermann A, Tirefort J, Zanchi D, Haller S, Charbonnier C, Hoffmeyer P, Cunningham G. Shoulder apprehension: A multifactorial approach. EFORT Open Rev 2018; 3:550-557. [PMID: 30662763 PMCID: PMC6335591 DOI: 10.1302/2058-5241.3.180007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Shoulder apprehension is related to changes in functional cerebral networks induced by dislocations, peripheral neuromuscular lesions and persistent mechanical glenohumeral instability consisting of micro-motion.All the damage to the osseous and soft-tissue stabilizers of the shoulder, as well as neurologic impairment persisting even after stabilization, must be properly identified in order to offer the best possible treatment to the patient.There is growing evidence supporting the use of a global multimodal approach, involving, on the one hand, shoulder 'reafferentation', including proprioception, mirror therapy and even cognitive behavioural approaches, and, on the other hand, surgical stabilization techniques and traditional physical therapy in order to minimize persistent micro-motion, which may help brain healing. This combined management could improve return to sport and avoid dislocation arthropathy in the long term. Cite this article: EFORT Open Rev 2018;3:550-557. DOI: 10.1302/2058-5241.3.180007.
Collapse
Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Jérome Tirefort
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Switzerland
| | - Davide Zanchi
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Sven Haller
- Faculty of Medicine, University of Geneva, Switzerland.,Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland.,Department of Surgical Sciences, Uppsala University, Sweden.,Department of Neuroradiology, University Hospital Freiburg, Germany
| | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, Switzerland.,Medical Research Department, Artanim Foundation, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Gregory Cunningham
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| |
Collapse
|
29
|
College Pitchers Demonstrate Directional Differences in Shoulder Joint Position Sense Compared With Controls. J Sport Rehabil 2018; 27:301-305. [PMID: 28513271 DOI: 10.1123/jsr.2017-0007] [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: 11/18/2022]
Abstract
CONTEXT The relationship between overhead throwing and its effect on proprioception is not well understood. It is important to gain a better understanding of how these are related, to protect overhead athletes from an increased risk of injury. OBJECTIVE To investigate proprioceptive alterations in the overhead thrower's shoulder. DESIGN Cross-sectional study. Independent variables are limb (dominant and nondominant), group (thrower or control), and target angle. Dependent variables are joint position sense and range of motion. SETTING An orthopedic biomechanics lab and university athletic training facility. PARTICIPANTS Twelve Division I baseball pitchers and 13 nonthrowing control subjects. INTERVENTION Shoulder proprioception was assessed using an active joint repositioning task administered with an iPod Touch. MAIN OUTCOME MEASURE Root mean square error and constant error of repositioning angles were used to assess accuracy and directional patterns, respectively. RESULTS Both groups demonstrated significantly higher joint acuity at the 80° external rotation target angle compared with 60° (1.5° [0.5°], P = .01). There were no differences in accuracy between groups. Constant error revealed differing repositioning patterns between limbs for the pitchers and also between groups for the dominant side. Although the throwing shoulder overshot the target angles by 0.4°, all nonthrowing shoulders undershot by an average of 2.7°. CONCLUSIONS There is no difference in shoulder joint position sense accuracy between throwers and nonthrowers, although both groups display increased accuracy closer to their end range of external rotation. The throwing shoulder demonstrates a different repositioning pattern, overshooting the desired target angle, while all other shoulders undershoot.
Collapse
|
30
|
Ager AL, Roy JS, Roos M, Belley AF, Cools A, Hébert LJ. Shoulder proprioception: How is it measured and is it reliable? A systematic review. J Hand Ther 2018. [PMID: 28641738 DOI: 10.1016/j.jht.2017.05.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Marianne Roos
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Amélie Fournier Belley
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc J Hébert
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| |
Collapse
|
31
|
Sahin E, Dilek B, Baydar M, Gundogdu M, Ergin B, Manisali M, Akalin E, Gulbahar S. Shoulder proprioception in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 2018; 30:857-862. [PMID: 28372317 DOI: 10.3233/bmr-160550] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. OBJECTIVE To investigate the shoulder proprioception in patients with SIS. METHODS Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. RESULTS The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P < 0.05). When involved shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P < 0.05) except active position sense at 0°. When uninvolved shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P < 0.05). CONCLUSION This study showed that shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.
Collapse
Affiliation(s)
- Ebru Sahin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Banu Dilek
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Meltem Baydar
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Mehtap Gundogdu
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Burcu Ergin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Metin Manisali
- Department of Radiodiagnostic, Dokuz Eylul University, Izmir, Turkey
| | - Elif Akalin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Selmin Gulbahar
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
32
|
Collin P, Lädermann A. Dynamic Anterior Stabilization Using the Long Head of the Biceps for Anteroinferior Glenohumeral Instability. Arthrosc Tech 2017; 7:e39-e44. [PMID: 29552467 PMCID: PMC5852254 DOI: 10.1016/j.eats.2017.08.049] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023] Open
Abstract
Anteroinferior glenohumeral instability can be treated by variants of the Bankart repair, remplissage, and the Latarjet procedure, although all options remain associated with complications, including recurrence, stiffness, persistent pain, apprehension, and dislocation arthropathy. The authors therefore thought of a concept of dynamic anterior stabilization to treat anteroinferior glenohumeral instability by transferring the long head of the biceps within a subscapularis split to the anterior glenoid margin, thereby creating a "sling effect" by using a conservative technique. A standard Bankart repair is then to re-establish the labral damper effect. The main benefit of the dynamic anterior stabilization procedure is that it grants the "sling effect," but is easier and safer than arthroscopic Latarjet. It does not require screws nor traction of the coracoid process, and should therefore reduce the risks of neurologic damage. Furthermore, the procedure can be performed with only 3 small incisions, because it does not require coracoid transfer, which eliminates risks of nerve dissection, graft overhang, and cortical resorption, hence reducing the probability for dislocation arthroplasty. Lastly, the pectoralis minor remains intact, which would avoid scapular dyskinesis.
Collapse
Affiliation(s)
- Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland,Faculty of Medicine, University of Geneva, Geneva, Switzerland,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland,Address correspondence to Alexandre Lädermann, M.D., Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue. J-D Maillard 3, CH-1217 Meyrin, Switzerland.Division of Orthopaedics and Trauma SurgeryLa Tour HospitalAvenue. J-D Maillard 3CH-1217 MeyrinSwitzerland
| |
Collapse
|
33
|
Miller AH, Evans K, Adams R, Waddington G, Witchalls J. Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors. J Sci Med Sport 2017; 21:368-377. [PMID: 28919494 DOI: 10.1016/j.jsams.2017.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Water polo is a popular water-based contact sport that involves swimming, throwing and defending. Cumulatively, these repetitive overhead activities are thought to increase the risk of shoulder injury and, subsequently to affect players' physical conditioning as well as team performance. The purpose of this review was to examine available evidence relating to shoulder injury rates and risk factors for shoulder injury in water polo. DESIGN Systematic review METHODS: CINAHL, AUSPORT, Pubmed, Pedro and SPORTDiscus databases were searched for original research papers using the predefined terms ("water polo") AND (shoulder OR glenohumeral* OR arm OR "upper limb"). RESULTS Twenty papers were identified as suitable for inclusion. Reported shoulder injury rates varied from 24% - 51%. Shoulder injuries were more likely to become chronic compared to all other reported injuries. Injury data during the last three World Championships indicates an increasing rate of shoulder injuries-per-year with participation in aquatic sports. Risk for shoulder injury in water polo is multi-factorial. Volume of shooting, range of motion, scapular dyskinesis, strength imbalance, proprioceptive deficit and altered throwing kinematics have been proposed to be associated with an increased risk of injury. CONCLUSIONS Although this review showed water polo to have a high propensity for shoulder injury, the descriptive nature of the included papers limited the inferences that could be drawn from the pooled literature. Future directions for research include collecting normative data for shoulder range of motion, strength ratio and proprioception with prospective analysis of these attributes in relation to injury rates and time lost.
Collapse
Affiliation(s)
- Andrea H Miller
- Research Institute for Sport and Exercise, University of Canberra, Australia; Centre of Excellence, Queensland Academy of Sport, Australia.
| | - Kerrie Evans
- Menzies Health Institute Queensland, Griffith University, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Australia
| |
Collapse
|
34
|
Ettinger LR, Shapiro M, Karduna A. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017. [PMID: 28638243 PMCID: PMC5470851 DOI: 10.1177/1179544117713196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS); however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance–matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS) was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P = .042) and elbow (5.6° difference, P = .001) than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater (P = .046) than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.
Collapse
Affiliation(s)
- Lucas R Ettinger
- Department of Exercise Science, Willamette University, Salem, OR, USA
| | - Matthew Shapiro
- Slocum Center for Orthopedics & Sports Medicine, Eugene, OR, USA
| | - Andrew Karduna
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| |
Collapse
|
35
|
Contemori S, Biscarini A. Shoulder position sense in volleyball players with infraspinatus atrophy secondary to suprascapular nerve neuropathy. Scand J Med Sci Sports 2017; 28:267-275. [PMID: 28370538 DOI: 10.1111/sms.12888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
Isolated infraspinatus atrophy (IIA) is a common condition among overhead-activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. As the suprascapular nerve is a mixed nerve, such damage could lead to reduced afferent proprioceptive information and impaired shoulder sensorimotor control. This study aimed to evaluate the proprioception of the shoulder with IIA, through the assessment of shoulder position sense. The shoulder position sense was assessed in 24 professional volleyball players (12 players with IIA and 12 healthy players) with a blind dynamic shoulder repositioning test (all participants were blindfolded during the test). Three functional glenohumeral movements were tested as follows: abduction, forward flexion, and a combination of abduction and external rotation. In all three tested movements, the affected shoulder of players with isolated infraspinatus atrophy showed significantly higher hand position error than the healthy contralateral (P<10-3 , for all movements) and the healthy control group hitting shoulder (P<10-3 , for abduction and flexion; P=.02, for combined movement of abduction and external rotation). The study highlights a reduced sense of position of the hitting shoulder in professional volleyball players with IIA secondary to suprascapular nerve palsy. The higher hand position error of the pathologic shoulder suggests an impairment of the shoulder sensorimotor control system, which likely results from reduced afferent proprioceptive information. Deficient afferent proprioceptive information may result in poor accuracy in descending motor commands and impairment of the shoulder neuromuscular function, leading to reduced shoulder functional stability and increased risk of injury.
Collapse
Affiliation(s)
- S Contemori
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - A Biscarini
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| |
Collapse
|
36
|
Hincapie OL, Elkins JS, Vasquez-Welsh L. Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. J Hand Ther 2017; 29:183-90. [PMID: 27264903 DOI: 10.1016/j.jht.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION Previously published studies demonstrate the importance of the sensory innervation of the carpal ligaments and the implication for the sensorimotor control of the wrist. In addition, this case considers key rehabilitation concepts to include the dart-throwing motion and the stabilizing effect of the forearm muscles. PURPOSE OF THE STUDY To describe the rehabilitation program for a patient with chronic wrist pain, diagnosed with a partial tear of the dorsal intercarpal ligament and a sprain of the scapholunate ligament of the right wrist. METHODS The patient participated in a staged treatment plan over a 3-month period (20 sessions), which began with a focus on proprioceptive awareness and joint position sense retraining. The treatment progressed to strengthening of specific muscles to enhance stability of the wrist joint. The patient completed the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation on initial evaluation, re-evaluation at ninth session, and discharge at 20th session. RESULTS Raw scores in the Quick Disabilities of the Arm, Shoulder and Hand and the patient-rated wrist evaluation improved from 33 and 61.5 on initial evaluation to 18 and 17.5 on discharge, respectively. CONCLUSIONS Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. The effectiveness of proprioceptive retraining needs to be evaluated in a well-designed randomized controlled trial recruiting this patient population. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
- Olga L Hincapie
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA.
| | - Jeananne S Elkins
- Northeastern University, College of Professional Studies, Boston, MA, USA
| | - Laura Vasquez-Welsh
- NYU Langone Medical Center, Center for Musculoskeletal Care, Hand Therapy Service, New York, NY, USA
| |
Collapse
|
37
|
Eshoj H, Juul-Kristensen B, Jørgensen RGB, Søgaard K. Reproducibility and validity of the Nintendo Wii Balance Board for measuring shoulder sensorimotor control in prone lying. Gait Posture 2017; 52:211-216. [PMID: 27939651 DOI: 10.1016/j.gaitpost.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION For the lower limbs, the Nintendo Wii Balance Board (NWBB) has been widely used to measure postural control. However, this has not been performed for upper limb measurements. Further, the NWBB has shown to produce more background noise with decreasing loads, which may be of concern when used for upper limb testing. The aim was to investigate reproducibility and validity of the NWBB. METHODS A test-retest design was performed with 68 subjects completing three different prone lying, upper limb weight-bearing balance tasks on a NWBB: two-arms, eyes closed (1) one-arm, non-dominant/non-injured (2) and one-arm, dominant/injured (3). Each task was repeated three times over the course of two test sessions with a 30-min break in between. Further, the level of background noise from a NWBB was compared with a force platform through systematic loading of both boards with increasing deadweights ranging from 5 to 90kg. RESULTS Test-retest reproducibility was high with ICCs ranging from 0.95 to 0.97 (95% CI 0.92 to 0.98). However, systematic bias and tendencies for funnel effects in the Bland Altman plots for both one-armed tests were present. The concurrent validity of the NWBB was low (CCC 0.17 (95% CI 0.12-0.22)) due to large differences between the NWBB and force platform in noise sensitivity at low deadweights (especially below 50kg). CONCLUSION The NWBB prone lying, shoulder sensorimotor control test was highly reproducible. Though, concurrent validity of the NWBB was poor compared to a force platform. Further investigation of the impact of the background noise, especially at low loads, is needed.
Collapse
Affiliation(s)
- H Eshoj
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Norway
| | - Rene Gam Bender Jørgensen
- Hospital of Southern Jutland, Center for Orthopedics and Medicine, Rehabilitation Clinic, Aabenraa, Denmark
| | - Karen Søgaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
38
|
A New Neurocognitive Interpretation of Shoulder Position Sense during Reaching: Unexpected Competence in the Measurement of Extracorporeal Space. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9065495. [PMID: 28105438 PMCID: PMC5220422 DOI: 10.1155/2016/9065495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/07/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022]
Abstract
Background. The position sense of the shoulder joint is important during reaching. Objective. To examine the existence of additional competence of the shoulder with regard to the ability to measure extracorporeal space, through a novel approach, using the shoulder proprioceptive rehabilitation tool (SPRT), during reaching. Design. Observational case-control study. Methods. We examined 50 subjects: 25 healthy and 25 with impingement syndrome with a mean age [years] of 64.52 +/− 6.98 and 68.36 +/− 6.54, respectively. Two parameters were evaluated using the SPRT: the integration of visual information and the proprioceptive afferents of the shoulder (Test 1) and the discriminative proprioceptive capacity of the shoulder, with the subject blindfolded (Test 2). These tasks assessed the spatial error (in centimeters) by the shoulder joint in reaching movements on the sagittal plane. Results. The shoulder had proprioceptive features that allowed it to memorize a reaching position and reproduce it (error of 1.22 cm to 1.55 cm in healthy subjects). This ability was lower in the impingement group, with a statistically significant difference compared to the healthy group (p < 0.05 by Mann–Whitney test). Conclusions. The shoulder has specific expertise in the measurement of the extracorporeal space during reaching movements that gradually decreases in impingement syndrome.
Collapse
|
39
|
|
40
|
Lädermann A, Denard PJ, Tirefort J, Kolo FC, Chagué S, Cunningham G, Charbonnier C. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study. Medicine (Baltimore) 2016; 95:e4369. [PMID: 27495043 PMCID: PMC4979797 DOI: 10.1097/md.0000000000004369] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography.Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values.While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder.
Collapse
Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Clinique La Colline
- Faculty of Medicine, University of Geneva
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Correspondence: Alexandre Lädermann, Division of Orthopaedics and Trauma Surgery, Clinique La Colline, Avenue de Beau-Séjour 6, 1206 Genève, Switzerland (e-mail: )
| | - Patrick J. Denard
- Southern Oregon Orthopedics, Medford
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Jérôme Tirefort
- Division of Orthopaedics and Trauma Surgery, Clinique La Colline
| | | | - Sylvain Chagué
- Artanim Foundation, Medical Research Department, Geneva, Switzerland
| | - Grégory Cunningham
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | |
Collapse
|
41
|
Lin YL, Karduna A. Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects. Hum Mov Sci 2016; 49:248-57. [PMID: 27475714 DOI: 10.1016/j.humov.2016.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes.
Collapse
Affiliation(s)
- Yin-Liang Lin
- Department of Human Physiology, University of Oregon, 1240 University of Oregon, Eugene, OR, USA
| | - Andrew Karduna
- Department of Human Physiology, University of Oregon, 1240 University of Oregon, Eugene, OR, USA.
| |
Collapse
|
42
|
Fabis J, Rzepka R, Fabis A, Zwierzchowski J, Kubiak G, Stanula A, Polguj M, Maciej R. Shoulder proprioception - lessons we learned from idiopathic frozen shoulder. BMC Musculoskelet Disord 2016; 17:123. [PMID: 26968796 PMCID: PMC4788938 DOI: 10.1186/s12891-016-0971-5] [Citation(s) in RCA: 13] [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: 08/24/2015] [Accepted: 03/03/2016] [Indexed: 02/07/2023] Open
Abstract
Background Of all the most frequent soft tissue disorders of the shoulder, idiopathic frozen shoulder (IFS) offers the greatest potential for studying proprioception. Studies concerning the presence of proprioception dysfunctions have failed to determine the potential for spontaneous healing of passive shoulder stabilizers (anterior and posterior capsule, middle and inferior gleno-humeral ligaments), its relationship with passive (PJPS) and active (AJPS) shoulder proprioception for internal and external rotation (IR, ER), as well as the isokinetic muscle performance of the internal and external rotators. This study investigates these dependencies in the case of arthroscopic release of IFS. Methods The study group comprised 23 patients (average aged 54.2) who underwent arthroscopic release due to IFS and 20 healthy volunteers. The average follow-up time was 29.2 months. The Biodex system was used for proprioception measurement in a modified neutral arm position and isokinetic evaluation. The results were analysed using the T-test, Wilcoxon and interclass correlation coefficient. P-values lower than 0.05 were considered significant. Results Statistically significant differences were found between involved (I) and uninvolved (U) shoulders only in the cases of PJPS and AJPS, peak torque, time to peak torque and acceleration time for ER (p < 0.05). No statistically significant difference was noted between PJPS IR and PJPS ER or between AJPS IR and AJPS ER (p > 0.05) for the U shoulders. Conclusions The anatomical structure of anterior (capsule, middle and anterior band of inferior gleno-humeral ligament) and posterior (capsule and posterior band of inferior gleno-humeral ligament) passive shoulder restraints has no impact on the difference in PJPS values between ER and IR in a modified neutral shoulder position. The potential for spontaneous healing of the anterior and posterior passive shoulder restraints influences PJPS recovery after arthroscopic release of IFS. ER peak torque deficits negatively affect AJPS values. PJPS and AJPS of ER and IR can be measured with a high level of reproducibility using an isokinetic dynamometer with the arm in a modified neutral shoulder position. Differences greater than 15 % for PJPS and >24 % for AJPS for ER and IR can be helpful for future studies as baseline data for identification of particular passive and active shoulder stabilizers at risk.
Collapse
Affiliation(s)
- Jaroslaw Fabis
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland.
| | - Remigiusz Rzepka
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Anna Fabis
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Jacek Zwierzchowski
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Grzegorz Kubiak
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Arkadiusz Stanula
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Michal Polguj
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| | - Radek Maciej
- Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland
| |
Collapse
|
43
|
Takasaki H, Lim ECW, Soon B. The effect of shoulder muscle fatigue on active repositioning acuity and scapulothoracic resting alignment: A systematic review with meta-analysis. Phys Ther Sport 2016; 20:61-78. [PMID: 27080109 DOI: 10.1016/j.ptsp.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose was to synthesize the current evidence for the impact of muscle fatigue on measures for active repositioning task of the glenohumeral or scapulothoracic movements including the absolute error and/or scapulothoracic resting alignment. METHODS We searched the PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, SportDiscuss and the Cochrane library databases. We included papers using a fatiguing task as part of their experimental design. Meta-analyses were undertaken for the active repositioning acuity of the glenohumeral outer/inner range of external rotation, glenohumeral inner range of internal rotation and scapulothoracic resting alignment in the scapular upward/downward rotation, anterior/posterior tilt and protraction/retraction planes. Qualitative data synthesis with standardized mean difference (SMD) was also conducted. RESULTS There was a significantly pooled SMD, -2.10 (95% confidence interval -2.57 to -1.63), P < 0.001) in active repositioning acuity of the glenohumeral outer range of external rotation before and after a fatiguing task. However, the pooled SMD in active repositioning acuity for other glenohumeral movements and scapulothoracic resting positions were not significant (P > 0.05). CONCLUSION Shoulder muscle fatigue impairs active repositioning acuity of the glenohumeral outer range of external rotation. Conversely, the current evidence does not support such impairment for the remaining glenohumeral movements and scapulothoracic resting alignments..
Collapse
Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Sannomiya 820, Kosigaya, Saitama, 343-8540, Japan.
| | - Edwin Choon Wyn Lim
- Department of Physiotherapy, Singapore General Hospital, Singapore; Health and Social Science Cluster, Academic Programmes, Singapore Institute of Technology, Singapore.
| | - Benjamin Soon
- Health and Social Science Cluster, Academic Programmes, Singapore Institute of Technology, Singapore.
| |
Collapse
|
44
|
Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. Eur J Appl Physiol 2014; 115:225-34. [DOI: 10.1007/s00421-014-3059-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/18/2014] [Indexed: 02/06/2023]
|