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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.
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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
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López-de-Celis C, Caudevilla-Polo S, Pérez-Bellmunt A, González-Rueda V, Bueno-Gracia E, Estébanez-de-Miguel E. Effect of Scapular Fixation on Lateral Movement and Scapular Rotation during Glenohumeral Lateral Distraction Mobilisation. Healthcare (Basel) 2023; 11:1829. [PMID: 37444663 DOI: 10.3390/healthcare11131829] [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: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. METHODS Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. RESULTS The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. CONCLUSIONS Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.
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Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | | | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Elena Bueno-Gracia
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
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ALBAROVA-CORRAL MI, CARDIEL-SÁNCHEZ S, FANLO-MAZAS P, RUIZ-DE-ESCUDERO-ZAPICO A, VIORRETA-PINTANEL P, MALO-URRIÉS M. A comparative study on shoulder pain, function, range of motion, and structure between handball players and non-throwing subjects. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Inoue J, Takenaga T, Tsuchiya A, Okubo N, Takeuchi S, Takaba K, Nozaki M, Kobayashi M, Fukushima H, Kato J, Murakami H, Yoshida M. Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data. Orthop J Sports Med 2022; 10:23259671221101924. [PMID: 35837445 PMCID: PMC9274420 DOI: 10.1177/23259671221101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Ultrasonography can be used to quantitatively assess anterior humeral head
translation (AHHT) at different degrees of shoulder abduction. Risk factors
for recurrent shoulder instability have been identified. Hypothesis: It was hypothesized that the number of dislocations or glenoid or humeral
bone loss would be associated with more AHHT as measured using
ultrasound. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 patients who underwent surgery for anterior shoulder
instability were prospectively studied. Ultrasound assessment of AHHT was
performed immediately after general anesthesia was induced. The upper arm
was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was
applied to the proximal third of the arm. The distance from the posterior
edge of the glenoid to that of the humeral head was measured at each
abduction angle using ultrasound with and without a 40-N anterior force, and
the AHHT was calculated. The differences in translation at each shoulder
angle were compared. Additionally, the authors investigated the association
between AHHT and demographic, radiographic, and clinical data. Results: Compared with the AHHT at 0° of abduction (5.29 mm), translation was
significantly larger at 45° of abduction (8.90 mm; P <
.01) and 90° of abduction (9.46 mm; P < .01). The mean
translation was significantly larger in female patients than in male
patients at all degrees of abduction (P ≤ .036 for all).
There was no correlation between AHHT at any abduction angle and number of
dislocations, clinical data, or radiographic data (including bone loss). Conclusion: Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90°
than at 0° of abduction. Anterior glenohumeral laxity was greater in female
than male patients. Glenoid or humeral bone loss did not correlate with
AHHT, thereby clarifying that bone loss has no direct effect on measurements
of capsular laxity in neutral rotation.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Norio Okubo
- Department of Orthopedic Surgery, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Keishi Takaba
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Sillevis R, Todd RM, Speare J, Shamus E, van Duijn A. Forces and translation distance during an inferior glide of the shoulder in asymptomatic individuals measured with the novel pliance glove and ultrasound imaging. J Bodyw Mov Ther 2022; 29:92-98. [DOI: 10.1016/j.jbmt.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
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Guerra-Rodríguez D, Rozo L, Basilio D, Guerrero-Henriquez J. In vivo measurements of glenohumeral distraction technique performed in three different joint positions. J Man Manip Ther 2021; 29:353-359. [PMID: 33761826 PMCID: PMC8725771 DOI: 10.1080/10669817.2021.1904350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Distraction techniques are an important part of the manual approach in the glenohumeral joint; however, there is controversy regarding the initial joint position to maximize separation of joint surfaces.Objective: To identify, through an in vivo exploration, the behavior of the coracohumeral distance (CHD) during the application of a short lever arm grade III distraction technique on the humeral head, executed in three different glenohumeral positions (zero position (P0), rest position (RP) and 90º abduction position with maximum external rotation (ABD+ER)).Methods: 15 participants were selected. A physical therapist executed grade III distraction techniques in described joint positions. Ultrasound was used to visualize the differences in CHD. Statistical analysis included interclass correlation coefficients (ICC) and repeated measurements of ANOVA.Results: The range of ICC values was 0.740 and 0.948. The differences in CHD were 5.74 ± 0.51 mm, 3.97 ± 0.24 mm, and 0.64 ± 0.02 mm, for P0, RP and ABD+ER during application of distraction technique, respectively. There were differences between P0 and RP with ABD+ER (P < 0.001), and no differences between P0 and RP.Conclusion: Initial joint position of application influences the separation of the articular surfaces, being wider in the zero and rest positions.
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Affiliation(s)
- Diego Guerra-Rodríguez
- Biomedical Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | - Liliana Rozo
- Postgraduate Department of Manual Therapy, Faculty of Rehabilitation Sciences, Andres Bello University, Santiago, Chile
| | - Daniel Basilio
- Kinetic-K Integral Therapy and Training Center, Antofagasta, Chile
| | - Juan Guerrero-Henriquez
- Rehabilitation and Human Movement Sciences Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
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An improved quantitative ultrasonographic technique could assess anterior translation of the glenohumeral joint accurately and reliably. Knee Surg Sports Traumatol Arthrosc 2021; 29:2595-2605. [PMID: 33554273 DOI: 10.1007/s00167-021-06459-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Since poor repeatability of the load and shift test using a grading scale has been reported, an objective and quantitative method to assess anterior translation should be established to assess glenohumeral joint function. The purpose of this study was to assess the accuracy and repeatability of the ultrasonographic techniques to quantify anterior translation of the glenohumeral joint. METHODS Eight fresh-frozen cadaveric shoulders were used. For the standard technique, the ultrasound transducer was positioned on the anterolateral aspect of the shoulder viewing the coracoid process, glenoid, and humeral head. For the revised technique, the transducer was positioned on the anterior aspect of the shoulder, perpendicular to the scapular plane, viewing the conjoint tendon, glenoid, and humeral head. During the load and shift test, the distance between anterior edges of the glenoid and the humeral head was measured. The difference between distances before and after applying an anterior load was calculated as an anterior translation and compared with the anterior translation assessed using a motion tracking system. The repeatability and accuracy of both techniques were analyzed statistically. RESULTS Intra- and inter-observer repeatability was good-excellent for both ultrasonographic techniques (ICC, 0.889-0.998). The revised technique achieved a stronger correlation to the anterior translations obtained using the motion tracking system (R = 0.810-0.913, p < 0.001) than the standard technique (R = 0.619-0.806, p < 0.001). CONCLUSION Better accuracy and repeatability was found in the revised technique than the standard technique. The revised technique will be useful to determine the individual laxity and modify the treatment plan and return-to-sports protocol. LEVEL OF EVIDENCE III.
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Influence of Shoulder Position on Functional Control Ratio During Isokinetic Assessment. J Sport Rehabil 2020; 29:588-593. [PMID: 31094638 DOI: 10.1123/jsr.2018-0432] [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: 11/21/2018] [Revised: 02/20/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT One of the possible mechanisms leading to secondary impingement syndrome may be the strength imbalance of shoulder rotators which is known as functional control ratio (FCR). The FCR is a ratio dividing the eccentric peak torque of the external rotators by the concentric peak torque of the internal rotators. Previous studies have focused on the reproducibility and reliability of isokinetic assessment, but there is little information on the influence of variable shoulder positions on FCR. OBJECTIVE To compare shoulder FCR across 3 different shoulder abduction positions during isokinetic assessment. DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PARTICIPANTS Thirty-one healthy young university students (age 22.35 [0.95] y, weight 60.52 [9.31] kg, height 168.23 [9.47] cm). INTERVENTIONS The concentric peak torque of internal rotators and eccentric peak torque of external rotators of right shoulder were measured on an isokinetic dynamometer. MAIN OUTCOME MEASURES Concentric peak torque of the internal rotators and eccentric peak torque of the external rotators, measured using an isokinetic dynamometer. RESULTS The concentric peak torque of internal rotators was significantly lower at 120° shoulder abduction compared with other positions (P < .001). The FCR was significantly higher at 120° shoulder abduction than 90° (P = .002) or 60° (P < .001) shoulder abduction because of the lower concentric peak torque. No significant difference was found in the FCR between the other 2 shoulder positions (P = .14). CONCLUSIONS Shoulder position variations may influence FCR because of weakness of the internal rotators. Rehabilitation and injury prevention training programs should specifically focus on strengthening the internal rotators at more elevated angles of shoulder abduction.
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Spanhove V, De Wandele I, Kjær BH, Malfait F, Vanderstukken F, Cools A. The effect of five isometric exercises on glenohumeral translations in healthy subjects and patients with the hypermobility type of the ehlers-danlos syndrome (heds) or hypermobility spectrum disorder (hsd) with multidirectional shoulder instability: an observational study. Physiotherapy 2020; 107:11-18. [DOI: 10.1016/j.physio.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/25/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022]
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Rathi S, Taylor NF, Green RA. A comparison of glenohumeral joint translation between young and older asymptomatic adults using ultrasonography: a secondary analysis. Physiother Theory Pract 2019; 36:1354-1362. [PMID: 30704320 DOI: 10.1080/09593985.2019.1571138] [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: 10/27/2022]
Abstract
Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees' abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p < 0.03), indicating rotator cuff activity-limited translation in a direction-specific manner. Young participants demonstrated increased passive posterior glenohumeral joint translation in the neutral shoulder position (p < 0.001) and their rotator cuff muscle contraction led to greater reductions in glenohumeral joint translation in the neutral shoulder position (p < 0.001), as compared with older participants. Conclusions: Rotator cuff contraction limits glenohumeral joint translation in a direction-specific manner in both young and older participants. However, younger age is associated with increased passive translation but greater ability to reduce glenohumeral joint translation with rotator cuff muscle contraction. Age-related changes should be considered when assessing and treating glenohumeral joint stability.
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Affiliation(s)
- Sangeeta Rathi
- Department of Pharmacy and Applied Science, La Trobe University , Bendigo, VIC, Australia.,Department of Allied Health, St. John of God Hospital , Bendigo, VIC, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University , Bundoora, VIC Australia
| | - Rodney A Green
- Department of Pharmacy and Applied Science, La Trobe University , Bendigo, VIC, Australia
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Rathi S, Taylor NF, Green RA. The upper and lower segments of subscapularis muscle have different roles in glenohumeral joint functioning. J Biomech 2017; 63:92-97. [PMID: 28867549 DOI: 10.1016/j.jbiomech.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 11/20/2022]
Abstract
Subscapularis muscle is divided into two independent segments, upper and lower (USUB and LSUB), but the role of each segment in glenohumeral functioning is unclear. We compared the electromyographic (EMG) activity of USUB and LSUB during a variety of shoulder movements, with and without an external translation force. Intramuscular electrodes were inserted in USUB and LSUB segments of 20 adults without pathology and EMG activity was measured in stabilization trials (with and without an anterior or posterior directed force at the humerus and isometric rotations) and two shoulder positions (shoulder neutral, abduction). Maximal voluntary isometric contraction (MVIC) trials were performed in abduction, internal and external rotation of the shoulder. In MVIC trials, USUB showed higher activity during internal rotation (p=0.03), whereas LSUB showed higher activity during external rotation (p<0.01). In stabilization trials, the interaction effects were significant for muscle segment×condition (p<0.01), and approached significance for muscle segment×position (p=0.06). In the neutral position, the pattern of activity for LSUB was similar to USUB. In the abducted position the LSUB, unlike USUB, was more active during external rotation (p=0.06) and also showed increased activity in response to the posterior directed force at the humerus (p=0.04). Our results suggest that USUB primarily acts asan agonist for internal rotation. In contrast LSUB was particularly active in external rotation in the abducted position and demonstrated increased EMG activity in response to the posteriorly directed force at the humerus in that position, suggesting more of a role in glenohumeral stabilization.
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Affiliation(s)
- Sangeeta Rathi
- Department of Pharmacy & Applied Science, College of Science Health & Engineering, La Trobe University, Bendigo, Victoria, Australia; St. John of God Hospital, Bendigo, Victoria, Australia.
| | | | - Rodney A Green
- Department of Pharmacy & Applied Science, College of Science Health & Engineering, La Trobe University, Bendigo, Victoria, Australia
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Rathi S, Taylor NF, Green RA. The effect of in vivo rotator cuff muscle contraction on glenohumeral joint translation: An ultrasonographic and electromyographic study. J Biomech 2016; 49:3840-3847. [DOI: 10.1016/j.jbiomech.2016.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/22/2022]
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