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Mohr D, Nammour MA, Marcaccio SE, Arner JW, Bradley JP. Location of Shoulder Glenoid Labral Tears: A Study of 1763 Consecutive Patients. Am J Sports Med 2024; 52:2063-2070. [PMID: 38828637 DOI: 10.1177/03635465241253835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Anterior shoulder labral tearing has historically been considered the most common location of shoulder labral pathology. Recently, smaller studies have reported that posterior labral involvement may be more common than previously recognized. PURPOSE To examine the location of surgically repaired labral tears by a single surgeon over a consecutive 23-year period. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 1763 consecutive patients who underwent arthroscopic or open shoulder labral repair by a single seniorsports medicine fellowship-trained orthopaedic surgeon between April 2000 and April 2023 were retrospectively reviewed. Current Procedural Terminology codes were used to identify patients, which included 29806, 29807, 29822, and 29823. Exclusion criteria included isolated shoulder manipulation or glenohumeral joint or labral debridement that did not include repair. Intraoperative glenoid labral tears observed were categorized into 7 broad categories: (1) anterior labral tears, (2) posterior labral tears, (3) superior labral anterior posterior (SLAP) type II tears (A, B, or C), (4) SLAP type V tears, (5) SLAP type VIII tears, or (6) circumferential labral tears (combined SLAP, anterior, and posterior labral tear). Shoulders diagnosed with multiple tear patterns (ie, anterior and posterior) were also noted. RESULTS During the 23-year period, 1763 patients underwent arthroscopic or open labral repair; they included 1295 male and 468 female patients, ranging in age from 12 to 70 years, with a mean age of 23.2 years and median age of 19 years. Overall, 28.4% of tears involved the anterior labrum, 64.9% involved the posterior labrum, and 59.6% involved the superior labrum. Regarding isolated tears, 9.3% were isolated anterior labral tears, 19.7% were isolated posterior labral tears, 11.5% involved the anterior and posterior labrum, 22.2% were isolated superior (SLAP type II-IV) tears, 3.63% were isolated SLAP type V tears, 29.8% were isolated SLAP type VIII tears, and 4.1% were circumferential tears. CONCLUSION Posterior shoulder labral tearing was more common than anterior tearing in a large consecutive series of 1763 patients who underwent surgical repair. This highlights the importance of posterior labral pathology, which sometimes may be overlooked because of more vague complaints, with pain and loss of function being the most common.
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Affiliation(s)
- Damaris Mohr
- Department of Orthopaedic Surgery, Burke & Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Nammour
- Department of Orthopaedic Surgery, Orthopaedic Shoulder, Hip, Knee, and Sports Medicine of Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Stephen E Marcaccio
- Department of Orthopaedic Surgery, Sports Medicine Fellowship, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Justin W Arner
- Department of Orthopaedic Surgery, Burke & Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James P Bradley
- Department of Orthopaedic Surgery, Burke & Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Costa E Silva Cabral AL, Marques JDP, Dionisio VC. Scapular dyskinesis and overhead athletes: A systematic review of electromyography studies. J Bodyw Mov Ther 2024; 39:606-614. [PMID: 38876694 DOI: 10.1016/j.jbmt.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Understanding how the main scapular muscles behave in overhead athletes with scapular dyskinesis (SD). DESIGN Systematic Review. SETTING Electronic searches were performed in Pubmed (MedLine), Embase, CINAHL, and SPORTDiscus databases. PARTICIPANTS Overhead athletes with SD. MAIN OUTCOME MEASURES Electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior (SA). RESULTS Eight studies were included in this review. The UT activity showed a tended to increase its activity mainly during tasks over 90° compared to 45°. SA activity had similar behavior, mainly during isometric tasks. The MT also increased its activity mainly in tasks with overhead angulations when compared to lower angulations. The LT activation tended to decrease its EMG activity at angulations below 60° in overhead athletes with SD. CONCLUSIONS The EMG behaviour of UT and SA for non-athletes appears to differ from what has already been described in the literature. The MT seems to be the most neglected muscle for scapular stabilization in overhead athletes with SD. The decrease in LT activity suggests that this may have implications for the performance of these athletes.
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Affiliation(s)
- Ana Luiza Costa E Silva Cabral
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil.
| | - Júlia de Paula Marques
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil
| | - Valdeci Carlos Dionisio
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil
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Stokes HL, Eaton K, Zheng N. Shoulder External Over Internal Rotation Ratio Is Related to Biomechanics in Collegiate Baseball Pitching. J Appl Biomech 2024; 40:209-216. [PMID: 38467121 DOI: 10.1123/jab.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240 Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers.
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Affiliation(s)
- Hannah L Stokes
- Depatment of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Koco Eaton
- Tampa Bay Rays and University of South Florida, Tampa, FL, USA
| | - Naiquan Zheng
- Depatment of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, NC, USA
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Hoenecke H, Fiske JW, Tamayo AE, D'Lima DD. Evolution of the throwing shoulder: why apes don't throw well and how that applies to throwing athletes. J Shoulder Elbow Surg 2024; 33:1404-1417. [PMID: 38316235 DOI: 10.1016/j.jse.2023.12.010] [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: 09/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Humans have unique characteristics making us the only primate that can throw well while most other primates throw predominately underhand with poor speed and accuracy. The purpose of this study is to illuminate the uniquely human characteristics that allow us to throw so well. When treating an injury such as a labral tear or capsule tear, this study hopes the reader can gain a better understanding of the issues that lead to the tear and those that may determine the success of treatment besides the actual repair. METHODS In addition to a review of scientific and medical literature, information was obtained from interviews and experience with primate veterinarians, anthropologists, archeologists, and professional baseball players. These sources were used to study the connection between evolutionary throwing activities and current sports medicine issues. RESULTS Arm acceleration requires a functional kinetic chain, rapid motor sequences, and the ability to absorb elastic energy in the shoulder. Successful treatment of the throwing shoulder requires awareness of the shoulder's position in the kinetic chain and correction of defects in the ability to execute the kinetic chain. Some problems in the shoulder could reflect regression to a more primitive anatomy or dyskinesis. Return of performance requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy. For example, tissue remodeling after rotator cuff repair continues for months to years; however, the newly formed tissue lacks the same elasticity of the native tendon. This suggests why throwing performance typically does not return for 7 or more months after repair even though there may be structural integrity at 3-4 months. CONCLUSION The shoulder has developed uniquely in modern man for the act of throwing. The anatomic deficiencies in primates for throwing provide an illustration of the more subtle changes that a throwing athlete might have that are detrimental to throwing. Nonhuman primates have been unable to demonstrate the kinetic chain sequence for throwing secondary to the lack of neurologic pathways required. Humans are more sophisticated and precise in their movements but lack robusticity in their bone and muscle architecture, seen especially in the human rotator cuff. Successful treatment of a throwing injury requires familiarity with the conditions that cause the injury or affect the rehabilitation process. The return of performance following injury or surgery requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy from the kinetic chain.
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Affiliation(s)
- Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA.
| | | | | | - Darryl D D'Lima
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
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Manzi JE, Dowling B, Wang Z, Cecere R, Sudah SY, Fu MC, Gulotta LV, Dines JS, Carr JB. An Analysis of Intrapitch Variation in Joint and Segment Velocities With Throwing Arm Kinetics in High School and Professional Baseball Pitchers. Am J Sports Med 2024; 52:1676-1684. [PMID: 38767156 DOI: 10.1177/03635465241247546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Improper sequencing order of maximal joint and segment velocities has been identified as an important predictor for both throwing arm kinetics and ball velocity. PURPOSE To investigate the intrapitcher variation of maximal segment velocities and the relationship to throwing arm kinetics and ball velocity in high school (HS) and professional (PRO) pitchers. STUDY DESIGN Descriptive laboratory study. METHODS HS (n = 59) and PRO (n = 338) pitchers, instructed to throw 8 to 12 fastball pitches, were evaluated with 3-dimensional motion capture (480 Hz). Maximal joint and segment velocities were calculated for each pitch, and the standard deviation of the maxima was calculated per pitcher. These standard deviations were used to classify pitchers as "low variance" or "high variance" for each segmental velocity subgroup, "overall low variance" or "overall high variance" based on cumulative segment velocity variation, or "population," with any pitcher eligible to be included in multiple subcategories. Maximal velocities and throwing arm kinetics were compared among the various subgroups. RESULTS The HS low-variance shoulder internal rotation velocity subgroup (4949 ± 642 deg/s) had significantly lower maximal shoulder internal rotation velocity compared with HS population (5774 ± 1057 deg/s) (P < .001); similar findings were observed for PROs (5269 ± 835 vs 5824 ± 1076 deg/s; P < .001), as well as lower shoulder superior force compared with the PRO population (14.8% ± 8.8% vs 17.8% ± 8.8% body weight; P = .001). The PRO low-variance lead knee extension velocity subgroup had significantly lower maximal lead knee extension velocity (216 ± 135 vs 258 ± 125 deg/s; P = .001) and shoulder distractive force (111.5% ± 14.4% vs 115.6% ± 15.9% body weight; P = .003) compared with the PRO population. The PRO overall low-variance subgroup had significantly lower shoulder distractive force (111.8% ± 14.1% vs 119.6% ± 15.5% body weight; P = .008) and elbow anterior force (40.6% ± 5.0% vs 43.6% ± 6.2% body weight; P = .008) compared with the PRO overall high-variance subgroup. CONCLUSION HS and PRO pitchers with low variance for joint and segment velocities achieved significantly lower maximal velocities in the subgroup of interest, while preserving ball velocity. PRO pitchers with overall low variance among multiple maximal joint and segment velocities demonstrated decreased shoulder distractive and elbow anterior force. CLINICAL RELEVANCE PRO pitchers with low intrapitch variation in maximal joint and segment velocities may be viewed as kinetically conservative throwers. These pitchers with similarly maintained mechanics between pitches may have an increasingly regimented form that preserves kinetic forces about the throwing arm. The opposite may be true for PRO pitchers with increased variability in segmental velocities during their pitching motion, as they showed increased throwing arm kinetics including shoulder distractive and elbow anterior force compared with the overall low-variance group, theoretically increasing their risk of injury.
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Affiliation(s)
- Joseph E Manzi
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Chicago Illinois, USA
| | | | | | - Suleiman Y Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Michael C Fu
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - James B Carr
- Sports Medicine Institute, Hospital for Special Surgery Florida, West Palm Beach, Florida, USA
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Rhim HC, Schon JM, Xu R, Schowalter S, Ha J, Hsu C, Andrew M, Robinson DM, Tenforde AS, Daneshvar DH. Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis. Clin J Sport Med 2024:00042752-990000000-00191. [PMID: 38810121 DOI: 10.1097/jsm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN Systematic review with meta-analysis. SETTING Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS Patients with adhesive capsulitis. INTERVENTIONS Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jason M Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Raylin Xu
- Harvard Medical School, Boston, Massachusetts; and
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jane Ha
- Clinical and Translational Epidemiology Unit, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Michael Andrew
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Strama E, Keenan KA, Sell T, Faherty M, Rafferty D, Salesi K, Csonka J, Varnell M. Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report. Sports Health 2024; 16:347-357. [PMID: 37740495 PMCID: PMC11025517 DOI: 10.1177/19417381231197217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits. HYPOTHESIS Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation. RESULTS Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain. CONCLUSION Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain. CLINICAL RELEVANCE The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.
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Affiliation(s)
- Emily Strama
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Timothy Sell
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Deirdre Rafferty
- Department of Medicine, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Karl Salesi
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Takahara M. Osteochondritis dissecans of the elbow: recent evolution of pathogenesis, imaging, and treatment modalities. JSES Int 2024; 8:588-601. [PMID: 38707580 PMCID: PMC11064639 DOI: 10.1016/j.jseint.2023.09.010] [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] [Indexed: 05/07/2024] Open
Abstract
Background The etiology and pathogenesis of osteochondritis dissecans (OCDs) lesions remain controversial. Methods This review presents the recent evolution about the healing, imaging, pathogenesis, and how to treat OCD of the capitellum in overhead athletes. Results Compressive and shear forces to the growing capitellum can cause subchondral separation, leading to OCD, composed of 3 layers: articular fragment, gap, and underlying bone. Subchondral separation can cause ossification arrest (stage IA), followed by cartilage degeneration (stage IB) or delayed ossification (stage IIA), occasionally leading to osteonecrosis (stage IIB) in the articular fragment. Articular cartilage fracture and gap reseparation make the articular fragment unstable. The mean tilting angle of capitellar OCD is 57.6 degrees in throwers. Anteroposterior radiography of the elbow at 45 degrees of flexion (APR45) can increase the diagnostic reliability, showing OCD healing stages, as follows: I) radiolucency, II) delayed ossification, and III) union. Coronal computed tomography and magnetic resonance imaging with an appropriate tilting angle can also increase the reliability. MRI is most useful to show the instability, although it occasionally underestimates. Sonography contributes to detection of early OCD in adolescent throwers on the field. OCD lesions in the central aspect of the capitellum can be more unstable and may not heal. Cast immobilization has a positive effect on healing for stable lesions. Arthroscopic removal provides early return to sports, although a large osteochondral defect is associated with a poor prognosis. Fragment fixation, osteochondral autograft transplantation, and their hybrid technique have provided better results. Discussion Further studies are needed to prevent problematic complications of capitellar OCD, such as osteoarthritis and chondrolysis.
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Affiliation(s)
- Masatoshi Takahara
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
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Funakoshi T, Furushima K, Miyamoto A, Kusano H, Takahashi T, Inoue A, Shimokobe H. Thoracic outlet syndrome in overhead athletes. JSES Int 2024; 8:620-629. [PMID: 38707577 PMCID: PMC11064620 DOI: 10.1016/j.jseint.2023.12.004] [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] [Indexed: 05/07/2024] Open
Abstract
Background We aimed to retrospectively compare the clinical outcomes of endoscopy-assisted first-rib resection for thoracic outlet syndrome (TOS) between overhead athletes and nonathletes and investigate the return to same-level sports rate in overhead athletes. Methods We retrospectively reviewed 181 cases with TOS (75 women, 106 men; mean age, 28.4 years; range, 12-57 years) who underwent endoscopy-assisted first-rib resection. We divided into two groups: 79 overhead athletes and 102 nonathletes groups. A transaxillary approach for first-rib resection and neurovascular decompression was performed under magnified visualization. Endoscopic findings related to the neurovascular bundle, interscalene distance, and scalene muscle were evaluated intraoperatively. We assessed the Roos and Disability of the Arm, Shoulder, and Hand scores, return to same-level sports rate, and ball velocity. Results Overhead athletes were significantly more likely to be men, younger, used the dominant side more frequently, and have a larger physique, more shoulder and elbow pain, and shorter symptom duration. The outcomes of the Roos score revealed significant differences in excellent or good results between overhead athletes (91.1%) and nonathletes (62.8%). The two groups significantly differed in preoperative and postoperative Disability of the Arm, Shoulder, and Hand and recovery rate scores (P = .007, < .001, < .001). Conclusion Overhead athletes with TOS were more likely to be men, younger, dominant side more frequently, and have more shoulder and elbow pain, and a shorter symptom duration. Endoscopy-assisted transaxillary first-rib resection and neurolysis provided superior clinical outcomes in overhead athletes with TOS compared with nonathletes and a high return-to-same-level-play rate in sports.
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Affiliation(s)
| | | | | | | | | | - Akira Inoue
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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10
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Tsurukami H, Itoigawa Y, Uehara H, Hatae F, Kubota A, Mizuno M, Maezawa K, Takazawa Y, Ishijima M. Stiffness Changes in Shoulder Muscles between Pitchers and Position Players after Throwing Overhead Using Shear Wave Elastography and Throwing Motion Analysis. J Clin Med 2024; 13:2056. [PMID: 38610821 PMCID: PMC11012453 DOI: 10.3390/jcm13072056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/16/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The objective is to compare stiffness changes around the shoulder muscles between pitchers and position players after throwing overhead using shear wave elastography (SWE) in relation to throwing motion analysis and muscle strength. Methods: A total of 32 male college baseball players (12 pitchers and 20 position players) were observed throwing 20 times, and SWE was performed to evaluate 13 shoulder muscle items-tendons (supraspinatus, infraspinatus, subscapularis, and teres minor), muscles (supraspinatus, infraspinatus [transverse and oblique part], teres minor, lower trapezius, latissimus dorsi, and pectoralis minor), and capsules (posterior and posteroinferior). Motion analysis was used to assess elbow torque, forearm angle, forearm rotation speed, and maximum external rotation angle of the shoulder. Muscle strength was measured using a dynamometer for abduction, internal/external rotation of the shoulder at an abduction of 0°, internal/external rotation of the shoulder at an abduction of 90°, and internal/external rotation of shoulder at a flexion of 90°. Results: In the pitcher group, SWE values for the teres minor muscle and latissimus dorsi muscle increased significantly after throwing. In the position player group, SWE values for the teres minor muscle significantly increased, and SWE values of the pectoralis minor muscle decreased after throwing. In the pitcher group, positive correlations were found between the teres minor muscle and forearm rotation speed and between the latissimus dorsi muscle and forearm angle. No significant difference was found in muscle strength after throwing in any of the groups. Conclusions: Stiffness changes occurred after throwing and were related to the motion analysis, but the regions in which stiffness occurred varied between pitchers and position players.
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Affiliation(s)
- Hironori Tsurukami
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Fumitoshi Hatae
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Atsushi Kubota
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan
| | - Motoki Mizuno
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
| | - Katsuhiko Maezawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
| | - Yuuji Takazawa
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
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Owens LP, Khaiyat O, Coyles G. Muscle Activations of the Upper Extremity and Core during Elevation and Rotational Movements in Overhead Throwing Athletes. Int J Sports Phys Ther 2024; 19:466-476. [PMID: 38576830 PMCID: PMC10987313 DOI: 10.26603/001c.94604] [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: 10/17/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Background A strong body of literature has been published outlining muscle activity differences during sports performance in groups of overhead athletes. However, there are limited studies that have directly compared the muscle activity in overhead athletes with and without history of shoulder injury during functional everyday tasks. Purpose This study aimed to identify muscle activities across fourteen upper extremity and core muscles during three functional everyday movements in athletes with and without history of shoulder injury. Study Design Cross-Sectional Study. Methods Thirty-two male overhead throwing athletes (fifteen healthy and seventeen injured) were recruited and completed three everyday functional movements of high elevation, low elevation, and rotation, using their dominant arm to move an object between two fixed positions. Electromyography (EMG) was recorded for fourteen muscles including: biceps brachii, deltoids (anterior, medial, and posterior), trapezius (upper and lower), pectoralis major, latissimus dorsi, serratus anterior, infraspinatus, external obliques, and gluteus maximus (all surface electrodes) and supraspinatus (fine wire electrode). Mixed model repeated measures ANOVA and post-hoc analysis assessed mean muscle activity (%MVC) between groups and each movement phase. Results Upper trapezius elicited higher mean activity in healthy athletes during both phases of the arm rotation task (p \< 0.05). No differences between groups were evident for arm elevation tasks. Qualitative analysis of muscle patterns during functional tasks reflected a temporal shift in muscle activation timings and magnitudes between athlete groups, suggesting potential compensatory mechanisms in injured athletes. Conclusion Injured overhead athletes appear to utilize other upper limb and shoulder girdle muscles to compensate for lower upper trapezius activity during functional everyday tasks. Level of Evidence 3.
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Affiliation(s)
- Liam P Owens
- School of Health and Sport Sciences Liverpool Hope University
| | - Omid Khaiyat
- School of Health and Sport Sciences Liverpool Hope University
| | - Ginny Coyles
- School of Health and Sport Sciences Liverpool Hope University
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12
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Vetter S, Witt M, Hepp P, Schleichardt A, Schleifenbaum S, Roth C, Denecke T, Henkelmann J, Köhler HP. A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players. Front Physiol 2024; 15:1368033. [PMID: 38516212 PMCID: PMC10955123 DOI: 10.3389/fphys.2024.1368033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging. Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players. Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume. Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group. Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises.
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Affiliation(s)
- Sebastian Vetter
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Maren Witt
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Axel Schleichardt
- Department of Biomechanics, Institute for Applied Training Science, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, Leipzig University, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Hans-Peter Köhler
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
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13
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Lin WH, Huang TY, Chen SW, Hamill J, Kung JT, Tang WT. Does Deep Squat Quality Affect the Propulsion of Baseball Throwing? Bioengineering (Basel) 2024; 11:248. [PMID: 38534522 DOI: 10.3390/bioengineering11030248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
This study investigates the influence of the quality of the "deep squat" movement, adapted from the Functional Movement Screen (FMS) system, on the lower extremity movement pattern during baseball throwing, and its potential impact on throwing performance and propulsion efficiency. Twenty-two baseball players were recruited and categorized into two groups: 13 in the high-score squat group (HSS) and 9 in the low-score squat group (LSS), based on their deep squat screening results. This research explored disparities in ball velocity, propulsion efficiency, propulsion ground reaction force (GRF) characteristics, and throwing kinematics between these two groups. The findings revealed no significant difference in ball velocity between the groups. However, the LSS group demonstrated a lower propulsion GRF efficiency (p < 0.030, ES = 0.46), along with a higher vertical peak GRF (p < 0.002, ES = 0.66). In the pivot leg, the HSS group exhibited significantly lower impulse forces in the Impulse Fresultant (p < 0.035, ES = 0.45), throwing direction (p < 0.049, ES = 0.42), and vertical direction (p < 0.048, ES = 0.42). Additionally, the contribution to the ball velocity of the pivot leg was significantly greater in the HSS group, along with significantly better efficiency in Impulse Fresultant (p < 0.035, ES = 0.45), throwing direction (p < 0.053, ES = 0.41), and vertical direction (p < 0.032, ES = 0.46). In the leading leg, the HSS group demonstrated significantly lower impulse forces in the Impulse Fresultant (p < 0.001, ES = 0.69), throwing direction (p < 0.007, ES = 0.58), and vertical direction (p < 0.001, ES = 0.70). Moreover, the contribution to the ball velocity of the leading leg was significantly greater in the HSS group, accompanied by significantly better efficiency in Impulse Fresultant (p < 0.003, ES = 0.63), throwing direction (p < 0.005, ES = 0.60), and vertical direction (p < 0.021, ES = 0.49). In conclusion, this study suggests that squat screening is a valuable tool for assessing propulsion efficiency. Coaches and trainers should be mindful of players with low squat quality but high throwing performance, as they may face increased impact and injury risks in the future.
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Affiliation(s)
- Wei-Hsuan Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333325, Taiwan
| | - Tsung-Yu Huang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333325, Taiwan
| | - Shu-Wei Chen
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333325, Taiwan
| | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Jung-Tang Kung
- Department of Sport Training Science-Balls, National Taiwan Sport University, Taoyuan 333325, Taiwan
| | - Wen-Tzu Tang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333325, Taiwan
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14
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Fukushima Y, Avilineni M, Kao M, Tirmizey H, Faber KJ, Furtado R, Sadi J. An evidence-informed rehabilitation management framework for posterior shoulder tightness: A scoping review. Shoulder Elbow 2024; 16:74-88. [PMID: 38425737 PMCID: PMC10901171 DOI: 10.1177/17585732231193166] [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: 11/15/2022] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 03/02/2024]
Abstract
Objective To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework. Design Scoping review. Literature search We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021. Study selection criteria Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population. Data synthesis Arksey and O'Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods. Results Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified. Conclusion Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction.
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Affiliation(s)
- Yukino Fukushima
- Advanced Health Care Practice, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Murali Avilineni
- Advanced Health Care Practice, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michelle Kao
- Advanced Health Care Practice, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Haider Tirmizey
- Advanced Health Care Practice, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kenneth J. Faber
- Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Rochelle Furtado
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Jackie Sadi
- Advanced Health Care Practice, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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15
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Alqarni AM, Nuhmani S, Muaidi QI. Glenohumeral internal rotation deficit in volleyball players with and without a history of shoulder pain. Res Sports Med 2024; 32:225-234. [PMID: 35860916 DOI: 10.1080/15438627.2022.2102915] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
This study aimed to investigate physiological and pathological Glenohumeral Internal Rotation Deficit (GIRD) in volleyball players with and without a history of shoulder pain. Volleyball players with a history of shoulder pain (n = 18) and without a history of shoulder pain (n = 18), who were matched in age, weight, height, BMI, years of experience and frequency of practice were recruited for this cross-sectional study. Shoulder internal and external rotation Range of Motion (ROM) was measured for the dominant and non-dominant shoulders of each participant using a digital inclinometer. Measurements of GIRD, External Rotation Gain (ERG), and Total Range of Motion (TROM) were calculated. There were significantly higher degrees of GIRD in the pain group (15.65⁰) than the no-pain group (9.06⁰) (p=0.004) and significantly higher differences in the TROM in the pain group (16.17⁰) than the no-pain group (10.17⁰) (p=0.007). There was no correlation between the level of pain and the presented ROM adaptations. The study showed that for volleyball players, pathological GIRD should be defined at 10-18⁰ degrees of GIRD that are accompanied by differences in the TROM that exceeds 8⁰.
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Affiliation(s)
- Ahmed Mohammed Alqarni
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Qassim Ibrahim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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16
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Sciascia AD. Rehabilitation of the painful shoulder. J Shoulder Elbow Surg 2024; 33:494-506. [PMID: 37573929 DOI: 10.1016/j.jse.2023.07.013] [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: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.
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Affiliation(s)
- Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
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17
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Gofflot A, Croisier JL, Kaux JF, Delvaux F, Tubez F, Tooth C, Bornheim S, Forthomme B. Return to play decision after shoulder dislocation in upper limb athletes: Critical analysis between the habits of medical professionals and the literature. Orthop Traumatol Surg Res 2024; 110:103715. [PMID: 37865233 DOI: 10.1016/j.otsr.2023.103715] [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: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/26/2022] [Indexed: 10/23/2023]
Abstract
BACKGROUND The return to field is a critical moment for an athlete who has dislocated his shoulder as there is a significant risk of recurrence. The decision to return to field made by the doctor will therefore be crucial for the smooth continuation of the athlete's career. HYPOTHESIS This objective is to compare the criteria most used by specialists in clearing an overhead athlete to return to competition after a first episode of antero-internal dislocation of the glenohumeral joint with or without surgery and those mentioned in the literature. PATIENTS AND METHODS The target population consisted of French-speaking physicians in orthopedic surgery, physical medicine and rehabilitation or sports medicine. This study was conducted by the means of a questionnaire. The questionnaire was validated by three experts in sports medicine and published on an online survey website. RESULTS Sixty-three medical specialists responded to the questionnaire. On average, they use more than nine criteria to decide if an athlete is fit to return to competition. Over the 12 criteria proposed, four are used by more than 90% of respondents: laxity/instability, pain, range of motion and patient's subjective feeling. The methods used to evaluate certain criteria such as pain, joint range or muscular strength are often subjective and very often not validated by the literature. CONCLUSION Doctors use a set of criteria to allow an overhead athlete to return to competition. This study highlights that the techniques employed to evaluate these criteria are not always thoroughly validated by literature reviews. LEVEL OF EVIDENCE III; observational study.
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Affiliation(s)
- Amandine Gofflot
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium; Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium.
| | - Jean-Louis Croisier
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium; Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium
| | - Jean-François Kaux
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium
| | - François Delvaux
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium; Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium
| | - François Tubez
- Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium
| | - Camille Tooth
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium
| | - Stephen Bornheim
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium
| | - Bénédicte Forthomme
- Department of Rehabilitation and Sports Sciences, University of Liege, Liege, Belgium; Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Center of Excellence, IOC Research Center for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liege, Liege, Belgium; Laboratory of Human Motion Analysis, University of Liege, Liege, Belgium
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18
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Jones SD, Safran MR. Current concepts: the hip, core and kinetic chain in the overhead athlete. J Shoulder Elbow Surg 2024; 33:450-456. [PMID: 38007174 DOI: 10.1016/j.jse.2023.10.009] [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: 06/14/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND As overhead sports continue to grow in popularity, there has been increased interest in optimizing sports performance and injury prevention in these athletes. The hip, core, and kinetic chain have become a focus of research in recent decades, and their importance in upper extremity mechanics is now being recognized. METHODS An extensive review was carried out to identify papers correlating the hip, core and/or kinetic chain in overhead athletic performance and injury. RESULTS Recent literature has shown that efficiency and synchrony of the hips and core during an overhead movement (such as in baseball, golf, tennis, or volleyball) is essential for a powerful and precise execution of the task. Impairments of the hip and core, particularly abnormal joint mobility or weakness, can limit efficient energy transfer through the kinetic chain and may negatively impact performance. Recent epidemiologic studies have found hip pain to be common in adolescent, collegiate, and adult athletes. Moreover, hip pain in overhead athletes specifically has also been found to occur at a high rate. Abnormalities in hip range of motion, hip morphology, and core strength can lead to abnormal mechanics upstream in the kinetic chain, which may place athletes at risk of injuries. CONCLUSION In this review, the complex and multifaceted relationship between the hip, core, and kinetic chain is highlighted with an emphasis on recent literature and relevant findings.
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Affiliation(s)
- Steven D Jones
- Department of Orthopedic Surgery, Sports Medicine, Stanford University, Redwood City, CA, USA
| | - Marc R Safran
- Department of Orthopedic Surgery, Sports Medicine, Stanford University, Redwood City, CA, USA.
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19
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Ueda A, Matsumura A, Shinkuma T, Oki T, Nakamura Y. Shoulder kinetic during pitching in baseball players with scapular dyskinesis. J Bodyw Mov Ther 2024; 37:57-62. [PMID: 38432842 DOI: 10.1016/j.jbmt.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 09/22/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players. METHOD Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18-camera motion-capture system. SD was classified into four types (I-IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed. RESULTS The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I-Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group. CONCLUSIONS These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching.
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Affiliation(s)
- Atsushi Ueda
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan.
| | | | | | - Takeshi Oki
- Department of Orthopaedic Surgery, Hankai Hospital, Japan
| | - Yasuo Nakamura
- Department of Health and Sports Science, Doshisha University, Japan
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20
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Dangare MS, Shedge SS, Ramteke SU. Rehabilitation of Supraspinatus Impingement in a Volleyball Athlete: A Case Report. Cureus 2024; 16:e51869. [PMID: 38327912 PMCID: PMC10849064 DOI: 10.7759/cureus.51869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Volleyball players with supraspinatus tendinopathy commonly present with a spectrum of symptoms, including shoulder pain, especially during the overhead phases of the game. They may experience pain during serves, spikes, or attempting to block at the net. Weakness in the affected shoulder and limited range of motion can impede performance and overall playing experience. Physiotherapy plays a crucial role in managing supraspinatus tendinopathy, focusing on reducing pain, improving shoulder joint range and function, and preventing recurrence. The research question arises as to how the rehabilitation process impacts the recovery and performance outcomes in a volleyball athlete with supraspinatus impingement which is explained as detailed in a case report. The present case is a 21-year-old male volleyball athlete complaining of pain in the anterolateral and posterior aspects of the right shoulder joint and a restricted range of motion while doing abduction and flexion at the shoulder joint for three months. After the orthopedic physical assessment, the patient was diagnosed with supraspinatus tendinopathy. This case report introduces an exact understanding of the rehabilitation tailored specifically to volleyball athletes with supraspinatus impingement.
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Affiliation(s)
- Mansee S Dangare
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saylee S Shedge
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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21
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Oliver GD, Fava A, Lozowski B, Zaremski JL, Holtz KA, Bowers RL. Evaluation of Hip Characteristics in Baseball and Softball Athletes with and Without Throwing Arm Pain. Int J Sports Med 2024; 45:71-78. [PMID: 37890497 DOI: 10.1055/a-2184-5893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
During throwing, the lower extremity assists in the generation and transfer of momentum. Lower extremity stability assists in this transfer by providing a base for distal mobility of the arm segments. This study aimed to determine differences between hip rotational range of motion and strength based on the presence of throwing-arm pain (yes/no) and throwing sport (baseball/softball). We hypothesized those experiencing pain would display decreases in hip range of motion and strength, and that softball players would display greater range of motion than baseball, but less strength based on sex-specific characteristics. Forty-four baseball (13±2 years, 165.2±13.0 cm, 58.5±13.4 kg) and 50 softball players (13±2 years, 160.9±11.2 cm, 62.7±17.9 kg) participated. Multivariate analysis of variance tests (2×2) determined differences in bilateral hip range of motion, total arc of motion, and strength between pain status and sport. There were no significant interactions (>0.05) for pain status and sport on hip range of motion, total arc of motion, and strength. Furthermore, no significant main effects (>0.05) were found for pain status or sport alone on range of motion or strength. Future work should be directed at explaining the effects of hip characteristics on the throwing motion and how it equates to throwing-arm health.
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Affiliation(s)
| | - Anthony Fava
- School of Kinesiology, Auburn University, Auburn, United States
| | - Billy Lozowski
- School of Kinesiology, Auburn University, Auburn, United States
| | - Jason L Zaremski
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, United States
| | - Kaila A Holtz
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert L Bowers
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, United States
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22
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Kim H, Park C, You J(SH. Sustainable effectiveness of kinetic chain stretching on active hip flexion movement and muscle activation for hamstring tightness: A preliminary investigation. Technol Health Care 2024; 32:155-167. [PMID: 38759046 PMCID: PMC11191522 DOI: 10.3233/thc-248014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Conventional hamstring (HAM) stretching therapeutic effects are not substantiable in neuromusculoskeletal conditions with HAM tightness or shortness. We developed a kinetic chain stabilization exercise to provide a more sustainable effectiveness in adults with HAM tightness. However, its therapeutic effects and underlying motor mechanisms remain unknown. OBJECTIVE To compare the effects of traditional active HAM stretching (AHS) and kinetic chain stretching (KCS) on electromyographic (EMG) amplitude and hip flexion range of motion (ROM) in participants with HAM tightness. METHODS In this randomized controlled trial, 18 participants (mean age: 25.01 ± 2.47 years) with HAM tightness were assigned to the AHS or KCS group. Hip joint movement, EMG amplitude, and onset times were recorded in the bilateral erector spinae, HAM, transverse abdominis/internal oblique (IO), external oblique (EO), and rectus abdominis during a straight leg raise test. RESULTS Compared to AHS, KCS led to greater increase in the hip flexion ROM and EMG activation amplitudes in the left and right EO and left IO. Post-test hip flexion ROM data in both the groups were higher than the pre-test data. CONCLUSION KCS produced more sustainable effectiveness in hip flexion movement and EMG motor control patterns in participants with HAM tightness than AHS.
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Affiliation(s)
- Heejun Kim
- Sports Movement Artificial Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Chanhee Park
- Sports Movement Artificial Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Joshua (Sung) H. You
- Sports Movement Artificial Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea
- Department of Physical Therapy, Yonsei University, Wonju, Korea
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23
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Goes PK, Flores DV, Damer A, Huang BK. Shoulder and Elbow Injuries in Adult Overhead Throwers: Imaging Review. Radiographics 2023; 43:e230094. [PMID: 37917538 DOI: 10.1148/rg.230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation shifts the humeral head posterosuperiorly, predisposing to glenohumeral internal rotation deficit (GIRD), Bennett, posterosuperior internal impingement (PSI), and superior labrum anterior-posterior (SLAP) lesions. GIRD represents loss of internal rotation at the expense of external rotation. Bennett lesion represents ossification of the posteroinferior glenohumeral ligament due to repetitive traction. PSI manifests with humeral head cysts and "kissing" tears of the posterosuperior cuff and labrum. Scapular dysfunction contributes to symptoms of PSI and predisposes to labral or rotator cuff disease. "Peel-back" or SLAP lesions occur when torsional forces detach the biceps-labral anchor from the glenoid. Finally, disorders of the anterior capsule, latissimus dorsi, teres major, and subscapularis are well recognized in overhead throwers. At the elbow, injuries typically involve the medial-sided structures. The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and can be thickened, attenuated, ossified, and/or partially or completely torn. Medial epicondylitis can occur with tendinosis, partial tear, or complete rupture of the flexor-pronator mass and can accompany UCL tears and ulnar neuropathy. Posteromedial impingement (PMI) and valgus extension overload syndrome are related entities that follow abundant valgus forces during late cocking or acceleration, and deceleration. These valgus stresses wedge the olecranon into the olecranon fossa, leading to PMI, osteophytes, and intra-articular bodies. Other osseous manifestations include olecranon stress fracture and cortical thickening of the humeral shaft. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Paola Kuenzer Goes
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Dyan V Flores
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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24
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Sumimoto Y, Yokoya S, Kitasaka A, Harada Y, Deie M, Adachi N. Range of Motion and Muscle Strength Changes in Japanese Professional Pitchers During the Baseball Season. Cureus 2023; 15:e49844. [PMID: 38174180 PMCID: PMC10762284 DOI: 10.7759/cureus.49844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There are no studies examining changes in the physical function throughout the baseball season in Japanese professional players. We examined the range of motion (ROM) and muscle strength changes in professional baseball pitchers as the season progresses. MATERIALS AND METHODS Five professional baseball pitchers were included. ROM, flexibility, and muscle strength of the trunk and shoulder, elbow, hip, knee, and ankle joints were measured pre-season (PRE), mid-season (MID), and post-season (POST). RESULTS The total shoulder arc ROM of the dominant sides significantly decreased compared to that of the nondominant sides at MID and POST. Shoulder abduction muscle strength of the dominant sides significantly decreased at POST compared to that at PRE. In the trunk, lateral flexion ROM of bilateral sides significantly decreased at MID and POST compared to that at PRE, and the duration time of the side bridge test of the dominant sides significantly decreased at POST to that at PRE. Hip extension ROM and muscle strength and internal rotation ROM of the push-off leg significantly decreased at POST compared to that at PRE. CONCLUSION The total shoulder arc ROM and shoulder abductor muscle strength of the dominant sides, trunk lateral flexion ROM and muscle strength, push-off leg hip joint extension muscle strength and ROM, and internal rotation ROM were more susceptible to changes as the season progressed. In order to maintain performance and prevent a throwing disorder, it is necessary to focus on these movements during the season and to appropriately train and condition these muscle groups.
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Affiliation(s)
- Yasuhiko Sumimoto
- Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shin Yokoya
- Orthopaedic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JPN
| | | | - Yohei Harada
- Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Masataka Deie
- Orthopaedic Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Nobuo Adachi
- Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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25
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Maemichi T, Meguriya S, Furusho A, Liu Z, Tsutsui T, Kumai T. Combined effects of stretching and low-frequency electroacupuncture on posterior shoulder joint tightness: a case report. Acupunct Med 2023; 41:380-382. [PMID: 37740698 DOI: 10.1177/09645284231197231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Affiliation(s)
- Toshihiro Maemichi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Institute of Life Innovation Studies, Toyo University, Tokyo, Japan
| | - Shigeru Meguriya
- Acupuncture and Physical Therapy Teacher Training School, Tsukuba University, Tsukuba, Japan
| | | | - Zijian Liu
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | | | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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26
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Tooth C, Schwartz C, Croisier JL, Gofflot A, Bornheim S, Forthomme B. Prevention of shoulder injuries in volleyball players: The usefulness and efficiency of a warm-up routine. Phys Ther Sport 2023; 64:97-103. [PMID: 37812954 DOI: 10.1016/j.ptsp.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The objective of this study was to assess the efficiency of a warm-up routine focused on shoulder injury prevention in volleyball players. DESIGN Prospective study. SETTING University. PARTICIPANTS Eight recreational volleyball teams (44 males, 49 females) were included in the study and assigned to two different groups (prevention or control) in a blinded way. In the prevention group, the players had to perform specific exercises at the beginning of each training session twice a week. MAIN OUTCOME MEASURES Injuries were recorded monthly in both groups with an online questionnaire. RESULTS A significant decrease in the total number of injuries as well as in the severity of the injuries was observed in the prevention group in comparison to the control group (p = 0.0001-0.013). For the shoulder, a decrease in injury incidence was also observed in the prevention group. This decrease reached significance in male players (p = 0.045). CONCLUSIONS The program appears to be efficient to reduce the risk of shoulder injuries in recreational volleyball players. Adjustments in the duration and in the contents of the program will have to be made to further improve compliance and better meet the requirements of both players and trainers.
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Affiliation(s)
- Camille Tooth
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium; Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium.
| | - Cédric Schwartz
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
| | - Jean-Louis Croisier
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium; Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Amandine Gofflot
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium; Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Stephen Bornheim
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Bénédicte Forthomme
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium; Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
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27
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Suphakitchanusan W, Kerdsomnuek P, Jamkrajang P, Fossum BW, Sudjai N, Paugchawee J, Limroongreungrat W, Vanadurongwan B, Keyurapan E, Ganokroj P. Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes. J Shoulder Elbow Surg 2023; 32:e504-e515. [PMID: 37285953 DOI: 10.1016/j.jse.2023.04.035] [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: 11/29/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The alteration of scapular kinematics can predispose patients to shoulder pathologies and dysfunction. Previous literature has associated various types of shoulder injuries with scapular dyskinesis, but there are limited studies regarding the effect that proximal humeral fractures (PHFs) have on scapular dyskinesis. This study aims to determine the change in scapulohumeral rhythm following treatment of a proximal humerus fracture as well as differences in shoulder motion and functional outcomes among patients who presented with or without scapular dyskinesis. We hypothesized that differences in scapular kinematics would be present following treatment of a proximal humerus fracture, and patients who presented with scapular dyskinesis would subsequently have inferior functional outcome scores. METHODS Patients treated for a proximal humerus fracture from May 2018 to March 2021 were recruited for this study. The scapulohumeral rhythm and global shoulder motion were determined using a 3-dimensional motion analysis (3DMA) and the scapular dyskinesis test. Functional outcomes were then compared among patients with or without scapular dyskinesis, including the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the visual analog scale (VAS) for pain, and the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L). RESULTS Twenty patients were included in this study with a mean age of 62.9 ± 11.8 years and follow-up time of 1.8 ± 0.2 years. Surgical fixation was performed in 9 of the patients (45%). Scapular dyskinesis was present in 50% of patients (n = 10). There was a significant increase in scapular protraction on the affected side of patients with scapular dyskinesis during abduction of the shoulder (P = .037). Additionally, patients with scapular dyskinesis demonstrated worse SICK scapula scores (2.4 ± 0.5 vs. 1.0 ± 0.4, P = .024) compared to those without scapular dyskinesis. The other functional outcome scores (ASES, VAS pain scores, and EQ-5D-5L) showed no significant differences among the 2 groups (P = .848, .713, and .268, respectively). CONCLUSIONS Scapular dyskinesis affects a significant number of patients following treatment of their PHFs. Patients presenting with scapular dyskinesis exhibit inferior SICK scapula scores and have more scapular protraction during shoulder abduction compared to patients without scapular dyskinesis.
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Affiliation(s)
- Wasaphon Suphakitchanusan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Orthopedic Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | | | | | - Narumol Sudjai
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirayu Paugchawee
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Ekavit Keyurapan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phob Ganokroj
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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28
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Jácome-López R, Tejada-Gallego J, Silberberg JM, García-Sanz F, García-Muro San José F. Treatment of glenohumeral internal rotation deficit in the general population with shoulder pain: An open single-arm clinical trial. Medicine (Baltimore) 2023; 102:e35263. [PMID: 37747030 PMCID: PMC10519522 DOI: 10.1097/md.0000000000035263] [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: 06/15/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Maladaptation can provoke important alterations in the arthrokinematics such as an internal rotation reduction in the dominant shoulder compared with the nondominant shoulder known as glenohumeral internal rotation deficit (GIRD). Though the number of studies investigating GIRD in athletic population, there are not studies reporting the efficacy of the GIRD treatment in the nonathlete population, a kind of study required to improve our understanding of patient care with this pathology. This study aimed to describe the efficacy of the GIRD treatment in nonathlete population with shoulder pain. METHODS An open single-arm trial with 35 patients was adopted for evaluating the efficacy of GIRD treatment in patients with shoulder pain. All patients with shoulder pain who attended the consultation, accepted, and agreed to participate in the study between October 2020 and March 2021 were included. A treatment sequence including joint manual therapy techniques and soft tissue release techniques was applied in the consultation. Then, patients were instructed to adapt the daily active biological stimulus at home. The IR before (IR0) and after (IR1) the treatment was considered the outcome measure. The GIRD was calculated as the difference between the IR of the non-painful shoulder and the IR of the painful shoulder before (GIRD0) and after treatment (GIRD1). A paired Student t test was used to compare the GIRD of each patient before and after the treatment. RESULTS Treatment of the patients significantly increased the IR of the painful shoulder in all the patients (P-value < .0001) So, the mean IR0 was 26.09 ± 14.46º (23.64-28.53), and after the treatment the mean IR1 was 67.98 ± 15.03º (65.48-70.52). The mean difference after the treatment (IR1-IR0) was 41.89 ± 14.74º (39.4-44.39). The treatment also significantly reduced GIRD (P-value < .0001). So, the mean GIRD0 was 42.95 ± 16.26º (40.2-45.7), and after the treatment the mean GIRD1 was -1.05 ± 17.18º (-3.96 to 1.85). CONCLUSIONS The treatment administrated in this study significantly increased the internal rotation of the treated and painful shoulder and reduced the GIRD from the first consultation. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Rafael Jácome-López
- Physiotherapy Unit, Clínica Universidad de Navarra, Madrid, Spain
- CEU International Doctoral School (CEINDO), University San Pablo-CEU, Madrid, Spain
| | - Javier Tejada-Gallego
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Madrid, Spain
| | - José María Silberberg
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Madrid, Spain
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29
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Batalha N, Sousa JP, Fernandes O, Dias E, Parraca JA, Villafaina S. Effects of an 11-Week Detraining, Imposed by the COVID-19 Confinement, on Handball Players' Shoulder Rotator Isokinetic Profile, Shoulder Range of Motion, and Ball Release Velocity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1548. [PMID: 37763667 PMCID: PMC10533007 DOI: 10.3390/medicina59091548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The COVID-19 confinement significantly impacted the physical condition of athletes. However, the detraining impacts of this period on the shoulder rotator and range of motion in handball players have not been studied. Thus, the main aim of this study was to investigate the effect of this 11-week detraining period, imposed by the COVID-19 pandemic confinement, on the shoulder rotator isokinetic profile (peak torque, ratio, fatigue index), shoulder rotator and flexion range of motion, and ball release velocity in handball players. Materials and Methods: A total of 16 handball players, with a mean age of 22.38 (5.28) years, participated in this study. The isokinetic strength was assessed using two protocols (three repetitions at an angular velocity of 60°/s and 20 repetitions at an angular velocity of 180°/s). In addition, the range of motion and ball release (at jump and standing shots) were measured. All these measurements were assessed before and after the COVID-19 confinement. Results: The results showed a significant reduction in the peak torque of the external rotation of their dominant and non-dominant shoulders. In addition, confinement significantly increased the fatigue index of external rotation and internal rotation and reduced the range of motion of internal rotation. Additionally, the ball release velocity during standing and jump shots was significantly reduced. Conclusions: These results suggested that strengthening external and internal rotation as well as recovering the internal rotation range of motion may be necessary after a detraining period in order to prevent shoulder injuries.
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Affiliation(s)
- Nuno Batalha
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-727 Évora, Portugal
| | - João Paulo Sousa
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-727 Évora, Portugal
| | - Orlando Fernandes
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-727 Évora, Portugal
| | - Eduardo Dias
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
| | - Jose A. Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-727 Évora, Portugal
| | - Santos Villafaina
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-727 Évora, Portugal; (J.P.S.); (O.F.); (E.D.); (J.A.P.); (S.V.)
- Grupo de Investigación Actividad Física y Calidad de Vida (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Cáceres, Spain
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30
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Gomes E, Andrade R, Valente C, Santos JV, Nunes J, Carvalho Ó, Correlo VM, Silva FS, Oliveira JM, Reis RL, Espregueira-Mendes J. Inconsistency in Shoulder Arthrometers for Measuring Glenohumeral Joint Laxity: A Systematic Review. Bioengineering (Basel) 2023; 10:799. [PMID: 37508826 PMCID: PMC10376824 DOI: 10.3390/bioengineering10070799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
There is no consensus on how to measure shoulder joint laxity and results reported in the literature are not well systematized for the available shoulder arthrometer devices. This systematic review aims to summarize the results of currently available shoulder arthrometers for measuring glenohumeral laxity in individuals with healthy or injured shoulders. Searches were conducted on the PubMed, EMBASE, and Web of Science databases to identify studies that measure glenohumeral laxity with arthrometer-assisted assessment. The mean and standard deviations of the laxity measurement from each study were compared based on the type of population and arthrometer used. Data were organized according to the testing characteristics. A total of 23 studies were included and comprised 1162 shoulders. Populations were divided into 401 healthy individuals, 278 athletes with asymptomatic shoulder, and 134 individuals with symptomatic shoulder. Sensors were the most used method for measuring glenohumeral laxity and stiffness. Most arthrometers applied an external force to the humeral head or superior humerus by a manual-assisted mechanism. Glenohumeral laxity and stiffness were mostly assessed in the sagittal plane. There is substantial heterogeneity in glenohumeral laxity values that is mostly related to the arthrometer used and the testing conditions. This variability can lead to inconsistent results and influence the diagnosis and treatment decision-making.
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Affiliation(s)
- Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
| | - J Victor Santos
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
| | - Jóni Nunes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Serviço de Ortopedia e Traumatologia do Hospital de Santa Maria Maior, 4750-333 Barcelos, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
| | - Óscar Carvalho
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - Vitor M Correlo
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- Pro2B, Consultoria e Gestão de Projetos, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Filipe S Silva
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - J Miguel Oliveira
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Rui L Reis
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
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31
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Nagamoto H, Kimura R, Hata E, Kumai T. Disabled throwing shoulder/elbow players have high rates of impaired foot function. Res Sports Med 2023; 31:679-686. [PMID: 35139696 DOI: 10.1080/15438627.2022.2038160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
The prevalence of impaired foot function and floating toes of 91 baseball players with disabled throwing shoulder or elbow were retrospectively investigated. Foot function was evaluated by foot "rock paper scissors" and floating toes were confirmed if none of the toes made contact with the mat in standing posture. The prevalence of impaired foot function and floating toes and the relationship between between them were determined. Abnormal foot function was observed in 83 players (91%); of those, 73 players (88%) also had floating toes, and the prevalence was statistically significant compared to those without it (12%) (P < 0.001). Floating toes were observed in 74 players (81%); of those, 73 players (99%) had impaired foot function, and the prevalence was also statistically significant compared to those without them (59%) (P < 0.001). Baseball players with disabled throwing shoulder or elbow have high rates of impaired foot function and floating toes.
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Affiliation(s)
- Hideaki Nagamoto
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
- Department of Orthopaedic Surgery, Tohoku University, Sendai, Japan
- Department of Orthopaedic Surgery, Kurihara Central Hospital, Kurihara, Japan
| | - Rei Kimura
- Department of Orthopaedic Surgery, Tohoku University, Sendai, Japan
- Department of Orthopaedic Surgery, Kurihara Central Hospital, Kurihara, Japan
| | - Eri Hata
- Department of Rehabilitation, Kurihara Central Hospital, Kurihara, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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32
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D A, Sudhan M A, Chandran S, Nuhmani S, Ahsan M, Alghadir AH, Khan M. Effects of modified sleeper stretch and modified cross-body stretch on upper limb functions and shoulder ROM in tennis players: a randomized trial. Sci Rep 2023; 13:9124. [PMID: 37277413 DOI: 10.1038/s41598-023-35977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
Tennis players often experience posterior shoulder pain due to restricted internal rotation (IR) range of motion (ROM) of the glenohumeral joint. No research has compared the effects of modified sleeper stretch (MSS) versus modified cross-body stretch (MCBS) on tennis players' upper limb functions and IR ROM. The study aimed to compare the efficacy of modified sleeper and cross-body adduction stretch in improving shoulder IR ROM and upper limb functions in tennis players. Thirty male lawn tennis players (aged 20 to 35 years) with more than 15° glenohumeral IR deficiency on the dominant side compared to the non-dominant side were recruited and divided into two groups: Modified sleeper stretch group (MSSG) and modified cross-body stretch group (MCBSG). MSSG received MSS, and MCBSG received MCBS, 3-5 repetitions once daily for 4 weeks. Upper limb functions were measured using the Disability of the Arm, Shoulder, and Hand (DASH) scale, and the IR ROM of the shoulder joint was measured using a universal goniometer. Both groups observed significant (p < 0.05) DASH scores and IR ROM improvements. DASH scores decreased by 85% in MSSG and 79.60% in MCBSG. IR ROM increased by 94.64% in MSSG and 89.52% in MCBSG. No significant differences (p > 0.05) were found in post-intervention DASH scores and IR ROM values between both groups. MSS and MCBS improved upper limb functions and IR ROM of the shoulder joint in the selected sample population of lawn tennis players. No difference was observed between both stretching techniques in improving upper limb functions and IR ROM of the shoulder joint.
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Affiliation(s)
- Anjupriya D
- Co-operative Institute of Health Sciences, Thalassery, Kerala, India
| | - Aparna Sudhan M
- Co-operative Institute of Health Sciences, Thalassery, Kerala, India
| | - Shilpa Chandran
- Co-operative Institute of Health Sciences, Thalassery, Kerala, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box. 10219, Riyadh, 11433, Saudi Arabia
| | - Masood Khan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box. 10219, Riyadh, 11433, Saudi Arabia.
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33
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Thomas ZM, Wilk KE. The Golfer's Fore, Fore +, and Advanced Fore + Exercise Program: An Exercise Series and Injury Prevention Program for the Golfer. Int J Sports Phys Ther 2023; V18:789-799. [PMID: 37425113 PMCID: PMC10324324 DOI: 10.26603/001c.74973] [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: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 07/11/2023] Open
Abstract
Golf is increasing in popularity with 24.8 million golfers in the U.S. in 2020, a 2% increase from the previous year. This number increased to 37.5 million in 2021 which can be further broken down to 25.1 million on course and 12.4 million participating in off course activities. Playing golf does not come without risk of injury, with an annual incidence between 15.8% and 40.9% in amateurs and 31% in professional golfers. Most injuries in golf occur due to overuse (82.6%) and only a small percentage occur from a single traumatic event (17.4%). Injuries most commonly occur at the low back followed by the wrist. Injury prevention programs have shown to be successful in other sports however to date there are no studies assessing a golfer's specific program. The purpose of this clinical commentary is to describe three individualized and unsupervised golf exercise programs (The Golfer's Fore, Fore+, and Advanced Fore+), of varying difficultly, designed to reduce the risk of injury, improve strength/mobility, and optimize performance. Level of Evidence 5.
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Affiliation(s)
| | - Kevin E Wilk
- Champion Sports Medicine Select Medical
- Director of Rehabilitative Research American Sports Medicine Institute
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34
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Zhang H, Katz L, Chang K, Testa EJ, Callanan T, Owens BD. A Bibliometric Analysis of the Most Cited Research on Humeral Avulsions of the Glenohumeral Ligament: A Paucity of High-Level Evidence. Arthrosc Sports Med Rehabil 2023; 5:e793-e798. [PMID: 37388877 PMCID: PMC10300590 DOI: 10.1016/j.asmr.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/15/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To identify the 25 most-cited articles on humeral avulsion of the glenohumeral ligament (HAGL) lesions and characterize them based on number of citations, citation density, source journal, year of publication, geographic origin, article type, and level of evidence. Methods The Science Citation Index Expanded database was queried for all possible publications regarding HAGL lesions. The 25 most-cited articles from 1976 to 2021 relevant to the topic were selected for further analysis. Articles were characterized based on the number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence. Results The number of citations for individual articles ranged from 21 to 182 (mean ± standard deviation: 44.72 ± 36.87). Ten countries contributed to the 25 most cited articles, with 14 of the 25 (56%) articles published in the United States. Furthermore, the top 25 cited articles were published in 9 journals, with the majority in Arthroscopy-The Journal of Arthroscopic and Related Surgery (n = 15, 60%). There were 15 (60%) articles classified as "Clinical," 9 (36%) as "Review/Expert Opinion," and 1 (4%) as "Basic Science." All clinical studies met the standard for level IV evidence. Conclusions This bibliometric analysis provides a list of the 25 most cited articles related to HAGL lesions, providing a reference of impactful articles for medical educators. The lack of high level of evidence "Clinical" studies demonstrates that higher-quality research is needed to establish guidelines for the treatment and management of HAGL lesions. Clinical Relevance A list of the 25 most-cited articles regarding recurrent glenohumeral instability can serve as a comprehensive reference for practitioners, educators, researchers, and orthopaedic trainees.
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Affiliation(s)
- Helen Zhang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Luca Katz
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward J. Testa
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Tucker Callanan
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Brett D. Owens
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA
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35
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Ike S, Momma D, Numaguchi K, Matsui Y, Yokota M, Oohinata J, Kondo E, Iwasaki N. Bilateral Humeral Retrotorsion Angle Measured Using an Ultrasound-Assisted Technique in Asian Baseball Players. Orthop J Sports Med 2023; 11:23259671231166927. [PMID: 37260582 PMCID: PMC10227875 DOI: 10.1177/23259671231166927] [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: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 06/02/2023] Open
Abstract
Background Repetitive pitching is thought to restrict the physiological derotation process of the humeral head. Some studies have reported that side-to-side differences in the humeral retrotorsion angle (ΔHRA) occur between the ages of 9 and 11 years in baseball players. However, it remains unclear whether the ΔHRA in Asian baseball players depends on pitching skill or competitive level. Purpose To evaluate the ΔHRA in Asian collegiate and professional baseball players and to determine the effects of pitching activity on the physiological derotation process of the humeral head. Study Design Cross-sectional study; Level of evidence, 3. Methods We evaluated 128 shoulders in 64 Asian baseball players who were stratified into 4 groups as follows: 13 professional pitchers; 9 professional fielders; 8 collegiate pitchers; and 34 collegiate fielders. The throwing and nonthrowing side HRA was assessed using an ultrasound-assisted technique, and the ΔHRA was compared among the 4 groups. In addition, Pearson correlation analysis was used to assess the relationship between ΔHRA and glenohumeral range of motion, baseball starting age, and fastball velocity in pitchers. Results The HRA was significantly greater in the throwing arm than in the nonthrowing arm in each group, with no significant differences among the groups. There was no correlation between ΔHRA and range of motion or fastball velocity. There was a significant negative correlation between baseball starting age and ΔHRA in professional fielders (r = -0.633; P = .036). Conclusion The findings of the present study provide evidence that in Asian baseball players, the HRA was significantly greater in the throwing arm than in the nonthrowing arm. There were no clear associations between HRA and pitching ability or competitive level.
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Affiliation(s)
- Shota Ike
- Faculty of Medicine and Graduate School
of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo,
Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido
University Hospital, Sapporo, Japan
| | - Kyosuke Numaguchi
- Faculty of Medicine and Graduate School
of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo,
Japan
| | - Yuki Matsui
- Faculty of Medicine and Graduate School
of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo,
Japan
| | | | | | - Eiji Kondo
- Center for Sports Medicine, Hokkaido
University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School
of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo,
Japan
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36
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Funakoshi T, Takahashi T, Shimokobe H, Miyamoto A, Furushima K. Arthroscopic findings of the glenohumeral joint in symptomatic anterior instabilities: comparison between overhead throwing disorders and traumatic shoulder dislocation. J Shoulder Elbow Surg 2023; 32:776-785. [PMID: 36343790 DOI: 10.1016/j.jse.2022.10.005] [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: 05/16/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The term shoulder instability refers to a variety of mechanisms and clinical presentations. One of the common pathologies of throwing disorders is internal impingement with anterior instability. Most throwing athletes with symptomatic internal impingement with anterior instability exhibit positive apprehension and relocation test results, whereas those with recurrent anterior shoulder instability display positive apprehension test results. While the glenoid labrum-inferior glenohumeral ligament complex is a significant critical stabilizer for the prevention of anterior shoulder dislocation, the characteristics of the essential lesion in internal impingement with anterior instability have not been determined yet. This study aimed to compare the intra-articular lesion of athletes with internal impingement related to the overhead throwing motion in athletes with a traumatic shoulder dislocation. METHODS Sixty-one athletes (all men; mean age, 25.2 ± 12.6 yr) who underwent an arthroscopic procedure were divided into 2 groups: 25 in the throwing group and 36 in the dislocation group. All shoulders had subtle glenohumeral instability defined by a positive anterior apprehension test and a relocation test. Those with voluntary and multidirectional instability and large glenoid bone loss (more than 25%) were excluded from the current study. All shoulders were evaluated for the following evidence: rotator cuff injury, superior labrum tear anterior and posterior lesions, labral pathologies including Bankart lesions, osteochondral lesions to the humeral head, biceps tendon fraying or rupture, and inferior glenohumeral ligament and middle glenohumeral ligament (MGHL) conditions. RESULTS Arthroscopic findings of the throwing group showed more supraspinatus injuries (92% and 25%, P < .001), type II superior labrum tear anterior and posterior lesions (60% and 3%, P < .001), posterosuperior labral lesions (92% and 39%, P < .001), and hypoplastic MGHLs (56% and 6%, P < .001) and lesser Bankart lesions (8% and 92%, P < .05) than those of the dislocation group. CONCLUSIONS These results indicate that the characteristic lesions of internal impingement with anterior instability in throwing athletes include partial thickness rotator cuff tears, superior labrum tear anterior and posterior lesions, posterosuperior labral tears, and hypoplastic MGHLs. As expected, the physiopathology of internal impingement with anterior instability in throwing athletes may be related to the dysfunction of the anterosuperior glenohumeral capsular ligament, including the MGHL, rather than the inferior glenohumeral ligament as in traumatic anterior shoulder dislocations. These findings would be useful for defining treatment strategies for internal impingement with anterior instability in overhead throwing athletes.
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37
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Takenaga T, Yoshida M, Chan CK, Musahl V, Debski RE, Lin A. Direction of non-recoverable strain in the glenohumeral capsule following multiple anterior dislocations: Implications for anatomic Bankart repair. J Orthop Res 2023; 41:479-488. [PMID: 35615943 DOI: 10.1002/jor.25385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
The study aimed to analyze the direction of non-recoverable strain and determine the optimal direction for anatomic capsular plication within four sub-regions of the inferior glenohumeral capsule following multiple dislocations. Seven fresh-frozen cadaveric shoulders were dissected. A grid of strain markers was affixed to the inferior glenohumeral capsule. Each joint was mounted in a 6-degree-of-freedom robotic testing system and repeatedly dislocated in the anterior direction 10 times at 60° of abduction and 60° of external rotation of the glenohumeral joint. The 3D positions of the strain markers were compared before and after dislocations to define the non-recoverable strain. The strain map was divided into four sub-regions. The angles of deviation between each maximum principle strain vector and the anterior band of the inferior glenohumeral ligament (AB-IGHL) or posterior band of the IGHL (PB-IGHL) for the anterior and posterior regions of the capsule were determined. The mean direction of all strain vectors in each sub-region was categorized. The direction of the non-recoverable strain in the anterior-band and anterior-axillary-pouch sub-regions was categorized as parallel to the AB-IGHL, whereas the posterior-axillary-pouch and posterior-band sub-regions were mostly perpendicular to the PB-IGHL. Clinical Significance: Plication of the anteroinferior capsule parallel to the AB-IGHL may be preferred during arthroscopic Bankart repair to restore anatomy; posteroinferior capsular plication may also be necessary and best performed perpendicular to the PB-IGHL. The direction of the capsular injury remains the same irrespective of the number of dislocations. This study provides the scientific and quantitative rationale for an anatomic approach to capsular plication.
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Affiliation(s)
- Tetsuya Takenaga
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahito Yoshida
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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38
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Winkelmann MT, Achenbach L, Zeman F, Laver L, Walter SS. The throwing shoulder in youth elite handball: adaptions of inferior but not anterior capsule thickness differ between the two sexes. Res Sports Med 2023; 31:112-124. [PMID: 34176387 DOI: 10.1080/15438627.2021.1943391] [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: 10/21/2022]
Abstract
The aim was to investigate side-to-side and sex differences of anterior and inferior capsule thickness (ACT, ICT) between the throwing and non-throwing shoulder (TS, NTS) in youth elite handball players. 125 youth female and male elite handball players (14.1±0.7yo) were assessed for ACT and ICT by ultrasound . ACT measurement was performed from anterior (3 o'clock) in upright position and for ICT from inferior (6 o'clock) in supine position. Measurements of ICT in the TS of all athletes (1.4±0.2 mm) differed significantly but marginally to those in the NTS (1.3±0.2 mm) (p = 0.001). Female (1.2±0.2 mm vs. 1.3±0.2 mm; p = 0.007) but not male youth players (1.4±0.2 mm vs. 1.4±0.2 mm, p = n.s.) demonstrated slight differences in ICT in the TS compared with the NTS. Although significant, the thickness in the TS compared to the NTS was within the measurement accuracy of the ultrasonic assessment. No difference in ACT was observed in the TS (1.4±0.3 mm) compared to the NTS (1.4±0.3 mm) for both sexes (n.s.).In conclusion, the anterior and inferior capsule thickness in youth elite handball athletes is not or only marginally different between throwing and non-throwing shoulders.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Lior Laver
- Department of Orthopaedics, Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion (Israel Institute of Technology), Halifax, Israel
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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39
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Sonnier JH, Ciccotti MC, Darius D, Hall AT, Freedman KB, Tjoumakaris F. Scapular Dyskinesis in the Athletic Patient: A Sport-Specific Review. JBJS Rev 2023; 11:01874474-202302000-00001. [PMID: 36745713 DOI: 10.2106/jbjs.rvw.22.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
» Scapular dyskinesis is an alteration of normal scapular kinematics. It is essential that each patient be evaluated holistically and that sport-related factors be taken into account. » The presentation of scapular dyskinesis may be highly variable depending on the underlying etiology or associated pathology, but the onset of symptoms is often gradual. » Sport-specific literature on scapular dyskinesis is most commonly reported in the context of baseball, swimming, and tennis. Treatment is most often conservative and involves physical therapy directed at the scapular stabilizers.
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Affiliation(s)
| | | | - Danielle Darius
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anya T Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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40
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Amorim E, Maganinho P, Rodrigues-Gomes D, Rodrigues-Gomes S, Sevivas N. Type IX Superior Labrum Anterior and Posterior Lesion in a Professional Football Player: A Rare Pattern of Shoulder Instability in a Non-throwing Athlete. Cureus 2023; 15:e34753. [PMID: 36909022 PMCID: PMC9999051 DOI: 10.7759/cureus.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Anterior shoulder instability is the most frequent type of glenohumeral instability, especially among young athletes. Superior labral anterior-posterior (SLAP) injuries involve the superior glenoid labrum where the long head of the biceps tendon (LHBT) inserts. There is still some debate regarding the pathogenesis, clinical presentation, and treatment of these lesions. We report a clinical case of an 18-year-old male professional football player with a rare type IX SLAP lesion. Given the recurrence of instability after prior nonoperative management, surgical treatment was seen as the best option, and a pan-labral arthroscopic repair suture anchor fixation was performed. Three months after undergoing a personalized postoperative rehabilitation program, he was able to return to full sport with the same competitive level, and no recurrent instability or other symptoms were reported throughout the 18-month follow-up period.
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Affiliation(s)
- Edgar Amorim
- Physical Medicine and Rehabilitation, Hospital de Braga, Braga, PRT
| | - Pedro Maganinho
- Radiology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | | | | | - Nuno Sevivas
- Orthopedics and Traumatology, Centro Hospitalar do Médio Ave, Braga, PRT
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41
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Brzoska R, Laprus H, Klaptocz P, Malik SS, Solecki W, Blasiak A. Arm Function After Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch in Volleyball Players. Orthop J Sports Med 2023; 11:23259671221147892. [PMID: 36874055 PMCID: PMC9974621 DOI: 10.1177/23259671221147892] [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: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 03/03/2023] Open
Abstract
Background Suprascapular nerve (SSN) entrapment in volleyball players leads to infraspinatus (ISP) muscle atrophy and weakness of abduction and external rotation (ER) of the shoulder. Purpose To assess functional outcome after arthroscopic extended decompression of SSN in the spinoglenoid notch and suprascapular notch in a group of volleyball athletes. Study Design Case series; Level of evidence, 4. Methods Volleyballers who underwent arthroscopic SSN decompression were analyzed retrospectively. Assessment tools consisted of range of motion and ER strength on Lovett scale and postoperative ER strength measured by dynamometer, Constant-Murley score (CMS), and visual evaluation of ISP muscle recovery by assessing muscle bulk. Results The study included 10 patients (9 male and 1 female). The mean age was 25.9 years (range, 19-33) and mean follow-up was 77.9 months (range, 7-123). The mean range of postoperative ER at 90° of abduction (ER2) was 105.6° (88°-126°) and 108.5° (93°-124°) for the contralateral side, while ER2 strength was 8 ± 2.6 and 12.65 ± 2.8 kg (P < .01) respectively. Mean CMS was 89.9 (84-100). In 5 cases, there was complete recovery of ISP muscle atrophy whereas 2 patients had partial recovery and 3 had none. Conclusion Arthroscopic SSN decompression in volleyball players improves shoulder function, but results of ISP recovery and ER strength are variable.
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Affiliation(s)
| | | | | | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
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42
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Increased Pitch Velocity Is Associated With Throwing Arm Kinetics, Injury Risk, and Ulnar Collateral Ligament Reconstruction in Adolescent, Collegiate, and Professional Baseball Pitchers: A Qualitative Systematic Review. Arthroscopy 2023; 39:1330-1344. [PMID: 36649827 DOI: 10.1016/j.arthro.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the relationship between pitch velocity and throwing arm kinetics, injury, and ulnar collateral ligament reconstruction (UCLr) among high school, collegiate, and professional baseball pitchers. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), and OVID/MEDLINE (2008-2019) were queried for articles that reported on pitch velocity predicting throwing arm kinetics, injury, or UCLr. The Methodological Index for Non-randomized Studies checklist was used to evaluate the quality of all included studies. Descriptive statistics with ranges were used to quantify data where appropriate. RESULTS A total of 24 studies examining 2,896 pitchers, with Level of Evidence II-V were included. Intergroup analysis noted pitch velocity was significantly correlated with elbow varus torque in high school (R2 = 0.36), collegiate (R2 = 0.29), and professional (R2 = 0.076) pitchers. Elbow distraction force was positively associated with ball velocity in interpitcher analyses of high school (R2 = 0.373), professional (R2 = 0.175), and mixed-cohort evaluations (R2 = 0.624). Intragroup analysis demonstrated a strong association between pitch velocity and elbow varus torque (R2 = 0.922-0.957) and elbow distraction force (R2 = 0.910) in professional pitchers. Faster ball velocity was positively associated with a history of throwing arm injury (R2 = 0.194) in nonadult pitchers. In 2 studies evaluating professionals, injured pitchers had faster pitch velocity before injury compared with uninjured controls (P = .014; P = .0354). The need for UCLr was positively correlated with pitch velocity (R2 = 0.036) in professional pitchers. The consequences of UCLr noted little to no decrease in pitch velocity. CONCLUSIONS Professional baseball pitchers with faster pitch velocity may be at the greatest risk of elbow injury and subsequent UCLr, potentially through the mechanism of increased distractive forces on the medial elbow complex. When a pitcher ultimately undergoes UCLr, decreases in pitching performance are unlikely, but may occur, which should encourage pitchers to caution against maximizing pitch velocity. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Giberson-Chen CC, Shaw BL, Rudisill SS, Carrier RE, Farina EM, Pearson B, Asnis PD, O’Donnell EA. Return to Play After Shoulder Surgery in Professional Baseball Players: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671221140853. [PMID: 36655019 PMCID: PMC9841850 DOI: 10.1177/23259671221140853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023] Open
Abstract
Background The current literature lacks an updated review examining return to play (RTP) and return to prior performance (RTPP) after shoulder surgery in professional baseball players. Purpose To summarize the RTP rate, RTPP rate, and baseball-specific performance metrics among professional baseball players who underwent shoulder surgery. Study Design Systematic review; Level of evidence, 4. Methods A literature search was performed utilizing the PubMed, MEDLINE, and CINAHL databases and according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language studies reporting on postoperative RTP and/or RTPP in professional baseball players who underwent shoulder surgery between 1976 and 2016. RTP rates, RTPP rates, and baseball-specific performance metrics were extracted from qualifying studies. A total of 2034 articles were identified after the initial search. Meta-analysis was performed where applicable, yielding weighted averages of RTP and RTPP rates and comparisons between pitchers and nonpitchers for each type of surgery. Baseball-specific performance metrics were reported as a narrative summary. Results Overall, 26 studies featuring 1228 professional baseball players were included. Patient-level outcome data were available for 529 players. Surgical interventions included rotator cuff debridement (n = 197), rotator cuff repair (RCR; n = 43), superior labrum from anterior to posterior repair (n = 124), labral repair (n = 103), latissimus dorsi/teres major (LD/TM) repair (n = 21), biceps tenodesis (n = 17), coracoclavicular ligament reconstruction (n = 15), anterior capsular repair (n = 5), and scapulothoracic bursectomy (n = 4). Rotator cuff debridement was the most common surgical procedure, while scapulothoracic bursectomy was the least common (37.2% and 0.8% of interventions, respectively). Meta-analysis revealed that the RTP rate was highest for LD/TM repair (84.5%) and lowest for RCR (53.5%), while the RTPP rate was highest for LD/TM repair (100.0%) and lowest for RCR (27.9%). RTP and RTPP rates were generally higher for position players than for pitchers. Nonvolume performance metrics were unaffected by shoulder surgery, while volume statistics decreased or remained similar. Conclusion RTP and RTPP rates among professional baseball players were modest after most types of shoulder surgery. Among surgical procedures commonly performed on professional baseball players, RTP and RTPP rates were highest for LD/TM repair and lowest for RCR.
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Affiliation(s)
- Carew C. Giberson-Chen
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L. Shaw
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Robert E. Carrier
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Evan M. Farina
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Peter D. Asnis
- Boston Red Sox, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan A. O’Donnell
- Boston Red Sox, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Evan A. O’Donnell, MD, Massachusetts General Hospital, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA ()
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Muacevic A, Adler JR, Saito H, Sugimura Y, Yoshikawa T, Miyakoshi N. Risk Factors for Glenohumeral Internal Rotation Deficit in Adolescent Athletes: A Comparison of Overhead Sports and Non-overhead Sports. Cureus 2023; 15:e34045. [PMID: 36814745 PMCID: PMC9940975 DOI: 10.7759/cureus.34045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/23/2023] Open
Abstract
Background A glenohumeral internal rotation deficit (GIRD) occurs in baseball players due to the repetitive pitching motion. However, few reports have addressed associations between GIRD and sports other than baseball. In this study, we investigated whether GIRD occurs in adolescent athletes playing overhead sports other than baseball, and also, the risk factors that cause GIRD in these sports were examined. Methods A total of 214 junior high school athletes who had undergone medical checks were evaluated. Seventy-five athletes playing sports requiring overhead motions were classified into the overhead sports group (39 tennis, 18 handball, 12 badminton, and 6 softball players). Eighty athletes participating in sports requiring the use of the upper limbs but not requiring frequent overhead motions were classified into the non-overhead sports group (31 kendo, 20 fencing, 19 basketball, and 10 table tennis players); 59 athletes who mainly did not use an upper limb were classified into the contact sports group (22 judo, 15 wrestling, 13 soccer, and 9 rugby football players). The range of shoulder motion (internal rotation, external rotation, and total arc), background factors, general laxity, and flexibility of the lower body were compared among the three groups. Results Thirty-four (16%) of 214 players were classified as having GIRD (internal rotation deficit >15°). Significantly more athletes had GIRD in the overhead sports group than in the other groups (p=0.007). The internal rotation deficit was significantly worse in the overhead sports group than in the other groups (p=0.006, p=0.02, respectively). Background factors, general laxity, and lower body flexibility did not differ significantly among the groups. Conclusion The sole risk factor for GIRD was participating in any sport that required overhead movements. Thus, not only baseball players, but also other athletes who participate in sports requiring overhead movements should receive correct information to prevent GIRD.
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Reinholz AK, Till SE, Arguello AM, Barlow JD, Okoroha KR, Camp CL. Advances in the Treatment of Rotator Cuff Tears: Management of Rotator Cuff Tears in the Athlete. Clin Sports Med 2023; 42:69-79. [PMID: 36375871 PMCID: PMC10009818 DOI: 10.1016/j.csm.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Unique biomechanical factors in the overhead and throwing athlete lead to a spectrum of rotator cuff pathology, usually with progressive lateralization of the supraspinatus footprint. Initial comprehensive nonoperative management is indicated for all athletes. Progression to arthroscopic debridement, repair of concomitant injuries, and possible rotator cuff repair with a transosseous equivalent technique are the current management strategies for athletes when nonoperative management fails.
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Affiliation(s)
- Anna K Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sara E Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Shitara H, Tajika T, Kuboi T, Ichinose T, Sasaki T, Hamano N, Kamiyama M, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H. Shoulder stretching versus shoulder muscle strength training for the prevention of baseball-related arm injuries: a randomized, active-controlled, open-label, non-inferiority study. Sci Rep 2022; 12:22118. [PMID: 36543874 PMCID: PMC9772170 DOI: 10.1038/s41598-022-26682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Glenohumeral internal rotation deficit (GIRD) and weakness in prone external rotation are risk factors for shoulder and elbow injuries in high school baseball pitchers. While a shoulder-stretching prevention program to improve GIRD decreases the injury rate, the effects of external rotation strength remain unclear. This non-inferiority (NI) study investigates the hypothesis that external rotation strength training is not inferior to sleeper stretching for shoulder and elbow injury prevention in high school baseball pitchers. Participants were randomly allocated to the stretching (n = 62; active control group) and muscle-training (n = 51) groups. Specific exercises were performed each night. Elbow and shoulder injuries were monitored for 150 days. Kaplan-Meier survival curves were generated, and the hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. The log-rank test was used to compare the injury-free time. A one-sided NI test using a fixed NI margin was performed (significance level, P = 0.025). The injury rates were 22.6% (n = 14) in the stretching group and 9.8% (n = 5) in the muscle-training group. The muscle-training group had a lower injury rate (P < 0.001) and a lower risk of injury than the stretching group (HR = 0.489). Therefore, external rotation muscle strength training is not inferior to stretching for preventing baseball-related arm injuries.
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Affiliation(s)
- Hitoshi Shitara
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Tsuyoshi Tajika
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Takuro Kuboi
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Tsuyoshi Ichinose
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Tsuyoshi Sasaki
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Noritaka Hamano
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Masataka Kamiyama
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Atsushi Yamamoto
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Tsutomu Kobayashi
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Kenji Takagishi
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
| | - Hirotaka Chikuda
- grid.256642.10000 0000 9269 4097Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan
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Higuchi T, Tanaka Y, Kanazawa Y, Matsuo M, Yokoyama S. The relationship between scapular position and glenohumeral rotational range of motion in high school baseball players. J Shoulder Elbow Surg 2022; 31:2611-2619. [PMID: 35781086 DOI: 10.1016/j.jse.2022.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Past research indicated that scapular malposition is related to the glenohumeral internal rotation deficit (GIRD). However, there is no research examining the effect of throwing-related pain on this relationship. This study investigated the relationship between scapular position and range of motion (ROM) and compared the difference in this relationship between with and without throwing-related pain. METHODS Forty male baseball players in high school were recruited for this study. The existence and degree of throwing-related pain were obtained from a questionnaire. Participants were divided into 2 groups according to the presence or absence of the pain. Glenohumeral internal and external rotation ROM (abduction internal rotation angle and abduction external rotation angle [ABER], respectively) were measured using a digital inclinometer. The pectoralis minor muscle length was measured using a vernier caliper and scapula index, which indicated the scapular position, measured using a measuring tape. All these measurements were taken on both dominant and nondominant sides. The GIRD and total motion arc (TMA) deficit were calculated from the ROM measurements. Groups were compared using a mixed-model analysis of variance. RESULTS There was a significant interaction between group and ABER dominance. Other variables were not seen as the interaction effect. There was a significant positive correlation between the scapula index and TMA (r = 0.47, P = .02) and a negative correlation between the scapula index and GIRD (r = -0.65, P < .01) in the dominant side of the pain group. In addition, in the nondominant side of the pain group, the scapula index and ABER were significantly correlated (r = 0.43, P = .04). CONCLUSIONS The results of this study indicate that the scapular position is associated with the glenohumeral ROM in high school baseball players. In addition, this study demonstrated that the scapular internally rotated position was correlated with the GIRD and TMA deficit in high school baseball players who had throwing-related pain. On the other hand, the scapular externally rotated position was correlated with increased ABER, mainly in the pain-free baseball players or on the nondominant side. These results indicated that the scapular position might affect the glenohumeral rotational ROM in high school baseball players.
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Affiliation(s)
- Takashi Higuchi
- Department of Physical Therapy, Osaka University of Human Sciences, Settsu, Osaka, Japan.
| | - Yasuaki Tanaka
- Department of Rehabilitation, Saiseikai Nagasaki Hospital, Nagasaki, Nagasaki, Japan
| | - Yuji Kanazawa
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Ishikawa, Japan
| | - Moemi Matsuo
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, Kanzaki, Saga, Japan
| | - Shigeki Yokoyama
- Department of Physical Therapy, Kyoto Tachibana University, Kyoto, Japan
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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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Rothermich MA, Ryan MK, Fleisig GS, Layton BO, Mussell EA, Andrews JR, Emblom BA, Cain EL, Dugas JR. Clinical outcomes and return to play in softball players following SLAP repair or biceps tenodesis. J Shoulder Elbow Surg 2022; 32:924-930. [PMID: 36442830 DOI: 10.1016/j.jse.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. Although past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch softball players. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the clinical outcomes and return to play for fast-pitch softball players treated for a superior labrum anterior posterior (SLAP) tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that the biceps tenodesis would have comparable outcomes with a faster return to play compared with SLAP repair. METHODS We performed a retrospective analysis on fast-pitch softball players treated surgically for SLAP tear, recalcitrant biceps tendonitis, or a combination between 2001 and 2019 at our institution. Inclusion criteria were fast-pitch softball players who underwent biceps tenodesis or a SLAP repair with greater than 2-year follow-up. Exclusion criteria involved slow-pitch softball players, patients with less than 2-year follow-up, and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a patient-reported outcomes (PRO)-managing software, or achieved over the phone. Follow-up data included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Andrews Carson Score, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, Numeric Rating Scale for Pain, and our institution-specific return-to-play questionnaire. We statistically compared players who underwent biceps tenodesis or a SLAP repair, and compared pitchers with position players using Student t tests and Fisher exact test with statistical significance determined to be P < .05. RESULTS From 60 eligible patients identified, follow-up outcome data were successfully captured for 47 (78%). Of the 18 SLAP repair patients, 17 (94%) returned to full competition at an average of 7.9 months. Of the 29 patients who underwent biceps tenodesis, 27 (93%) returned to full competition at an average of 7.1 months. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcomes, including no statistical difference in pitchers compared with position players. CONCLUSION In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group of fast-pitch softball players. There was no significant difference between RTP times between the 2 groups.
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Affiliation(s)
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA.
| | - Glenn S Fleisig
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
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Prevalence of Glenohumeral Internal Rotation Deficit and Sex Differences in Range of Motion of Adolescent Volleyball Players: A Case-Control Study. Healthcare (Basel) 2022; 10:healthcare10112263. [PMID: 36421587 PMCID: PMC9690562 DOI: 10.3390/healthcare10112263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Shoulder range of motion (ROM) adaptation is common observed among volleyball players, but studies on the shoulder joint function of adolescent athletes are lacking. This study aimed to clarify the prevalence of glenohumeral internal rotation deficit (GIRD) among adolescent players and differences in ROM based on sex. A questionnaire survey and ROM measurements of the shoulder joint and trunk using a plastic goniometer were conducted on 123 volleyball players (63 males and 60 females; mean age, 15.8 years). The prevalence of GIRD was investigated for internal rotation differences of >10° and total rotation motion of <5°. Questionnaire items and ROM were compared between GIRD and non-GIRD patients, and sex differences in ROM were also presented. Of the participants, 38.2% (n = 47/123) had GIRD. The GIRD group showed a decrease in external rotation on the dominant side (p = 0.003, 1 − beta = 0.84), but this was not associated with a history of shoulder injury. Sex differences in shoulder ROM showed hypomobility in males and hypermobility in females. However, there was no association between shoulder injury and GIRD among adolescent players. There are sex differences in ROM, which should be considered in future studies.
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