Upper extremity range of motion, grip strength, and girth in highly skilled tennis players

Shoulder impingement in the United States military

BACKGROUND

Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service.

METHODS

The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups.

RESULTS

In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively).

CONCLUSIONS

The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury.

Reliability of a New Clinical Instrument for Measuring Internal and External Glenohumeral Rotation

Background:

The shoulder plays a critical role in many overhead athletic activities. Several studies have shown alterations in shoulder range of motion (ROM) in the dominant shoulder of overhead athletes and correlation with significantly increased risk of injury to the shoulder and elbow. The purpose of this study was to measure isolated glenohumeral joint internal/external rotation (IR/ER) to determine inter- and intraobserver reliability of a new clinical device.

Hypothesis:

(1) Inter- and intraobserver reliability would exceed 90% for measures of glenohumeral joint IR, ER, and total arc of motion; (2) the dominant arm would exhibit significantly increased ER, significantly decreased IR, and no difference in total arc of motion compared with the nondominant shoulder; and (3) a significant difference exists in total arc between male and female patients.

Study Design:

Case series.

Level of Evidence:

Level 4.

Methods:

Thirty-seven subjects (mean age, 23 years; range, 13-54 years) were tested by 2 orthopaedic surgeons. A single test consisted of 1 arc of motion from neutral to external rotation to internal rotation and back to neutral within preset torque limits. Each examiner performed 3 tests on the dominant and nondominant shoulders. Each examiner completed 2 installations.

Results:

Testing reliability demonstrated that neither trial, installation, nor observer were significant sources of variation. The maximum standard deviation was 1.3° for total arc of motion and less than 2° for most other measurements. Dominant arm ER was significantly greater than nondominant arm ER (P = 0.02), and dominant arm IR was significantly less than nondominant arm IR (P = 0.00). Mean total rotation was 162°, with no significant differences in total rotation between dominant and nondominant arms (P = 0.34). Mean total arc of motion was 45° greater in female subjects. Differences in total arc of motion between male and female subjects was statistically significant (P < 0.00).

Conclusion:

This simple, clinical device allows for both inter- and intraobserver reliability measurements of glenohumeral internal and external rotation.

Muscle hypertrophy in prepubescent tennis players: a segmentation MRI study

PURPOSE

To asses if tennis at prepubertal age elicits the hypertrophy of dominant arm muscles.

METHODS

The volume of the muscles of both arms was determined using magnetic resonance imaging (MRI) in 7 male prepubertal tennis players (TP) and 7 non-active control subjects (CG) (mean age 11.0 ± 0.8 years, Tanner 1-2).

RESULTS

TP had 13% greater total muscle volume in the dominant than in the contralateral arm. The magnitude of inter-arm asymmetry was greater in TP than in CG (13 vs 3%, P<0.001). The dominant arm of TP was 16% greater than the dominant arm of CG (P<0.01), whilst non-dominant arms had similar total muscle volumes in both groups (P = 0.25), after accounting for height as covariate. In TP, dominant deltoid (11%), forearm supinator (55%) and forearm flexors (21%) and extensors (25%) were hypertrophied compared to the contralateral arm (P<0.05). In CG, the dominant supinator muscle was bigger than its contralateral homonimous (63%, P<0.05).

CONCLUSIONS

Tennis at prepubertal age is associated with marked hypertrophy of the dominant arm, leading to a marked level of asymmetry (+13%), much greater than observed in non-active controls (+3%). Therefore, tennis particpation at prepubertal age is associated with increased muscle volumes in dominant compared to the non-dominant arm, likely due to selectively hypertrophy of the loaded muscles.

Injury risk factors in junior tennis players: a prospective 2-year study

The aim was to investigate injury risk factors in junior tennis players. Fifty-five players, 35 boys and 20 girls, answered a questionnaire about training habits, time of exposure, previous injuries and equipment factors. A battery of clinical tests and functional performance tests were also carried out. All tennis-related injuries that occurred during a 2-year period were identified and recorded. An injury was defined as an injury if it was impossible to participate in regular tennis training or playing matches during at least one occasion, a time loss injury. Potential injury risk factors were tested in a forward stepwise logistic regression model for injury. Thirty-nine players sustained totally 100 new and recurrent injuries. Injuries to the lower extremity were the most common ones (51%) followed by the upper extremity (24%) and the trunk (24%). Injured players performed more singles per week (P<0.0001) and played more tennis hours per year (P=0.016) than the uninjured players. Playing tennis more than 6 h/week was found to be a risk factor for back pain. A previous injury regardless of location was identified as an injury risk factor, and a previous injury to the back was a risk factor for back pain.

Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion

DESIGN

Prospective case series.

OBJECTIVE

To determine if an osseous component in the form of increased humeral head retroversion may contribute to observed differences in the amount of rotation between the throwing and nonthrowing shoulders of competitive baseball players.

BACKGROUND

Differences in side-to-side shoulder rotation range of motion (ROM) are seen in throwing athletes. In the past, these differences have been attributed to adaptive changes to the surrounding soft tissue structures, including attenuation of the anteroinferior capsule and ligaments, and tightening of the posterior capsule. Recent studies, however, suggest that a possible osseous adaptation in the form of increased humeral head retroversion may be the cause of this side-to-side ROM difference. bilateral computed tomography (CT) scans to determine the angle of humeral head version. Maximal shoulder internal and external rotation ROM at 90 degrees abduction were measured both passively and actively for both shoulders.

RESULTS

Players had statistically significant (P<.001) side-to-side difference in humeral head version, with an average of 10.60 greater retroversion in their throwing arm compared to their nonthrowing arm. A significant side-to-side difference was not observed in the control group (average difference, 2.30; P = .197). Greater humeral head retroversion was associated with greater external rotation ROM and lesser internal rotation ROM in the throwing arm of the throwers.

CONCLUSIONS

Our results indicated that highly competitive baseball players do have greater humeral head retroversion in their dominant arm, which can partially explain the observed differences in side-to-side shoulder rotation ROM.

Phenotypic plasticity and functional asymmetry in response to grip forces exerted by intercollegiate tennis players

This study examined phenotypic and functional responses to extreme asymmetry in hand use, and recorded the grip forces that occur during the tennis serve to assess the forces that contribute to asymmetry. Compressive grip performance was measured for Division I collegiate tennis players (24 female, 24 male) and nonathlete college students (18 females, 17 males) during three experiments: single-repetition maximum voluntary contraction, 30 consecutive repetitions, and a 30-s static hold. Tennis players had significant asymmetry in both forearm circumference and grip strength. The dominant hand of female tennis players produced 25% more force than the opposite hand, while the difference between hands of male tennis players was 18%. However, endurance over 30-repetitions and during the 30-s hold did not significantly differ between the limbs of tennis players. No significant asymmetry in forearm measurements, grip strength, or endurance was detected between the limbs of nonathletes. Grip forces generated during the tennis serve were recorded for 4 male tennis players, using a racket with a dynamometer incorporated into the handle. Peak handgrip forces generated during the serve (150-250 N) averaged 31-44% of the maximum grip force of the participant. Tennis players have increased muscle mass and strength of the dominant limb. Moderate forces, occurring hundreds of times each match and practice, are likely the primary forces contributing to this morphological and functional asymmetry.

Shoulder strength and range of motion in female amateur-league tennis players

STUDY DESIGN

Cross sectional.

OBJECTIVES

To compare the strength and range of motion of the dominant and nondominant shoulders of adult female amateur tennis players. The secondary purpose of the study was to examine whether there were any differences in the observed relationships between women with a past history of shoulder pain and those with no history of shoulder pathology.

BACKGROUND

Information on characteristics of the shoulder in amateur female tennis players is scarce, as research has concentrated on highly skilled or male players, despite the cumulative prevalence of shoulder pain in this group.

METHODS AND MEASURES

Fifty-one female competitive, amateur tennis players (average age, 45 years) were tested bilaterally for shoulder internal/external rotation passive range of motion and isokinetic concentric strength.

RESULTS

Shoulder range of motion and strength ratios were comparable between sides. In the dominant arm, the total rotational range of motion was 221 degrees, with an internal to external rotator peak torque ratio of 1.05. External rotator strength was significantly greater in the dominant arm of individuals with no history of pain.

CONCLUSIONS

Range of motion and strength adaptations widely reported in highly skilled tennis players were not apparent in amateur female players. In assessment and management, clinicians should regard the amateur female tennis player as a separate entity from the highly skilled player.

Specificity of the lateral scapular slide test in asymptomatic competitive athletes

STUDY DESIGN

A prospective, criterion-based specificity study.

OBJECTIVE

To determine the specificity of the lateral scapular slide test (LSST) in detecting shoulder dysfunction in the competitive athlete.

BACKGROUND

The LSST was introduced in an attempt to objectively measure scapular stabilizer strength at varying amounts of load. Measurements between the inferior angle of the scapula and the closest spinous process are recorded in 3 different test positions. The original study of the LSST established a difference between the involved and noninvolved sides of 1.5 cm or greater in any position as an indication of shoulder dysfunction. In addition, the original sample used to develop the LSST consisted of symptomatic athletes only, with no asymptomatic control group. The LSST was originally based on the assumption that normal shoulder girdle function is symmetrical. However, some research reports that scapular resting position is highly variable between sides.

METHODS AND MEASURES

The LSST was administered to 38 female and 33 male collegiate athletes who participated in 1-arm-dominant sports. All subjects had no present or past history of scoliosis, or cervical, shoulder, or elbow dysfunction.

RESULTS

Fifty-two of the 71 subjects displayed a difference of at least 1.5 cm in 1 or more of the 3 positions. Specificity of the test was determined to be 26.8%.

CONCLUSION

Scapular position was commonly asymmetrical in the asymptomatic subjects. These variances in scapular position suggest that asymmetry does not necessarily indicate a dysfunction. The results show that the LSST has low specificity and its use is not recommended for determining shoulder dysfunction in competitive athletes.

Isokinetic profile of elbow flexion and extension strength in elite junior tennis players

STUDY DESIGN

Descriptive study.

OBJECTIVES

To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players.

BACKGROUND

The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength.

METHODS AND MATERIALS

Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed.

RESULTS

Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002).

CONCLUSION

These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.

Measuring shoulder internal rotation range of motion: a comparison of 3 techniques

OBJECTIVE

To compare the reliability of shoulder internal rotation (IR) range of motion (ROM) measured using 3 different methods: standard technique, manual scapular stabilization technique, and visual inspection technique.

DESIGN

Prospective study.

SETTING

Clinic-based sports medicine center.

PARTICIPANTS

Convenience sample of 56 unimpaired high-school athlete volunteers.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Shoulder IR ROM was measured by using a digital inclinometer with each of the 3 techniques. All measurements were performed independently by 2 groups of examiners and repeated to determine intra- and interrater reliabilities.

RESULTS

IR ROM measurements obtained with the scapula stabilized or by visual inspection were significantly less than when measured with the standard technique (P=.001). Intrarater reliability was good or excellent for all 3 methods (intraclass correlation coefficients=.63-.71), was similar for the scapular stabilization and visual inspection techniques, and was superior to that previously reported for similar measurements. In general, interrater reliability was lower than intrarater reliability for all measurements.

CONCLUSION

Because the visual inspection and scapular stabilized techniques control for accessory scapulothoracic motion, these techniques may represent more valid measures of glenohumeral motion than the standard technique. Both the visual inspection and scapular stabilized techniques exhibited equally acceptable reliability for clinical use. However, because the visual inspection technique may be applied by a single examiner, we recommend its use to measure shoulder IR ROM in the clinical setting.

The effects of age, sex, and shoulder dominance on range of motion of the shoulder

To determine the effects of age, sex, and arm dominance on shoulder range of motion, we measured active and passive forward elevation, abduction, internal and external rotation at 90 degrees of abduction, external rotation with the arm adducted, and extension bilaterally in 280 subjects ranging in age from 4 to 70 years. Linear regression analyses were performed for all motions except forward elevation. This motion, which showed a nonlinear pattern of decline with age, was evaluated with 3-way analysis of variance. Shoulder range of motion decreased with age for all measured motions with the exception of internal rotation, which increased with age. Female subjects had a significantly greater range of motion than male subjects for all motions measured. Dominant arms displayed significantly greater external rotation than nondominant, regardless of whether the arm was abducted or adducted at the time of measurement. However, nondominant shoulders demonstrated significantly greater internal rotation and extension than dominant. No significant differences were found between dominant and nondominant sides for forward elevation or abduction.

Manual scapular stabilization: its effect on shoulder rotational range of motion

OBJECTIVES

To study the effect of a recently described method of measuring shoulder rotational range of motion in which the scapula is manually stabilized, and to determine the reliability of that technique compared with measurements taken with the scapula unstabilized.

DESIGN

Fifty high school athletes underwent measurement of shoulder rotational range of motion with and without the scapula manually stabilized. Measurements were performed by two groups of physical therapists blinded to the movement results, with repeat measurements performed 5 days later.

RESULTS

Rotational motion measured with the scapula stabilized was significantly less than when it was measured with the scapula unstabilized. Reliability was comparable for the two techniques when measuring external rotation, but the new technique was more reliable for measuring internal rotation.

CONCLUSION

Scapular stabilization should be used when measuring internal rotation of the shoulder to obtain more accurate measurement of pure glenohumeral rotation. The technique described is promising, but warrants further refinement before it can be recommended for widespread clinical use. With practice, in experienced clinicians' hands, this technique may be the most reliable method for measuring outcome in clinical trials and for following clinically significant rotational motion deficits.

Reliability and validity of a new method of measuring posterior shoulder tightness

STUDY DESIGN

Repeated measures of shoulder flexibility on nonimpaired subjects and intercollegiate baseball pitchers.

OBJECTIVES

To present a new objective method of measuring posterior shoulder tightness, define the intratester and intertester reliability of the measurement, and assess its construct validity.

BACKGROUND

Posterior shoulder tightness has been linked to anterior humeral head translation and decreased internal rotation. The reliability of an objective assessment of posterior shoulder tightness has yet to be established in the literature.

METHODS AND MEASURES

Five repeat measurements were made using a standardized protocol on 21 nonimpaired subjects to determine intratester reliability. To determine intertester reliability, 2 testers (blinded to their measurement) each performed 1 measurement on 49 shoulders. Twenty-two intercollegiate baseball pitchers were measured once by 1 tester to evaluate the construct validity of the measurement.

RESULTS

Measurements of posterior shoulder tightness performed by the same physical therapist had high reliability (ICC dominant = 0.92, nondominant = 0.95). Intertester measures revealed good reliability (ICC = 0.80). Pitchers had reduced dominant arm internal rotation and increased external rotation ROM compared to their other arm whereas nonimpaired subjects had less reduction in external rotation compared to the nondominant arm (pitchers: dominant, 109.7 degrees +/-2.4 degrees, nondominant, 98.9 degrees +/-1.6 degrees; nonimpaired subjects: dominant, 95.9 degrees +/-1.5 degrees, nondominant, 95.2 degrees +/-1.6 degrees) and internal rotation (pitchers: dominant, 50.0+/-2.0 degrees, nondominant, 69.5+/-2.5 degrees; nonimpaired subjects: dominant, 46.4+/-1.3 degrees, nondominant, 50.2+/-1.4 degrees). Pitchers had significantly greater posterior shoulder tightness compared to nonimpaired subjects (pitchers; dominant, 44.9+/-0.8 cm, nondominant, 37.5+/-0.7 cm, nonimpaired subjects; dominant, 32.9+/-0.8 cm, nondominant, 31.4+/-0.8 cm) and manifested a significant correlation between posterior shoulder tightness and internal rotation (r = -0.61) that was not evident in nonimpaired subjects.

CONCLUSIONS

Measurement of posterior shoulder tightness using this technique is objective and reliable when done by the same physical therapist. Validity of this measurement is supported from the observation of athletes thought to have tight posterior structures. Further study is needed to determine the relationship of this measurement to patients diagnosed with shoulder impingement syndrome.

Humeral torsion in the throwing arm of handball players

Sport-specific upper extremity strain, mostly unilateral, during growth may lead to adaptations in soft tissue and bone. We investigated 51 male professional handball players between 18 and 39 years of age (average, 27 years), 39 right-handed and 12 left-handed. Thirty-eight players had no shoulder problems, and 13 had chronic shoulder pain. Humeral retrotorsion was determined by radiograph. The differences between the throwing and contralateral arms were compared with those of 37 controls who had no history of unilateral strain either through sports or profession. Standard statistical analysis was performed using the t-test. The retrotorsional angle of the humerus in the handball professionals' throwing arm was an average of 9.4 degrees larger in the dominant side than in the nondominant, with a side-to-side difference up to 29 degrees. In the control group, no statistically significant difference was found. In the group without chronic shoulder pain, the side-to-side difference was an average of 14.4 degrees more in the throwing arm than the other side. Players with chronic shoulder pain did not exhibit this increase, even showing an average decrease of humeral retrotorsion of 5.2 degrees in the throwing arm. The humeral retrotorsion increase can be explained as an adaptation to extensive external rotation in throwing practice during growth. Athletes who do not adapt this way seem to have more strain on their anterior capsules at less external rotation and develop chronic shoulder pain because of anterior instability.

Shoulder range of motion in elite tennis players. Effect of age and years of tournament play

We studied glenohumeral rotational range of motion in 39 members of the United States Tennis Association National Tennis Team and touring professional program. We took goniometric measurements of internal and external rotation of dominant and nondominant shoulders at the glenohumeral joint with the humerus at 90 degrees of abduction. We categorized the tennis players by age and by years of tournament play. Results were analyzed by total rotation, internal rotation, external rotation, and dominant-to-nondominant shoulder differences. In our results, dominant internal rotation of the shoulder declined and the difference between dominant and nondominant internal rotation increased with both age and years of tournament play. Men and women tennis players showed the same degree of deficits in range of motion. Significant analysis of variance statistics were calculated for dominant internal rotation with years of total play, dominant total rotation with years of total play, and nondominant total rotation with age. Moderate negative correlations were found between dominant internal rotation and years of total play and dominant total rotation and years of total play. These results indicate a loss of internal rotation that seems progressive with longer periods of play. This loss of internal rotation of the shoulder is an absolute loss of motion because total rotation also decreases. Early detection and a corrective training program should be considered because adaptations may result in deleterious biomechanics affecting both performance and risk of injury.

A comparison of cervical rotation in age-matched adolescent competitive swimmers and healthy males

Physical therapists routinely compare range of motion measurements with the opposite side and/or with a standard for "normal" range. However, "normal" range may vary in relation to the individual's occupational and recreational movement patterns. The purposes of this study were 1) to compare the range of active physiological cervical rotation in 14- to 17-year-old male competitive swimmers (N = 40) and controls (N = 40) and 2) to investigate the relationship between the freestyle stroke breathing pattern and differences in right and left cervical rotation in swimmers. Analysis of variance determined if a group difference existed in goniometric measurement of cervical rotation. The experimental group demonstrated a significantly greater mean range of total active cervical rotation right (p = 0.002) than the control group. Swimmers also demonstrated a significantly greater (p = 0.0002) range of rotation on their breathing side (mean difference of 5 degrees). It was concluded that the differences in physiological cervical rotation between swimmers and nonswimmers and between sides in the swimmers were influenced by the swimming activity. The clinician needs to consider the influence of activity when assessing range of motion.

Rehabilitation for the overhead athlete

Rehabilitation of the shoulder of the overhead athlete has undergone significant changes during the past few years. This article illustrates shoulder problems related to repetitive overhead activities, such as throwing. Additionally, we present basic science contributions in this area, principles of shoulder rehabilitation, and a comprehensive rehabilitation program for the symptomatic or asymptomatic athlete based on these principles.

Grip strength and fatigue in junior college tennis players

Change in grip strength over 30 trials was documented in two samples of junior college tennis players to assess possible fatigue. Eight men and eight women performed 30 maximum-grip strength tests with 25-sec. rests between trials. Significant positive correlations (.38 and .53 for men and women) were observed between grip strength and trials. In practical terms, grip strength did not change over 30 trials in these tennis players. The data suggested that the repetitive gripping patterns used by these players in tennis play resulted in consistent maximum-grip strengths across 30 trials.

Epidemiology of shoulder impingement in upper arm sports events

An epidemiological survey was conducted to collect data relating to the prevalence and frequency of shoulder pain and other related problems among different athletic groups that demanded vigorous upper arm activities. A questionnaire was administered on site thus ensuring that the response rate was 100 percent. Analysis of results revealed that of the 372 respondents there were 242 male (65.1 percent) and 130 female subjects (34.9 percent), with seven (1.9 percent) above the age of 40, 119 (32 percent) between the ages of 25 and 40, and 246 (66.1 percent) below 25 years of age. A total of 163 athletes (43.8 percent) indicated that they had shoulder problems, 109 (29 percent) suffering pain. Diffuse pain was indicated by 20 respondents (5.4 percent), while localized pain during movement was reported in 89 (23.9 percent). The prevalence of shoulder pain ranked highest among volley ball players (N = 28) followed by swimmers (N = 22), while badminton, basketball and tennis participants were equally affected (N = 10).

A preliminary study on the measurement of static and dynamic motion at the glenohumeral joint

Measurement of glenohumeral joint motion has, for the most part, been performed with the simple goniometer. The purpose of this paper is to describe a method for measuring and recording static and dynamic external rotation of the glenohumeral joint using the Cybex II Isokinetic Dynamometer and an MFE model 815 X-Y plotter. Static range of motion was assessed at 60 deg/sec using a slow arm action externally from a 90 degree abduction position. Dynamic motion was recorded at 300 deg/sec using a rapid rotational whipping action from a 90 degree abducted position. Measurements were recorded on three groups of athletes, and the influences of sex, hand dominance, overarm activity, and surgery were analyzed. The subjects in the first two groups were divided according to sex and their participation in overarm versus nonoverarm (control) activities. Static and dynamic motion in both groups was significantly influenced by sex and hand dominance (P less than 0.05). Although there was no overall difference in the motion measurements between the control and overarm groups, the interaction of this factor with sex and type of measurement was significant. Males who participated in overarm activities had, on the average, more static range of motion than males in the control group. A third group that had undergone a modified Bristow procedure for recurrent dislocation/subluxation of the shoulder demonstrated that static and dynamic range of motion were significantly reduced by the surgery (P less than 0.05). The average differences in static and dynamic motion between the surgical arm and its nonsurgical counterpart were 17.5 degrees and 21 degrees, respectively, resulting in an overall range of motion difference of 19 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

The Elbow and Tennis, Part 1: An Analysis of Players With and Without Pain

After studylng 2,633 average tennis players, the authors offer some surprlslng new ideas about the factors that may contribute to elbow pain.