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Mertens MG, Meeus M, Lluch Girbes E, Dueñas L, Twickler MT, Verborgt O, Struyf F. Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study. Musculoskelet Sci Pract 2024; 72:102980. [PMID: 38820869 DOI: 10.1016/j.msksp.2024.102980] [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: 10/06/2023] [Revised: 05/06/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND the pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS. OBJECTIVES to compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals. DESIGN cross-sectional study. METHOD Thirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level. RESULTS Patients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups. CONCLUSION A clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | - Marcel Tb Twickler
- Department of Endocrinology, Diabetology and Metabolic Disease, AZ Monica, Deurne/Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital Antwerp (UZA), Edegem, Belgium.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Greenspan SJ, Stuckey MI. Preparation For Flight: The Physical Profile of Pre-Professional and Professional Circus Artists in the United States. Int J Sports Phys Ther 2024; 19:591-608. [PMID: 38707849 PMCID: PMC11065775 DOI: 10.26603/001c.116332] [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: 10/05/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background Established norms for fitness and performance measures are lacking in circus arts. These would assist healthcare professionals and coaches to screen for readiness to participate in training or performance, determine post-injury return to performance, and develop targeted conditioning programs. Purpose The purpose of this research was to establish norms for trunk and extremity physical exam and performance measures in circus artists by professional status, assigned sex at birth (ASAB), and age. Study Design Descriptive laboratory study. Methods Circus artists (n=201; ages 13-69y; 172 females ASAB, 29 males ASAB) from 10 cities across the United States underwent a baseline physical examination including shoulder, hip and trunk measures of passive (PROM) and active (AROM) range of motion, measures of flexibility (shoulder and hip), strength (manual muscle tests, grip strength), cardiovascular fitness (3 minute-step test), balance (single limb and handstand), and performance, (pull-ups, and the closed kinetic chain upper extremity stability test [CKCUEST]). ANOVAs were used to determine between group differences by age and T-tests to discern differences by ASAB or professional status. Results Differences existed by professional status for shoulder external rotation PROM, hip PROM, hip flexibility, shoulder and abdominal strength, and cardiovascular fitness. Sex differences were seen in active scapular upward rotation, hip and shoulder PROM and flexibility, hip and grip strength, and for functional performance measures (pull-ups, CKCUEST). Differences by age were limited to active scapular upward rotation, shoulder PROM, flexibility and strength, cardiovascular fitness, and balance. Overall, professionals outperformed pre-professionals for lower abdominal strength, pull-ups, handstand balance, cardiovascular fitness, hamstring, and straddle flexibility. Generally, males ASAB demonstrated greater shoulder flexibility and upper body functional strength while females ASAB had greater hip and lumbar flexibility and hip strength. No measures showed consistent declines with increasing age, though some showed differences between adolescents and adults. Conclusion These normative values for physical characteristics and functional performance in pre-professional and professional circus artists may be used to guide screening for readiness to participate in advanced training or performance, return to performance after injury, and the development of targeted strength and conditioning programs. Level of Evidence 3.
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Affiliation(s)
| | - Melanie I Stuckey
- Centre de recherche, d’innovation et de transfert en arts du cirqueÉcole nationale de cirque
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Fox JA, Luther L, Epner E, LeClere L. Shoulder Proprioception: A Review. J Clin Med 2024; 13:2077. [PMID: 38610841 PMCID: PMC11012644 DOI: 10.3390/jcm13072077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed and Medline, published between 1906 and 2021. The development of digital/smart phone goniometers can improve shoulder joint range of motion (ROM) measurements and demonstrate comparable measurement accuracy to the universal standard goniometer. The inclinometer offers a portable and cost-effective method for measuring shoulder joint angles and arcs of motion in the vertical plane. Two types of dynamometers, the computerized isokinetic machine and the handheld hydraulic dynamometer, are reliable tools for objective shoulder rotator cuff strength assessment. Motion analysis systems are highly advanced modalities that create three-dimensional models of motion arcs using a series of cameras and reflective beads, offering unparalleled precision in shoulder proprioception measurement; however, they require time-consuming calibration and skilled operators. Advancements in wearable devices and compact mobile technology such as iPhone applications may make three-dimensional motion analysis more affordable and practical for outpatient settings in the future. The complex interplay between proprioception and shoulder dysfunction is not fully understood; however, shoulder proprioception can likely both contribute to and be caused by shoulder pathology. In patients with rotator cuff tears, glenohumeral osteoarthritis, and shoulder instability, clinicians can track proprioception to understand a patient's disease progression or response to treatment. Finally, rehabilitation programs targeting shoulder proprioception have shown promising initial results in restoring function and returning athletes to play.
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Affiliation(s)
| | | | - Eden Epner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S Ste 3200, Nashville, TN 37232, USA; (J.A.F.); (L.L.); (L.L.)
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Warby SA, Ganderton C, Watson L, Pizzari T, Balster S, Hoy G, Barwood S, Kerr B, Lawrence S, Lenssen R, Rotstein A, Takla A, Civier O, Hughes M. Effect of a physiotherapy-directed rehabilitation programme on patients with multidirectional instability of the glenohumeral joint: a multimodal interventional MRI study protocol. BMJ Open 2024; 14:e071287. [PMID: 38373861 PMCID: PMC10882378 DOI: 10.1136/bmjopen-2022-071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Altered neuromuscular control of the scapula and humeral head is a typical feature of multidirectional instability (MDI) of the glenohumeral joint, suggesting a central component to this condition. A previous randomised controlled trial showed MDI patients participating in the Watson Instability Program 1 (WIP1) had significantly improved clinical outcomes compared with a general shoulder strength programme. The aim of this paper is to outline a multimodal MRI protocol to identify potential ameliorative effects of the WIP1 on the brain. METHODS AND ANALYSIS Thirty female participants aged 18-35 years with right-sided atraumatic MDI and 30 matched controls will be recruited. MDI patients will participate in 24 weeks of the WIP1, involving prescription and progression of a home exercise programme. Multimodal MRI scans will be collected from both groups at baseline and in MDI patients at follow-up. Potential brain changes (primary outcome 1) in MDI patients will be probed using region-of-interest (ROI) and whole-brain approaches. ROIs will depict areas of functional alteration in MDI patients during executed and imagined shoulder movements (MDI vs controls at baseline), then examining the effects of the 24-week WIP1 intervention (baseline vs follow-up in MDI patients only). Whole-brain analyses will examine baseline versus follow-up voxel-wise measures in MDI patients only. Outcome measures used to assess WIP1 efficacy will include the Western Ontario Shoulder Index and the Melbourne Instability Shoulder Score (primary outcomes 2 and 3). Secondary outcomes will include the Tampa Scale for Kinesiophobia, Short Form Orebro, Global Rating of Change Score, muscle strength, scapular upward rotation, programme compliance and adverse events. DISCUSSION This trial will establish if the WIP1 is associated with brain changes in MDI. ETHICS AND DISSEMINATION Participant confidentiality will be maintained with publication of results. Swinburne Human Research Ethics Committee (Ref: 20202806-5692). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621001207808).
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Affiliation(s)
- Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, Victoria, Australia
| | - Lyn Watson
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Mill Park Physiotherapy, Melbourne, Victoria, Australia
| | - Simon Balster
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Shane Barwood
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Bonnie Kerr
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Sam Lawrence
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Andrew Rotstein
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Annalaise Takla
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Oren Civier
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Matthew Hughes
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Rezende MS, Rossi DM, Ribeiro de Lima AM, Clemente GS, Siriani de Oliveira A, Caldeira de Oliveira Guirro E. Shoulder and scapulothoracic impairments in women with breast cancer-related lymphedema in the upper limb: A cross-sectional study shoulder and breast cancer-related lymphedema. J Bodyw Mov Ther 2024; 37:177-182. [PMID: 38432802 DOI: 10.1016/j.jbmt.2023.11.055] [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: 09/20/2022] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Lymphedema in the upper limb as a complication of breast cancer may lead to shoulder pain and dysfunctions. OBJECTIVE To compare the scapular positioning, the shoulder range of motion, and muscle strength among women undergoing treatment for breast cancer with and without lymphedema and a control group. METHODS This cross-sectional study evaluated women undergoing treatment for breast cancer (N = 25) and without lymphedema (N = 25), and a control group (N = 25). Static scapular positions and shoulder range of motion were measured by using an inclinometer. The shoulder and periscapular muscle strength were measured by using a hand-held dynamometer and the Disabilities of the Arm, Shoulder, and Hand Questionnaire was applied. Linear regression of the mixed effects model was used to compare the groups. RESULTS Both groups of mastectomized women had reduced shoulder range of motion, scapular upward rotation, and muscle strength for shoulder and periscapular muscles compared to the control group. Also, women undergoing treatment for breast cancer with lymphedema had reduced shoulder range of motion, scapular upward rotation, increased anterior tilt, reduced muscle strength of the upper trapezius, and greater upper limb disability compared to women without lymphedema. CONCLUSION Women undergoing treatment for breast cancer with lymphedema had even greater shoulder and scapulothoracic impairments when compared to the control group and women without lymphedema.
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Affiliation(s)
- Monique Silva Rezende
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Denise Martineli Rossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
| | - Aline Maria Ribeiro de Lima
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Giovani Sanches Clemente
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Mantovani M, Sciascia A, Varini A, Muraccini M, Nardini F, Tonino P, Kibler BW. Accuracy of measuring scapular position and motion with a novel motion capture system. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:303-311. [PMID: 37588505 PMCID: PMC10426632 DOI: 10.1016/j.xrrt.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Scapula kinematics is recognized to be a crucial variable in shoulder dysfunction. Nevertheless, quantitative scapula tracking and measurement are not part of the current clinical evaluation. The main concern is measurement accuracy. Methods To assess the accuracy of the wearable sensor technology Showmotion a cadaver experiment was designed, allowing a direct comparison between sensors directly pinned to the scapula and superficial sensors. A measurement protocol was adopted to evaluate errors in measurement, mimicking the suggested in vivo evaluation. Sensors were simultaneously placed above (supraspinal) and below (infraspinal) the scapular spine to determine if one placement resulted in fewer errors compared to the other. Results Mean and standard deviations of the supraspinal sensor root mean square error (RMSE) in flexion-extension movements resulted in 3.59° ± 2.36°, 4.73° ± 2.98°, and 6.26° ± 3.62° for upward-downward rotation (up-down), anterior-posterior tilt and internal-external (intra-extra) rotation, respectively, while 2.16° ± 1.21°, 2.20° ± 1.02°, and 4.46° ± 2.16° for the infraspinal sensor. In abduction-adduction movements, mean and standard deviations of the supraspinal sensor RMSE resulted in 4.26° ± 2.98°, 5.68° ± 4.22°, and 7.04° ± 4.36° for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.38° ± 1.63°, 2.47° ± 1.77°, and 4.92° ± 3.14° for the infraspinal sensor. The same behavior was confirmed in shrug movements, where 4.35° ± 3.24°, 4.63° ± 3.09°, and 5.34° ± 6.67° are mean and standard deviations of the supraspinal sensor RMSE for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.76° ± 1.87°, 2.83° ± 2.53°, and 4.68° ± 5.22° for the infraspinal sensor. Conclusion This method of quantitative assessment of scapular motion is shown to have good accuracy and low error between the sensor measurements and actual bone movement in multiple planes of scapular motion, both over the entire range of motion and in its individual segment intervals. The decreased amount of error with the infraspinal sensor placement suggests that placement is ideal for clinical quantitative assessment of scapular motion.
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Affiliation(s)
| | - Aaron Sciascia
- Institute of Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA
| | | | - Marco Muraccini
- NCS Lab Srl, Medical Device Research Lab, Carpi (Modena), Italy
| | | | - Pietro Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Mertens MG, Meeus M, Verborgt O, Girbes EL, Horno SMD, Aguilar-Rodriguez M, Dueñas L, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F. Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments. Braz J Phys Ther 2023; 27:100539. [PMID: 37639942 PMCID: PMC10474583 DOI: 10.1016/j.bjpt.2023.100539] [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: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). OBJECTIVES To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. METHODS Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. RESULTS Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). CONCLUSION Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marta Aguilar-Rodriguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | | | | | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Gutiérrez-Espinoza H, Pinto-Concha S, Sepúlveda-Osses O, Araya-Quintanilla F. Effectiveness of scapular mobilization in people with subacromial impingement syndrome: A randomized controlled trial. Ann Phys Rehabil Med 2023; 66:101744. [PMID: 37030191 DOI: 10.1016/j.rehab.2023.101744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Scapular mobilization is a manual therapy technique widely used in the management of musculoskeletal disorders of the shoulder. OBJECTIVE To determine the effects of scapular mobilization in addition to an exercise program in people with subacromial impingement syndrome (SIS). METHODS Seventy-two adults with SIS were randomly allocated to 1 of 2 groups. The control group (n=36) participated in a 6-week exercise program, and the intervention group (n = 36) participated in the same exercise program plus passive manual scapular mobilization. Both groups were assessed at baseline and 6 weeks (end of treatment). The primary outcome measure was upper limb function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcome measures were the Constant-Murley questionnaire, pain (visual analog scale [VAS]), and scapular upward rotation. RESULTS All participants completed the trial. The between-group difference in DASH was -1.1 points (Cohen d = 0.05; p = 0.911), Constant-Murley 2.1 points (Cohen d = 0.08; p = 0.841), VAS rating of pain at rest -0.1 cm (Cohen d = 0.05; p = 0.684), and VAS rating of pain during movement -0.2 cm (Cohen d = 0.09; p = 0.764); scapular upward rotation at rest (arm by the side) was 0.6° (Cohen d = 0.09; p = 0.237), at 45° shoulder abduction was 0.8° (Cohen d = 0.13; p = 0.096), at 90° was 0.1° (Cohen d = 0.04; p = 0.783), and at 135° was 0.1° (Cohen d = 0.07; p = 0.886). Most differences were in favor of the intervention group; however, the effect sizes were weak and not statistically significant. CONCLUSIONS In the short-term, the addition of scapular mobilization did not provide significant clinical benefits in terms of function, pain or scapular motion in participants with SIS. TRIAL REGISTRATION Brazilian registry of clinical trials UTN number U1111-1226-2081. Registered February 25, 2019.
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Ben Kibler W, Lockhart JW, Cromwell R, Sciascia A. Managing Scapular Dyskinesis. Phys Med Rehabil Clin N Am 2023; 34:427-451. [PMID: 37003662 DOI: 10.1016/j.pmr.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.
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Rehabilitation for atraumatic shoulder instability in circus arts performers: delivery via telehealth. J Shoulder Elbow Surg 2022; 31:e246-e257. [PMID: 34861406 DOI: 10.1016/j.jse.2021.10.033] [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: 08/03/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Watson Instability Program (WIP1) is current best evidence for conservative management of atraumatic shoulder instability, but it is unknown if this program can be effectively delivered via tele-consultation. The purpose of this longitudinal pre-post intervention study was to determine the effects of the WIP1 on patient-reported outcome measures, scapular position, shoulder strength, and handstand stability in student circus performers with atraumatic shoulder instability when delivered via tele-consultation. METHODS Student circus performers aged between 15 and 35 years from the National Institute of Circus Arts were recruited. A 12-week shoulder exercise program was delivered via tele-consultation during the Melbourne, Australia COVID-19 (coronavirus disease 2019) lockdown. The primary outcome measures were the Western Ontario Shoulder Instability Index score and the Melbourne Instability Shoulder Scale score. Secondary outcomes measures included the Orebro Musculoskeletal Pain Questionnaire, the Tampa Scale for Kinesiophobia, and physical assessment measures including strength via handheld dynamometry, scapular position using an inclinometer, and handstand stability via center-of-pressure fluctuation. Patient-reported outcomes were collected at baseline and 6-week, 12-week, 6-month, and 9-month time points, and physical outcomes were measured at baseline and 9-month time points. A repeated-measures mixed model (with effect sizes [ESs] and 95% confidence intervals [CIs]) was used to analyze patient-reported outcomes, handstand data, strength, and scapular measures. Significance was set at P < .05. RESULTS Twenty-three student circus arts performers completed the study. Significant improvements were found in both Western Ontario Shoulder Instability Index scores (effect size [ES], 0.79 [95% CI, 0.31-1.33] at 6 weeks; ES, 1.08 [95% CI, 0.55-1.6] at 12 weeks; ES, 1.17 [95% CI, 0.62-1.78] at 6 months; and ES, 1.31 [95% CI, 0.74-1.95] at 9 months; P < .001) and Melbourne Instability Shoulder Scale scores (ES, 0.70 [95% CI, 0.22-1.22] at 6 weeks; ES, 0.83 [95% CI, 0.34-1.37] at 3 months; ES, 0.98 [95% CI, 0.46-1.54] at 6 months; and ES, 0.98 [95% CI, 0.43-1.50] at 9 months; P < .001), as well as Orebro Musculoskeletal Pain Questionnaire scores at all follow-up time points. The Tampa Scale for Kinesiophobia scores reached significance at 6 weeks and 12 weeks. Following rehabilitation, we found statistically significant increases in shoulder strength in all positions tested and increased scapular upward rotation measured at end-of-range abduction, as well as during loaded external rotation. The affected arm showed greater instability than the unaffected arm with a significant intervention effect on the affected arm showing a greater consistent anterior-posterior movement pattern. CONCLUSION In a group of circus performers with atraumatic shoulder instability, treatment with the WIP1 via telehealth resulted in clinically and statistically significant improvements in shoulder symptoms and function.
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Mohamed RR, Abdel-Aziem AA, Mohammed HY, Diab RH. Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study. J Back Musculoskelet Rehabil 2022; 35:119-127. [PMID: 34151823 DOI: 10.3233/bmr-200253] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with chronic low back pain (LBP) have an impaired dynamic spinal stability, which may lead to arm injuries. OBJECTIVES To examine the latissimus dorsi and gluteus maximus muscles activation pattern and the upward scapular rotation in patients with chronic LBP. METHODS Sixty-one right-handed males were divided into two groups: chronic LBP group (n= 31) and healthy controls (n= 30). The electromyography (EMG) activities of the right and left latissimus dorsi and gluteus maximus were recorded. The upward scapular rotation in different shoulder positions (neutral, 45∘, 90∘, 135∘ abduction and end range) was measured in both groups. RESULTS The LBP group has a bilateral significant increased EMG of latissimus dorsi (p< 0.05) and significantly decreased EMG of gluteus maximus (p< 0.05) compared to the control group, without significant differences between the right and left sides (p> 0.05). There was a significant increase in upward scapular rotation in the LBP group relative to the control group in all shoulder abduction positions on both sides. The left side upward scapular rotation was more significant than the right (p< 0.05). CONCLUSION Chronic LBP increased the latissimus dorsi muscle activities and decreased the gluteus maximus activities. It furthermore increased the upward scapular rotation in different shoulder abduction positions.
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Affiliation(s)
- Rania R Mohamed
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amr A Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Hatem Y Mohammed
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Reham H Diab
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, College of Medical Rehabilitation Science, Taibah University, Madina, Saudi Arabia
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An DI, Park JE, Lee CH, Kim SY. Reliability of scapular upward rotation and anterior-posterior tilt measurements using a modified digital inclinometer in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 2021; 34:837-843. [PMID: 33935062 DOI: 10.3233/bmr-200080] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUD Reliable scapular upward rotation and anterior-posterior tilt data are required for patients with subacromial impingement syndrome (SIS). Only a few studies have explored the reliability of such measurements derived using a modified inclinometer. OBJECTIVES To determine the relative and absolute reliability of scapular upward rotation and anterior-posterior tilt measurements derived using a modified digital inclinometer in patients with SIS. METHOD Seventeen SIS patients were assessed twice within 1 week. We determined the relative and absolute measurement reliability by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Both intra- and interrater reliability were determined. RESULTS The intra-rater reliability (both measurements) was high (0.72-0.88), and the interrater ICC was high to excellent (0.72-0.98). Clinically acceptable SEM and MCID values were obtained for scapular upward rotation (SEM: 4.28-9.33∘, MCID: 5.1-11.3∘) and anterior-posterior tilt (SEM: 3.72-7.55∘, MCID: 2.5-10.8∘). CONCLUSIONS Measurements of scapular upward rotation and anterior-posterior tilt using a modified digital inclinometer reliably reveal scapular position and kinematics in patients with SIS.
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Affiliation(s)
- Da-In An
- Department of Physical Therapy, Pusan National Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea
| | - Jung-Eun Park
- Department of Physical Therapy, Pusan National Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea
| | - Chang-Hyung Lee
- Research Institute for Convergence of Biomedical Science and Technology Physical Medicine and Rehabilitation, Pusan National Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea
| | - Soo-Yong Kim
- Department of Physical Therapy, Pusan National Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea
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Croteau F, Paradelo D, Pearsall D, Robbins S. Risk Factors for Shoulder Injuries in Water Polo: a Cohort Study. Int J Sports Phys Ther 2021; 16:1135-1144. [PMID: 34386291 PMCID: PMC8329310 DOI: 10.26603/001c.25432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Very limited investigations have been conducted exploring risk factors for injury in water polo players. A gap remains in the literature regarding identification of variables that should be considered as part of player screening evaluations. PURPOSE To estimate whether previous injury, changes in strength, range of motion (ROM) or upward scapular rotation (UR) are related to shoulder injuries in water polo players. STUDY DESIGN Descriptive cohort study. METHODS Thirty-nine international-level players participated (19 males). Shoulder internal (IR) and external rotation (ER) peak torque was measured using an isokinetic device (CONtrex MJ). Shoulder ROM was measured passively using standard goniometry. Scapular UR was measured using a laser digital inclinometer. At baseline players were divided into groups: those with and without previous shoulder injuries. Independent t-tests and Mann-Whitney U tests were used to compare the study variables between groups. After nine months, a second analysis compared the same athletes, who were then grouped by those who had or had not sustained new injuries. Effect sizes were calculated with a Hedge's g. Chi squared analysis compared proportion of injured players with and without previous injury. RESULTS Eighteen participants (46%) had previous injuries at baseline. Players with a previous injury showed higher peak torques for IR (0.62±0.15 vs 0.54±0.13N/kg, p=0.04, g=0.60); larger loss of IR ROM (9.9±9.1 vs 4.1±7.5°, p=0.04, g=0.68), but no statistical difference in UR (p=0.70). After nine months, there were no statistical strength differences between groups. Loss of IR ROM was significantly higher in the injured group (9.8±9.8 vs 4.0±6.7°, p=0.04, g=0.68), as well as UR (13.0±3.0 vs 10.4±3.3°, p=0.01, g=0.81). History of previous injury was significantly related to developing a new injury (OR 6.5, p=0.02). Logistic regression found previous injury and UR most important contributors to injury risk. CONCLUSIONS Previous injury, changes in IR ROM and UR are related to new shoulder injuries in water polo, but further variables such as rest, training load, or psychosocial factors may explain the incidence of new injuries. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Félix Croteau
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Institut National du Sport du Québec, Montreal, Quebec, Canada
| | | | | | - Shawn Robbins
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Layton-Lethbridge-MacKay Rehabilitation Centre
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Silverson OA, Lemaster NG, Hettrich CM, Heebner NR, Uhl TL. Reliability and Validity of a Clinical Assessment Tool for Measuring Scapular Motion in All 3 Anatomical Planes. J Athl Train 2021; 56:586-593. [PMID: 33150418 DOI: 10.4085/276-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT A single clinical assessment device that can be used to objectively measure scapular motion in each anatomical plane is not currently available. The development of a novel electric goniometer would allow scapular motion in all 3 anatomical planes to be quantified. OBJECTIVE To investigate the reliability and validity of an electric goniometer for measuring scapular motion in each anatomical plane during upper extremity elevation. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Sixty participants (29 women, 31 men; age = 30 ± 14 years, height = 1.73 ± 0.10 m, mass = 75.32 ± 16.90 kg) recruited from the general population. INTERVENTION(S) An electric goniometer was used to record clinical measurements of scapular position at rest and total arc of motion (excursion) during active upper extremity elevation in 2 testing sessions separated by several days. Measurements were recorded independently by 2 examiners. In 1 session, scapular motion was recorded simultaneously using a 14-camera, 3-dimensional optical motion-capture system. MAIN OUTCOME MEASURE(S) Reliability analysis included examination of clinical measurements for scapular position at rest and excursion during each condition. Both the intrarater reliability between testing sessions and the interrater reliability recorded in the same session were assessed using intraclass correlation coefficients (ICCs [2,3]). The criterion validity was examined by comparing the mean excursion values of each condition recorded using the electric goniometer and the 3-dimensional optical motion-capture system. Validity was assessed by evaluating the average difference and root mean square error. RESULTS The between-sessions intrarater reliability was moderate to good (ICC [2,3] range = 0.628-0.874). The within-session interrater reliability was moderate to excellent (ICC [2,3] range = 0.545-0.912). The average difference between total excursion values recorded using the electric goniometer and the 3-dimensional optical motion-capture system ranged from -7° to 4°, and the root mean square error ranged from 7° to 10°. CONCLUSIONS The reliability of scapular measurements was best when a standard operating procedure was used. The electric goniometer provided an accurate measurement of scapular excursions in all 3 anatomical planes during upper extremity elevation.
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Affiliation(s)
| | | | | | | | - Tim L Uhl
- College of Health Sciences, University of Kentucky, Lexington
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Sattasuk W, Sitilertpisan P, Joseph L, Paungmali A, Pirunsan U. A Clinical Evaluation of Scapular Dyskinesis Among Professional Bus Drivers With Unilateral Upper Quadrant Musculoskeletal Pain. Workplace Health Saf 2021; 69:460-466. [PMID: 33966565 DOI: 10.1177/21650799211003562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Professional bus drivers report a high prevalence of upper quadrant musculoskeletal pain which could be associated with scapular dyskinesis (SD). However, the evidence for valid and reliable screening methods for this condition is limited as SD among bus drivers is an emerging area of research. Therefore, the main aim of the study was to investigate the reliability of dynamic scapular motion test (DSMT) using video analysis as an accurate method to evaluate SD and to identify patterns of SD among bus drivers. METHODS In total, 32 bus drivers from a private bus company with unilateral upper quadrant musculoskeletal pain participated in the study. The DSMT was conducted and the SD was captured in the video during shoulder flexion-abduction movements. Two investigators analyzed the video recordings and identified the patterns of SD. The intra- and interrater reliability were determined using the percentage of agreement and weighted Kappa coefficients (Kw). Descriptive analysis was used to examine the patterns of SD. FINDINGS The intra- and interrater reliability of DSMT using video analysis were excellent (Kw coefficient: 0.762-0.878 and 0.87-1.00, respectively). About 56.2% and 53.1% of bus drivers presented SD with the shoulder flexion and abduction movements during DSMT. Medial border prominence (Type II pattern of SD) was identified as the common pattern of SD. CONCLUSION/APPLICATION TO PRACTICE The DSMT using video analysis showed excellent intra- and interrater reliability to evaluate SD. Occupational health practitioners can consider DSMT using video analysis to identify SD among people with upper quadrant musculoskeletal pain at the workplace.
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Affiliation(s)
- Wipawee Sattasuk
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | | | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
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Schmitt M, Vogt L, Wilke J, Niederer D. Unilateral and bilateral training competitive archers differ in some potentially unhealthy neck-shoulder region movement behaviour characteristics. BMC Sports Sci Med Rehabil 2021; 13:44. [PMID: 33902697 PMCID: PMC8077866 DOI: 10.1186/s13102-021-00272-6] [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: 09/21/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Excessive unilateral joint loads may lead to overuse disorders. Bilateral training in archery is only performed as a supportive coordination training and as a variation of typical exercise. However, a series of studies demonstrated a crossover transfer of training-induced motor skills to the contralateral side, especially in case of mainly unilateral skills. We compared the cervical spine and shoulder kinematics of unilateral and bilateral training archers. METHODS In this cross-sectional study, 25 (5 females, 48 ± 14 years) bilaterally training and 50 age-, sex- and level-matched (1:2; 47.3 ± 13.9 years) unilaterally training competitive archers were included. Cervical range of motion (RoM, all planes) and glenohumeral rotation were assessed with an ultrasound-based 3D motion analysis system. Upward rotation of the scapula during abduction and elevation of the arm were measured by means of a digital inclinometer and active shoulder mobility by means of an electronic caliper. All outcomes were compared between groups (unilaterally vs. bilaterally) and sides (pull-hand- vs. bow-hand-side). RESULTS Unilateral and bilateral archers showed no between group and no side-to-side-differences in either of the movement direction of the cervical spine. The unilateral archers had higher pull-arm-side total glenohumeral rotation than the bilateral archers (mean, 95% CI), (148°, 144-152° vs. 140°, 135°-145°). In particular, internal rotation (61°, 58-65° vs. 56°, 51-61°) and more upward rotation of the scapula at 45 degrees (12°, 11-14° vs. 8°, 6-10°), 90 degrees (34°, 31-36° vs. 28°, 24-32°), 135 degrees (56°, 53-59° vs. 49°, 46-53°), and maximal (68°, 65-70° vs. 62°, 59-65°) arm abduction differed. The bow- and pull-arm of the unilateral, but not of the bilateral archers, differed in the active mobility of the shoulder (22 cm, 20-24 cm vs. 18 cm, 16-20 cm). CONCLUSIONS Unilaterally training archers display no unphysiologic movement behaviour of the cervical spine, but show distinct shoulder asymmetris in the bow- and pull-arm-side when compared to bilateral archers in glenohumeral rotation, scapula rotation during arm abduction, and active mobility of the shoulder. These asymmetries in may exceed physiological performance-enhancing degrees. Bilateral training may seems appropriate in archery to prevent asymmetries.
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Affiliation(s)
- Mareike Schmitt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany.
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Hwang M, Lee S, Lim C. Effects of the Proprioceptive Neuromuscular Facilitation Technique on Scapula Function in Office Workers with Scapula Dyskinesis. ACTA ACUST UNITED AC 2021; 57:medicina57040332. [PMID: 33915824 PMCID: PMC8067054 DOI: 10.3390/medicina57040332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives; Proprioceptive neuromuscular facilitation (PNF) are effective in improving and maintaining Range of motion(ROM), increasing muscular strength and power, and increasing athletic performance, especially after exercise. The scapula patterns defined in PNF are activated within the upper extremity patterns and scapula motions together. Proper function of the upper extremities requires both motion and stability of the scapula. The purpose of this study was to compare the effects of scapula stabilization exercise training involving muscle strengthening, muscle balance, and movement control exercises on office workers with scapula dysfunction. Materials and Methods: A total of 42 office workers with scapula dyskinesis were recruited and randomly divided into three groups: muscle strengthening exercise group (n = 14), muscle balance exercise group (n = 14), and movement control exercise group (n = 14). The participants underwent 18 sessions (25 min/session, 3 days a week for 6 weeks) of training involving the three types of exercises. Results: The measurement outcomes included the scapula index, measured using a digital Vernier caliper; scapula function, evaluated using the Disability of the Arm, Shoulder, and Hand (DASH) outcome questionnaire (pain and performing, work ability, and sports and art activities); and scapulohumeral movements (scapula upward rotation at humeral abduction angles of 0°, 45°, 90°, 135°, and 180°), evaluated using inclinometers. After the exercise intervention, the scapula index (p = 0.002), DASH pain and performing score (p = 0.000), DASH work ability score (p = 0.000), DASH sports and art activity score (p = 0.027), and scapulohumeral movements (scapula upward rotation at 0° (p = 0.013) and 45° (p = 0.043) humeral abduction) showed significantly greater improvements in the movement control group than in the muscle strengthening and muscle balance groups. Conclusions: Thus, proprioceptive neuromuscular facilitation can be used as a rehabilitation intervention for scapula position and movement, pain reduction, and functional improvement in office workers with scapula dyskinesis.
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Affiliation(s)
- Myeungsik Hwang
- Department of Physical Therapy, Bumin Hospital, Seoul 07590, Korea;
| | - Sangbin Lee
- Department of Physical Therapy, Namseoul University, Cheonan 31020, Korea
- Correspondence: (S.L.); (C.L.); Tel.: +82-41-580-2532 (S.L.); +82-32-820-4424 (C.L.); Fax: +82-32-820-4069 (C.L.)
| | - Chaegil Lim
- Department of Physical Therapy, Gachon University, Incheon 21936, Korea
- Correspondence: (S.L.); (C.L.); Tel.: +82-41-580-2532 (S.L.); +82-32-820-4424 (C.L.); Fax: +82-32-820-4069 (C.L.)
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18
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Bhosale K, Verma C. Evaluation of neck pain and scapular stability in graduate dental students: A cross-sectional study. INDIAN JOURNAL OF DENTAL SCIENCES 2021. [DOI: 10.4103/ijds.ijds_177_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Grimes JK, Puentedura EJ, Cheng MS, Seitz AL. Scapular movement impairments in individuals with subacromial pain syndrome based on scapular assistance test and scapula reposition test outcomes. Musculoskelet Sci Pract 2020; 49:102214. [PMID: 32739653 DOI: 10.1016/j.msksp.2020.102214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals with subacromial pain present with a variety of contributing impairments related to the movement problem. The scapular assistance test (SAT) and scapula reposition test (SRT) are proposed to identify shoulder pain related to abnormal scapular movement or position. It remains unknown if scapular movement related impairments are present in those with positive tests. OBJECTIVES To determine if scapular motion related impairments differ based on the result of the SAT or SRT in individuals with subacromial pain syndrome. DESIGN Cross-sectional METHOD: Sixty individuals with subacromial pain syndrome were included. Prior to obtaining results of the SAT and SRT, a single examiner measured scapular upward rotation and posterior tilt active and passive motion, pectoralis minor length, and strength of the middle trapezius, lower trapezius, and serratus anterior. Dynamic scapular motion was qualitatively assessed with the Scapular Dyskinesis Test. The Mann-Whitney U test assessed for differences based on the outcome of the SAT and SRT. RESULTS There was a significant difference (P = .023) in pectoralis minor length for the SAT. Participants with a positive SAT had decreased muscle length compared to those who tested negative. There were no significant differences in scapular motion or strength based on the result of either the SAT or SRT. CONCLUSIONS A positive SAT was associated with greater pectoralis minor length impairment, but not muscle strength or mobility. The SRT did not identify greater impairments in any of the scapular movement related impairments assessed. Individuals may vary in contributing impairments related to SAT or SRT results.
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20
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Hotta GH, Gomes de Assis Couto A, Cools AM, McQuade KJ, Siriani de Oliveira A. Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial. Musculoskelet Sci Pract 2020; 49:102171. [PMID: 32861372 DOI: 10.1016/j.msksp.2020.102171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interventions focused on the scapula should be considered in treating subacromial pain syndrome (SAPS). However, the effect of adding scapular stabilization exercises to protocols of progressive strengthening of the shoulder complex muscles on a non-multimodal approach remains unclear. OBJECTIVE To investigate the effect of adding scapular stabilization exercises, emphasizing retraction, and depression of the scapula, to a progressive periscapular strengthening protocol on disability, pain, muscle strength, and ROM in patients with SAPS. DESIGN Randomized, controlled, superiority trial, prospectively registered, two-arms, parallel, blind assessor, blind patient, and allocation concealment. METHODS Sixty patients with SAPS were randomly allocated into two groups: Periscapular Strengthening (PSG) or Scapular Stabilization (SSG) exercises. The interventions were performed three times a week for eight weeks. The primary outcome function and secondary outcomes (Pain, kinesiophobia, global perceived effect, satisfaction with treatment, the range of motion, scapula position and muscle strength) were measured in the baseline, four weeks, eight weeks (end of intervention) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br). RESULTS A total of 60 patients were included and randomized to PSG (n = 30) or SSG (n = 30) from March 2016 to June 2017. There were no between group differences in primary and secondary outcomes at any time point. CONCLUSION The inclusion of the isolated scapular stabilization exercises, emphasizing retraction and depression of the scapula, to a progressive general periscapular strengthening protocol did not add benefits to self-reported shoulder pain and disability, muscle strength, and ROM in patients with SAPS. TRIAL REGISTRATION ClinicalTrials.gov.
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Affiliation(s)
- Gisele Harumi Hotta
- University of São Paulo, School of Medicine of Ribeirao Preto, Health Sciences Department, Ribeirão Preto, SP, Brazil
| | - Amanda Gomes de Assis Couto
- University of São Paulo, School of Medicine of Ribeirao Preto, Health Sciences Department, Ribeirão Preto, SP, Brazil
| | - Ann M Cools
- Ghent University, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium
| | - Kevin James McQuade
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, Seattle, United States
| | - Anamaria Siriani de Oliveira
- University of São Paulo, School of Medicine of Ribeirao Preto, Health Sciences Department, Ribeirão Preto, SP, Brazil.
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Luque Suarez A. Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement. J Manipulative Physiol Ther 2020; 43:824-831. [PMID: 32928568 DOI: 10.1016/j.jmpt.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. METHODS This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. RESULTS The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45° (r = 0.17, P = .21), 90° (r = 0.08, P = .57), and 135° (r = 0.10, P = 0.45) of shoulder elevation. CONCLUSION The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.
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Affiliation(s)
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alejandro Luque Suarez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain; Instituto de la Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Kinesiophobia Is Associated With Pain Intensity and Disability in Chronic Shoulder Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2020; 43:791-798. [PMID: 32829946 DOI: 10.1016/j.jmpt.2019.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Kinesiophobia is a clinically relevant factor in the management of chronic musculoskeletal pain. The aim of this study was to explore the cross-sectional association between kinesiophobia and both pain intensity and disability among individuals with chronic shoulder pain. METHODS A total of 65 participants with chronic unilateral subacromial shoulder pain were recruited from 3 primary care centers. The Shoulder Pain and Disability Index assessed pain intensity and disability. The Tampa Scale for Kinesiophobia short form assessed the presence of kinesiophobia. A linear multivariable regression analysis evaluated the potential association between kinesiophobia and range of movement free of pain with pain intensity and disability. The analysis was adjusted for sex and age. RESULTS In the linear multivariable regression analysis, only greater kinesiophobia (standardized β = 0.35, P < .01) and sex (standardized β = -0.29, P < .01) contributed to explain 19% of the variance in shoulder pain and disability scores. CONCLUSION This cross-sectional study provides preliminary evidence about the association between kinesiophobia and pain intensity and disability among individuals with chronic shoulder pain. However, our findings only contributed to explain 19% of the variance in shoulder pain and disability scores.
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Giuseppe LU, Laura RA, Berton A, Candela V, Massaroni C, Carnevale A, Stelitano G, Schena E, Nazarian A, DeAngelis J, Denaro V. Scapular Dyskinesis: From Basic Science to Ultimate Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082974. [PMID: 32344746 PMCID: PMC7215460 DOI: 10.3390/ijerph17082974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023]
Abstract
Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.
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Affiliation(s)
- Longo Umile Giuseppe
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-062-2541-1613; Fax: +39-0622-5411
| | - Risi Ambrogioni Laura
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Carlo Massaroni
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Joseph DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
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The Comparative Effects of Upper Thoracic Spine Thrust Manipulation Techniques in Individuals With Subacromial Pain Syndrome: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2019; 49:716-724. [PMID: 30862274 DOI: 10.2519/jospt.2019.8484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Subacromial pain syndrome (SPS) accounts for as much as 44% of shoulder pain encountered by physical therapists. Thoracic spine thrust manipulation (TSTM) is effective in the short term for improving pain and function in individuals with SPS, but its mechanisms remain elusive. Furthermore, it is unknown whether individuals with SPS respond differently based on the TSTM technique received. OBJECTIVES To compare the immediate effects of a supine TSTM, seated TSTM, and sham manipulation on the primary outcomes of self-reported pain, function, and satisfaction and secondary biomechanical impairments examined in individuals with SPS. METHODS Participants in this randomized clinical trial were randomized to receive a seated TSTM (n = 20), supine TSTM (n = 20), or sham manipulation (n = 20). The primary outcomes of self-reported pain, function, and satisfaction were measured via the Penn Shoulder Score. Secondary outcomes were changes in scapular upward rotation and posterior tilt; peak force generated in tests for the middle trapezius, lower trapezius, and serratus anterior; and pectoralis minor muscle length. Impairment measures were immediately reassessed, and the Penn Shoulder Score was reassessed after 48 hours. RESULTS There were no significant between-group differences in immediate or short-term follow-up outcomes. CONCLUSION Two TSTM techniques resulted in no differences in pain, satisfaction, and function when compared to a sham manipulation. Thoracic spine thrust manipulation did not have an immediate effect on the scapular impairments examined. LEVEL OF EVIDENCE Therapy, level 1. J Orthop Sports Phys Ther 2019;49(10):716-724. Epub 12 Mar 2019. doi:10.2519/jospt.2019.8484.
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Reliability of Clinical Assessment Methods to Measure Scapular Upward Rotation: A Critically Appraised Topic. J Sport Rehabil 2019; 28:650-655. [PMID: 29809085 DOI: 10.1123/jsr.2018-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/12/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Assessing movement of the scapula is an important component in the evaluation and treatment of the shoulder complex. Currently, gold-standard methods to quantify scapular movement include invasive technique, radiation, and 3D motion systems. This critically appraised topic focuses on several clinical assessment methods of quantifying scapular upward rotation with respect to their reliability and clinical utility. Clinical Question: Is there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Key Findings: Four studies were selected to be critically appraised. The quality appraisal of diagnostic reliability checklist was used to score the articles on methodology and consistency. Three of the 4 studies demonstrated support for the clinical question. Clinical Bottom Line: There is moderate evidence to support reliable clinical methods for measuring scapular upward rotation in subjects with or without shoulder pathology. Strength of Recommendation: There is moderate evidence to suggest there are reliable clinical measures to quantify scapular upward rotation in patients with or without shoulder pathology.
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Martinez-Calderon J, Miguel Morales-Asencio J, Luque-Suarez A. Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting. BMJ Open 2019; 9:e023020. [PMID: 31196895 PMCID: PMC6575639 DOI: 10.1136/bmjopen-2018-023020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. SETTING Three different primary care centres. PARTICIPANTS A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. PRIMARY OUTCOME MEASURES The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. RESULTS When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. CONCLUSIONS SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Granada. Faculty of Health Sciences, Granada, Spain
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Universiteit Antwerpen, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | - Jose Miguel Morales-Asencio
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Department of Nursing, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Larsen CM, Søgaard K, Eshoj H, Ingwersen K, Juul-Kristensen B. Clinical assessment methods for scapular position and function. An inter-rater reliability study. Physiother Theory Pract 2019; 36:1399-1420. [PMID: 30924383 DOI: 10.1080/09593985.2019.1579284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The aim of this study was to assess the inter-rater reliability of selected static, semi-dynamic, and dynamic test assessment methods for evaluation of scapular positioning and function. Methods: A standardized three-phase (i.e. training, overall agreement, and actual study) protocol for reliability studies was applied on 41 overhead sports participants, aged 18-56 (22 with obvious scapular winging, classified as visibility of the medial or inferior angle border of scapula). Ten scapular test assessment methods (two static, three semi-dynamic, and five dynamic) were evaluated. Results: Bland-Altman plots showed no funnel effects, although systematic bias and significant differences between raters were present in three of the methods. ICC values ranged from 0.71 to 0.80 for the static test assessment methods and from 0.25-0.92 for the semi-dynamic test assessment methods. Three of the five dynamic test assessment methods had ICCs of 0.47-0.68. For the two remaining dynamic test assessment methods, kappa varied between -0.034 and 0.71. Using PABAK, kappa increased to 0.54-0.86. Conclusion: Four scapular test assessment methods (Upper horizontal distance, Lower horizontal distance at max shoulder flexion, Acromial distance, and Winging scapula) showed satisfactory inter-rater reliability. Simple visual observational methods and quantitative distance measurements have better reliability between clinicians than more complex measurements and may be better suited for use in clinical practice.
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Affiliation(s)
- Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark.,Health Sciences Research Center, UCL University College , Odense, Denmark.,Department of Physiotheraphy, UCL University College , Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark.,Occupational and Environmental Medicine, University Hospital , Odense, Denmark
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital , Odense, Denmark
| | - Kim Ingwersen
- Department of Rehabilitation, Hospital Lillebaelt - Vejle Hospital , Vejle, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark
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Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review. J Athl Train 2019; 54:283-295. [PMID: 30829536 DOI: 10.4085/1062-6050-309-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. OBJECTIVE To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. DATA SOURCES We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. STUDY SELECTION Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. DATA EXTRACTION Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. DATA SYNTHESIS Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = -0.04; 95% CI = -0.31, 0.22), posterior tilt (mean difference = -0.09; 95% CI = -0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = -0.19, 0.31). CONCLUSIONS The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.
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Affiliation(s)
- Katsumi Takeno
- College of Health and Human Services, University of Toledo, OH
| | - Neal R Glaviano
- College of Health and Human Services, University of Toledo, OH
| | - Grant E Norte
- College of Health and Human Services, University of Toledo, OH
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A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series. J Orthop Sports Phys Ther 2019; 49:192-201. [PMID: 30658049 DOI: 10.2519/jospt.2019.8194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. CASE DESCRIPTION Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. OUTCOMES Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. DISCUSSION Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2019;49(3):192-201. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8194.
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Stępień A, Jędrzejowska M, Guzek K, Rekowski W, Stępowska J. Reliability of four tests to assess body posture and the range of selected movements in individuals with spinal muscular atrophy. BMC Musculoskelet Disord 2019; 20:54. [PMID: 30732590 PMCID: PMC6367749 DOI: 10.1186/s12891-018-2389-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/19/2018] [Indexed: 01/26/2023] Open
Abstract
Background The majority of individuals with spinal muscular atrophy (SMA) experience progressive skeletal deformities which may affect the quality of life and mobility. To date, no studies have evaluated the reliability of tests assessing body posture and joint mobility in SMA patients. The purpose of this study was to assess the reliability of Cervical Rotation test (CR), Supine Angle of Trunk Rotation test (SATR), Hip Extension test (HE) and Pelvic Obliquity test (PO) developed to evaluate the musculoskeletal system in SMA individuals. Methods Thirty individuals (12 girls and 18 boys) aged 4–15 with SMA type II (n = 24) and III (n = 6) confirmed by genetic examinations were qualified for the study. The participants were examined twice by three physiotherapists on the same day. The examination included four tests, i.e. CR, SATR, HE and PO tests aimed at assessing ranges of rotation in the cervical spine, chest deformities, ranges of hip extension and pelvis position while sitting. Statistical calculations were made with the use of statistical software IBM SPSS Statistics version 20. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). Results Intraobserver reliability was excellent for CR (ICC range 0.839–0.911), SATR (ICC range 0.918–0.939 - the upper part of the sternum; ICC range 0.951–0.975 - the lower part of the sternum), HE (ICC range 0.988–0,991) and PO (ICC range 0.896–0.935) tests. The interobserver ICC reached the excellent values in CR (ICC range 0.912–0.920), SATR (ICC = 0.888 - the upper part of the sternum, ICC = 0.951 - the lower part of the sternum), HE (ICC range 0.922–0.923) and PO (ICC = 0.928) tests. Conclusions CR, SATR, HE and PO tests are reliable and may be used for examining individuals with SMA. The application of these tests provides a possibility to detect early changes in the musculoskeletal system in children and adolescents and to assess the effectiveness of the implemented pharmacotherapy and rehabilitation.
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Affiliation(s)
- Agnieszka Stępień
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland.
| | - Maria Jędrzejowska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Neuromuscular Unit, Pawińskiego 5, 02-106, Warsaw, Poland
| | - Katarzyna Guzek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Witold Rekowski
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Jolanta Stępowska
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
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Konieczka C, Gibson C, Russett L, Dlot L, MacDermid J, Watson L, Sadi J. What is the reliability of clinical measurement tests for humeral head position? A systematic review. J Hand Ther 2018; 30:420-431. [PMID: 28802538 DOI: 10.1016/j.jht.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Physiotherapists routinely assess the position of the humeral head (HH) in patients with shoulder pain. PURPOSE OF THE STUDY To conduct a systematic review to determine the quality and content of studies that evaluated the reliability of clinical measurement methods for assessing the HH position. METHODS Five databases and gray literature were searched for studies fitting the eligibility criteria. After abstract and full-text review, the included studies were appraised using the Quality Appraisal of Reliability Studies checklist. Articles were considered of high quality if 8 was achieved on the checklist, and the overall quality of evidence was classified using prespecified criteria. Multiple raters extracted and performed quality ratings; a consensus process was used to finalize the reliability data that were synthesized and presented in a narrative synthesis. Reliability was classified as excellent if the intracorrelation coefficients or intercorrelation coefficients (ICCs) reported exceeded 0.75. RESULTS Fifteen studies on the reliability of ultrasound (US) and 3 studies on palpation were included. The methodologic quality was moderate in 17 of 18 studies. The intrarater reliability for all studies was excellent (ICC, 0.76-0.99) with the exception of the 90° abduction in internal rotation position (ICC, 0.48) for palpation. The inter-rater reliability tended to be lower (ICC, 0.48-0.68) for palpation and higher (ICC, 0.66-0.99) for US. Physiotherapists demonstrated excellent intrarater reliability across different levels of training in ultrasonography. DISCUSSION Our study found a moderate overall level of evidence to support the use of US for assessing HH position in symptomatic or asymptomatic subjects. CONCLUSION A moderate overall level of evidence exists for the use of US to reliably assess the HH position. Limited research supports the methods used for palpation within a clinical setting. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Christine Konieczka
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Christine Gibson
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leeann Russett
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leah Dlot
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Joy MacDermid
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Lyn Watson
- LifeCare, Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Jackie Sadi
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada.
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Warby SA, Ford JJ, Hahne AJ, Watson L, Balster S, Lenssen R, Pizzari T. Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial. Am J Sports Med 2018; 46:87-97. [PMID: 29048942 DOI: 10.1177/0363546517734508] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The recommended initial treatment for multidirectional instability (MDI) of the shoulder is a rehabilitation program, yet there is very low-quality evidence to support this approach. Purpose/Hypothesis: The purpose was to compare the Watson MDI program and Rockwood Instability program among patients with nontraumatic, nonstructural MDI. The hypothesis was that the Watson MDI program would produce clinically and statistically superior outcomes over the Rockwood Instability program. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Forty-one participants with MDI were randomly allocated to the Watson MDI or Rockwood Instability program. Participants attended 12 weekly physiotherapy sessions for exercise prescription. Outcomes were assessed at baseline and 6, 12, and 24 weeks after randomization. Primary outcomes were the Melbourne Instability Shoulder Score (MISS) and the Western Ontario Shoulder Index (WOSI). Secondary outcomes included the Orebro Musculoskeletal Pain Questionnaire, pain, muscle strength, scapular upward rotation, scapular coordinates, global rating of change, satisfaction scales, limiting angle in abduction range, limiting factor in abduction range, and incidence of dislocation. Primary analysis was by intention to treat based on linear mixed models. RESULTS Between-group differences showed significant effects favoring the Watson program for the WOSI (effect size [ES], 11.1; 95% CI, 1.9-20.2; P = .018) and for the limiting factor in abduction (ES, 0.1; 95% CI, 0.0-1.6; P = .023) at 12 weeks, and for the WOSI (ES, 12.6; 95% CI, 3.4-21.9; P =. 008), MISS (ES, 15.4; 95% CI, 5.9-24.8; P = .002), and pain (ES, -2.0; CI: -2.3 to -0.7, P = .003) at 24 weeks. CONCLUSION For people with MDI, 12 sessions of the Watson MDI program were more effective than the Rockwood program at 12- and 24-week follow-up. Registration: ACTRN12613001240730 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Sarah A Warby
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Jon J Ford
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Andrew J Hahne
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Ross Lenssen
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Watson L, Balster S, Lenssen R, Hoy G, Pizzari T. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. J Shoulder Elbow Surg 2018; 27:104-111. [PMID: 28947382 DOI: 10.1016/j.jse.2017.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conservative management is commonly recommended as the first-line treatment for multidirectional instability (MDI) of the shoulder. Despite this, the evidence for efficacy of treatment is limited, and until recently, guidance for clinicians on conservative rehabilitation programs has been inadequate. This study evaluated the effectiveness of a physiotherapy-led exercise program for participants with MDI. METHODS In a single-group study design, 43 participants (16 male, 27 female; mean age, 19.8 years, standard deviation, 4.9 years) diagnosed with MDI undertook a 12-week exercise program. Primary outcome measures were the Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and Oxford Shoulder Instability Score. Secondary outcomes were strength and scapular position. All measures were taken at baseline and repeated at the conclusion of the program. Test differences before and after rehabilitation were evaluated with dependent t tests and single-group effect size calculations (standardized mean difference [SMD]) to provide a measure of the magnitude of the difference. RESULTS Large effects were found between pre- and postrehabilitation scores on all functional instability questionnaires, with the Western Ontario Shoulder Instability Index demonstrating the largest effect (SMD, -3.04). Scapular upward rotation improved significantly in the early ranges of abduction (0°-60°), with moderate to large effects (SMDs, 0.54-0.95). All strength measures significantly improved, with large differences identified (SMDs, 0.69-2.08). CONCLUSION The identified improvement in functional status, shoulder muscle strength, and scapular positioning after rehabilitation allows greater confidence in the value of conservative management of MDI and informs further research by way of clinical trials in the area.
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Affiliation(s)
- Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia.
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McLaine SJ, Ginn KA, Fell JW, Bird ML. Scapular upward rotation position is symmetrical in swimmers without current shoulder pain. Phys Ther Sport 2017; 29:9-13. [PMID: 29156219 DOI: 10.1016/j.ptsp.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/29/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A history of shoulder pain is common in swimmers and may influence scapular position, possibly increasing the risk of shoulder pain recurring. The aim of this study was to establish and compare bilateral static measures of scapular upward rotation in swimmers (14-20 years), some with a history of shoulder pain but all currently pain free, in two different elevated positions of shoulder abduction. DESIGN Cross-sectional, observational study. PARTICIPANTS Eighty-five swimmers without current shoulder pain. METHODS Scapular upward rotation position was measured on both shoulders using a digital inclinometer in 90° and 140° shoulder abduction. Descriptive statistics were calculated for degrees of scapular upward rotation in both shoulder positions. Differences between shoulders (dominant, non-dominant, history and no history of pain) were explored using one-way ANOVA and paired t tests. RESULTS A large range of values for scapular upward rotation was found at both positions of shoulder abduction but there were no significant differences between the shoulders: with and without a history of shoulder pain for the dominant and non-dominant sides. CONCLUSIONS A history of shoulder pain and arm dominance did not influence scapular upward rotation position when measured in shoulder abduction in swimmers without current shoulder pain.
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Affiliation(s)
- Sally J McLaine
- School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston 7250, TAS, Australia(2).
| | - Karen A Ginn
- Discipline of Biomedical Science, Sydney Medical School, Edward Ford Building University of Sydney, 2006, NSW, Australia
| | - James W Fell
- School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston 7250, TAS, Australia(2)
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston 7250, TAS, Australia(2)
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Camargo PR, Phadke V, Zanca GG, Ludewig PM. Concurrent validity of inclinometer measures of scapular and clavicular positions in arm elevation. Physiother Theory Pract 2017; 34:121-130. [DOI: 10.1080/09593985.2017.1370753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula R Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - Vandana Phadke
- Department of Clinical Research, Indian Spinal Injuries Center, New Delhi, India
| | | | - Paula M Ludewig
- Department of Rehabilitation Medicine, The University of Minnesota, Minneapolis, MN, USA
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Lange T, Struyf F, Schmitt J, Lützner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review. Phys Ther Sport 2017; 26:64-89. [DOI: 10.1016/j.ptsp.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/01/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022]
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Jeong HJ, Cynn HS, Yi CH, Yoon JW, Lee JH, Yoon TL, Kim BB. Stretching position can affect levator scapular muscle activity, length, and cervical range of motion in people with a shortened levator scapulae. Phys Ther Sport 2017; 26:13-19. [PMID: 28578252 DOI: 10.1016/j.ptsp.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Levator scapulae (LS) muscle stretching exercises are a common method of lengthening a shortened muscle; however, the appropriate stretching position for lengthening the LS in people with a shortened LS remains unclear. The purpose of this study was to compare the effects of different stretching exercise positions on the LS and introduce effective stretching exercise methods to clinicians. PARTICIPANTS Twenty-four university students (12 men, 12 women) with a shortened LS were recruited. METHODS LS muscle activity, LS index (LSI), and cervical range of motion (ROM) were measured pre (baseline) and post three different stretching exercise positions (sitting, quadruped, and prone). RESULTS The LSI and cervical ROM exceeded the minimal detectable change and had significant changes. The LSI was greater in the sitting position than at the baseline (p = 0.01), quadruped position (p < 0.01); the LSI in the prone position presented a higher increase than the quadruped position (p = 0.01). The cervical ROM increased in the sitting position when compared to the baseline (p < 0.01) and quadruped position (p < 0.01). CONCLUSIONS Stretching the LS in the sitting position was the most effective exercise for improving LS muscle length and cervical ROM.
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Affiliation(s)
- Hyo-Jung Jeong
- Movement Science Program, Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101 St. Louis, MO 63108-2212, United States.
| | - Heon-Seock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Gangwon-do, Republic of Korea.
| | - Chung-Hwi Yi
- Department of Physical Therapy, College of Health Science, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Gangwon-do, Republic of Korea.
| | - Jang-Whon Yoon
- Department of Physical Therapy, Hoseo University, Art and Technology Building, 79 Hoseoro, Asan, Chungnam, Republic of Korea.
| | - Ji-Hyun Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Gangwon-do, Republic of Korea.
| | - Tae-Lim Yoon
- Department of Physical Therapy, College of Health Science, Cheongju University, 298 Daeseongro, Sangdang-gu, Cheongju, Chungbuk, Republic of Korea.
| | - Bo-Been Kim
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Gangwon-do, Republic of Korea.
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Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review. Phys Ther 2017; 97:124-144. [PMID: 27587801 DOI: 10.2522/ptj.20160088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. PURPOSE The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. DATA SOURCES The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. STUDY SELECTION Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. DATA EXTRACTION Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. DATA SYNTHESIS Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. LIMITATIONS All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. CONCLUSIONS High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar tests was present, and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently, these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinically meaningful context of movement into clinical tests is warranted.
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Warby SA, Ford JJ, Hahne AJ, Watson L, Balster S, Lenssen R, Pizzari T. Effect of exercise-based management on multidirectional instability of the glenohumeral joint: a pilot randomised controlled trial protocol. BMJ Open 2016; 6:e013083. [PMID: 27619831 PMCID: PMC5030545 DOI: 10.1136/bmjopen-2016-013083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/26/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The most commonly recommended treatment for multidirectional instability (MDI) of the shoulder is exercise. Despite this recommendation, there is limited evidence to support the effectiveness of exercise. The aim of this paper is to describe a pilot randomised controlled trial comparing the effectiveness of 2 exercise programmes on outcomes of participants with MDI. METHODS AND ANALYSIS Consenting participants between 12 and 35 years, with non-traumatic MDI will be randomly allocated to participate in either the Rockwood Instability programme or the Watson MDI programme. Both programmes involve 1 consultation per week for 12 weeks with a physiotherapist to prescribe and progress a home exercise programme. Outcomes will be assessed at baseline, 6, 12, 24 and 52 weeks. Primary outcome measures include the Melbourne Instability Shoulder Score and Western Ontario Shoulder Index. Secondary outcomes include scapular coordinates, scapular upward rotation angles, muscle strength, symptomatic onset, limiting factor and angle of limiting factor in abduction range, incidence of complete glenohumeral joint dislocation, global rating of change, satisfaction scores, the Orebro Musculoskeletal Pain Questionnaire, adverse events and compliance with the home exercise programme. Data will be analysed on intention-to-treat principles and a per protocol basis. DISCUSSION This trial will evaluate whether there are differences in outcomes between the Rockwood and the Watson MDI programmes for participants with MDI. ETHICS AND DISSEMINATION Participant confidentiality will be maintained with publication of results. Ethics approval: Faculty of Health Sciences (FHEC12/201). TRIAL REGISTRATION NUMBER ACTRN12613001240730; Pre-results.
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Affiliation(s)
- Sarah A Warby
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Jon J Ford
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Andrew J Hahne
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Ross Lenssen
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
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Abstract
OBJECTIVES To investigate inter-rater reliability of a set of shoulder measurements including inclinometry [shoulder range of motion (ROM)], acromion-table distance and pectoralis minor muscle length (static scapular positioning), upward rotation with two inclinometers (scapular kinematics) and pain pressure thresholds (muscle tenderness) in middle-aged women. DESIGN Observational study. PARTICIPANTS Thirty symptom-free middle-aged women (first cohort) were measured by two raters. All measurements with an intraclass correlation coefficient (ICC) below 0.75 were retested after an additional training period in a second cohort of 30 symptom-free middle-aged women. MAIN OUTCOME MEASURES Inter-rater reliability of all variables was measured with the ICC (95% confidence interval) and standard error of measurement (SEM). RESULTS Acromion-table distance (ICC=0.91, SEM 0.22 to 0.28% of body length), pectoralis minor muscle length (ICC=0.91, SEM 0.16% of body length), pain pressure thresholds (ICC=0.78 to 0.85, SEM 0.39 to 0.70kg) and abduction ROM (ICC=0.77, SEM 5°) showed good to excellent inter-rater reliability in the first cohort. After an additional training period, forward flexion ROM showed good inter-rater reliability (ICC=0.83, SEM 5°), scapular upward rotation in resting position showed moderate reliability (ICC=0.52, SEM 2°), and other scaption angles showed weak reliability (ICC=0.26 to 0.43, SEM 3 to 8°). CONCLUSIONS In a battery of clinical tools to evaluate factors contributing to shoulder pain, static scapular positioning and pressure pain thresholds were found to have good to excellent inter-rater reliability in middle-aged women. Additional training is recommended for measurements with a gravity inclinometer.
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Shah NA, Shimpi AP, Rairikar SA, Ashok S, Sancheti PK. Presence of scapular dysfunction in dominant shoulder of professional guitar players. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2016; 22:422-5. [DOI: 10.1080/10803548.2016.1154720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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De Baets L, Jaspers E, Van Deun S. Scapulohumeral control after stroke: A preliminary study of the test-retest reliability and discriminative validity of a clinical scapular protocol (ClinScaP). NeuroRehabilitation 2016; 38:359-70. [PMID: 27061164 DOI: 10.3233/nre-161327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical scapulohumeral tests are lacking post-stroke. OBJECTIVE To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke. METHODS Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and IwS and between IwS with different levels of PAF were assessed. RESULTS ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p < .01); decreased maximal active humeral elevation (p < .001); and more often tilting and winging (p < .05). CONCLUSIONS The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke.
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Affiliation(s)
- Liesbet De Baets
- REVAL Rehabilitation Research Center - BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Sara Van Deun
- REVAL Rehabilitation Research Center - BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Clinical Assessment of Scapula Motion: Scapula Upward Rotation and Relationship with Injury in Swimmers. Sports (Basel) 2016; 4:sports4010008. [PMID: 29910256 PMCID: PMC5968946 DOI: 10.3390/sports4010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 11/22/2022] Open
Abstract
Abnormal scapulothoracic mechanics and scapulohumeral rhythm are implicated in shoulder pathologies, including glenohumeral impingement and rotator cuff tears. Upward scapula rotation, specifically asymmetry of scapula motion and associations of patterns through range with injury, was investigated in dominant and non-dominant limbs of nationally ranked junior and Paralympic swimmers during competition season. The static and throughout phases measures of upward scapula rotation were: Phase I (start position, 45°), Phase II (45° to 90°), Phase III (90° to 135°) and Phase IV (135° to max). Injury was assessed with a validated questionnaire. Differences between side (dominant and non-dominant), group (junior and Paralympic), and phase were examined. Significant differences (P < 0.05) between groups were identified for dominant side at rest, 45° and 135°, and in phases II and IV (including range). Scapulohumeral rhythm was higher in the non-dominant limb of Paralympic swimmers but in the dominant limb of junior swimmers. Greatest differences in upward rotation between injured and non-injured swimmers were found in Phase 1: 43.6% (3.3°) Paralympic; 73.1% (8°) junior. Results suggest asymmetry of movement in both limbs, through all phases, and at single points in range, should be investigated for assessing injury and developing preventive strategies and rehabilitation protocols.
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Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Hum Mov Sci 2015; 45:119-29. [PMID: 26625348 DOI: 10.1016/j.humov.2015.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 11/27/2022]
Abstract
Scapular dyskinesis, characterized by scapular downward rotation syndrome (SDRS) affects scapula-humeral rhythm and results in shoulder dysfunction. Previous study has led to the recommendation of standard shrug exercise to contend with SDRS and strengthen the upper trapezius (UT) muscle. However, few researchers have examined which shrug exercise is most effective. The aim of this research was to compare scapular kinematic changes and scapular rotator muscles activity across three different shrug exercises in SDRS. The amounts of scapular downward rotation were measured by a caliper and the scapular upward rotation angle was measured using two digital inclinometers. Surface electromyography was used to measure EMG amplitude from the UT, lower trapezius (LT), serratus anterior (SA), and levator scapula (LS). Seventeen subjects with SDRS were recruited for this study. The subjects performed three shrug exercises with 30° shoulder abduction (preferred shrug, frontal shrug, and stabilization shrug). The stabilization shrug showed a significantly greater scapular upward rotation angle compared with the preferred shrug (P=0.004) and frontal shrug (P=0.006). The UT activity was significantly greater in the frontal shrug than in the preferred shrug (P=0.002). The UT/LS muscle activity ratio was also significantly greater in the frontal shrug than in the preferred shrug (P=0.004). The stabilization shrug should be preferred to enhance the upward rotation angle. In addition, the frontal shrug can be used as an effective method to increase UT activity and to decrease LS activity in SDRS.
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Hannah DC, Scibek JS. Collecting shoulder kinematics with electromagnetic tracking systems and digital inclinometers: A review. World J Orthop 2015; 6:783-794. [PMID: 26601060 PMCID: PMC4644866 DOI: 10.5312/wjo.v6.i10.783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
The shoulder complex presents unique challenges for measuring motion as the scapula, unlike any other bony segment in the body, glides and rotates underneath layers of soft tissue and skin. The ability for clinicians and researchers to collect meaningful kinematic data is dependent on the reliability and validity of the instrumentation utilized. The aim of this study was to review the relevant literature pertaining to the reliability and validity of electromagnetic tracking systems (ETS) and digital inclinometers for assessing shoulder complex motion. Advances in technology have led to the development of biomechanical instrumentation, like ETS, that allow for the collection of three-dimensional kinematic data. The existing evidence has demonstrated that ETS are reliable and valid instruments for collecting static and dynamic kinematic data of the shoulder complex. Similarly, digital inclinometers have become increasingly popular among clinicians due to their cost effectiveness and practical use in the clinical setting. The existing evidence supports the use of digital inclinometers for the collection of shoulder complex kinematics as these instruments have been demonstrated to yield acceptable reliability and validity. While digital inclinometers pose a disadvantage to ETS regarding accuracy, precision, and are limited to two-dimensional and static measurements, this instrument provides clinically meaningful data that allow clinicians and researchers the ability to measure, monitor, and compare shoulder complex kinematics.
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Seitz AL, McClelland RI, Jones WJ, Jean RA, Kardouni JR. A COMPARISON OF CHANGE IN 3D SCAPULAR KINEMATICS WITH MAXIMAL CONTRACTIONS AND FORCE PRODUCTION WITH SCAPULAR MUSCLE TESTS BETWEEN ASYMPTOMATIC OVERHEAD ATHLETES WITH AND WITHOUT SCAPULAR DYSKINESIS. Int J Sports Phys Ther 2015; 10:309-318. [PMID: 26075146 PMCID: PMC4458918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The significance of scapular dyskinesis is being challenged due to a lack of the association with pain and ability to predict injury in athletic populations. However, it is unknown whether asymptomatic overhead athletes with dyskinesis cope by normalizing scapular position with higher demand activities. HYPOTHESIS/PURPOSE The purpose of this study was to compare change in scapular kinematics from an active unweighted contraction to a maximal isometric contraction in asymptomatic overhead athletes with and without scapular dyskinesis. Secondarily, force generated with manual muscle tests were explored for differences and relationships with kinematics. STUDY DESIGN Cross-sectional laboratory study. METHODS Twenty-five matched asymptomatic overhead athletes with (n=14) and without (n=11) scapular dyskinesis, defined with a reliable and validated clinical method, participated in this study. Three-dimensional scapular kinematics were evaluated in an active unweighted condition, and during maximal isometric contractions at 90 ° of shoulder flexion. Isometric force produced with lower trapezius and serratus anterior manual muscle tests were assessed with a dynamometer. Changes in scapular kinematics were compared between groups. Differences in force generated with manual muscle tests between groups and relationships with kinematics were explored. RESULTS Athletes with dyskinesis demonstrated greater deficits in scapular upward rotation with maximal contraction (p=<0.001), less external rotation (p=0.036) and weaker lower trapezius manual muscle test strength (p=0.031). Lower trapezius (p=0.003;r=0.57) and serratus anterior (p=0.042;r=0.41) manual muscle test strength deficits were fair to moderately associated with a lack of scapular upward rotation during maximal contraction. CONCLUSION Small to moderate changes in scapular kinematics are normal responses to a maximal contraction, but with scapular dyskinesis this response is accentuated. Athletes with dyskinesis generate less force with lower trapezius manual muscle testing compared to athletes without dyskinesis. Decreased strength with lower trapezius and serratus anterior manual muscle testing was also related to a lack of upward rotation in all athletes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Amee L. Seitz
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago Illinois, USA
| | | | - W. Justin Jones
- Department of Physical Therapy, Simmons College, Boston, Massachusetts, USA
| | - Randy A. Jean
- South Shore Hospital, Center for Orthopedics, Spine and Sports Medicine, Hingham, Massachusetts, USA
| | - Joseph R. Kardouni
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Sharma SP, Bærheim A, Kvåle A. Passive range of motion in patients with adhesive shoulder capsulitis, an intertester reliability study over eight weeks. BMC Musculoskelet Disord 2015; 16:37. [PMID: 25888419 PMCID: PMC4340115 DOI: 10.1186/s12891-015-0495-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring range of motion (ROM) in the shoulder joint is important for the diagnosis and monitoring of change over time. To what degree passive ROM can be trusted as a reliable outcome measure was examined as part of an on-going randomized controlled trial for patients with shoulder capsulitis. The aim of this study was to examine intertester reliability of passive ROM in the shoulder joint over a period of eight weeks in patients with adhesive capsulitis stage II. METHODS Fifty patients with a clinical diagnosis of adhesive shoulder capsulitis were examined by two independent testers. A predefined protocol was used for measuring passive range of motion with an inclinometer, a plurimeter, in both affected and non-affected shoulders three times; at the start of the study and after 4 and 8 weeks. RESULTS Very good to excellent intertester agreements were found for most parameters for the affected arm at all three test points. The intraclass correlation coefficient (ICC 2.1) values ranged from 0.76 to 0.98, i.e. from very reliable to excellent. The measurement error was in general small for the affected arm (5°-7°). ICCs were slightly lower for the non-affected arm at 8 weeks, but with acceptable measurement errors. CONCLUSIONS Intertester reliability between two testers was very good at three visits over a time period of eight weeks using a plurimeter to measure passive range of motion in patients with adhesive shoulder capsulitis. This method can reliably determine passive range of motion in this patient population and be a reliable outcome measure.
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Affiliation(s)
- Satya Pal Sharma
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Alice Kvåle
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.
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Lee JH, Cynn HS, Yoon TL, Ko CH, Choi WJ, Choi SA, Choi BS. The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. J Electromyogr Kinesiol 2015; 25:107-14. [DOI: 10.1016/j.jelekin.2014.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/18/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022] Open
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Lee JH, Cynn HS, Yoon TL, Choi SA, Choi WJ, Choi BS, Ko CH. Comparison of scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor stretching on scapular alignment and scapular upward rotators activity in subjects with short pectoralis minor. Phys Ther Sport 2015; 16:255-61. [PMID: 26025320 DOI: 10.1016/j.ptsp.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/30/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor (PM) stretching on the PM index (PMI), scapular anterior tilting index, scapular upward rotation angle, and scapular upward rotators' activity in subjects with a short PM. PARTICIPANTS Fifteen subjects with a short PM participated in this study. MAIN OUTCOME MEASURES The PMI, scapular anterior tilting index, and scapular upward rotation angle were measured after scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. Scapular upward rotators' activities were collected during scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. RESULTS The PMI and scapular upward rotation angle, as well as the activity of the upper trapezius, lower trapezius, and serratus anterior muscles, were significantly greater for scapular posterior tilting exercise after PM stretching and the scapular anterior tilting index was significantly lower for scapular posterior tilting exercise after PM stretching than the scapular posterior tilting exercise alone. CONCLUSIONS Scapular posterior tilting exercise after PM stretching in subjects with a short PM could be an effective method of modifying scapular alignment and scapular upward rotator activity.
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Affiliation(s)
- Ji-Hyun Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
| | - Heon-Seock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea.
| | - Tae-Lim Yoon
- Department of Physical Therapy, College of Health and Welfare, Woosong University, #17-2, Jayang-dong, Dong-gu, Daejeon, South Korea
| | - Sil-Ah Choi
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
| | - Woo-Jeong Choi
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
| | - Bong-Sam Choi
- Department of Physical Therapy, College of Health and Welfare, Woosong University, #17-2, Jayang-dong, Dong-gu, Daejeon, South Korea
| | - Chang-Hee Ko
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
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50
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Intrarater Test-retest Reliability of the Inclinometer to Assess Scapular Upward Rotation in Unimpaired Females: A Measurement Focused Study. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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