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Schwartz C, Tooth C, Gofflot A, Martens G, Croisier JL, Denoël V, Brüls O, Forthomme B. Strength and activity of the protractor and retractor muscles of the asymptomatic dyskinetic scapula. J Electromyogr Kinesiol 2024; 77:102899. [PMID: 38810415 DOI: 10.1016/j.jelekin.2024.102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024] Open
Abstract
The role of scapular dyskinesis as a risk factor of shoulder injury has been largely discussed. However, most studies have focused on symptomatic patients and less is known on the asymptomatic dyskinetic scapula. Removing the confounding effects of the pathologies could contribute to better characterize the scapula dyskinesis. As muscle properties (strength, fatigue, nerve injury …) have been identified as causative factors of scapular dyskinesis, this study focuses specifically on characterizing the protractor and retractor muscles of the dyskinetic scapula. Thirteen asymptomatic dyskinetic volunteers were compared to eleven asymptomatic non-dyskinetic control volunteers. Muscle characteristics were evaluated in terms of maximal strength, fatigue resistance and electromyographic activity during a functional closed-chained task. The results did not identify kinematic or muscle activity significant differences between the dyskinetic and the control group even in fatigue conditions. However, the results demonstrated that protractors vs. retractors fatigue resistance ratios were imbalanced (<0.8) in the dyskinetic group and significantly lower than in the non-dyskinetic one. Our study suggests that that strength imbalances are not necessarily related to the presence of pain at the shoulder joint. These results demonstrated the importance to complete the clinical assessments of the scapula with strength evaluations even for asymptomatic sport practitioners.
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Affiliation(s)
- Cédric Schwartz
- LAM - Motion Lab, University of Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium; Department of Urban and Environmental Engineering, University of Liège, Liège, Belgium; Department of Aerospace and Mechanical Engineering, University of Liège, Liège, Belgium.
| | - Camille Tooth
- LAM - Motion Lab, University of Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium; ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, University Hospital of Liège, Belgium
| | - Amandine Gofflot
- LAM - Motion Lab, University of Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Géraldine Martens
- Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium; ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, University Hospital of Liège, Belgium
| | - Jean-Louis Croisier
- LAM - Motion Lab, University of Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium; ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, University Hospital of Liège, Belgium
| | - Vincent Denoël
- LAM - Motion Lab, University of Liège, Belgium; Department of Urban and Environmental Engineering, University of Liège, Liège, Belgium
| | - Olivier Brüls
- LAM - Motion Lab, University of Liège, Belgium; Department of Aerospace and Mechanical Engineering, University of Liège, Liège, Belgium
| | - Bénédicte Forthomme
- LAM - Motion Lab, University of Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium; ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, University Hospital of Liège, Belgium
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Ranne JO, Kainonen TU, Kanto KJ, Lehtinen JT, Niemi PT, Scheinin H. Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05461-9. [PMID: 39025979 DOI: 10.1007/s00402-024-05461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. MATERIALS AND METHODS Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. RESULTS No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. CONCLUSIONS There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. STUDY REGISTRATION This clinical trial was registered on Clinicaltrials.gov.
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Affiliation(s)
- Juha O Ranne
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland.
- Department of Physical Activity and Health, The Paavo Nurmi Centre, The University of Turku, Turku, Finland.
| | | | | | - Janne T Lehtinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Pekka T Niemi
- Hospital Mehiläinen Neo, 20520, Joukahaisenkatu 6Turku, Finland
| | - Harry Scheinin
- Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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Kjær BH, Svensson RB, Warming S, Peter Magnusson S. Supraspinatus Muscle and Tendon Characteristics 1 Year After Surgical Rotator Cuff Repair Compared With Contralateral Shoulder: Data From the CUT-N-MOVE Trial. Am J Sports Med 2024; 52:2082-2091. [PMID: 38860727 DOI: 10.1177/03635465241255143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND It is necessary to better understand the structural characteristics of the supraspinatus tendon and associated muscle after rotator cuff repair and in the event of retear. PURPOSE To study structural differences between the repaired and contralateral shoulders 1 year after rotator cuff repair in patients who received either progressive exercise therapy (PR) or usual care (UC) in a randomized controlled trial and to investigate whether there was interaction with tendon retear and limb dominance. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with surgically repaired traumatic full-thickness rotator cuff tears involving the supraspinatus tendon were included. After surgery, they were randomized to PR or UC (active from postoperative week 2 or 6, respectively). The subacromial structures (acromiohumeral distance, supraspinatus tendon thickness, and vascularity) and the supraspinatus muscle thickness were examined with ultrasound at the 1-year follow-up. RESULTS A total of 79 patients were included. The characteristics of the 2 intervention groups (PR and UC) were comparable, including the Western Ontario Rotator Cuff Index score and number of retears. The authors found significantly thinner supraspinatus tendon (PR, P < .001; UC, P = .003) and reduced acromiohumeral distance (PR, P = .023; UC, P = .025) in the repaired versus the contralateral shoulders in both intervention groups. For neovascularization, there was no interlimb difference in either of the groups or between groups (PR vs UC). In patients with intact tendons, there was no interlimb difference in the muscle thickness, but in patients with tendon retear the muscle was significantly thinner on the repaired side (P = .024 and P < .001, respectively). When the dominant supraspinatus tendon was repaired (both groups), it was significantly thinner than the nondominant healthy tendon, but this difference was not seen when the nondominant supraspinatus tendon was repaired (P = .006). CONCLUSION One year after rotator cuff surgery, the repaired supraspinatus tendon was significantly thinner and the corresponding acromiohumeral distance was reduced. In patients with retear, the supraspinatus muscle was significantly thinner on the repaired side and early initiation of tendon-loading exercises did not affect these findings. REGISTRATION NCT02969135 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Geurkink TH, Marang-van de Mheen PJ, Robbers T, Nagels J, Nelissen RG. Long-term outcomes of pectoralis major transfer for scapular winging due to long thoracic nerve palsy: results after a median follow-up of 17 years. JSES Int 2024; 8:822-827. [PMID: 39035646 PMCID: PMC11258848 DOI: 10.1016/j.jseint.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background A pectoralis major (PM) transfer is a viable treatment option for patients with scapular winging due to long thoracic nerve (LTN) palsy not responding to nonsurgical management. However, the long-term outcomes remain unknown. Therefore, the purpose of this study was to evaluate the long-term outcome of shoulder function (ie, minimum follow-up of 10 years) and quality-of-life (QoL) of patients treated for scapular winging due to LTN palsy with a PM transfer. Methods This observational cohort study included 15 patients (16 shoulders) who underwent PM transfer, using a tendoachilles allograft, between 1995 and 2012. Shoulder forward flexion and abduction were analyzed preoperatively, 1 year after surgery and at the final follow-up. SF-36 component scores (physical component summary (PCS) and mental component summary (MCS)) were used to evaluate the QoL. Results Shoulder forward flexion and abduction measured in degrees improved from 86 (SD 14.5) and 82 (SD 33.8) preoperatively to 140 (SD 27.3) and 138 (31.3) at 1 year postoperatively. After a median follow-up of 17 years, mean shoulder functions were slightly lower than at 1 year postoperatively, but still better than preoperative function, ie, forward flexion 121 (SD 41.9) and abduction 122 (SD 44.5). The mean PCS score at the final follow-up was 41.9 (SD 9.7), and the mean MCS score was 49.9 (SD 12.5). Better shoulder function at the final follow-up was significantly associated with higher QoL in terms of PCS scores (P = .023), but not MCS scores (P = .287). Conclusion The results of the present study indicate that PM transfer augmented with an achilles tendon allograft for scapular winging due to LTN palsy leads to functional improvements that persist in long term. These functional improvements likely translate to better QoL based on their association.
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Affiliation(s)
- Timon H. Geurkink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
- Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, Delft, The Netherlands
| | - Tim Robbers
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
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D'Antonio L, Fiumana G, Reina M, Lodi E, Porcellini G. Breaking the operator variability in Kibler's scapular dyskinesis assessment. Musculoskelet Surg 2024:10.1007/s12306-024-00834-0. [PMID: 38904866 DOI: 10.1007/s12306-024-00834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/17/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Alterations of scapular kinematics are generically reported as scapular dyskinesis (SD), and are a nonspecific response to various shoulder pathologies. The most widely used classification is Kibler's (K), which is, however, characterized by poor sensitivity. To overcome this limit, using a 3D motion analysis system, we identified a specific pattern for each type of SD according to Kibler. MATERIALS AND METHODS We analyzed 34 patients with a total of 68 shoulders who came to our observation for shoulder pain. All patients underwent clinical examination, video-recording and motion analysis with SHoW Motion 3D kinematic tracking system (SM). Three independent observers classified SD into K types I, II and III. Only patients with concordant classification among the 3 operators were studied to identify a characteristic graphic pattern by type of SD. RESULTS Typical patterns emerged from the examination with SM. K. type 1 consists of decreased or reversed posterior tilt and increased protraction in flexion-extension (FE) in early degrees of motion. K. type 2 consists of increased protraction and marked reversal of lateral rotation in abduction-adduction (Ab-Ad) in early degrees of movement. K. type 3 has been subdivided into two subgroups: K. type 3-A, composed of patients with massive rotator cuff lesions, shows an increase in all scapular movements in both FE and Ab-Ad. K. type 3-B, composed of patients with scapular stiffness and/or impingement, presents a slight increase in posterior tilt and lateral rotation in the final grades of FE and Ab-Ad. CONCLUSIONS The SM system allows reproducible dynamic analyses with low intra- and intra- operator variability. In our study, we demonstrated its applicability in the classification of SD. It also provides an objective and quantitative assessment of motor pattern alteration that is essential in the follow-up of patients to evaluate the effectiveness of rehabilitation and/or surgical treatment. LEVEL OF EVIDENCE 3: According to "The Oxford 2011 Levels of Evidence".
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Affiliation(s)
- L D'Antonio
- Department of Sport Medicine, University of Modena and Reggio Emilia, Modena, Italy.
- Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso cardiaco, Cardiopatie dell'Infanzia e A rischio), University of Modena and Reggio Emilia, Modena, Italy.
| | | | - M Reina
- Department of Orthopaedics and Traumatology, IRCC A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - E Lodi
- Department of Sport Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso cardiaco, Cardiopatie dell'Infanzia e A rischio), University of Modena and Reggio Emilia, Modena, Italy
| | - G Porcellini
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
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Luo SL, Shih YF, Lin JJ, Lin YL. Scapula-Focused Exercises With or Without Biofeedback and Corticospinal Excitability in Recreational Overhead Athletes With Shoulder Impingement. J Athl Train 2024; 59:617-626. [PMID: 37648216 PMCID: PMC11220774 DOI: 10.4085/1062-6050-0066.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
CONTEXT Individuals with shoulder impingement syndrome (SIS) exhibit changes in corticospinal excitability, scapular kinematics, and scapular muscle-activation patterns. To restore the scapular kinematics and muscle-activation patterns in individuals with SIS, treatment protocols usually include scapula-focused exercises, such as scapular-orientation and strength training. OBJECTIVE To investigate whether scapular-orientation and strength training can reverse the altered corticospinal excitability of recreational overhead athletes with SIS. DESIGN Randomized controlled clinical trial. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-one recreational overhead athletes with SIS: 20 in the scapular-orientation group (age = 26.45 ± 4.13 years, height = 171.85 ± 7.88 cm, mass = 66.70 ± 10.68 kg) and 21 in the strengthening group (age = 26.43 ± 5.55 years, height = 171.62 ± 5.87 cm, mass = 68.67 ± 10.18 kg). INTERVENTION(S) Both groups performed a 30-minute training protocol consisting of 3 exercises to strengthen the lower trapezius (LT) and serratus anterior muscles without overactivating the upper trapezius muscles. Participants in the scapular-orientation group were instructed to consciously activate their scapular muscles with electromyographic biofeedback and cues, whereas the strengthening group did not receive biofeedback or cues for scapular motion. MAIN OUTCOME MEASURE(S) Corticospinal excitability was assessed using transcranial magnetic stimulation. Scapular kinematics and muscle activation during arm elevation were also measured. RESULTS After training, both groups demonstrated an increase in motor-evoked potentials in the LT (P = .004) and increases in scapular upward rotation (P = .03), LT activation (P < .001), and serratus anterior activation (P < .001) during arm elevation. Moreover, the scapular-orientation group showed higher LT activation levels during arm elevation after training than the strengthening group (P = .03). CONCLUSIONS With or without biofeedback and cues, scapula-focused exercises improved scapular control and increased corticospinal excitability. Adding biofeedback and cues for scapular control during exercise helped facilitate greater LT activation, so feedback and cues are recommended during scapula-focused training.
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Affiliation(s)
- Shi-Lun Luo
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei
| | - Yin-Liang Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tazawa T, Yasui M, Otsuka S, Hatayama N, Naito M, Ohshima S, Yokota H. Development of a musculoskeletal shoulder model considering anatomic joint structures and soft-tissue deformation for dynamic simulation. Anat Sci Int 2024; 99:278-289. [PMID: 38698275 DOI: 10.1007/s12565-024-00773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
The shoulder joint has a high degree of freedom and an extremely complex and unstable kinematic mechanism. Coordinated contraction of the rotator cuff muscles that stop around the humeral head and the deltoid muscles and the extensibility of soft tissues, such as the joint capsule, labrum, and ligaments, contribute to shoulder-joint stability. Understanding the mechanics of shoulder-joint movement, including soft-tissue characteristics, is important for disease prevention and the development of a device for disease treatment. This study aimed to create a musculoskeletal shoulder model to represent the realistic behavior of joint movement and soft-tissue deformation as a dynamic simulation using a rigid-body model for bones and a soft-body model for soft tissues via a spring-damper-mass system. To reproduce the muscle-contraction properties of organisms, we used a muscle-expansion representation and Hill's mechanical muscle model. Shoulder motion, including the movement of the center of rotation in joints, was reproduced, and the strain in the joint capsule during dynamic shoulder movement was quantified. Furthermore, we investigated narrowing of the acromiohumeral distance in several situations to induce tissue damage due to rotator cuff impingement at the anterior-subacromial border during shoulder abduction. Given that the model can analyze exercises under disease conditions, such as muscle and tendon injuries and impingement syndrome, the proposed model is expected to help elucidate disease mechanisms and develop treatment guidelines.
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Affiliation(s)
- Taku Tazawa
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
- ASAHI INTECC CO., LTD., Aichi, Japan
| | - Masaya Yasui
- Department of Judo Seifuku and Health Sciences, Tokoha University, 1230 Miyakodacho, Kita-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Shun Otsuka
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Naoyuki Hatayama
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Shigemichi Ohshima
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
| | - Hiroki Yokota
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan.
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Mendez-Rebolledo G, Araya-Quintanilla F, Guzmán-Muñoz E, Salazar-Mendez J, Cruz-Montecinos C, Berckmans KR, Calatayud J. Comparative Electromyographic Study of Scapular Stabilizing Muscles During Five Main Rehabilitation Exercises. Am J Phys Med Rehabil 2024; 103:502-509. [PMID: 38261765 DOI: 10.1097/phm.0000000000002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of the study is to compare the surface electromyographic amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises. DESIGN Twenty-seven healthy participants performed five scapular exercises (wall slide, wall push-up plus, prone horizontal abduction with external rotation, external rotation in side lying, and low row) while simultaneously recording surface electromyographic of serratus anterior, middle trapezius, lower trapezius, and upper trapezius. Surface electromyographic amplitudes, onset latencies, and activation ratios were calculated. RESULTS Prone horizontal abduction with external rotation showed an excellent upper trapezius/middle trapezius (0.43) and upper trapezius/lower trapezius (0.30) muscle balance with high (>50% maximum voluntary isometric contraction) middle trapezius and lower trapezius amplitudes, a low (<20% maximum voluntary isometric contraction) upper trapezius amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to upper trapezius. External rotation in side lying showed excellent upper trapezius/serratus anterior (0.26), upper trapezius/middle trapezius (0.32), and upper trapezius/lower trapezius (0.21) activation ratios and, along with low row and wall slide, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms). CONCLUSIONS Prone horizontal abduction with external rotation presented optimal scapular neuromuscular control. Although external rotation in side lying, low row, and wall slide did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- From the Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile (GM-R, EG-M, JS-M); Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile (FA-Q); Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile (CC-M); Department of Rehabilitation Sciences (Physical Therapy), University Hospital Ghent, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium (KRB); and Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain (JC)
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Jacquier-Bret J, Gorce P. Kinematics of the Tennis Serve Using an Optoelectronic Motion Capture System: Are There Correlations between Joint Angles and Racket Velocity? SENSORS (BASEL, SWITZERLAND) 2024; 24:3292. [PMID: 38894086 PMCID: PMC11175047 DOI: 10.3390/s24113292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024]
Abstract
The serve is the most important stroke in tennis. It is a complex gesture consisting of numerous rotations with a wide amplitude, which are important to manage for performance. The aim of this study was to investigate whether correlations exist between joint kinematic parameters and racket velocity. A quantitative kinematics analysis of four ranked players (two boys and two girls) was carried out using an optoelectronic system composed of 10 cameras (150 Hz). Five flat serves per player were analyzed. Eighty-two markers were located across the 15 body segments and on the racket. A descriptive statistical analysis including a correlation analysis was carried out between joint angles and racket kinematic parameters (vertical position, velocity, and acceleration) during the cocking and acceleration phases. Ten very high (0.7 < r < 0.9) and three almost perfect (r > 0.9) correlations were found. Shoulder and hip axial rotations, knee flexion, and trunk extension were correlated linearly with racket vertical position and velocity during the cocking phase. For the acceleration phase, elbow flexion, trunk flexion/extension, and trunk axial rotation were linked to racket kinematics. Some of these parameters showed differences between slow and fast serves. These parameters, which are involved in transmitting ball velocity, are important to consider for tennis players and coaches in training programs, education, and performance enhancement.
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Affiliation(s)
- Julien Jacquier-Bret
- International Institute of Biomechanics and Occupational Ergonomics, 83418 Hyères, France;
- Université de Toulon/University of Toulon, CS60584, 83041 Toulon, France
| | - Philippe Gorce
- International Institute of Biomechanics and Occupational Ergonomics, 83418 Hyères, France;
- Université de Toulon/University of Toulon, CS60584, 83041 Toulon, France
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Melo AS, Moreira JS, Afreixo V, Moreira-Gonçalves D, Donato H, Cruz EB, Vilas-Boas JP, Sousa AS. Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:161-174. [PMID: 38706660 PMCID: PMC11065746 DOI: 10.1016/j.xrrt.2023.12.006] [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: 05/07/2024]
Abstract
Background Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Methods Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. Results From the 8318 records identified, 8 (high to low risk of bias- scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: -0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Conclusions Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
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Affiliation(s)
- Ana S.C. Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Juliana S. Moreira
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| | - Vera Afreixo
- Department of Mathematics, Center for Research and Development in Mathematics and Applications – CIDMA, University of Aveiro, Portugal
| | - Daniel Moreira-Gonçalves
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Helena Donato
- Documentation and Scientific Information Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo B. Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J. Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia S.P. Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
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Sasagawa K, Kawabata M, Takaki N, Tsuruike M, Ellenbecker TS, Tsuihiji Y, Watanabe H, Takahira N, Hirose N. Reproducibility and Validity of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (Japanese Version). Cureus 2024; 16:e59139. [PMID: 38803762 PMCID: PMC11129665 DOI: 10.7759/cureus.59139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players. METHODS The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability. RESULTS Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316). CONCLUSIONS The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications.
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Affiliation(s)
- Kaoru Sasagawa
- Therapeutics, Medical Plaza Ichikawa Station, Ichikawa, JPN
| | - Masashi Kawabata
- Therapeutics, School of Allied Health Sciences, Kitasato University, Sagamihara, JPN
| | | | | | | | - Yusuke Tsuihiji
- Therapeutics, Kitasato University Graduate School of Medical Sciences, Sagamihara, JPN
| | - Hiroyuki Watanabe
- Therapeutics, School of Allied Health Sciences, Kitasato University, Sagamihara, JPN
| | - Naonobu Takahira
- Orthopaedic Surgery, School of Allied Health Sciences, Kitasato University, Sagamihara, JPN
| | - Norikazu Hirose
- Therapeutics, Faculty of Sport Sciences, Waseda University, Saitama, JPN
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12
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Zhong Z, Zang W, Tang Z, Pan Q, Yang Z, Chen B. Effect of scapular stabilization exercises on subacromial pain (impingement) syndrome: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1357763. [PMID: 38497039 PMCID: PMC10940535 DOI: 10.3389/fneur.2024.1357763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the effectiveness of scapular stabilization exercises (SSE) in the treatment of subacromial pain syndrome (SAPS). Methods Clinical randomized controlled trials (RCTs) on SSE in the treatment of SAPS were searched electronically in PubMed, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, Physiotherapy Evidence Database (PEDro), Web of Science, and other databases from 2000 to 2022, supplemented by manual search. Final RCTs were selected based on inclusion and exclusion criteria, and the Physiotherapy Evidence Database scale was used to evaluate the methodological quality of the study. A meta-analysis was conducted on data using the RevMan5.4 software. Results Eight RCTs involving 387 participants were included. The meta-analysis showed that the experimental group (SSE) had greater improvements in the Visual Analog Scale score [Weighted Mean Difference (WMD) = -0.94, 95% CI (-1.23, -0.65), p < 0.001] and the Shoulder Pain and Disability Index score [WMD = -10.10, 95% CI (-18.87, -1.33), p = 0.02] than the control group (conventional physical therapy). However, range of motion (ROM) was not found to be greater in the experimental group than in the control group. Conclusion Existing evidence moderately supports the efficacy of SSE for reducing pain and improving function in SAPS, without significant improvement in ROM. Future research should focus on larger, high-quality, standardized protocols to better understand SSE's effects across diverse SAPS populations, treatment, and outcome measures. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307437, CRD42022307437.
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Affiliation(s)
- Ziyi Zhong
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Wanli Zang
- Postgraduate School, Harbin Sport University, Harbin, China
| | - Ziyue Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiaodan Pan
- School of Medicine, Tongji University, Shanghai, China
| | - Zhen Yang
- Department of Movement Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Bin Chen
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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13
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Melo AS, Montóia B, Cruz EB, Vilas-Boas JP, Sousa AS. Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions. Proc Inst Mech Eng H 2024; 238:288-300. [PMID: 38403635 DOI: 10.1177/09544119241228082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.
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Affiliation(s)
- Ana Sc Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Bárbara Montóia
- Escola Superior de Saúde, Politécnico do Porto, Porto, Portugal
| | - Eduardo B Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia Sp Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
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14
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Lawrence RL, Richardson LB, Bilodeau HL, Bonath DJ, Dahn DJ, Em MA, Sarkar S, Braman JP, Ludewig PM. Effects of Scapular Angular Deviations on Potential for Rotator Cuff Tendon Mechanical Compression. Orthop J Sports Med 2024; 12:23259671231219023. [PMID: 38435717 PMCID: PMC10906059 DOI: 10.1177/23259671231219023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/14/2023] [Indexed: 03/05/2024] Open
Abstract
Background One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration. Purpose To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction. Study Design Descriptive laboratory study. Methods Three-dimensional bone models were reconstructed from computed tomography scans obtained from 10 asymptomatic subjects and 9 symptomatic subjects with a clinical presentation of impingement syndrome. Models were rotated to average scapular orientations from a healthy dataset at higher (120°) and lower (subject-specific) humeral elevation angles to investigate internal and subacromial impingement risks, respectively. Incremental deviations in scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt were imposed on the models to simulate scapular movement impairments. The minimum distance between the rotator cuff insertions and potential impinging structures (eg, glenoid, acromion) was calculated. Two-way mixed-model analyses of variance assessed for effects of scapular deviation and group. Results At 120° of humerothoracic elevation, minimum distances from the supraspinatus and infraspinatus insertions to the glenoid increased with ≥5° changes in upward rotation (1.6-9.8 mm, P < .001) or external rotation (0.9-5.0 mm, P≤ .048), or with ≥10° changes in anterior tilt (1.1-3.2 mm, P < .001). At lower angles, ≥20° changes in most scapular orientations significantly increased the distance between the supraspinatus and infraspinatus insertions and the acromion or coracoacromial ligament. Conclusion A reduction in scapular upward rotation decreases the distance between the rotator cuff tendon insertions and glenoid at 120° humerothoracic elevation. Interpretation is complicated for lower angles because the humeral elevation angle was defined by the minimum distance. Clinical Relevance These results may assist clinical decision making regarding the effects of scapular movement deviations in patients with rotator cuff pathology and scapular dyskinesia and may help inform the selection of clinical interventions.
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Affiliation(s)
- Rebekah L. Lawrence
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura B. Richardson
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hannah L. Bilodeau
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dane J. Bonath
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel J. Dahn
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary-Ann Em
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanjay Sarkar
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P. Braman
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit Michigan
| | - Paula M. Ludewig
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
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15
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Sciascia AD. Rehabilitation of the painful shoulder. J Shoulder Elbow Surg 2024; 33:494-506. [PMID: 37573929 DOI: 10.1016/j.jse.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.
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Affiliation(s)
- Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
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16
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Gutiérrez-Espinoza H, Estrella-Flores E, Cuyul-Vásquez I, Jorquera-Aguilera R, Francisco López-Gil J, Araya-Quintanilla F. Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study. J Sport Rehabil 2024; 33:106-113. [PMID: 38167648 DOI: 10.1123/jsr.2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/30/2023] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. METHODS A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. RESULTS A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). CONCLUSION At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.
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Affiliation(s)
| | | | - Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | | | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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17
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Kibler WB, Sciascia AD, Grantham WJ. The shoulder joint complex in the throwing motion. J Shoulder Elbow Surg 2024; 33:443-449. [PMID: 37499784 DOI: 10.1016/j.jse.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023]
Abstract
The shoulder joint complex in the overhead athlete is organized to effectively transfer the proximally generated forces distally into the arm. The organization also protects the joints and anatomic structures against the repetitive high velocities, large ranges of motions, and compressive, shear, translational, and distraction loads in the overhead motion while placing the hand in the "launch window." Coupling of the movements of the scapula, clavicle, and humerus results in scapulohumeral rhythm (SHR). Effective SHR requires the clavicle and scapula-and, at times, the mechanically linked claviscapular segment-to move the arm into the task-specific position and motion and requires the humerus to move through the ranges of motion to achieve the specific task in the throwing motion. Alterations in SHR can negatively affect effective shoulder joint complex function in the overhead throwing motion and increase injury risk. There are 4 phases of clavicular, scapular, and claviscapular motion that are coupled with arm motion in SHR. The first 3 phases occur in arm elevation motions from 0°-90° and result in the claviscapula and humerus being placed in task-specific positions. The fourth phase is coupling of claviscapular motion with humeral motion to maintain ball-and-socket kinematics throughout the throwing motion. Alterations in this composite motion are termed "scapular dyskinesis." The dyskinesis is considered an impairment of the efficient mobility of the claviscapular segment of the shoulder complex. The most prevalent problem with scapular dyskinesis is the association of scapular protraction and consequent glenoid antetilt with alterations in humeral rotation and posterior humeral head translation to produce shoulder joint internal impingement. Task effectiveness in overhead throwing is also based on and determined by humeral range of motion, precision of humeral motion, and velocity of humeral motion, as well as humeral and arm position in 3-dimensional space. This activity requires maximum ball-and-socket kinematics to create the highest amount of concavity-compression that creates stability for the joint. There are bony and soft-tissue contributions to this stability. Injuries to the glenoid labrum are among the most common deficits that alter concavity-compression. Clinical evaluation of the shoulder joint complex in the injured throwing athlete should be comprehensive and systematic, following an evaluation pathway for proximal and distal causative factors and including observation of humeral motion. This type of evaluation can result in intervention protocols that address the pathoanatomic, pathophysiological, and pathomechanical deficits identified.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY, USA
| | - Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
| | - W Jeff Grantham
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY, USA
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18
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Martínez-Gago A, García-Mesa Y, Cuendias P, Martín-Cruces J, Abellán JF, García-Suárez O, Vega JA. Sensory innervation of the human shoulder joints in healthy and in chronic pain shoulder syndromes. Ann Anat 2024; 252:152206. [PMID: 38154784 DOI: 10.1016/j.aanat.2023.152206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Afferent innervation of shoulder joints plays a fundamental role in nociception and mechanoception and its alteration result in shoulder´s disease that course with pain and functional disability. METHODS Joints shoulder from healthy subjects (n = 20) and with chronic pain shoulder syndromes (n = 17) were analyzed using immunohistochemistry for S100 protein to identify nerve structures (nerve fibers and sensory corpuscles), coupled with a quantification of the sensory formations. Sensory nerve formations were quantified in 13 distinct areas in healthy joint shoulder and in the available equivalent areas in the pathological joints. Statistical analyses were conducted to assess differences between healthy shoulder and pathological shoulder joint (p< 0.05). RESULTS All analyzed structures, i.e., glenohumeral capsule, acromioclavicular capsule, the extraarticular structures (subcoracoid region and subacromio-subdeltoid bursa) and intraarticular structures (biceps brachii tendon and labrum articulare) are variably innervated except the extrinsic coracoacromial ligament, which was aneural. The afferent innervation of healthy human shoulder joints consists of free nerve endings, simple lamellar corpuscles and Ruffini's corpuscles. Occasionally, Golgi-Mazzoni's and Pacinian corpuscles were found. However, the relative density of each one varied among joints and/or the different zones within the same joint. As a rule, the upper half and anterior half of healthy glenohumeral capsules have a higher innervation compared to the lower and posterior respectably. On the other hand, in joints from subjects suffering chronic shoulder pain, a reduced innervation was found, involving more the corpuscles than free nerve endings. CONCLUSIONS Our findings report a global innervation map of the human shoulder joints, especially the glenohumeral one, and this knowledge might be of interest for arthroscopic surgeons allowing to develop more selective and unhurt treatments, controlling the pain, and avoiding the loss of afferent innervation after surgical procedures. To the light of our results the postero-inferior glenohumeral capsular region seems to be the more adequate to be a surgical portal (surgical access area) to prevent nerve lesions.
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Affiliation(s)
- Abel Martínez-Gago
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain; Servicio de Cirugía Ortopédica y Traumatología, Hospital Vital Álvarez-Buylla, Mieres, Spain
| | - Yolanda García-Mesa
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain
| | - Patricia Cuendias
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain
| | - José Martín-Cruces
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain
| | - Juan F Abellán
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Morales Meseguer, Murcia, Spain; Cátedra de Traumatología del Deporte, Universidad Católica San Antonio, Murcia, Spain
| | - Olivia García-Suárez
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain
| | - José A Vega
- Departamento de Morfología y Biología Celular, Grupo SINPOS, Universidad de Oviedo, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile.
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19
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Ueda A, Matsumura A, Shinkuma T, Oki T, Nakamura Y. Shoulder kinetic during pitching in baseball players with scapular dyskinesis. J Bodyw Mov Ther 2024; 37:57-62. [PMID: 38432842 DOI: 10.1016/j.jbmt.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 09/22/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players. METHOD Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18-camera motion-capture system. SD was classified into four types (I-IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed. RESULTS The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I-Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group. CONCLUSIONS These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching.
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Affiliation(s)
- Atsushi Ueda
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan.
| | | | | | - Takeshi Oki
- Department of Orthopaedic Surgery, Hankai Hospital, Japan
| | - Yasuo Nakamura
- Department of Health and Sports Science, Doshisha University, Japan
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20
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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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21
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Özçadırcı A, Doğan Y, Öztürk F, Cinemre ŞA, Coşkun G, Özçakar L. Shoulder structures and strength in competitive preadolescent swimmers: A longitudinal ultrasonographic study. PM R 2024; 16:47-53. [PMID: 37294616 DOI: 10.1002/pmrj.13009] [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: 02/08/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Repetitive shoulder movements during competitive training may cause changes in the strength of periarticular shoulder structures in preadolescent swimmers. OBJECTIVE To prospectively determine the effects of training on shoulder periarticular structures and muscle strength in preadolescent swimmers. DESIGN Prospective cohort study. SETTING Community-based natatorium. PARTICIPANTS Twenty-four preadolescent swimmers aged 10-12 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measurements were repeated in three periods as preseason, midseason, and postseason. Ultrasonographic measurements (supraspinatus tendon thickness, humeral head cartilage thickness, deltoid muscle thickness, and acromiohumeral distance) were performed using a portable device and a linear probe. Shoulder (flexion, extension, abduction, internal and external rotation) and back (serratus anterior, lower, and middle trapezius) isometric muscle strength were measured with a handheld dynamometer. RESULTS Supraspinatus tendon thickness and acromiohumeral distance were similar in all periods (all p > .05); however, deltoid muscle and humeral head cartilage thicknesses increased throughout the season (p = .002, p = .008, respectively). Likewise, whereas shoulder muscle strength increased (all p < .05), back muscle strength was similar in all periods (all p > .05). CONCLUSIONS In preadolescent swimmers, acromiohumeral distance and supraspinatus tendon thickness seem to not change; but humeral head cartilage and deltoid muscle thicknesses as well as shoulder muscle strength increase throughout the season.
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Affiliation(s)
- Aykut Özçadırcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yahya Doğan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ferhat Öztürk
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | - Gürsoy Coşkun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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22
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Deniz V, Sariyildiz A, Buyuktas B, Basaran S. Comparison of the activation and mechanical properties of scapulothoracic muscles in young tennis players with and without scapular dyskinesis: an observational comparative study. J Shoulder Elbow Surg 2024; 33:192-201. [PMID: 37579939 DOI: 10.1016/j.jse.2023.07.016] [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: 03/25/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND In tennis athletes with scapular dyskinesis, the activation of the scapulothoracic muscles during serve is not known. Also, the mechanical properties (tone, elasticity, and stiffness) of the scapulothoracic muscles of the tennis athletes with scapular dyskinesis are likely to change. The study aimed to evaluate the activation of the scapulothoracic muscles while performing tennis serve and to determine the changes in the mechanical properties of the same muscles in young tennis athletes with scapular dyskinesis. METHODS Seventeen tennis athletes with scapular dyskinesis aged between 11 and 18 years (the scapular dyskinesis group) and age- and gender-matched 17 asymptomatic tennis athletes (the control group) were included in the study. Activation of scapulothoracic muscles (descending-transverse-ascending trapezius and serratus anterior) in the 3 phases (preparation, acceleration, and follow-through) of the serve was evaluated using surface electromyography, and the mechanical properties of the same muscles were measured at rest by myotonometry. RESULTS Ascending trapezius activation in the follow-through phase was lower in the scapular dyskinesis group compared with the control group (mean difference 95% confidence interval: -22.8 [-41.2 to -4.5]) (P = .017). The tone and stiffness of the transverse trapezius (P = .043 and P = .017, respectively) were higher, whereas the same parameters of the ascending trapezius were lower (P = .008 and P = .010, respectively) in the scapular dyskinesis group compared with the control group. CONCLUSIONS Activation of the ascending trapezius and the tone and stiffness of the transverse-ascending trapezius were altered in tennis athletes with scapular dyskinesis. Implementations to improve these changes can be included in the rehabilitation or training programs of young tennis athletes with scapular dyskinesis.
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Affiliation(s)
- Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Tarsus University Faculty of Health Sciences, Mersin, Turkey.
| | - Aylin Sariyildiz
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bilgihan Buyuktas
- Department of Physical Education and Sports Teacher, Cukurova University Faculty of Sports Sciences, Adana, Turkey
| | - Sibel Basaran
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
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Yuksel E, Yesilyaprak SS. Scapular stabilization exercise training improves treatment effectiveness on shoulder pain, scapular dyskinesis, muscle strength, and function in patients with subacromial pain syndrome: A randomized controlled trial. J Bodyw Mov Ther 2024; 37:101-108. [PMID: 38432789 DOI: 10.1016/j.jbmt.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Subacromial pain syndrome (SPS) is a common cause of shoulder pain, and is associated with functional limitation, workdays lost, disability, and poor quality of life. PURPOSE Our purpose was to investigate the effects of scapular stabilization exercises in patients with SPS. METHOD Sixty-four patients with SPS who also exhibit observable scapular dyskinesis defined by the scapular dyskinesis test were recruited and randomized to scapular stabilization exercise training group or to control group. All participants received the same rehabilitation protocol including glenohumeral and scapular mobilization, pendulum exercises, shoulder stretching, range of motion exercises, strengthening, and proprioceptive exercises. Patients in the scapular stabilization exercise training group performed additional scapular stabilization exercises. The presence of scapular dyskinesis, shoulder pain severity, motion, muscle strength, scapular upward rotation, and shoulder disability were assessed before and after the four-week rehabilitation program. RESULTS The scapular stabilization exercise training group had better improvement in scapular dyskinesis, pain, muscle strength, and shoulder disability compared to the control group (p < 0.05). However, there was no statistically significant time-group interaction regarding shoulder motion and scapular upward rotation (p > 0.05). CONCLUSIONS Scapular stabilization exercises added to the shoulder mobilization, stretching, and strengthening are effective in improving scapular dyskinesis, reducing pain, increasing muscle strength and shoulder function in patients with SPS accompanied by scapular dyskinesis.
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Affiliation(s)
- Ertugrul Yuksel
- Graduate School of Health Sciences, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey.
| | - Sevgi Sevi Yesilyaprak
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
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24
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Soliño S, Raguzzi I, Castro LV, Porollan JC, Aponte BG, de Ilzarbe MG, Bouzat P, Vuoto T, Salzberg S, Villalba FJ, Graef CM, Rubiera C, Farías K, De la Rúa MG, Mignone F, Pierobon A, Policastro PO. Prevalence of positive modified scapular assistance test in patients with shoulder pain with and without scapular dyskinesis: a cross-sectional study. J Hand Ther 2024; 37:136-143. [PMID: 37777447 DOI: 10.1016/j.jht.2023.07.004] [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: 03/22/2023] [Revised: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Scapular dyskinesis (SD) is defined as an altered position of the scapula or altered motion patterns and their relationship with shoulder pain (SP) is still under debate. The modified scapular assistance test (mSAT) modifies scapular kinematics and is used to determine the impact of scapular dyskinesis in shoulder pain. However, data about the relationship between SD and the result of mSAT is scarce. PURPOSE The aim of this study is to establish the frequency of positive mSAT in patients with SP and compare the prevalence in those with and without SD. As a secondary objective, we compare changes in pain intensity during the mSAT in patients with a positive test between those with and without SD. STUDY DESIGN Cross-sectional study. METHODS Adult patients with a diagnosis of SP and with pain ≥2 during anterior flexion were included. The mSAT, scapular dyskinesis test (SDT), and shoulder function were assessed. RESULTS The study was conducted between August 2018 and May 2022 and included 70 patients. The prevalence of SDT was 54.29%. No statistically significant associations were detected when assessing the relation between the presence of mSAT and SDT (p-value 0.83). When comparing pain response during the mSAT in patients with a positive test, no differences were seen between patients with SD and patients without SD (p-value 0.26). CONCLUSIONS The prevalence of positive mSAT results was equal between individuals with and without SD. These findings suggest that the presence or absence of SD in individuals with SP was independent of the mSAT result. The mSAT should not be used solely for the assessment of SD in clinical practice nor be influenced by the SDT result. More research is needed to determine if the result of this test could inform prognosis and guide treatment choices.
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Affiliation(s)
- Santiago Soliño
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina; KINÉ- Kinesiología Deportiva y Funcional Sports Clinic, Buenos Aires, Argentina; Sports Physiotherapy Specialty, Universidad Favaloro, Buenos Aires, Argentina.
| | - Ignacio Raguzzi
- Rehabilitation Science Graduate Program, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Pedro Bouzat
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina
| | - Tomas Vuoto
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina
| | - Sandra Salzberg
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina
| | - Federico José Villalba
- KINÉ- Kinesiología Deportiva y Funcional Sports Clinic, Buenos Aires, Argentina; Sports Physiotherapy Specialty, Universidad Favaloro, Buenos Aires, Argentina
| | | | | | - Karen Farías
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina
| | | | | | - Andrés Pierobon
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina; Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Pablo Oscar Policastro
- Physical Therapy Unit, Durand Hospital, Buenos Aires, Argentina; KINÉ- Kinesiología Deportiva y Funcional Sports Clinic, Buenos Aires, Argentina; Sports Physiotherapy Specialty, Universidad Favaloro, Buenos Aires, Argentina; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
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25
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Moon SE, Kim YK. Neck and Shoulder Pain with Scapular Dyskinesis in Computer Office Workers. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2159. [PMID: 38138262 PMCID: PMC10744820 DOI: 10.3390/medicina59122159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Computer office workers spend long periods in front of a computer, and neck and shoulder pain are common. Scapular dyskinesis (SD) is associated with neck and shoulder pain. However, SD in computer office workers has not been elucidated. We aimed to investigate the prevalence of SD, neck and shoulder pain, disability, and working hours in computer office workers. Materials and Methods: In total, 109 computer office workers participated in this study. The results of a scapular dyskinesis test (SDT), lateral scapular slide test (LSST), neck disability index (NDI), shoulder pain and disability index (SPADI), visual analog scale (VAS) scores of the neck and shoulder, and working hours were recorded. Results: Ninety-eight computer office workers (89.9%) had SD. Computer office workers with SD had significantly higher NDI (p = 0.019), neck VAS (p = 0.041), and dominant shoulder VAS scores (p = 0.043). The LSST results showed a significantly greater distance (p = 0.016) in participants with SD. Conclusions: The prevalence of SD was very high in computer office workers, and neck and shoulder pain were more prevalent in workers with obvious SD.
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Affiliation(s)
| | - Young Kyun Kim
- Graduate School of Sports Medicine, CHA University, Seongnam 13496, Republic of Korea;
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26
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Almansoof HS, Nuhmani S, Muaidi Q. Role of kinetic chain in sports performance and injury risk: a narrative review. J Med Life 2023; 16:1591-1596. [PMID: 38406779 PMCID: PMC10893580 DOI: 10.25122/jml-2023-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 02/27/2024] Open
Abstract
The kinetic chain refers to the body's intricate coordination of various segments to perform a specific activity involving precise positioning, timing, and speed. This process is based on task-oriented and activity-specific pre-programmed muscle activation patterns enhanced by repeated practice. It demands muscular eccentric strength, joint flexibility, and musculotendinous elastic energy storage. The body core (lumbopelvic-hip complex) forms the kinetic chains' central point of activities in most sports because it facilitates load transfers to and from the limbs. The kinetic chain relationship with fascia, peripheral nerves, and tensegrity is fundamental to holistic human body movements. The kinetic chain function demands neuromuscular, sensorimotor, and neurocognitive control. Any blockage or defect in the kinetic chain can develop compensatory patterns, high demands on distal parts, and overuse and overload injuries. Taking a holistic approach and evaluating the integrity of the kinetic chain in athletes can significantly enhance efforts to improve sports performance and mitigate injury risk.
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Affiliation(s)
- Haifa Saleh Almansoof
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Qassim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Suphakitchanusan W, Kerdsomnuek P, Jamkrajang P, Fossum BW, Sudjai N, Paugchawee J, Limroongreungrat W, Vanadurongwan B, Keyurapan E, Ganokroj P. Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes. J Shoulder Elbow Surg 2023; 32:e504-e515. [PMID: 37285953 DOI: 10.1016/j.jse.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The alteration of scapular kinematics can predispose patients to shoulder pathologies and dysfunction. Previous literature has associated various types of shoulder injuries with scapular dyskinesis, but there are limited studies regarding the effect that proximal humeral fractures (PHFs) have on scapular dyskinesis. This study aims to determine the change in scapulohumeral rhythm following treatment of a proximal humerus fracture as well as differences in shoulder motion and functional outcomes among patients who presented with or without scapular dyskinesis. We hypothesized that differences in scapular kinematics would be present following treatment of a proximal humerus fracture, and patients who presented with scapular dyskinesis would subsequently have inferior functional outcome scores. METHODS Patients treated for a proximal humerus fracture from May 2018 to March 2021 were recruited for this study. The scapulohumeral rhythm and global shoulder motion were determined using a 3-dimensional motion analysis (3DMA) and the scapular dyskinesis test. Functional outcomes were then compared among patients with or without scapular dyskinesis, including the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the visual analog scale (VAS) for pain, and the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L). RESULTS Twenty patients were included in this study with a mean age of 62.9 ± 11.8 years and follow-up time of 1.8 ± 0.2 years. Surgical fixation was performed in 9 of the patients (45%). Scapular dyskinesis was present in 50% of patients (n = 10). There was a significant increase in scapular protraction on the affected side of patients with scapular dyskinesis during abduction of the shoulder (P = .037). Additionally, patients with scapular dyskinesis demonstrated worse SICK scapula scores (2.4 ± 0.5 vs. 1.0 ± 0.4, P = .024) compared to those without scapular dyskinesis. The other functional outcome scores (ASES, VAS pain scores, and EQ-5D-5L) showed no significant differences among the 2 groups (P = .848, .713, and .268, respectively). CONCLUSIONS Scapular dyskinesis affects a significant number of patients following treatment of their PHFs. Patients presenting with scapular dyskinesis exhibit inferior SICK scapula scores and have more scapular protraction during shoulder abduction compared to patients without scapular dyskinesis.
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Affiliation(s)
- Wasaphon Suphakitchanusan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Orthopedic Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | | | | | - Narumol Sudjai
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirayu Paugchawee
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Ekavit Keyurapan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phob Ganokroj
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess 2023; 27:1-389. [PMID: 37929629 PMCID: PMC10641714 DOI: 10.3310/tfws2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship. Limitations Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future work There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study registration This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - David Brandie
- Sportscotland Institute of Sport, Airthrey Road, Stirling, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Isabelle Harrison
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Colin MacLean
- Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Laura Mitchell
- NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK
| | - Dylan Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK
| | - Rachel Ann Moss
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | | | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
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Jaideep A, Eapen C, Prabhakar AJ, Patel V. Upper-crossed syndrome and disability in shoulder adhesive capsulitis. J Bodyw Mov Ther 2023; 36:282-290. [PMID: 37949573 DOI: 10.1016/j.jbmt.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 11/12/2023]
Abstract
STUDY DESIGN Cross-sectional analytical study. INTRODUCTION Adhesive capsulitis (AC) is a long-standing condition with varying extents of disability seen among patients. The role of postural manifestations and contractile tissue involvement in this condition is poorly understood and yet to be explored. PURPOSE This study aimed to analyze if individuals with adhesive capsulitis demonstrated the characteristics of an upper crossed syndrome (UCS) postural manifestation and whether or not its presence affected the extent of disability experienced by this population. METHODS Sixty-five individuals with AC were assessed for the presence of UCS. Scapular muscle strength and length alterations, forward head posture (FHP), and disability were assessed and compared between those with and without UCS. Paired T test and an independent T test were utilized to compare means within and between these groups, respectively, while non-parametric measures were utilized for their skewed counterparts. Phi coefficient (φ) was used to determine the strength of association between the descriptive patient characteristics. The correlation between symptom duration and degree of postural involvement was analyzed using Pearson's correlation coefficient. RESULTS 43.1% of the study population demonstrated UCS and 80% FHP with a significant negative correlation between Cranio Vertebral Angle and chronicity of AC (r = -0.27). Individuals with AC demonstrated significantly decreased scapular muscle strength (p = <.001) and pectoralis minor length on the affected side (p = .03). No differences were seen between groups with and without UCS. The mean SPADI scores between groups demonstrated a more significant level of perceived pain and disability in individuals with UCS (p = .049). CONCLUSIONS As seen in UCS, individuals with AC demonstrated alterations in movement patterns and posture. UCS was seen to contribute towards the existing disability in AC. This study suggests a careful evaluation and intervention based on these findings to document its effect on pain and dysfunction in AC.
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Affiliation(s)
- Aishwarya Jaideep
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Ashish John Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vivekbhai Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Yamamoto N, Szymski D, Voss A, Ishikawa H, Muraki T, Cunha RA, Ejnisman B, Noack J, McCarty E, Mulcahey MK, Itoi E. Non-operative management of shoulder osteoarthritis: Current concepts. J ISAKOS 2023; 8:289-295. [PMID: 37321293 DOI: 10.1016/j.jisako.2023.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/26/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain. Conservative treatment options include physical therapy, pharmacological therapy, and biological therapy. Patients with glenohumeral OA present shoulder pain and decreased shoulder range of motion (ROM). Abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion. Physical therapy is performed to (1) decrease pain, (2) increase shoulder ROM, and (3) protect the glenohumeral joint. To decrease pain, it should be assessed whether the pain appears at rest or during shoulder motion. Physical therapy may be effective for motion pain rather than rest pain. To increase shoulder ROM, the soft tissues responsible for the ROM loss need to be identified and targeted for intervention. To protect the glenohumeral joint, rotator cuff strengthening exercises are recommended. Administration of pharmacological agents is the major part next to physical therapy in the conservative treatment. The main aim of pharmacological treatment is the reduction of pain and diminution of inflammation in the joint. To achieve this aim, non-steroidal anti-inflammatory drugs are recommended as first-line therapy. Additionally, the supplementation of oral vitamin C and vitamin D can help to slow down cartilage degeneration. Depending on the individual comorbidities and contraindications, sufficient medication with good pain reduction is thus possible for each patient. This interrupts the chronic inflammatory state in the joint and, in turn, enables pain-free physical therapy. Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells have gathered increased attention. Good clinical outcomes have been reported, but we need to be aware that these options are helpful in decreasing shoulder pain but neither stopping the progression nor improving OA. Further evidence of biologics needs to be obtained to determine their effectiveness. In athletes, a combined approach of activity modification and physical therapy can be effective. Oral medications can provide patients with transient pain relief. Intra-articular corticosteroid injection, which provides longer-term effects, must be used cautiously in athletes. There is mixed evidence for the efficacy of hyaluronic acid injections. There is still limited evidence regarding the use of biologics.
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Affiliation(s)
- Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg 93053, Germany; Sporthopaedicum Regensburg, Regensburg 93053, Germany
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg 93053, Germany; Sporthopaedicum Regensburg, Regensburg 93053, Germany
| | - Hiroaki Ishikawa
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Ronaldo A Cunha
- Department of Sports Medicine, Federal University of São Paulo, São Paulo 05508-090, Brazil
| | - Benno Ejnisman
- Department of Sports Medicine, Federal University of São Paulo, São Paulo 05508-090, Brazil
| | - Joseph Noack
- Department of Orthopaedic Surgery, University of Colorado, CO 80309, USA
| | - Eric McCarty
- Department of Orthopaedic Surgery, University of Colorado, CO 80309, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, LA 70112, USA
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai 981-8563, Japan.
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Jeong JH, Kim YK. Association of Scapular Dyskinesis with Neck and Shoulder Function and Training Period in Brazilian Ju-Jitsu Athletes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1481. [PMID: 37629771 PMCID: PMC10456877 DOI: 10.3390/medicina59081481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Neck and shoulder injuries are common in Brazilian ju-jitsu (BJJ) athletes, and scapular dyskinesis (SD) is associated with these injuries. This study aimed to investigate the prevalence of SD in BJJ athletes, their neck and shoulder function and strength, and the BJJ training period. Materials and Methods: Forty-eight BJJ athletes participated in the study. Years of experience with BJJ, belt, shoulder internal and external rotation strength, neck strength, neck disability index (NDI), and SD were measured. Results: Approximately 31 BJJ athletes (64.6%) showed SD, and the nondominant arm showed a more obvious SD (n = 22, 45.8%) than the dominant arm (n = 18, 37.5%). Those with over five years of BJJ training experience showed a significantly higher rate of SD (p = 0.006) than those with less than five years of experience. Shoulder isometric internal rotation strength was significantly weaker in the obvious SD group than in the normal SD group (p = 0.014). Neck isometric strength and NDI did not differ significantly between individuals with or without SD. Conclusions: SD was common among BJJ athletes, and more experienced BJJ athletes exhibited higher rates of SD. Shoulder rotational strength was weaker with SD. Further studies are necessary on the neck and shoulders of BJJ athletes with SD.
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Affiliation(s)
| | - Young Kyun Kim
- Graduate School of Sports Medicine, CHA University, Seongnam 13496, Republic of Korea;
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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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Umay-Altaş E, Ecem-Konak H, Ünsal-Delialioğlu S, Şahin-Onat Ş, Günay-Uçurum S. Mid-term effects of two different Kinesio tape treatments in female patients with subacromial impingement syndrome: Randomized controlled ultrasonographic study. J Hand Ther 2023; 36:514-522. [PMID: 36918309 DOI: 10.1016/j.jht.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/09/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Randomized controlled study. PURPOSE OF THE STUDY To evaluate the effect of Kinesio Tape (KT) applied differently in patients diagnosed with Subacromial Impingement Syndrome (SIS) on acromiohumeral distance (AHD) and supraspinatus tendon (SsT) thickness using ultrasound (US) and its effect on pain, upper limb functional status and hand grip muscle strength in the short and mid-term. METHODS The 90 patients diagnosed with unilateral SIS by clinical examination were randomized into 3 groups. In addition to exercise therapy, the deltoid in group 1 and the supraspinatus muscle in group 2 were taped from insertion to origin. Group 3, which was the control group, was applied 9 sessions of sham taping for 3 weeks. Cases were evaluated for AHD and SsT thickness, pain was evaluated with the Visual Analog Scale (VAS), function with the Disabilities of the arm, shoulder and hand (DASH) and the Western Ontario Rotator Cuff Index (WORC), and hand grip strength (HGS) using a dynamometer before, and 3rd week and 3rd month after the KT application. RESULTS There was a significant improvement in all parameters in the short and mid-term intra group comparisons in Group 1 and 2 after taping (P < .05). In intergroup comparisons, significant improvement was achieved in all parameters in Group 1 and Group 2 in the mid and short term compared to the control group (P < .05). In comparison of Group 1 and Group 2, HGS in the short term (p: 0.07) and the SsT thickness in the short and mid-term (p: 0.36, p: 0.85) did not exhibit any difference. The improvement in all other parameters in group 1 was statistically significant. CONCLUSION The findings of our study provide definitive evidence for the effectiveness of KT treatment depending on the method of tape application employed.
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Affiliation(s)
- Elif Umay-Altaş
- Department of Physical Medicine and Rehabilitation, İzmir Bakırçay University Çiğli Training and Research Hospital, Izmir, Turkey.
| | - Hatice Ecem-Konak
- Ankara City Hospital, Physical Medicine and Rehabilitation, Ankara, Turkey
| | | | - Şule Şahin-Onat
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sevtap Günay-Uçurum
- İzmir Katip Çelebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
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Houry M, Bonnard M, Tourny C, Gilliaux M. Kinematic, electromyographic and isokinetic measurements for the management of shoulder subacromial pain syndrome: A systematic review. Clin Biomech (Bristol, Avon) 2023; 107:106029. [PMID: 37348207 DOI: 10.1016/j.clinbiomech.2023.106029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Subacromial shoulder pain syndrome is a very common and challenging musculoskeletal disorder. Kinematics, electromyographic muscle activity and isokinetic dynamometry are promising non-invasive movement analysis tools to improve understanding of this condition. No review has combined their results to provide a better understanding of the effects of subacromial pain syndrome on shoulder movement. This systematic review aimed to synthesise the associations between exposure to shoulder pain due to subacromial pain syndromes or subacromial impingement and changes in shoulder movement measures. METHODS The databases were Scholar google, Pubmed, Science Direct, Scopus and the Cochrane Library. We included studies that observed the association of the presence of subacromial pain syndromes or subacromial impingement with changes in shoulder motion measures. FINDINGS Seventeen studies with 943 participants were included. The main kinematic change was a lower scapular posterior during abduction in the subacromial pain syndrome group with a "low" level of evidence (standardised mean difference = -0.61, 95% confidence interval [-0.80; -0.43]). The main electromyographic change was an earlier onset of activation of the upper trapezius in the subacromial pain syndrome group, with a "moderate" level of evidence (standardised mean difference = 1.01, 95% confidence interval: [-2.97; 0.96]). The main isokinetic change was a lower peak internal rotator torque in the subacromial pain syndrome group, with a 'low' level of evidence (standardised mean difference = -0.41, 95% confidence interval: [-0.53; -0.29]). INTERPRETATION The variables measured during movement are associated with subacromial pain syndrome or subacromial impingement syndrome. Consistency between the results supports the importance of scapula biomechanics measurements in these conditions.
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Affiliation(s)
- Maxime Houry
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France; Clinical Research Departement, La Musse Hospital, La Renaissance Sanitaire Fundation, Saint Sébastien de Morsent, France.
| | | | - Claire Tourny
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France
| | - Maxime Gilliaux
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821 Mont-Saint-Aignan, France; Clinical Research Departement, La Musse Hospital, La Renaissance Sanitaire Fundation, Saint Sébastien de Morsent, France
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Liu J, Hui SSC, Yang Y, Liu Y, Song Q, Mao D. Scapular kinematics and muscle activity during Yi Jin Bang exercises. Front Physiol 2023; 14:1169092. [PMID: 37362425 PMCID: PMC10285390 DOI: 10.3389/fphys.2023.1169092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of shoulder rehabilitation. Our previous randomized controlled trial showed that Yi Jin Bang (YJB) exercises could effectively manage SAPS, but scapular motions and muscle activity during YJB exercises remain unknown. This study examined scapular kinematics synchronously with scapular muscle activation during YJB exercises. Methods: Thirty healthy participants with no shoulder complaints were enrolled in this study. Three-dimensional (3D) scapular kinematics and electromyography (EMG) activation of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, anterior deltoid, middle deltoid, and posterior deltoid were synchronously measured during nine YJB movements. Results: During all YJB movements, the scapula was upwardly rotated and anteriorly tilted, with more upward rotation and a similar or less anterior tilt than the mean resting scapular angle. Column rotation, arm crossover, shoulder support circle, and armpit support high lift generated more internal rotation than the mean resting scapular angle, with the angles of internal rotation significantly greater than the other five movements (p < 0.001). Regarding EMG activity, all YJB movements elicited low activity (1.42%-19.19% maximal voluntary isometric contraction [MVIC]) from the upper trapezius and posterior deltoid and low to moderate activity (0.52%-29.50% MVIC) from the middle trapezius, lower trapezius, serratus anterior, anterior deltoid, and middle deltoid. Conclusion: YJB exercises could be useful in the middle to later phases of shoulder rehabilitation. For patients with insufficient external rotation, some YJB movements should be prescribed with caution.
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Affiliation(s)
- Jinde Liu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Stanley Sai-chuen Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Yanhao Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Dewei Mao
- College of Sports and Health, Shandong Sport University, Jinan, China
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Pascoal AG, Ribeiro A, Infante J. Scapular Resting Posture and Scapulohumeral Rhythm Adaptations in Volleyball Players: Implications for Clinical Shoulder Assessment in Athletes. Sports (Basel) 2023; 11:114. [PMID: 37368564 DOI: 10.3390/sports11060114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Volleyball players develop shoulder sports-related adaptations due to repetitive overhead motions. It is essential to differentiate between these sports-related adaptations and pathological patterns in clinical assessments, particularly on scapular resting posture and scapulohumeral rhythm. Using an electromagnetic tracking system, the 3D shoulder kinematics of 30 male elite asymptomatic volleyball players and a matching control group were recorded at rest and in eight humeral elevation positions, in 15-degree increments from 15 to 120 degrees. The results indicated that the dominant scapular resting posture of the volleyball group was more anteriorly tilted than the control group (Volleyball: mean = -12.02°, STD = 4.16°; Control: mean = -7.45°, STD = 5.42°; Mean difference = 4.57°; STD = 6.85°; CI95% = 2.1° to 7.1°). The scapulohumeral rhythm in the volleyball group showed greater scapular internal rotation (Volleyball: mean = 41.60°, STD = 9.14°; Control: mean = 35.60°, STD = 6.03°; mean difference = 6.02°, STD = 1.47°; CI95% = 4.80° to 7.25°) and anterior tilt (Volleyball: mean = -9.10°, STD = 5.87°; mean = -2.3°, STD = 9.18°; mean difference = 6.88°, STD = 0.66°; CI95% = 6.34° to 7.43°). These findings suggest that volleyball players have developed a sports-related scapular adaptive pattern. This information may be valuable for clinical assessment and rehabilitation planning in injured volleyball players and may aid in the decision-making process for determining a safe return-to-play after a shoulder injury.
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Affiliation(s)
- Augusto Gil Pascoal
- Biomechanics and Functional Morphology Laboratory (BFML), Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, P-1499-002 Lisboa, Portugal
| | - Andrea Ribeiro
- ISAVE, Instituto Superior de Saúde, Rua Castelo de Almourol 13, P-4720-155 Amares, Portugal
- CIR, Escola Superior de Saúde, Politécnico do Porto, Rua Doutor António Bernardino de Almeida 400, P-4200-072 Porto, Portugal
| | - Jorge Infante
- Sports Expertise Laboratory (LPD), Faculdade de Motricidade Humana, Universidade de Lisboa, P-1499-002 Lisboa, Portugal
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Longo UG, Risi Ambrogioni L, Candela V, Berton A, Lo Presti D, Denaro V. Scapular Kinematics and Patterns of Scapular Dyskinesis in Rotator Cuff Tears: A Prospective Cohort Study. J Clin Med 2023; 12:jcm12113841. [PMID: 37298036 DOI: 10.3390/jcm12113841] [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: 04/26/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Scapular dyskinesis (SD) is a condition of loss of normal mobility or function of the scapula. SD is frequently observed in patients with other shoulder disorders, such as rotator cuff (RC) tears. This study evaluates the different presentations in clinical outcomes and range of motions (ROMs) in patients suffering from RC tears with and without SD. A total of 52 patients were enrolled, of which 32 patients with RC tears and SD (group A) and 20 patients with RC tears without SD (group B). Statistically significant differences between the groups in terms of clinical outcomes were identified. There were statistically significant differences in terms of flexion (p = 0.019), extension (p = 0.015), abduction (p = 0.005), and external rotation at 90° (p = 0.003) and at 0° (p = 0.025). In conclusion, this prospective study demonstrated that SD influences the clinical presentation of patients with RC tears in terms of clinical outcomes and ROMs, apart from internal rotation. Further studies will need to show whether these differences occur regardless of SD type.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Laura Risi Ambrogioni
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Vincenzo Candela
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alessandra Berton
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Tsuruike M, Ellenbecker TS. Effect of Scapular Retraction on Lower Trapezius, Infraspinatus, and Deltoid Muscle Electromyographic Activity During the Side-Lying Abduction Exercise. Int J Sports Phys Ther 2023; V18:715-725. [PMID: 37425105 PMCID: PMC10324291 DOI: 10.26603/001c.74969] [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: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background The lower trapezius (LT) muscle, which stabilizes the scapula posteriorly during arm elevation, has been interesting to both clinicians and researchers for its importance in throwing-related shoulder rehabilitation and injury prevention. Purpose The purpose of this study was to investigate the electromyographic activity of the LT and other relevant muscles during scapular and shoulder activities in the side-lying position. Methods Twenty collegiate baseball players volunteered to participate in this study. Electromyographic (EMG) output of the lower trapezius, infraspinatus, posterior deltoid, middle deltoid, serratus anterior, and upper trapezius muscles were collected. All the subjects performed isometric resistance exercises in four arm positions: 0° horizontal abduction from the coronal plane (NEUT) with protraction (NEUT-PRO), 15° horizontal adduction from the coronal plane (HADD) with protraction (HADD-PRO), and NEUT with retraction (NEUT-RET), and HADD-RET in a side-lying isometric abduction exercise with two external loads: a 9.1 kg dumbbell and 40% of the manual muscle test (MMT). The subjects also performed two more isometric resistance exercises: supine protraction and side-lying external rotation (ER) of the glenohumeral (GH) joint in GH adduction at 90° of GH ER or with as much ER as possible. All raw EMG data were normalized to maximal voluntary isometric contraction (% MVIC) of the corresponding muscle. Results LT activity was significantly greater in HADD-RET with 9.1 kg than that of HADD-PRO (p < 0.001) (55 vs 21% MVIC) while middle deltoid muscle activity was significantly decreased in both NEUT and HADD-RET compared to that of NEUT and HADD-PRO (p < 0.001). In contrast, IS muscle activity was significantly increased in HADD-RET with 9.1 kg compared with that 40% MMT (p < 0.001) (41 vs 22% MVIC). Conclusion LT activity was modulated by changes in scapulothoracic and glenohumeral joint positioning during a side-lying isometric abduction exercise. These findings may help clinicians to select exercises to improve scapular muscle balance ratios during rehabilitation of the shoulder complex. Level of Evidence Level 3b, Controlled laboratory study.
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Affiliation(s)
- Masaaki Tsuruike
- Department of Kinesiology, College of Health and Human Sciences San Jose State University
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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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Salamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, Kolber MJ. Is it Time to Normalize Scapular Dyskinesis? The Incidence of Scapular Dyskinesis in Those With and Without Symptoms: a Systematic Review of the Literature. Int J Sports Phys Ther 2023; V18:558-576. [PMID: 37425102 PMCID: PMC10324350 DOI: 10.26603/001c.74388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Up to 67% of adults experience shoulder pain in their lifetime. Numerous factors are related to the etiology of shoulder pain, one of which is thought to be scapular dyskinesis (SD). Given the prevalence of SD among the asymptomatic population a concern is that the condition is being medicalized (clinical findings suggested to require treatment but is ultimately a normal finding). Therefore, the purpose of this systematic review was to investigate the prevalence of SD among both symptomatic and asymptomatic populations. Methods A systematic review of the literature up to July of 2021. Relevant studies identified from PubMed, EMBASE, Cochrane and CINAHL were screened utilizing the following inclusion and exclusion criteria; inclusion: (a) individuals being assessed as having SD, including reliability and validity studies (b) subjects aged 18 or older; (c) sport and non-sport participants; (d) no date restriction; (e) symptomatic, asymptomatic, or both populations; (f) all study designs except case reports. Studies were excluded if: (a) they were not published in the English language; (b) they were a case report design; (c) the presence of SD was part of the studies inclusion criteria; (d) data were not present distinguishing the number of subjects with or without SD; (e) they did not define participants as having or not having SD. Methodological quality of the studies was assessed utilizing the Joanna Briggs Institute checklist. Results The search resulted in 11,619 after duplicates were removed with 34 studies ultimately retained for analysis after three were removed due to low quality. A total of 2,365 individuals were studied. Within the studies for the symptomatic athletic and general orthopedic population there were 81% and 57% individuals with SD, respectively, and a total of 60% among both symptomatic groups (sport and general orthopedic population). Within the studies for the asymptomatic athletic and general population there were 42% and 59% individuals with SD, respectively, and a total of 48% among both asymptomatic groups (sport and general orthopedic population). Limitation A strict inclusion and exclusion criteria was used to identify studies that provided the appropriate data for the purpose of this study. There was a lack of consistency for measuring SD across studies. Conclusion A considerable number of individuals with shoulder symptoms do not present with SD. More revealing is the number of asymptomatic individuals who do present with SD, suggesting that SD may be a normal finding among nearly half of the asymptomatic population. Level of Evidence 2a.
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Micoogullari M, Uygur SF, Yosmaoglu HB. Effect of Scapular Stabilizer Muscles Strength on Scapular Position. Sports Health 2023; 15:349-356. [PMID: 36872601 PMCID: PMC10170236 DOI: 10.1177/19417381231155192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Maintaining scapular mechanics is important for upper extremity functionality and posture. Determining the extent to which the scapular stabilizer muscles affect the scapular position may guide the creation of an exercise program for people with scapular dyskinesis. HYPOTHESIS The serratus anterior (SA), upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) muscles play different roles on scapular position when humeral elevation increase. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS A total of 70 women aged 40 to 65 years (mean age, 49 ± 7 years) who met the inclusion criteria were included in the study. Isometric muscle strength of the SA, UT, MT, and LT was evaluated with a handheld dynamometer. For assessment of scapular position, the lateral scapular slide test (LSST) was used. Multiple stepwise regression analysis was used to evaluate scapular parameters. RESULTS There were positive and statistically significant correlations between the isometric muscle strength of the SA, UT, MT, and LT muscles and the values at different humerus positions in the LSST (P < 0.05). The UT and SA muscles greatly affected the changes in the position of the inferior region of the scapula (R2 > 24.5%). The LT (11.3%) in neutral position, MT (25.4%) with arm abducted at 45°, and SA (34.5%) with arm abducted 90° had a major effect on the changes in the mediolateral position of the scapula. CONCLUSION While the LT muscle affects the mediolateral position of the scapula to a large extent, the strength of the MT and SA muscles becomes effective as the shoulder elevation increases. SA and UT muscle strength have a greater effect on the position of the inferior region of the scapula. CLINICAL RELEVANCE Dyskinesis can be observed at different levels of the scapula; therefore, it is important to determine at which level the dyskinesis is more prominent for each individual and consequently to form a personalized exercise program to increase function and control dyskinesis.
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Affiliation(s)
- Mehmet Micoogullari
- Cyprus International University,
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Lefkoşa,
Turkey
| | - S. Fatma Uygur
- Cyprus International University,
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Lefkoşa,
Turkey
| | - H. Baran Yosmaoglu
- Baskent University, Faculty of Health
Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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Giovannetti de Sanctis E, Ciolli G, Mocini F, Cerciello S, Maccauro G, Franceschi F. Evaluation of the range of motion of scapulothoracic, acromioclavicular and sternoclavicular joints: State of the art. Shoulder Elbow 2023; 15:132-139. [PMID: 37035616 PMCID: PMC10078813 DOI: 10.1177/17585732221090226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022]
Abstract
The scapulothoracic, acromioclavicular and sternoclavicular joints play a fundamental role in the shoulder function. Shoulder complex kinematics have been studied with different methods using: goniometers, 2 static radiographs, 3D motion analyzers (invasive or noninvasive) and digital inclinometers. Goniometers have been used traditionally to assess scapular rotation in relation to the thorax. The intrinsic limit of multiple static two-dimensional shoulder radiographs is the attempt of describing in two what is occurring in three dimensions. Technology innovations have led to the development of the 3D shoulder complex kinematics analysis ETS (Electromagnetic tracking systems) using sensors (invasive bone-pin markers or noninvasive skin surface marker) stitched to the scapula/clavicula, thorax, and humerus. Despite being uncomfortable, invasive 3D motion cortical pins analyzers still represent the current gold standard for tracking shoulder complex kinematics. Therefore, access to three-dimensional biomechanical instrumentations for collecting kinematic data represents an active problem for many physicians. A precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet. Further researches are necessary to design a new non-invasive method able to draw and analyze the kinematics of the scapula and the whole shoulder complex, precisely.
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Affiliation(s)
| | - Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Simone Cerciello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Casa di Cura Villa Betania, Rome, Italy
- Marrelli Hospital, Crotone, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Franceschi
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
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Parel I, Candoli V, Filippi MV, Padolino A, Merolla G, Sanniti S, Galassi R, Paladini P, Cutti AG. Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program. JMIR Res Protoc 2023; 12:e35757. [PMID: 36947146 PMCID: PMC10131889 DOI: 10.2196/35757] [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: 12/16/2021] [Revised: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. OBJECTIVE The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. METHODS For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. RESULTS We describe various applications of the ISEO exercise program in terms of frequency and intensity. CONCLUSIONS An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35757.
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Affiliation(s)
- Ilaria Parel
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Valeria Candoli
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Maria Vittoria Filippi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Antonio Padolino
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Giovanni Merolla
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Stefano Sanniti
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Riccardo Galassi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Paolo Paladini
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Andrea Giovanni Cutti
- Laboratory of Motion Analysis, National Institute for Insurance against Accidents at Work Prosthetic Center, Vigorso di Budrio, Italy
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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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Vongsirinavarat M, Wangbunkhong S, Sakulsriprasert P, Petviset H. Prevalence of scapular dyskinesis in office workers with neck and scapular pain. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:50-55. [PMID: 34927576 DOI: 10.1080/10803548.2021.2018855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives. This study aimed to investigate the presence of scapular dyskinesis (SD) in office workers with neck and scapular complaints. The postural malalignment and related muscle adaptations were also explored. Methods. SD and its subtypes were determined. Postural deviations and the length of commonly reported muscle tightness were evaluated. Results. Among 99 participants, 90% of them had SD. Considering both sides or 198 scapula, 90.4% were identified as having painful scapula and 19% as having painless scapula. There was a difference in the proportion of SD on painful (93%) and painless (69%) sides. Postural deviations including rounded shoulder (100%), forward head (43.3%) and thoracic hyperkyphosis (54.5%) were prevalent. Persons with type III SD had a higher percentage of forward head than other types. There was also tightness of the pectoralis minor (100%), levator scapulae (93.0%) and upper trapezius (98.3%) muscles without different proportions among types of SD. The greatest proportion of persons with SD had tightness of the levator scapulae. Conclusions. There was a high prevalence of SD among office workers with neck and scapular complaints. SD was also associated with abnormal posture and muscle tightness. The proper management of SD and working posture is warranted.
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Affiliation(s)
| | - Sukhon Wangbunkhong
- Physical Medicine and Rehabilitation Department, Rajavithi Hospital, Thailand
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Sonnier JH, Ciccotti MC, Darius D, Hall AT, Freedman KB, Tjoumakaris F. Scapular Dyskinesis in the Athletic Patient: A Sport-Specific Review. JBJS Rev 2023; 11:01874474-202302000-00001. [PMID: 36745713 DOI: 10.2106/jbjs.rvw.22.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
» Scapular dyskinesis is an alteration of normal scapular kinematics. It is essential that each patient be evaluated holistically and that sport-related factors be taken into account. » The presentation of scapular dyskinesis may be highly variable depending on the underlying etiology or associated pathology, but the onset of symptoms is often gradual. » Sport-specific literature on scapular dyskinesis is most commonly reported in the context of baseball, swimming, and tennis. Treatment is most often conservative and involves physical therapy directed at the scapular stabilizers.
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Affiliation(s)
| | | | - Danielle Darius
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anya T Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Geurkink TH, Gacaferi H, Marang-van de Mheen PJ, Schoones JW, de Groot JH, Nagels J, Nelissen RGHH. Treatment of neurogenic scapular winging: a systematic review on outcomes after nonsurgical management and tendon transfer surgery. J Shoulder Elbow Surg 2023; 32:e35-e47. [PMID: 36252782 DOI: 10.1016/j.jse.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what the best treatment decision is for their patients, and such recommendations should be based on the total evidence available. Therefore, the purpose of this review was to systematically review the evidence regarding nonsurgical management and tendon transfer surgery of patients with neurologic scapular winging due to serratus anterior (SA) or trapezius (TP) palsy. METHODS PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier were searched up to April 5, 2022, for studies reporting on clinical outcomes after nonsurgical management and tendon transfer surgery of scapular winging due to weakness of the SA or TP muscle. The Integrated quality Criteria for Review Of Multiple Study (ICROMS) tool was used to classify the quality of the studies. Primary outcomes were the fraction of patients with spontaneous recovery after nonsurgical management and improvement in shoulder function, pain scores, and shoulder scores after tendon transfer surgery. Data were pooled if data on the same outcome were available for at least 3 studies, using random-effects meta-analysis. RESULTS Twenty-three (10 moderate-quality [MQ] and 13 low-quality) studies were included. Six studies (3 MQ; 234 shoulders) reported on outcomes after nonsurgical management of SA palsy, whereas 12 (6 MQ; 221 shoulders) and 6 studies (1 MQ; 80 shoulders) evaluated the outcomes of tendon transfer for SA or TP palsy (1 study addressed both). Spontaneous recovery of scapular winging with nonsurgical management varied between 21% and 78% across studies after a median follow-up of 72 months. For surgical management of SA palsy, pooling data in a meta-analysis showed that patients on average improved by 47° (95% confidence interval [CI]: 34-61, P ≤ .001) in active forward flexion, had lower visual analog scale scores for pain (mean difference [MD]: -3.0, 95% CI: -4.9 to -1.0, P = .003), and had substantial improvements in American Shoulder and Elbow Surgeons (MD: 24, 95% CI: 9-39, P = .002) and Constant scores (MD: 45, 95% CI: 39-51, P ≤ .001). Patients with TP palsy on average improved by 36° (95% CI: 21-51, P ≤ .001) in active forward flexion after tendon transfer. Statistical pooling was not possible for other outcome measures as insufficient data were available. CONCLUSION A substantial part of nonsurgically managed patients with scapular winging seem to have persistent complaints, which should be part of the information provided to patients. Data pooling demonstrated significant improvements in shoulder function, pain scores, and shoulder scores after tendon transfer surgery, but higher quality evidence is needed to allow for more robust recommendations and guide clinical decision-making on when to perform such functional surgery.
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Affiliation(s)
- Timon H Geurkink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hamez Gacaferi
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Yilmaz Gokmen G, Akcay B, Kecelioglu S, Ozen MS, Yuce H. Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study. J Back Musculoskelet Rehabil 2023; 36:1375-1383. [PMID: 37694348 DOI: 10.3233/bmr-220396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature. OBJECTIVE To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS. METHODS The study was conducted with 60 outpatients diagnosed with SIS, aged 40-65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied along the inferior-medial edge of the scapula, starting from the processus coracoids), n= 30] and control [conventional physiotherapy program, n= 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being. RESULTS The interaction effect of Group*Time was not statistically significant in all outcome measures (p> 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p< 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p< 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81. CONCLUSION Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate.
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Yu IY, Kang MH. Influence of scapular motion cues on trapezius muscle activity during Y exercise. J Back Musculoskelet Rehabil 2023; 36:1171-1178. [PMID: 37458020 DOI: 10.3233/bmr-220366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Y exercise is a therapeutic exercise facilitating lower trapezius muscle activity. OBJECTIVE To identify the effects of scapular movement cues (posterior tilt vs. posterior tilt with adduction/depression) on trapezius muscle activity during Y exercise. METHODS Fifteen healthy men without current shoulder pain performed general Y exercise; Y exercise with cues for scapular posterior tilt; and Y exercise with cues for scapular posterior tilt, adduction, and depression. Electromyography (EMG) data for the trapezius muscles were collected during Y exercise. The posterior tilt angle of the scapula was measured in the prone position with and without cues for scapular posterior tilt using an inclinometer application. RESULTS The greatest lower trapezius muscle activity was observed during Y exercise with cues for scapular posterior tilt, while the greatest EMG activity of the upper trapezius was observed during Y exercise with cues for scapular posterior tilt, adduction, and depression (p< 0.05). Middle trapezius muscle activity did not significantly differ among the three Y exercise conditions (p= 0.175). Cues for scapular posterior tilt significantly increased the scapular posterior tilt angle in the prone shoulder abduction position (p= 0.007). CONCLUSION Cues for scapular posterior tilt were most effective in facilitating lower trapezius muscle activity during Y exercise.
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Affiliation(s)
- Il-Young Yu
- Rehabilitation Center, Dang Dang Korean Medicine Hospital, Changwon, Korea
| | - Min-Hyeok Kang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea
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Wu F, Ng CY. Long Thoracic Nerve Palsy: When Is Decompression Indicated. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [PMID: 37521538 PMCID: PMC10382883 DOI: 10.1016/j.jhsg.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Scapular winging due to long thoracic nerve palsy can occur through traumatic injuries and nontraumatic events. The traditional view is that most patients will achieve spontaneous recovery within 2 years of winging onset. However, there is evidence that points to a less clear-cut natural history, with residual winging, muscle weakness, and fatigability being exhibited in a significant percentage of patients. Reports from proponents of a more proactive approach have shown that the surgical decompression of the long thoracic nerve beyond 12 months, through thoracic, supraclavicular, or combined approaches, can yield satisfactory results. This review examines our current understanding of long thoracic nerve palsy and explores the varying treatment strategies with their reported outcomes.
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