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Seyres M, Postans N, Freeman R, Pandyan A, Chadwick EK, Philp F. Children and adolescents with all forms of shoulder instability demonstrate differences in their movement and muscle activity patterns when compared to age- and sex-matched controls. J Shoulder Elbow Surg 2024; 33:e478-e491. [PMID: 38467183 DOI: 10.1016/j.jse.2024.01.043] [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: 07/22/2023] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024]
Abstract
HYPOTHESIS AND BACKGROUND Shoulder instability (SI) is a complex impairment, and identifying biomarkers that differentiate subgroups is challenging. Children and adolescents with SI (irrespective of etiology) have differences in their movement and muscle activity profiles compared to age- and sex-matched controls (2-tailed). There are limited fundamental movement and muscle activity data for identifying different mechanisms for SI in children and adolescents that can inform subgrouping and treatment allocation. METHODS Young people between 8 and 18 years were recruited into 2 groups of SI and age- and sex-matched controls (CG). All forms of SI were included, and young people with coexisting neurologic pathologies or deficits were excluded. Participants attended a single session and carried out 4 unweighted and 3 weighted tasks in which their movements and muscle activity was measured using 3-dimensional (3D) movement analysis and surface electromyography (sEMG). Statistical parametric mapping was used to identify between-group differences. RESULTS Data were collected for 30 young people (15 SI [6 male, 9 female] and 15 CG [8 male, 7 female]). The mean (standard deviation) age of the participants was 13.6 years (3.0). The SI group demonstrated consistently more protracted and elevated sternoclavicular joint positions during all movements. Normalized muscle activity in latissimus dorsi was lower in the SI group and had the most statistically significant differences across all movements. Where differences were identified, the SI group also had increased normalized activity of their middle trapezius, posterior deltoid, and biceps muscles but decreased activity of their latissimus dorsi, triceps and anterior deltoid muscles compared with the CG group. No statistically significant differences were found for the pectoralis major across any movements. Weighted tasks produced fewer differences in muscle activity patterns compared with unweighted tasks. DISCUSSION AND CONCLUSION Young people with SI may adapt their movements to minimize glenohumeral joint instability. This was demonstrated by reduced variability in acromioclavicular and sternoclavicular joint angles, adoption of different movement strategies across the same joints, and increased activity of the scapular stabilizing muscles, despite achieving similar arm positions to the CG. Young people with SI demonstrated consistent differences in their muscle activity and movement patterns. Consistently observed differences at the shoulder girdle included increased sternoclavicular protraction and elevation accompanied by increased normalized activity of the posterior scapula-stabilizing muscles. Existing methods of measurement may be used to inform clinical decision making; however, further work is needed to evaluate the prognostic and clinical utility of derived 3D and sEMG data for informing decision making within SI.
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Affiliation(s)
- Martin Seyres
- School of Pharmacy and Bioengineering, Keele University, Keele, UK; School of Engineering, University of Aberdeen, Aberdeen, UK
| | - Neil Postans
- ORLAU, Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, UK
| | - Robert Freeman
- ORLAU, Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, UK
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
| | | | - Fraser Philp
- School of Health Sciences, University of Liverpool, Liverpool, UK.
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Kawamata J, Fukuta S, Nakai D, Kano M, Tezuka F, Wada K, Sairyo K. Relation between spine alignment and scapular position by plain radiograph examination. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:398-405. [PMID: 39157241 PMCID: PMC11329014 DOI: 10.1016/j.xrrt.2024.02.009] [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: 08/20/2024]
Abstract
Background Both scapular dynamics and static scapular position are important in the treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately. Methods Using four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades. Results SPAPs associated with GAT were sagittal vertical axis (R = 0.14, P = .011), TK (R = 0.12, P = .026), and LL (R = -0.11, P = .046). Multivariate analysis identified TK and LL as independent influencing factors (TK, P = .001; LL, P = .008). SPAPs associated with GAVA were CL (R = 0.17, P = .002), TK (R = 0.29, P < .001), and LL (R = 0.25, P < .001). Multivariate analysis identified CL, TK, and LL as independent influencing factors (CL, P = .01; TK, P = .03; LL, P = .03). There were 183, 127, and 19 cases categorized as grades 1, 2, and 3. GAT (grade 1, 24.0 ± 7.8; 2, 32.4 ± 7.0; 3, 41.0 ± 7.8), GAVA (1, 29.3 ± 7.6; 2, 33.7 ± 9.5; 3, 31.5 ± 8.3), and TK (1, 30.6 ± 13.6; 2, 35.1 ± 14.2; 3, 43.1 ± 20.4) differed significantly according to grade. Conclusion We identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs.
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Affiliation(s)
- Jun Kawamata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Shoji Fukuta
- Department of Orthopaedic Surgery, National Hospital Organization Kochi National Hospital, Kochi, Japan
| | - Daisuke Nakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Masashi Kano
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Hori M, Muraki T, Ishikawa H, Sekiguchi Y, Izumi SI. Analysis of the three-dimensional scapular kinematics and associated scapular muscle activity during scapular muscle exercises. J Bodyw Mov Ther 2024; 39:483-488. [PMID: 38876672 DOI: 10.1016/j.jbmt.2024.03.005] [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: 05/21/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To compare scapular kinematics and muscle activity among various scapular muscle exercises. DESIGN A cross-sectional study. SETTING A university research laboratory. PARTICIPANTS Eighteen healthy men participated in this study. MAIN OUTCOME MEASURES Three-dimensional scapular kinematics was measured with an electromagnetic motion capture system. Activities of the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) were measured by using surface electromyography (EMG). In addition, the ratio of LT to the UT (LT/UT) and SA to the UT (SA/UT) was calculated. A repeated one-way analysis of variance and Shaffer's post-hoc analysis were used to detect the differences in each outcome during five exercises. RESULTS The scapula was rotated upwardly during all exercises except push-up plus. The LT/UT ratio during side-lying external rotation and side-lying flexion were significantly higher than that for scapular plane elevation (P < .05), although the highest activity of the lower trapezius was produced during scapular plane elevation. The activities of the serratus anterior and SA/UT ratio during horizontal adducted elevation and push-up plus were significantly higher than that during scapular plane elevation (P < .05). CONCLUSION Horizontal adducted elevation might be more appropriate for increasing scapular upward rotation with high serratus anterior activity and SA/UT ratio than push-up plus.
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Affiliation(s)
- Masataka Hori
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Hiroaki Ishikawa
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
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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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Akgün D, Gebauer H, Paksoy A, Schafer F, Herbst E, Karczewski D, Pastor MF, Moroder P. Differences in Osseous Shoulder Morphology, Scapulothoracic Orientation, and Muscle Volume in Patients With Constitutional Static Posterior Shoulder Instability (Type C1) Compared With Healthy Controls. Am J Sports Med 2024; 52:1299-1307. [PMID: 38488401 PMCID: PMC10986147 DOI: 10.1177/03635465241233706] [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: 04/04/2024]
Abstract
BACKGROUND Constitutional static posterior humeral decentering (type C1 according to ABC Classification) has been recognized as a pre-osteoarthritic deformity that may lead to early-onset posterior decentering osteoarthritis at a young age. Therefore, it is important to identify possible associations of this pathologic shoulder condition to find more effective treatment options. PURPOSE To perform a comprehensive analysis of all parameters reported to be associated with a C1 shoulder-including the osseous shoulder morphology, scapulothoracic orientation, and the muscle volume of the shoulder girdle in a single patient cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A retrospective, comparative study was conducted analyzing 17 C1 shoulders in 10 patients who underwent magnetic resonance imaging (MRI) with the complete depiction of the trunk from the base of the skull to the iliac crest, including both humeri. The mean age of the patients was 33.5 years, and all patients were men. To measure and compare the osseous shoulder morphology (glenoid version, glenoid offset, humeral torsion, anterior acromial coverage, posterior acromial coverage, posterior acromial height, and posterior acromial tilt) and scapulothoracic orientation (scapular protraction, scapular internal rotation, scapular upward rotation, scapular translation, scapular tilt, and thoracic kyphosis), these patients were matched 1 to 4 according their age, sex, and affected side with shoulder-healthy patients who had received positron emission tomography (PET)-computed tomography. To measure and compare the muscle volume of the shoulder girdle (subscapularis, infraspinatus/teres minor, supraspinatus, trapezius, deltoid, latissimus dorsi/teres major, pectoralis major, and pectoralis minor), patients were matched 1 to 2 with patients who had received PET-MRI. Patients with visible pathologies of the upper extremities were excluded. RESULTS The C1 group had a significantly higher glenoid retroversion, increased anterior glenoid offset, reduced humeral retrotorsion, increased anterior acromial coverage, reduced posterior acromial coverage, increased posterior acromial height, and increased posterior acromial tilt compared with controls (P < .05). Decreased humeral retrotorsion showed significant correlation with higher glenoid retroversion (r = -0.742; P < .001) and higher anterior glenoid offset (r = -0.757; P < .001). Significant differences were found regarding less scapular upward rotation, less scapular tilt, and less thoracic kyphosis in the C1 group (P < .05). The muscle volume of the trapezius and deltoid was significantly higher in the C1 group (P < .05). CONCLUSION Patients with C1 shoulders differ from healthy controls regarding osseous scapular and humeral morphology, scapulothoracic orientation, and shoulder girdle muscle distribution. These differences may be crucial in understanding the delicate balance of glenohumeral centering.
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Affiliation(s)
- Doruk Akgün
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Henry Gebauer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alp Paksoy
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Schafer
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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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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Verweij LPE, Sierevelt IN, van der Woude HJ, Hekman KMC, Veeger HEJD, van den Bekerom MPJ. Surgical Intervention Following a First Traumatic Anterior Shoulder Dislocation Is Worthy of Consideration. Arthroscopy 2023; 39:2577-2586. [PMID: 37597706 DOI: 10.1016/j.arthro.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large "gray area" for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Inger N Sierevelt
- Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, the Netherlands; Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, the Netherlands
| | - Henk-Jan van der Woude
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Radiology, OLVG, Amsterdam, the Netherlands
| | - Karin M C Hekman
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder Center IBC Amstelland, Amstelveen, the Netherlands
| | - H E J DirkJan Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, the Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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8
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Lang AE, Friesen KB. Defining humeral axial rotation with optical motion capture and inertial measurement units during functional task assessment. Med Biol Eng Comput 2023; 61:2963-2970. [PMID: 37535299 DOI: 10.1007/s11517-023-02894-z] [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: 03/18/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
Humeral motion can be challenging to measure and analyze. Typically, Euler/Cardan sequences are used for humeral angle decomposition, but choice of rotation sequence has substantial effects on outcomes. A new method called True axial rotation calculation may be more precise. The objective of this study is to compare humeral axial rotation measured from two systems (optical motion capture and inertial measurement units (IMUs)) and calculated with two methods (Euler angles and True axial). Motion of torso and dominant humerus of thirty participants free from any upper limb impairments was tracked using both systems. Each participant performed a functional tasks protocol. Humeral axial rotation was calculated with Euler decomposition and the True axial method. Waveforms were compared with two-way ANOVA statistical parametric mapping. A consistent pattern emerged: axial rotation was not different between motion capture systems when using the True axial method (p > .05), but motion capture systems showed relatively large magnitude differences (~ 20-30°) when using Euler angle calculation. Between-calculation method differences were large for both motion capture systems. Findings suggest that the True axial rotation method may result in more consistent findings that will allow for precise measurements and comparison between motion capture systems. Two methods for calculating humeral axial rotation measured from optical motion capture and inertial measurement units were compared.
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Affiliation(s)
- Angelica E Lang
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
| | - Kenzie B Friesen
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
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Imai T, Nagamatsu T, Kawakami J, Karasuyama M, Harada N, Kudo Y, Madokoro K. Effects of elevation on shoulder joint motion: comparison of dynamic and static conditions. Clin Shoulder Elb 2023; 26:148-155. [PMID: 37316175 DOI: 10.5397/cise.2022.01319] [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: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. METHODS The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. RESULTS At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°- 120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. CONCLUSIONS Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions. Level of evidence: Level III, diagnostic cross-sectional study.
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Affiliation(s)
- Takaki Imai
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare, Kumamoto, Japan
| | - Takashi Nagamatsu
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare, Kumamoto, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Masaki Karasuyama
- Department of Rehabilitation, Minamikawa Orthopedic Hospital, Fukuoka, Japan
| | - Nobuya Harada
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Yu Kudo
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Kazuya Madokoro
- Department of Physical Therapy, Technical School of Medical and Welfare Ryokuseikan, Saga, Japan
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Friesen KB, Wu LZ, Waslen A, Lang AE. Defining repeatability for scapulothoracic and thoracohumeral motion during the novel work-related activities and functional task (WRAFT) protocol. J Biomech 2023; 153:111596. [PMID: 37126882 DOI: 10.1016/j.jbiomech.2023.111596] [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: 09/07/2022] [Revised: 03/31/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Upper limb motion can be challenging to measure and analyze during work or daily life tasks. Further, humeral angle calculation method substantially influences angle outcomes. Therefore, the purpose of this study was to assess the repeatability of scapular and humeral kinematics and compare thoracohumeral angle calculation during a work-related and functional task (WRAFT) protocol. Thirty healthy young adults completed the WRAFT protocol (Comb Hair, Wash Axilla, Tie Apron, Overhead Reach, Side Reach, Forward Transfer, Floor Lift, and Overhead Lift) on two separate occasions. Peak humeral angles and select scapular angles were extracted for each task. Intra-class correlation coefficients (ICCs), standard error of measurement, and minimal detectable change (MDC) were examined. Humeral angles were compared using the XZY and ZXY rotation sequences and "true" axial rotation for incidence of gimbal lock and amplitude coherence. Results showed that for scapular kinematics, elevation-based WRAFTs produced overall better ICC scores (0.23-0.90) compared to those tasks primarily driven by lateral humeral motion (0.02-0.84). MDCs ranged from 7°-78°, suggesting some tasks demonstrated good repeatability (Comb Hair, Overhead Reach, Floor Lift), while others had very high variability (Side Reach, Tie Apron). Amplitude coherence for thoracohumeral angles was best for ZXY for all tasks except the Comb Hair and Tie Apron, for which XZY is recommended. "True" axial rotation demonstrated good coherence for all but Tie Apron. The WRAFT protocol may be used for functionally relevant scapular and humeral kinematic assessment for select task and posture combinations.
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Affiliation(s)
- Kenzie B Friesen
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura Z Wu
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander Waslen
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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11
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The influence of three-dimensional scapular kinematics on arm elevation angle in healthy subjects. J Orthop Sci 2023; 28:346-351. [PMID: 35063330 DOI: 10.1016/j.jos.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/13/2021] [Accepted: 12/26/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND We often clinically observe individual differences in arm elevation angles, but the motion producing these differences remains unclear, partly because of the difficulty of accurately measuring scapular motion. The aim of this study was to determine whether the scapular or glenohumeral (GH) motion has more influence on differences in the arm elevation angles by capturing not only the humerus and scapula but also the trunk using two- (2D) and three-dimensional (3D) shape-matching registration techniques. METHODS Fifteen healthy subjects (13 male and 2 female; mean age: 27.7 years) were instructed to elevate their arms in the sagittal, scapular, and coronal planes. They were divided into high and low groups based on the average of arm elevation angle measured by a goniometer. The 3D scapular, thoracohumeral, and glenohumeral motions were evaluated using 2D/3D single-plane registration. To compare 3D motions between groups, we performed a two-way repeated measures analysis of variance. RESULTS Eight subjects were assigned to the high group, while seven subjects were assigned to the low groups based on an average elevation angle of 172°. The low group demonstrated a significant larger scapular protraction during elevation in all planes (P = 0.0002 for flexion; P = 0.0047 for scaption; P = 0.0314 for abduction), and smaller posterior tilting only during flexion (P = 0.0157). No significant differences occurred in scapular upward rotations or the glenohumeral positions and rotations. CONCLUSIONS This study revealed that insufficient scapular retraction and posterior tilting results in lower arm elevation angles, suggesting that improving the flexibility and activation of muscles surrounding the scapula may be important to achieve complete arm elevation.
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12
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Melo ASC, Vilas-Boas JP, Cruz EB, Macedo RM, E Ferreira SB, Sousa AS. The influence of shoulder position during multi-joint exercises in the relative scapular muscles activity in symptomatic and asymptomatic conditions. J Back Musculoskelet Rehabil 2023:BMR220056. [PMID: 36776036 DOI: 10.3233/bmr-220056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain. OBJECTIVE To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze. METHODS Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0∘ and 90∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles.
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Affiliation(s)
- Ana S C Melo
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal.,Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory, Porto, Portugal.,Center for Interdisciplinary Applied Research in Health, Health School of the Setubal Polytechnic Institute, Campus do IPS Estefanilha, Setúbal, Portugal
| | - João P Vilas-Boas
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do IPS Estefanilha, Setúbal, Portugal.,Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rui M Macedo
- Department of Physiotherapy, Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, School of Health, Polytechnic of Porto, Porto, Portugal
| | | | - Andreia S Sousa
- Department of Physiotherapy, Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, School of Health, Polytechnic of Porto, Porto, Portugal
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13
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Yoshida Y, Matsumura N, Miyamoto A, Oki S, Yokoyama Y, Yamada M, Yamada Y, Nakamura M, Nagura T, Jinzaki M. Three-dimensional shoulder kinematics: Upright four-dimensional computed tomography in comparison with an optical three-dimensional motion capture system. J Orthop Res 2023; 41:196-205. [PMID: 35430725 DOI: 10.1002/jor.25342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Although shoulder kinematics have been analyzed by various methods, dynamic shoulder motion is difficult to track. This study aimed to validate the shoulder kinematic analysis using upright four-dimensional computed tomography (4DCT) and to compare the results with optical three-dimensional motion capture. During active elevation, bilateral shoulders of 10 healthy volunteers were tracked using 4DCT and motion capture. The scapulothoracic and glenohumeral rotations and the scapulohumeral rhythm (SHR) at each position were calculated, and the differences between 4DCT and motion capture were compared. During 10-140° of humerothoracic elevation, the scapulothoracic joint showed upward rotation, internal rotation, and posterior tilting, and the glenohumeral joint showed elevation, external rotation, and anterior plane of elevation in both analyses. In scapulothoracic rotations, the mean differences between the two analyses were -2.6° in upward rotation, 13.9° in internal rotation, and 6.4° in posterior tilting, and became significant with humerothoracic elevation ≥110° in upward rotation, ≥50° in internal rotation, and ≥100° in posterior tilting. In glenohumeral rotations, the mean differences were 3.7° in elevation, 9.1° in internal rotation, and -8.8° in anterior plane of elevation, and became significant with humerothoracic elevation ≥110° in elevation, ≥90° in internal rotation, and ≥100° in anterior plane of elevation. The mean overall SHRs were 1.8 in 4DCT and 2.4 in motion capture, and the differences became significant with humerothoracic elevation ≥100°. The 4DCT analysis of in vivo shoulder kinematics using upright computed tomography scanner is feasible, but the values were different from those by skin-based analysis at the elevated arm positions.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Watson L, Pizzari T, Balster S, Lenssen R, Warby SA. Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint. J Clin Med 2022; 11:5140. [PMID: 36079068 PMCID: PMC9456769 DOI: 10.3390/jcm11175140] [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: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, VIC 3752, Australia
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
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15
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靳 宝, 李 焱, 马 林, 周 兵, 唐 康. [Rebalancing theory of shoulder stability mechanism for the diseases related to the shoulder instability and dysfunction of motion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:380-385. [PMID: 35293182 PMCID: PMC8923926 DOI: 10.7507/1002-1892.202110075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 01/24/2023]
Abstract
Objective To introduce a new theory of shoulder stability mechanism, rebalancing theory, and clinical application of this new theory for the shoulder instability and dysfunction of motion. Methods Through extensive review of the literature related to shoulder instability and dysfunction of the motion in recent years, combined with our clinical practice experience, the internal relation between passive stability mechanism and dynamic stability mechanism were summarized. Results Rebalancing theory of shoulder stability mechanism is addressed, namely, when the shoulder stability mechanism is destructive, the stability of the shoulder can be restored by the rebalance between dynamic stability mechanism and passive stability mechanism. When dynamic stability is out of balance, dynamic stability can be restored by rebalancing the different parts of dynamic stability mechanism or to strengthen the passive stability mechanism. When passive stability mechanism is out of balance, passive stability can be restored by rebalancing the soft tissue and bone of the shoulder. Conclusion Rebalancing theory of shoulder stability mechanism could make a understanding the occurrence, development, and prognosis of shoulder instability and dysfunction from a comprehensive and dynamic view and guide the treatment effectively.
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Affiliation(s)
- 宝雍 靳
- 中国人民解放军陆军军医大学第一附属医院运动医学中心(重庆 445000)Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China
| | - 焱 李
- 中国人民解放军陆军军医大学第一附属医院运动医学中心(重庆 445000)Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China
| | - 林 马
- 中国人民解放军陆军军医大学第一附属医院运动医学中心(重庆 445000)Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China
| | - 兵华 周
- 中国人民解放军陆军军医大学第一附属医院运动医学中心(重庆 445000)Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China
| | - 康来 唐
- 中国人民解放军陆军军医大学第一附属医院运动医学中心(重庆 445000)Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China
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16
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Ludewig PM, Saini G, Hellem A, Kahnert EK, Rezvanifar SC, Braman JP, Staker JL. Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification. Int J Sports Phys Ther 2022; 17:7-17. [PMID: 35024204 PMCID: PMC8720248 DOI: 10.26603/001c.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 12/30/2022] Open
Abstract
Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.
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Affiliation(s)
- Paula M Ludewig
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Gaura Saini
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science
| | - Aaron Hellem
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Emily K Kahnert
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science; Orofacial Pain & Dental Sleep Medicine Clinic, University of Minnesota School of Dentistry
| | - S Cyrus Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | | | - Justin L Staker
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
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17
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Kłaptocz P, Solecki W, Grzegorzewski A, Błasiak A, Brzóska R. Effectiveness of conservative treatment of multidirectional instability of the shoulder joint. Literature review and meta-analysis. POLISH JOURNAL OF SURGERY 2021; 94:6-11. [DOI: 10.5604/01.3001.0015.2415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<br><b>Introduction:</b> Multidirectional shoulder instability (MDI) occurs when the shoulder is dislocating in at least two directions. The patient usually experiences pain with apprehension and a clicking sensation inside the joint. So far, a few classification scales of shoulder instability have been made. Despite this fact, MDI is highly problematic for clinicians in diagnosis and treating.</br>
<br><b>Aim:</b> This article presents the current trends in the conservative treatment of multidirectional instability, assess effectiveness of rehabilitation and indicates the directions of MDI research.</br>
<br><b>Material and methods:</b> In order to find current literature and conduct a critical analysis, the following scientific database was used: Cochrane Library, Physiotherapy Evidence Database (PEDro), MEDLINE and PubMed. We chose four articles which included a comparison of conservative and operative treatment, and four which evaluate the effectiveness of rehabilitation.</br>
<br><b>Results:</b> Low quality evidence shows priority of surgical treatment over conservative treatment. The protocol developed by Watson obtains a statistically significant advantage over the Burkhead and Rockwood protocol.
Discussion: The effectiveness of rehabilitation reaches different levels. Rehabilitation should last from 3 to 12 months. If rehabilitation does not achieve a sufficient effect, arthroscopic methods of reducing the volume of the articular capsule should be considered. Due to the small number of scientific reports and their quality, the obtained data should be interpreted with caution. Much further research is required to create a precise and most effective algorithm.</br>
<br><b>Conclusion:</b> Rehabilitation exercises play an important role in the treatment of multidirectional instability of the shoulder joint, especially when the patient has not had an injury. Exercise types and load should be dosed individually. At present, the protocol described by Watson is the most effective.</br>
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Affiliation(s)
- Patryk Kłaptocz
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | - Wojciech Solecki
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | | | - Adrian Błasiak
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | - Roman Brzóska
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
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18
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Serratus Anterior Fatigue Reduces Scapular Posterior Tilt and External Rotation During Arm Elevation. J Sport Rehabil 2021; 30:1151-1157. [PMID: 34294607 DOI: 10.1123/jsr.2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Fatigue of the scapular stabilizing muscles resulting from repeated arm motion has been reported to alter scapular kinematics, which could result in shoulder pathology, especially impingement. OBJECTIVE This study aimed to examine the effects of fatigue of the serratus anterior muscle on scapular kinematics, specifically, decrease scapular posterior tilt and upward scapular rotation during arm elevation. DESIGN Repeated measures. SETTING Laboratory. PARTICIPANTS Thirty participants were included in the investigation. INTERVENTIONS Scapular kinematics and shoulder strength were measured before and immediately following a serratus anterior fatigue protocol. MAIN OUTCOME Scapular 3-dimensional position during arm elevation. RESULTS No difference in upward rotation of the scapula between prefatigue and postfatigue conditions (ascending: P = .188; descending: P = .798). Scapular posterior tilt decreased during arm elevation following the fatigue protocol between 60° and 90° and 90° and 120° of arm elevation during the ascent (P = .004) and the descent (P = .013). Fatigue by arm elevation angle interaction was found for clavicular elevation during the ascent (P = .050) between 90° and 120° of arm elevation. Scapular internal rotation increased during the ascent (P = .027). There was no difference in clavicular protraction between the prefatigue and postfatigue conditions (ascending: P ≤ .001; descending: P ≤ .001). CONCLUSION Fatigue of the serratus anterior decreases posterior scapular tilt and greater clavicular elevation and scapular internal rotation at higher arm elevation angles. These findings are consistent with the scapular kinematic patterns associated with shoulder pain. Improving serratus anterior endurance might delay the changes in scapular kinematics associated with repeated arm motion and shoulder injury mechanisms.
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Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR. Scapulothoracic Dyskinesis: A Concept Review. Curr Rev Musculoskelet Med 2021; 14:246-254. [PMID: 33822304 DOI: 10.1007/s12178-021-09705-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Scapulothoracic dyskinesis (SD) occurs when there is a noticeable disruption in typical position and motion of the scapula, which can result in debilitating pain. The purpose of this review is to describe the current knowledge regarding the diagnosis and management of scapulothoracic dyskinesis by providing an evidence-based overview of clinical exams and treatment modalities available for orthopedic surgeons and provide insight into which treatment modalities require further investigation. RECENT FINDINGS SD is highly prevalent in athletes, particularly those participating in overhead activities (e.g., baseball, tennis, and swimming) and can coexist with several shoulder pathologies. A holistic approach in the diagnosis of SD has been supported in the literature; however, it is important to recognize that diagnosis is currently limited to the absence of a quantitative SD clinical assessment. The main goal of the treatment of SD is to regain proper scapular positioning and dynamics. The standard of care for the management of SD is conservative interventions aimed at optimizing scapular kinematics. Surgical intervention is only considered in the presence of concomitant pathology requiring surgery. Due to the complexity of coordinated movement of the shoulder girdle, recent literature has begun to move away from the use of traditional orthopedic tests, in favor of a more system-based approach for the diagnosis of SD. We present a concise review of clinical exams and treatment modalities available for orthopedic surgeons in the management of SD.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Daisy A Ference
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Eric X Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Kelechi R Okoroha
- Mayo Clinic, Department of Orthopedic Surgery, 600 Hennepin Avenue, Suite 310, Minneapolis, MN, 55403, USA
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Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals. JSES Int 2020; 5:238-246. [PMID: 33681843 PMCID: PMC7910733 DOI: 10.1016/j.jseint.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Altered scapular motion is thought to be one of the factors associated with the development of symptomatic rotator cuff tears. However, the differences in kinematics and muscle activities of scapular upward/downward rotation between patients with symptomatic and asymptomatic tears are unclear. The purpose of this study was to compare the differences in kinematics and muscle activities of scapular rotation among patients with symptomatic and asymptomatic tears, and healthy individuals. Methods Twenty-three patients with rotator cuff tears and 9 healthy individuals (healthy group) participated in this study. Based on a visual analog scale (VAS, 0-100 mm), the patients were divided into symptomatic (13 patients; VAS ≥20 mm) and asymptomatic (10 patients; VAS <20 mm) groups. Scapular upward rotation was measured with a digital inclinometer. Elasticities of the upper trapezius, levator scapulae, and rhomboid major were assessed by using ultrasound real-time tissue elastography to quantify their muscle activities. All measurements were performed at 0°, 60°, 90°, and 120° of active arm elevation in the scapular plane. Results Scapular upward rotation was significantly less in the symptomatic group (9.4° ± 5.6°) compared with the asymptomatic group (15.7° ± 6.0°; P = .022) at 90° of arm elevation. The activity of the levator scapulae was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups (P = .013 and P = .005, respectively) at 90° of arm elevation. The activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group (P = .015) at 120° of arm elevation. Conclusion Patients with symptomatic rotator cuff tears showed less scapular upward rotation and higher activity of the levator scapulae at 90° of arm elevation compared to patients with asymptomatic rotator cuff tears.
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21
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Spanhove V, Calders P, Berckmans K, Palmans T, Malfait F, Cools A, De Wandele I. Electromyographic muscle activity and three-dimensional scapular kinematics in patients with multidirectional shoulder instability. Arthritis Care Res (Hoboken) 2020; 74:833-840. [PMID: 33253470 DOI: 10.1002/acr.24525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate differences in EMG muscle activity and scapular kinematics during elevation in the scapular plane between healthy controls, participants with multidirectional shoulder laxity (MDL), and patients with multidirectional shoulder instability (MDI) who are diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). METHODS Twenty-seven women with hEDS/HSD and MDI, 27 female healthy control subjects, and 28 female subjects with MDL participated in this study. Scapular 3D kinematic data were obtained using 8 Oqus Qualisys cameras. Simultaneously, surface electromyography (EMG) was used to measure muscle activity of the upper, middle, and lower trapezius, infraspinatus, latissimus dorsi, serratus anterior, posterior deltoid, and pectoralis major during arm elevation in the scapular plane. Group differences were assessed using statistical parametric mapping. RESULTS Regarding scapular kinematics, significantly less upward rotation was observed in hEDS/HSD patients with MDI compared to both healthy controls and MDL subjects. Significantly less posterior tilt was seen in hEDS/HSD patients compared to MDL subjects. Furthermore, significantly higher EMG activity of the infraspinatus, middle trapezius, and posterior deltoid was found in hEDS/HSD patients with MDI. CONCLUSION hEDS/HSD patients with MDI demonstrate altered scapular kinematics and increased EMG muscle activity compared to subjects without MDI. These findings could serve as stepping stone for future research regarding treatment strategies in patients belonging to the hypermobility spectrum.
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Affiliation(s)
- Valentien Spanhove
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kelly Berckmans
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Fransiska Malfait
- Center for Medical Genetics, Department for Biomolecular Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Inge De Wandele
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Center for Medical Genetics, Department for Biomolecular Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Spanhove V, Van Daele M, Van den Abeele A, Rombaut L, Castelein B, Calders P, Malfait F, Cools A, De Wandele I. Muscle activity and scapular kinematics in individuals with multidirectional shoulder instability: A systematic review. Ann Phys Rehabil Med 2020; 64:101457. [PMID: 33221471 DOI: 10.1016/j.rehab.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking. OBJECTIVE This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls. METHOD The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration. RESULTS After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface. CONCLUSION There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
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Affiliation(s)
- Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Matthias Van Daele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Aäron Van den Abeele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Lies Rombaut
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Birgit Castelein
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Fransiska Malfait
- Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Inge De Wandele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Yildiz TI, Eraslan L, Demirci S, Kara D, Ulusoy B, Turgut E, Duzgun I. The repeatability of 3-dimensional scapular kinematic analysis during bilateral upper extremity movements. J Bodyw Mov Ther 2020; 24:37-42. [PMID: 33218536 DOI: 10.1016/j.jbmt.2020.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/01/2020] [Accepted: 06/07/2020] [Indexed: 11/30/2022]
Abstract
Although three-dimensional electromagnetic systems are widely used to evaluate the 3-dimensional scapular kinematics their reliability when testing bilateral upper extremity tasks is unknown. The purpose of this study was to investigate the repeatability of the scapular kinematic analyses using the Flock of Birds (FOB) system during bilateral upper extremity movements. Twenty-one volunteers without shoulder problems were included (aged 24.8 years; body mass index averaged 21.2 kg/m2) to the study. Scapular internal-external rotation, upward-downward rotation, and anterior-posterior tilt was recorded during bilateral arm elevation on sagittal, scapular and frontal planes. Measurements were repeated at 5-7 days intervals. Intra-session and inter-session repeatability were determined using intraclass correlation coefficients (ICC) scores and standard errors of measurements (SEM). The ICC scores were found to be 0.81 to 0.99 for intra-session measurements and 0.60 to 0.83 for inter-session measurements. The SEM scores were 0.8°-3.4° and 2°-7.2° for the intra and inter-session measurements respectively. The repeatability of the FOB system was excellent for the intra-session measurements, but it was weaker for the inter-session measurements. These results support the use of the FOB system for assessing scapular orientation but the analyses should be conducted more carefully when it is applied to the longitudinal measurements.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey.
| | - Leyla Eraslan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | | | - Dilara Kara
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | | | - Elif Turgut
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | - Irem Duzgun
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
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Hall PT, Crouch DL. Effect of continuous, mechanically passive, anti-gravity assistance on kinematics and muscle activity during dynamic shoulder elevation. J Biomech 2020; 103:109685. [DOI: 10.1016/j.jbiomech.2020.109685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/17/2020] [Accepted: 02/18/2020] [Indexed: 01/10/2023]
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Harrington SE, Hoffman J, Katsavelis D. Measurement of Pectoralis Minor Muscle Length in Women Diagnosed With Breast Cancer: Reliability, Validity, and Clinical Application. Phys Ther 2020; 100:429-437. [PMID: 32043149 DOI: 10.1093/ptj/pzz174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Decreased pectoralis minor muscle length is common after primary breast cancer treatment and can result in an abnormal position of the scapula. This position can contribute to shoulder pain and pathomechanics and can lead to problems such as impingement syndrome, rotator cuff tears, and frozen shoulder. Currently, there are limited reliable methods for measuring pectoralis minor length. OBJECTIVE The objective of this study was to examine the reliability and validity of measuring pectoralis minor length in women diagnosed with breast cancer. DESIGN This was a cross-sectional reliability and validity study. METHODS Bilateral pectoralis minor length (in centimeters) was assessed using a palpation meter in women (N = 29) diagnosed with breast cancer by 2 licensed physical therapists who were masked to the measures. Bilateral pectoralis minor length was also measured using a motion capture system to assess validity. RESULTS Intratester reliability (intraclass correlation coefficient, ICC [3,k] = 0.971; 95% confidence interval [CI] = 0.939-0.986; standard error of measurement [SEM] = 0.16 cm) and intertester reliability (ICC[3,k] = 0.915; 95% CI = 0.81-0.962; SEM = 0.31 cm) were excellent for the palpation meter on the affected side and the unaffected side (intratester reliability: ICC[3,k] = 0.951; 95% CI = 0.897-0.977; SEM = 0.19 cm; intertester reliability: ICC[3,k] = 0.945; 95% CI = 0.877-0.975; SEM = 0.22 cm). Significant correlations were found between the motion capture system and the palpation meter on the affected side (r = 0.87) and the unaffected side (r = 0.81). Bland-Altman plots between the palpation meter and the motion capture system demonstrated that all the measures fell within the limits of agreement. LIMITATIONS This study encountered possible errors with the accuracy of the motion capture system tracking because of the proximity of the markers and inherent volumetric restrictions. CONCLUSIONS The palpation meter is a reliable, valid, easily administered, and cost-effective tool for assessing pectoralis minor length in women with breast cancer.
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Affiliation(s)
- Shana E Harrington
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Blatt PE Center, 101G, Columbia, SC 29208 (USA)
| | - Julie Hoffman
- Department of Physical Therapy, Creighton University, Omaha, Nebraska
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Kjær BH, de Wandele I, Spanhove V, Juul-Kristensen B, Cools AM. Subacromial space outlet in female patients with multidirectional instability based on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder measured by ultrasound. J Shoulder Elbow Surg 2020; 29:600-608. [PMID: 31629650 DOI: 10.1016/j.jse.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/03/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups. METHODS Twenty-nine female patients with hEDS/HSD (aged 34 ± 12.9 years) and 20 healthy controls (aged 33 ± 10.8 years) participated in the study. The supraspinatus tendon (SST) thickness and AHD were measured using ultrasound. The interplay between the SST and the AHD was expressed as the occupation ratio (OcAHD), calculated as the SST thickness as a percentage of AHD. The measures were performed in the resting position and in subsequently 45° and 60° of active arm elevation in the scapular plane. RESULTS The main finding is that patients with hEDS/HSD have a larger subacromial space outlet compared with the controls when measured by ultrasound. Furthermore, in both groups, we found an increased OcAHD during active arm elevation compared with the resting position, which indicates that similar mechanisms occur for patients with hEDS/HSD and healthy controls. CONCLUSION Patients with hEDS/HSD have a larger available subacromial space outlet compared with healthy individuals. OcAHD increased during active arm elevation compared with the resting position in both groups. This knowledge is important when designing rehabilitation exercise programs for shoulder instability patients with abnormal glenohumeral biomechanics.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Inge de Wandele
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ann M Cools
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ribeiro LP, Barreto RPG, Pereira ND, Camargo PR. Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test. Clin Biomech (Bristol, Avon) 2020; 73:166-171. [PMID: 32000046 DOI: 10.1016/j.clinbiomech.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test. METHODS Fifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively. FINDINGS There were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups. INTERPRETATION Individuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.
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Affiliation(s)
- Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Rodrigo Py Gonçalves Barreto
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Natalia Duarte Pereira
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Paula Rezende Camargo
- 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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Lawrence RL, Braman JP, Keefe DF, Ludewig PM. The Coupled Kinematics of Scapulothoracic Upward Rotation. Phys Ther 2020; 100:283-294. [PMID: 31696926 PMCID: PMC8204887 DOI: 10.1093/ptj/pzz165] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/01/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Scapulothoracic upward rotation (UR) is an important shoulder complex motion allowing for a larger functional work space and improved glenohumeral muscle function. However, the kinematic mechanisms producing scapulothoracic UR remain unclear, limiting the understanding of normal and abnormal shoulder movements. OBJECTIVE The objective of this study was to identify the coupling relationships through which sternoclavicular and acromioclavicular joint motions contribute to scapulothoracic UR. DESIGN This was a cross-sectional observational study. METHODS Sixty participants were enrolled in this study; 30 had current shoulder pain, and 30 had no history of shoulder symptoms. Shoulder complex kinematics were quantified using single-plane fluoroscopy and 2D/3D shape matching and were described as finite helical displacements for 30-degree phases of humerothoracic elevation (30 degrees-60 degrees, 60 degrees-90 degrees, and 90 degrees-120 degrees). A coupling function was derived to estimate scapulothoracic UR from its component motions of acromioclavicular UR, sternoclavicular posterior rotation, and sternoclavicular elevation as a function of acromioclavicular internal rotation. The proportional contributions of each of the component motions were also calculated and compared between phases of humerothoracic elevation and groups. RESULTS Scapulothoracic UR displacement could be effectively predicted using the derived coupling function. During the 30- to 60-degree humerothoracic elevation phase, acromioclavicular UR accounted for 84.2% of scapulothoracic UR, whereas sternoclavicular posterior rotation and elevation each accounted for < 10%. During later phases, acromioclavicular UR and sternoclavicular posterior rotation each accounted for 32% to 42%, whereas sternoclavicular elevation accounted for < 11%. LIMITATIONS Error due to the tracking of sternoclavicular posterior rotation may have resulted in an underprediction of its proportional contribution and an overprediction of the proportional contribution of acromioclavicular UR. CONCLUSIONS Acromioclavicular UR and sternoclavicular posterior rotation are the predominant component motions of scapulothoracic UR. More research is needed to investigate how these coupling relationships are affected by muscle function and influenced by scapular dyskinesis.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, and Bone and Joint Center, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202 (USA)
| | | | - Daniel F Keefe
- Department of Computer Science and Engineering, University of Minnesota
| | - Paula M Ludewig
- PhD, Department of Rehabilitation Medicine, University of Minnesota
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Three-Dimensional Analysis of Scapular Kinematics During Arm Elevation in Baseball Players With Scapular Dyskinesis: Comparison of Dominant and Nondominant Arms. J Sport Rehabil 2020; 29:93-101. [DOI: 10.1123/jsr.2017-0216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
Background: The knowledge of 3-dimensional scapular kinematics is essential for understanding the pathological lesions of the shoulder and elbow in throwing athletes. Many studies about alterations of the resting scapular position, dynamic scapular motion, or scapular dyskinesis (SD) have been conducted, yet none of them have identified a consistent pattern of altered scapular kinematics in throwing athletes. Hypothesis/Purpose: To analyze the 3-dimensional scapular kinematics of dominant and nondominant arms in baseball players with a pathological condition of the shoulder or elbow. Study Design: Cross-sectional study. Methods: Bilateral scapular positions, consisting of upward rotation (UR), superior translation (ST), internal rotation (IR), protraction (PRO), and anterior tilting (AT) with an arm at rest and at 150° forward elevation, were measured among 319 baseball players with SD using 3-dimensional computed tomography. Angular values of scapula were compared between dominant and nondominant arms with statistical analysis. Level of Evidence: Level III, diagnostic study. Results: The scapular position of dominant arms showed significantly more AT, less ST at rest and more UR and IR and less ST, PRO, and AT at 150° full forward elevation compared with the nondominant arms. The magnitude of mean change of UR, IR, PRO, and AT during arm elevation increased significantly between the paired arms (P value: UR, ST, PRO, and AT: <.001 and IR: .001). Conclusion: When compared with the nondominant arms, UR, AT, and PRO with the arm at 150° forward elevation of dominant symptomatic arms in baseball players tilted toward positive compensation, whereas IR altered toward negative decompensation. In addition, the angular increment of the scapula increased significantly in dominant symptomatic arms compared with the nondominant arms.
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Yildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol, Avon) 2019; 70:97-106. [PMID: 31450180 DOI: 10.1016/j.clinbiomech.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/04/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although it is thought that there is a relationship between neck pain and scapular dysfunction, there are controversial results and no clear information in the literature regarding this issue. This study aimed to investigate the alterations in the 3-Dimensional scapular orientation on patients with non-specific neck pain. METHOD Thirty-four patients with chronic non-specific neck pain [age, 29.1 (5) years; height, 165.3 (6.1) centimeters; weight, 62.1 (9.6) kilogram] and 29 healthy controls [age, 28.2 (3.3) years; height, 166.8 (8.1) centimeters; weight, 60.9 (8.5) kilogram] were included in the study. 3-Dimensional scapular kinematics were obtained during arm elevation and lowering trials in the sagittal, scapular, and frontal planes. FINDINGS Compared to healthy controls, the patients with neck pain demonstrated significantly reduced upward scapular rotation on both the dominant and non-dominant sides in all three planes. Patients with neck pain had increased internal rotation in the sagittal and frontal planes on the dominant side and increased external rotation in the frontal plane on the non-dominant side. No difference was observed between groups considering posterior scapular tilt. INTERPRETATION There are alterations in the 3-Dimensional scapular orientations in patients with chronic non-specific neck pain compared to healthy controls. Therefore, the scapular control may also be examined in patients with neck pain and it can be included in the rehabilitation program if needed.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey.
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Irem Duzgun
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
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Abstract
PURPOSE OF REVIEW This review will outline scapular function in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and present an algorithm that encompasses guidelines for evaluation and can serve as a basis for treatment. RECENT FINDINGS Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies. Although scapular motion alterations may be common in overhead athletes, various reports have shown that identification and management of the alterations can result in improved rehabilitation and performance outcomes. Baseball throwing occurs as the result of integrated, multisegmented, sequential joint motion, and muscle activation within the kinetic chain. The scapula is a key component link within the chain through its function to maximize the scapulohumeral rhythm and efficient throwing mechanics. Evaluation and management beginning with the scapula can produce improved outcomes related to shoulder pathology in overhead athletes.
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Turgut E, Yildiz TI, Eraslan LS, Demirci S, Huri G, Turhan E, Duzgun I. A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping. J Orthop Sci 2019; 24:426-430. [PMID: 30538077 DOI: 10.1016/j.jos.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/27/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping. METHODS Twenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models. RESULTS The scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition. CONCLUSIONS Operated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.
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Affiliation(s)
- Elif Turgut
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Taha Ibrahim Yildiz
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Leyla Sümeyye Eraslan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Serdar Demirci
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Irem Duzgun
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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Analysis of Shoulder Complex Function After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis. J Pediatr Orthop 2019; 39:e32-e38. [PMID: 30312252 DOI: 10.1097/bpo.0000000000001267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonsurgically treated patients with AIS demonstrate altered scapular kinematics and decreased patient-reported shoulder function compared with typically developing adolescents. It is unknown whether surgical correction of the spine deformity has beneficial or detrimental effects on scapulothoracic joint function, as previous assessments of shoulder function following surgery have only focused on humerothoracic motion. The objective of this study was to perform a comprehensive analysis of scapular kinematics before and after PSF and compare postoperative scapular kinematics in AIS to those of a typically developing cohort. METHODS Typically developing adolescents (n=33) and patients with AIS (n=20) with a planned PSF surgery were recruited. Motion capture was used to analyze scapular kinematics at rest and in full abduction. AIS subjects were evaluated before surgery and at a 6-month follow-up. Individual changes following surgery were assessed, and postoperative scapular kinematics were compared with the typically developing subjects. RESULTS Patients with AIS patients in this study demonstrated significant losses of scapulothoracic range of motion for the convex side shoulder and gains of scapulothoracic range of motion for the concave side shoulder following PSF. When compared with typically developing adolescents, the resting scapular position of the postoperative AIS group seemed normalized, but the AIS group still exhibited altered scapular motion, particularly along the upward rotation and tilt axes. CONCLUSIONS Patients with AIS demonstrated significant changes at the scapulothoracic joint following PSF. Compared with typically developing adolescents, scapular resting position normalized, but the AIS group still demonstrated altered scapular kinematics, including patterns associated with shoulder pathology. The results of this study will inform the course of short-term postoperative rehabilitation by addressing the upper extremity implications of PSF for individuals with AIS. LEVEL OF EVIDENCE Level III.
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Ayekoloye C, Nwangwu O. Multidirectional instability of the shoulder (MDI) – focus on non-operative management. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1514651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Charles Ayekoloye
- Department of Orthopaedics, Oaklands Hospital, Salford, United Kingdom
| | - Osondu Nwangwu
- Department of Orthopaedics, Luton & Dunstable Hospital, Bedfordshire, United Kingdom
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35
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Rabin A, Chechik O, Dolkart O, Goldstein Y, Maman E. A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis. Phys Ther Sport 2018; 34:129-135. [PMID: 30268967 DOI: 10.1016/j.ptsp.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Assess the frequency of a positive scapular assistance test (SAT) in different shoulder disorders and establish its association with scapular dyskinesis. DESIGN Cross-sectional. SETTING Shoulder clinic. PARTICIPANTS Seventy-four patients. MAIN OUTCOME MEASURES The SAT and visual assessment of scapular movement were performed by a physical therapist. An orthopaedic surgeon classified participants into 4 diagnostic categories: rotator cuff disease, superior labrum anterior posterior lesion (SLAP), shoulder instability, and other. RESULTS Twenty-seven (36.5%) participants presented with a positive SAT. The SAT was positive among 9 of 28 participants (32.1%) with rotator cuff disease, 7 of 23 participants (30.4%) with SLAP lesions, 9 of 21 participants (42.9%) with shoulder instability, and 2 of 2 participants (100.0%) with other pathologies. The frequency of a positive SAT did not differ between the various diagnostic categories (P = 0.64). The SAT was more frequently positive among participants with scapular dyskinesis (48.5% versus 26.8%, P = 0.05). CONCLUSIONS The SAT is found similarly positive among patients with various common shoulder disorders. Although associated with scapular dyskinesis, the SAT was positive in less than half of those demonstrating scapular dyskinesis suggesting the SAT may help identify patients in whom altered scapular movement is contributing to shoulder pain.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Israel.
| | - Ofir Chechik
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Oleg Dolkart
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Yariv Goldstein
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Eran Maman
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
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Multidirectional Instability of the Shoulder: Treatment Options and Considerations. Sports Med Arthrosc Rev 2018; 26:113-119. [PMID: 30059445 DOI: 10.1097/jsa.0000000000000199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Multidirectional instability (MDI) is a debilitating condition that involves chronic subluxation or dislocation of the shoulder in >1 direction. Numerous proposed mechanisms of MDI exist, which occurs in the setting of redundant capsular tissue. Symptoms can range from recurrent dislocations or subluxations to vague aching pain that disrupts activities of daily living. Magnetic resonance imaging is often performed during evaluation of this condition, although magnetic resonance arthrography may provide more detailed images of the patulous capsule. In the absence of a well-defined traumatic cause, such as a labral tear, initial treatment for MDI is a structured rehabilitation program with exercises aimed at strengthening the rotator cuff and periscapular muscles to improve scapular kinematics. Patients with recalcitrant symptoms may benefit from surgical stabilization, including open capsular shift or arthroscopic capsular plication, aimed at decreasing capsular volume and improving stability.
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Rapp van Roden EA, Richardson RT, Russo SA, Rose WC, Chafetz RS, Gabos PG, Shah SA, Samdani AF, Richards JG. Shoulder Complex Mechanics in Adolescent Idiopathic Scoliosis and Their Relation to Patient-perceived Function. J Pediatr Orthop 2018; 38:e446-e454. [PMID: 29975295 DOI: 10.1097/bpo.0000000000001207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proper contribution of the scapulothoracic joint is necessary for adequate shoulder complex function. Associations between trunk shape and abnormal scapular kinematics and subsequent shoulder dysfunction have been established; however, the extent of shoulder dysfunction in adolescent idiopathic scoliosis (AIS) is still poorly understood. The purpose of this study was to perform a comprehensive analysis of scapular kinematics during multiplanar arm motion in patients with AIS and compare kinematics and patient-reported function with that of a typically developing cohort. METHODS Typically developing adolescents (n=33) and patients with AIS (n=26) with no history of spine or shoulder surgery were recruited for this study. A 3-dimensional optoelectronic motion capture system was used to analyze scapular kinematics in 4 positions: rest, full abduction, forward reach, and hand to spine. Subjects in each group also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a measure of patient-reported function. RESULTS The convex shoulders of the patients with AIS exhibited deficits in scapular upward rotation and posterior tilt in all positions and reduced protraction range of motion during reaching. The AIS group also reported worse patient-perceived shoulder function than the typically developing group; however, this dysfunction was not related to specific scapular kinematic patterns. CONCLUSIONS Patients with AIS show alterations in scapular kinematics that are associated with shoulder pathology. Despite displaying an unaffected ability to place the hand in space, the underlying joint mechanics place these adolescents at risk for future pathology. Accordingly, consideration of scapulothoracic and glenohumeral joint function is warranted in the treatment of AIS. LEVEL OF EVIDENCE Level III-cross-sectional comparison.
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Affiliation(s)
| | - Robert Tyler Richardson
- Kinesiology Program, School of Behavioral Sciences and Education, Penn State Harrisburg, Middletown
| | - Stephanie A Russo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Hamot, Erie
| | - William C Rose
- Biomechanics and Movement Science Program, University of Delaware, Newark
| | | | - Peter G Gabos
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
| | - Suken A Shah
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA
| | - James G Richards
- Biomechanics and Movement Science Program, University of Delaware, Newark
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Nagamatsu T, Kai Y, Gotoh M, Madokoro K, Imai T, Kawakami J, Shiba N. Influence of Brassiere Wearing on Shoulder Kinematics. Prog Rehabil Med 2018; 3:20180013. [PMID: 32789238 DOI: 10.2490/prm.20180013] [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: 02/11/2018] [Accepted: 06/08/2018] [Indexed: 11/09/2022] Open
Abstract
Objective Gender differences in scapular kinematics during arm elevation have been reported. Because women wear brassieres (bras) daily, their scapular motion may be restricted by the garment; however, the influence of bra wearing on this motion has not been reported. Therefore, using a three-dimensional electromagnetic tracking device, we investigated the influence of bra wearing on shoulder kinematics during arm elevation. Methods The subjects were 19 healthy women, and the shoulder on the dominant side was evaluated. Subjects performed scapular plane arm elevation while wearing or not wearing bras. Kinematic data were recorded using an electromagnetic tracking device. The glenohumeral elevation angle, scapular upward and internal rotation angles, and the posterior tilt angle were determined from the recorded data. The angles were calculated at 20°-120° arm elevation, and the data were compared between the two conditions. Results The scapular upward and internal rotation angles and the posterior tilt angle were significantly smaller with the subjects wearing bras than not wearing bras. In contrast, the glenohumeral elevation angle was significantly greater when bras were warn. Conclusions Bra wearing may influence shoulder kinematics. Consequently, great care should be taken to account for this factor during the evaluation of kinematics in female subjects.
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Affiliation(s)
- Takashi Nagamatsu
- Department of Physical Therapy, Fukuoka Rehabilitation College, Hakata-ku, Fukuoka, Japan.,Kurume University School of Medicine Graduate School, Kurume, Fukuoka, Japan
| | - Yoshihiro Kai
- Faculty of Health Science, Kyoto Tachibana University, Yamashina-ku, Kyoto, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Kazuya Madokoro
- Department of Physical Therapy, Technical School of Medical and Welfare Ryokuseikan, Tosu, Saga, Japan
| | - Takaki Imai
- Kurume University School of Medicine Graduate School, Kurume, Fukuoka, Japan
| | - Junichi Kawakami
- Kurume University School of Medicine Graduate School, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
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Glenohumeral Instability Related to Special Conditions: SLAP Tears, Pan-labral Tears, and Multidirectional Instability. Sports Med Arthrosc Rev 2018; 25:e12-e17. [PMID: 28777213 DOI: 10.1097/jsa.0000000000000153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Glenohumeral instability is one of the more common conditions seen by sports medicine physicians, especially in young, active athletes. The associated anatomy of the glenohumeral joint (the shallow nature of the glenoid and the increased motion it allows) make the shoulder more prone to instability events as compared with other joints. Although traumatic dislocations or instability events associated with acute labral tears (ie, Bankart lesions) are well described in the literature, there exists other special shoulder conditions that are also associated with shoulder instability: superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. SLAP tears can be difficult to diagnose and arthroscopic diagnosis remains the gold standard. Surgical treatment as ranged from repair to biceps tenodesis with varying reports of success. Along the spectrum of SLAP tears, pan-labral tears consist of 360-degree injuries to the labrum. Patients can present complaining of either anterior or posterior instability alone, making the physical examination and advanced imaging a crucial component of the work up of the patients. Arthroscopic labral repair remains a good initial option for surgical treatment of these conditions. Multidirectional instability remains one of the more difficult conditions for the sports medicine physician to diagnose and treat. Symptoms may only be reported as vague pain versus frank instability making the diagnoses particularly challenging, especially in a patient with overall joint laxity. Conservative management to include physical therapy is the mainstay initial treatment in patients without an identifiable structural abnormality. Surgical management of this condition has evolved from open to arthroscopic capsular shifts with comparable results.
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Watson L, Balster S, Warby SA, Sadi J, Hoy G, Pizzari T. A comprehensive rehabilitation program for posterior instability of the shoulder. J Hand Ther 2018. [PMID: 28641736 DOI: 10.1016/j.jht.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Posterior shoulder instability is recognised as being less prevalent than anterior instability, however the diagnosis of this pathology is easily overlooked or missed and this may contribute to an underestimation of prevalence. Recently, there has been increasing recognition of this condition and consequently a greater requirement for knowledge of diagnostic procedures and treatment directions. Currently there is limited research into the conservative management of posterior instability, although it is recommended as first-line treatment prior to surgical review, particularly in those with an atraumatic instability mechanism. The aim of this paper is to outline a comprehensive rehabilitation program for the conservative management of posterior instability with a focus on scapular and humeral head control. The information provided includes extensive written information, flowcharts, figures and a table of management parameters that will provide therapists with adequate detail to replicate the program in the clinical setting.
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Affiliation(s)
- Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Sarah Ann Warby
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | | | - Greg Hoy
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
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Lefèvre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V, Poiraudeau S, Roby-Brami A, Roren A. Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications. Ann Phys Rehabil Med 2018; 61:46-53. [PMID: 28987866 DOI: 10.1016/j.rehab.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints. METHODS This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. RESULTS For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation. CONCLUSION The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
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Affiliation(s)
- Marie-Martine Lefèvre-Colau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Christelle Nguyen
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Clemence Palazzo
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Srour
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Guillaume Paris
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Valerie Vuillemin
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Poiraudeau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Agnes Roby-Brami
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandra Roren
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Warby SA, Ford JJ, Hahne AJ, Watson L, Balster S, Lenssen R, Pizzari T. Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial. Am J Sports Med 2018; 46:87-97. [PMID: 29048942 DOI: 10.1177/0363546517734508] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The recommended initial treatment for multidirectional instability (MDI) of the shoulder is a rehabilitation program, yet there is very low-quality evidence to support this approach. Purpose/Hypothesis: The purpose was to compare the Watson MDI program and Rockwood Instability program among patients with nontraumatic, nonstructural MDI. The hypothesis was that the Watson MDI program would produce clinically and statistically superior outcomes over the Rockwood Instability program. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Forty-one participants with MDI were randomly allocated to the Watson MDI or Rockwood Instability program. Participants attended 12 weekly physiotherapy sessions for exercise prescription. Outcomes were assessed at baseline and 6, 12, and 24 weeks after randomization. Primary outcomes were the Melbourne Instability Shoulder Score (MISS) and the Western Ontario Shoulder Index (WOSI). Secondary outcomes included the Orebro Musculoskeletal Pain Questionnaire, pain, muscle strength, scapular upward rotation, scapular coordinates, global rating of change, satisfaction scales, limiting angle in abduction range, limiting factor in abduction range, and incidence of dislocation. Primary analysis was by intention to treat based on linear mixed models. RESULTS Between-group differences showed significant effects favoring the Watson program for the WOSI (effect size [ES], 11.1; 95% CI, 1.9-20.2; P = .018) and for the limiting factor in abduction (ES, 0.1; 95% CI, 0.0-1.6; P = .023) at 12 weeks, and for the WOSI (ES, 12.6; 95% CI, 3.4-21.9; P =. 008), MISS (ES, 15.4; 95% CI, 5.9-24.8; P = .002), and pain (ES, -2.0; CI: -2.3 to -0.7, P = .003) at 24 weeks. CONCLUSION For people with MDI, 12 sessions of the Watson MDI program were more effective than the Rockwood program at 12- and 24-week follow-up. Registration: ACTRN12613001240730 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Sarah A Warby
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Jon J Ford
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Andrew J Hahne
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Ross Lenssen
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,LifeCare Prahran Sports Medicine Centre, Prahran, Australia.,Melbourne Orthopedic Group, Windsor, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Watson L, Balster S, Lenssen R, Hoy G, Pizzari T. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. J Shoulder Elbow Surg 2018; 27:104-111. [PMID: 28947382 DOI: 10.1016/j.jse.2017.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conservative management is commonly recommended as the first-line treatment for multidirectional instability (MDI) of the shoulder. Despite this, the evidence for efficacy of treatment is limited, and until recently, guidance for clinicians on conservative rehabilitation programs has been inadequate. This study evaluated the effectiveness of a physiotherapy-led exercise program for participants with MDI. METHODS In a single-group study design, 43 participants (16 male, 27 female; mean age, 19.8 years, standard deviation, 4.9 years) diagnosed with MDI undertook a 12-week exercise program. Primary outcome measures were the Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and Oxford Shoulder Instability Score. Secondary outcomes were strength and scapular position. All measures were taken at baseline and repeated at the conclusion of the program. Test differences before and after rehabilitation were evaluated with dependent t tests and single-group effect size calculations (standardized mean difference [SMD]) to provide a measure of the magnitude of the difference. RESULTS Large effects were found between pre- and postrehabilitation scores on all functional instability questionnaires, with the Western Ontario Shoulder Instability Index demonstrating the largest effect (SMD, -3.04). Scapular upward rotation improved significantly in the early ranges of abduction (0°-60°), with moderate to large effects (SMDs, 0.54-0.95). All strength measures significantly improved, with large differences identified (SMDs, 0.69-2.08). CONCLUSION The identified improvement in functional status, shoulder muscle strength, and scapular positioning after rehabilitation allows greater confidence in the value of conservative management of MDI and informs further research by way of clinical trials in the area.
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Affiliation(s)
- Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia.
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Ben Kibler W, Ellenbecker T, Sciascia A. Neuromuscular adaptations in shoulder function and dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:385-400. [PMID: 30482367 DOI: 10.1016/b978-0-444-63954-7.00037-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation stiffness. They may be based on inherent neuromuscular architecture, but are commonly affected by positive or negative adaptations to imposed functional demands. Positive neuromuscular adaptations improve the efficiency of performing the task, which can result in less energy expenditure, maximum force delivered to the task, and protection of involved joints from excessive loads/motions, and improve the effectiveness of task performance. They frequently result from specific training in task mechanics and optimal conditioning of the neuromuscular structures involved in the task. Negative neuromuscular maladaptations can affect the efficiency of performing the task, increase energy expenditure and loads, decrease the effectiveness of task performance, and can be associated with clinical presentation of injury symptoms. They can result from overload, injury, and/or limited recovery. This chapter will focus specifically on shoulder joint function to provide examples of positive adaptations and negative maladaptations. It will then provide guidelines for clinical evaluation, treatment of clinical injury, and training/conditioning, based on understanding the neuromuscular activation.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, KY, United States
| | - Todd Ellenbecker
- Rehab Plus Sports Therapy and ATP World Tour, Scottsdale, AZ, United States.
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, KY, United States
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Rosa DP, Borstad JD, Pogetti LS, Camargo PR. Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain. J Hand Ther 2017; 30:20-29. [PMID: 27769843 DOI: 10.1016/j.jht.2016.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/09/2016] [Accepted: 06/17/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Parallel-group intervention with repeated measures. INTRODUCTION Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. PURPOSE OF THE STUDY To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. METHODS A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. RESULTS Disabilities of the Arm, Shoulder, and Hand scores decreased (P < .05) in the patient group at post-intervention. No differences (P > .05) were found for PM length in both groups. Scapular anterior tilt increased (P < .05) at 90° of flexion in the healthy group. DISCUSSION This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. CONCLUSION The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the upper limbs improved in patients with shoulder pain. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Dayana P Rosa
- Physical Therapist, Master of Physical Therapy Program, Methodist University of Piracicaba, Piracicaba, SP, Brazil
| | - John D Borstad
- Associate Professor, Physical Therapy Division, The Ohio State University, Columbus, OH, USA
| | - Lívia S Pogetti
- Physical Therapist, Adjunct Professor, Physical Therapy Department, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula R Camargo
- Physical Therapist, Adjunct Professor, Physical Therapy Department, Federal University of São Carlos, São Carlos, SP, Brazil.
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Ruiz Ibán MA, Díaz Heredia J, García Navlet M, Serrano F, Santos Oliete M. Multidirectional Shoulder Instability: Treatment. Open Orthop J 2017; 11:812-825. [PMID: 28979595 PMCID: PMC5611704 DOI: 10.2174/1874325001711010812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background: The treatment of multidirectional instability of the shoulder is complex. The surgeon should have a clear understanding of the role of hiperlaxity, anatomical variations, muscle misbalance and possible traumatic incidents in each patient. Methods: A review of the relevant literature was performed including indexed journals in English and Spanish. The review was focused in both surgical and conservative management of multidirectional shoulder instability. Results: Most patients with multidirectional instability will be best served with a period of conservative management with physical therapy; this should focus in restoring strength and balance of the dynamic stabilizers of the shoulder. The presence of a significant traumatic incident, anatomic alterations and psychological problems are widely considered to be poor prognostic factors for conservative treatment. Patients who do not show a favorable response after 3 months of conservative treatment seem to get no benefit from further physical therapy. When conservative treatment fails, a surgical intervention is warranted. Both open capsular shift and arthroscopic capsular plication are considered to be the treatment of choice in these patients and have similar outcomes. Thermal or laser capsuloraphy is no longer recommended. Conclusion: Multidirectional instability is a complex problem. Conservative management with focus on strengthening and balancing of the dynamic shoulder stabilizers is the first alternative. Some patients will fare poorly and require either open or arthroscopic capsular plication.
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Affiliation(s)
| | - Jorge Díaz Heredia
- Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain
| | - Miguel García Navlet
- Hospital Asepeyo Coslada, Calle de Joaquín de Cárdenas, 2, 28823 Coslada, Madrid, Spain
| | - Francisco Serrano
- Hospital Asepeyo Coslada, Calle de Joaquín de Cárdenas, 2, 28823 Coslada, Madrid, Spain
| | - María Santos Oliete
- Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain
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Navlet MG, Asenjo-Gismero CV. Multidirectional Instability: Natural History and Evaluation. Open Orthop J 2017; 11:861-874. [PMID: 29081865 PMCID: PMC5633721 DOI: 10.2174/1874325001711010861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Multidirectional instability (MDI) represents a great challenge to the orthopedic surgeon. When treating these patients we must be aware that instability refers to a symptomatic situation, thus multidirectional instability is defined as symptomatic involuntary instability in two or more directions, and should be clearly differentiated from asymptomatic hyperlaxity. It may be associated with hyperlaxity, either congenital or acquired following repetitive stress, but also may be present without hyperlaxity, which is rare. Methods: We searched in the online data bases and reviewed the relevant published literature available. Results: Many differences can be seen in the current literature when identifying these patients, unclear definitions and criteria to be included in this patient group are common. Conclusion: Understanding the complex shoulder biomechanics as well as being aware of the typical clinical features and the key examination signs, which we review in this article, is of paramount importance in order to identify and classify these patients, allowing the best treatment option to be offered to each patient.
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Affiliation(s)
- Miguel García Navlet
- Shoulder and Elbow Unit, Upper extremity department at ASEPEYO Hospital Coslada, Madrid, Spain
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Lange T, Struyf F, Schmitt J, Lützner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review. Phys Ther Sport 2017; 26:64-89. [DOI: 10.1016/j.ptsp.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/01/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022]
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Kozono N, Okada T, Takeuchi N, Hamai S, Higaki H, Ikebe S, Shimoto T, Miake G, Nakanishi Y, Iwamoto Y. In vivo kinematic analysis of the glenohumeral joint during dynamic full axial rotation and scapular plane full abduction in healthy shoulders. Knee Surg Sports Traumatol Arthrosc 2017; 25:2032-2040. [PMID: 27511218 DOI: 10.1007/s00167-016-4263-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the kinematics of healthy shoulders during dynamic full axial rotation and scapular plane full abduction using three-dimensional (3D)-to-two-dimensional (2D) model-to-image registration techniques. METHODS Dynamic glenohumeral kinematics during axial rotation and scapular plane abduction were analysed in 10 healthy participants. Continuous radiographic images of axial rotation and scapular plane abduction were taken using a flat panel radiographic detector. The participants received a computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial radiographic images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the humerus and scapula during dynamic full axial rotation and scapular plane full abduction. RESULTS The humeral head centre translated an average of 2.5 ± 3.1 mm posteriorly, and 1.4 ± 1.0 mm superiorly in the early phase, then an average of 2.0 ± 0.8 mm inferiorly in the late phase during external rotation motion. The glenohumeral external rotation angle had a significant effect on the anterior/posterior (A/P) and superior/inferior (S/I) translation of the humeral head centre (both p < 0.05). 33.6 ± 15.6° of glenohumeral external rotation occurred during scapular plane abduction. The humeral head centre translated an average of 0.6 ± 0.9 mm superiorly in the early phase, then 1.7 ± 2.6 mm inferiorly in the late phase, and translated an average of 0.4 ± 0.5 mm medially in the early phase, then 1.6 ± 1.0 mm laterally in the late phase during scapular plane abduction. The humeral abduction angle had a significant effect on the S/I and lateral/medial (L/M) translation of the humeral head centre (both p < 0.05). CONCLUSION This study investigated 3D translations of the humerus relative to the scapula: during scapular plane full abduction, the humerus rotated 33.6° externally relative to the scapula, and during external rotation motion in the adducted position, the humeral head centre translated an average of 2.5 mm posteriorly. Kinematic data will provide important insights into evaluating the kinematics of pathological shoulders. For clinical relevance, quantitative assessment of dynamic healthy shoulder kinematics might be a physiological indicator for the assessment of pathological shoulders.
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Affiliation(s)
- Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Takamitsu Okada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Naohide Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1, Matsukadai, Higashi-ku, Fukuoka City, Fukuoka, 813-8503, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1, Matsukadai, Higashi-ku, Fukuoka City, Fukuoka, 813-8503, Japan
| | - Takeshi Shimoto
- Department of Information and System Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka City, Fukuoka, 811-0295, Japan
| | - Go Miake
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yoshitaka Nakanishi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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Keshavarz R, Bashardoust Tajali S, Mir SM, Ashrafi H. The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach. J Bodyw Mov Ther 2017; 21:386-400. [DOI: 10.1016/j.jbmt.2016.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/10/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
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