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Mendez-Rebolledo G, Araya-Quintanilla F, Guzmán-Muñoz E, Salazar-Mendez J, Cruz-Montecinos C, Berckmans KR, Calatayud J. Comparative Electromyographic Study of Scapular Stabilizing Muscles During Five Main Rehabilitation Exercises. Am J Phys Med Rehabil 2024; 103:502-509. [PMID: 38261765 DOI: 10.1097/phm.0000000000002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of the study is to compare the surface electromyographic amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises. DESIGN Twenty-seven healthy participants performed five scapular exercises (wall slide, wall push-up plus, prone horizontal abduction with external rotation, external rotation in side lying, and low row) while simultaneously recording surface electromyographic of serratus anterior, middle trapezius, lower trapezius, and upper trapezius. Surface electromyographic amplitudes, onset latencies, and activation ratios were calculated. RESULTS Prone horizontal abduction with external rotation showed an excellent upper trapezius/middle trapezius (0.43) and upper trapezius/lower trapezius (0.30) muscle balance with high (>50% maximum voluntary isometric contraction) middle trapezius and lower trapezius amplitudes, a low (<20% maximum voluntary isometric contraction) upper trapezius amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to upper trapezius. External rotation in side lying showed excellent upper trapezius/serratus anterior (0.26), upper trapezius/middle trapezius (0.32), and upper trapezius/lower trapezius (0.21) activation ratios and, along with low row and wall slide, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms). CONCLUSIONS Prone horizontal abduction with external rotation presented optimal scapular neuromuscular control. Although external rotation in side lying, low row, and wall slide did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- From the Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile (GM-R, EG-M, JS-M); Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile (FA-Q); Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile (CC-M); Department of Rehabilitation Sciences (Physical Therapy), University Hospital Ghent, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium (KRB); and Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain (JC)
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Vandenbosch D, Van Tongel A, De Wilde L, Cools AM. Electromyographic analysis of selected shoulder muscles during shoulder rehabilitation exercises in patients after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00349-5. [PMID: 38754545 DOI: 10.1016/j.jse.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) aims to restore function in patients with rotator cuff failure and joint arthropathy. After surgery, patients are routinely referred to a rehabilitation specialist to regain range of motion, strength, and function. A key element in these programs is active exercises. The exercises are often selected based on assumed muscle activity, investigated by electromyography (EMG). In particular, in this patient population, activation of the deltoid and the scapular muscles is the focus of exercise therapy. Currently, most studies investigating muscle activity levels during exercises are performed on healthy individuals. To our knowledge, no study exists analyzing EMG activity during exercises in a population of shoulder arthroplasty patients. Therefore, the study aimed to analyze activity in the shoulder girdle muscles during 6 commonly used rehabilitation exercises 12 weeks after reverse shoulder arthroplasty surgery. METHODS Forty-four patients (50 shoulders) participated in this cross-sectional study, 12 weeks postoperatively (mean 99.18 ± 12.8 days), aged 68.9 ± 7.75 years. Surface EMG activity was measured in 10 shoulder girdle muscles: the 3 trapezius parts, serratus anterior, the 3 deltoid parts, latissimus dorsi, and 2 pectoralis major parts during 6 exercises, 3 in a closed chain, and 3 open chain elevation exercises. RESULTS Gravity-minimized exercises (horizontal plane) show low activity for almost all muscles. Vertical closed kinetic chain exercises show an increased activity compared to horizontal plane exercises. Open kinetic chain exercises against gravity showed the greatest activity in deltoid and upper trapezius. For the other muscles, no consistency in progression was found. CONCLUSION This study offers a progression of exercises for patients after reverse shoulder arthroplasty based on increased muscle activity.
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Affiliation(s)
- Dominiek Vandenbosch
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Ghent, Belgium; Department of Physical Health and Rehabilitation, Ghent University Hospital, Ghent, Belgium.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann M Cools
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Ghent, Belgium
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Yadav SK, Lal G, Jain SB, Jha CK, Corwin C, Van Gorp B, Sharma CK, Kumar A, Sinha DK. Indian surgery Trainee's perspective on surgical ergonomics principles and education: A long road ahead. Am J Surg 2023; 226:735-740. [PMID: 37308348 DOI: 10.1016/j.amjsurg.2023.05.037] [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: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aimed to determine the baseline knowledge and beliefs, along with the impact of incorporating surgical ergonomics lectures during a residency. METHODS A cohort of 123 Indian surgical residents participated in this educational intervention, which consisted of two educational webinars on ergonomics. Both pre- and post-intervention surveys were electronically sent to the participants. These included questions related to their demographics, prevalence of musculoskeletal (MSK) symptoms, and factors affecting participant awareness of ergonomic recommendations. RESULTS Seventy-one residents responded to the pre-webinar survey. Eighty-five percent of respondents reported MSK symptoms, with the most common being pain (70%) and stiffness (40%), which the residents attributed to their surgical training. Forty-six residents completed the post-webinar survey. The majority of respondents strongly agreed or agreed that surgical ergonomic educational sessions improved their understanding of the fundamental causes of MSK symptoms and increased their awareness of options available for prevention MSK injuries. CONCLUSION The rate of MSK symptoms and/or injury was high among this cohort of surgical residents. These surveys and educational session demonstrated there is limited awareness of the comprehension of ergonomics related to surgical procedures. Our study shows that a simple surgical ergonomic educational intervention can lead to improved understanding of prevention and ergonomic changes.
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Affiliation(s)
| | - Geeta Lal
- Adult Inpatient, Division of Surgical Oncology and Endocrine Surgery, University of Iowa, USA
| | - Sapana Bothra Jain
- Consultant (Endocrine and Breast Surgery), Mahatma Gandhi Institute of Medical Sciences, Jaipur, India
| | - Chandan Kumar Jha
- Department of Surgery, All India Institute of Medical Sciences, Patna, India
| | - Claudia Corwin
- Department of Internal Medicine, Carver College of Medicine, University of Iowa Employee Health, University of Iowa Hospitals and Clinics, USA
| | - Barbara Van Gorp
- Iowa Orthopedic Sports Medicine and Rehabilitation, Iowa Carver College of Medicine, Dept of Physical Therapy and Rehabilitation Science, University of Iowa, USA
| | - Chitresh Kumar Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, India
| | - Amit Kumar
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India
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Mantovani M, Sciascia A, Varini A, Muraccini M, Nardini F, Tonino P, Kibler BW. Accuracy of measuring scapular position and motion with a novel motion capture system. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:303-311. [PMID: 37588505 PMCID: PMC10426632 DOI: 10.1016/j.xrrt.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Scapula kinematics is recognized to be a crucial variable in shoulder dysfunction. Nevertheless, quantitative scapula tracking and measurement are not part of the current clinical evaluation. The main concern is measurement accuracy. Methods To assess the accuracy of the wearable sensor technology Showmotion a cadaver experiment was designed, allowing a direct comparison between sensors directly pinned to the scapula and superficial sensors. A measurement protocol was adopted to evaluate errors in measurement, mimicking the suggested in vivo evaluation. Sensors were simultaneously placed above (supraspinal) and below (infraspinal) the scapular spine to determine if one placement resulted in fewer errors compared to the other. Results Mean and standard deviations of the supraspinal sensor root mean square error (RMSE) in flexion-extension movements resulted in 3.59° ± 2.36°, 4.73° ± 2.98°, and 6.26° ± 3.62° for upward-downward rotation (up-down), anterior-posterior tilt and internal-external (intra-extra) rotation, respectively, while 2.16° ± 1.21°, 2.20° ± 1.02°, and 4.46° ± 2.16° for the infraspinal sensor. In abduction-adduction movements, mean and standard deviations of the supraspinal sensor RMSE resulted in 4.26° ± 2.98°, 5.68° ± 4.22°, and 7.04° ± 4.36° for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.38° ± 1.63°, 2.47° ± 1.77°, and 4.92° ± 3.14° for the infraspinal sensor. The same behavior was confirmed in shrug movements, where 4.35° ± 3.24°, 4.63° ± 3.09°, and 5.34° ± 6.67° are mean and standard deviations of the supraspinal sensor RMSE for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.76° ± 1.87°, 2.83° ± 2.53°, and 4.68° ± 5.22° for the infraspinal sensor. Conclusion This method of quantitative assessment of scapular motion is shown to have good accuracy and low error between the sensor measurements and actual bone movement in multiple planes of scapular motion, both over the entire range of motion and in its individual segment intervals. The decreased amount of error with the infraspinal sensor placement suggests that placement is ideal for clinical quantitative assessment of scapular motion.
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Affiliation(s)
| | - Aaron Sciascia
- Institute of Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA
| | | | - Marco Muraccini
- NCS Lab Srl, Medical Device Research Lab, Carpi (Modena), Italy
| | | | - Pietro Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Liu J, Hui SSC, Yang Y, Liu Y, Song Q, Mao D. Scapular kinematics and muscle activity during Yi Jin Bang exercises. Front Physiol 2023; 14:1169092. [PMID: 37362425 PMCID: PMC10285390 DOI: 10.3389/fphys.2023.1169092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of shoulder rehabilitation. Our previous randomized controlled trial showed that Yi Jin Bang (YJB) exercises could effectively manage SAPS, but scapular motions and muscle activity during YJB exercises remain unknown. This study examined scapular kinematics synchronously with scapular muscle activation during YJB exercises. Methods: Thirty healthy participants with no shoulder complaints were enrolled in this study. Three-dimensional (3D) scapular kinematics and electromyography (EMG) activation of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, anterior deltoid, middle deltoid, and posterior deltoid were synchronously measured during nine YJB movements. Results: During all YJB movements, the scapula was upwardly rotated and anteriorly tilted, with more upward rotation and a similar or less anterior tilt than the mean resting scapular angle. Column rotation, arm crossover, shoulder support circle, and armpit support high lift generated more internal rotation than the mean resting scapular angle, with the angles of internal rotation significantly greater than the other five movements (p < 0.001). Regarding EMG activity, all YJB movements elicited low activity (1.42%-19.19% maximal voluntary isometric contraction [MVIC]) from the upper trapezius and posterior deltoid and low to moderate activity (0.52%-29.50% MVIC) from the middle trapezius, lower trapezius, serratus anterior, anterior deltoid, and middle deltoid. Conclusion: YJB exercises could be useful in the middle to later phases of shoulder rehabilitation. For patients with insufficient external rotation, some YJB movements should be prescribed with caution.
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Affiliation(s)
- Jinde Liu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Stanley Sai-chuen Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Yanhao Liu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Dewei Mao
- College of Sports and Health, Shandong Sport University, Jinan, China
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Tsuruike M, Ellenbecker TS. Effect of Scapular Retraction on Lower Trapezius, Infraspinatus, and Deltoid Muscle Electromyographic Activity During the Side-Lying Abduction Exercise. Int J Sports Phys Ther 2023; V18:715-725. [PMID: 37425105 PMCID: PMC10324291 DOI: 10.26603/001c.74969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background The lower trapezius (LT) muscle, which stabilizes the scapula posteriorly during arm elevation, has been interesting to both clinicians and researchers for its importance in throwing-related shoulder rehabilitation and injury prevention. Purpose The purpose of this study was to investigate the electromyographic activity of the LT and other relevant muscles during scapular and shoulder activities in the side-lying position. Methods Twenty collegiate baseball players volunteered to participate in this study. Electromyographic (EMG) output of the lower trapezius, infraspinatus, posterior deltoid, middle deltoid, serratus anterior, and upper trapezius muscles were collected. All the subjects performed isometric resistance exercises in four arm positions: 0° horizontal abduction from the coronal plane (NEUT) with protraction (NEUT-PRO), 15° horizontal adduction from the coronal plane (HADD) with protraction (HADD-PRO), and NEUT with retraction (NEUT-RET), and HADD-RET in a side-lying isometric abduction exercise with two external loads: a 9.1 kg dumbbell and 40% of the manual muscle test (MMT). The subjects also performed two more isometric resistance exercises: supine protraction and side-lying external rotation (ER) of the glenohumeral (GH) joint in GH adduction at 90° of GH ER or with as much ER as possible. All raw EMG data were normalized to maximal voluntary isometric contraction (% MVIC) of the corresponding muscle. Results LT activity was significantly greater in HADD-RET with 9.1 kg than that of HADD-PRO (p < 0.001) (55 vs 21% MVIC) while middle deltoid muscle activity was significantly decreased in both NEUT and HADD-RET compared to that of NEUT and HADD-PRO (p < 0.001). In contrast, IS muscle activity was significantly increased in HADD-RET with 9.1 kg compared with that 40% MMT (p < 0.001) (41 vs 22% MVIC). Conclusion LT activity was modulated by changes in scapulothoracic and glenohumeral joint positioning during a side-lying isometric abduction exercise. These findings may help clinicians to select exercises to improve scapular muscle balance ratios during rehabilitation of the shoulder complex. Level of Evidence Level 3b, Controlled laboratory study.
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Affiliation(s)
- Masaaki Tsuruike
- Department of Kinesiology, College of Health and Human Sciences San Jose State University
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Roehl T, Lambert BS, Ankersen J, Hernandez K, McCulloch PC, Hedt C. Optimal Blood Flow Restriction Occlusion Pressure for Shoulder Muscle Recruitment With Upper Extremity Exercise. Am J Sports Med 2023:3635465231166959. [PMID: 37092707 DOI: 10.1177/03635465231166959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND As blood flow restriction (BFR) utilization continues to rise, it is crucial to define optimal parameters for use. Currently unknown are the effects of occlusion level during BFR on muscle activity in the proximal shoulder. PURPOSE/HYPOTHESIS The purpose of this study was to compare electromyographic amplitude (EMGa) of shoulder musculature during exercise using limb occlusion percentages (LOPs). The authors hypothesized that EMGa would increase concurrently with occlusion. STUDY DESIGN Controlled laboratory study. METHODS α Fifteen healthy adults were recruited and underwent 4 experimental sessions, performing 3 common rotator cuff exercises at low intensity (20% maximal strength) to failure in the following order: cable external rotation (ER), cable internal rotation (IR), and dumbbell scaption. Exercises were completed at a different occlusion pressure (0%, 25%, 50%, and 75% LOP- order randomized) applied at the proximal arm. EMGa was recorded from shoulder musculature proximal to the occlusion site and averaged across 5-repetition intervals and overall for the first 30 repetitions. An analysis of variance repeated on occlusion pressure followed by a Bonferroni post hoc test was used to compare EMGa, repetitions to fatigue, and ratings of discomfort (visual analog scale [VAS], 0-10) between occlusion pressures. The type 1 error was set at α = .05 for all analyses. RESULTS Significant effects of the occlusion level on shoulder muscle EMGa were observed for all exercises (P < .05) with diminishing returns above 50% LOP (overall). For ER, elevations in EMGa were observed at ≥50% LOP for the anterior deltoid, middle deltoid, infraspinatus, and trapezius compared with 0% LOP (P < .05). For IR, elevations in EMGa were observed at ≥25% LOP for the anterior deltoid and trapezius compared with 0% LOP (P < .05). For the teres minor, a significant elevation in EMGa occurred at 75% LOP compared with 0%, 25%, and 50% LOP (P < .05). A decrease in EMGa was observed at ≥50% LOP compared with 0% LOP for the posterior deltoid (P < .05). For scaption, an increase in EMGa was observed at ≥25% LOP for the infraspinatus and teres minor muscles, at 75% LOP for the posterior deltoid, and at ≥50% LOP for the trapezius compared with 0% LOP (P < .05). Decreases in repetitions to failure relative to 0% LOP were observed at 75% LOP for ER (0%: 47 ± 5; 75%: 40 ± 2; P = .034), IR (0%: 82 ± 10; 75%: 64 ± 5; P = .017), and scaption (0%: 85 ± 9; 75%: 64 ± 6; P < .001). A significant linear increase in discomfort was observed for all exercises with increasing occlusion pressures (VAS: 0-10, 0% → 75% LOP; ER: 2.2 ± 0.4 → 7.2 ± 0.3; IR: 1.3 ± 0.2 → 6.1 ± 0.6; scaption: 1.3 ± 0.4 → 6.1 ± 0.4; P < .01). CONCLUSION There are several differences in muscle activation about the shoulder based on exercise and occlusion when utilizing BFR. Increasing the percentage of limb occlusion leads to heightened EMGa with diminished returns past 50% LOP when considering muscle activation, discomfort, and achievable exercise volume. CLINICAL RELEVANCE These findings may be used to refine upper extremity BFR guidelines.
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Affiliation(s)
- Tyler Roehl
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Bradley S Lambert
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Jordan Ankersen
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Karen Hernandez
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Patrick C McCulloch
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Corbin Hedt
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
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Mendez-Rebolledo G, Orozco-Chavez I, Morales-Verdugo J, Ramirez-Campillo R, Cools AM. Electromyographic analysis of the serratus anterior and upper trapezius in closed kinetic chain exercises performed on different unstable support surfaces: a systematic review and meta-analysis. PeerJ 2022; 10:e13589. [PMID: 35791364 PMCID: PMC9250763 DOI: 10.7717/peerj.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 01/17/2023] Open
Abstract
Background Multiple investigations have compared the electromyographic (EMG) activity of the scapular muscles between stable and unstable support surfaces during the execution of closed kinetic chain exercises. However, these comparative analyses have grouped different unstable surfaces (wobble board, BOSU, therapeutic ball, and suspension equipment) into a single data pool, without considering the possible differences in neuromuscular demand induced by each unstable support surface. This study aimed to analyze the individual effect of different unstable support surfaces compared to a stable support surface on scapular muscles EMG activity during the execution of closed kinetic chain exercises. Methodology A literature search was conducted of the Pubmed Central, ScienceDirect and SPORTDiscus databases. Studies which investigated scapular muscles EMG during push-ups and compared at least two support surfaces were included. The risk of bias of included articles was assessed using a standardized quality assessment form for descriptive, observational and EMG studies, and the certainty of the evidence was measured with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A random-effects model was used to calculate effect sizes (ES, Hedge's g). Results Thirty studies were selected in the systematic review. Of these, twenty-three low-to-high quality studies (498 participants) were included in the meta-analysis. The main analyzes revealed, in decreasing order, greater UT EMG activity during push-ups performed on suspension equipment (ES = 2.92; p = 0.004), therapeutic ball (ES = 1.03; p < 0.001) and wobble board (ES = 0.33; p = 0.003); without effect on the BOSU ball. In addition, no effect was observed for SA on any unstable device. The certainty of the evidence ranged from low to very low due to the inclusion of descriptive studies, as well as high imprecision, inconsistency, and risk of publication bias. Conclusion These findings could be applied in scapular muscles strengthening in healthy individuals. The use of suspension equipment achieves higher UT activation levels. Conversely, the use of any type of unstable devices to increase the activation levels of the SA in shoulder musculoskeletal dysfunctions is not recommended. These conclusions should be interpreted with caution as the available evidence showed a low to very low certainty of evidence, downgraded mostly by inconsistency and imprecision.
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Affiliation(s)
| | - Ignacio Orozco-Chavez
- Departamento de Ciencias del Movimiento Humano, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Juan Morales-Verdugo
- Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Ann M.J. Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ehmann YJ, Berthold DP, Reuter S, Beitzel K, Köhler R, Stöcker F, Muench LN, Pogorzelski J, Rupp MC, Braun S, Imhoff AB, Buchmann S. Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits. Knee Surg Sports Traumatol Arthrosc 2022; 30:2060-2066. [PMID: 34741625 PMCID: PMC9165257 DOI: 10.1007/s00167-021-06751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the sensorimotor and clinical function of patients with confirmed successful outcome after either undergoing acromioclavicular joint (ACJ) stabilization, Bankart repair (BR), or rotator cuff repair (RC), and to compare these measures to the contralateral, healthy side without history of previous injuries or surgeries of the upper extremity. It was hypothesized that patients of each interventional group would have inferior sensorimotor function of the shoulder joint compared to the contralateral, healthy side, while presenting with successful clinical and functional outcomes. METHODS Three intervention groups including ten patients who had confirmed successful clinical and functional outcomes after either undergoing ACJ stabilization, BR, or RC were evaluated postoperatively at an average follow-up of 31.7 ± 11.6 months. Additionally, a healthy control group (CG) of ten patients was included. Clinical outcomes were assessed using the Constant-Murley (CM) and American Shoulder and Elbow Surgeons (ASES) Score. Pain was evaluated using the visual analogue scale (VAS). Sensorimotor function was assessed by determining the center of pressure (COP) of the shoulder joint in a one-handed support task in supine position on a validated pressure plate. RESULTS Each interventional group demonstrated excellent clinical outcome scores including the CM Score (ACJ 83.3 ± 11.8; BR 89.0 ± 10.3; RC 81.4 ± 8.8), ASES Score (ACJ 95.5 ± 7.0; BR 92.5 ± 9.6; RC 96.5 ± 5.2), and VAS (ACJ 0.5 ± 0.9; BR 0.5 ± 0.8; RC 0.5 ± 0.8). Overall, the CG showed no significant side-to-side difference in COP, whereas the ACJ-group and the BR-group demonstrated significantly increased COP compared to the healthy side (ACJ 103 cm vs. 98 cm, p = 0.049; BR: 116 cm vs. 102 cm, p = 0.006). The RC-group revealed no significant side-to-side difference (120 cm vs. 108 cm, n.s.). CONCLUSION Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. This may indicate that specific postoperative training and rehabilitation protocols should be established for patients who underwent surgery of the upper extremity. These results underline that sensorimotor training should be an important component of postoperative rehabilitation and physiotherapeutic activities to improve postoperative function and joint control. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yannick J Ehmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sven Reuter
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- SRH University for Applied Health Sciences, Stuttgart, Germany
| | - Knut Beitzel
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Atos Orthoparc Klinik, Cologne, Germany
| | - Robin Köhler
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Fabian Stöcker
- Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sepp Braun
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Gelenkpunkt, Sport and Joint Surgery Innsbruck, Innsbruck, Austria
- OSMI - Research Unit for Orthopaedic Sports Medicine and Injury Prevention, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stefan Buchmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- OFZ Weilheim, Weilheim, Germany
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