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Garret J, Cuinet T, Guillard V, Montalvan B. Shoulder range of motion in competitive tennis players: systematic review and meta-analysis. JSES Int 2024; 8:551-569. [PMID: 38707586 PMCID: PMC11064711 DOI: 10.1016/j.jseint.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background To compare shoulder range of motion (ROM) in dominant vs. nondominant shoulder of competitive tennis players, and to determine whether shoulder ROM is different between younger and older players, or males and females. Methods A search was performed on PubMed, Embase, and Epistemonikos on December 18, 2023. This study conforms to the principles of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Clinical studies or case reports on shoulder ROM including external rotation (ER; shoulder at 90° of abduction) and internal rotation (IR) in competitive, elite, or professional tennis players. Results We found 25 eligible studies that reported on a total of 18,534 tennis players, of which 20 studies reported the ROM for the dominant and nondominant side. Comparing dominant vs. nondominant shoulders revealed that dominant shoulders had significantly smaller IR (53.0° vs. 62.6°; P < .001). Comparing adults vs. children revealed that adults have significantly smaller IR (44.5° vs. 57.1°; P < .001) and ER (95.3° vs. 110.3°; P < .001). Comparing females vs. males revealed no significant differences in ER (113.4° vs. 104.9°; P = .360) or IR (54.3° vs. 56.4°; P = .710). Conclusion IR in shoulders of tennis players is significantly smaller in dominant vs. nondominant sides (53.0° vs. 62.6°, P < .001), and significantly smaller in adults vs. children (44.5° vs. 57.1°, P < .001). These findings could be relevant in the context of physical preparation and training of tennis players, to monitor evolution of IR as a result of their sport and/or as they transition from childhood to adulthood.
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Affiliation(s)
| | - Thomas Cuinet
- Clinique du Parc, ELSAN, Lyon, France
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
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Joo YB, Lee WY, Chung HJ. Suprascapular nerve entrapment caused by a large hematoma of the scapula: a case report. BMC Musculoskelet Disord 2023; 24:589. [PMID: 37468872 DOI: 10.1186/s12891-023-06723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 07/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Suprascapular nerve entrapment is a rare disorder that is frequently misdiagnosed as another disease. The suprascapular nerve is commonly entrapped at the following two sites: the suprascapular and spinoglenoid notches. Nerve entrapment at the spinoglenoid notch causes infraspinatus muscle weakness and atrophy. Patients present with posterior shoulder pain and weakness. Magnetic resonance imaging is used to confirm the diagnosis of a spinoglenoid cyst and nerve compression. Open or arthroscopic aspiration or decompression is indicated for patients with cysts in whom conservative treatment has failed and those with cysts associated with suprascapular nerve compression. CASE PRESENTATION Herein, we describe the case of a 49-year-old man with suprascapular nerve entrapment caused by a large cyst, namely, a hematoma, in the superior scapular and spinoglenoid notches. Open surgical decompression of the suprascapular nerve was performed owing to an intact rotator cuff and glenoid labrum. CONCLUSION Posterior shoulder pain promptly resolved without complications.
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Affiliation(s)
- Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woo Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyung Jin Chung
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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López-Vidriero Tejedor R, Laver L, López-Vidriero Tejedor E. Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome. Knee Surg Sports Traumatol Arthrosc 2023; 31:2152-2159. [PMID: 36637477 DOI: 10.1007/s00167-023-07310-5] [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: 09/26/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To analyze the shoulder alterations of professional tennis players during the competition season and to compare the differences between their dominant vs. non-dominant shoulders, as well as gender and age differences. METHODS Two-hundred and seventy shoulders of (78 men and 57 women) professional active tennis players were assessed during 3 ATP and WTA tournaments. MAIN VARIABLES STUDIED long head of biceps (LHB) tenderness and synovitis; glenohumeral internal rotation deficit (GIRD), total range of motion (TRM), external rotation (ER) and scapular dyskinesis (DK). Secondary variables: shoulder dominance, gender, age, training hours, ranking, type of backhand. LHB tenderness and synovitis were assessed by clinical and ultrasound examination, TRM with goniometer and DK by dynamic observation. RESULTS LHB tenderness of the dominant shoulder was present in 35% of all players, being more prevalent in women (47.4%) than men (26.9%) p = 0.023. LHB synovitis of the dominant shoulder was present in 20.2% of all players without difference between genders (n.s). High prevalence of GIRD was found in both dominant (87.4%) and non-dominant (56.3%) shoulders, being more prevalent in the dominant shoulder p = 0.00005. TRM was decreased in both dominant (144.5° ± 20.2°) and non-dominant shoulders (161.2° ± 18.9°) p = 0.00005. ER was normal in dominant (93.8° + /9.3°) and non-dominant shoulders (93.4° + /8.4°) (n.s). DK was present in 57.7% of dominant and 45.9% of non-dominant shoulders (n.s). The combination of LHB alterations, GIRD and DK in the dominant shoulder was present in 13.3% of the participants. There were no significant differences between younger (< 22 years) vs older players (≥ 22 years). CONCLUSION Professional tennis players actively playing suffer a high prevalence of LHB inflammation, GIRD, scapular dyskinesis and decreased TRM in their dominant and non-dominant shoulders. The LHB is a significant cause for anterior shoulder pain in this population. Women suffer more LHB tenderness than men. Young players are as affected as older players. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Rosa López-Vidriero Tejedor
- ISMEC (International Sports Medicine Clinic), Seville, Spain. .,Hospital Universitario Infanta Elena, Madrid, Spain. .,Mutua Madrid Open 1000 ATP/WTA Tennis Masters, Madrid, Spain.
| | - Lior Laver
- Department of Orthopaedics and Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,AtrhroSport Clinic, Tel-Aviv, Israel
| | - Emilio López-Vidriero Tejedor
- ISMEC (International Sports Medicine Clinic), Seville, Spain.,Hospital Universitario Infanta Elena, Madrid, Spain.,Mutua Madrid Open 1000 ATP/WTA Tennis Masters, Madrid, Spain.,Andalusian Tennis Federation, Seville, Spain.,Orthopedic Department, Hospital Universitario Virgen Macarena, Seville, Spain
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Giordano KA, Wasserberger KW, Oliver GD. Altered Cervical Spine Position Results in Decreased Shoulder Rotation Strength. Clin Orthop Relat Res 2022; 480:1719-1727. [PMID: 35417438 PMCID: PMC9384907 DOI: 10.1097/corr.0000000000002212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Strength testing of shoulder rotation is commonly used in clinical examinations of the shoulder. People prone to shoulder injury, such as overhead athletes and manual trade workers, place their shoulders under tremendous amounts of stress when the cervical spine is in nonneutral positions. If these nonneutral cervical spine positions result in decreased shoulder strength, it may help explain the etiology of the high prevalence of shoulder injuries in these populations. Given standard clinical strength assessments are performed with a neutral cervical spine, an investigation into the effects of cervical spine rotation is warranted. QUESTIONS/PURPOSES We sought to compare isokinetic shoulder rotation strength while in a neutral position with rotated cervical spine positions, specifically (1) with the cervical spine rotated contralaterally with the shoulder elevated in the frontal plane and (2) with the cervical spine rotated ipsilaterally and the shoulder elevated in the scapular plane. METHODS A convenience sample of 52 individuals (height 170 ± 10 cm; weight 73 ± 18 kg, age 21 ± 2 years; 18 males, 34 females), without shoulder or cervical spine pathology participated in this study. Participants were screened for eligibility via questionnaire. Concentric shoulder internal and external rotation torque was measured through a 90° arc on an isokinetic dynamometer with the shoulder elevated 90° in the frontal plane, and again 45° anterior to the frontal plane (scapular plane). Two repetitions were performed in a single testing session with the participant's cervical spine in neutral in both planes, maximally rotated contralaterally in the frontal plane, and maximally rotated ipsilaterally with the shoulder in the scapular plane; the second repetition was used for analysis. The testing order was randomized. Data were imported into a platform for statistical parametric mapping analysis (a technique that allows data from the entire arc of motion to be compared with data from another arc to identify differences in the wave form) to compare strength between positions throughout 90° arc of motion. RESULTS Rotating the cervical spine contralaterally with the shoulder in the frontal plane resulted in a decrease in external (2.24 Nm or 12% average difference; p < 0.001) and internal (2.22 Nm or a 6% average difference; p = 0.02) rotation strength with the forearm within 15° and 20° of the vertical position. Rotating the cervical spine ipsilaterally with the shoulder in the scapular plane resulted in a decrease in external rotation strength (1.27 Nm or a 6% average difference; p < 0.001) throughout nearly all the motion, with peaks approximately 20° and 60° from the horizontal position, and internal rotation strength (1.78 Nm or 5% average difference; p < 0.001) the last 60° towards the horizontal position. CONCLUSION Patient populations who require strenuous use of their shoulders in altered cervical spine positions may be at increased risk for injury from decreased shoulder rotator strength. CLINICAL RELEVANCE Clinicians should assess shoulder strength in the position the patient requires to use their shoulder because cervical spine position may cause weakness that would be missed in standard testing positions.
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Affiliation(s)
| | - Kyle W. Wasserberger
- Auburn University, Auburn, AL, USA
- Research and Development – Driveline Baseball, Seattle, WA, USA
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Johansson F, Asker M, Malmberg A, Fernandez-Fernandez J, Warnqvist A, Cools A. Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players. Front Sports Act Living 2022; 4:798255. [PMID: 35252855 PMCID: PMC8891455 DOI: 10.3389/fspor.2022.798255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.
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Affiliation(s)
- Fredrik Johansson
- Tennis Research and Performance Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
- *Correspondence: Fredrik Johansson
| | - Martin Asker
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
- Handball Research Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Andreas Malmberg
- Tennis Research and Performance Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Gent, Belgium
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Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle. J Bodyw Mov Ther 2021; 28:276-282. [PMID: 34776153 DOI: 10.1016/j.jbmt.2021.08.001] [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: 10/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.
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Plancher KD, Evely TB, Brite JE, Briggs KK, Petterson SC. Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:198-206. [PMID: 37588953 PMCID: PMC10426469 DOI: 10.1016/j.xrrt.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Suprascapular nerve compression at the spinoglenoid notch can lead to posterior shoulder pain, muscle weakness, and longstanding muscle atrophy of the infraspinatus. Although rare, it is most commonly seen in overhead athletes and laborers who perform repetitive overhead activities. Early diagnosis requires a thorough history and physical examination including imaging, diagnostic injections, and electromyography to avoid a missed diagnosis. While a course of nonoperative treatment is most often prescribed, early surgical intervention may be prudent to avoid irreversible damage especially if a space occupying lesion is present. This article will describe the history, physical examination findings, diagnostic workup, and our surgical technique for arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch through a simple posterior approach avoiding the subacromial space.
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Affiliation(s)
- Kevin D. Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
- Plancher Orthopaedics & Sports Medicine, New York, NY, USA
- Orthopaedic Foundation, Stamford, CT, USA
| | - Thomas B. Evely
- Plancher Orthopaedics & Sports Medicine, New York, NY, USA
- Orthopaedic Foundation, Stamford, CT, USA
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Schulterinstabilität beim Überkopfsportler. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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