Selective Activation of the Infraspinatus during Various Shoulder External Rotation Exercises

Activation patterns of rotator-cuff muscles from quantitative IVIM DWI after physical testing

BACKGROUND

The diagnostic value of clinical rotator cuff (RC) tests is controversial, with only sparse evidence available about their anatomical specificity. We prospectively assessed regional RC muscle activation patterns by means of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) after the execution of common clinical RC tests.

METHODS

Ten healthy subjects (five males, five females) underwent three sessions of diffusion-weighted 3-T shoulder MRI before and after testing the supraspinatus (SSP, Jobe test, session 1), subscapularis (SSC, lift-off test, session 2, at least 1 week later), and infraspinatus muscle (ISP, external rotation test, session 3, another week later). IVIM parameters (perfusion fraction, f; pseudo-diffusion coefficient. D*; and their product, fD*) were measured in regions of interest placed in images of the SSP, SSC, ISP, and deltoid muscle. The Wilcoxon signed-rank test was used for group comparisons; p-values were adjusted using the Bonferroni correction.

RESULTS

After all tests, fD* was significantly increased in the respective target muscles (SSP, SSC, or ISP; p ≤ 0.001). After SSP testing, an additional significant increase of fD* was observed in the deltoid, the SSC, and the ISP muscle (p < 0.001). After the SSC and ISP tests, no significant concomitant increase of any parameter was observed in the other RC muscles.

CONCLUSION

IVIM revealed varying activation patterns of RC muscles for different clinical RC tests. For SSP testing, coactivation of the deltoid and other RC muscles was observed, implying limited anatomical specificity, while the tests for the SSC and ISP specifically activated their respective target muscle.

RELEVANCE STATEMENT

Following clinical RC tests, IVIM MRI revealed that SSP testing led to shoulder muscle coactivation, while the SSC and ISP tests specifically activated the target muscles.

KEY POINTS

In this study, intravoxel incoherent motion MRI depicted muscle activation following clinical rotator cuff tests. After supraspinatus testing, coactivation of surrounding shoulder girdle muscles was observed. Subscapularis and infraspinatus tests exhibited isolated activation of their respective target muscles.

The Effects of Body Positions and Abduction Angles on Shoulder Muscle Activity Patterns during External Rotation Exercises

BACKGROUND

Excess and repetitive glenohumeral external rotation (ER) is at a higher risk for shoulder injuries, which occurs frequently in professional sports and specific occupations. Current rehabilitation programs emphasize selective targeting of muscle activity, which can help restore dysfunctional muscle imbalances or prevent injuries. However, the impact of different body postures on GH muscle activity during ER exercises has not been fully understood. Therefore, the purpose of this study was to investigate shoulder EMG activity for different body positions and humeral abduction angles during ER exercises.

METHOD

Twenty-three healthy young men (age: 22.3 ± 2.3, height: 175.75 ± 4.02, mass: 75.37 ± 9.14) participated in this study. Surface Electromyography was recorded from seven shoulder muscles: upper trapezius, lower trapezius, serratus anterior, infraspinatus, and deltoid. Six ER exercises: three postures (sitting, supine lying, and prone lying) and two abduction angles (ABD; 45° and 90°) were tested using an isokinetic dynamometer.

RESULTS

During a sitting position, the lower trapezius/upper trapezius muscle activity ratios were significantly increased for sitting compared to supine lying and prone lying (p < 0.001, p = 0.004). Serratus anterior/upper trapezius co-contraction indices were significantly increased for 90° than 45° ABD (p < 0.001).

CONCLUSION

These findings can provide insight into new training programs aimed at restoring GH muscle imbalances.

Estimation of Time-Frequency Muscle Synergy in Wrist Movements

Muscle synergy analysis is a kind of modularized decomposition of muscles during exercise controlled by the central nervous system (CNS). It can not only extract the synergistic muscles in exercise, but also obtain the activation states of muscles to reflect the coordination and control relationship between muscles. However, previous studies have mainly focused on the time-domain synergy without considering the frequency-specific characteristics within synergy structures. Therefore, this study proposes a novel method, named time-frequency non-negative matrix factorization (TF-NMF), to explore the time-varying regularity of muscle synergy characteristics of multi-channel surface electromyogram (sEMG) signals at different frequency bands. In this method, the wavelet packet transform (WPT) is used to transform the time-scale signals into time-frequency dimension. Then, the NMF method is calculated in each time-frequency window to extract the synergy modules. Finally, this method is used to analyze the sEMG signals recorded from 8 muscles during the conversion between wrist flexion (WF stage) and wrist extension (WE stage) movements in 12 healthy people. The experimental results show that the number of synergy modules in wrist flexion transmission to wrist extension (Motion Conversion, MC stage) is more than that in the WF stage and WE stage. Furthermore, the number of flexor and extensor muscle synergies in the frequency band of 0–125 Hz during the MC stage is more than that in the frequency band of 125–250 Hz. Further analysis shows that the flexion muscle synergies mostly exist in the frequency band of 140.625–156.25 Hz during the WF stage, and the extension muscle synergies appear in the frequency band of 125–156.25 Hz during the WE stage. These results can help to better understand the time-frequency features of muscle synergy, and expand study perspective related to motor control in nervous system.

Comparison of the Shoulder External Rotator Strength and Asymmetry Ratio Between Workers With and Without Shoulder Impingement Syndrome

ABSTRACT

Kim, J-H, Kwon, O-Y, Hwang, U-J, Jung, S-H, Ahn, S-H, and Kim, H-A. Comparison of shoulder external rotator strength and the asymmetry ratio between workers with and without shoulder impingement syndrome. J Strength Cond Res 35(12): 3364-3369, 2021-Shoulder impingement syndrome (SIS) is the most common shoulder problem causing shoulder pain. Several studies have indicated that shoulder external rotator muscles provide dynamic stability to the shoulder joint. However, the relationship of SIS to changes in shoulder external rotator muscle strength remains controversial. The purpose of the study was to compare the shoulder external rotator strength and asymmetry ratio between workers with SIS and the normal group in a side-lying position. Twelve male industrial workers with SIS and the normal group of 12 workers participated in this study. A pulling sensor measured shoulder external rotator muscle strength in a side-lying position with the shoulder at 0° and 90° of flexion. The asymmetry ratio was calculated by a specific formula using the shoulder external rotator muscle strength of the dominant side and the unaffected side. Two-way analysis of variance was used to determine between-group differences in shoulder external rotator muscle strength and the asymmetry ratio among the 2 positions. Subjects with SIS did not exhibit significant differences in shoulder external rotator muscle strength in the side-lying position with the shoulder at 0° and 90° of flexion relative to the normal group. However, subjects with SIS had a significantly increased asymmetry ratio of shoulder external rotation strength in the side-lying position with the shoulder at 90° of flexion compared with the normal group. In conclusion, workers with SIS had an asymmetry of shoulder external rotator strength in side-lying with the shoulder at 90° of flexion.

Análise eletromiográfica de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica

RESUMO Na artrocinemática do ombro, o manguito rotador atua estabilizando a cabeça umeral em contato com a cavidade glenoidal, enquanto realiza a translação inferior para contrabalancear a força rotacional promovida principalmente pelo deltoide. Exercícios de rotação externa (RE) vêm sendo utilizados na reabilitação de pacientes com disfunções no complexo do ombro buscando restaurar a artrocinemática. Porém, poucos estudos abordam a utilização da faixa elástica e a avaliação dos músculos da cintura escapular, determinantes para uma cinemática adequada. O objetivo deste estudo é comparar a atividade eletromiográfica (EMG) de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. Participaram 11 sujeitos do sexo masculino que foram avaliados durante os movimentos de (1) RE em ortostase; (2) RE com abdução de ombro; (3) RE em decúbito lateral (DL). Os músculos avaliados pela EMG foram: (1) trapézio superior (TS); (2) deltoide médio (DM); (3) deltoide posterior (DP); e (4) infraespinal (IN). A resistência foi determinada por uma faixa elástica cinza calibrada com carga de 5% do peso corporal. A análise dos dados foi realizada no software Biomec-SAS e as estatísticas foram calculadas por meio da Anova de medidas repetidas no software SPSS v20.0. Pôde-se constatar que os músculos TS e DM obtiveram maior atividade EMG durante o exercício de RE com abdução de ombro, o músculo DP durante a RE com abdução de ombro e RE em decúbito lateral, enquanto o IN a obteve durante a RE em ortostase e RE em decúbito lateral.

Infraspinatus Isolation During External Rotation Exercise at Varying Degrees of Abduction

CONTEXT

External rotation (ER) strengthening exercises are a common component of shoulder injury prevention and rehabilitation programs. They are primarily intended to target the infraspinatus muscle, based on its role in glenohumeral stabilization and inferior humeral glide. ER also recruits the posterior deltoid, which can be undesirable due to its role in subacromial space narrowing.

OBJECTIVE

To determine the angle of humeral abduction that maximizes the infraspinatus to posterior deltoid activation ratio (INFRA/PD) during ER.

DESIGN

Within-subjects repeated-measures controlled lab trial.

PARTICIPANTS

A total of 10 healthy participants (5 males, 5 females) aged 21 (0.67) years participated in the study.

INTERVENTION

7 consecutive repetitions of ER at 7 different abduction angles ranging from 0° to 90°, with resistance normalized to 3% body mass.

MAIN OUTCOME MEASURES

Surface electromyography was performed on the infraspinatus, middle deltoid, and posterior deltoid. Surface electromyography data were processed to determine absolute muscle activation as well as INFRA/PD at each abduction angle. Group means were compared between abduction angles using 1-way analysis of variance.

RESULTS

Abduction significantly reduced overall infraspinatus activity but increased posterior deltoid activity (P < .01). Average and peak INFRA/PD decreased as the angle of abduction increased (P < .001 and P < .01, respectively).

CONCLUSION

Our findings suggest that ER should be performed in 0° of abduction to maximize infraspinatus isolation. Slight abduction, such as placing a towel under the humerus, as recommended by some clinicians, may improve patient comfort, but did not increase infraspinatus isolation in this study.

A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair

Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, and to identify exercises that meet a cut point of 15% maximal voluntary isometric contraction (MVIC) or less and are unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, Embase, CINAHL, SPORTDiscus, PubMed, and the Cochrane Library for all years up to June 2016 was performed. Studies were selected in relation to predefined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC), low to moderate (16%-20% MVIC), moderate (21%-40% MVIC), high (41%-60% MVIC), and very high (greater than 60% MVIC). Results A search identified 2159 studies. After applying the selection criteria, 20 studies were included for quality assessment, data extraction, and data synthesis. In total, 43 exercises spanning passive range of motion, active-assisted range of motion, and strengthening exercises were evaluated. Out of 13 active-assisted exercises, 9 were identified as suitable (15% MVIC or less) to load the supraspinatus and 10 as suitable to load the infraspinatus early after surgery. All exercises were placed in a theoretical-continuum model, by which general recommendations could be made for prescription in patients post rotator cuff repair. Conclusion This review identified passive and active-assisted exercises that may be appropriate in the early stages after rotator cuff repair. J Orthop Sports Phys Ther 2017;47(12):931-944. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7271.

Changes in the electromyographic activities of the infraspinatus and posterior deltoid according to abduction angles of the shoulder joint during shoulder external rotation in closed kinetic chain exercise

[Purpose] This study's purpose was to identify abduction angles of the shoulder joint that can provide effective infraspinatus muscle exercises while minimizing the muscle activity of the posterior deltoid muscle. [Subjects and Methods] The subjects of this study were 15 healthy young students in their 20s. Subjects adopted a standing position and performed shoulder external abduction while pushing their hands against the wall. The current research was undertaken to compare the activity of the infraspinatus muscle and the posterior deltoid muscle at abduction angles of 45, 90 and 135° of the shoulder joint during closed kinetic chain exercises. [Results] A activity of the infraspinatus muscle showed no statistically significant differences. The activities of posterior deltoid muscle were greater at the angle of 45° than at 90 and 135°. [Conclusion] These results indicate that to strengthen the infraspinatus, shoulder external rotation exercises at abduction angles of the shoulder joint greater than 45° are more effective.

The effect of exercise types for rotator cuff repair patients on activities of shoulder muscles and upper limb disability

[Purpose] This study investigated the effect on activities, shoulder muscle fatigue, upper limb disability of two exercise types performed by patients in the post- immobilization period of rotator cuff repair. [Subjects and Methods] The intervention program was performed by 20 patients from 6 weeks after rotator cuff repair. Ten subjects each were randomly allocated to a group performing open kinetic chain exercise and a group preforming closed kinetic chain exercise. Muscle activity and median frequency were measured by using sEMG and the Upper Extremity Function Assessment before and after conducting the intervention and changes in the results were compared. [Results] There was a significant within group increases in the activities of the shoulder muscles, except for the posterior deltoid. The median power frequencies (MFD) of the supraspinatus, infraspinatus and anterior deltoid significantly increased in the open kinetic chain exercise group, but that of the posterior deltoid decreased. There were significant differences in the changes in the upper limb disability scores of the two groups, in the shoulder muscle activities, except for that of the posterior deltoid, in the comparison of the change in the muscle activities of the two groups, and in the MDFs of all shoulder muscles. [Conclusion] The Median power frequencies of all these muscles after closed kinetic chain exercise increased indicating that muscle fatigue decreased. Therefore, research into exercise programs using closed kinetic chain exercises will be needed to establish exercise methods for reducing muscle fatigue.

Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis

[Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis.

Differences in Muscle Activities of the Infraspinatus and Posterior Deltoid during Shoulder External Rotation in Open Kinetic Chain and Closed Kinetic Chain Exercises

[Purpose] This study investigated the changes in electromyographic (EMG) activities of the infraspinatus and posterior deltoid muscles during shoulder external rotation under open kinetic chain (OKC) and closed kinetic chain (CKC) exercise conditions. [Subjects] In total, 15 healthy males participated in this study. [Methods] Subjects performed shoulder external rotations under CKC and OKC conditions while standing with and without weight support provided by a height-adjustable table. Pressure biofeedback was used to ensure a constant amount of weight support. The activities of the infraspinatus and posterior deltoid muscles during shoulder external rotation were measured using a wireless surface EMG system. The paired t-test was used to compare the EMG activities of the infraspinatus and the posterior deltoid muscles and the ratio of the infraspinatus to the posterior deltoid during shoulder external rotation under OKC and CKC conditions. [Results] The EMG activity of the infraspinatus and the ratio of the infraspinatus to the posterior deltoid activities were significantly increased, whereas the posterior deltoid activity was significantly decreased under the CKC condition compared to the OKC condition. [Conclusion] Clinicians should consider the CKC shoulder external rotation exercise when they wish to selectively strengthen the infraspinatus.

Changes in Shoulder External Rotator Muscle Activity during Shoulder External Rotation in Various Arm Positions in the Sagittal Plane

[Purpose] The aim of this study was to investigate changes in electromyographic (EMG) activity of the infraspinatus and posterior deltoid muscles during shoulder external rotation under different shoulder flexion angles. [Subjects] Thirteen participants were included in this study. [Methods] The participants performed isometric shoulder external rotation at 45°, 90°, and 135° of shoulder flexion. A surface EMG system recorded the EMG activity of the infraspinatus and posterior deltoid muscles during shoulder external rotation. The changes in the muscle activity of infraspinatus and posterior deltoid and ratio of infraspinatus to posterior deltoid muscle activity were analyzed using one-way repeated-measures analysis of variance with Bonferroni’s correction. [Results] The posterior deltoid activity was significantly decreased, while the ratio of the infraspinatus to posterior deltoid activity was significantly increased at 45° of shoulder flexion compared with 90° and 135° of shoulder flexion (p < 0.05). There were no significant differences in the EMG activity of the infraspinatus among the three conditions (p > 0.05). [Conclusion] These findings indicate that shoulder external rotation at 45° of shoulder flexion effectively reduced the contribution of the posterior deltoid activation to shoulder external rotation.