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Krishnan P, Koh J, Pradhan S, Bobko A, Athiviraham A, Amirouche F. Analysis of abduction moment arms after rotator cuff tear and acellular dermal matrix allograft reconstruction. J Shoulder Elbow Surg 2023; 32:2207-2213. [PMID: 37276919 DOI: 10.1016/j.jse.2023.04.031] [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: 09/25/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Biomechanical testing of abduction moment arms presents a useful method to assess the contributions of individual rotator cuff muscles to glenohumeral function. This study aimed to investigate the changes in abduction moment arms after the treatment of supraspinatus tears with superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and a combined SCR-BAR procedure, all with human dermal allograft. METHODS We tested 7 fresh-frozen cadaveric specimens under 6 conditions: (1) intact, (2) 50% supraspinatus tear (partial tear), (3) 100% supraspinatus tear, (4) SCR, (5) SCR combined with BAR, and (6) BAR. In each condition, the moment arms for the individual muscles of the teres minor, subscapularis, and infraspinatus were calculated throughout 90° of abduction using a motion capture system. Analysis of variance and post hoc Tukey testing were performed to determine significance. RESULTS In the teres minor, the moment arms in the SCR (11.9 mm), BAR (10.1 mm), and SCR-BAR (11.9 mm) conditions were greater than those in the intact (8.5 mm; P = .001, P = .001, and P = .001, respectively), partial tear (9.1 mm; P = .001, P = .128, and P = .001, respectively), and complete tear (8.8 mm; P = .001, P = .011, and P = .001, respectively) conditions. Similarly, in the subscapularis, the moment arms in the SCR (13.4 mm), BAR (13.8 mm), and SCR-BAR (13.5 mm) conditions were greater than those in the intact (10.6 mm; P = .006, P = .001, and P = .003, respectively) and partial tear (10.4 mm; P = .006, P = .001, and P = .003, respectively) conditions. In the teres minor, the SCR (11.9 mm) and SCR-BAR (11.9 mm) conditions were also found to have significantly increased moment arms compared with the BAR condition (10.1 mm; P = .001 and P = .001, respectively). In the infraspinatus, the BAR condition (13.8 mm) was found to have a significantly decreased moment arm compared with the partial tear condition (15.8 mm, P = .026), with no other significant findings between conditions. CONCLUSION Our results suggest that the moment arm contributions of the individual muscles comprising the rotator cuff can change after reconstruction to compensate for tears. SCR and SCR-BAR increase the moment arms in the teres minor and subscapularis, potentially allowing for increased abduction ability.
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Affiliation(s)
- Pranav Krishnan
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
| | - Jason Koh
- Department of Orthopaedic Surgery, NorthShore University Health System, Chicago, IL, USA
| | - Sonia Pradhan
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Aimee Bobko
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Farid Amirouche
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA; Department of Orthopaedic Surgery, NorthShore University Health System, Chicago, IL, USA
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Rezaie M, Negahban H, Mostafaee N, Ebrahimzadeh MH, Eshraghi R, Raeesi J. Comparison of the physiotherapy with and without focus on the scapulothoracic joint on pain, range of motion, functional disability, quality of life, and treatment effectiveness of patients after arthroscopic shoulder rotator cuff tendon repair: A randomized controlled trial with short-term follow-up. J Hand Ther 2023:S0894-1130(23)00135-7. [PMID: 37866984 DOI: 10.1016/j.jht.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence. PURPOSE This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR). STUDY DESIGN Two arms, parallel-group, randomized controlled trial, with concealed allocation METHODS: This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used. RESULTS Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: -17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: -19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = -25.4 to 0.56; active ROM: confidence interval = -20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported. CONCLUSIONS Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR.
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Affiliation(s)
- Marzieh Rezaie
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Neda Mostafaee
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Reza Eshraghi
- Department of Orthopaedic Surgery, Sina Hospital, Mashhad, Iran
| | - Javad Raeesi
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
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Garcia JF, Herrera C, Maciukiewicz JM, Anderson RE, Ribeiro DC, Dickerson CR. Variation of muscle recruitment during exercises performed below horizontal arm elevation that target the lower trapezius: A repeated measures cross-sectional study on asymptomatic individuals. J Electromyogr Kinesiol 2023; 70:102777. [PMID: 37159974 DOI: 10.1016/j.jelekin.2023.102777] [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: 11/30/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
The gold standard exercise for recruitment of the lower trapezius is the Y prone exercise which is performed above 90° of shoulder elevation. However, clinicians often prescribe exercises that avoid high elevation postures during early stages of rehabilitation. Comparatively little data exists on relative muscle recruitment during lower arm elevation exercises. This study examined the EMG activity of four shoulder girdle muscles during four exercises accomplished below 90° of shoulder elevation and compared them to the Y prone while considering sex effects. Variance across exercises of the ratio between upper trapezius and lower trapezius was also explored. 32 healthy participants completed standardized muscle-specific MVCs and two repetitions of each exercise. The side lying external rotation and the wall slide exercises produced the highest peak EMG for the lower trapezius, both 33 and 29% lower than the Y Prone. For the upper trapezius to lower trapezius ratio, the side lying external rotation elicited the lowest value, followed by the Y prone and wall slide (53 and 59% respectively higher). Sex influenced some EMG values, typically interacting with exercise type. Thus, side lying external rotation and the wall slide are recommended for targeting the lower trapezius muscle during early rehabilitation.
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Affiliation(s)
- Jonathan F Garcia
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Cristina Herrera
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Reagan E Anderson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Daniel C Ribeiro
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Clark R Dickerson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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Immediate Effects of the Reverse Plank Exercise on Muscle Thickness and Postural Angle in Individuals with the Forward Shoulder Posture. J Funct Morphol Kinesiol 2022; 7:jfmk7040082. [PMID: 36278743 PMCID: PMC9624361 DOI: 10.3390/jfmk7040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
The forward shoulder posture (FSP) results from shoulders being pulled forward by shortened anterior shoulder girdle muscles. The objective of this study was to investigate the short-term effectiveness of the reverse plank exercise on parascapular muscle thickness and forward shoulder angle (FSA) in patients with FSP. Participants were divided into the FSP and non-FSP (NFSP) groups based on the observed angle between the horizontal line of the C7 spinous process and the acromion process. All participants performed a total of five sets of reverse plank exercises at 30 s per set. FSA and muscle thickness of the pectoralis major (PM), serratus anterior (SA), upper trapezius (UT), and lower trapezius (LT) were measured before and after the reverse plank exercise. The muscle thicknesses of the SA and LT, and the FSA, were significantly increased after exercise in the FSP group (p < 0.05). Muscle thickness of the PM and UT significantly decreased after the exercise. In the NFSP group, muscle thickness of the LT was significantly increased, and muscle thickness of the PM and UT were significantly reduced after exercise (p < 0.05). Upon using between-group analysis, there were significant differences between the FSA, SA, UT, and LT groups (p < 0.05). The reverse plank exercise has the short-term benefit of correcting and preventing FSP by increasing SA and LT thickness while decreasing PM and UT thickness. We believe that the reverse plank exercise significantly improved the ability to prevent FSP in FSP-related muscles and was beneficial in achieving optimal postural alignment.
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Short N, Almonroeder TG, Fenker CA, Fisher OA, Francetic KE, Hodel AE, Lange CA, Mathew MM. Intra-rater reliability of goniometry to measure scapular protraction and retraction. J Hand Ther 2022; 35:275-281. [PMID: 35241356 DOI: 10.1016/j.jht.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/29/2021] [Accepted: 01/21/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Observational, descriptive design. BACKGROUND Despite scapular mobility being essential for the completion of activities of daily living (ADLs), there is currently no established, a reliable goniometric technique to measure scapular protraction and retraction. A proposed method has shown clinically significant inter-rater reliability for a goniometric technique for these measurements. PURPOSE This observational descriptive study examined the intra-rater reliability of a goniometric technique to assess scapular protraction and retraction among a sample of healthy adults. METHODS An occupational therapist who is a certified hand therapist (CHT) and an occupational therapy student used goniometry to measure the neutral (resting), protracted, and retracted positions of the right and left scapula for a sample of healthy young adults (n = 54; a total of 108 data points for each measurement). These measurements were compared to analyze intra-rater and inter-rater reliability. RESULTS For measurements of the scapula in neutral, protraction, and retraction, the standard error of measure (SEM) for repeat measures by the expert and novice raters was < 4.5° and < 3.9° respectively and ICC values ranged from poor to moderate (0.37-0.63). The SEM for measures between evaluators was < 5.0° and the ICC was poor (0.16-0.35). Minimum detectable change (MDC) values as a percentage of the mean (% MDC) ranged between 15.9 and 43.7% for intra-rater reliability and 21.9-52.8% for inter-rater reliability. DISCUSSION The results of the study were mixed; variance of less than 5° for repeat measures by the same rater and measures between raters suggest clinically acceptable reliability. However, variance as a proportion of available motion (%MDC) demonstrates a broader range both above and below the threshold of 30% suggested for rehabilitation assessments. CONCLUSION There are few efficient, reliable techniques to measure scapular mobility in clinical practice. The absolute reliability of goniometry to measure scapular protraction and retraction is similar to measurements of other joints. However, additional research and possible refinement of the technique is recommended to further address relative reliability and validity.
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Affiliation(s)
- Nathan Short
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA.
| | - Thomas G Almonroeder
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Caroline A Fenker
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Olivia A Fisher
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Kailey E Francetic
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Amy E Hodel
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Clayton A Lange
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
| | - Manu M Mathew
- Doctorate of Occupational Therapy (OTD) Program, Huntington University, Fort Wayne, IN, USA
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Barragan Echenique DM, Dolan MT, Koh JL, Goldberg BA, Amirouche F. Infraspinatus Muscle Fiber Moment Arms During Abduction: A Biomechanical Comparison of Values for Intact Rotator Cuff, Supraspinatus Tear, Superior Capsular Reconstruction, and Reverse Total Shoulder Arthroplasty. Orthop J Sports Med 2022; 10:23259671221098378. [PMID: 35651480 PMCID: PMC9149620 DOI: 10.1177/23259671221098378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Lines of action of the superior, middle, and inferior infraspinatus muscle
fibers work together to produce moment arms that change throughout abduction
in an intact shoulder, after a supraspinatus tear, and after superior
capsular reconstruction (SCR) and reverse total shoulder arthroplasty
(rTSA). Purpose: To use moment arm values to indicate the efficacy of SCR and rTSA to restore
infraspinatus function during shoulder abduction. Study Design: Descriptive laboratory study. Methods: A total of 5 human cadaveric shoulders placed in a testing apparatus were
each actively abducted (0°-90°) under the following 4 conditions: intact,
complete supraspinatus tear, SCR, and rTSA. The 3-dimensional coordinates of
points were tracked along the origin and insertion of the superior, middle,
and inferior infraspinatus fibers during abduction. Moment arm values were
calculated using the origin-insertion method to determine abduction
contribution of infraspinatus fiber sections. Analysis of variance and post
hoc Tukey testing were used to compare differences in moment arms between
the 4 conditions and between fiber sections. Results: In the intact condition, the superior infraspinatus fibers had an abduction
moment that decreased with elevation until shifting to adduction.
Conversely, the middle and inferior fibers had an adduction moment that
turned to abduction (mean moment arm values from 0° to 90°: inferior, from
–5.9 to 19.4 mm; middle, from –4.7 to 15.9 mm; superior, from 5.6 to –5.1
mm; P < .05). After a supraspinatus tear, superior
fibers lacked any torque, and inferior and middle fibers lost adduction
potential (inferior, from 4.8 to 14.0 mm; middle, from –0.2 to 9.6 mm;
superior, from 1.0 to 0.7 mm; P < .05). SCR restored the
initial superior fiber abduction moment (5.6 mm at 0°; P
< .05); middle and inferior fibers had some restoration but were weaker
than intact fibers. Loss of abduction moment in all fibers was seen with
rTSA (inferior, from –9.6 to –1.6 mm; middle, from –10.5 to –3.6 mm;
superior, from –1.7 to –4.6 mm; P < .05). Conclusion: Infraspinatus fiber groups had different and inverse moment arms during
scapular plane elevation. SCR most closely resembled the intact shoulder,
whereas rTSA transformed the infraspinatus into an adductor. Clinical Relevance: These results support the efficacy of SCR at restoring biomechanical muscle
function and suggest that the changes in moment arms for each fiber group be
considered when choosing treatment modalities and rehabilitation protocols
after rotator cuff tear.
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Affiliation(s)
| | - Martine T. Dolan
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Jason L. Koh
- Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
- Department of Orthopaedics, Shoulder and Elbow Surgery, University of Chicago, Chicago, Illinois, USA
| | - Benjamin A. Goldberg
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
- Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, an Affiliate of University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
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Diaphragmatic Mobility and Chest Expansion in Patients with Scapulocostal Syndrome: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10050950. [PMID: 35628087 PMCID: PMC9141335 DOI: 10.3390/healthcare10050950] [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: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Scapulocostal syndrome (SCS) is a subset of myofascial pain syndrome affecting the posterior shoulder and upper back area. Some of the affected muscles are attached to the rib cage, which may affect diaphragmatic mobility and chest expansion. The purpose of this study was to investigate the characteristics of diaphragmatic mobility and chest expansion in patients with SCS. Twenty-nine patients with SCS and twenty-nine healthy participants of a similar age, gender, weight, and height were included in the study. All participants were evaluated for diaphragmatic mobility (DM) by real-time ultrasound (RTUS) and for chest expansion (CE) using a cloth tape measure. An independent t-test was used to compare the outcome variables between groups. The DM value in the SCS group was 46.24 ± 7.26 mm, whereas in the healthy group it was 54.18 ± 9.74 mm. The DM value was lower in the SCS group compared to in healthy participants (p < 0.05). Chest expansion at the axilla, the fourth intercostal space (4th ICS), and the xiphoid level in the SCS group was 7.26 ± 1.13, 6.83 ± 0.94, and 6.86 ± 1.25, respectively, while chest expansion at the axilla, 4th ICS, and xiphoid level in the healthy group was 7.92 ± 1.39, 7.54 ± 1.43, and 8.13 ± 1.32, respectively. Chest expansion at the 4th ICS and the xiphoid level in the SCS group was significantly lower than in the healthy group (p < 0.05). Patients with SCS presented a decrease in diaphragmatic mobility and chest expansion. Therefore, SCS treatment programs ought to add breathing exercises to improve lung expansion.
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Nomura Y, Toda H, Katayose M, Watanabe S, Yoshida M, Yoshida M, Yamamoto K. Relationship between scapular control during isometric shoulder flexion and scapular motion during baseball pitching: a cross-sectional study. BMC Sports Sci Med Rehabil 2022; 14:76. [PMID: 35484560 PMCID: PMC9047336 DOI: 10.1186/s13102-022-00471-9] [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: 07/02/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022]
Abstract
Background A baseball pitcher with decreased scapular control may not be able to achieve suitable scapular motion at maximum shoulder external rotation (MER) of baseball pitching during the pitching action. It is common clinically to compare scapular control of the throwing and non-throwing arms to detect side-to-side differences. However, it remains unclear whether scapular control is different between the throwing and non-throwing arms. Moreover, no data exist on the relationship between scapular control and scapular motion at MER of pitching. Primarily, this study aimed to compare scapular control during isometric shoulder flexion between the throwing and non-throwing arms. Secondly, this study aimed to investigate the relationship between scapular control during isometric shoulder flexion and scapular motion at MER of pitching. Methods Fifteen healthy collegiate baseball pitchers (age, 20.2 ± 1.9 years; height, 1.76 ± 0.05 m; body mass, 73.3 ± 6.7 kg) were recruited. An optical motion tracking system was used to assess scapular motion. Scapular control was defined as the amount of change in the scapular internal rotation angle, downward rotation angle, and anterior tilt angle during isometric shoulder flexion. We assessed scapular position at MER of pitching. Results No significant differences were detected for any of the scapular angles during isometric shoulder flexion between the throwing and non-throwing arms. The amount of change in the scapular internal rotation angle, scapular downward rotation angle, and scapular anterior tilt angle during isometric shoulder flexion had a significant relationship with the scapular downward rotation angle at MER. Conclusions No side-to-side difference was noted in scapular control during isometric shoulder flexion in healthy collegiate baseball pitchers at the group level. Further studies are required to understand the side-to-side differences at the individual level. Additionally, there was a relationship between scapular control during isometric shoulder flexion and scapular position at MER. These findings suggest that clinicians may consider using isometric shoulder flexion to assess scapular control in baseball pitchers.
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Affiliation(s)
- Yuki Nomura
- Graduate School of Health Sciences, Sapporo Medical University, West 11, South 5, Chuo-ku, Sapporo City, 060-8556, Japan. .,Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, 1-3, West 27, North 7, Chuo-ku, Sapporo City, 060-0007, Japan.
| | - Hajime Toda
- School of Health Sciences, Sapporo Medical University, West 11, South 5, Chuo-ku, Sapporo City, 060-8556, Japan
| | - Masaki Katayose
- School of Health Sciences, Sapporo Medical University, West 11, South 5, Chuo-ku, Sapporo City, 060-8556, Japan
| | - Shun Watanabe
- School of Lifelong Sport, Hokusho University, 23, Bunkyodai, Ebetsu City, 069-8511, Japan
| | - Masahiro Yoshida
- School of Lifelong Sport, Hokusho University, 23, Bunkyodai, Ebetsu City, 069-8511, Japan
| | - Makoto Yoshida
- School of Lifelong Sport, Hokusho University, 23, Bunkyodai, Ebetsu City, 069-8511, Japan
| | - Keizo Yamamoto
- School of Lifelong Sport, Hokusho University, 23, Bunkyodai, Ebetsu City, 069-8511, Japan
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Savitzky JA, Abrams LR, Galluzzo NA, Ostrow SP, Protosow TJ, Liu SA, Handrakis JP, Friel K. Effects of a Novel Rotator Cuff Rehabilitation Device on Shoulder Strength and Function. J Strength Cond Res 2021; 35:3355-3363. [PMID: 35133996 DOI: 10.1519/jsc.0000000000003347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Savitzky, JA, Abrams, LR, Galluzzo, NA, Ostrow, SP, Protosow, TJ, Liu, SA, Handrakis, JP, and Friel, K. Effects of a novel rotator cuff rehabilitation device on shoulder strength and function. J Strength Cond Res 35(12): 3355-3363, 2021-The glenohumeral joint, a multiaxial ball and socket joint, has inherent instability counterbalanced by the muscular stability of the rotator cuff (RC) and connective tissue. Exercise has been shown to alleviate pain and disability arising from degenerative changes of the RC due to overuse, trauma, or poor posture. This study compared the training effects of ShoulderSphere (SS), an innovative device that uses resistance to centrifugal force, to TheraBand (TB), a traditional device that uses resistance to elasticity. Thirty-five healthy male and female adults (24.2 ± 2.4 years) were randomized into 3 groups: SS, TB, and control. Five outcomes were assessed before and after the twice-weekly, 6-week intervention phase: strength (shoulder flexion [Fx], extension [Ext], external rotation [ER], and internal rotation [IR]), proprioception (6 positions), posterior shoulder endurance (ShEnd), stability (Upper Quarter Y-Balance Test [YBal] (superolateral [YBalSup], medial [YBalMed], and inferolateral [YBalInf]), and power (seated shot put [ShtPt]). Data were analyzed using a 3 (group: SS, TB, and control) × 2 (time: pre and post) generalized estimating equation. Analyses demonstrated a main effect of time for all strength motions (p < 0.01): YBalInf (p < 0.0001), ShtPt (p < 0.05), and ShEnd (p < 0.0001) but no interaction effects of group × time. There were no main or interaction effects for proprioception. Both SS and TB groups had significant within-group increases in Ext, IR, YBalInf, and ShEnd. Only the SS group had significant increases in ER, Fx, and ShtPt. ShoulderSphere demonstrated comparable conditioning effects with TB and may afford additional strength gains in Fx and ER, and power. ShoulderSphere should be considered a viable alternative in RC conditioning.
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Affiliation(s)
- Jamie A Savitzky
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - Lindsay R Abrams
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - Nicole A Galluzzo
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - Samantha P Ostrow
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - Tracy J Protosow
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - Shou-An Liu
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
| | - John P Handrakis
- Department of Physical Therapy, School of Health Professions, New York Institute of Technology, Old Westbury, New York
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York; and
| | - Karen Friel
- Department of Physical Therapy, Wingate University, Wingate, North Carolina
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10
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Luo GF, Chang CM, Shih YF. The effects of muscle fatigue on scapulothoracic joint position sense and neuromuscular performance. Musculoskelet Sci Pract 2021; 56:102461. [PMID: 34619416 DOI: 10.1016/j.msksp.2021.102461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fatigue of the scapular musculature might affect the sensorimotor system and neuromuscular control and therefore impair the dynamic alignment of the scapula. The purpose of this study was to investigate the effects of scapular muscle fatigue on joint position sense and the neuromuscular performance of the scapulothoracic joint. METHODS Thirty healthy subjects were recruited. The joint position sense (measured as reposition errors during the scapular elevation and protraction task) of the scapulothoracic joint and scapular kinematics and muscle activation (% of maximum voluntary isometric contraction) during scaption, shoulder elevation in the scapular plane, before and after the fatigue task (modified push-up) were measured. The repeated measures analysis of variance (ANOVA) was used to assess the effects of fatigue on scapular reposition error and neuromuscular control. RESULTS Although joint reposition sense did not change after fatigue, muscle activation of the serratus anterior increased significantly (18.5%-26.3%, p = 0.006, elevation task; 15.2%-27.4%, p = 0.037, protraction task). At 120° scaption, the scapula showed a decreased posterior tilt (13.8°-10.3°, p < 0.001), increased protraction (10.2°-13.3°, p = 0.004) and lateral rotation (52.8°-54.4°, p = 0.005). Muscle activation of the serratus anterior increased (65.9%-84.6%, p = 0.002) during 90°-120°scaption. CONCLUSION Scapular muscle fatigue did not alter the scapulothoracic joint position sense, but increased serratus anterior activation and resulted in a more anteriorly tilted, protracted, and laterally rotated scapula during scaption. Whether or not these fatigue-related changes are linked to the development of shoulder problems needs to be investigated further.
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Affiliation(s)
- Guo-Fong Luo
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chia-Ming Chang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Physical Therapy, China Medical University, Taichung, Taiwan.
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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11
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Thomas CN, Lindquist TJ, Paull TZ, Tatro JM, Schroder LK, Cole PA. Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures. J Trauma Acute Care Surg 2021; 91:940-946. [PMID: 34417408 DOI: 10.1097/ta.0000000000003382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures. LEVEL OF EVIDENCE Diagnostic test, level IV.
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Affiliation(s)
- Claire N Thomas
- From the Department of Orthopaedic Surgery (C.N.T., T.Z.P., J.M.T., L.K.S., P.A.C.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (C.N.T., J.M.T., L.K.S., P.A.C.), Regions Hospital, University of Minnesota, St. Paul, Minnesota; Department of Biology (T.J.L.), Wheaton College, Wheaton, Illinois; and HealthPartners Orthopaedics and Sports Medicine (P.A.C.), Bloomington, Minnesota
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12
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Kwon KY, Kim DS, Baik SH, Lee JW. Comparison of In Vivo Three-Dimensional Glenohumeral Positions and Scapular Kinematics between Young and Older Male Groups. Clin Orthop Surg 2021; 13:376-384. [PMID: 34484631 PMCID: PMC8380533 DOI: 10.4055/cios20238] [Citation(s) in RCA: 3] [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: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background Many researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group. Methods Twenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder. Results During scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035). Conclusions Scapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55–65 years.
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Affiliation(s)
- Ki Youn Kwon
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Doo Sup Kim
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Hoon Baik
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Moslehi M, Letafatkar A, Miri H. Feedback improves the scapular-focused treatment effects in patients with shoulder impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2021; 29:2281-2288. [PMID: 32725447 DOI: 10.1007/s00167-020-06178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of scapular-focused treatment with (SFTF) and without (SFT) feedback on pain, function, and scapular kinematics in patients with Shoulder Impingement Syndrome (SIS). METHODS Seventy-five males and females with SIS were randomly assigned into SFTF (n = 25), SFT (n = 25) and control (n = 25) groups. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function and scapular kinematics, assessed by DASH Questionnaire and a 3-D motion capture, respectively. All outcomes were measured at the baseline and after the 8-week interventions. RESULTS A post hoc analysis performed to show significant differences between groups after the 8-week interventions. For pain, there were significant differences between SFTF vs. SFT (ES (95% CI) = - 0.3(- 0.4 to - 0.1); P = 0.04), SFTF vs. control (ES (95% CI) = 1.3(0.7-1.9); P = 0.01). For DASH, also, there were significant differences between SFTF vs. SFT (ES (95% CI) = 1.8(1.1-2.4); P = 0.03), SFTF vs. control (ES (95% CI) = 4.4(3.3-5.4); P = 0.01), and SFT vs. control (ES (95% CI) = 2.6(1.8-3.4); P = 0.01). For scapular internal rotation (the sagittal or scapular planes), scapular upward rotation, and the scapular tilt, however, there were no differences between SFTF vs. SFT. CONCLUSION Based on the study results, a rehabilitation program integrated with verbal feedbacks is effective to relieve pain, and improve function and scapular kinematics in patients with SIS. Adding feedback to an exercise therapy could clinically enhance outcomes in patients with SIS. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION This study was prospectively registered at UMIN-CTR website, and the unique trail number is UMIN000036399.
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Affiliation(s)
- Mahsa Moslehi
- Department of Physical Education and Sports Sciences, Raja University, Qazvin, Iran
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran.
| | - Hadi Miri
- Department of Physical Education and Sports Sciences, Amir Kabir University of Technology, Tehran, Iran
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Evaluation of rotator cuff abduction moment arms for superior capsular reconstruction and reverse total shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:1767-1774. [PMID: 34027565 DOI: 10.1007/s00264-021-05066-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The rotator cuff (RC) muscles contribute to dynamic stability and rotational actions of the glenohumeral joint. Moment arm can be used to demonstrate the potential work a muscle contributes to a musculoskeletal joint rotation. This study aimed to understand the moment arm contributions of the RC muscles and explore changes following a complete supraspinatus tear treated with either superior capsular reconstruction (SCR) or reverse total shoulder arthroplasty (rTSA). METHODS Five fresh-frozen cadaveric specimens were prepared and mounted in an apparatus where each intact RC muscle was held in tension with a line of action toward its origin on the scapula. Mean moment arms for each muscle were determined experimentally based on Optotrak data collected during cadaveric shoulder arm abduction. RESULTS Using ANOVA testing, our analysis demonstrated significant differences (p < 0.001) in infraspinatus and teres minor moment arms after rTSA compared to the intact shoulder model. After SCR, significant differences (p < 0.001) were seen in teres minor, with these differences being statistically similar to the changes seen in teres minor after rTSA. Subscapularis showed no significant difference in moment arm values between the models (p = 0.148). CONCLUSION Our results illustrate that mean moment arms were preserved in the RC muscles after complete supraspinatus tear. This study also shows evidence that subscapularis function may be maintained after SCR or rTSA. After SCR, infraspinatus may maintain similar abduction ability compared to the anatomical shoulder, while teres minor ability may increase. Infraspinatus may have decreased abduction ability after rTSA while teres minor may have increased ability.
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15
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Bordelon NM, Wasserberger KW, Cassidy MM, Oliver GD. The Effects of Load Magnitude and Carry Position on Lumbopelvic-Hip Complex and Scapular Stabilizer Muscle Activation During Unilateral Dumbbell Carries. J Strength Cond Res 2021; 35:S114-S119. [PMID: 33298714 DOI: 10.1519/jsc.0000000000003880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nicole M Bordelon
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, Alabama
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16
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Jones M, Mills C, Exell T, Wakefield-Scurr J. A novel multi-study intervention investigating the short and long term effects of a posture bra on whole body and breast kinematics. Gait Posture 2021; 83:194-200. [PMID: 33161276 DOI: 10.1016/j.gaitpost.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Poor standing posture has been reported in women with larger breasts, increasing the risk of back pain. Whilst breast reduction surgery can improve posture, conservative measures such as special bras may offer short or long-term relief of symptoms without surgical intervention. RESEARCH QUESTION This study aimed to utilise a multi-study intervention to investigate the short and long-term kinematic effects of wearing a posture bra. METHODS Study one utilised biomechanics and physiotherapy expertise to modify the design of a prototype bra to improve posture and breast kinematics; resulting in a second-generation posture bra. To test this bra, 24 females were randomly assigned to control and intervention groups. The control group wore their everyday bra; the intervention group wore the generation 2 posture bra in place of their everyday bra for three months. Pre and post intervention, posture (spine curvature, scapula position, whole body alignment) and breast kinematics were assessed during sitting, standing and walking. Short-term effects of the posture bra were compared to an everyday bra and no bra (study two), whilst the long-term effects were compared using the no bra condition (study three). RESULTS Biomechanical intervention improved posture and breast kinematics in a prototype posture bra resulting in a second-generation prototype. Pre-intervention, the generation 2 posture bra significantly improved scapula retraction by 6° during both sitting and standing, but also increased deviation of whole body alignment compared to everyday bra and no bra conditions. During walking the posture bra reduced breast motion by 17 % compared to the everyday bra. Following the three-month wearer intervention, scapula depression significantly improved in the intervention group. SIGNIFICANCE A biomechanically informed posture bra was able to effectively support the breasts and improve scapula position without compromising spinal curvature, reducing the risk of musculoskeletal pain associated with poor posture.
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Affiliation(s)
- Melissa Jones
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
| | - Chris Mills
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom.
| | - Tim Exell
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
| | - Joanna Wakefield-Scurr
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, PO1 2ER, United Kingdom
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17
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Park KN, Jung DY, Kim SH. Trapezius and serratus anterior muscle strength in violinists with unilateral neck pain. J Back Musculoskelet Rehabil 2020; 33:631-636. [PMID: 31594199 DOI: 10.3233/bmr-181147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Weakness of the trapezius and serratus anterior (SA) muscle may be a risk factor for unilateral neck pain. OBJECTIVE This study examined the trapezius (upper, middle, and lower) and SA muscle strength ipsilateral and contralateral to the painful side in violinists with unilateral neck pain. METHOD Twenty-six female violinists with unilateral neck pain participated in this study. Participants reported the pain intensity and duration and completed the Neck Disability Index (NDI). The strengths of the upper (UT), middle (MT), and lower (LT) trapezius and SA muscles were measured using a handheld dynamometer. Paired t-test was used to compare the strength of the muscles between ipsilateral and contralateral to the painful side within subjects. The relationship between pain intensity, pain duration, and neck disability and strength deficit of the muscle was demonstrated by Pearson's correlation and Spearman's rank correlation. RESULTS The strengths of the UT, MT, LT, and SA muscles were significantly decreased on the painful side compared with the contralateral side (P< 0.05). Except for correlations between pain intensity and percent strength deficit of the UT and between pain duration and percent strength deficit of the MT (P< 0.05), there were no significant associations between pain intensity, pain duration, or NDI and the percent strength deficit of the UT, MT, LT and SA muscles (P> 0.05). CONCLUSIONS These results suggest that decreased UT, MT, LT, and SA muscle strength on the side of the pain should be considered in the rehabilitation of violinists with unilateral neck pain.
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Affiliation(s)
- Kyue-Nam Park
- Department of Physical Therapy, Jeonju University, Jeonju-si, Jeonrabuk-do, South Korea
| | - Do-Young Jung
- Department of Physical Therapy, College of Health and Welfare, Joongbu University, Geumsan-gun, Chungcheongnam-do, South Korea
| | - Si-Hyun Kim
- Department of Physical Therapy, Sangji University, Wonju-si, South Korea
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18
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Ager AL, Roy JS, Gamache F, Hébert LJ. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2020; 184:e385-e393. [PMID: 30423137 DOI: 10.1093/milmed/usy294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. MATERIALS AND METHODS Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T0), 6 (T6) and 12 (T12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. RESULTS Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. CONCLUSIONS Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - France Gamache
- Physiotherapy Department, Valcartier Garrison, Canadian Armed Forces, Quebec, Canada
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Department of Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,1 Canadian Field Hospital, Detachment Ottawa, Ottawa, Ontario, Canada
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Mihata T, McGarry MH, Akeda M, Peterson AB, Hunter RC, Nguyen L, Neo M, Lee TQ. Posterior shoulder tightness can be a risk factor of scapular malposition: a cadaveric biomechanical study. J Shoulder Elbow Surg 2020; 29:175-184. [PMID: 31420224 DOI: 10.1016/j.jse.2019.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapular malposition and posterior shoulder tightness are key pathologic processes in the shoulder of throwing athletes. The objective of this study was to investigate the effects of posterior capsule tightness, posterior rotator cuff muscle tightness, or both on scapular position. METHODS Ten shoulders from 5 fresh frozen cadaveric male torsos were tested in maximum internal, neutral, and maximum external shoulder rotations at 0°, 45°, and 90° of shoulder abduction. Scapular rotation-namely, upward and downward rotation, internal and external rotation, and anterior and posterior tilt-and the scapula-spine distance were measured by using a MicroScribe digitizer (Revware, Raleigh, NC, USA). Each shoulder underwent 4 experimental stages: intact; isolated posterior rotator cuff muscle (infraspinatus and teres minor) tightness; both posterior rotator cuff muscle and capsule tightness; and isolated posterior capsule tightness. RESULTS Posterior muscle tightness significantly decreased upward rotation (P< .05) only in maximum shoulder internal rotation at 45° or 90° of shoulder abduction, whereas posterior capsule tightness did not affect upward rotation (P= .09 to .96). Posterior capsule tightness significantly increased scapular internal rotation (P< .01), but posterior muscle tightness did not change scapular internal rotation (P= .62 to .89). Posterior capsule tightness significantly increased both the superior and inferior scapula-spine distance (ie, caused scapular protraction) in maximum shoulder external rotation at 90° of abduction (P< .01). CONCLUSION Posterior shoulder tightness resulted in scapular malposition. However, the muscular and capsular components of that tightness affected the scapular position differently. For the treatment of scapula malposition, stretching of the posterior shoulder capsule and muscles is recommended.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Masaki Akeda
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Alexander B Peterson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Ross C Hunter
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Lauren Nguyen
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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Seo YG, Park WH, Lee CS, Kang KC, Min KB, Lee SM, Yoo JC. Is Scapular Stabilization Exercise Effective for Managing Nonspecific Chronic Neck Pain?: A Systematic Review. Asian Spine J 2019; 14:122-129. [PMID: 31668049 PMCID: PMC7010515 DOI: 10.31616/asj.2019.0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/07/2019] [Indexed: 12/22/2022] Open
Abstract
Scapular stabilization is thought to have an important role in improving pain and dysfunction around the neck and shoulders, but evidence of this is lacking. We aim to systematically review the effect of a scapular stabilization exercise (SSE) on pain and dysfunction in patients with nonspecific chronic neck pain (NP). We searched the PubMed, EMBASE, CINAHL, and Cochrane Library databases using the terms (NP [MeSH] OR NP OR cervical pain OR neck ache OR cervicalgia) AND (scapular exercise OR periscapular exercise OR SSEs). We included suitable studies that met the study's inclusion criteria. Among the 227 studies identified by our search strategy, a total of four (three randomized controlled studies and one prospective study) met the inclusion criteria. The SSE was intense. It included three sets of 10 repetitions. In most of the studies, the exercises were conducted 3 times per week. Most studies reported that the SSE improved pain and dysfunction in patients with nonspecific chronic NP; however, the reviewed articles did not use the same variables for measurement. Additionally, the sample size was small. Although several studies show that SSE might improve NP and dysfunction, the effects of SSE on pain and dysfunction in the neck region remain unclear because the number of studies was small. Further high-quality studies are necessary to identify the detailed effects of SSE in patients with NP.
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Affiliation(s)
- Yong Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hah Park
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Suh Lee
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Chung Kang
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyoung Bin Min
- Department of Sports Medicine, Korea University, Sejong, Korea
| | - Sang Min Lee
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Chul Yoo
- Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jayasinghe GS. Scapula Dyskinesis: A Review of Current Concepts and Evaluation of Assessment Tools. Curr Sports Med Rep 2018; 17:338-346. [PMID: 30300196 DOI: 10.1249/jsr.0000000000000526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Scapula dyskinesis is prevalent in athletes conducting forceful overhead movements. This review summarizes our current understanding of the condition and evaluates the different options for assessing dyskinesis. Current methods for assessing scapula dyskinesis involve clinical observations, three-dimensional kinematics and three-dimensional wing computer tomography. Clinical observation is the most pragmatic method for assessing dyskinesis yielding inter-rater agreement of 79% and sensitivity of 76%. Similar sensitivities have been recorded using three-dimensional kinematics. Three-dimensional wing computer tomography has yielded a near-perfect interclass correlation coefficient of 0.972 when used to assess dyskinesis. Three-dimensional wing computer tomography, given its expense, low availability, and levels of irradiation, should be reserved for high-performance athletes where detailed assessments need to be made to aid rehabilitation. Observational assessments should remain the main modality used for general assessment.
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Umehara J, Kusano K, Nakamura M, Morishita K, Nishishita S, Tanaka H, Shimizu I, Ichihashi N. Scapular kinematic and shoulder muscle activity alterations after serratus anterior muscle fatigue. J Shoulder Elbow Surg 2018; 27:1205-1213. [PMID: 29478944 DOI: 10.1016/j.jse.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/24/2017] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the serratus anterior muscle has an important role in scapular movement, no study to date has investigated the effect of serratus anterior fatigue on scapular kinematics and shoulder muscle activity. The purpose of this study was to clarify the effect of serratus anterior fatigue on scapular movement and shoulder muscle activity. METHODS The study participants were 16 healthy men. Electrical muscle stimulation was used to fatigue the serratus anterior muscle. Shoulder muscle strength and endurance, scapular movement, and muscle activity were measured before and after the fatigue task. The muscle activity of the serratus anterior, upper and lower trapezius, anterior and middle deltoid, and infraspinatus muscles was recorded, and the median power frequency of these muscles was calculated to examine the degree of muscle fatigue. RESULTS The muscle endurance and median power frequency of the serratus anterior muscle decreased after the fatigue tasks, whereas the muscle activities of the serratus anterior, upper trapezius, and infraspinatus muscles increased. External rotation of the scapula at the shoulder elevated position increased after the fatigue task. CONCLUSION Selective serratus anterior fatigue due to electric muscle stimulation decreased the serratus anterior endurance at the flexed shoulder position. Furthermore, the muscle activities of the serratus anterior, upper trapezius, and infraspinatus increased and the scapular external rotation was greater after serratus anterior fatigue. These results suggest that the rotator cuff and scapular muscle compensated to avoid the increase in internal rotation of the scapula caused by the dysfunction of the serratus anterior muscle.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Ken Kusano
- ASICS Corporation, Institution of Sport Science, Kobe, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niitaga University of Health and Welfare, Niigata, Japan
| | - Katsuyuki Morishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Nishishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Itsuroh Shimizu
- Department of Physical Therapy, Fukui General Clinic, Fukui, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Upper body kinematic and muscular variability in response to targeted rotator cuff fatigue. Hum Mov Sci 2018; 59:121-133. [DOI: 10.1016/j.humov.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 11/23/2022]
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Park SE, Kim YR, Kim YY. Immediate effects of scapular stabilizing exercise in chronic stroke patient with winging and elevated scapula: a case study. J Phys Ther Sci 2018; 30:190-193. [PMID: 29410596 PMCID: PMC5788805 DOI: 10.1589/jpts.30.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of scapular stabilizing
exercise in a stroke patient with winging and elevated scapula. [Subject and Methods] The
subject was a 46-year-old female with a history of stroke. She had right side hemiplegia
with winging and elevated scapula on the right side, and had compensatory motions of the
neck and shoulder when using the paretic upper extremity. The subject participated in
scapular stabilizing exercises for four days. This exercise program consisted of scapular
protraction-retraction in an upright seated position. Scapular position was measured as
distance between scapular medial border and thoracic vertebrae 3, 4. Upper extremity
function was measured as time required for lifting and lowering a cup with the affected
arm. [Results] After intervention, distance between scapular medial border and spinouse
process of T3, 4 decreased. Time required for lifting and lowering a cup with the affected
arm decreased. Compensatory motions of the neck and shoulder joint decreased. [Conclusion]
Despite the short period, scapular stabilizing exercises had a positive effect on scapular
position and upper extremity function.
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Affiliation(s)
- Si-Eun Park
- Department of Physical Therapy, Pohang College, Republic of Korea
| | - Yang-Rae Kim
- Department of Physical Therapy, Anyang Sam Hospital, Republic of Korea
| | - Yong-Youn Kim
- Department of Physical Therapy, Dongnam Health University: 50 Cheoncheon-ro, 74beon-gil, Jeongja sam-dong, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea
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Kenyon P, Flynn S, Marlow W. Assessment of the adult patient presenting with shoulder pain. Int J Orthop Trauma Nurs 2017; 28:40-45. [PMID: 29254753 DOI: 10.1016/j.ijotn.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Kenyon
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK.
| | - Sandra Flynn
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK.
| | - William Marlow
- Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, UK
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Abstract
Background An aberrant upper body posture has been proposed as one of the etiological factors contributing to the development of subacromial impingement syndrome (SAIS). Clinicians have translated this supposition into assessment and rehabilitation programs despite insufficient and conflicting evidence to support this approach. Purpose The purpose of this study was to compare several postural variables between the SAIS patients and asymptomatic healthy controls. Study Design Case-Control Study. Methods A total of 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated several postural variables including forward head posture (FHP), forward shoulder posture (FSP), thoracic kyphosis index (TKI), scapular index (SI), normalized scapular protraction (NSP), and the lateral scapular slide test (LSST). The variables were compared between patient and control groups according to sex. Results Significant differences were observed in the female patients compared to asymptomatic controls for the FHP (49.38 + 9.6o vs 55.5o+8.38, p=0.03), FSP (45.58 + 10.1o vs 53.68 + 7.08, p=0.02), and LSST in third position (10.2 + 2.1cm vs 11.5 + 0.7cm, p=0.01). Male patients showed a significant difference only in the FSP compared to controls (61.9o+9.4o vs 49.78 + 9.28, p<0.001). Conclusions While inadequate data on the relationship between dysfunctional posture and SAIS has led to broad variations in current rehabilitation strategies, the results of the present study revealed different patterns of postural aberrations in female and male patients with SAIS. This clarifies the need to develop individualized or sex-specific approaches for assessing posture in men and women with SAIS and rehabilitation programs based on the assessment results. Level of Evidence 3b.
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Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, Molenaers G, Feys H, Klingels K. Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study. Front Hum Neurosci 2017; 11:482. [PMID: 29051729 PMCID: PMC5633911 DOI: 10.3389/fnhum.2017.00482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/19/2017] [Indexed: 11/13/2022] Open
Abstract
Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.
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Affiliation(s)
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopedic Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), BIOMED, University of Hasselt, Diepenbeek, Belgium
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Santos GL, Russo TL, Nieuwenhuys A, Monari D, Desloovere K. Kinematic Analysis of a Drinking Task in Chronic Hemiparetic Patients Using Features Analysis and Statistical Parametric Mapping. Arch Phys Med Rehabil 2017; 99:501-511.e4. [PMID: 28939425 DOI: 10.1016/j.apmr.2017.08.479] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/06/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare sitting posture and movement strategies between chronic hemiparetic and healthy subjects while performing a drinking task, using statistical parametric mapping (SPM) and feature analysis. DESIGN Cross-sectional study. SETTING A university physical therapy department. PARTICIPANTS Participants (N=26) consisted of chronic hemiparetic (n=13) and healthy individuals (n=13) matched for sex and age. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The drinking task was divided into phases: reaching, transporting the glass to mouth, transporting the glass to table, and returning to initial position. An SPM 2-sample t test was used to compare the entire kinematic waveforms of different joint angles (trunk, scapulothoracic, humerothoracic, elbow). Joint angles at the beginning and end of the motion, movement time, peak velocity timing, trajectory deviation, normalized integrated jerk, and range of motion were extracted from the motion data. Group differences for these parameters were analyzed using independent t tests. RESULTS At the static posture and beginning of the reaching phase, patients showed a shoulder position more deviated from the midline and externally rotated with increased scapula protraction, medial rotation, anterior tilting, trunk anterior flexion and inclination to the paretic side. Altered spatiotemporal variables throughout the task were found in all phases, except for the returning phase. Patients returned to a similar posture as the task onset, except for the scapula, which was normalized after the reaching phase. CONCLUSIONS Chronic hemiparetic subjects showed more deviations in the proximal joints during seated posture and reaching. However, the scapular movement drew nearer to the healthy individuals' patterns after the first phase, showing an interesting point to consider in rehabilitation programs.
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Affiliation(s)
- Gabriela Lopes Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Thiago Luiz Russo
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Angela Nieuwenhuys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium
| | - Davide Monari
- Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium; Department of Mechanical Engineering, Faculty of Engineering, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, CERM, University Hospital Pellenberg, Pellenberg, Belgium
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Balcı NC, Yuruk ZO, Zeybek A, Gulsen M, Tekindal MA. Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial. J Phys Ther Sci 2016; 28:1219-27. [PMID: 27190456 PMCID: PMC4868216 DOI: 10.1589/jpts.28.1219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/26/2015] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The aim of our study was to compare the initial effects of scapular
proprioceptive neuromuscular facilitation techniques and classic exercise interventions
with physiotherapy modalities on pain, scapular dyskinesis, range of motion, and function
in adhesive capsulitis. [Subjects and Methods] Fifty-three subjects were allocated to 3
groups: scapular proprioceptive neuromuscular facilitation exercies and physiotherapy
modalities, classic exercise and physiotherapy modalities, and only physiotherapy
modalities. The intervention was applied in a single session. The Visual Analog Scale,
Lateral Scapular Slide Test, range of motion and Simple Shoulder Test were evaluated
before and just after the one-hour intervention in the same session (all in one session).
[Results] All of the groups showed significant differences in shoulder flexion and
abduction range of motion and Simple Shoulder Test scores. There were statistically
significant differences in Visual Analog Scale scores in the proprioceptive neuromuscular
facilitation and control groups, and no treatment method had significant effect on the
Lateral Scapular Slide Test results. There were no statistically significant differences
between the groups before and after the intervention. [Conclusion] Proprioceptive
neuromuscular facilitation, classic exercise, and physiotherapy modalities had immediate
effects on adhesive capsulitis in our study. However, there was no additional benefit of
exercises in one session over physiotherapy modalities. Also, an effective treatment
regimen for shoulder rehabilitation of adhesive capsulitis patients should include
scapular exercises.
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Affiliation(s)
- Nilay Comuk Balcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Turkey
| | - Zeliha Ozlem Yuruk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Turkey
| | - Aslican Zeybek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Turkey
| | - Mustafa Gulsen
- Physiotherapy Program, Vocational School of Health Sciences, Baskent University, Turkey
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Abstract
Literature has revealed the importance of quantifying resting scapular posture in overhead athletes as well as quantifying scapular kinematics during dynamic movement. Prior to this project much of the attention in throwing research had been focused on the position of the humerus without description of the positioning of the scapula. Therefore, it was the purpose of this study to present scapular kinematics during pitching in youth baseball players. Twenty-five youth baseball players (age 11.3 + 1.0 years; body height 152.4 + 9.0 cm; body mass 47.5 + 11.3 kg), with no history of injury, participated in the study. Scapular kinematics at the events of maximum humeral external rotation (MER) and maximum humeral internal rotation (MIR) during the pitching motion were assessed three-dimensionally while pitching fastballs for strikes. Results revealed that at the event of MER, the scapula was in a position of retraction, upward rotation and a posterior tilt. While at the event of MIR, the scapula was protracted, upward rotated and tilted anteriorly.
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Affiliation(s)
- Gretchen Oliver
- Auburn University. School of Kinesiology. Auburn, Alabama. USA
| | - Wendi Weimar
- Auburn University. School of Kinesiology. Auburn, Alabama. USA
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31
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Deng HR, Shih YF. Test validity and intra-rater reliability in the measurement of scapular position sense in asymptomatic young adults. ACTA ACUST UNITED AC 2015; 20:503-7. [DOI: 10.1016/j.math.2015.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/29/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
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Khadilkar SV, Chaudhari CR, Soni G, Bhutada A. Is pushing the wall, the best known method for scapular winging, really the best? A Comparative analysis of various methods in neuromuscular disorders. J Neurol Sci 2015; 351:179-183. [DOI: 10.1016/j.jns.2015.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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Yang J, Lee J, Lee B, Jeon S, Han B, Han D. The effects of active scapular protraction on the muscle activation and function of the upper extremity. J Phys Ther Sci 2014; 26:599-603. [PMID: 24764642 PMCID: PMC3996430 DOI: 10.1589/jpts.26.599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/15/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of adjusting the scapula into its ideal position through active scapular protraction on the muscle activation and function of the upper extremity. [Subjects] Twenty female college students aged 19-21 without any physical or functional disability were the subjects of this study. They had no history of injury to their upper extremities or hands. [Methods] After the initial measurements the experimental group was asked to perform active scapular protraction; then, their grip strength and muscle activation were measured again. Every action was maintained for 5 seconds and repeated 3 times. The mean values of the measurements were analyzed. A resting of 1 minute was given between each action. [Results] The results revealed a significant change in the experimental group's grip strength after active scapular protraction had been performed. The surrounding muscles of the scapula, such as the serratus anterior, upper trapezius, flexor carpi ulnaris, flexor carpi radialis and palmaris longus, showed significant changes in muscle activation after active scapular protraction. The muscles of the upper extremity also showed significant changes after active scapular protraction. [Conclusion] The adjustment of scapula into its ideal position through active scapular protraction increased the activations of the muscles surrounding the shoulder joint and improved the function of the upper extremity.
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Affiliation(s)
- Jeongok Yang
- Division of Physical Education, College of Medical and Life Science, Silla University, Republic of Korea
| | - Joongsook Lee
- Division of Physical Education, College of Medical and Life Science, Silla University, Republic of Korea
| | - Bomjin Lee
- Division of Physical Education, College of Medical and Life Science, Silla University, Republic of Korea
| | - Sora Jeon
- Department of Physical Therapy, College of Medical and Life Science, Silla University, Republic of Korea
| | - Bobae Han
- Department of Physical Therapy, College of Medical and Life Science, Silla University, Republic of Korea
| | - Dongwook Han
- Department of Physical Therapy, College of Medical and Life Science, Silla University, Republic of Korea
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Dickerson CR, Brookham RL, Chopp JN. The working shoulder: assessing demands, identifying risks, and promoting healthy occupational performance. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Oliver GD, Sola M, Dougherty C, Huddleston S. Quantitative Examination of Upper and Lower Extremity Muscle Activation During Common Shoulder Rehabilitation Exercises Using the Bodyblade. J Strength Cond Res 2013; 27:2509-17. [DOI: 10.1519/jsc.0b013e31827fd4c2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Casonato O, Musarra F, Frosi G, Testa M. The Role of Therapeutic Exercise in the Conflicting and Unstable Shoulder. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331903225002434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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37
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Plafcan DM, Canavan PK, Sebastianelli WJ, Michael Swope K. Reliability of a New Instrument to Measure Scapular Position. J Man Manip Ther 2013. [DOI: 10.1179/jmt.2000.8.4.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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38
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Huijbregts P. Biomechanics and Pathology of the Overhead Throwing Motion: A Literature Review. J Man Manip Ther 2013. [DOI: 10.1179/jmt.1998.6.1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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40
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De Baets L, Jaspers E, Desloovere K, Van Deun S. A systematic review of 3D scapular kinematics and muscle activity during elevation in stroke subjects and controls. J Electromyogr Kinesiol 2013; 23:3-13. [DOI: 10.1016/j.jelekin.2012.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 06/05/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
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Mihata T, Jun BJ, Bui CNH, Hwang J, McGarry MH, Kinoshita M, Lee TQ. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am 2012; 94:1576-83. [PMID: 22992848 DOI: 10.2106/jbjs.j.01972] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although deviations in scapular orientation are thought to predispose to shoulder injuries in throwing athletes, the biomechanical mechanism underlying shoulder injuries in throwing athletes with an altered scapular orientation remains unclear. METHODS Seven fresh-frozen cadaveric shoulders were evaluated at 90° of abduction, with the humerus externally rotated from 90° to the maximum angle, to simulate the late cocking phase of the throwing motion. Loads were applied to the deltoid, pectoralis major, latissimus dorsi, teres major, and all rotator cuff muscles. Contact pressure in the glenohumeral joint was measured with use of a pressure sensor. The area of internal impingement was calculated on the basis of three-dimensional position data. Glenohumeral contact pressure and the area of impingement were compared between 20°, 30°, and 40° of internal scapular rotation; between 20°, 30°, and 40° of upward scapular rotation; and between 0° and 10° of anterior scapular tilt. Data were analyzed with use of repeated-measures analysis of variance with the Tukey post hoc test. RESULTS Contact pressure was at its maximum in the posterior aspect of the glenohumeral joint. The glenohumeral contact pressure and internal impingement area increased with increasing internal scapular rotation. The glenohumeral contact pressure at 40° of internal scapular rotation was significantly (43.4%) greater than that at 20° of internal scapular rotation (p < 0.01), and the impingement area at 40° of internal scapular rotation was significantly (43.1%) greater than that at 20° of internal scapular rotation (p < 0.05). Decreasing upward scapular rotation resulted in an increase in internal impingement area. The internal impingement area at 40° of upward motion was 38.1% less than that at 20° of upward rotation (p < 0.001) and 28.9% less than that at 30° of upward rotation (p < 0.01). CONCLUSIONS Increasing internal scapular rotation and decreasing upward scapular rotation significantly increase glenohumeral contact pressure and the area of impingement of the rotator cuff tendon between the greater tuberosity and glenoid during simulated throwing motion.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
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Kibler WB, McMullen J, Uhl T. Shoulder Rehabilitation Strategies, Guidelines, and Practice. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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Jaspers E, Desloovere K, Bruyninckx H, Klingels K, Molenaers G, Aertbeliën E, Van Gestel L, Feys H. Three-dimensional upper limb movement characteristics in children with hemiplegic cerebral palsy and typically developing children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:2283-2294. [PMID: 21862283 DOI: 10.1016/j.ridd.2011.07.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 05/31/2023]
Abstract
The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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Affiliation(s)
- Ellen Jaspers
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
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Nordenson U, Garofalo R, Conti M, Linger E, Classon J, Karlsson J, Castagna A. Minor or occult shoulder instability: an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. Knee Surg Sports Traumatol Arthrosc 2011; 19:1570-5. [PMID: 21607736 DOI: 10.1007/s00167-011-1552-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/10/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Disruption in the balance of shoulder stability can produce a widely varied spectrum of clinical symptoms, ranging from minor shoulder instability to frank shoulder dislocation, followed by recurrent instability. In this study, a series of patients suffering from minor shoulder instability, all with clinical signs of preoperative subacromial impingement associated with instability, were treated. The shoulder instability alone was addressed, with the aim of eliminating the clinical symptoms of subacromial impingement and pain. MATERIAL In this study, 20 patients with minor shoulder instability, presenting with subacromial impingement symptoms, underwent arthroscopic treatment to address capsule-labral pathology. All patients underwent a preoperative assessment by one independent physiotherapist, using Constant and WOSI scores, as well as the Castagna test, on both the affected and non-affected sides. The Hawkins test and subacromial pain in 90° of abduction and internal rotation were also evaluated. All patients followed the same rehabilitation protocol by a second physiotherapist. All patients were followed up at 6, 12 and 24 months postoperatively by the same independent physiotherapist. RESULTS We observed that 20/20 patients had a positive Hawkins sign at >20° of internal rotation preoperatively, while 4/19 had a positive Hawkins sign--all with less pain--at the 24-month follow-up (P < 0.0001). Moreover, 20/20 had a positive Castagna test preoperatively, while 1/20 had a positive Castagna test at the 24-month follow-up. In terms of shoulder scores, at 24 months, the Constant score had improved from a median value of 70 (51-91) preoperatively to a median value of 91 (86-100). The median WOSI score was 48.3 (12.7-78.6) preoperatively and improved to 84.9 (39.5-98.5) at 24 months postoperatively. CONCLUSION Minor shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. By treating the intra-articular pathology, the extra-articular symptoms can be relieved in the vast majority of patients.
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Affiliation(s)
- Ulf Nordenson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cerullo J. The Luge Start: Rotator Cuff and Scapulothoracic Stabilization Exercises to Consider. Strength Cond J 2011. [DOI: 10.1519/ssc.0b013e3182289058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alteration in shoulder kinematics and associated muscle activity in people with idiopathic scoliosis. Spine (Phila Pa 1976) 2010; 35:1151-7. [PMID: 20421854 DOI: 10.1097/brs.0b013e3181cd5923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional control-matched study in adolescents with idiopathic scoliosis (IS). OBJECTIVE To evaluate whether subjects with IS had shoulder dysfunction and associated impairment in shoulder kinematics and muscular activation. SUMMARY OF BACKGROUND DATA Evidence indicates that shoulder kinematics are related to shoulder pain and dysfunction. Despite the degree of morbidity associated with altered shoulder kinematics likely to occur in subjects with IS, no report has been published to address this hypothesis. METHODS In this investigation, shoulder kinematics (scapular tipping, scapular upward rotation, and scapulohumeral rhythm) and associated muscular activities [upper trapezius (UT), lower trapezius (LT), serrantus anterior (SA), and middle deltoid (MD)] were evaluated with a 3-dimensional electromagnetic tracking device and electromyography during arm elevations in 13 female subjects with IS and 13 age-gender-dominant hand-matched controls. Additionally, self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) was evaluated between the 2 groups. RESULTS Subjects with IS demonstrated lower FLEX-SF scores than the controls (P = 0.01). For the convex side, more anterior tilt of the scapula in resting position was identified (P = 0.006). For the concave side, more scapular upward rotation in resting position was identified (P = 0.01). For the EMG amplitude, higher LT contraction activity on the convex side and lower LT and SA contraction activity on the concave side were established (P = 0.007 and less than 0.01, respectively). A moderate positive association was found between scapular posterior tipping during movement and FLEX-SF functional score (R = 0.51). A moderate negative association was found between LT muscular activity and FLEX-SF functional score (R = -0.54). CONCLUSION Given the progressive nature of IS and kinematic linkage among the thoracic spine, scapula, and arm, inadequate posterior tipping movement and high LT muscular activity on the convex side of IS are important to consider in rehabilitation programs for subjects with IS.
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Long-term patient satisfaction and functional outcome 8-11 years after subacromial decompression. Knee Surg Sports Traumatol Arthrosc 2010; 18:394-403. [PMID: 19851753 DOI: 10.1007/s00167-009-0963-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
The aim of this investigation was to evaluate the long-term outcome of arthroscopic subacromial decompression (ASD) in patients with primary impingement syndrome stage II and early stage III. Ninety-five patients (105 shoulders, 48 female), mean age 54 years (range 26-69), who had undergone surgery between 1996 and 1999, were included. Pain intensity during activity and at rest, patient satisfaction, active range of motion (ROM), muscular strength and shoulder function using the Constant score were evaluated. Fifty-three (50%) shoulders were pain-free (Visual Analogue Scale < or = 10 mm) during activity and 72 (68%) shoulders were pain-free at rest. Sixty-one (58%) patients stated that they were very satisfied and 27 (25%) were quite satisfied with regard to their current shoulder function. Shoulders were divided into Group 1: Pain-free patients (n = 53), Group 2: Patients with shoulder pain and no arthropathy (n = 41) and Group 3: Patients with shoulder pain and arthropathy (n = 11). The groups had average active ROM of 157 degrees, 135 degrees and 117 degrees, respectively, in abduction and 97 degrees, 79 degrees, and 68 degrees in external rotation. The average strength in elevation in the scapular plane was 7.4, 5.8 and 3.9 kg, respectively, whereas the mean value in external rotation was 8.4, 7.9 and 5.3 kg, respectively. The Constant score had a mean value of 87, 69 and 59 points in the three groups, respectively. Eleven shoulders have undergone re-operation, one after a new trauma. We conclude that ASD is a valuable procedure. Patients expressed a high degree of satisfaction with shoulder function 8-11 years after ASD.
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Gagnon D, Verrier M, Masani K, Nadeau S, Aissaoui R, Popovic M. Effects of Trunk Impairments on Manual Wheelchair Propulsion Among Individuals with a Spinal Cord Injury: A Brief Overview and Future Challenges. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1502-59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gagnon D, Koontz A, Mulroy S, Nawoczenski D, Butler-Forslund E, Granstrom A, Nadeau S, Boninger M. Biomechanics of Sitting Pivot Transfers Among Individuals with a Spinal Cord Injury: A Review of the Current Knowledge. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1502-33] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Struyf F, Nijs J, De Coninck K, Giunta M, Mottram S, Meeusen R. Clinical assessment of scapular positioning in musicians: an intertester reliability study. J Athl Train 2009; 44:519-26. [PMID: 19771291 PMCID: PMC2742462 DOI: 10.4085/1062-6050-44.5.519] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians. OBJECTIVE To examine the intertester reliability of scapular observation and 2 clinical tests for the assessment of scapular positioning in musicians. DESIGN Intertester reliability study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty healthy student musicians at a single university. MAIN OUTCOME MEASURE(S) Two assessors performed a standardized observation protocol, the measurement of the distance between the posterior border of the acromion and the wall, and the modified lateral scapular slide test. Each assessor was blinded to the other's findings. RESULTS The intertester reliability coefficients (kappa) for the observation in relaxed position, during unloaded movement, and during loaded movement were 0.41, 0.63, and 0.36, respectively. The kappa values for the observation of tilting and winging at rest were 0.48 and 0.42, respectively; during unloaded movement, the kappa values were 0.52 and 0.78, respectively; and with a 1-kg load, the kappa values were 0.24 and 0.50, respectively. The intraclass correlation coefficient (ICC) of the measurement of the acromial distance was 0.72 in relaxed position and 0.75 with the participant actively retracting both shoulders. The ICCs for the modified lateral scapular slide test varied between 0.63 and 0.58. CONCLUSIONS Our results demonstrated that the modified lateral scapular slide test was not a reliable tool to assess scapular positioning in these participants. Our data indicated that scapular observation in the relaxed position and during unloaded abduction in the frontal plane was a reliable assessment tool. The reliability of the measurement of the distance between the posterior border of the acromion and the wall in healthy musicians was moderate.
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Affiliation(s)
- Filip Struyf
- University College Antwerp, Antwerp, Belgium
- Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- University College Antwerp, Antwerp, Belgium
- Vrije Universiteit Brussel, Brussels, Belgium
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