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Türkmen OB, Akçay B, Demir C, Kurtoğlu A, Alotaibi MH, Elkholi SM. Does the Effect of Mental Fatigue Created by Motor Imagery on Upper Extremity Functions Change with Diaphragmatic Breathing Exercises? A Randomized, Controlled, Single-Blinded Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1069. [PMID: 39064498 PMCID: PMC11279225 DOI: 10.3390/medicina60071069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: This study focused on the impact of mental fatigue induced by motor imagery on upper limb function, an area with limited research compared to lower limb performance. It aimed to explore how diaphragmatic breathing exercises influence these effects. Materials and Methods: This study included 30 participants, and Group 1 participated in 12 sessions of diaphragmatic breathing exercises under the supervision of a physiotherapist; Group 2 did not receive any intervention. For all the participants, mental fatigue was induced with motor imagery before and after the intervention, and evaluations were performed before and after mental fatigue. Upper extremity functions were evaluated using isometric elbow flexion strength, hand grip strength, upper extremity reaction time and endurance, finger reaction time, the nine-hole peg test, shoulder position sense, light touch-pressure threshold, and two-point discrimination. Results: The study results showed that after mental fatigue, there was a decrease in isometric elbow flexion strength, nondominant hand grip strength, and nondominant upper extremity endurance, and an increase in nondominant tactile sensation (p < 0.05). No changes were found in two-point discrimination, nine-hole peg test time, and position sense on either side (p > 0.05). The effect of mental fatigue on isometric elbow flexion strength and nondominant grip strength showed significant improvement following diaphragmatic breathing exercises (p < 0.05). Conclusions: This study found that mental fatigue from motor imagery can impact elbow flexion, hand grip strength, upper extremity endurance, and tactile sensitivity. Breathing exercises may help improve strength parameters affected by mental fatigue. It is crucial to consider these effects on upper extremity functions in rehabilitation programs.
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Affiliation(s)
- Ozan Bahadır Türkmen
- Physical Therapy and Rehabilitation, Health Sciences, Bandirma Onyedi Eylul University, 10200 Balıkesir, Türkiye
| | - Burçin Akçay
- Physical Therapy and Rehabilitation, Health Sciences, Bandirma Onyedi Eylul University, 10200 Balıkesir, Türkiye
| | - Canan Demir
- Physical Therapy and Rehabilitation, Health Sciences, Bandirma Onyedi Eylul University, 10200 Balıkesir, Türkiye
| | - Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandirma Onyedi Eylul University, 10200 Balıkesir, Türkiye
| | - Madawi H. Alotaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Safaa M. Elkholi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Depreli O, Erden Z. The effects of shoulder stabilization exercises on muscle strength, proprioceptive sensory ability and performance in office workers with shoulder protraction. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:599-610. [PMID: 38533585 DOI: 10.1080/10803548.2024.2326358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
Objectives. Shoulder protraction is frequently seen in office workers because of working with excessive trunk flexion for a long time. This study aimed to compare the effectiveness of stabilization exercises (SE) given in addition to office exercises (OE). Methods. Sixty office workers with shoulder protraction were divided into SE + OE (n = 30) and OE (n = 30) groups by stratified random sampling for 8 weeks and followed up for 4 weeks. Shoulder protraction was assessed with a caliper, muscle strength with a hand-held dynamometer, proprioception with an isokinetic dynamometer, vibration sense with a vibrometer and upper extremity functional performance with the closed kinetic chain upper extremity stability test. Results. There were significant improvements in all parameters in the OE + SE group, while increases in the strength of the upper trapezius, pectoralis major and infraspinatus muscles and in upper extremity functional performance were also found in the OE group (p < 0.05). During detraining, shoulder protraction, muscle strength, proprioception and upper extremity performance showed longer-term improvement with SE + OE (p < 0.05). Conclusion. The results obtained with the exercises demonstrate the importance of SE + OE in terms of maintaining proper posture and improving shoulder proprioception, muscle strength and functional performance.
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Affiliation(s)
- O Depreli
- Eastern Mediterranean University, Health Sciences Faculty, Physiotherapy and Rehabilitation Department, Famagusta, North Cyprus, via Mersin 10 Turkey
| | - Z Erden
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Karabay D, Yeşilyaprak SS, Erduran M, Ozcan C. Effects of Eccentric Versus Concentric Strengthening in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial. Sports Health 2024:19417381241236817. [PMID: 38532530 DOI: 10.1177/19417381241236817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS. HYPOTHESIS Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24. RESULTS For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG (P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant (P > 0.05). CONCLUSION In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS. CLINICAL RELEVANCE Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.
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Affiliation(s)
- Damla Karabay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Sevgi Sevi Yeşilyaprak
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Bakircay University, Izmir, Turkey
| | - Mehmet Erduran
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cem Ozcan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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Alfaya FF, Reddy RS, Alkhamis BA, Kandakurti PK, Mukherjee D. Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study. Diagnostics (Basel) 2023; 13:2099. [PMID: 37370994 DOI: 10.3390/diagnostics13122099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Subacromial Impingement Syndrome (SAIS) is a common shoulder condition characterized by pain and functional impairment. Proprioception, the sense of joint position and movement, is crucial in maintaining joint stability and coordinating movements. The relationship between shoulder proprioception, pain intensity, and functional disability in individuals with SAIS remains unclear, with conflicting findings in the literature. This cross-sectional study aimed to evaluate shoulder proprioception, examine its correlation with pain intensity and functional disability, and contribute to our understanding of the clinical implications of proprioceptive deficits in individuals with SAIS. Forty-two individuals were diagnosed with SAIS, and an equal number of asymptomatic controls were recruited. Shoulder proprioception was assessed using a digital inclinometer, measuring joint position sense at various angles of flexion and rotation. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Shoulder Pain and Disability Index (SPADI). Results: Individuals with SAIS exhibited significantly higher joint position error (JPE) values compared to asymptomatic controls in all measured angles of flexion and rotation (p < 0.001). Strong positive correlations were observed between JPE and pain intensity (r = 0.61 to 0.71, p < 0.01) and disability (r = 0.56 to 0.68, p < 0.01). These findings suggest impaired shoulder proprioception is associated with higher pain intensity and functional disability in SAIS. This study provides evidence of impaired shoulder proprioception in individuals with SAIS and its correlation with pain intensity and functional disability. The results highlight the clinical relevance of proprioceptive deficits in SAIS and emphasize the importance of incorporating proprioceptive assessment and targeted rehabilitation interventions into managing this condition. Future research should focus on longitudinal studies with larger and more diverse samples to further understand the underlying mechanisms and evaluate the effectiveness of proprioceptive interventions in improving outcomes for individuals with SAIS.
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Affiliation(s)
- Fareed F Alfaya
- Department of Orthopaedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Batool Abdulelah Alkhamis
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | | | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Çalık M, Utlu DK, Demirtaş A, Canbora MK, Erdil ME, Düzgün İ. Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears? INTERNATIONAL ORTHOPAEDICS 2023; 47:1021-1029. [PMID: 36719444 DOI: 10.1007/s00264-023-05702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants. METHODS Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense. RESULTS Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05). CONCLUSION AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.
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Affiliation(s)
- Mahmut Çalık
- Department of Sports Physiotherapy, Institute of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Defne Kaya Utlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Uludag University, Bursa, Turkey
| | - Abdullah Demirtaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, İstanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Kerem Canbora
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Uskudar University, Istanbul, Turkey
| | - Mehmet Emin Erdil
- Department of Orthopaedics and Traumatology, Maslak Acıbadem Hospital, Istanbul, Turkey
| | - İrem Düzgün
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Forcin Favaro I, Martins J, Rossi DM, de Lima Boarati E, Felippe de Morais M, Oliveira AS. Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome. Physiother Theory Pract 2022; 39:1287-1296. [PMID: 35135433 DOI: 10.1080/09593985.2022.2035031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The proprioception plays an important role in the stability of the shoulder joint. However, clinical practice lacks reliable and user-friendly tools. OBJECTIVES To evaluate the intra- and inter-rater reliability of the Laser-Pointer assisted Angle Reproduction Test (LP-ART), to analyze the difference in proprioception between the symptomatic and asymptomatic shoulders, and to investigate if there is a correlation between the LP-ART and the pain intensity assessed by 11-point Numerical Rating Pain Scale (NRPS) and the level of shoulder disability and pain assessed by the Disability Index and Shoulder Pain (SPADI - BR). METHODS Fifty patients (age = 56.2 ± 10.4 years) performed the LP-ART at 90° of shoulder flexion. RESULTS The intra and interrater reliability of the LP-ART measurements was moderate (Intraclass Correlation Coefficient2,3 = 0.41 to 0.65) for both shoulders, symptomatic and asymptomatic. There was no difference in the absolute angular deviation between shoulders (mean difference of 0.4°, P = .581). The absolute angular deviation was not significantly correlated with the pain intensity (rs = 0.007, P = .962) and the SPADI - BR (rs = 0.022, P = .881). CONCLUSION The LP-ART measurement showed moderate reliability in participants with subacromial pain syndrome. The active joint position sense was not different between symptomatic and asymptomatic shoulders, and there was no correlation between proprioception and the pain intensity and shoulder pain and disability level.
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Affiliation(s)
- Isabela Forcin Favaro
- Physiotherapy Graduate Program of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Denise Martineli Rossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo de Lima Boarati
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Mayra Felippe de Morais
- Physiotherapy Graduate Program of Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Anamaria Siriani Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Proprioception: How is it affected by shoulder pain? A systematic review. J Hand Ther 2021; 33:507-516. [PMID: 31481340 DOI: 10.1016/j.jht.2019.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proprioception encompasses the submodalities of joint position sense (JPS), kinesthesia, sense of force, and velocity. Owing to the vast mobility of the shoulder, it heavily relies on an intact sense of proprioception. Moreover, shoulder injuries are associated with a decreased sense of proprioception. What remains unclear is how shoulder proprioception is affected by pain and competing nociceptive senses. PURPOSE OF THE STUDY To summarize the literature evaluating the relationship between pain and shoulder proprioception. METHODS A literature review was conducted from inception until 22 October 2018, using electronic databases (PubMed, Web of Science, Scopus, EBSCO, CINAHL, and Embase). Retrieved citations were screened for eligibility, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Eleven studies were included (n = 447 participants with shoulder pain, n = 20 with experimentally induced pain [EIP]/n = 600 painful shoulders and n = 20 [EIP]). The mean methodological quality of the studies was good (76%). Five studies investigated active JPS, four investigated passive JPS, six investigated kinesthesia, sense of force was measured in one study, and no study investigated sense of velocity. There is moderate evidence for impaired kinesthesia and low evidence for reduced sense of force among painful shoulders. Conflicting evidence is seen for the other proprioceptive submodalities. CONCLUSION The overall impact of pain on shoulder JPS remains unclear, while moderate evidence for an affected sense of kinesthesia is possible. There is low evidence for an impaired sense of force among painful shoulders. Standardization between studies is lacking, limiting the range of our conclusions. Further investigation is required into well-controlled and pain-induced studies to better understand the influence of pain on shoulder proprioception.
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Overbeek CL, Gacaferi H, Schoones JW, Jayakumar P, Vermeulen HM, de Groot JH, Nelissen RGHH, Nagels J. The effect of conservative therapies on proprioception in subacromial pain syndrome: a narrative synthesis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1787511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Celeste L. Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Hamez Gacaferi
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands
| | - Prakash Jayakumar
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henricus M. Vermeulen
- Department of Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
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Analysis of the presence and influence of Glenohumeral Internal Rotation Deficit on posterior stiffness and isometric shoulder rotators strength ratio in recreational and amateur handball players. Phys Ther Sport 2019; 42:1-8. [PMID: 31865237 DOI: 10.1016/j.ptsp.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether recreational and amateur handball players exhibit Glenohumeral Internal Rotation Deficit (GIRD), and if it is accompanied by posterior stiffness and changes in shoulder rotators strength. DESIGN Cross-Sectional Study; SETTING: Research laboratory. PARTICIPANTS Indoor and beach handball players, members of handball teams or engaged in some handball recreational group. MAIN OUTCOME MEASURES Range of motion (ROM) of internal rotation (IR) and horizontal adduction (HA), and isometric internal and external rotators strength. Based on the ROM of internal rotation, they were allocated to groups with and without GIRD. RESULTS The dominant shoulder of GIRD group obtained a lower ROM of IR compared to the non-dominant shoulder of the same group (p < 0.01) and to the dominant (p = 0.02) and non-dominant (p = 0.01) shoulders of the group without GIRD. Less horizontal adduction was observed in both groups (p = 0.01), as well as greater external rotator strength (p = 0.01) and external/internal rotators strength ratio (p < 0.04) in the dominant shoulder. The rotators strength ratio was greater in GIRD group (p < 0.01). CONCLUSIONS The present study showed the dominant shoulder had greater posterior stiffness and external rotator strength, regardless of GIRD. Also the group with GIRD showed higher rotators strength ratio.
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Ramos MM, Carnaz L, Mattiello SM, Karduna AR, Zanca GG. Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability. Phys Ther Sport 2019; 37:157-163. [PMID: 30978602 DOI: 10.1016/j.ptsp.2019.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN Reliability study. SETTING Clinical measurement. PARTICIPANTS Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.
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Affiliation(s)
- Marieli M Ramos
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | - Letícia Carnaz
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | - Stela M Mattiello
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Andrew R Karduna
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Gisele G Zanca
- Master's Program in Physical Therapy, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil.
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Lubiatowski P, Ogrodowicz P, Wojtaszek M, Romanowski L. Bilateral shoulder proprioception deficit in unilateral anterior shoulder instability. J Shoulder Elbow Surg 2019; 28:561-569. [PMID: 30502033 DOI: 10.1016/j.jse.2018.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Proprioception is an important element of shoulder dynamic stability. It has been shown to be affected in cases of capsular or labral injuries of the glenohumeral joint. Therefore, this study was conducted to investigate bilateral shoulder proprioception by active reproduction of joint position both in patients with post-traumatic recurrent unilateral shoulder instability and in normal healthy volunteers. METHODS We compared 41 patients, comprising 11 female and 30 male patients with an average age of 25.6 years (range, 18-39 years), with post-traumatic unilateral anterior shoulder instability with a control group of 27 healthy volunteers with no history of shoulder problems and with normal shoulder function during examination. All patients were examined using a high-accuracy computer-controlled electronic goniometer (Propriometer). The error of active reproduction of joint position (EARJP) was measured in abduction, flexion, external rotation, and internal rotation in both shoulders. RESULTS We observed a significant deficit in the EARJP in the unstable shoulders within the instability group. Surprisingly, similar results were recorded for the contralateral, unaffected shoulders within this group of patients compared with the control group. Joint acuity increased with higher elevation of the arm position. CONCLUSION Unilateral shoulder injuries, resulting in instability, affect proprioception in both shoulders, as demonstrated by an increased EARJP. This is the first report of unilateral shoulder instability coexisting with inferior proprioception in both shoulders.
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Affiliation(s)
- Przemysław Lubiatowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland; Rehasport Clinic, Poznań, Poland.
| | - Piotr Ogrodowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland; Rehasport Clinic, Poznań, Poland
| | - Marcin Wojtaszek
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, Poznań, Poland
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Gomes BSQ, Coelho VK, Terra BS, Bunn PS, Saragiotto BT, Ferreira AS, Nogueira LAC. Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study. PM R 2019; 11:972-978. [PMID: 30609221 DOI: 10.1002/pmrj.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood. OBJECTIVE To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls. STUDY DESIGN Matched case-control study. SETTING Physical Functional Rehabilitation Service of an outpatient clinic. PARTICIPANTS A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness. INTERVENTIONS All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index. MAIN OUTCOME MEASUREMENTS The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS). RESULTS The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS. CONCLUSIONS Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bruno S Q Gomes
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Vanessa K Coelho
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Bruno S Terra
- B.S.T. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Priscila S Bunn
- P.S.B. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil and Exercise and Sport Sciences Department, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Bruno T Saragiotto
- B.T.S. Musculoskeletal Division, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Arthur S Ferreira
- A.S.F. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro A C Nogueira
- L.A.C.N. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. INTERNATIONAL ORTHOPAEDICS 2018; 43:229-235. [DOI: 10.1007/s00264-018-4150-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022]
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Sahin E, Dilek B, Baydar M, Gundogdu M, Ergin B, Manisali M, Akalin E, Gulbahar S. Shoulder proprioception in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 2018; 30:857-862. [PMID: 28372317 DOI: 10.3233/bmr-160550] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. OBJECTIVE To investigate the shoulder proprioception in patients with SIS. METHODS Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. RESULTS The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P < 0.05). When involved shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P < 0.05) except active position sense at 0°. When uninvolved shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P < 0.05). CONCLUSION This study showed that shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.
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Affiliation(s)
- Ebru Sahin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Banu Dilek
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Meltem Baydar
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Mehtap Gundogdu
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Burcu Ergin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Metin Manisali
- Department of Radiodiagnostic, Dokuz Eylul University, Izmir, Turkey
| | - Elif Akalin
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Selmin Gulbahar
- Department of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Ettinger LR, Shapiro M, Karduna A. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017. [PMID: 28638243 PMCID: PMC5470851 DOI: 10.1177/1179544117713196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS); however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance–matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS) was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P = .042) and elbow (5.6° difference, P = .001) than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater (P = .046) than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.
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Affiliation(s)
- Lucas R Ettinger
- Department of Exercise Science, Willamette University, Salem, OR, USA
| | - Matthew Shapiro
- Slocum Center for Orthopedics & Sports Medicine, Eugene, OR, USA
| | - Andrew Karduna
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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Watts AR, Williams B, Kim SW, Bramwell DC, Krishnan J. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow 2017; 9:31-41. [PMID: 28572848 PMCID: PMC5441616 DOI: 10.1177/1758573216663201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/04/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions. METHODS This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL. RESULTS Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations. CONCLUSIONS This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.
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Affiliation(s)
- Amy R. Watts
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Ben Williams
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
| | - Susan W. Kim
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Donald C. Bramwell
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Jeganath Krishnan
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
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Sole G, Osborne H, Wassinger C. The effect of experimentally-induced subacromial pain on proprioception. ACTA ACUST UNITED AC 2014; 20:166-70. [PMID: 25261091 DOI: 10.1016/j.math.2014.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 08/02/2014] [Accepted: 08/26/2014] [Indexed: 02/06/2023]
Abstract
Shoulder injuries may be associated with proprioceptive deficits, however, it is unknown whether these changes are due to the experience of pain, tissue damage, or a combination of these. The aim of this study was to investigate the effect of experimentally-induced sub-acromial pain on proprioceptive variables. Sub-acromial pain was induced via hypertonic saline injection in 20 healthy participants. Passive joint replication (PJR) and threshold to detection of movement direction (TTDMD) were assessed with a Biodex System 3 Pro isokinetic dynamometer for baseline control, experimental pain and recovery control conditions with a starting position of 60° shoulder abduction. The target angle for PJR was 60° external rotation, starting from 40°. TTDMD was tested from a position of 20° external rotation. Repeated measures ANOVAs were used to determine differences between PJR absolute and variable errors and TTDMD for the control and experimental conditions. Pain was elicited with a median 7 on the Numeric Pain Rating Scale. TTDMD was significantly decreased for the experimental pain condition compared to baseline and recovery conditions (≈30%, P = 0.003). No significant differences were found for absolute (P = 0.152) and variable (P = 0.514) error for PJR. Movement sense was enhanced for the experimental sub-acromial pain condition, which may reflect protective effects of the central nervous system in response to the pain. Where decreased passive proprioception is observed in shoulders with injuries, these may be due to a combination of peripheral tissue injury and neural adaptations that differ from those due to acute pain.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, University of Otago, New Zealand.
| | | | - Craig Wassinger
- Department of Physical Therapy, East Tennessee State University, USA
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Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2014; 20:28-37. [PMID: 25241661 DOI: 10.1016/j.math.2014.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/08/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022]
Abstract
The aim of this systematic review was to synthesize the evidence for changes for proprioceptive variables consisting of movement and position sense in participants with glenohumeral musculoskeletal disorders. Five databases were searched until 13th August 2013. Methodological quality was assessed and meta-analyses were performed for active and passive joint reposition sense (AJPS and PJPS) and movement sense, determined with threshold to detection of passive motion (TTDPM). The search yielded 17 studies, four of which were classified as having high methodological quality, seven as moderate and six as low quality. For participants with post-traumatic glenohumeral instability, pooled findings indicate moderate evidence for higher TTDPM for involved shoulders compared to control groups and the contralateral uninvolved side, indicating decreased movement sense. For AJPS and PJPS there was moderate to limited evidence for significant increased errors for involved compared to uninvovled shoulders, but not when compared to the control groups. Limited evidence was found for decreased AJPS acuity for patients with chronic rotator cuff pain and for patients with unspecified shoulder pain compared to healthy controls. Movement sense is most likely to be impaired after shoulder injury involving post-traumatic instability when compared to the contralateral shoulder and to controls, while deficits for AJPS and PJPS are more likely to be evident compared to the contralateral shoulder in participants with glenohumeral musculoskeletal disorders.
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Affiliation(s)
- Charlotte Fyhr
- Institution of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Sweden
| | - Linnéa Gustavsson
- Institution of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Sweden
| | - Craig Wassinger
- Department of Physical Therapy, East Tennessee State University, USA
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
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