Active Scapular Retraction and Acromiohumeral Distance at Various Degrees of Shoulder Abduction

Utilizing Scapula Retraction Exercises With or Without Glenohumeral Rotational Exercises With a Gradual Progression for Subacromial Pain Syndrome

BACKGROUND

Although exercise interventions are recommended in the management of subacromial pain syndrome (SPS), there is a lack of data regarding the exercises focusing on the principal biomechanical deficiencies that cause symptoms.

HYPOTHESIS

Utilizing progressive scapula retraction exercises (SRE) and glenohumeral rotation exercises (GRE) in the scapula stabilization program may lead to more reduction in symptoms and greater acromiohumeral distance (AHD) values.

STUDY DESIGN

A double-blind, randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 33 patients were assigned randomly to either SRE or SRE+GRE. Both groups received a 12-week supervised rehabilitation program, including manual therapy and exercises (stretching and progressive scapula stabilization exercises). In addition, the SRE+GRE group performed GRE exercises at gradual elevation angles. From 12 to 24 weeks, patients performed exercise programs less frequently (3 times per week). Disability (shoulder pain and disability index [SPADI]), AHD (at 5 active abduction angles), pain intensity (visual analogue scale [VAS]), and patient satisfaction were recorded at baseline, 12 weeks, and 24 weeks. A total of 16 healthy individuals were recruited as a control group to compare AHD values. Data were analyzed using mixed model analyses of variance.

RESULTS

A statistically significant group-by-time interaction was found for AHD values (F4,92 = 6.38; P = 0.001), a significant group-by-time interaction for SPADI-disability (F1,33 = 5.148; P = 0.01), SPADI-total (F1,32 = 4.172; P = 0.03), and for pain during activity (F2,62 = 3.204; P = 0.05). However, no significant group-by-time interaction for SPADI-pain (F1,33 = 0.533; P = 0.48), for pain at rest (F1,31 < 0.001; P = 0.99), and at night (F1,32 = 2.166; P = 0.15). Yet, a significant time effect was observed.

CONCLUSION

Progressive SRE and GRE in the scapula stabilization program lessens symptoms and improves AHD values in patients with SPS. Moreover, this program could preserve outcomes and further increase AHD when applied less frequently.

CLINICAL RELEVANCE

Utilizing SRE and GRE in the scapula stabilization program at gradual shoulder abduction angles provides better rehabilitation outcomes.

Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Instrument-assisted soft tissue mobilization versus myofascial release therapy in treatment of chronic neck pain: a randomized clinical trial

OBJECTIVE

The purpose of this study was to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) versus myofascial release therapy (MRT) on college students with chronic mechanical neck pain (CMNP).

METHODS

Thirty-three college students with a mean age of 21.33 ± 0.98 involved in distance learning due to the Corona Virus 2019 (COVID-19) restriction were randomized to receive either IASTM on the upper trapezius and levator scapulae muscles or MRT. Researchers measured their pain with a visual analog scale (VAS), function with neck disability index (NDI), and pain pressure threshold (PPT) with a pressure algometer. The subjects received eight therapy sessions over four weeks and outcome measures were assessed pre and post-intervention. The study was registered as a clinical trial on clinicaltrials.gov (registration number: NCT05213871).

RESULT

Unpaired t-test showed no statistical significance between the two groups post-intervention regarding improvement in pain, function, and PPT (p > 0.05).

CONCLUSION

This study showed insignificant differences between groups. However, we did not use a control group, indicating that the improvement in outcomes may not have been caused by the intervention.

STUDY DESIGN

Quasi-experimental two groups pre-posttest clinical trial.

LEVEL OF EVIDENCE

Therapy, level 2b.

In Vivo Anatomical Research by 3D CT Reconstruction Determines Minimum Acromiohumeral, Coracohumeral, and Glenohumeral Distances in the Human Shoulder: Evaluation of Age and Sex Association in a Sample of the Chinese Population

Accurate measurement of the minimum distance between bony structures of the humeral head and the acromion or coracoid helps advance a better understanding of the shoulder anatomical features. Our goal was to precisely determine the minimum acromiohumeral distance (AHD), coracohumeral distance (CHD), and glenohumeral distance (GHD) in a sample of the Chinese population as an in vivo anatomical analysis. We retrospectively included 146 patients who underwent supine computed tomography (CT) examination of the shoulder joint. The minimum AHD, CHD, and GHD values were quantitatively measured using three-dimensional (3D) CT reconstruction techniques. The correlation between minimum AHD, CHD, and GHD value and age with different sexes was evaluated using Pearson Correlation Coefficient. The mean value of minimum AHD in males was greater than that in females (male 7.62 ± 0.98 mm versus female 7.27 ± 0.86 mm, p = 0.046). The CHD among different sexes differed significantly (male 10.75 ± 2.40 mm versus female 8.76 ± 1.38 mm, p < 0.001). However, we found no statistical differences in GHD with different sexes (male 2.00 ± 0.31 mm versus female 1.96 ± 0.36 mm, p > 0.05). In terms of age correlation, a negative curve correlation existed between age and AHD among the different sexes (male R2 = 0.124, p = 0.030, female R2 = 0.112, p = 0.005). A negative linear correlation was found in CHD among the different sexes (male R2 = 0.164, p < 0.001, female R2 = 0.122, p = 0.005). There were no differences between age and minimum GHD in both sexes. The 3D CT reconstruction model can accurately measure the minimum AHD, CHD, and GHD value in vivo and is worthy of further investigation for standard clinical anatomical assessment. Aging may correlate with AHD and CHD narrowing for both sexes.

[Comparison of the effectiveness of the long head of the biceps tendon with or without proximal amputation after arthroscopic repair of the rotator cuff]

OBJECTIVE

To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury.

METHODS

The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups ( P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction.

RESULTS

There was no significant difference in operation time between the two groups ( t=-0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference ( t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups ( χ ²=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation ( P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation ( P<0.05), and there was no significant difference between the two groups at 12 months after operation ( P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant ( Z=-1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up ( t=-2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B ( P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B ( P<0.05).

CONCLUSION

In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.

Clinical utility of ultrasonography imaging in musculoskeletal conditions: A Systematic review and Meta-analysis

Optimising ultrasonography imaging (UI) applications for clients is a highly specific and sensitive add-on method. The aim of this meta-analysis was to systematically evaluate the clinical utilisation of UI in musculoskeletal conditions by rehabilitation providers in the past decade. Two reviewers independently assessed relevant research articles from five databases electronically (Medline, Cochrane Library, EMBASE, ProQuest, EBSCO) and screened titles and abstracts based on predefined eligibility criteria (2010- 2020). A total of 147 articles were screened for eligibility by two reviewers independently, and any disagreements were resolved by another reviewer using Rayyan QCRI software. Ninety-seven duplicates were removed, and after excluding 21 studies, 16 randomized controlled trials were included and full texts retrieved. Data were synthesised using Revman 5.4 software for qualitative analysis and risk-of-bias assessment. Four similar studies were statistically analysed for heterogeneity of abdominal muscle contraction ratios. Two interventional studies were also analysed to assess the effect of feedback. The diagnostic application of UI was investigated using a consistent amount of literature, though from a rehabilitation perspective the literature is inconclusive. The clinical utility of UI in rehabilitation by physical therapists is conclusive and has potential to advance clinical practice. Further well-designed randomized controlled trials minimising selection biases will help improve the quality in this domain. Critical reflection, clinical reasoning, and mutual goal setting will help practising physical therapists to scrutinize the clinical practice more objectively.

Mechanisms of Modulation of Automatic Scapulothoracic Muscle Contraction Timings

Erected posture provides humans a large shoulder mobility that requires complex automatic muscle synergies to accomplish joint stability needs. This is evident in shoulder abduction, wherein the voluntary activation of glenohumeral muscles is coupled with an automatic recruitment of scapulothoracic muscles. Here, we investigated whether volitional modification of the scapular position, and dynamic scapular elevation, modulate the contraction timing of five shoulder muscles (middle deltoid, upper, middle and lower fiber of the trapezius, serratus anterior) during shoulder abduction. The results show matched contraction timings of the deltoid and upper trapezius across the scapular positions, whereas the contraction timings of the middle and lower fibers of the trapezius change secondary to the scapular position. These results might reflect different central strategies to coordinate the automatic sequences of contraction of the scapulothoracic muscles. This suggest a flexible and adaptable predisposition of the motor control system in exploring alternative solutions to accomplish the functional movement needs, such as the fulfillment of unconstrained movements. Intriguingly, the shoulder abduction may represent a powerful, non-invasive, and straightforward tool to deepen the understanding of the neural basis underlying the voluntary motor command modulation of the out-of-volition automatic muscle contractions.

Shoulder kinematics impact subacromial proximities: a review of the literature

BACKGROUND

Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space.

OBJECTIVE

The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities.

CONCLUSIONS

A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.

Trapezius muscle activation levels and ratios during scapular retraction exercises: A comparative study between patients with subacromial impingement syndrome and healthy controls

BACKGROUND

Little is known about trapezius muscle activities during scapular retraction exercises in patients with subacromial impingement syndrome. The aim of this study was to compare upper trapezius, middle trapezius and lower trapezius muscle activity and upper/middle and upper/lower trapezius ratios between patients with subacromial impingement syndrome and healthy individuals during six scapular retraction exercises.

METHODS

Twenty-two patients with subacromial impingement syndrome and 22 healthy individuals participated. Upper, middle, and lower trapezius activities were measured by surface electromyography, while the participants performed six scapular retraction exercises at different shoulder abduction angles in a standing position. Upper/middle and upper/lower trapezius ratios were also calculated. Repeated-measures analyses of variance were performed to determine whether muscle activation levels and ratios differed between groups during exercises.

FINDINGS

There was no significant exercise × group interactions for upper, middle, and lower trapezius activation levels and upper/middle and upper/lower trapezius ratios (P > .05). A main effect for the exercise was observed for the upper/middle and upper/lower trapezius ratios (P < .05).

INTERPRETATION

Compared to healthy individuals, patients with subacromial impingement syndrome did not exhibit different upper, middle, and lower trapezius activity and had similar upper/middle and upper/lower trapezius ratios during the various scapular retraction exercises. Therefore, scapular retraction exercises with various shoulder abduction could be safely offered for the patients with subacromial impingement syndrome since it does not lead to abnormal compensatory trapezius muscle activity. If the goal is to minimize upper/middle and upper/lower trapezius ratios, the scapular retraction exercises at 0° shoulder abduction may be used in early stage of shoulder rehabilitation.