Asymptomatic Elite Adolescent Tennis Players' Signs of Tendinosis in Their Dominant Shoulder Compared With Their Nondominant Shoulder

Assessment of shoulder joint derangements with magnetic resonance imaging in adult Nigerians

Objectives

Shoulder pain secondary to various aetiologies is a common musculoskeletal complaint worldwide, and Magnetic Resonance Imaging (MRI) is the most accurate imaging method for evaluating shoulder pain in all age groups. While the patterns of shoulder MRI abnormalities in various demographics have been reported, data on sub-Sahara African populations are still sparse. This study aims to describe the imaging features and spectrum of shoulder joint pathologies on MRI in adult Nigerians.

Materials and Methods

This was a retrospective review of the shoulder MRI of 100 adult Nigerians (with and without trauma) from September 2020 to December 2021. Their clinical data and shoulder MRI findings were extracted and analysed. Statistical significance was set at P ≤ 0.05.

Results

There were 64 males and 36 females aged 18-82 years. Right shoulder MRI was done in 53 subjects (53%), while the left shoulder was studied in 47 (47%). Supraspinatus tendinopathy (73%), acromioclavicular joint arthropathy (68%), and subacromial-subdeltoid (SASD) bursitis (64%) were the most frequently detected pathologies. Other demonstrated derangements include glenohumeral joint effusion (24%), long head of biceps tendon sheath effusion (18%), labral abnormalities (16%), subcoracoid bursitis (4%), Hill Sach's deformity (3%), anterior glenohumeral dislocation (2%), fatty degeneration of the supraspinatus/infraspinatus muscles (2%), adhesive capsulitis (1%), and other bony abnormalities (contusion, erosion, subchondral cysts). There was no significant difference in the frequency of shoulder abnormalities between the male and female subjects.

Conclusion

Acromioclavicular joint arthropathy, SASD bursitis, and rotator cuff disorders were the dominant pathologies in the participants' shoulders.

Wheelchair basketball, health, competitive analysis, and performance advantage: a review of theory and evidence

The purpose of this study was to review the various risks and benefits of wheelchair basketball (WB) and explore some of the research which outlines factors that influence WB player performance and conditioning. WB offers several physical and psychological advantages. Physically, it can improve muscle strength, endurance, and cardiovascular fitness while decreasing the prevalence of chronic physical disorders. From a psychological standpoint, WB has been shown to alleviate anxiety and feelings of depression while also creating and improving social relationships. Despite the many benefits, WB can cause injuries, particularly in the upper extremities, and preventative measures should be employed. WB necessitates intense intermittent efforts and athletes must maintain excellent cardiovascular fitness, strength, and muscular endurance. Healthy sleeping patterns have also been shown to improve performance in WB players. Wheelchair mobility and biomechanical variables as well as wheelchair size and weight appear to be critical success elements in WB. WB can be a powerful tool for coaches and therapists to boost the physical and emotional health of individuals with disabilities and motivate them to participate in team-based sport.

The aging athlete

Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.

A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations

Wheelchair tennis players are prone to develop shoulder injuries, due to the combination of wheelchair propulsion, overhead activities and daily wheelchair activities. A methodical literature search was conducted to identify articles on shoulder complaints in wheelchair tennis, wheelchair sports and tennis. The aims were to identify (1) type of shoulder complaints; (2) possible risk factors for the development of shoulder injuries; (3) musculoskeletal adaptations in the shoulder joint in wheelchair tennis players. Fifteen papers were included in this review, five on wheelchair tennis, three on wheelchair sports and seven on tennis. Type of shoulder complaints were acromioclavicular pathology, osteoarthritic changes, joint effusion and rotator cuff tears. Possible risk factors for the development of shoulder injuries in wheelchair tennis are overhead movements, repetitive activation of the anterior muscle chain and internal rotators, as well as a higher spinal cord injury level. Muscular imbalance with higher values for the internal rotators, increase in external range of motion, decrease in internal range of motion and reduced total arc of motion were the most common proposed musculoskeletal adaptations due to an unbalanced load. These presented risk factors and musculoskeletal adaptations might help researchers, coaches and wheelchair tennis players to prevent shoulder injuries.

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

Rotator Cuff Injuries in Tennis Players

PURPOSE OF REVIEW

This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players.

RECENT FINDINGS

Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance. Rotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.

Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes

Background

The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes.

Purpose/Hypothesis

The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI.

Study Design

Cross-sectional study; Level of evidence, 4.

Methods

A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance.

Results

Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient -0.731; P = .021).

Conclusion

Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

Swimming Practice and Scapular Kinematics, Scapulothoracic Muscle Activity, and the Pressure-Pain Threshold in Young Swimmers

CONTEXT

Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers.

OBJECTIVES

To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers.

INTERVENTION(S)

Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior.

MAIN OUTCOME MEASURE(S)

Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05.

RESULTS

Competitive swimmers presented more internal rotation at 90° ( P = .03) and 120° ( P = .047) and more anterior tilt at 90° ( P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° ( P = .004) and 120° ( P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° ( P = .02) and 90° to 120° ( P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners ( P = .04). No differences were found in any of the muscles for the PPT ( P > .05).

CONCLUSIONS

Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.

Taping to Improve Scapular Dyskinesis, Scapular Upward Rotation, and Pectoralis Minor Length in Overhead Athletes

CONTEXT

Deviations in scapular motions and subsequent alterations in associated soft tissues are thought to contribute to overuse shoulder injuries in overhead athletes. Whereas rigid and Kinesio taping are recommended for preventing these injuries, high-level evidence from clinical trials is still needed.

OBJECTIVE

To determine and compare the short-term effects of rigid and Kinesio taping on scapular dyskinesis, scapular upward rotation, and pectoralis minor length in asymptomatic overhead athletes.

DESIGN

Randomized controlled trial.

SETTING

Athletic training rooms.

PATIENTS OR OTHER PARTICIPANTS

Seventy-two elite asymptomatic overhead athletes (age = 17.00 ± 4.09 years, height = 1.75 ± 0.11 m, mass = 67.26 ± 15.25 kg, body mass index = 21.80 ± 3.00).

INTERVENTION(S)

We randomly assigned participants to 1 of 4 groups: rigid taping, Kinesio taping, placebo, or control (no taping). For the first 3 groups, we applied tape to the shoulder and scapular region.

MAIN OUTCOME MEASURE(S)

We evaluated all groups for observable scapular dyskinesis using the scapular dyskinesis test, scapular upward rotation using a digital inclinometer, and pectoralis minor length using the pectoralis minor index at baseline, immediately after taping, and at 60 to 72 hours after taping.

RESULTS

The scapular dyskinesis percentage ( P < .05) decreased and the pectoralis minor index ( P < .001) increased immediately and at 60 to 72 hours after taping in the rigid-taping and Kinesio-taping groups. We observed no differences among groups for the change in the pectoralis minor index ( P > .05). Scapular upward rotation did not change after taping in any group ( P > .05).

CONCLUSIONS

Rigid or Kinesio taping of the shoulder and scapular region improved scapular dyskinesis and pectoralis minor length but did not alter scapular upward rotation. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.

Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes

PURPOSE

In order to provide science-based guidelines for injury prevention or return to play, regular measurement of isometric and eccentric internal (IR) and external (ER) rotator strength is warranted in overhead athletes. However, up to date, no normative database exists regarding these values, when measured with a hand-held dynamometer. Therefore, the purpose of the study was to provide a normative database on isometric and eccentric rotator cuff (RC) strength values in a sample of overhead athletes, and to discuss gender, age and sports differences.

METHODS

A HHD was used to measure RC strength in 201 overhead athletes between 18 and 50 years old from three different sports disciplines: tennis, volleyball and handball. Isometric as well as eccentric strength was measured in different shoulder positions. Outcome variables of interest were isometric ER and IR strength, eccentric ER strength, and intermuscular strength ratios ER/IR.

RESULTS

Our results show significant side, gender and sports discipline differences in the isometric and eccentric RC strength. However, when normalized to body weight, gender differences often are absent. In general, strength differences are in favour of the dominant side, the male athletes and handball. Intermuscular ER/IR ratios showed gender, sports, and side differences.

CONCLUSION

This normative database is necessary to help the clinician in the evaluation of RC strength in healthy and injured overhead athletes. In view of the preventive screening and return-to-play decisions in overhead athletes, normalization to body weight and calculating intermuscular ratios are key points in this evaluation.

LEVEL OF EVIDENCE

Diagnostic study, Level III.