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Funakoshi T, Furushima K, Miyamoto A, Kusano H, Takahashi T, Inoue A, Shimokobe H. Thoracic outlet syndrome in overhead athletes. JSES Int 2024; 8:620-629. [PMID: 38707577 PMCID: PMC11064620 DOI: 10.1016/j.jseint.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background We aimed to retrospectively compare the clinical outcomes of endoscopy-assisted first-rib resection for thoracic outlet syndrome (TOS) between overhead athletes and nonathletes and investigate the return to same-level sports rate in overhead athletes. Methods We retrospectively reviewed 181 cases with TOS (75 women, 106 men; mean age, 28.4 years; range, 12-57 years) who underwent endoscopy-assisted first-rib resection. We divided into two groups: 79 overhead athletes and 102 nonathletes groups. A transaxillary approach for first-rib resection and neurovascular decompression was performed under magnified visualization. Endoscopic findings related to the neurovascular bundle, interscalene distance, and scalene muscle were evaluated intraoperatively. We assessed the Roos and Disability of the Arm, Shoulder, and Hand scores, return to same-level sports rate, and ball velocity. Results Overhead athletes were significantly more likely to be men, younger, used the dominant side more frequently, and have a larger physique, more shoulder and elbow pain, and shorter symptom duration. The outcomes of the Roos score revealed significant differences in excellent or good results between overhead athletes (91.1%) and nonathletes (62.8%). The two groups significantly differed in preoperative and postoperative Disability of the Arm, Shoulder, and Hand and recovery rate scores (P = .007, < .001, < .001). Conclusion Overhead athletes with TOS were more likely to be men, younger, dominant side more frequently, and have more shoulder and elbow pain, and a shorter symptom duration. Endoscopy-assisted transaxillary first-rib resection and neurolysis provided superior clinical outcomes in overhead athletes with TOS compared with nonathletes and a high return-to-same-level-play rate in sports.
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Affiliation(s)
| | | | | | | | | | - Akira Inoue
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Kirac M, Ergun S, Gamli A, Bayram B, Kocaoglu B. Remplissage reduced sense of apprehension and increased the rate of return to sports at preinjury level of elite overhead athletes with on-track anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2023; 31:5979-5986. [PMID: 37889321 DOI: 10.1007/s00167-023-07631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE The purpose of this study was to compare the results of arthroscopic isolated Bankart repair (B) with Bankart repair plus Remplissage (B + R) procedure in contact overhead athletes with on-track anterior shoulder instability. METHODS A total of 64 athletes playing basketball, volleyball and handball in elite professional level who underwent arthroscopic isolated Bankart repair (34 patients) or Bankart repair plus Remplissage procedure (30 patients) with the diagnosis of recurrent anterior shoulder instability between 2017 and 2020, were retrospectively reviewed. Radiologically all patients had on-track Hill-Sachs defects and minimal or subcritical glenoid bone loss (< 13.5%). Patients were evaluated using pre- and postoperative pVAS, SANE, ASES, ROWE, WOSI scores and postoperative active ROM assessment. Patients were also asked for the frequency of any subjective apprehension and satisfaction with the surgery in four grades. RESULTS The mean ages of the groups B and B + R were 26.8 and 26 years (SD = 3.22), respectively; the mean follow-up times were 37.8 and 36.2 months (SD = 11.19). Compared with the preoperative status, there was a statistically significant improvement of all 5 postoperative outcome scores in both groups (P < 0.001). However, significant difference between the improvement of the groups were only found for the SANE (B: 22.3 ± 4.1, B + R: 26.3 ± 4.3; P = 0.0004), ASES (B: 26.1 ± 2.6, B + R: 30.2 ± 3.6; P < 0.001) and ROWE (B: 42 ± 3.7, B + R: 47.7 ± 2.8; P < 0.001) scores in favor of the group B + R. The loss of internal and external rotation of the adducted arm in group B + R was found to be approximately 5 degrees compared to the group B (P < 0.001). More than 80% of group B + R showed no apprehension in sports activities and almost completely returned to pre-injury athletic level, depicting statistically significant improvement compared to group B athletes (P = 0.002 and 0.036, respectively). 3 patients developed re-dislocation after isolated Bankart repair, whereas no re-dislocation occurred in the B + R group. CONCLUSION Adding Remplissage procedure to the Bankart repair provided an advantage in terms of both return to sport at preinjury level and the frequency of apprehension sensation during sports activity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Muge Kirac
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Kayışdağı St. No:32 Atasehir, Istanbul, Turkey.
| | - Selim Ergun
- Department of Orthopaedics and Traumatology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Alper Gamli
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Kayışdağı St. No:32 Atasehir, Istanbul, Turkey
| | - Berhan Bayram
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Kayışdağı St. No:32 Atasehir, Istanbul, Turkey
| | - Baris Kocaoglu
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Kayışdağı St. No:32 Atasehir, Istanbul, Turkey
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Harada Y, Iwahori Y, Kajita Y, Takahashi R, Yokoya S, Sumimoto Y, Deie M, Adachi N. Return to sports after arthroscopic Bankart repair in teenage athletes: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:64. [PMID: 36694133 PMCID: PMC9872416 DOI: 10.1186/s12891-023-06145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Anterior shoulder instability is frequent among young athletes. Surgical treatment for this injury aims to facilitate an early return to sports (RTS). However, the rate of recurrent instability after surgery is reportedly high among young patients, and it is unclear whether surgery ensures satisfactory RTS. The purpose of this study was to verify the clinical outcomes and RTS after arthroscopic Bankart repair in competitive teenage athletes without critical bone loss in the glenoid. METHODS We retrospectively reviewed competitive teenage athletes who underwent arthroscopic Bankart repair. Patients with large bony defects in the glenoid, larger than 20% of the healthy side, were excluded. Clinical outcomes, recurrent instability, the final level of RTS, and the time needed for RTS were analyzed. RESULTS In total, 50 patients with a mean follow-up period of 44.5 ± 19.6 (range, 24-85 months) months were included. The mean age at surgery was 16.8 ± 1.7 (range, 13-19 years) years. Two patients (4.0%) experienced recurrent instability. All patients returned to sports, 96% of patients participated competitively, and 76% achieved a complete return to the pre-injury level without any complaints. The time for RTS was 6.6 ± 2.7 months (range, 3-18 months), to competitions was 9.3 ± 4.0 (range, 6-24 months) months, and to complete return was 10.6 ± 4.3 (range, 8-24 months) months. The complete return rates varied by sports type, with 82% in contact athletes, 59% in dominant-hand overhead athletes, and 100% in other athletes (P = 0.026). Other preoperative factors or concomitant lesion such as bony Bankart, superior labrum tear, or humeral avulsion of glenohumeral ligament lesion did not affect the complete RTS. CONCLUSION Arthroscopic Bankart repair is an effective surgical procedure for anterior shoulder instability, even among competitive teenage athletes. Sports type was the only factor associated with complete RTS after surgery.
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Affiliation(s)
- Yohei Harada
- grid.257022.00000 0000 8711 3200Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551 Japan ,grid.411234.10000 0001 0727 1557Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Yusuke Iwahori
- grid.413946.dSports Medicine and Joint Center, Asahi Hospital, 2090 Shimoharacho Azamurahigashi, Kasugai, Aichi 486-0819 Japan
| | - Yukihiro Kajita
- grid.411234.10000 0001 0727 1557Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan ,Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1 Azahira, Kaimei, Ichinomiya City, Aichi 494-0001 Japan
| | - Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1 Azahira, Kaimei, Ichinomiya City, Aichi 494-0001 Japan
| | - Shin Yokoya
- grid.257022.00000 0000 8711 3200Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551 Japan
| | - Yasuhiko Sumimoto
- grid.257022.00000 0000 8711 3200Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551 Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima City, Hiroshima, 730-8518 Japan
| | - Nobuo Adachi
- grid.257022.00000 0000 8711 3200Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551 Japan
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Harada Y, Iwahori Y, Kajita Y, Takahashi R, Yokoya S, Sumimoto Y, Deie M, Adachi N. Return to sports after arthroscopic bankart repair on the dominant shoulder in overhead athletes. J Orthop Sci 2022; 27:1240-1245. [PMID: 34419320 DOI: 10.1016/j.jos.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/02/2021] [Accepted: 07/22/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Arthroscopic Bankart repair (ABR) yields good results in young athletes with anterior shoulder instability. However, the treatment for overhead athletes is challenging because recovery of range of motion is necessary for return to play and repeated shoulder motion may lead to recurrent instability. The aim of this study was to investigate the clinical outcomes and return to sports after ABR on the dominant shoulder in overhead athletes. METHODS This study included 24 competitive level overhead athletes who underwent ABR on their dominant shoulders. The mean age at surgery was 17.6 years, and the mean follow-up was 39.7 months. The range of bilateral shoulder motion, the Rowe score, the Japanese Shoulder Society Shoulder Instability Score (JSS-SIS), and the Japanese Shoulder Society Shoulder Sports Score (JSS-SSS) were evaluated before the surgery and at the final visit. Recurrent instability, the final level of return to sports, and the duration before returning to sports were confirmed, as well as the pre-, intra- and postoperative factors, which prohibited complete return to play. RESULTS There were no cases of recurrent instability. The Rowe score, JSS-SIS, JSS-SSS, and the range of flexion, abduction, internal rotation significantly improved postoperatively. Fifteen athletes (62.5%) returned to the same or superior levels without any complaint in their shoulders. The mean duration needed for a complete return was 13.3 months. The postoperative external rotation deficit in abduction was larger in the athletes who returned incompletely than those who returned completely, 7.8° and 2.3°, respectively. CONCLUSIONS ABR is a reliable surgery for preventing recurrent instability in overhead athletes, however the rate of a complete return to preinjury level was low and a long duration was needed for complete return to play. The postoperative external rotation may be necessary for a complete return to overhead sports. LEVEL OF EVIDENCE Level IV: Retrospective Case Series.
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Affiliation(s)
- Yohei Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan; Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, 2090, Shimoharacho Azamurahigashi, Kasugai, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Ryosuke Takahashi
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Shin Yokoya
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Yasuhiko Sumimoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
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Fernandez-Fernandez J, Granacher U, Martinez-Martin I, Garcia-Tormo V, Herrero-Molleda A, Barbado D, Garcia-Lopez J. Physical fitness and throwing speed in U13 versus U15 male handball players. BMC Sports Sci Med Rehabil 2022; 14:113. [PMID: 35725495 PMCID: PMC9210574 DOI: 10.1186/s13102-022-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Background The aim of this study was to analyze the shoulder functional profile (rotation range of motion [ROM] and strength), upper and lower body performance, and throwing speed of U13 versus U15 male handball players, and to establish the relationship between these measures of physical fitness and throwing speed. Methods One-hundred and nineteen young male handball players (under (U)-13 (U13) [n = 85]) and U15 [n = 34]) volunteered to participate in this study. The participating athletes had a mean background of sytematic handball training of 5.5 ± 2.8 years and they exercised on average 540 ± 10.1 min per week including sport-specific team handball training and strength and conditioning programs. Players were tested for passive shoulder range-of-motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, overhead medicine ball throw (OMB), hip isometric abductor (ABD) and adductor (ADD) strength, hip ROM, jumps (countermovement jump [CMJ] and triple leg-hop [3H] for distance), linear sprint test, modified 505 change-of-direction (COD) test and handball throwing speed (7 m [HT7] and 9 m [HT9]). Results U15 players outperformed U13 in upper (i.e., HT7 and HT9 speed, OMB, absolute IR and ER strength of the dominant and non-dominant sides; Cohen’s d: 0.76–2.13) and lower body (i.e., CMJ, 3H, 20-m sprint and COD, hip ABD and ADD; d: 0.70–2.33) performance measures. Regarding shoulder ROM outcomes, a lower IR ROM was found of the dominant side in the U15 group compared to the U13 and a higher ER ROM on both sides in U15 (d: 0.76–1.04). It seems that primarily anthropometric characteristics (i.e., body height, body mass) and upper body strength/power (OMB distance) are the most important factors that explain the throw speed variance in male handball players, particularly in U13. Conclusions Findings from this study imply that regular performance monitoring is important for performance development and for minimizing injury risk of the shoulder in both age categories of young male handball players. Besides measures of physical fitness, anthropometric data should be recorded because handball throwing performance is related to these measures.
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Affiliation(s)
- Jaime Fernandez-Fernandez
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, Faculty of Human Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany.
| | - Isidoro Martinez-Martin
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Vicente Garcia-Tormo
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Alba Herrero-Molleda
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - David Barbado
- Department of Sport Science, Sport Research Centre, Miguel Hernandez University of Elche, Elche, Spain
| | - Juan Garcia-Lopez
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
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Gharisia O, Lohman E, Daher N, Eldridge A, Shallan A, Jaber H. Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:402. [PMID: 33941143 PMCID: PMC8091767 DOI: 10.1186/s12891-021-04292-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD). Methods Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention. Results There was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46). Conclusion Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients. Trial registration Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236.
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Affiliation(s)
- Omar Gharisia
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Noha Daher
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Alan Eldridge
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Amjad Shallan
- Department of Physical Therapy, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Hatem Jaber
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA. .,Department of Physical Therapy, College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, Austin, TX, USA. .,Department of Physical Therapy, College of Health and Human Development, California State University, CA, Northridge, USA.
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Abstract
PURPOSE OF REVIEW To summarize the current anatomy, biomechanics, presentation, treatment, and outcomes of injuries to the biceps and superior labral complex in overhead athletes. RECENT FINDINGS The biceps and superior labral complex is composed of anatomically distinct zones. The inability to accurately diagnose biceps lesions contributes to continued morbidity especially as arthroscopy and advanced imaging fail to fully evaluate the entire course of the biceps tendon. Superior labrum anterior and posterior (SLAP) repair, long head of biceps tenodesis, and tenotomy are the most common operative techniques for surgical treatment of biceps-labral complex (BLC) pathology. Labral repair in overhead athletes has resulted in mixed outcomes for athletes and is best indicated for patients under age 40 years old. Injuries to the BLC are potentially challenging injuries to diagnose and treat, particularly in the overhead athlete. SLAP repair remains the treatment of choice for high-level overhead athletes and patients younger than 40 years of age, while biceps tenodesis and tenotomy are preferred for older patients.
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Affiliation(s)
- Kyle W Morse
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Jonathan-James Eno
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David W Altchek
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
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Deans CF, Gentile JM, Tao MA. Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes. Curr Rev Musculoskelet Med 2019; 12:80-86. [PMID: 30806899 PMCID: PMC6542865 DOI: 10.1007/s12178-019-09542-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF THE REVIEW To review the relevant literature surrounding acromioclavicular (AC) joint injuries particularly pertaining to overhead athletes. RECENT FINDINGS The AC joint is a unique anatomic and biomechanical portion of the shoulder that can be problematic for athletes, particularly throwers, when injured. Treatment of these injuries remains a topic in evolution. Low-grade injuries (Rockwood types I & II) are typically treated non-operatively while high-grade injuries (types IV, V, and VI) are considered unstable and often require operative intervention. Type III AC separations remain the most controversial and challenging as no clear treatment algorithm has been established. A wide variety of surgical techniques exist. Unfortunately, relatively little literature exists with regard to overhead athletes specifically. Treatment of AC joint injuries remains challenging, at times, particularly for overhead athletes. Operative indications and techniques are still evolving, and more research is needed specifically surrounding overhead athletes.
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Affiliation(s)
| | - Joseph M Gentile
- Novant Health Orthopedics & Sports Medicine, Huntersville, NC, USA
| | - Matthew A Tao
- University of Nebraska Medical Center, 985640, Omaha, NE, 68198, USA.
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9
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Merolla G, Paladini P, Porcellini G. Assessment of return to play in professional overhead athletes subjected to arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow score. Musculoskelet Surg 2018; 102:29-34. [PMID: 29948936 DOI: 10.1007/s12306-018-0547-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The self-administered Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow questionnaire is a reliable and sensitive outcome tool to assess upper extremity athletic performance and functional changes affecting return to play in overhead athletes. We report the results of a study of return to sport in professional overhead athletes at a mean follow-up of 2 years after arthroscopic repair of rotator cuff tears and associated labral injuries using the Italian version of the score. MATERIALS AND METHODS A total number of 38 patients completed the 10-item questionnaire before and after surgery. They were also asked (1) whether they had returned to play; (2) how many months after the operation they had done so; (3) the level of postoperative performance (preinjury or less); and (4) whether they had had to change sport due to their shoulder problems. RESULTS Significant differences were found (1) between preoperative and postoperative scores; (2) between the scores of patients who returned to play at preinjury level and those who merely returned to competition; and (3) between the postoperative subscores of 8/10 items, which were higher in the patients who returned to preinjury performance than in those who merely returned to play; the two items that were not significantly different between these subgroups concerned pain and joint stability. Even though item analysis highlighted a major role for athletic performance in recovery of preinjury performance, it also stressed that the athlete's relationship with coach, agent, and staff and his/her feeling of the extent to which the arm affects current performance significantly contribute to the final score. CONCLUSIONS The KJOC Shoulder and Elbow score provides an accurate and exhaustive assessment of the recovery of the athlete's shoulder in relation to preinjury performance and provides the surgeon with key information on the pros and cons of surgical management.
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Affiliation(s)
- G Merolla
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna Ambito Rimini, Via L.V. Beethoven 5, 47841, Cattolica, Italy.
- Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica, Italy.
| | - P Paladini
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna Ambito Rimini, Via L.V. Beethoven 5, 47841, Cattolica, Italy
| | - G Porcellini
- Orthopaedic and Trauma Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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10
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Abstract
PURPOSE OF REVIEW To review the etiology, classification, presentation, evaluation, treatment strategy, and outcomes in overhead athletes with partial thickness rotator cuff tears. RECENT FINDINGS Despite advances in surgical repair techniques, return to play following surgical repair of partial rotator cuff tears remains modest at best. Overhead athletes may be particularly prone to rotator cuff pathology due to the supraphysiological strains within the tendon during the throwing motion, as well as mechanical stress with contact between the undersurface of the rotator cuff and the glenoid. The true prevalence of partial tears may be underestimated given the high incidence of asymptomatic tears. Both dynamic ultrasound and enhanced contrast MRI have improved our understanding of this pathology. For most overhead athletes, nonoperative management is the most common course. Despite advances in imaging, diagnosis, and surgical techniques, our ability to return these patients to their elite level is modest at best when nonoperative management fails and surgical treatment is performed. If a surgical route is needed, debridement alone is the most frequent procedure given concerns of over constraint and poor return to play with surgical repair of the partial thickness rotator cuff tear.
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Affiliation(s)
- Joseph N Liu
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA.
| | - Grant H Garcia
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Anirudh K Gowd
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Brandon C Cabarcas
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Michael D Charles
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Anthony A Romeo
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
| | - Nikhil N Verma
- Section of Sports Medicine, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 200, Chicago, IL, 60612, USA
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11
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Leong HT, Ng GY, Fu SN. Effects of scapular taping on the activity onset of scapular muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy. J Sci Med Sport 2017; 20:555-60. [PMID: 27839664 DOI: 10.1016/j.jsams.2016.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/23/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine the effect of scapular taping on the activity onset of scapular muscles and the scapular kinematics during arm elevation in volleyball players with rotator cuff (RC) tendinopathy. DESIGN Randomized placebo-controlled repeated measures METHODS: Twenty-six male volleyball players with RC tendinopathy (mean age=23.6±3.3years) participated in the study. Electromyography (EMG) activity onset of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) and the three-dimensional scapular kinematics quantified by using an acromial marker cluster method were compared with three scapular taping protocols, namely, no taping, therapeutic taping, and placebo taping. RESULTS The MT, LT and SA activated significantly earlier in both therapeutic taping (all p<0.005) and placebo taping conditions than no taping conditions (all p<0.002). There was a small increase in the scapular upward rotation when therapeutic taping and no taping conditions were compared (p=0.007). CONCLUSIONS Scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scapular kinematics during arm movement in athletes with RC tendinopathy await for further studies.
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Abstract
Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch, and a tenuous vascular supply of the capitellum. Recent literature reveals that the prevalence is likely higher than previously thought. This, in conjunction with increased levels of athletic competition in children at younger ages, has fed the recent interest in this topic. The literature continues to show that non-operative treatment is still successful for stable lesions. Unstable lesions, therefore, have been the focus of the new literature regarding operative management and outcomes. The aim of this paper is to provide a summary of current literature and an up-to-date approach to the diagnosis, evaluation, and treatment of osteochondritis dissecans of the capitellum.
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Affiliation(s)
- Ryan W. Churchill
- />Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007 USA
| | - Julianne Munoz
- />Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1122, 10032 New York, NY USA
| | - Christopher S. Ahmad
- />Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-1122, 10032 New York, NY USA
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13
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Leong HT, Tsui SSM, Ng GYF, Fu SN. Reduction of the subacromial space in athletes with and without rotator cuff tendinopathy and its association with the strength of scapular muscles. J Sci Med Sport 2016; 19:970-974. [PMID: 27102401 DOI: 10.1016/j.jsams.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare the reduction of subacromial space (SAS) during arm abduction between overhead athletes with and without rotator cuff (RC) tendinopathy, and to explore the relationship between the strength of scapular muscles with the SAS. DESIGN Cross-sectional study. METHODS Sixty-six athletes (33 healthy and 33 with RC tendinopathy, mean age=22.3 years) participated in the study. Ultrasound measurement of the SAS with arm at 0°, 30° and 60° of shoulder abduction were taken, and the maximal isometric force in upper, middle and lower trapezius, and serratus anterior with manual muscle tests (MMT) were assessed using a handheld dynamometer. The change in SAS during arm abduction from 0° to 30° (SAS0°-30°), 30° to 60° (SAS30°-60°) and 0° to 60° (SAS0°-60°) was compared between groups. Differences in force produced with scapular muscles MMT between groups and relationships with reduction in SAS were explored. RESULTS We found more reduction of the SAS during SAS0°-30° in athletes with RC tendinopathy (0.44±1.22mm) than healthy athletes (-0.06±1.41mm) (p=0.045). Athletes with RC tendinopathy demonstrated significant decrease in all scapular muscles MMT strength when compared to their healthy counterparts (p<0.05). In healthy athletes, a lower middle and lower trapezius MMT strength were moderately associated with a greater reduction in SAS during 0° to 30° (r=-0.445, p=0.016 and r=-0.423, p=0.022, respectively) and 0° to 60° of shoulder abduction (r=-0.415, p=0.018 and r=-0.504, p=0.003, respectively). CONCLUSIONS Athletes with RC tendinopathy demonstrated more reduction in the SAS during early arm abduction. Decreased strength of middle and lower trapezius was related to reduction of the SAS.
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Affiliation(s)
- Hio Teng Leong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Sammi Sin Mei Tsui
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Gabriel Yin-Fat Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
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Abstract
Posterior shoulder instability in overhead athletes presents a unique and difficult challenge. Often, this group has an inherent capsular laxity and/or humeral retroversion to accommodate the range of motion necessary to throw. This adaptation makes the diagnosis of posterior capsulolabral pathology challenging, as the examiner must differentiate between adaptive capsular laxity and pathologic instability. Further complicating matters, the intraoperative surgeon must find the delicate balance of achieving stability while still allowing the necessary range of motion.
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Affiliation(s)
- Edward S Chang
- Department of Orthopaedic Surgery, Sports Medicine Institute at Inova Medical Group, Inova Health System, 8501 Arlington Boulevard, Suite 200, Fairfax, VA 22031, USA.
| | - Nicholas J Greco
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA
| | - Michael P McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA
| | - James P Bradley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Delafield Road, 200 Medical Arts Building, Suite 4010, Pittsburgh, PA 15125, USA
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Hosseinimehr SH, Anbarian M, Norasteh AA, Fardmal J, Khosravi MT. The comparison of scapular upward rotation and scapulohumeral rhythm between dominant and non-dominant shoulder in male overhead athletes and non-athletes. ACTA ACUST UNITED AC 2015; 20:758-62. [PMID: 25795109 DOI: 10.1016/j.math.2015.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
Previous studies have stated that the scapulohumeral rhythm dysfunction can make person prone to glenohumeral joint pathologies. The purpose of this study was to compare scapular upward rotation and scapulohumeral rhythm between dominant and non-dominant shoulder in male overhead athletes and non-athletes. Seventeen overhead athletes and seventeen non-athletes volunteered for this study. Two inclinometers were used to measure humeral abduction and scapular upward rotation in rest position, 45°, 90° and 135° humeral abduction in frontal plane. Findings indicated there was no significant asymmetry in scapular upward rotation and scapulohumeral rhythm in different abduction angles between dominant and non-dominant shoulder in non-athletes. In contrast, overhead athletes' dominant shoulders have more downward rotation in scapular rest position and more upward rotation in 90° and 135° shoulder abduction than non-dominant shoulders. Also, overhead athletes presented scapulohumeral rhythm asymmetry between dominant and non-dominant shoulder in 90° and 135° humeral abduction as dominant shoulders have less scapulohumeral rhythm ratio than non-dominant shoulders. Furthermore, overhead athletes dominant shoulders have more scapular downward rotation in scapular rest position, more scapular upward rotation in 90° and 135° humeral abduction and less scapulohumeral rhythm ratio in 45°, 90° and 135° humeral abduction than non-athletes in dominant shoulders. We suggest that clinicians should be aware that some scapular asymmetry may be common in some athletes. It should not be considered as a pathological sign but rather an adaptation to extensive use of upper limb.
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Affiliation(s)
- Seyed Hossein Hosseinimehr
- Department of Sport Biomechanics, Faculty of Physical Education and Sport Sciences, Bu ali Sina University, Hamadan, Iran; Department of Sport Biomechanics, Sport Science Research Center, Tehran, Iran.
| | - Mehrdad Anbarian
- Department of Sport Biomechanics, Faculty of Physical Education and Sport Sciences, Bu ali Sina University, Hamadan, Iran; Department of Sport Biomechanics, Sport Science Research Center, Tehran, Iran
| | - Ali Asghar Norasteh
- Department of Sport Medicine and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
| | - Javad Fardmal
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taghi Khosravi
- Department of Sport Medicine and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
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16
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Lädermann A, Chagué S, Kolo FC, Charbonnier C. Kinematics of the shoulder joint in tennis players. J Sci Med Sport 2014; 19:56-63. [PMID: 25481481 DOI: 10.1016/j.jsams.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 10/19/2014] [Accepted: 11/07/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Shoulder pain and injury are common in tennis players. The precise causes for such pain remain unclear. Impingement at critical tennis positions and glenohumeral instability have never been dynamically evaluated in vivo. The purpose of this study was to evaluate the different types of impingement and stability during tennis movements. DESIGN Laboratory study. METHODS Type and frequency of impingement as well as percentage of subluxation were evaluated in 10 tennis players through a novel dedicated patient-specific measurement technique based on optical motion capture and Magnetic Resonance Imaging (MRI). RESULTS All volunteers, nine male and one female, had a clinically functional rotator cuff. MRI revealed 11 rotator cuff lesions in six subjects and six labral lesions in five subjects. Lateral subacromial, anterior subacromial, internal anterosuperior, and internal posterosuperior impingements were observed in four, three, two and seven subjects, respectively. No instability could be demonstrated in this population. CONCLUSIONS Tennis players presented frequent radiographic signs of structural lesions that could mainly be related to posterosuperior impingements due to repetitive abnormal motion contacts. This is the first study demonstrating that a dynamic and precise motion analysis of the entire kinematic chain of the shoulder is possible through a non-invasive method of investigation. This premier kinematic observation offers novel insights into the analysis of shoulder impingement and instability that could, with future studies, be generalized to other shoulder pathologies and sports. This original method may open new horizons leading to improvement in impingement comprehension.
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Affiliation(s)
- A Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Switzerland; Faculty of Medicine, University of Geneva, Switzerland.
| | - S Chagué
- Artanim Foundation, Medical Research Department, Switzerland
| | - F C Kolo
- Rive Droite Radiology Center, Switzerland
| | - C Charbonnier
- Artanim Foundation, Medical Research Department, Switzerland
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