Prevalence of impaired foot function in baseball players with and without disabled throwing shoulder/elbow: a case-control study

Prevalence of impaired foot function among baseball players with and without a disabled throwing shoulder/elbow was investigated. The study included 138 male players. Players who had previously complained of shoulder/elbow pain during throwing motion were defined as the players with a history, and those who experienced shoulder/elbow pain during the examination were defined as having the injury. Foot function was evaluated by foot "rock paper scissors" movements and floating toes. Their prevalence was assessed and the relationships between players with and without the injuries were statistically analyzed. The prevalence of players with a history and injury was 27% and 7%, respectively. The prevalence of impaired foot function on the non-throwing side among players with injury was significantly higher than those without (60% vs. 28%, P < 0.001) and higher tendency on the throwing side than those without (60% vs. 32%). Regarding floating toes, players with a relevant history showed a significantly higher prevalence on the throwing side than those without (49% vs 28%, P < 0.001) and higher tendency on the non-throwing side than those without (49% vs 32%). Players with disabled throwing shoulder/elbow have a significantly higher prevalence of impaired foot function and floating toes than players without it.

Isokinetic arm and shoulder muscle torque-velocity characteristics in mobility limited children and adolescents with spina bifida

INTRODUCTION

Propulsive wheelchair capacity may be influenced by arm muscle performance.Objectives: To determine whether children and adolescent wheelchair-users with spina bifida show reduced arm muscle strength compared to their typically developing peers and to compare muscle strength data obtained by isokinetic and handheld dynamometry (HHD).

METHODS

Participants (mean age 12.5 ± 2.5 years) were assigned to spina bifida (SB; n = 11) or control (n = 22) groups. Isokinetic dynamometry was used to measure peak torque (PT) during dynamic (60°s-1 and 120°s-1) and isometric strength testing (MVIC) for shoulder and elbow flexors and extensors. HHD was used to measure MVIC of the same muscle groups.

RESULTS

SB showed reduced isokinetic PT for shoulder extensors at 60°s-1 and 120°s-1, shoulder flexor MVIC, and elbow flexors at 60°s-1 and MVIC; higher PT for shoulder flexors and elbow flexors at 120°s-1; and decreased MVIC for elbow flexors but not extensors compared to controls when assessed by HHD. The SB and control groups showed strong positive correlations between MVIC data obtained by the two devices for all muscle groups (r ≥ 0.81; p < .01), except for shoulder flexor MVIC in controls (r = 0.68; p < .01).

CONCLUSION

SB presented reduced levels of dynamic slow-speed and isometric shoulder and elbow muscle strength and greater dynamic high-speed shoulder and elbow flexor strength than controls possibly due to the exposure to self-sustained wheelchair ambulation. Exercise-based intervention protocols to increase slow-speed arm muscle strength should be considered in youth with SB. Strong positive correlations observed between muscle strength assessed by isokinetic dynamometry and HHD support the use of HHD in this clinical population.

Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair

BACKGROUND

Rotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR.

METHODS

A total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant-Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations.

RESULTS

At three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β =  - 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up.

CONCLUSIONS

Higher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.

Effects of shoulder brace usage on postural stability in stroke survivors: A pilot randomized controlled trial

BACKGROUND

Despite advances in stroke rehabilitation, challenges in upper limb motor recovery and postural stability persist, negatively affecting overall well-being. Arm slings and shoulder braces have been proposed to address these issues, but their efficacy in promoting postural stability remains unclear.

OBJECTIVE

This pilot randomized controlled study aimed to evaluate the impact of a new shoulder brace (N1-Neurosling) on trunk postural stability during walking, pain, and upper limb muscle strength in chronic stroke survivors.

METHODS

Twenty-four adult chronic stroke patients were involved and randomly assigned to the shoulder brace group (SBg) or control group (CTRLg). Were assessed at baseline (T0) and after 4 weeks (T1) through the Trunk Control Test, the Numerical Rating Scale, the Motricity Index, Manual Muscle Test, and instrumental wearable-based assessment.

RESULTS

After 4 weeks, the SBg showed significant improvement in Trunk Control Test scores (p = 0.020) and smoothness of gait measured by log dimensionless jerk along the Antero-Posterior axis (- 5.31±0.25 vs. - 5.18±0.27, p = 0.018) compared to the CTRLg. The SBg also demonstrated a reduction in pain in the shoulder girdle and enhanced upper limb muscle strength.

CONCLUSION

The use of the N1-Neurosling shoulder brace led to improvements in postural stability and smoothness of gait in stroke patients.

Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up

This study aimed to describe changes in supraspinatus tendon thickness, acromiohumeral distance, and the presence of fluid in the subacromial bursa as measured by ultrasound, as well as shoulder range of motion and strength, perceived shoulder disability, and health-related quality of life in women before and after breast cancer treatment. Women who underwent surgery for unilateral breast cancer who did not suffer from shoulder pain or difficulty performing activities of daily living in the 6 months prior to surgery were included. One pre-surgical (A0) and three post-surgical assessments at 7-10 days (A1), 3 months (A2), and 6 months (A3) after surgery were carried out. The thickness of the supraspinatus tendon on the affected side decreased between post-surgical (A1) and 6-month (A3) follow-up assessments (p = 0.029), although the minimal detectable change was not reached. The active range of motion of the affected shoulder decreased after surgery. Strength changes were observed in both shoulders after surgery. The intensity of shoulder pain increased between post-surgical and 6-month follow-up assessments. Shoulder function was decreased at the post-surgical assessment and increased throughout the follow-ups. Health-related quality of life declined after surgery. A trend of decreasing thickness of the supraspinatus tendon of the affected shoulder was observed. Detecting these possible structural changes early would allow for early or preventive treatment.

The impact of experimental pain on shoulder movement during an arm elevated reaching task in a virtual reality environment

BACKGROUND

People with chronic shoulder pain have been shown to present with motor adaptations during arm movements. These adaptations may create abnormal physical stress on shoulder tendons and muscles. However, how and why these adaptations develop from the acute stage of pain is still not well-understood.

OBJECTIVE

To investigate motor adaptations following acute experimental shoulder pain during upper limb reaching.

METHODS

Forty participants were assigned to the Control or Pain group. They completed a task consisting of reaching targets in a virtual reality environment at three time points: (1) baseline (both groups pain-free), (2) experimental phase (Pain group experiencing acute shoulder pain induced by injecting hypertonic saline into subacromial space), and (3) Post experimental phase (both groups pain-free). Electromyographic (EMG) activity, kinematics, and performance data were collected.

RESULTS

The Pain group showed altered movement planning and execution as shown by a significant increased delay to reach muscles EMG peak and a loss of accuracy, compared to controls that have decreased their mean delay to reach muscles peak and improved their movement speed through the phases. The Pain group also showed protective kinematic adaptations using less shoulder elevation and elbow flexion, which persisted when they no longer felt the experimental pain.

CONCLUSION

Acute experimental pain altered movement planning and execution, which affected task performance. Kinematic data also suggest that such adaptations may persist over time, which could explain those observed in chronic pain populations.

The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study

BACKGROUND

Hyperkyphosis (HKP) and forward head posture (FHP) occur due to prolonged poor postures and repetitive activities.

OBJECTIVE

The present study aimed to compare the effects of the National Academy of Sports Medicine (NASM) and Sahrmann corrective exercises on HKP and FHP correction.

METHODS

This quasi-experimental study was conducted on 30 subjects with HKP and FHP, who were randomly assigned to the NASM (n= 15) and Sahrmann groups (n= 15). The ImageJ software and a spinal mouse device were used to measure FHP and HKP deformities, and neck and shoulder muscle strength, range of motion (ROM), and pulmonary function were assessed as the secondary outcomes before and after the eight-week intervention.

RESULTS

FHP improved more significantly in the Sahrmann group compared to the NASM group (P< 0.05), while no significant difference was observed between the groups in HKP (P> 0.05). The improvement in the neck and shoulder muscle strength was more significant in the Sahrmann group compared to the NASM (P< 0.05), except for the neck flexors. In addition, the neck extension ROM enhanced more significantly in the Sahrmann group compared to the NASM group (P< 0.05).

CONCLUSION

According to the results, the Sahrmann corrective exercises that focused on the correction of imbalanced muscle stiffness had more significant effects on the correction of FHP, neck and shoulder muscle strength and neck extension ROM.

Is the Combination of Convex Compression for the Proximal Thoracic Curve and Concave Distraction for the Main Thoracic Curve Using Separate-rod Derotation Effective for Correcting Shoulder Balance and Thoracic Kyphosis?

BACKGROUND

Posterior correction of the proximal thoracic curve in patients with adolescent idiopathic scoliosis has been recommended to achieve shoulder balance. However, finding a good surgical method is challenging because of the small pedicle diameters on the concave side of the proximal thoracic curve. If the shoulder height can be corrected using screws on the convex side, this would appear to be a more feasible approach.

QUESTIONS/PURPOSES

In patients with adolescent idiopathic scoliosis, we asked: (1) Is convex compression with separate-rod derotation effective for correcting the proximal thoracic curve, shoulder balance, and thoracic kyphosis? (2) Which vertebrum is most appropriate to serve as the uppermost-instrumented vertebra? (3) Is correction of the proximal thoracic curve related to the postoperative shoulder balance?

METHODS

Between 2015 and 2017, we treated 672 patients with scoliosis. Of those, we considered patients with elevated left shoulder, Lenke Type 2 or 4, or King Type V idiopathic scoliosis as potentially eligible. Based on that, 17% (111 of 672) were eligible; 5% (6 of 111) were excluded because of other previous operations and left-side main thoracic curve, 22% (24 of 111) were excluded because they did not undergo surgery for the proximal thoracic curve with only pedicle screws, 21% (23 of 111) were excluded because the proximal thoracic curve was not corrected by convex compression and separate rod derotation, and another 3% (3 of 111) were lost before the minimum study follow-up of 2 years, leaving 50% (55 of 111) for analysis. During the study period, we generally chose T2 as the uppermost level instrumented when the apex was above T4, or T3 when the apex was T5. Apart from the uppermost-instrumented level, the groups did not differ in measurable ways such as age, sex, Cobb angles of proximal and main thoracic curves, and T1 tilt. However, shoulder balance was better in the T3 group preoperatively. The median (range) age at the time of surgery was 15 years (12 to 19 years). The median follow-up duration was 26 months (24 to 52 months). Whole-spine standing posteroanterior and lateral views were used to evaluate the improvement of radiologic parameters at the most recent follow-up and to compare the radiologic parameters between the uppermost-instrumented T2 (37 patients) and T3 (18 patients) vertebra groups. Finally, we analyzed radiologic factors related to shoulder balance, defined as the difference between the horizontal lines passing both superolateral tips of the clavicles (right-shoulder-up was positive), at the most recent follow-up.

RESULTS

Convex compression with separate-rod derotation effectively corrected the proximal thoracic curve (41° ± 11° versus 17° ± 10°, mean difference 25° [95% CI 22° to 27°]; p < 0.001), and the most recent shoulder balance changed to right-shoulder-down compared with preoperative right-shoulder-up (8 ± 11 mm versus -8 ± 10 mm, mean difference 16 mm [95% CI 12 to 19]; p < 0.001). Proximal thoracic kyphosis decreased (13° ± 7° versus 11° ± 6°, mean difference 2° [95% CI 0° to 3°]; p = 0.02), while mid-thoracic kyphosis increased (12° ± 8° versus 18° ± 6°, mean difference -7° [95% CI -9° to -4°]; p < 0.001). Preoperative radiographic parameters did not differ between the groups, except for shoulder balance, which tended to be more right-shoulder-up in the T2 group (11 ± 10 mm versus 1 ± 11 mm, mean difference 10 mm [95% CI 4 to 16]; p = 0.002). At the most recent follow-up, the correction proportion of the proximal thoracic curve was better in the T2 group than the T3 group (67% ± 10% versus 49% ± 22%, mean difference 19% [95% CI 8% to 30%]; p < 0.001). In the T2 group, T1 tilt (6° ± 4° versus 6° ± 4°, mean difference 1° [95% CI 0° to 2°]; p = 0.045) and shoulder balance (-14 ± 11 mm versus -7 ± 9 mm, mean difference -7 mm [95% CI -11 to -3]; p = 0.002) at the most recent follow-up improved compared with those at the first erect radiograph. The most recent shoulder balance was correlated with the correction proportion of the proximal thoracic curve (r = 0.29 [95% CI 0.02 to 0.34]; p = 0.03) and change in T1 tilt (r = 0.35 [95% CI 0.20 to 1.31]; p = 0.009).

CONCLUSION

Using the combination of convex compression and concave distraction with separate-rod derotation is an effective method to correct proximal and main thoracic curves, with reliable achievement of postoperative thoracic kyphosis and shoulder balance. T2 was a more appropriate uppermost-instrumented vertebra than T3, providing better correction of the proximal thoracic curve and T1 tilt. Additionally, spontaneous improvement in T1 tilt and shoulder balance is expected with upper-instrumented T2 vertebrae. Preoperatively, surgeons should evaluate shoulder balance because right-shoulder-down can occur after surgery in patients with a proximal thoracic curve.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Ultrasound-guided dextrose solution perimysium dissection for posterior shoulder myofascial pain

BACKGROUND

To assess the efficacy and safety of perimysium dissection for posterior shoulder myofascial pain.

METHODS

This retrospective single-arm study was performed at a medical center between April 2016 and August 2017. Fifty-seven participants with refractory chronic posterior shoulder pain of myofascial origin underwent ultrasound (US)-guided perimysium dissection with hypertonic dextrose solution. Visual analog scale (VAS) scores and complication rate were evaluated before treatment and 4 weeks after treatment.

RESULTS

US-guided perimysium dissection with dextrose solution resulted in excellent treatment efficacy and safety. Nineteen participants (33.3%) were free of pain after treatment, and 32 (56.1%) had >50% improvement in pain score. Forty-nine participants had complete VAS records. Overall mean pre- and posttreatment VAS scores were 7.18 ± 1.60 and 1.91 ± 2.04 (mean difference -5.27, 95% CI -5.99 to -4.55, p < 0.0001), respectively, including 7.26 ± 1.44 and 1.84 ± 1.98 (mean difference -5.43, 95% CI -6.33 to -4.52, p < 0.0001) for those with infraspinatus myofascial pain, and 7.00 ± 1.96 and 2.07 ± 2.26 (mean difference -4.93, 95% CI -6.23 to -3.62, p < 0.0001) for those in the teres minor subgroup. No complications were reported in any of the participants. One participant received retreatment for teres minor myofascial pain.

CONCLUSION

US-guided perimysium dissection is an easy, safe, and effective injection method to manage posterior myofascial shoulder pain.

The effect of an eight-week shoulder rehabilitation intervention programme on pain and function, range of motion and muscle strength among teachers: A pilot study

BACKGROUND

Teachers present with shoulder musculoskeletal disorders, which result in pain and poor shoulder function.

OBJECTIVE

To determine the effect of an eight-week shoulder rehabilitation intervention on pain and function, range of motion and muscle strength among teachers.

METHODS

Thirty teachers presenting with shoulder pain were recruited and divided into equal control and experimental groups. The intervention group participated in an eight-week rehabilitation programme. Pre- and post-intervention measurements included the scapular position test, range of motion, muscle strength measurements as well as a shoulder rating questionnaire.

RESULTS

There was a significant improvement in the experimental group's internal range of motion for the dominant (p= 0.006) and non-dominant arms (p= 0.003) post-intervention. Additionally, significant improvements were found in muscle strength in the experimental group in dominant and non-dominant flexion; abduction; external rotation (p< 0.001); dominant internal rotation (p< 0.001) and non-dominant internal rotation strength (p= 0.007). Post-intervention questionnaire data found a decrease in pain (p= 0.003); improved ability to perform daily activities (p= 0.006); improved overall score (p< 0.001) and satisfaction (p= 0.023) in the intervention group compared to the control group.

CONCLUSION

The implementation of a rehabilitation programme in schools should be considered to manage the prevalence of shoulder musculoskeletal disorders among teachers.

Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011-0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020-1.144; P = .008) for the need to other treatments during follow-up.ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.

Development and validation of a cumulative exposure shoulder risk assessment tool based on fatigue failure theory

OBJECTIVE

To present a new risk assessment tool for shoulder intensive occupational tasks based on fatigue failure theory.

METHODS

The tool estimates cumulative damage (CD) based on shoulder moments and loading cycles using an S-N curve derived from in vitro tendon fatigue failure tests. If multiple shoulder tasks are performed, the CD for each is summed. In the validation, 293 workers were evaluated for five separate shoulder outcomes. Logistic regression was used to assess the log CD against five shoulder outcomes adjusted for covariates including age, sex, body mass index (BMI), and plant site.

RESULTS

Both crude and adjusted logistic regression results demonstrated strong dose-response associations between the log CD measure and all five shoulder outcomes (continuous ORs ranged from 2.12 to 5.20).

CONCLUSIONS

The CD measure of The Shoulder Tool demonstrated dose-response relationships with multiple health outcomes. This provides further support that MSDs may be the result of a fatigue failure process.

PRACTITIONER SUMMARY

This study presents a new, easy-to-use risk assessment tool for occupational tasks involving stressful shoulder exertions. The tool is based on fatigue failure theory. The tool was tested against an existing epidemiology study and demonstrated strong relationships to multiple shoulder outcomes.

ABBREVIATIONS

MSD: musculoskeletal disorder; NORA: national occupational research agenda; RULA: rapid upper limb assessment; REBA: rapid entire body assessment; S-N: stress-number of cycles; EDL: extensor digitorum longus; DPC: damage per cycle; CD: cumulative damage; UTS: ultimate tensile strength; FTOV: first time office visit; 3DSSPP: 3-dimensional static strength prediction program; AS: visual analogue scale; BMI: body mass index; CI: confidence interval; Nm: newton-metre; LiFFT: lifting fatigue failure tool; DUET: distal upper extremity tool; OMNI-RES: OMNI resistance exercise scale.

Development and validation of a cumulative exposure shoulder risk assessment tool based on fatigue failure theory

OBJECTIVE

To present a new risk assessment tool for shoulder intensive occupational tasks based on fatigue failure theory.

METHODS

The tool estimates cumulative damage (CD) based on shoulder moments and loading cycles using an S-N curve derived from in vitro tendon fatigue failure tests. If multiple shoulder tasks are performed, the CD for each is summed. In the validation, 293 workers were evaluated for five separate shoulder outcomes. Logistic regression was used to assess the log CD against five shoulder outcomes adjusted for covariates including age, sex, body mass index (BMI), and plant site.

RESULTS

Both crude and adjusted logistic regression results demonstrated strong dose-response associations between the log CD measure and all five shoulder outcomes (continuous ORs ranged from 2.12 to 5.20).

CONCLUSIONS

The CD measure of The Shoulder Tool demonstrated dose-response relationships with multiple health outcomes. This provides further support that MSDs may be the result of a fatigue failure process.

PRACTITIONER SUMMARY

This study presents a new, easy-to-use risk assessment tool for occupational tasks involving stressful shoulder exertions. The tool is based on fatigue failure theory. The tool was tested against an existing epidemiology study and demonstrated strong relationships to multiple shoulder outcomes.

ABBREVIATIONS

MSD: musculoskeletal disorder; NORA: national occupational research agenda; RULA: rapid upper limb assessment; REBA: rapid entire body assessment; S-N: stress-number of cycles; EDL: extensor digitorum longus; DPC: damage per cycle; CD: cumulative damage; UTS: ultimate tensile strength; FTOV: first time office visit; 3DSSPP: 3-dimensional static strength prediction program; AS: visual analogue scale; BMI: body mass index; CI: confidence interval; Nm: newton-metre; LiFFT: lifting fatigue failure tool; DUET: distal upper extremity tool; OMNI-RES: OMNI resistance exercise scale.

Healing of partial tear of the supraspinatus tendon after atelocollagen injection confirmed by MRI: A case report

RATIONALE

Recently, collagen therapy has been made available for treating rotator cuff tendon injuries. However, to our knowledge, there are no clinical studies objectively investigating the effect of collagen therapy.

PATIENT CONCERNS

A 53-year-old female patient visited our pain clinic because of pain in the right shoulder. Although she had never experienced trauma and had not overused her shoulder and arm, the patient showed limited range of motion with painful arc syndrome. Moreover, the Neer test and Hawkins-Kennedy test were positive with subacromial tenderness.

DIAGNOSES

The MRI findings revealed partial tears on the articular surface of the anterior supraspinatus tendon in the rotator cuff.

INTERVENTIONS

The patient was treated with injections of exogenous collagen at the site of the partial tear under ultrasound guidance.

OUTCOMES

Follow-up MRI after injection of collagen revealed healing of the previous partial rupture of the tendon without any complications. Moreover, the patient reported reduction in pain and improvement in the movement of her shoulder during the follow-up period.

LESSONS

In this report, we demonstrate healing of a partial tear of the supraspinatus tendon in the rotator cuff after injection of exogenous collagen, as confirmed by MRI.

The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with Adolescent Idiopathic Scoliosis

PURPOSE

This study sought to analyze factors that predict postoperative shoulder balance based on clinical photography.

METHODS

Based on inclusion criteria, 132 AIS patients were selected. Age, sex, and BMI of each patient were recorded. The following parameters were recorded from radiographs: clavicle angle, T1 tilt, the upper instrumented vertebra (UIV), lowest instrumented vertebra (LIV) thoracic kyphosis, lumbar modifier, preoperative and postoperative proximal thoracic Cobb angle, preoperative and postoperative main thoracic Cobb angle, and preoperative and postoperative thoracolumbar Cobb angle, if applicable. Two spine surgeons independently assigned the photographs shoulder balance grades based on the WRVAS (1-2 = Acceptable, 3-5 = Unacceptable). Surgeons were blinded as to whether the photographs were taken preoperatively or postoperatively. The shoulders were also graded as right high, left high, or balanced.

RESULTS

Of all variables analyzed, only main thoracic Cobb angle correction (MTCAC) showed a statistically significant relationship with postoperative shoulder balance (p = 0.01). Odds of having unacceptable shoulder balance increase by 21% for every 5° increase in MTCAC (Adjusted OR = 1.21, 95% CI 1.015-1.452). The odds of unbalanced shoulders are 4.7 times higher for patients whose MTCAC is 40° or more (p = 0.001). Inter-rater reliability was excellent (k =0 .7). Intra rater reliability was perfect for Surgeon 1 (kappa = 1.0) and showed substantial agreement for Surgeon 2 (kappa = 0.8) CONCLUSIONS: Greater correction of main thoracic Cobb angle predicts unacceptable postoperative shoulder balance with 40° of correction signifying a major dichotomy between acceptable and unacceptable.

Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome

PURPOSE

This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance.

METHODS

Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system.

RESULTS

During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups.

CONCLUSION

This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.

Interactive associations of sex and hyperlipidemia with calcific tendinitis of the shoulder in Taiwanese adults

Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08-2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02-1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30-2.92) in women and 0.82 (95% CI, 0.48-1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53-1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29-3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.

Comparison of locking plates and intramedullary nails in treatment of three-part or four-part proximal humeral neck fractures in elderly population: A randomized trial protocol

BACKGROUND

Locking plate and intramedullary nail are two commonly applied methods to fix proximal humeral fractures. There are limited randomized studies that specifically evaluate the results of proximal humeral neck fractures with three-part or four-part treated by locking plates or intramedullary nails. Our goal was to compare functional outcomes, complications, and imaging features between the two groups.

METHODS

This single-center, prospective, randomized controlled test will be conducted in Tengzhou Central People's Hospital. Patients with these conditions will be included: age between 55 and 80 years; are able to communicate normally and agree to participate in our study; with the radiological evidence of proximal humeral fractures with three-part or four-part; surgical treatment was performed within twenty-one days after the acute fracture. Consecutive patients with proximal humeral fractures will be stochastic to be dealt with a locking plate or a bone nail. The informed consent will be acquired in each patients. Two groups will use the same postoperative rehabilitation protocol. Clinical outcomes include Intraoperative blood loss, operation time, Constant-Murley score, Disability, Arm, Shoulder and Hand score, shoulder range of motion (such as external rotation), and postoperative complications. The significance level was defaulted as P < .05.

RESULTS

This study will provide a solid theoretical basis for exploring which technique is better in treatment of 3-part or 4-part proximal humeral neck fractures in elderly population.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (number: researchregistry6047).

Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement

OBJECTIVE

Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles.

METHODS

This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed.

RESULTS

The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45° (r = 0.17, P = .21), 90° (r = 0.08, P = .57), and 135° (r = 0.10, P = 0.45) of shoulder elevation.

CONCLUSION

The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.

Reproducibility of measurements on physical performance in head and neck cancer survivors; measurements on maximum mouth opening, shoulder and neck function, upper and lower body strength, level of physical mobility, and walking ability

Background

Survivors of Head and Neck Cancer experience specific problems in functional performance. The aim of this study was to obtain the test-retest reliability of measurements on Maximal Mouth Opening (MMO), shoulder and neck function, lower and upper body strength, level of mobility and walking ability.

Materials and methods

Test-retest study design. Measurements on MMO (intra- and extra orally), Active range of motion of shoulders and neck, 30 Seconds Chair Stand Test, Grip Strength, Timed Up and Go test, and Six Minute Walk test.

Results

In total 50 participants were included. The mean age was 68.6. ± 9.9 years and median time since end of treatment was 3.0 years (Q1–Q3: 1.0–5.25 years). We found good to excellent test-retest reliability on the core set of measurements (Intraclass Correlation Coefficient (ICC) 0.77 to 0.98). Measurement of MMO with cardboard card, forward flexion shoulder and Six Minute Walk test had a relatively small measurement error (Smallest Detectable Change (SDC) % 5.4% - 15.1%). Measurement of MMO with a caliper, shoulder abduction, shoulder external rotation, later flexion and rotation of the neck, grip strength, 30 Seconds Chair Stand Test, and Timed up and Go test had a relatively large measurement error (SDC% 19.8% - 44.7%).

Conclusion

This core set of measurements on physical performance is found reliable and therefore able to differentiate in physical performance. The reported measurement errors should be taken into consideration when interpreting the results of repeated measurements.

Implications for cancer survivors

A core set of physical measurements can be used to measure physical performance in survivors of Head and Neck Cancer.

Motor control integrated into muscle strengthening exercises has more effects on scapular muscle activities and joint range of motion before initiation of radiotherapy in oral cancer survivors with neck dissection: A randomized controlled trial

Background

Accessory nerve shoulder dysfunction is common after neck dissection in oral cancer survivors. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy.

Methods

Thirty-eight participants were randomly allocated into the motor-control and regular-exercise groups. Each group received conventional physical therapy and specific scapular muscle strengthening exercises for 1 month immediately after neck dissection. Motor control techniques were integrated with scapular strengthening exercises for the motor-control group. Shoulder pain, active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training.

Results

Both groups reduced shoulder pain and increased muscle activity of maximum voluntary isometric contraction (MVIC) of each muscle after the intervention. Increased AROM of shoulder abduction was only observed in the motor-control group (95% CI 3.80 to 20.51, p = 0.004). Relative to baseline evaluation, muscle activities of UT decreased in the motor-control group when performing shoulder shrug with 1-kg weight (95% CI -33.06 to -1.29, p = 0.034). Moreover, the SA activity decreased in the motor-control group (95% CI -29.73 to -27.68, p<0.001) but increased in the regular-exercise group (95% CI 28.16 to 30.05, p<0.001) when performing shoulder horizontal adduction and flexion.

Conclusion

Early strengthening exercise with motor control techniques has greater benefits for improving AROM of shoulder abduction, muscle economy, and reducing compensatory scapular muscle activities in patients with neck dissection-related shoulder dysfunction before the initiation of radiotherapy.

Use sonoelastography to predict the reparability of large-to-massive rotator cuff tears

INTRODUCTION

Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs.

METHODS

This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI.

DISCUSSION

The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.

Laterality judgement and tactile acuity in patients with frozen shoulder: A cross-sectional study

BACKGROUND

Disrupted tactile acuity and poor laterality judgement have been shown in several chronic musculoskeletal pain conditions. Whether they are impaired in people with frozen shoulder (FS) remains unknown.

OBJECTIVES

To determine whether there is impairment in tactile acuity and laterality judgement in subjects with FS.

METHODS

Thirty-eight subjects with idiopathic FS and 38 sex and age-matched healthy controls were enrolled. The two-point discrimination threshold (TPDT) over the affected and unaffected shoulder of patients with FS and shoulder of healthy controls was evaluated. In addition, all participants performed a left/right judgment task (LRJT). Independent and dependent t-tests were used to compare group means. Pearson-product moment coefficient correlations between pain intensity and duration and LRJT and TPDT were calculated for the FS group.

RESULTS

The TPDT over the affected shoulder was significantly increased compared to the unaffected shoulder (mean difference, 3.82 mm; 95% confidence interval [CI]:0.53, 7.10; p = .02) and controls (mean difference, 5.80 mm; 95% CI: 1.09, 10.52; p = .02). Patients with FS were less accurate (mean difference, 5.90%; 95% CI: 0.36, 11.43; p = .03) and slower (mean difference, -0.26 s; 95% CI: 0.06, 0.45; p = .01) responding to images of their affected shoulder compared to their unaffected shoulder. No associations were found between pain intensity and duration and either TPDT or laterality judgement.

CONCLUSIONS

Participants with FS demonstrated reduced tactile acuity and impaired laterality judgement over their affected shoulder compared to their unaffected shoulder. When compared to controls, subjects with FS showed reduced tactile acuity. TRIAL REGISTRATION CLINICALTRIALS.

GOV IDENTIFIER

NCT03320200.

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer

BACKGROUND

The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer.

METHODS

A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status.

RESULTS

In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R2 = 0.51, F = 5.41, p < 0.001).

CONCLUSIONS

During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.

Three-dimensional in vivo comparative analysis of the kinematics of normal shoulders and shoulders with massive rotator cuff tears with successful conservative treatment

BACKGROUND

This study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders.

METHODS

Ten patients (age, 67.4 ± 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders.

FINDINGS

There was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p < .05). This difference disappeared in the range from 40° to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9° at rest (p < .05) and by 11.6° at terminal elevation (p < .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups.

INTERPRETATION

Kinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.

Effect of elastic scapular taping on shoulder and spine kinematics in adolescents with idiopathic scoliosis

OBJECTIVE

The aim of this study was to investigate the short-term effects of scapular repositioning using an elastic taping technique on the three-dimensional (3-D) shoulder and thoracic kinematics during various activities of daily living (ADLs) in adolescents with idiopathic scoliosis (IS).

METHODS

Shoulder and spine kinematics during five ADL movement tasks were assessed in 24 adolescents with IS (3 males and 21 females; mean age: 15.8 years; age range: 14-17 years) before and 15 min after elastic scapular taping. All the participants had a moderate curve magnitude (Cobb angle: 20°-45°), with a primary thoracic curve. A 3-D electromagnetic tracking system (Ascension Technology Corporation, Shelburne, VT, USA) was used to record 3-D shoulder and thoracic kinematics. ADL movement tasks included touching the mouth/drinking, touching the back, touching the contralateral shoulder, reaching upward, and bilateral 4-kg weight lifting. Two separate strips of elastic tape were applied using the same correction technique for each shoulder and scapular region to control scapular alterations in the resting position.

RESULTS

Elastic scapular taping significantly improved scapular external rotation and scapular upward rotation. Similarly, humeral horizontal adduction, external rotation, thoracic flexion, and lateral bending significantly increased in the taped condition depending on the specific task (p<0.05).

CONCLUSION

Elastic scapular taping can change scapular orientations on the convex and concave sides, thereby affecting upper extremity and trunk kinematics. Thus, the dynamic stability of the scapula increases to produce larger movements during functional activities.

LEVEL OF EVIDENCE

Level IV, Therapeutic study.

Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles - A randomized trial

Migraine is a burdensome disease with an especially high prevalence in women between the age of 15 and 49 years. Non-pharmacological, non-invasive therapeutic methods to control symptoms are increasingly in demand to complement a multimodal intervention approach in migraine. Thirty-seven subjects (age: 25.0 ± 4.1 years; 36 females) diagnosed with high-frequency episodic migraine who presented at least one active myofascial trigger point (mTrP) in the trapezius muscles and at least one latent mTrP in the deltoid muscles bilaterally prospectively underwent six sessions of repetitive peripheral magnetic stimulation (rPMS) over two weeks. Patients were randomly assigned to receive rPMS applied to the mTrPs of the trapezius (n = 19) or deltoid muscles (n = 18). Whereas the trapezius muscle is supposed to be part of the trigemino-cervical complex (TCC) and, thus, involved in the pathophysiology of migraine, the deltoid muscle was not expected to interfere with the TCC and was therefore chosen as a control stimulation site. The headache calendar of the German Migraine and Headache Society (DMKG) as well as the Migraine Disability Assessment (MIDAS) questionnaire were used to evaluate stimulation-related effects. Frequency of headache days decreased significantly in both the trapezius and the deltoid group after six sessions of rPMS (trapezius group: p = 0.005; deltoid group: p = 0.003). The MIDAS score decreased significantly from 29 to 13 points (p = 0.0004) in the trapezius and from 31 to 15 points (p = 0.002) in the deltoid group. Thus, rPMS applied to mTrPs of neck and shoulder muscles offers a promising approach to alleviate headache frequency and symptom burden. Future clinical trials are needed to examine more profoundly these effects, preferably using a sham-controlled setting.

Effect of surgical radiation personal protective equipment on EMG-based measures of back and shoulder muscle fatigue: A laboratory study of novices

Interventional radiologists are at increased risk for musculoskeletal discomfort/disorders and this has been linked to the use of radiation personal protective equipment (rPPE). This study examined the effects of rPPE on the development of fatigue of the erector spinae and trapezius muscles. Surface electromyography (EMG) was used to capture muscle activity, and both time domain (average rectified value) and frequency domain (median frequency) measures were considered in the assessment of localized muscle fatigue. Sixteen participants performed a simulated surgical procedure requiring intermittent 30° flexed static trunk posture with and without rPPE on separate days. The results showed that the rPPE condition demonstrated significantly greater (p < 0.05) downward shift in median frequency in the left lumbar erector spinae and left lower thoracic erector spinae consistent with task-induced localized muscle fatigue. Ergonomic intervention strategies are discussed.

Post hoc analysis of the improvement in shoulder spasticity and safety observed following treatment with incobotulinumtoxinA

OBJECTIVE

The Titration study in lOWer and uppER-limb spasticity (TOWER) study (NCT01603459), evaluated incobotulinumtoxinA for upper- and lower-limb spasticity. This post hoc analysis assessed shoulder spasticity in patients who received injections into the shoulder.

METHODS

Subjects received 3 injection cycles with escalating incobotulinumtoxinA doses on the same side (400, 600, 600-800 U; ≤ 600 U per limb including optional shoulder dose, planned range 100-250 U). Joint function was assessed with the Ashworth Scale shoulder sumscore (AS-SSS) in subjects treated in the shoulder vs those who were not. Safety was assessed in subjects treated in the shoulder, and in those who had upper-limb treatment without shoulder treatment.

RESULTS

The proportion of subjects receiving shoulder treatment increased with escalating dose at each cycle (n = 84/140 (60.0%) by cycle 3; mean (standard deviation (SD)) shoulder dose 118.4 U (SD 60.2)). From baseline to 4-weeks post-injection, mean AS-SSS improved by -1.1 (SD 1.9), -1.7 (SD 1.8) and -1.7 (1.8) in cycles 1, 2 and 3, respectively, in subjects treated in the shoulder, and -0.5 (SD 1.3), -0.8 (SD 1.6) and -0.9 (SD 1.4) in subjects who were not. A significant dose effect on AS-SSS was observed in cycle 3 (p = 0.0081). No unexpected safety concerns were reported.

CONCLUSION

The results demonstrate an improvement in shoulder spasticity and safety following incobotulinumtoxinA treatment.

The protocol for a multisite, double blind, randomized, placebo-controlled trial of axillary nerve stimulation for chronic shoulder pain

BACKGROUND

Shoulder impingement syndrome is one of the most common causes of shoulder pain, accounting for approximately 30% of all shoulder pain. Approximately 35% of patients with shoulder impingement syndrome are refractory to conservative treatment. For patients who fail conservative treatment, there is no established treatment to successfully treat their chronic pain. Prior randomized control trials have demonstrated efficacy for the use of a single lead intramuscular peripheral nerve stimulation of the axillary nerve at the motor points of the deltoid muscle for treatment of hemiplegic shoulder pain. This is the first controlled trial to utilize the same novel technology to treat shoulder impingement syndrome outside of the stroke population.

METHODS

This is a dual-site, placebo-controlled, double-blinded, randomized control trial. Participants will be randomized to two treatment groups. The intervention group will be treated with active peripheral nerve stimulation of the axillary nerve of the affected shoulder and the control group will be treated with sham peripheral nerve stimulation of the axillary nerve of the affected shoulder. Both groups will receive a standardized exercise therapy program directed by a licensed therapist.

DISCUSSION

This study protocol will allow the investigators to determine if this novel, non-pharmacologic treatment of shoulder pain can demonstrate the same benefit in musculoskeletal patients which has been previously demonstrated in the stroke population.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03752619. Registered on 26 November 2018.

Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques

OBJECTIVE

This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques.

METHODS

Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear.

CONCLUSION

In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term.

LEVEL OF EVIDENCE

Level III, Therapeutic study.

Functional passive range of motion of individuals with chronic cervical spinal cord injury

OBJECTIVE

Functional passive range of motion (PROM) requirements for individuals with cervical spinal cord injury (SCI) are clinically accepted despite limited evidence defining the specific PROM needed to perform functional tasks. The objective of this investigation was to better define the minimum PROM needed for individuals with cervical SCI to achieve optimal functional ability, and as a secondary outcome gather self-reported standardized functional data via the Spinal Cord Independence Measure-III (SCIM-III), and the Spinal Cord Injury Functional Index (SCI-FI).

DESIGN

Observational cohort.

SETTING

128-bed rehabilitation hospital with inpatient and outpatient spinal cord injury rehabilitation programs.

PARTICIPANTS

A convenience sample of 29 community-dwelling individuals with chronic (greater than one year) tetraplegic SCI (C5-8) who use a wheelchair for mobility.

INTERVENTIONS

None.

OUTCOME MEASURES

Therapist goniometric measurement of upper and lower extremity PROM, and participant completion of a demographic questionnaire and two functional self-report measures (SCIM-III and SCI-FI) were completed.

RESULTS

Compared to the general population, differences observed in our study participants included limitations in forearm pronation and elbow extension and increased shoulder extension and wrist extension (likely related to prop sitting). Elbow hyperextension was noted in one-third of the participants. Limitations in straight leg raise, hip flexion, abduction, and internal rotation, in combination with increased hip external rotation suggested these individuals with cervical SCI potentially completed activities of daily living (ADLs) in frog-sitting, rather than long-sitting. Ankle plantarflexion contractures were found in many participants. Shoulder horizontal adduction, elbow extension, hip flexion, knee flexion, ankle plantarflexion, and forefoot eversion ROM were associated with functional performance.

CONCLUSION

Based on our results healthcare providers should work with individuals with cervical SCI to develop long term PROM plans to optimize functional abilities.

Statistical shape-kinematics models of the skeletal joints: Application to the shoulder complex

Patient-specific biomechanical simulations of joints require accurate reconstruction of bony anatomy from medical image data. The articular geometries of the joints may influence their biomechanics. Statistical shape models (SSMs) have become ubiquitous in the literature and aim to capture the natural variation of biological objects. They work by learning the variation from training examples to define the space of valid biological shapes. However, the kinematic information descriptive of the anato-physiological relationship of two interacting objects is not generally encoded in the SSM. Here, we propose a framework for developing combined statistical shape and kinematics models (SSKMs) as Gaussian process morphable models to analyse the shape and kinematics relationship. We demonstrate the framework on a three-dimensional (3D) image data set consisting of ten right-handed cadaveric shoulder joints acquired using computed tomography. Additionally, we simulate specific bone motions to encode kinematics in the combined model. Our SSKM built from shoulder data (matching scapulae and humeri) correctly depicts a correlation between the shape and kinematics as hypothesized. We furthermore demonstrate the ability to marginalize from the SSKM to obtain shape-only variation and kinematics-only variation. Future work aims to use the SSKM framework to understand the relationships between kinematics and shape for various joints as well as to develop patient-specific computational models to evaluate joint biomechanics.

Identification of gender differences in the factors influencing shoulders, neck and upper limb MSD by means of multivariate adaptive regression splines (MARS)

In the present research, models based on multivariate adaptive regression splines (MARS) are proposed to study the influence of gender in the factors affecting the development of shoulders, neck and upper limb MSD. Two different MARS models, corresponding to men and women, are constructed to identify variables with the strongest effect on the target MSD. Both models are capable to predict successfully the occurrence of the studied disorders. Men seem to be more vulnerable to physical risk factors and some other working conditions, whereas women appear to be more affected by psychosocial risk factors and activities carried out outside their working hours. According to the results, gender needs to be considered to ensure the success and effectiveness of ergonomic interventions on the whole working population.

Determining User Intent of Partly Dynamic Shoulder Tasks in Individuals With Chronic Stroke Using Pattern Recognition

Stroke remains the leading cause of long-term disability in the US. Although therapy can achieve limited improvement of paretic arm use and performance, weakness and abnormal muscle synergies-which cause unintentional elbow, wrist, and finger flexion during shoulder abduction-contribute significantly to limb disuse and compound rehabilitation efforts. Emerging wearable exoskeleton technology could provide powered abduction support for the paretic arm, but requires a clinically feasible, robust control scheme capable of differentiating multiple shoulder degrees-of-freedom. This study examines whether pattern recognition of sensor data can accurately identify user intent for 9 combinations of 1- and 2- degree-of-freedom shoulder tasks. Participants with stroke (n = 12) used their paretic and non-paretic arms, and healthy controls (n = 12) used their dominant arm to complete tasks on a lab-based robot involving combinations of abduction, adduction, and internal and external rotation of the shoulder. We examined the effect of arm (paretic, non-paretic), load level (25% vs 50% maximal voluntary torque), and dataset (electromyography, load cell, or combined) on classifier performance. Results suggest that paretic arm, lower load levels, and using load cell or EMG data alone reduced classifier accuracy. However, this method still shows promise. Further work will examine classifier-user interaction during active control of a robotic device and optimization/minimization of sensors.

Reduced shoulder strength and change in range of motion are risk factors for shoulder injury in water polo players

OBJECTIVE

To determine whether pre-season shoulder ROM and strength can be used to identify athletes at risk of future shoulder injury.

DESIGN

Prospective cohort.

SETTING

High performance sports institute.

PARTICIPANTS

76 sub-elite water polo players.

MAIN OUTCOME MEASURES

Mean pre-season shoulder internal (IR) and external rotation (ER) ROM and strength values compared by gender, dominance and prospective injury status.

RESULTS

14-dominant shoulder injuries were recorded. There was a significant difference (p = 0.05) in total ROM difference (TROM) between the prospectively injured and no injury groups (-17.2°(30.4);-0.8°(13.3)), and dominant side ER strength (11.7%(2.4) vs 14.5%(2.8), p = 0.03) and IR strength (16.5%(3.0) vs 21.6%(4.9) as a percentage body weight (PBW) were also significantly different (p ≤ 0.03). Separate significant associations were found between future episodes of shoulder injury and; dominant shoulder TROM difference of ≥7.5°(OR 3.6,95%CI 0.8-16.0), ER strength as a PBW≤12.5%(OR 5.2,95%CI 1.0-27.9), and IR strength as a PBW≤16.8%(OR 13.8,95%CI 2.2-88.0).

CONCLUSION

Pre-season dominant TROM difference, and reduced shoulder IR and ER strength relative to body weight were significant predictors for future shoulder injury. Although further investigation with a larger sample size is required, achieving optimal values on these measures may reduce future episodes of shoulder injury in water polo players.

Bilateral Tactile Feedback-Enabled Training for Stroke Survivors Using Microsoft KinectTM

Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery of post-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralateral arm matching” and “both arms moving together”, were carried out by the participant. Each of the protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the “contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle. The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that position for ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training of a post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation.

Superficial Shoulder Muscle Synergy Analysis in Facioscapulohumeral Dystrophy During Humeral Elevation Tasks

Facioscapulohumeral dystrophy (FSHD) is a progressive muscle-wasting disease which leads to a decline in upper extremity functionality. Although the scapulohumeral joint's stability and functionality are affected, evidence on the synergetic control of the shoulder muscles in FSHD individuals is still lacking. The aim of this paper is to understand the neuromuscular changes in shoulder muscle control in people with FSHD. Upper arm kinematics and electromyograms (EMG) of eight upper extremity muscles were recorded during shoulder abduction-adduction and flexion-extension tasks in eleven participants with FSHD and 11 healthy participants. Normalized muscle activities were extracted from EMG signals. Non-negative matrix factorization was used to compute muscle synergies. Maximum muscle activities were compared using non-parametric analysis of variance. Similarities between synergies were also calculated using correlation. The Biceps Brachii was significantly more active in the FSHD group (25±2%) while Trapezius Ascendens and Serratus Anterior were less active (32±7% and 39±4%, respectively). Muscle synergy weights were altered in FSHD individuals and showed greater diversity while controls mostly used one synergy for both tasks. The decreased activity by selected scapula rotator muscles and muscle synergy weight alterations show that neuromuscular control of the scapulohumeral joint is less consistent in people with FSHD compared to healthy participants. Assessments of muscle coordination strategies can be used to evaluate motor output variability and assist in management of the disease.

A Robot with an Augmented-Reality Display for Functional Capacity Evaluation and Rehabilitation of Injured Workers

Occupational rehabilitation is an integral part of the recovery process for workers who have sustained injuries at the workplace. It often requires the injured worker to engage in functional tasks that simulate the workplace environment to help regain their functional capabilities and allow for a return to employment. We present a system comprised of a robotic arm for recreating the physical dynamics of functional tasks and a 3D Augmented Reality (AR) display for immersive visualization of the tasks. While this system can be used to simulate a multitude of occupational tasks, we focus on one specific functional task. Participants perform a virtual version of the task using the robot-AR system, and a physical version of the same task without the system. This study shows the results for two able-bodied users to determine if the robot-AR system produces upper-limb movements similar to the real-life equivalent task. The similarity between relative joint positions, i.e., hand-to-elbow (H2E) and elbow-to-shoulder (E2S) displacements, is evaluated within clusters based on the spatial position of the user's hand. The H2E displacements for approximately 50% of hand position clusters were consistent between the robot-AR and real-world conditions and approximately 30% for E2S displacements. The similar clusters are distributed across the entire task space however, indicating the robot-AR system has the potential to properly simulate real-world equivalent tasks.

Comparison of intra articular NSAID (ketorolac) injection versus hyaluronic acid injection for the mean decrease of pain score (according to UCLA shoulder rating scale) in the management of adhesive capsulitis

Adhesive capsulitis is painful condition, associated with gradual loss of active and passive shoulder motion that has a disabling capability. In this study we compared the short term outcome by measuring the mean decrease of pain in adhesive capsulitis using University of California Los-Angeles (UCLA) shoulder rating scale after intra-articular Non-Steroidal Anti Inflammatory Drug (NSAID) Ketorolac and Hyaluronic acid injection. This Randomized controlled trial was carried out using non probability consecutive sampling technique from 1st November 2015 to 30th April 2016. Total 160 patients with adhesive capsulitis for six months' age between 18 to 70 years were taken and randomly divided into two equal groups by computer allocation method. The 80 patients in Group A received Intra-articular (NSAID) Ketorolac injection while patients in Group B were given Intra-articular Hyaluronic acid. Pain score for both the groups were recorded using UCLA shoulder rating scale before treatment and then at follow up after a period of 4 weeks. Out of total 160 cases, 47.5% (n=38) in Group A and 45% (n=36) in Group B were male whereas 52.5% (n=42) in Group A and 55% (n=44) in Group B were females. Most commonly affected age group with 40% (n=32) participants was aged between 51 - 60 years. Mean age of Group A was 37.87±1.027 and in Group B was 45.37±5.743. Interestingly 60% (n=48) of Group A and 55% (n=44) of Group B had involvement of the right shoulder. Pre-treatment UCLA pain score was calculated to be 14.90±4.969 in Group-A and 15.16±5.578 in Group-B. Final post treatment UCLA score was 26.67±2.331 in Group A and 21.72±3.838 in Group B. The mean decrease of pain in Adhesive capsulitis using UCLA rating scale was significantly better in NSAID group as compared to Hyaluronic acid group.

Acute effects of a single tennis match on passive shoulder rotation range of motion, isometric strength and serve speed in professional tennis players

Shoulder pain has been associated with glenohumeral internal rotation deficit (GIRD) and a reduction in external rotation (ER) strength; however, in tennis players, there is scarce evidence regarding the impact of a single match on shoulder range of motion (ROM), strength and serve speed. The aim of this study was to determine the acute effect of a single tennis match on shoulder rotation ROM, isometric strength and serve speed. Twenty-six professional tennis players participated in the study (20.4±4.4 years; 10.5±3.2 years tennis expertise; 20.5±5.4 h/week training). Passive shoulder external (ER-ROM) and internal rotation ROM (IR-ROM), ER and IR isometric strength were measured before and after a single tennis match (80.3±21.3 min) in both shoulder´s. Moreover, the total arc of motion (TAM) and ER/IR strength ratio were calculated. Video analysis was used to assess the number of serves and groundstrokes, while a radar gun was utilized to measure maximal ball speed. In the dominant shoulder, compared to pre-match levels, IR-ROM was significantly reduced (-1.3%; p = 0.042), while ER-ROM (5.3%; p = 0.037) and TAM (3.1%; p = 0.050) were significantly increased. In the non-dominant shoulder, ER-ROM (3.7%; p = 0.006) was increased. Furthermore, in the dominant shoulder, the isometric ER strength was significantly reduced after the match (-4.8%; p = 0.012), whereas serve speed was not significantly reduced after match (-1.16%; p = 0.197). A single tennis match leads to significant reductions in shoulder ROM (e.g., IR of the dominant shoulder) and isometric strength (e.g., ER of the dominant shoulder). This study reveals the importance of recovery strategies prescription aiming at minimize post-match alteration in the shoulders.

Algorithmically detectable directional changes in upper extremity motion indicate substantial myoelectric shoulder muscle fatigue during a repetitive manual task

Repetitive workplace tasks are associated with fatigue-induced changes to shoulder muscular strategies, potentially altering kinematics and elevating susceptibility to tissue overexposures. Accessible and reliable methods to detect shoulder muscle fatigue in the workplace are therefore valuable. Detectable changes in joint motion may provide a plausible fatigue identification method. In this investigation, the onset of the first kinematic changes, as identified by a symbolic motion representation (SMSR) algorithm, and the onset of substantial surface electromyography (sEMG) mean power frequency (MPF) fatigue were not significantly different, both occurring around 10% of task duration. This highlights the potential utility of SMSR identified directional changes in joint motion during repetitive tasks as a cue of substantial muscle fatigue, enabling ergonomics responses that can mitigate shoulder muscular fatigue accumulation and its associated deleterious physical effects. Practitioner Summary: The onset of substantial muscle fatigue during a repetitive dynamic task was assessed using kinematics and myoelectric-based techniques. Algorithmically detectable directional changes in upper extremity joint motion occurred with the onset of substantial muscle fatigue, highlighting the potential of this as a useful approach for workplace fatigue identification.

Muscular and kinematic adaptations to fatiguing repetitive upper extremity work

Repetitive work is common in the modern workplace and the effects are often studied using fatigue protocols; however, there is evidence that the manner in which fatigue develops impacts the kinematic and muscular response to reduced physical capacity. The purpose of this study was to simultaneously evaluate muscular and kinematic adaptations during fatiguing, repetitive work until exhaustion. We measured muscle activity in 13 muscles in the shoulder and trunk, and captured full body kinematics while participants completed simulated, repetitive work tasks. Every 12 min, reference data were collected to quantify fatigue. This sequence continued until they reached the termination criteria. Participants displayed significant signs of muscle fatigue, loss of strength and increased perceived fatigue (p < 0.05). Analysis revealed a significant effect of time on posture and muscle activity that was both task and time dependent, and variable both between and within individuals. Participants were able to compensate for reduced physical capacity and maintain task performance through coordinated compensation strategies.

Effects of elastic tape on kinematic parameters during a functional task in chronic hemiparetic subjects: A randomized sham-controlled crossover trial

Background

Approximately 50 to 70% of post-stroke subjects present a reduction in the upper limb (UL) function even during the chronic phase. An adjuvant technique widely used in neurorehabilitation is elastic taping applications. However, its efficacy in UL treatment for post-stroke subjects still requires further investigation.

Objective

To verify the effects of elastic tape (ET) used on the paretic shoulder in upper limb (UL) performance during a drinking task.

Method

A single-center randomized sham-controlled crossover trial randomized thirteen post-stroke subjects with mild to moderate UL impairment for group allocation to receive first Sham Tape (ST) or first Elastic Tape (ET), with one month of washout. Kinematic measures of a drinking task were taken before and after each intervention (elastic and sham tape), using Three-Dimensional Motion Analysis, and studied using feature analysis and Statistical Parametric Mapping. Outcome measures included spatiotemporal variables, scalar kinematic parameters (starting angles, range of motion—ROM, and endpoint angles) and time-normalized kinematic waveforms of trunk and UL joint angles (scapulothoracic, humerothoracic and elbow).

Results

Elastic tape provided common modifications throughout the task (shoulder more towards midline, reduced scapula protraction and trunk flexion) and important alterations at specific time-instants. At the end of the reaching phase, for both groups (ET and ST), the elastic tape increased elbow extension [ET: CI = 12.57 (6.90 to 18.17), p<0.001; ST: CI: 12.89 (6.79 to 18.98), p<0.001). At the end of transporting the glass to the mouth, patients who underwent the elastic tape intervention presented more shoulder elevation [ET: CI = 16.40 (4.28 to 28.52), p = 0.007; ST: CI: 15.13 (5.79 to 24.48), p = 0.002)]. Moreover, an increase of elbow extension at the end of transporting the glass to the table was observed for both groups [ET: CI = 8.13 (1.48 to 14.79), p = 0.014; ST: CI: 8.20 (4.03 to 12.38), p<0.001)]. However, no changes in the spatiotemporal parameters were observed for both groups during all the phases of the task (p>0.05).

Conclusion

The ET changed UL joint motions and posture during a drinking task in chronic hemiparetic subjects, which defines its role as an adjuvant therapy.

Loss of Functional Internal Rotation Following Various Combinations of Bilateral Shoulder Arthroplasty

BACKGROUND

Limited internal rotation (IR) remains a concern for activities of daily living (ADLs) following bilateral shoulder arthroplasty (BSA). The purpose of this study was to evaluate the loss of the ability to perform functional IR tasks following BSA using various combinations of anatomic (TSA) and reverse (RSA) shoulder arthroplasty.

METHODS

A retrospective review of an institutional shoulder-surgery database was conducted for patients who underwent BSA with any combination of TSA or RSA with at least a 2-year follow-up. IR range of motion (ROM) and individual American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) questions specific to IR were used to assess a patient's ability to perform IR tasks with at least one of their shoulders.

RESULTS

Seventy-three patients met the inclusion criteria (47 TSA/TSA, 17 RSA/RSA, and 9 TSA/RSA). Average age at surgery was 72.1 years. Average follow-up was 51.4 months. Loss of ability to wash one's back was observed in 30.4% TSA/TSA, 33.3% TSA/RSA, and 52.9% RSA/RSA. Loss of ability to tuck in a shirt was observed in 10.6% TSA/TSA, 11.1% TSA/RSA, and 29.4% RSA/RSA. Loss of ability to manage toileting was observed in no TSA/TSA or TSA/RSA, but in 11.8% RSA/RSA. For each of the tasks, there were no significant differences in the ability to perform the task among the groups (p>0.05). Post-operative IR ROM for TSA/TSA was superior to those for TSA/RSA and RSA/RSA (p<0.01). IR ROM efficacies for both RSA/RSA and TSA/RSA were inferior to that for TSA/TSA (p<0.05).

CONCLUSION

Bilateral RSA patients can perform most IR tasks, and their ability to complete these tasks does not differ significantly from those in patients with other BSA.

Changes in propulsion technique and shoulder complex loading following low-intensity wheelchair practice in novices

Background

Up to 80% of wheelchair users are affected by shoulder pain. The Clinical Practice Guidelines for preservation of upper limb function following spinal cord injury suggest that using a proper wheelchair propulsion technique could minimize the shoulder injury risk. Yet, the exact relationship between the wheelchair propulsion technique and shoulder load is not well understood.

Objective

This study aimed to examine the changes in shoulder loading accompanying the typical changes in propulsion technique following 80 min of low-intensity wheelchair practice distributed over 3 weeks.

Methods

Seven able-bodied participants performed the pre- and the post-test and 56 min of visual feedback-based low-intensity wheelchair propulsion practice. Kinematics and kinetics of propulsion technique were recorded during the pre- and the post-test. A musculoskeletal model was used to calculate muscle force and glenohumeral reaction force.

Results

Participants decreased push frequency (51→36 pushes/min, p = 0.04) and increased contact angle (68→94°, p = 0.02) between the pre- and the post-test. The excursion of the upper arm increased, approaching significance (297→342 mm, p = 0.06). Range of motion of the hand, trunk and shoulder remained unchanged. The mean glenohumeral reaction force per cycle decreased by 13%, approaching significance (268→232 N, p = 0.06).

Conclusions

Despite homogenous changes in propulsion technique, the kinematic solution to the task varied among the participants. Participants exhibited two glenohumeral reaction force distribution patterns: 1) Two individuals developed high force at the onset of the push, leading to increased peak and mean glenohumeral forces 2) Five individuals distributed the force more evenly over the cycle, lowering both peak and mean glenohumeral forces.

A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis

OBJECTIVE

Assess the frequency of a positive scapular assistance test (SAT) in different shoulder disorders and establish its association with scapular dyskinesis.

DESIGN

Cross-sectional.

SETTING

Shoulder clinic.

PARTICIPANTS

Seventy-four patients.

MAIN OUTCOME MEASURES

The SAT and visual assessment of scapular movement were performed by a physical therapist. An orthopaedic surgeon classified participants into 4 diagnostic categories: rotator cuff disease, superior labrum anterior posterior lesion (SLAP), shoulder instability, and other.

RESULTS

Twenty-seven (36.5%) participants presented with a positive SAT. The SAT was positive among 9 of 28 participants (32.1%) with rotator cuff disease, 7 of 23 participants (30.4%) with SLAP lesions, 9 of 21 participants (42.9%) with shoulder instability, and 2 of 2 participants (100.0%) with other pathologies. The frequency of a positive SAT did not differ between the various diagnostic categories (P = 0.64). The SAT was more frequently positive among participants with scapular dyskinesis (48.5% versus 26.8%, P = 0.05).

CONCLUSIONS

The SAT is found similarly positive among patients with various common shoulder disorders. Although associated with scapular dyskinesis, the SAT was positive in less than half of those demonstrating scapular dyskinesis suggesting the SAT may help identify patients in whom altered scapular movement is contributing to shoulder pain.

Musculoskeletal Basics: The Shoulder and the Knee Workshop for Primary Care Residents

Introduction

Although musculoskeletal (MSK) complaints are very common in ambulatory clinics, internal medicine residents report low confidence in performing MSK examinations and intra-articular steroid injections. Our goal is to strengthen residents' MSK competence by using visual, auditory, and kinesthetic educational modalities during an academic half-day session.

Methods

Our intervention was a workshop/academic half-day session that included multimodal educational materials on common shoulder and knee MSK complaints. The intervention featured a PowerPoint presentation highlighting three areas of MSK education: history taking, physical examination, and procedural skills. The curriculum contained a novel interactive charades game in which competitors demonstrated joint exams, an engaging anatomy quiz, and the performance of knee and subacromial bursae injections using interactive models and educational videos.

Results

The effectiveness of our session was measured using a pre- and postsurvey. In our 2017 resident survey to determine the level of comfort in performing knee and shoulder physical examination and intra-articular injections, the majority of respondents perceived themselves as inadequately trained. After the session, confidence in performing knee and shoulder examinations and in performing knee and subacromial bursae injections increased significantly. In addition, 100% of the residents who attended and evaluated the session either agreed or strongly agreed that the experience improved MSK knowledge and employed effective teaching strategies.

Discussion

The workshop/academic half-day session positively enhanced residents' perception of their knowledge of MSK medicine and their ability to perform joint injections.

Potential Relevance of Altered Muscle Activity and Fatigue in the Development of Performance-Related Musculoskeletal Injuries in High String Musicians

BACKGROUND

Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period.

PURPOSE

To investigate muscle activity patterns in muscles of the arms, shoulder, and back of high string musicians during prolonged performance.

METHODS

Fifteen professional or university high string musicians were divided into PRMD and non-PRMD groups. All musicians played a chromatic scale, then an individual "heavy" piece for 1 hr, and finally the chromatic scale again. Surface electromyography (sEMG) data were recorded from 16 muscles of the arm, shoulder, and trunk on both sides of the body. Two parameters were analyzed: the percentage load in relation to the respective maximum force during the chromatic scale, and the low-frequency spectrum to determine the fatigue behavior of muscles during the 1-hr play.

RESULTS

Changes in muscle activation patterns were observed at the beginning and end of the trial duration; however, these varied depending on whether musicians had PRMDs or no PRMDs. In addition, low-frequency spectrum changes were observed after 1 hr of playing in the PRMD musicians, consistent with signs of muscular fatigue.

CONCLUSION

Differences in muscle activity appear between high string musicians with and without PRMDs as well as altered frequency spectrum shifts, suggesting possible differential muscle fatigue effects between the groups. The applied sEMG analysis proved a suitable tool for detailed analysis of muscle activation characteristics over prolonged playing periods for musicians with and without PRMDs.