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Sports Medicine and Arthroscopy Review Sep 2018The shoulder is a complex joint, with a wide range of motion and functional demands. An understanding of the intricate network of bony, ligamentous, muscular, and... (Review)
Review
The shoulder is a complex joint, with a wide range of motion and functional demands. An understanding of the intricate network of bony, ligamentous, muscular, and neurovascular anatomy is required in order to properly identify and diagnose shoulder pathology. There exist many articulations, unique structural features, and anatomic relationships that play a role in shoulder function, and therefore, dysfunction and injury. Evaluation of a patient with shoulder complaints is largely reliant upon physical exam. As with any exam, the basic tenets of inspection, palpation, range of motion, strength, and neurovascular integrity must be followed. However, with the degree of complexity associated with shoulder anatomy, specific exam maneuvers must be utilized to isolate and help differentiate pathologies. Evaluation of rotator cuff injury, shoulder instability, or impingement via exam guides clinical decision-making and informs treatment options.
Topics: Humans; Joint Instability; Ligaments; Muscle, Skeletal; Physical Examination; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder
PubMed: 30059442
DOI: 10.1097/JSA.0000000000000202 -
Journal of Athletic Training Mar 2015Proprioception is essential to motor control and joint stability during daily and sport activities. Recent studies demonstrated that athletes have better joint position... (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT
Proprioception is essential to motor control and joint stability during daily and sport activities. Recent studies demonstrated that athletes have better joint position sense (JPS) when compared with controls matched for age, suggesting that physical training could have an effect on proprioception.
OBJECTIVE
To evaluate the result of an 8-week strength-training program on shoulder JPS and to verify whether using training intensities that are the same or divergent for the shoulder's dynamic-stabilizer muscles promote different effects on JPS.
DESIGN
Randomized controlled clinical trial.
SETTING
We evaluated JPS in a research laboratory and conducted training in a gymnasium.
PATIENTS OR OTHER PARTICIPANTS
A total of 90 men, right handed and asymptomatic, with no history of any type of injury or shoulder instability.
INTERVENTION(S)
For 8 weeks, the participants performed the strength-training program 3 sessions per week. We used 4 exercises (bench press, lat pull down, shoulder press, and seated row), with 2 sets each.
MAIN OUTCOME MEASURE(S)
We measured shoulder JPS acuity by calculating the absolute error.
RESULTS
We found an interaction between group and time. To examine the interaction, we conducted two 1-way analyses of variance comparing groups at each time. The groups did not differ at pretraining; however, a difference among groups was noted posttraining.
CONCLUSIONS
Strength training using exercises at the same intensity produced an improvement in JPS compared with exercises of varying intensity, suggesting that the former resulted in improvements in the sensitivity of muscle spindles and, hence, better neuromuscular control in the shoulder.
Topics: Exercise; Female; Humans; Male; Muscle Spindles; Muscle, Skeletal; Neuromuscular Monitoring; Proprioception; Range of Motion, Articular; Resistance Training; Shoulder; Shoulder Joint; Treatment Outcome; Young Adult
PubMed: 25594912
DOI: 10.4085/1062-6050-49.3.84 -
Annals of Physical and Rehabilitation... Jan 2021Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a... (Review)
Review
BACKGROUND
Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.
OBJECTIVE
This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.
METHOD
The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration.
RESULTS
After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface.
CONCLUSION
There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
Topics: Biomechanical Phenomena; Humans; Joint Instability; Muscle, Skeletal; Range of Motion, Articular; Scapula; Shoulder; Shoulder Joint
PubMed: 33221471
DOI: 10.1016/j.rehab.2020.10.008 -
Journal of Shoulder and Elbow Surgery Jan 2020Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this...
BACKGROUND
Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI.
METHODS
In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared.
RESULTS
Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed.
CONCLUSION
FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.
Topics: Adolescent; Adult; Female; Fluoroscopy; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Posture; Prospective Studies; Shoulder; Shoulder Joint; Young Adult
PubMed: 31378683
DOI: 10.1016/j.jse.2019.05.025 -
Annals of Physical and Rehabilitation... Jan 2018The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and... (Review)
Review
BACKGROUND
The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.
METHODS
This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience.
RESULTS
For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation.
CONCLUSION
The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
Topics: Biomechanical Phenomena; Humans; Range of Motion, Articular; Rotation; Scapula; Shoulder; Shoulder Impingement Syndrome; Shoulder Pain
PubMed: 28987866
DOI: 10.1016/j.rehab.2017.09.002 -
The Journal of Orthopaedic and Sports... Dec 2017Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff... (Review)
Review
Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, and to identify exercises that meet a cut point of 15% maximal voluntary isometric contraction (MVIC) or less and are unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, Embase, CINAHL, SPORTDiscus, PubMed, and the Cochrane Library for all years up to June 2016 was performed. Studies were selected in relation to predefined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC), low to moderate (16%-20% MVIC), moderate (21%-40% MVIC), high (41%-60% MVIC), and very high (greater than 60% MVIC). Results A search identified 2159 studies. After applying the selection criteria, 20 studies were included for quality assessment, data extraction, and data synthesis. In total, 43 exercises spanning passive range of motion, active-assisted range of motion, and strengthening exercises were evaluated. Out of 13 active-assisted exercises, 9 were identified as suitable (15% MVIC or less) to load the supraspinatus and 10 as suitable to load the infraspinatus early after surgery. All exercises were placed in a theoretical-continuum model, by which general recommendations could be made for prescription in patients post rotator cuff repair. Conclusion This review identified passive and active-assisted exercises that may be appropriate in the early stages after rotator cuff repair. J Orthop Sports Phys Ther 2017;47(12):931-944. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7271.
Topics: Electromyography; Exercise Therapy; Humans; Muscle, Skeletal; Range of Motion, Articular; Reference Values; Rotator Cuff Injuries; Shoulder
PubMed: 28704624
DOI: 10.2519/jospt.2017.7271 -
The Journal of the American Academy of... Jan 2018The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder... (Review)
Review
The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology. Patients with high-level spinal cord injury, leading to quadriplegia and motor deficits, have an increased incidence of shoulder pain. Understanding the needs of patients who use manual wheelchairs or walking aids can help the physician to better comprehend the pathology of and better manage the weight-bearing shoulder.
Topics: Activities of Daily Living; Biomechanical Phenomena; Canes; Humans; Postoperative Care; Shoulder; Shoulder Impingement Syndrome; Shoulder Injuries; Shoulder Pain; Weight-Bearing; Wheelchairs
PubMed: 29176492
DOI: 10.5435/JAAOS-D-15-00598 -
Journal of Bodywork and Movement... Jul 2016Postural abnormalities can affect the emotions and vice-versa. The aim of the present study was to investigate the existence of a relationship between subjective anger...
Postural abnormalities can affect the emotions and vice-versa. The aim of the present study was to investigate the existence of a relationship between subjective anger and body posture in 28 women, aged between 20 and 39 years, with a normal body mass index (or underweight) and an absence of neurological, psychiatric or musculoskeletal disorders. The postural parameters photographed were the inclination of the shoulders, protrusion of the head, hyperextension of the knees and shoulder elevation. The degree of anger was rated by analogue scales representing current and usual anger. The results indicated that a relationship exists between current anger and the inclination of the shoulders (p = 0.03), protrusion of the head (p = 0.05) and hyperextension of the knees (p = 0.05). Correlations were found between usual anger, shoulder elevation (p = 0.05) and hyperextension of the knees (p = 0.05). In conclusion, posture is associated with emotions, and usual anger can lead to shoulder protraction.
Topics: Adult; Anger; Female; Head; Humans; Knee; Posture; Shoulder
PubMed: 27634065
DOI: 10.1016/j.jbmt.2016.01.002 -
World Neurosurgery Oct 2023
Topics: Humans; Shoulder; Upper Extremity
PubMed: 37803688
DOI: 10.1016/j.wneu.2023.08.001 -
The Journal of the American Academy of... Apr 2016Surgical repair, reduction, fixation, and reconstruction for glenohumeral trauma, instability, and degenerative joint disease often require an open surgical exposure.... (Review)
Review
Surgical repair, reduction, fixation, and reconstruction for glenohumeral trauma, instability, and degenerative joint disease often require an open surgical exposure. Open shoulder surgery is challenging because the deltoid and rotator cuff musculature envelop the joint, and in most approaches, exposure is limited by the proximity and importance of the axillary nerve. An understanding of the importance of the deltoid and the rotator cuff for glenohumeral function has led to a progression of innovative, advanced, and less invasive approaches to the shoulder. Various advantages, disadvantages, and risks are encountered when performing deltopectoral, deltoid-splitting, and posterior approaches to the glenohumeral joint, with variations of each approach and techniques to extend them and maximize exposure. The ability to perform each of these exposures provides the surgeon with the flexibility to best address the widest variety of pathology.
Topics: Humans; Joint Instability; Shoulder; Shoulder Joint
PubMed: 26918414
DOI: 10.5435/JAAOS-D-14-00342