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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 -
Brazilian Journal of Physical Therapy 2019The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this... (Review)
Review
BACKGROUND
The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this important muscle is believed to be associated with several painful conditions involving the shoulder complex. Studies and clinical intuition have therefore identified several exercises that selectively target the activation of the SA.
METHODS
This paper reviews the anatomy, innervation, testing, and complex actions of the SA. In addition, this paper describes the classic signs and symptoms of weakness or reduced activation of the SA. Several exercises are described and illustrated that purportedly target the activation of the SA, with the intention of optimizing muscular control and encouraging pain free shoulder motion.
CONCLUSIONS
This review provides the theoretical background and literature-based evidence that can help explain the SA's complex pathokinesiology, as well as guide the clinician to further develop exercises that likely challenge the muscle. This paper is written along with a companion paper entitled: Kinesiologic considerations for targeting activation of scapulothoracic muscles: part 2: trapezius. Both papers prepare the reader to expand their pallet of exercises that target and challenge these two dominant muscles, with a goal of improving function of the shoulder for several painful conditions caused by their reduced or altered activation pattern.
Topics: Exercise; Humans; Muscle, Skeletal; Shoulder; Superficial Back Muscles
PubMed: 30737019
DOI: 10.1016/j.bjpt.2019.01.008 -
Arthritis and Rheumatism May 2009To conduct a systematic review of the quality and content of the psychometric evidence relating to 4 shoulder disability scales: the Disabilities of the Arm, Shoulder,... (Review)
Review
OBJECTIVE
To conduct a systematic review of the quality and content of the psychometric evidence relating to 4 shoulder disability scales: the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Shoulder Pain and Disability Index (SPADI), the American Shoulder and Elbow Surgeons (ASES) score, and the Simple Shoulder Test (SST).
METHODS
We conducted a structured search using 3 databases (Medline, CINAHL, EMBase). In total, 71 published primary studies were analyzed. A pair of raters conducted data extraction and critical appraisal using structured tools. A descriptive synthesis was performed.
RESULTS
Quality ratings of 55% of the studies reviewed reached a level of > or =75%. Most studies suggest that all 4 questionnaires have excellent reliability (intraclass correlation coefficient > or =0.90). The 4 questionnaires are strongly correlated (r >0.70) with each other and with a number of similar indices, and the questionnaires were able to differentiate between different populations and disability levels. The minimal detectable change (MDC) is approximately 9.4 for the ASES, 10.5 for the DASH, and 18 for the SPADI; the minimal clinically important difference (MCID) is approximately 6.4 for the ASES and 10.2 for the DASH, and ranges between 8 and 13 for the SPADI. MDC and MCID have not been defined for the SST.
CONCLUSION
The psychometric properties of the ASES, DASH, and SPADI have been shown to be acceptable for clinical use. Conversely, some properties of the SST still need be evaluated, particularly the absolute errors of measurement. Overall, validation studies have focused on less clinically relevant properties (construct validity or group reliability) than estimates of MDC and MCID.
Topics: Disability Evaluation; Humans; Language; Psychometrics; Reproducibility of Results; Shoulder; Surveys and Questionnaires
PubMed: 19405008
DOI: 10.1002/art.24396 -
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 -
Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 2: trapezius.Brazilian Journal of Physical Therapy 2019The trapezius is an extensive muscle subdivided into upper, middle, and lower parts. This muscle is a dominant stabilizer of the scapula, normally operating... (Review)
Review
BACKGROUND
The trapezius is an extensive muscle subdivided into upper, middle, and lower parts. This muscle is a dominant stabilizer of the scapula, normally operating synergistically with other scapular muscles, most notably the serratus anterior. Altered activation, poor control, or reduced strength of the different parts of the trapezius have been linked with abnormal scapular movements, often associated with pain. Several exercises have been designed and studied that specifically target the different parts of the trapezius, with the goal of developing exercises that optimize scapular position and scapulohumeral rhythm that reduce pain and increase function.
METHODS
This paper describes the anatomy, kinesiology, and pathokinesiology of the trapezius as well as exercises that selectively target the activation of the different parts of this complex muscle.
CONCLUSIONS
This review provides the anatomy and kinesiology of the trapezius muscle with the underlying intention of understanding how this muscle contributes to the normal mechanics of the scapula as well as the entire shoulder region. This paper can guide the clinician with planning exercises that specifically target the different parts of the trapezius. It is recommended that this paper be read as a companion to another paper: Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 1: serratus anterior.
Topics: Dyskinesias; Exercise Therapy; Humans; Muscle, Skeletal; Scapula; Shoulder; Superficial Back Muscles
PubMed: 30797676
DOI: 10.1016/j.bjpt.2019.01.011 -
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 -
International Journal of Environmental... Nov 2022Tennis is an asymmetric sport characterized by a systematic repetition of specific movements that may cause disturbances in muscular strength, power, and torque. Thus,...
Tennis is an asymmetric sport characterized by a systematic repetition of specific movements that may cause disturbances in muscular strength, power, and torque. Thus, we assessed (i) the torque, power, ratio production, and bilateral asymmetries in the shoulder's external and internal rotations at 90 and 180°/s angular velocities, and (ii) the point duration influence of the above-mentioned variables. Twenty competitive tennis players performed external and internal shoulder rotations; an isokinetic evaluation was conducted of the dominant and non-dominant upper limbs before and after five and ten forehands. A higher torque production in the shoulder's internal rotations at 90 and 180°/s was observed for the dominant vs. non-dominant sides (e.g., 63.1 ± 15.6 vs. 45.9 ± 9.8% and 62.5 ± 17.3 vs. 44.0 ± 12.6% of peak torque/body mass, < 0.05). The peak torque decreased only after ten forehands (38.3 ± 15.8 vs. 38.2 ± 15.8 and 39.3 ± 16.1 vs. 38.1 ± 15.6 Nm, respectively, < 0.05), but without impacting speed or accuracy. Unilateral systematic actions of tennis players caused contralateral asymmetries, evidencing the importance of implementing compensatory training. The forehand kinematic assessment suggests that racket and wrist amplitude, as well as speed, are important success determinants in tennis.
Topics: Shoulder; Tennis; Torque; Upper Extremity; Biomechanical Phenomena; Shoulder Joint
PubMed: 36497932
DOI: 10.3390/ijerph192315857 -
Medical Ultrasonography Jun 2012Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. It has some advantages over the other imaging techniques, such as plain... (Review)
Review
Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. It has some advantages over the other imaging techniques, such as plain radiography, computed tomography and magnetic resonance imaging, represented by the non-invasiveness and multiplanar imaging capability, repeatability, lack of radiation burden, good patient acceptance, and relatively limited costs. US offers an excellent resolution and a possibility for real-time dynamic examination of the joints and surrounding soft tissues, as well as enables monitoring of therapeutic response. The most common clinical indications for US examination of the shoulder are rotator cuff and biceps tendon pathology (tenosynovitis, tendinosis, complete and partial tears, and impingement) and disorders of other soft-tissue structures (joint recesses, bursae, muscles, suprascapular and axillary nerves) as well as bony cortex abnormalities. US is very useful for US-guided procedures (biopsy, joint and bursae aspirations and injections, aspiration and dissolution of calcific tendinosis). The aim of this article is to analyze the current literature about US of the shoulder and to describe both normal and pathological findings.
Topics: Humans; Joint Diseases; Shoulder; Shoulder Joint; Ultrasonography
PubMed: 22675714
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... May 2022Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the...
INTRODUCTION
Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population.
MATERIALS AND METHODS
This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder.
RESULTS
The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change.
DISCUSSION
Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Follow-Up Studies; Humans; Middle Aged; Range of Motion, Articular; Retrospective Studies; Rotator Cuff Injuries; Shoulder; Shoulder Joint; Shoulder Pain; Treatment Outcome; Weight-Bearing
PubMed: 34780996
DOI: 10.1016/j.otsr.2021.103145