Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SHOULDER”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources
PubMed2006

Descriptive report of shoulder range of motion and rotational strength 6 and 12 weeks following rotator cuff repair using a mini-open deltoid splitting technique.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears. BACKGROUND: Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist. MATERIALS AND METHODS: Charts from 11 female and 26 male patients, with a mean +/- SD age of 57.3 +/- 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery. RESULTS: For the postsurgical shoulder, ROM deficits ranging between 5 degrees to 7 degrees were measured for shoulder abduction and external rotation and internal rotation at 90 degrees of abduction. The postsurgical extremity had greater flexion ROM (9 degrees ) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points. CONCLUSION: The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

Aged↗
PubMed2000

Operative treatment of medial rotation contracture of the shoulder caused by obstetric brachial plexus palsy.

OBJECTIVE: To introduce an operation of subscapularis slide from its origin and anterior release from its insertion for treatment of medial rotation contracture, subluxation and dislocation of the shoulder caused by obstetric brachial plexus palsy (OBPP). METHODS: Thirty-six cases with medial rotation contracture of the shoulder were diagnosed by measurement of the inferior glenohumeral angle, passive lateral rotation of the shoulder and plain radiographs. Subscapularis slide was performed in 24 cases with simple medial rotation contracture, and anterior release in 12 cases with complex contracture-medial rotation contracture combined with subluxation, dislocation, or other deformities of the shoulder joint. Systems of Mallet scoring and Gilbert grading for the shoulder were used to evaluate the postoperative shoulder function. RESULTS: With follow up for a minimum of six months, 32 cases got apparent gains from operations, accounting for 88.8% of the total operated on. The younger the child was, the better the result. Of 4 cases with no operative effects, 3 had no flexion of the elbow preoperatively, suggesting a poor recovery of the upper trunk of the brachial plexus; the rest one had no repair of the severed subscapularis tendon. CONCLUSIONS: Subscapularis slide and anterior release of the shoulder are effective for treatment of medial rotation contracture as well as its consequence of subluxation and dislocation of the shoulder in OBPP. The operative effect is related to children's age and the recovery extent of the upper trunk of the brachial plexus.

Journal Article↗
PubMed2005

[External rotation osteotomy of the humerus for the treatment of shoulder problems secondary to obstetric brachial plexus palsy].

OBJECTIVES: We evaluated the results of external rotation osteotomy of the humerus for the treatment of shoulder problems secondary to obstetric brachial plexus palsy. METHODS: Forty children (24 boys, 16 girls; mean age 7.5 years; range 23 months to 14.8 years) underwent external rotation osteotomy of the humerus. Involvement was at the C5-6 roots in 11 patients, C5-6-7 roots in 19 patients, and at all the roots in 10 patients. Twenty-six patients had humeral head deformity and eight patients had posterior subluxation. The shoulder was ankylosed in one patient. Zancolli and Putti signs were positive in six and eight patients, respectively. The mean active shoulder abduction was 80 degrees (range 0 to 170 degrees ) and the mean internal rotation contracture was 27 degrees (range 10 degrees to 50 degrees ). Fourteen patients, all of whom were beyond five years of age, had an abduction contracture. Preoperative and postoperative functional evaluations were made with the use of the Mallet scale. Preoperatively, 35 shoulders had a score of II, five had a score of III. Osteotomies were performed in the proximal humerus in patients older than five years and in the mid-humerus in those without a contracture or younger than five years. RESULTS: The mean postoperative shoulder abduction was 95.7 degrees (range 30 degrees to 170 degrees ). Internal rotation contractures improved in all the patients. Abduction contractures did not resolve in two patients in whom a mid-humeral osteotomy was performed. Postoperative Mallet scores ranged from II to V in five, six, 15, and 14 shoulders, respectively. Rotation provided by the osteotomy was lost in one patient because of a humerus fracture that occurred in a traffic accident. Passive total shoulder rotation remained unchanged following surgery. Patients having better preoperative range of motion and who were at younger ages benefited the most from surgical treatment. CONCLUSION: External rotation osteotomy of the humerus must be performed at early ages before the shoulder gets stiffer.

Adolescent↗
PubMed2000

The role of the sensorimotor system in the athletic shoulder.

OBJECTIVE: To discuss the role of the sensorimotor system as it relates to functional stability, joint injury, and muscle fatigue of the athletic shoulder and to provide clinicians with the necessary tools for restoring functional stability to the athletic shoulder after injury. DATA SOURCES: We searched MEDLINE, SPORT Discus, and CINAHL from 1965 through 1999 using the key words "proprioception," "neuromuscular control," "shoulder rehabilitation," and "shoulder stability." DATA SYNTHESIS: Shoulder functional stability results from an interaction between static and dynamic stabilizers at the shoulder. This interaction is mediated by the sensorimotor system. After joint injury or fatigue, proprioceptive deficits have been demonstrated, and neuromuscular control has been altered. To restore stability after injury, deficits in both mechanical stability and proprioception and neuromuscular control must be addressed. A functional rehabilitation program addressing awareness of proprioception, restoration of dynamic stability, facilitation of preparatory and reactive muscle activation, and implementation of functional activities is vital for returning an athlete to competition. CONCLUSIONS/RECOMMENDATIONS: After capsuloligamentous injury to the shoulder joint, decreased proprioceptive input to the central nervous system results in decreased neuromuscular control. The compounding effects of mechanical instability and neuromuscular deficits create an unstable shoulder joint. Clinicians should not only address the mechanical instability that results from joint injury but also implement both traditional and functional rehabilitation to return an athlete to competition.

Journal Article↗
PubMed2005

Significance of the latissimus dorsi for shoulder instability. II. Its influence on dislocation behavior in a sequential cutting protocol of the glenohumeral capsule.

In a cadaveric instability model that leaves all muscles intact initially, the latissimus dorsi seemed to play a role when complete section of the glenohumeral capsuloligamentous structures did not result in a locked anteroinferior dislocation. The present study was carried out to determine whether the latissimus dorsi does truly affect dislocation in a modified cutting protocol, and to find an anatomic explanation for this apparent behavior. This article (Part II) details the results of a sequential cutting study and relates these results with the anatomic findings of Part I. In 75 shoulders, the influence of the latissimus dorsi on dislocation behavior in the apprehension position after section of all capsuloligamentous structures was examined. After cutting all capsuloligamentous structures, either on the glenoid or on the humeral side, the tendon of either the latissimus dorsi or the subscapularis was cut. Capsular lesions on the glenoid side (20 shoulders) resulted in a locked dislocation in 16 specimens. In the other four shoulders, there was a metastable dislocation after cutting the entire capsule, which did not change after cutting either tendon. With lesions on the humeral side (55 shoulders), three possibilities arose: metastable (17 shoulders), locked anterior (9 shoulders) or locked anteroinferior (29 shoulders) dislocation. This difference in dislocation behavior was related to the variability of the tendon-cartilage distance (TCD) and the type of scapular connection of the latissimus dorsi. A locked anteroinferior dislocation was always observed when the TCD was more than 20 mm, regardless of the type of scapular connection. With a TCD < 20 mm, a metastable dislocation was the result when there was a type 1 scapular connection and a locked anterior dislocation was seen when there was a type 2 scapular connection. The tendon of the latissimus dorsi can restrain the humeral head from dropping inferiorly or can lead to a spontaneous reduction of a dislocation, depending on its anatomy. This effect can only take place in the infrequent situation of humeral avulsion of the glenohumeral ligaments. This may be an explanation for the relative paucity of these lesions in clinical instability series.

Aged↗
PubMed2005

[Post-traumatic shoulder instability in adolescence].

BACKGROUND: Post-traumatic shoulder instability in adolescence represents a very rare condition. However, most of these patients develop recurrent shoulder dislocations over time. METHODS: We report about a retrospective study, which included 32 patients younger than 16 years of age. The mean follow-up was 5 years. Our evaluation focussed on patients' age at the time of first shoulder dislocation, type of injury, and the results after conservative and operative treatment. RESULTS: After the first dislocation, all shoulders were immobilized for 3 weeks and were treated with physiotherapy afterwards. Of these 32 patients, 30 (94%) developed recurrent shoulder dislocations. Eight patients remained in a conservative regimen (age <15 years) and 21 patients were operated for persistent shoulder instability (age >15 years). The recurrence rate was 8 of 21 patients (36.5%) in the operative group and 4 of 8 patients in the conservative group. At the time of follow-up, 4 of 8 conservatively treated patients had returned to their former sports activities and 15 of 21 (71%) in the operated group. CONCLUSIONS: Our results on post-traumatic shoulder instability in adolescence show high recurrence rates in both conservative and operative groups. After adolescence, including ossification of the glenoid, operative treatment is able to decrease the recurrence rate and to increase the sports ability of these young patients.

Adolescent↗
PubMed2006

Muscle activation and cutaneous reflex modulation during rhythmic and discrete arm tasks in orthopaedic shoulder instability.

In orthopaedic shoulder instability, muscle activity (EMG) is altered during unconstrained discrete arm movement tasks (e.g. elevation against a load). These findings have been ascribed to deficits in afferent feedback and neural control with glenohumeral instabilities resulting from orthopaedic injury. However, the integrity of neural control during shoulder movements in those with unstable shoulders is unclear. It is not known if there are altered EMG patterns during rhythmic arm movement or during discrete tasks involving no load, as would be experienced in many arm motions performed in daily living. The primary objective of this study was to evaluate neural control of arm movements between those with unstable shoulders and control participants, within a constrained arm movement paradigm involving both rhythmic arm cycling and discrete reaching. To achieve this objective, we determined if the amplitude and timing of EMG related to the movement pattern (background EMG) was significantly different between groups. Cutaneous reflexes were used to simulate a perturbation to the upper limb that would typically evoke a coordinated response. In the elevation phase of the movement path for anterior and posterior deltoid, upper trapezius, infraspinatus and serratus anterior, background EMG during rhythmic arm cycling was significantly (24%, p < 0.05) larger in unstable shoulders than in controls. No differences were found in background EMG between the groups during the discrete task. Significant differences (p < 0.05) were also noted in cutaneous reflexes between groups for both the rhythmic and discrete tasks with the reflex amplitudes being either increased or reduced in unstable shoulders as compared to controls. The differences in the background EMG and the cutaneous reflexes patterns in those with shoulder instabilities suggest that neural control is altered during rhythmic movement.

Adult↗
PubMed2000

Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings.

We report seven missed traumatic posterior dislocations of the shoulder in six patients. In all seven shoulders, anteroposterior radiographs did not provide the diagnosis in the emergency room after the trauma (epileptic seizure in four patients) and diagnosis was delayed for at least 24 h. The final diagnosis was reached by clinical suspicion and computed tomography (CT) scan of the seven shoulders. Two shoulders were treated by closed reduction and three were treated by closed reduction and percutaneous pinning, although four of these five shoulders presented a defect in the humeral head involving 20%-25% of the articular surface. Two shoulders dislocated for more than 6 months were treated according to Mc Laughlin's technique modified by Hawkins instead of an arthroplasty. At a minimum follow-up of 2 years and 2 months, the functional results according to Hawkins were good in all seven shoulders. There was no recurrence of the dislocation in any patient. Radiographs showed mild degenerative changes. The establishment of indications for treatment, based on the proportion of articular surface of the humeral head involved and the time of evolution of the dislocation, needs more clinical or experimental evidence. In epileptic patients, strict control of medication is of the utmost importance.

Adult↗
PubMed1992

The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint.

It was shown on human corpses that the glenohumeral joint may be compared to a piston surrounded by a valve. The glenoid labrum, then, should work like the valve block, sealing the joint from atmospheric pressure. In order to test this hypothesis, 18 human shoulder preparations were studied. The mean stabilizing force obtained by atmospheric pressure was 146 N. Additionally, 15 patients without any sign of instability and 17 patients with an anterior instability of the shoulder were tested under general anesthesia. In stable shoulder joints, traction at the arm caused negative intra-articular pressure that could be correlated to the amount of force exerted. In contrast, unstable shoulder joints with a tear of the glenoid labrum (Bankart lesion) did not exhibit this phenomenon. For unstable shoulder joints, the piston-and-valve model is no longer valid. This enlarges the current concept of shoulder joint stability in two ways: (a) the absence of negative intra-articular pressure disturbs joint mechanics and (b) altered pressure receptors might disturb motor coordination that dynamically protects the shoulder from dislocating forces.

Adult↗
PubMed2005

Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement.

BACKGROUND: Scapular function during humeral elevation has been reported in groups with and without shoulder impingement pathology. To date, no one has assessed scapular kinematics during upper extremity loaded tasks that manual wheelchair users must perform on a daily basis. Therefore, the objective of this study was to compare scapular kinematics and muscle activation patterns during two different wheelchair transfers in groups of manual wheelchair users with and without shoulder impingement. METHODS: A case controlled study of manual wheelchair users, with and without shoulder impingement was performed. Twenty-three male manual wheelchair users (13 without shoulder impingement, 10 with shoulder impingement) performed transfers toward the involved or dominant limb (lead limb transfer) and away from the instrumented limb (trail limb transfer). Position and orientation measures of the thorax, scapula and humerus were obtained using an electromagnetic tracking system. Muscle activity data were collected using telemetered electromyography. Each subject performed three trials of wheelchair transfers to each side. FINDINGS: Manual wheelchair users with impingement performed transfers with reduced thoracic flexion, increased scapular internal rotation, and increased humeral internal rotation as compared to those without impingement. Differences were found between the tasks in the scapular motions and EMG amplitude. Trail limb transfer presented with reduced scapular upward rotation and posterior tip as compared to the lead limb transfer task. Increased muscle activity for the lower trapezius and serratus anterior muscles was demonstrated in the trail limb transfer. INTERPRETATION: This study provides the first kinematic description of scapular kinematics during transfer tasks. Shoulder impingement and direction of transfer does affect transfer task performance in manual wheelchair users. Scapular kinematics and muscle patterns during transfers may predispose manual wheelchair users to the development of shoulder pathology.

Adult↗
PubMed2006

Outcome evaluation in shoulder surgery using 3D kinematics sensors.

A new method of scoring systems for the functional assessment of the shoulder is presented. 3D accelerometers and gyroscopes attached on the humerus were used to differentiate a healthy from a painful shoulder. The method was first tested on 10 healthy volunteer subjects with no shoulder pathology. The system was then tested on 10 patients with unilateral shoulder pathology (rotator cuff disease, osteoarthritis) before and after surgery (3, 6 months). In order to evaluate the system, nine tests based on the Simple Shoulder Test (SST) were performed on each shoulder for each patient. Three scores were defined: the P score was based on the angular velocities and accelerations of the humerus; the RAV score was based only on the angular velocities of the humerus; the M score was based on the sum of all moments of the humerus. Our kinematic scores indicated significant differences between baseline and follow-up (p<0.05) and differentiated between patients with varying severity of the same condition. We demonstrated a reliable technique of evaluating shoulder pathology and the results of surgery.

Activities of Daily Living↗
PubMedDate not supplied

Incidence and risk factors for blood transfusion in shoulder arthroplasty.

Although there have been numerous reports concerning the incidence and risk factors for transfusion with knee and hip arthroplasty, there is no information available for shoulder arthroplasty. Therefore, the purpose of this study was to determine the incidence of transfusion in a consecutive group of patients undergoing shoulder arthroplasty and examine risk factors for a transfusion. Between January 1, 1998, and December 31, 2002, the senior author performed 407 consecutive primary shoulder arthroplasties. Risk factors analyzed included preoperative hemoglobin level, age, sex, diagnosis, and hemiarthroplasty versus total shoulder arthroplasty. The indications for transfusion and associated complications were also reviewed. The overall transfusion rate was 8.1% (33/407). The incidence of transfusion was significantly greater among women (13.6% [29/213]) in comparison to men (2.1% [4/194]) (P = .0002). The risk for transfusion was significantly greater for patients undergoing shoulder arthroplasty for sequelae of trauma (15.8% [9/57]) (P = .0048) and rheumatoid arthritis (13.8% [8/58]) (P = .0153) compared with osteoarthritis (4.6% [10/218]). Preoperative hemoglobin level was found to be a significant risk factor for the need for transfusion (P < .0001). The rate of transfusion for hemiarthroplasty (8.3% [9/108]) and that for total shoulder arthroplasty (8.0% [24/299]) were not significantly different (P = .9203). The data from this study suggest that the rate of transfusion for shoulder arthroplasty varies markedly by sex and diagnosis. This information may be used to more accurately predict the need for transfusion and tailor preoperative blood ordering accordingly.

Aged↗
PubMed2006

The success of closed reduction in acute locked posterior fracture-dislocations of the shoulder.

We retrospectively reviewed the results of closed treatment in 7 patients with acute locked posterior fracture-dislocations of the shoulder. Shoulders were reduced with patients under general anesthesia and were splinted in neutral rotation for 6 weeks. Follow-up averaged 46 months (range, 24-88 months). All shoulders were reduced within 14 days. Humeral head defects ranged from 18% to 32% of the articular surface, and all patients had documented posterior instability under anesthesia after relocation. Of the 7 patients, 6 had a stable shoulder. The mean American Shoulder and Elbow Surgeons shoulder index was 93.5 (range, 83-100). The mean findings with regard to motion were active forward elevation to 169 degrees , external rotation to 73 degrees , and internal rotation to T11. All patients without preexisting shoulder pathology were treated successfully. Closed management of acute posterior fracture-dislocations can be highly successful, even in the face of instability under anesthesia and a 30% humeral head defect.

Acute Disease↗
PubMed2002

Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: a meta-analysis.

After stroke, up to 81% of individuals develop shoulder subluxation, a condition frequently associated with poor upper limb function. Recently, electrical stimulation has been applied to shoulder muscles to treat shoulder subluxation. The purpose of this meta-analysis was to examine the efficacy of surface electrical stimulation for the prevention or reduction of shoulder subluxation after stroke. A meta-analysis of all eligible randomised or quasi-randomised trials of electrical stimulation for the treatment of shoulder subluxation identified by computerised and hand searches of the literature was carried out. The primary outcome measure of interest was subluxation. Seven (four early and three late) trials met the inclusion criteria. The mean PEDro score out of 10 for quality of the methods was 5.8 for the four early trials and 4.3 for the three late trials. Data were pooled when subluxation was measured in millimetres. Analysis found that, when added to conventional therapy, electrical stimulation prevented on average 6.5mm of shoulder subluxation (weighted mean difference, 95% CI 4.4 to 8.6) but only reduced it by 1.9mm (weighted mean difference, 95% CI -2.3 to 6.1) compared with conventional therapy alone. Therefore, evidence supports the use of electrical stimulation early after stroke for the prevention of, but not late after stroke for the reduction of, shoulder subluxation.

Electric Stimulation Therapy↗
PubMed2001

A three-dimensional regression model of the shoulder rhythm.

OBJECTIVE: The development of a thorax-fixed regression model for the shoulder which statistically predicts the orientation of the clavicle and the scapula from the humerus orientation. BACKGROUND: The application of three-dimensional position recording systems to the shoulder mechanism is limited to laboratory conditions. Studies in the field of ergonomics and sports require a method that can be applied in situ. It was found that the relation between the scapular and the humeral motions is consistent. In order to facilitate the biomechanical research on the shoulder a descriptive statistical model of the shoulder rhythm was developed. METHODS: The orientation of the shoulder bones of 10 subjects was determined in a large range of 23 humerus positions. The elbow was flexed in a splint and the arm was fully supported. The subjects exerted a 20 N external abduction and adduction force at the elbow in a plane perpendicular to the humerus. Other forces and moments were mechanically minimized. During the task the postures of the shoulder were recorded. The linear regression equations for the clavicular and scapular orientations were determined by means of a repeated measurements multi-variate analysis of variance for the co-variates: humerus orientation, initial orientation of the clavicle and the scapula, external force direction, gender and morphological characteristics of the subjects. RESULTS: The orientation of the clavicle and the scapula was predicted by five linear regression equations, including the co-variates: humerus orientation, external force direction and initial position. Morphology and gender did not significantly contribute to the clavicular and scapular orientation predictions. CONCLUSIONS: A statistical model is developed for the prediction of clavicular and scapular orientations, based on the humerus position, the initial posture and the direction of the external force. The model fitted well on an independent set of recorded position data for a different group of subjects. RELEVANCE: Morphological data of the shoulder girdle and gender did not significantly contribute to the model structure.

Biomechanical Phenomena↗
PubMed2004

Shoulder pain in hemiplegia.

Shoulder pain is a common complication in poststroke hemiplegia that reduces functional recovery. Many types of shoulder pathology have been suggested as causes of shoulder pain in hemiplegia,including shoulder subluxation, capsulitis, tendinitis, rotator cuff injury, bursitis, impingement syndrome, spasticity, complex regional pain syndrome, brachial plexus injury, and proximal mononeuropathies. More than one type of pathology may exist in a given patient. Shoulder pain improves in many cases with prompt diagnosis and appropriate management. Although the relationship between subluxation and pain is controversial, upper limb support to reduce subluxation is the standard of care and may prevent the development of pain and secondary complications. Further work is needed to elucidate the natural history of shoulder pain in hemiplegia, including the identification of physiologic common denominators that can lead to improved strategies to treat and prevent shoulder pain.

Brachial Plexus Neuropathies↗
PubMedDate not supplied

The anatomy of the glenohumeral ligamentous complex and its contribution to anterior shoulder stability.

One hundred four enbalmed cadaver shoulders were evaluated. With a dorsal approach we opened the dorsal capsule after resecting the infraspinatus and teres minor muscles. For reaching the anterior capsule and the glenohumeral ligaments, the humeral head was resected. In this way we could quantify and qualify the glenohumeral ligaments and classify the synovial recesses based on the classification system of DePalma into type I to VI. Secondary signs of shoulder instability were documented. The superior glenohumeral ligament was missing in 6 (5.8%) shoulders, the middle glenohumeral ligament in 16 (15.4%) shoulders, and the inferior glenohumeral ligament in 7 (6.8%) shoulders. Most of the synovial recesses belonged to group I (38.5%) and III (46.2%). As a secondary sign of instability four shoulders had a Hill-Sachs fracture and a bony Bankart lesion. All four shoulders had no middle glenohumeral ligament and a large anterior type IV recess.

Aged↗
PubMed2003

Hip and shoulder internal rotation range of motion deficits in professional tennis players.

One hundred tennis players were recruited from the professional men's tennis tour to investigate the correlation between hip internal rotation deficits and low back pain (LBP), as well as shoulder internal rotation deficits and shoulder pain. A statistically significant correlation was observed between dominant shoulder internal rotation deficits and shoulder pain. Also observed was a statistically significant correlation between lead hip internal rotation deficits and lumbar extension deficits with LBP. We conclude that due to repetitive demands on the dominant shoulder and repetitive pivoting at the lead hip, the cycle of microtrauma and scar formation leads to capsular contracture and subsequent reduction in internal range of motion. It is likely that the limitation in lumbar extension in the symptomatic group is not only due to decreased flexibility from an increased load on the spine, but also due to a protective mechanism to prevent further exacerbation of the LBP. Physical conditioning that includes shoulder as well as hip internal rotation stretching programs should therefore be essential aspects in the treatment of tennis players with shoulder pain and LBP respectively.

Adolescent↗