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PubMed1995

Development of the Wheelchair User's Shoulder Pain Index (WUSPI).

Chronic shoulder pain is a frequently reported phenomenon in individuals who use wheelchairs as their primary means of mobility. No indices are currently available which detect difficulties in performing daily activities due to shoulder discomfort in a largely independent population of wheelchair users. The Wheelchair User's Shoulder Pain Index (WUSPI) was designed to measure shoulder pain in individuals who use wheelchairs. A pilot index was created to measure shoulder pain and related difficulty during basic and instrumental activities of daily living. The instrument was administered to 64 wheelchair users at an athletic event. Analyses of internal consistency and interitem correlations were used to revise and refine the original instrument. Individual item analysis revealed that the subjects in this study experienced the most shoulder pain when wheeling up an incline or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair and when washing their backs. The final 15-item index shows high internal consistency. This instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

Activities of Daily Living↗
PubMed1999

Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users.

PURPOSE: To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities. SUBJECTS: Forty-two wheelchair users, 35 males and seven females: average age of 35 years and an average duration of wheelchair use of 14 years. METHODS: Subjects were randomly assigned to treatment (n=21) and control (n=21) groups. The treatment group received instruction in five shoulder exercises which they performed daily for 6 months. The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature. OUTCOME MEASURES: All subjects completed a self-report questionnaire and the Wheelchair Users Shoulder Pain Index (WUSPI) initially and at bimonthly intervals during the 6-month intervention. RESULTS: Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use. The average initial performance-corrected (PC-WUSPI) score of the 42 subjects was 17.7 (+/-21.3) with a range of 0-103.2 points. Over 83% of the subjects (35 of 42) completed the 6-month study. Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9%, compared to decreases of only 2.5% in the control group. CONCLUSIONS: These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users.

Adult↗
PubMedDate not supplied

An arthroscopic technique for treating patients with frozen shoulder.

Forty-three patients with a diagnosis of primary or secondary frozen shoulder who had symptoms for an average of 12 months and failed conservative treatment of at least 12 weeks of physical therapy, were treated with an arthrosopic capsular release. On completion of standard shoulder arthroscopy, intra-articular cautery was used to completely divide the anterior-inferior capsule, the intra-articular portion of the subscapularis tendon, and the middle glenohumeral, the superior glenohumeral, and the coracohumeral ligaments. The subacromial space was inspected in all patients. Eighteen patients had extensive subacromial fibrosis that required debridement. Subacromial decompression was reserved for patients with evidence of an acromial spur seen at the time of arthroscopy. Postoperatively, all patients showed substantial gains in shoulder range of motion, as well as diminished shoulder pain. Thirty-five patients completed a telephone survey at an average of 22 months after surgery. The average modified shoulder score was 19 (scale, 13 to 65), with 83% of patients indicating that their shoulder was normal or caused only mild symptoms. In conclusion, the authors believe that arthroscopic capsular release is an effective and safe alternative to manipulation in patients with a recalcitrant frozen shoulder.

Adult↗
PubMed2005

Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study.

OBJECTIVE: Despite effective epidural analgesia, up to 85% of post-thoracotomy patients complain of moderate-to-severe ipsilateral shoulder pain. This study assessed the efficacy of acetaminophen in decreasing postoperative shoulder pain after a thoracotomy. DESIGN: Double-blind randomized and placebo-controlled study. SETTING: University medical center. PARTICIPANTS: 65 patients. INTERVENTION: Patients were randomized into 2 groups; 31 patients received acetaminophen (group A), and 34 patients received a placebo (group P). After induction of anesthesia, patients received either a loading dose of acetaminophen, 1000 mg intrarectally, or a placebo suppository. Thereafter, acetaminophen, 650 mg, or a placebo, was administered intrarectally every 4 hours for 48 hours postoperatively. MEASUREMENTS AND MAIN RESULTS: Postoperative pain at the surgical site and shoulder pain were assessed separately every 4 hours for 48 hours using a numerical rating scale (NRS). Rescue analgesia for severe shoulder pain (NRS > 7) consisted of subcutaneous hydromorphone. Sixty-three patients experienced shoulder pain (97% prevalence). Demographic and intraoperative data were similar between the 2 groups. Average NRS for shoulder pain was higher in group P compared with group A at 8, 12, and 16 hours postoperatively (3.1 +/- 2.9, 2.6 +/- 2.6, 2.3 +/- 2.4 vs 1.8 +/- 2.6, 1.2 +/- 1.5, 1.3 +/- 1.8; P < 0.05). The total dose of hydromorphone did not differ between the 2 groups at 16, 24, and 48 hours. CONCLUSION: Acetaminophen decreases post-thoracotomy ipsilateral shoulder pain when given preemptively and regularly during the first 48 hours postoperatively in patients who received thoracic epidural analgesia.

Acetaminophen↗
PubMedDate not supplied

Multiquadrant digital analysis of shoulder capsular thickness.

PURPOSE: Nonablative thermal capsular shrinkage has been developed in an attempt to address the plastic capsule deformation thought to cause increased rates of recurrent instability following arthroscopic stabilization procedures. Although the temperature required to optimize collagen shrinkage is known, a safe depth of thermal penetration, in various locations about the shoulder capsule, has not been defined. The purpose of this study was to measure shoulder capsule thickness by quadrant and circumferentially from the glenoid to the humerus so that thermal energy in shoulder procedures can be more precisely applied to limit possible injury to pericapsular structures. TYPE OF STUDY: This is an anatomic study using a cadaveric shoulder specimens. MATERIALS AND METHODS: Soft tissue was dissected from 8 fresh cadaveric shoulders to isolate intact glenohumeral joint capsules. The humeral insertion was released and the capsule was cut into 6 longitudinal quadrants around the glenoid. The capsule specimens were then flash frozen and stored at -80 degrees C. Quadrant tissue was cut into longitudinal sections 14 to 16 microm wide and stained with hematoxylin and eosin. The specimens were then digitized under a dissecting microscope and measured using computer imaging software at approximately 4-mm intervals. Two-way analysis of variance (ANOVA) was performed on the measurements of the intact capsule specimens 2.5 cm off the glenoid. Humeral insertion data were recorded separately. RESULTS: A total of 248 separate measurements were made throughout the capsule in 8 specimens. Capsular thickness increased from an average of 2.42 mm anteriorly to 2.80 mm in the inferior capsular pouch and again thinned to 2.22 mm posteriorly. Global shoulder capsule thickness ranged from 1.32 to 4.47 mm. When analyzed by position, from glenoid to humerus, a general thinning was noted with a mean thickness of 3. 03 mm at the glenoid to 2.17 mm at the humeral insertion. Two-way ANOVA showed a significant thickness variation along the specimen (P <.05), a nearly significant thickness variation with regard to quadrant (P <.03), and no significant interaction (P >.07) when applied to specimen measurements approximately 2.5 cm off the glenoid. CONCLUSIONS: The thickness of the shoulder capsule ranges from 1.32 to 4.47 mm, with a significant thinning laterally from the glenoid to the humerus. Further, capsule thickness ranges from 2.76 to 3.18 mm in the regions in closest proximity to the axillary nerve. These data may help determine the proper amount of thermal penetration necessary when performing shrinkage procedures and provide safety guidelines to limit the depth of thermal penetration to avoid possible injury to pericapsular structures.

Aged↗
PubMed2002

Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique.

PURPOSE: The purpose of this study was to compare the results of open and arthroscopic Bankart repair using suture anchors in traumatic anterior glenohumeral instability. Variables measured were recurrence rate, range of motion, and return to preinjury activity. TYPE OF STUDY: Case control study. METHODS: Eighty-nine shoulders in 88 patients with traumatic unilateral anterior shoulder instability were evaluated using Rowe and University of California Los Angeles scores, recurrence, return to activity, and range of motion by an independent examiner at an average of 39 months after either an arthroscopic or open Bankart repair using suture anchors. The arthroscopic technique included a minimum of 3 anchors in most patients and a routine incorporation of capsular plication and proximal shift. Of the 89 shoulders, 30 shoulders (30 patients) underwent open Bankart repair and 59 shoulders (58 patients) underwent arthroscopic Bankart repair. RESULTS: Twenty-six shoulders (86.6%) in the open repair group showed excellent or good results, and 54 (91.5%) shoulders in the arthroscopic repair group showed excellent or good results. The arthroscopic group revealed slightly higher scores in the Rowe (P =.041) and UCLA scores (P =.026). Two patients (6.7%) in the open repair group and 2 (3.4%) in the arthroscopic repair group had experienced at least 1 episode of redislocation after the surgery. One patient (3.3%) in the open repair group and 4 (6.8%) in the arthroscopic repair group demonstrated mild apprehension. The overall residual instability was 10% in the open repair group and 10.2% in the arthroscopic repair group. There were no significant differences in the loss of external rotation and return to prior activity between the 2 groups (P >.05). Residual instability occurred more frequently in patients with fewer anchors. CONCLUSIONS: Arthroscopic suture anchor capsulorraphy showed similar results to the open Bankart procedure.

Adolescent↗
PubMed2003

Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes.

PURPOSE: The etiology, pathogenesis, time course, and response to treatment of stiff shoulder pathology is still under investigation and debate. This prospective study evaluated arthroscopic capsular release to treat stiff shoulder pathology that was resistant to conservative management. The etiology of the shoulder stiffness was categorized and analyzed for effect on outcomes. TYPE OF STUDY: Operative technique and prospective evaluation. METHODS: In 68 stiff shoulders (41 in women, 27 in men) that underwent arthroscopic capsular release, 5 distinct etiologies were identified: postsurgical in 20, idiopathic in 17, post-traumatic in 15, diabetic in 8, and impingement syndrome (prior primary impingement developing stiffness) in 8. Average age was 50 years (range, 29 to 72), and follow-up averaged 3 years (range, 2 to 8). Prior to this procedure, duration of symptoms averaged 7.3 months (range, 3 to 48), and formal physical therapy averaged 3.7 months (range, 1 to 12). Preoperative average American Shoulder and Elbow Surgeons Score (ASES) was 35.5 (range, 10 to 77), median Simple Shoulder Test (SST) was 3 (0 to 10), and median Visual Analog Score (VAS) for pain was 6 (0 to 10). Average active forward elevation (FE) was 92 degrees, external rotation (ER) at side was 12 degrees, and median internal rotation (IR) was to the buttock. All patients underwent arthroscopic capsular release with a standard aftercare protocol. RESULTS: The study population showed significant improvement (P <.0001) for all outcome scores and active motion parameters. Average and median outcome parameters for the population, with improvement in parenthesis were: ASES 93 (+57.5), SST 10 (+7), VAS 0 (-6), FE 165 degrees (+73 degrees ), ER at side 56 degrees (+44 degrees ), and IR to T -12 (+7 spinal segments). The time in formal physical therapy averaged 2.3 months (2 to 20 weeks) and time to attain final, pain-free range of motion averaged 2.8 months (1 to 6). Outcomes for, and between, each etiology were analyzed. There was no difference in time to final motion between the etiologic groups. CONCLUSIONS: Stiff shoulder pathology can result from a variety of differing etiologic factors. Arthroscopic capsular release was equally effective across the 5 identified etiologic groups, and provided significant pain relief, restoration of motion, and function within an average of 3 months.

Adult↗
PubMed2001

Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia.

Clinical observations have suggested a relationship between shoulder range of movement (ROM) and lateral epicondylalgia. This study reports the effect of a single intervention of a mobilization with movement (MWM) applied to the elbow, on shoulder rotation ROM in subjects with lateral epicondylalgia. Twenty-three subjects with lateral epicondylalgia were included. In a one-group pretest-post-test design, ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM, of both the unaffected and the affected limbs. Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia, but no significant difference remained post-intervention. It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia, probably due to a facilitated level of shoulder rotator muscle tone. Shoulder internal and external rotation ROM increases significantly following MWM to the elbow, in subjects with unilateral lateral epicondylalgia. Surprisingly, these ROM increases are also apparent on the 'unaffected' limb. These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone.

Biomechanical Phenomena↗
PubMed2002

[Physical activity after shoulder arthroplasty].

A hemi- or total shoulder arthroplasty was performed in 171 patients between 1992 and 1997. We examined 118 patients under the age of 70 regarding their level of physical activity. For a pre- and postoperative comparison we divided the patients in two groups. Group one included all patients with osteoarthritis, rheumatoid arthritis, instability associated arthritis, avascular necrosis and other arthropathies. Group two included acute fractures and fracture sequelae. The postoperative outcome was functionally assessed by using the Constant score. There was an average Constant score of 60,9 for group one and 67,1 for group two. Both groups showed a domination of activities with motion patterns unspecific for the shoulder. There were more patients in group two reporting activities which depend on a good or very good shoulder function. There is no general estimation for the ability to be active in sports after shoulder arthroplasty. An individual assessment of the shoulder function is essential. Important criterias beside motivation and age are the status of the rotator cuff and the soft tissue balancing. The correct indication for shoulder arthroplasty as well as the preoperative planning and the postoperative rehabilitation program are essential for a good functional outcome and the key for physical activity after shoulder arthroplasty.

Adult↗
PubMedDate not supplied

[Evaluation of force and mobility following the open Bankart operation for treatment of recurrent dislocation of the shoulder].

AIM: The purpose of this study was to evaluate the isokinetic muscle strength, range of motion and radiological signs of arthopathy of recurrent dislocation of the shoulder after an open Bankart procedure. METHODS: This retrospective study is based on the analysis of isokinetic muscle strength, range of motion, function and arthropathy of the shoulders of 81 patients at an average of 2.3 years (range 1-4 years) after a Bankart procedure. Isokinetic muscle strength testing was performed using the Cybex 6000 dynamometer. RESULTS: Clinical testing at follow-up revealed no significant loss of range of motion of the operated shoulder compared to the healthy contralateral shoulder. The deficit of muscle strength (average peak torque, total work, total power) of the involved side averaged 10 % of the not-involved side and was not statistically different. Follow-up radiographs demonstrated an increase of arthropathy in 35 % of the shoulders after the Bankart procedure. CONCLUSION: At an average follow-up of 2.3 years after an open Bankart repair for treatment of recurrent dislocation of the shoulder we found no significant difference between the operated shoulder and the healthy contralateral side concerning range of motion and isokinetic muscle strength. From that we conclude that the Bankart procedure offers an excellent clinical outcome combined with a low degree of morbidity.

Adolescent↗
PubMedDate not supplied

[Secondary operations for improving shoulder function after brachial plexus lesion].

UNLABELLED: The results of an integrated concept of therapy are presented including a description of indications and the various operative procedures to compensate insufficient shoulder muscles following brachial plexus lesion. PATIENTS AND METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 12 patients (1 female; 11 male; average age 29.4 years, range 17 to 56 years) underwent a shoulder arthrodesis. In 54 patients (11 female; 43 male; average age 30.3 years, range 18 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 4 male patients (average age 29.8 years, range 16 to 42 years). Our results are based upon an average follow-up of 2.0 (0.5-7.5) years after shoulder fusion, 1.9 (0.5-4.5) years after trapezius transfer and 1.6 (0.5-3.5) years after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.2 degrees to 37.1 degrees (5 degrees-80 degrees) and forward flexion of 15.1 degrees to 36.2 degrees (10 degrees-90 degrees). A more stable condition of multidirectional shoulder instability was experienced by 50 patients (92.6%) and 49 patients (90.7%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction of 9.6 degrees to 65 degrees (40 degrees-90), forward flexion of 15.4 degrees to 59.2 degrees (30 degrees-90 degrees). 10 patients (83.3%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 20 degrees before operation. After osteotomy an improvement of 32.5 degrees to 12.5 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with brachial plexus palsy, secondary operations according to the individual pattern of paralysis result in an improvement of shoulder function and stability as well as patients satisfaction.

Adolescent↗
PubMedDate not supplied

Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions.

This study was undertaken to determine whether patients with severe rheumatoid arthritis and irreparable rotator cuff rupture can be treated successfully with the Grammont shoulder arthroplasty. Seven patients with rheumatoid arthritis (8 shoulders) with nonreconstructible rotator cuff lesions and Larsen stage-V radiographic changes of the glenoid and the humeral head underwent a Grammont reverse shoulder arthroplasty. The Constant score improved from a mean of 17 points (range 4 to 25) preoperatively to a mean of 63 points (range 41 to 79) at a mean of 54 months (range 48 to 73) after shoulder arthroplasty. The mean strength at 90 degrees of abduction measured 3.6 kg (range 1 to 6). Shoulder instability was not observed. Complications included septic implant loosening (1 shoulder), aseptic glenoid loosening (2), and failed acromion osteosynthesis following the transacromial approach (3). These data of Grammont arthroplasty are encouraging with respect to restoration of stability and satisfactory function in rheumatoid, cuff-deficient shoulders. However, glenoid loosening remained a serious problem, and transacromial approaches were complicated by failure of acromial fixation.

Adult↗
PubMedDate not supplied

Glenoid revision surgery after total shoulder arthroplasty.

Forty-eight shoulders that underwent glenoid component revision surgery were reviewed at a mean of 4.9 years (range, 2 to 12 years). The indications for surgery were glenoid component loosening in 29 shoulders, glenoid implant failure in 14 shoulders, and glenoid component malposition or wear leading to instability in 5 shoulders. Seventeen shoulders had associated instability. Thirty shoulders underwent implantation of a new glenoid component and 18 underwent removal of the component and bone grafting for bone deficiencies. There was significant pain relief, improvement in active elevation and external rotation, and satisfaction with revision glenoid surgery (P <.05). Patients without a glenoid component were significantly less satisfied with the procedure than those patients who underwent reimplantation of a glenoid component (P =.01). Satisfactory pain relief was achieved in 86% of patients with a new glenoid component and 66% of patients who underwent glenoid component removal. Seven shoulders with a new glenoid component (2 for glenoid loosening) and 5 who underwent removal without reimplantation (3 for painful glenoid arthritis) required re-revision surgery. Eleven of the 17 patients with instability were stable at the most recent follow-up. The data from this study suggest that at the time of revision glenoid surgery, patients who have placement of a glenoid component have a higher degree of satisfaction than those undergoing glenoid component removal. Patients who continue to have pain after bone grafting without placement of a component may be candidates for glenoid component placement after graft consolidation.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging of painful shoulder arthroplasty.

Specialized magnetic resonance imaging (MRI) was performed in 42 painful shoulder arthroplasties, 22 of which underwent subsequent revision surgery, allowing surgical confirmation of the pathology identified on MRI. One hemiarthroplasty was excluded because of motion artifact, leaving 21 studies (19 patients) to be correlated retrospectively to the surgical findings. At the time of revision surgery, there were full-thickness rotator cuff tears in 11 of 21 shoulders; MRI correctly predicted these in 10 of 11 shoulders. Full-thickness subscapularis tears were the most common finding (8/11 shoulders). Of the 21 shoulders, 10 did not have a rotator cuff tear, and MRI correctly predicted the absence of a tear in 8 of 10. MRI also correctly predicted glenoid cartilage wear in 8 of 9 shoulders. With limited pulse-sequence parameter modification, the data from this preliminary study suggest that MRI may be a useful technique with which to determine the integrity of the rotator cuff and residual cartilage and, thus, is potentially a tool in the management of painful shoulder arthroplasty.

Adult↗
PubMed2003

Free shoulder space requirements in the design of high backrests.

The objective of this study was to determine the influence of scapular support on the effects of lumbar support and to prove that a high and straight backrest is inappropriate. In literature the importance of a lumbar support is noted, although data about optimal dimensions is an under-researched topic and in earlier studies on force distribution and muscle activity the backrest had a fixed form. The lumbar support is needed to maintain the lumbar lordosis but no studies deal with the question of the precise dimensions of the backrest at shoulder level. With a specially designed apparatus, forces on shoulder and seat were measured separately, and the force on the pelvis calculated, while varying seat and backrest inclination within the range from 0 degrees to 17 degrees. Seat-to-backrest angle (at the level of lumbar support) was kept constant at 90 degrees. The distance between the tangent to the lumbar support and the parallel tangent to the scapular support was varied from 0, 2, 4, 6 and 8 cm. This distance is called the free shoulder space. Electromyography was measured at the erector spinae at the levels of the L1, T8 and T5 vertebrae. For all seat angles, a free shoulder space of d=0 cm resulted in the highest back muscle activity. In agreement with the biomechanical model, EMG activity reduced with an increase of seat tilt and increase of free shoulder space. With increasing free shoulder space, a larger part of the total backrest force was carried by the lumbar support. This study shows that a high and straight backrest overrules lumbar support. Offering free shoulder space of at least 6 cm reduces back muscle activity and allows for lumbar support.

Adult↗
PubMed1993

Occupational risk factors associated with soft tissue disorders of the shoulder: a review of recent investigations in the literature.

Cumulative trauma illness currently accounts for over half of all occupational illness in the United States. From 1987 to 1989 there was a 100% increase in the reported number of cases of cumulative trauma illness (Bureau of Labor Statistics 1990). Shoulder region pain ranks second only to low back and neck pain in clinical frequency, and the occurrence of occupational shoulder illness is on the rise. This paper summarizes findings of a subset of recent epidemiologic, laboratory, and field studies conducted in order to identify occupational risk factors for cumulative trauma disorders (CTDs) of the shoulder region. These studies have identified the following risk factors as being associated with particular shoulder pain syndromes: awkward or static postures, heavy work, direct load bearing, repetitive arm movements, working with hands above shoulder height, and lack of rest. The paper begins with a discussion of several shoulder disorders, includes problems in studying cumulative trauma, presents results of recent studies, and concludes with suggested ergonomic controls that could help to reduce the incidence of shoulder disorders, by eliminating or reducing exposure to the associated risk factors.

Bursitis↗
PubMed2002

The measurement of shoulder alignment in cricket fast bowling.

The aim of this study was to compare thoracic spine alignment with two- and three-dimensional calculations of shoulder alignment (defined as a line joining the acromion processes of the right and left scapula) when all measures were projected onto the transverse plane. A six-camera Vicon system was used to reconstruct three markers positioned on the plane of the thorax such that the orthogonal vector to the thoracic spine, projected onto the transverse plane, was used as a virtual shoulder alignment during cricket fast bowling. This same measurement system was used to calculate the three-dimensional line between the acromion processes projected onto the transverse plane. These acromion markers were also used to calculate the two-dimensional transverse plane alignment of the shoulders from images recorded by a video camera positioned above ball release. All cameras operated at 50 Hz. A significant association was recorded between thorax alignment and the three- (0.97) and two-dimensional (0.87) shoulder alignment estimations at back-foot impact. The strength of association remained at front-foot impact, when correlations of 0.89 (three-dimensional) and 0.84 (two-dimensional) were recorded. However, at ball release, non-significant associations of 0.58 (three-dimensional) and 0.41 (two-dimensional), representing shoulder alignment differences of approximately 10 degrees, were recorded. The 95% limits of agreement comparisons for shoulder alignment at back-foot impact, front-foot impact and ball release produced mean random errors for the two comparisons of 9.5 degrees, 11.7 degrees and 22.5 degrees respectively. Three- and two-dimensional transverse plane projections of shoulder alignment are reasonable estimates of thorax alignment at back-foot impact and front-foot impact but not at ball release.

Adolescent↗
PubMedDate not supplied

Normal values for range of shoulder abduction in men and women aged over 65 years.

The range of movement of the shoulder in abduction at 45 degrees of flexion was objectively measured using a standard technique in a demographically representative survey of 1000 men and women living in their own homes. Sampling was stratified to obtain approximately equal numbers of those aged 65-74 years and those aged 75 and over. The response rate was 80%. Normal values for shoulder abduction grouped by age and sex are presented as frequency distributions, means and deciles. Information about health problems was also recorded in the survey; the prevalences of these problems and their associations with shoulder abduction have been investigated. Women had significantly lower values for shoulder abduction than men. For both sexes values were on average about 30 degrees lower than those found in younger adults, and about half of the elderly group had values below 120 degrees. The prevalence of specified health problems was high with only 3% of the older group and 6% of the younger group being free from all the specified health problems. There was a significant independent negative association between shoulder abduction and both age and reported health. The associations were more marked in women than in men. This was so for both a cumulated 14-item health index and selected individual health items which included arthritis, lack of mobility and incontinence. The decile values for shoulder abduction for women without these health problems are presented. This provides more appropriate normal data for them; it is more normally distributed and reduces the percentage with a shoulder abduction less than 120 degrees to 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗