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 1,063 records · Page 59Linked to original sources
PubMedDate not supplied

The measurement of normative American Shoulder and Elbow Surgeons scores.

We determined baseline scores on the American Shoulder and Elbow Surgeons (ASES) questionnaire in individuals who had no known shoulder condition and evaluated related factors that could influence the score. A modified version of the questionnaire was completed by 343 patients from an outpatient orthopaedic center being seen for conditions unrelated to the shoulder. A separate group completed the questionnaire at two different times to assess its reliability. The mean ASES score was 92.2 +/- 14.5 points. The instrument was found to be very reliable (intraclass correlation coefficient = 0.96). Only the variables of shoulder status and sports participation entered the regression model to explain the variance in scores. Subjects aged 60 years or older exhibited decreased ability to lift above shoulder level and reach behind the back when compared with younger cohorts. Previous investigators have made the assumption that a normal preinjury ASES score is 100 points. This study raises questions about this assumption. This information can serve as a basis to compare normative scores with those of patients with active shoulder disease.

Adolescent↗
PubMedDate not supplied

Technique for selecting capsular tightness in repair of anterior-inferior shoulder instability.

Part I of our study consisted of sending a survey questionnaire to all members of the American Shoulder and Elbow Surgeons in which specific questions were asked about their technique of surgical repair in patients with anterior instability who had capsular laxity or injury in conjunction with marked inferior laxity. Part II is a description of the technique and preliminary results in 18 patients of a modified anterior-inferior capsular shift technique that tightens the inferior capsule with the shoulder positioned in abduction and external rotation and the superior capsule with the shoulder in adduction and external rotation. Of the members of the Society of the American Shoulder and Elbow Surgeons who responded to the survey, 80% agreed that preservation of external rotation was important and that shoulder position at the time of capsular repair might influence the ultimate range of motion obtained. However, no more than 50% of the respondents agreed on any one position for the arm when repairing the capsule. The most common responses for each position were flexion 0 degrees (49%) (range, 0 degrees to 40 degrees), abduction 30 degrees (24%) (range, 0 degrees to 80 degrees), and external rotation 30 degrees (37%) (range, 0 degrees to 70 degrees). The average postoperative follow-up period for the 18 patients was 27 months (range, 24 to 39 months). Of the 18 patients, 11 (61%) maintained symmetric motion; the others had minimal loss of external rotation compared with that of the contralateral shoulder. Six of eight patients with repair on the dominant side were able to return to full premorbid recreational throwing or racquet sports, and seven with repair on the nondominant side returned to full participation in overhead sports such as basketball and swimming. We conclude that this method of "selective" capsular repair may be a useful guideline to gauge the degree of capsular tightening in patients who have capsular injury or laxity.

Adult↗
PubMedDate not supplied

Total shoulder replacement in rheumatoid arthritis: proximal migration and loosening.

A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal migration of the humerus before surgery was performed. The mean follow-up time was 92 months (range 52 to 139 months). The results revealed proximal migration in 55% of the patients (34 shoulders), and 40% (25 shoulders) showed progressive radiographic loosening of the glenoid component. Five of 12 press-fit humeral components demonstrated progressive radiographic loosening, whereas no signs of loosening were found in 50 cemented humeral components. In spite of progressive component loosening and progressive migration, this study demonstrated good pain relief in 89% of the patients (55 shoulders) and also a significant improvement in range of movement and function. The presence of proximal humeral migration did not significantly influence the average results-neither pain relief, range of movement, abduction force, nor function. Also, component loosening did not significantly influence the average pain relief, range of movement, abduction force, or function. The risk of clinical asymptomatic loosening is a relatively late complication that is eventually followed by pronounced bone destruction related to the loose component. Long-term radiographic control of total shoulders with rheumatoid arthritis is recommended. Hemiarthroplasty with a cemented humeral prosthesis may be a better treatment in the end stage of rheumatoid arthritis of the shoulder.

Adult↗
PubMedDate not supplied

Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder.

Seventy-three shoulders (66 patients) with posterior fracture-dislocation of the shoulder were treated. Thirty patients were treated during the acute phase. One case was classified as subspinous, and 56 were considered subacromial; 4 cases had posterior fracture-dislocation in three parts, 3 in four parts, and 9 at the anatomic neck. Treatment consisted of closed reduction and immobilization in the emergency department, McLaughlin's procedure, hemiarthroplasty, total shoulder, open reduction with internal fixation, arthroplastic resection, and arthrodesis. Ten shoulders were treated conservatively. The University of California-Los Angeles rating score was used to analyze 56 shoulders during a mean follow-up period of 32.7 months. Good and excellent results can be achieved in those cases that are treated up to 2 years of the lesion; after 2 years results tend to be fair. We do not suggest total shoulder arthroplasty as a treatment option for those surgeons without the necessary expertise.

Acute Disease↗
PubMedDate not supplied

Revision shoulder stabilization: 2- to 10-year results.

We evaluated 43 patients who underwent revision shoulder stabilization between 1978 and 1992. Twenty-three shoulders in 23 patients had unidirectional anterior shoulder instability (group A), whereas 21 shoulders in 20 patients exhibited multiple directions of shoulder instability (group B). Within group A recurrent instability developed at a mean of 35.5 months after the initial stabilization. Recurrence was traumatic in 12 patients. Revision surgery included a Bankart repair in 19 patients (coupled with capsular shift in 15 and a Bristow in 1) and capsular shift alone in 4. Within group B recurrent instability developed at a mean of only 16 months after the initial stabilization and was traumatic in only 2 patients. Revision surgery included capsular shift in 11 patients, Bankart repair in 5, anterior/posterior graft reconstruction in 3, and posterior bone block in 2. All patients had significant capsular laxity. A Bankart lesion was found in only 24% of patients. The mean follow-up from revision was 77.3 months (range 24 to 196 months) in group A. The results were excellent in 8 patients, good in 7, fair in 4, and poor in 4. Three of the 4 failures, however, had undergone successful reoperation before follow-up, improving the number of good or excellent results to 18 (78%). In contrast, at a mean follow-up of 61.5 months, only 9 (39%) good or excellent results occurred in group B despite multiple reoperations. Four patients ultimately went on to have glenohumeral fusion. Revision shoulder stabilization is a reliable procedure for patients who have recurrent anterior instability; however, it is unpredictable in patients who have multidirectional instability, with surgical failure and reoperation occurring frequently.

Adolescent↗
PubMedDate not supplied

Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: an anatomic study.

Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock. The needles were then removed and the position of the shoulder changed to determine the effect on the position of the axillary nerve. The axillary nerve was held to the shoulder capsule with loose areolar tissue in the zone between 5 and 7 o'clock and was close to the glenoid in the neutral position, in extension, and in internal rotation. With shoulder abduction, external rotation, and perpendicular traction, the capsule became taut and the axillary nerve moved away from the glenoid. Abduction, external rotation, and perpendicular traction increase the zone of safety during arthroscopic anteroinferior capsulotomy adjacent to the glenoid between the 5 and 7 o'clock positions.

Aged↗
PubMed2002

Limb-sparing resections of the shoulder girdle.

BACKGROUND: Limb-sparing surgeries around the shoulder girdle pose a surgical difficulty, because tumors arising in this location are frequently large at presentation, are juxtaposed to the neurovascular bundle, require en bloc resection of proportionally large amounts of bone and soft tissues, and necessitate complex resection and reconstruction. STUDY DESIGN: Between 1980 and 1997, we treated 134 patients who presented with 110 primary malignant, 12 metastatic, and 12 benign aggressive bone and soft tissue tumors of the shoulder girdle and subsequently underwent a limb-sparing resection. Reconstruction of the bone defect included 92 proximal humerus and 9 scapular prostheses. All patients were followed up for a minimum of 2 years. We summarize the principles of limb-sparing resections of the shoulder girdle, with emphasis on the surgical anatomy of the shoulder girdle, principles of resection and reconstruction, and functional outcomes. RESULTS: Function was estimated to be good or excellent in 101 patients (75.4%), moderate in 23 patients (17.1%), and poor in 10 patients (7.5%). Complications included 13 transient nerve palsies, 2 deep wound infections, and 1 prosthetic loosening. Local tumor recurrence occurred in 5 of 103 (4.9%) patients with primary sarcomas of the shoulder girdle. CONCLUSIONS: Detailed preoperative evaluation and surgical planning are essential for performing a limb-sparing resection around the shoulder girdle. Local tumor control, associated with good functional outcomes, is achieved in the majority of patients.

Adult↗
PubMedDate not supplied

Neck and shoulder pain in 70- to 79-year-old men and women: findings from the Health, Aging and Body Composition Study.

BACKGROUND CONTEXT: Musculoskeletal pain in the cervicobrachial region is considered a major health problem among adults of working age, but little is known about the impact of this pain in the elderly. PURPOSE: Determine the prevalence of neck and shoulder pain in a well-functioning cohort, identify factors associated with this pain, assess the pattern of coexisting joint pain and evaluate the impact of this pain on physical functioning. STUDY DESIGN: Cross-sectional study. PATIENT SAMPLE: Black and white men and women, aged 70 to 79 years, participating in the Health, Aging and Body Composition (Health ABC) study. OUTCOME MEASURES: Not applicable. METHODS: Between April 1997 and June 1998, 3,075 men and women participating in Health ABC study completed the initial home interview and clinical examination. Information was collected on musculoskeletal pain, medical history, depressive symptomatology and physical function. Physical performance measures were obtained. RESULTS: A total of 11.9% of participants reported neck pain of one month or more in duration and 18.9% reported shoulder pain. White women had the highest prevalence of neck pain (15.4%) and black women the highest prevalence of shoulder pain (24.3%). The correlates of both neck and shoulder pain were female gender, no education beyond high school, poorer self-rated health, depressive symptomatology and a medical history of arthritis, heart attack, angina. Increasing severity of both neck and shoulder pain was associated with an increased prevalence of joint pain at other body sites and with poor functional capacity. Measures of physical performance involving the upper extremity were also decreased. CONCLUSIONS: Neck and shoulder pain, either alone or in conjunction with pain in other joints, has a substantial impact on the function and well-being of the older adults in this cohort.

Age Distribution↗
PubMed2005

Neural crest origins of the neck and shoulder.

The neck and shoulder region of vertebrates has undergone a complex evolutionary history. To identify its underlying mechanisms we map the destinations of embryonic neural crest and mesodermal stem cells using Cre-recombinase-mediated transgenesis. The single-cell resolution of this genetic labelling reveals cryptic cell boundaries traversing the seemingly homogeneous skeleton of the neck and shoulders. Within this assembly of bones and muscles we discern a precise code of connectivity that mesenchymal stem cells of both neural crest and mesodermal origin obey as they form muscle scaffolds. The neural crest anchors the head onto the anterior lining of the shoulder girdle, while a Hox-gene-controlled mesoderm links trunk muscles to the posterior neck and shoulder skeleton. The skeleton that we identify as neural crest-derived is specifically affected in human Klippel-Feil syndrome, Sprengel's deformity and Arnold-Chiari I/II malformation, providing insights into their likely aetiology. We identify genes involved in the cellular modularity of the neck and shoulder skeleton and propose a new method for determining skeletal homologies that is based on muscle attachments. This has allowed us to trace the whereabouts of the cleithrum, the major shoulder bone of extinct land vertebrate ancestors, which seems to survive as the scapular spine in living mammals.

Amphibians↗
PubMed2006

Shoulder pain following tetraplegia: a follow-up study 2-4 years after injury.

OBJECTIVES: To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life. DESIGN: Longitudinal study. SETTING: Spinal Injuries Unit, Australia. METHODS: Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life. RESULTS: Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants. CONCLUSION: Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.

Activities of Daily Living↗
PubMed2000

Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.

BACKGROUND: Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain. METHODS: Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation. RESULTS: The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P<0.05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P<0.001). CONCLUSION: A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.

Adult↗
PubMed2002

Muscle tenderness in pericranial and neck-shoulder region in children with headache. A controlled study.

Increased pericranial muscle tenderness is connected with tension-type headache in adults. In children, the importance of muscle tenderness in the pericranial or neck-shoulder region in the pathogenesis of different types of headache is unknown. The present study evaluated muscle tenderness in the pericranial and neck-shoulder region in children with migraine, those with tension-type headache and those without headache. An unselected population-based questionnaire study concerning headache was carried out in 1135 Finnish schoolchildren aged 12 years. Of them, 183 children were randomly selected for a face-to-face interview and a clinical examination. Muscle tenderness was recorded by manual palpation and dolorimeter. Children with migraine had increased overall tenderness, recorded by manual palpation, compared with those without headache. They also self-reported tenderness in the neck-shoulder region during daily activities more often than the children of the other groups. Muscle tenderness was not associated with paediatric tension-type headache. The mean pressure pain thresholds did not differ among the three groups. However, a negative correlation between the total tenderness score and the dolorimeter score was found in each group. In conclusion, children with migraine had increased muscle tenderness at palpation of the pericranial and neck-shoulder muscles and they also reported pain symptoms in the neck-shoulder region most frequently. Instead, increased pericranial and neck-shoulder muscle tenderness was not associated with tension-type headache in children.

Child↗
PubMed2001

Manipulation under anesthesia for frozen shoulder with and without steroid injection.

OBJECTIVE: To study the effect of manipulating a shoulder with adhesive capsulitis (frozen shoulder) under anesthesia with and without corticosteroid injection. DESIGN: Randomized trial. SETTING: Hospital. PARTICIPANTS: Twenty-four patients referred for manipulation of a frozen shoulder. INTERVENTION: The patients were randomized into 2 groups. One group received an injection of corticosteroid and manipulation; the other was only administered manipulation during anesthesia. MAIN OUTCOME MEASURES: The degree of shoulder mobility and pain before and after the manipulation. RESULTS: Manipulation under anesthesia increased the mobility of the affected shoulder. Injection with lidocaine and betamethason did not enhance the effect of the manipulation. CONCLUSION: Manipulation under anesthesia without intraarticular corticosteroids is recommended as the therapy for frozen shoulder.

Activities of Daily Living↗
PubMedDate not supplied

Arthroscopic release of the glenohumeral joint in shoulder stiffness: a review of 26 cases. French Society for Arthroscopy.

The purpose of this multicenter retrospective study of arthroscopic release of the glenohumeral joint was to evaluate the technical feasibility, the results, and the potential correlations between results and cause of the stiffness. Twenty-six shoulders in 25 patients (19 women and six men) were re-evaluated 3 to 72 months (mean, 21 months) after arthroscopic release of the glenohumeral joint. Diagnoses were primary frozen shoulder in 13 cases, bipolar stiffness (rotator cuff tear plus capsular contraction) in 3 cases, and postinjury or postsurgery stiffness in 10 cases. Results were evaluated on passive range of motion, Constant's score, and subjective assessment. Anterior or anterior inferior capsular release was done at the anterior rim of the glenoid fossa. Posterior capsule release was not performed in this series. There were no intraoperative complications. Mean range of motion gains were 86 degrees for forward elevation, 72 degrees for abduction, 34 degrees for external rotation, and 6 spinal processes for internal rotation. Constant's range of motion score increased from 12.9 out of 40 to 32 out of 40 points. Thirteen patients were very satisfied, 5 satisfied, 5 improved, and 3 unchanged. Range of motion gains were independent from the cause of shoulder stiffness, but global results were better in the primary frozen shoulder group in terms of pain and strength. Arthroscopic release of the glenohumeral joint is feasible and safe. For primary frozen shoulders, in case of failure of the functional treatment, arthroscopic release is a less traumatic alternative to manipulation under general anesthesia. For bipolar stiffness, arthroscopy provides the opportunity for treating concomitant lesions. For postsurgical stiffness, arthroscopic release improves range of motion, but the shoulder often remains painful.

Adult↗
PubMed2000

Post stroke shoulder pain: more common than previously realized.

Stroke is a common disease often requiring rehabilitation, which may be prolonged by shoulder pain. The true incidence of post stroke shoulder pain has not been fully evaluated. In order to establish this, we undertook a prospective study of 123 consecutive patients with a diagnosis of acute stroke during a 6-month period. Patients were assessed by interview, full rheumatological and neurological examination, 14 days post stroke, for a history of shoulder pain according to predetermined criteria. In addition, Barthel Index, HAD score and pain scores were also recorded. Twenty-five percent of patients developed shoulder pain within 2 weeks of their stroke. There was a statistically significant association with ipsilateral sensory impairment (p < 0.005), abnormal rheumatological examination (p < 0.001) and depression score (p < 0.005). We conclude that post stroke shoulder pain is more common than previously realized and in addition to abnormal shoulder joint examination may also be associated with upper limb sensory impairment. Thorough neurological examination is required to detect sensory loss and hence establish patients at risk. This is probably best done by a structured proforma.

Aged↗
PubMed2001

Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.

We report the results of 15 patients who underwent nerve transfer for restoration of shoulder and elbow function at our institution for traumatic brachial plexus palsy. We present these results in the context of a meta-analysis of the English literature, designed to quantitatively assess the efficacy of individual nerve transfers for restoration of elbow and shoulder function in a large number of patients. One thousand eighty-eight nerve transfers from 27 studies met the inclusion criteria of the analysis. Seventy-two percent of direct intercostal to musculocutaneous transfers (without interposition nerve grafts) achieved biceps strength > or =M3 versus 47% using interposition grafts. Direct intercostal transfers to the musculocutaneous nerve had a better ability to achieve > or =M4 elbow strength than transfers from the spinal accessory nerve (41% vs 29%). The suprascapular nerve fared significantly better than the axillary nerve in obtaining > or =M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10) achieved > or =M3 bicep strength and 70% achieved > or =M4 strength. Four of seven patients achieved > or =M3 shoulder abduction with a single nerve transfer and 6 of 7 regained > or =M3 strength with a dual nerve transfer. This study suggests that interposition nerve grafts should be avoided when possible when performing nerve transfers. Better results for restoration of elbow flexion have been attained with intercostal to musculocutaneous transfers than with spinal accessory nerve transfers and spinal accessory to suprascapular transfers appear to have the best outcomes for return of shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis.

Adolescent↗
PubMed2001

A pilot study to evaluate the effectiveness of Bowen technique in the management of clients with frozen shoulder.

OBJECTIVE: To evaluate clients' experience of Bowen Technique in the treatment of frozen shoulder in terms of their pain, functional ability and well-being. DESIGN: A case series that used primarily quantitative methods and qualitative interviews. PARTICIPANTS: Twenty participants with frozen shoulder. INTERVENTION: Bowen Technique, using 'frozen shoulder procedure'. MAIN OUTCOME MEASURES: Range of active and passive motion (abduction, flexion, extension, medial rotation, lateral rotation and 'wall climb') in both shoulders, pain intensity scores, impact on well-being and health status. MAIN RESULTS: Improvement in shoulder mobility and associated function for all participants. Median 'worst pain' pre-therapy score reduced from 7 (mean 7, range 1-10) to a median 'worst pain' score of 1 (mean 1.45, range 0-5) post-therapy. Fewer pain quality descriptors used by all participants. All participants experienced improvement in their daily activities. CONCLUSIONS: Bowen Technique demonstrated an improvement for participants, even those with a very longstanding history of frozen shoulder. Further trials are warranted.

Adult↗
PubMedDate not supplied

[Normal values of the shoulder strength in dependency on age and gender--comparison with the constant, UCLA, ASES scores and SF36 health survey].

AIM: The purpose of this study was to establish normal strength values of shoulder abduction in a male and female population aged between 6 to 90 years. These values were compared to the sex- and age-related values given by Constant for an Irish population, referred to as Constant 1991. Further strength values resulting from fixation of the measuring device at the deltoid insertion or at the wrist were compared. The assessment and comparison of shoulder function using different shoulder scores (Constant, UCLA, ASES) and the SF-36 was another aim of this study. METHOD: 120 male and 120 female probands were examined. For interpretation age- and sex-related groups of 20 probands each were used (group 1: 6 - 15 years; group 2: 16 - 30 years; group 3: 31 - 45 years; group 4: 46 - 60 years; group 5: 60 - 70 years, group 6: 71 - 90 years). Subjective and objective clinical parameters were registered, shoulder abduction strength was obtained using an isometric measuring device with fixation points at the deltoid insertion and at the wrist and the respective torque values were calculated. The shoulder function was quantified using Constant, UCLA and ASES scores. With the exception of group 1, the quality of life was measured with the SF-36 health-status questionnaire. RESULTS: Normal values of the shoulder abduction strength and valuation according to the Constant score are given for a German reference group related to age and gender. In addition to the Constant score more values for children are given. Strength values measured at the deltoid insertion (fixation point 1, FP1) and wrist (fixation point 2, FP2) are in a linear relation. Thus FP1 = 2.5 x FP2 and FP2 = 0.4 x FP1. If torque values instead of strength are used, 25 points correspond to 50 Nm. Total score values calculated by the use of the Constant score (methods published 1991) were markedly higher in groups 3 - 6 related to the values of Constant in the Irish population; the main reason is the higher abduction strength in our population. There exists a good relation between the Constant, UCLA and ASES scores (Constant 1991). The results of the SF-36 health survey were similar to the results of Bullinger et al. 1996. CONCLUSION: The normal values of C. R. Constant of an Irish population differ in part to those of our groups due to the different strength values. Our values may be more representative for German patients. The linear regression between strength values measured at a fixation point at the deltoid insertion or the wrist facilitates the calculation of each point from the other. This allows a comparison of the results of studies with different fixation points. The additional calculation of the torque allows a comparison of different studies independently of the fixation point of the strength measuring device.

Adolescent↗