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PubMed1999

Resistance properties of Thera-Band tubing during shoulder abduction exercise.

STUDY DESIGN: Single-group, repeated measures. OBJECTIVES: To investigate the relationship between tubing length and tubing tension for 6 colors of Thera-Band tubing (each color representing a different level of resistance) and to estimate the resistive shoulder torque provided during shoulder abduction exercise. BACKGROUND: Thera-Band tubing is popular for providing resistance in rehabilitation strengthening programs. Unfortunately, it is difficult to compare use of elastic tubing with other resistance training methods because no published data exist on how much resistance is being provided during exercise. METHODS AND MEASURES: Nine male and 6 female subjects (age, 25.9 +/- 3.6 years; height, 173 +/- 10 cm) performed shoulder abduction, using 6 colors of tubing. A strain gauge attached at the fixed end of the tubing directly measured the tension generated during stretch. For each color of tubing, each subject momentarily held a position at 30 degrees, 60 degrees, 90 degrees, 120 degrees, and 150 degrees of abduction. Shoulder joint abduction, limb segment position, and tubing length were analyzed by means of the Peak Motion Measurement System. Simple linear regression equations predicted tubing tension from percent change in tubing length at the joint angle positions. A 2-way (5 x 6) repeated-measures ANOVA determined the mean differences in tubing tension across tubing colors at the shoulder abduction positions. RESULTS: Strong linear relationships were found for each tubing tension when referenced according to changes in tubing length. Significant differences in tension were found for the various colors of tubing. The resistive torque curves for each color tubing were similar to isotonic exercise. CONCLUSIONS: Thera-Band tubing provides linear resistance during shoulder abduction, but the resistive torque provided by the tubing mimics isotonic exercise.

Adult↗
PubMed2001

Determination of functional rotation axes during elevation of the shoulder complex.

STUDY DESIGN: A cross-sectional, descriptive study of shoulder movements conducted on nonimpaired subjects. OBJECTIVE: To investigate whether a single functional rotation axis about the shoulder complex can be determined during elevation in the coronal or sagittal planes, and to identify their location. BACKGROUND: Accurate measurement of isokinetic torques about a joint requires alignment of the dynamometer axis with an assumed rotation axis of the joint. To assess shoulder function on a dynamometer, the location of a single rotation axis is not evident because the shoulder joint motion is based on several anatomical joints. Therefore, the rotation axis where humerothoracic movements occur should be judged as a functional rotation axis. METHODS AND MEASURES: During slow elevation movements in the sagittal and coronal plane, the position of the epicondyle and acromion were recorded with a motion analysis system. The motion trajectory of the elbow coordinates was fitted to a circle and considered an estimate of the functional shoulder joint rotation axis in the specified plane. RESULTS: The fitted trajectory appeared to be very accurate (root-mean-square error < 2%; N = 7). In the sagittal plane, the estimated functional rotation axis was found at the humeral head; in the coronal plane, it was located about 13 centimeters medial relative to the acromion. CONCLUSION: The shoulder complex of nonimpaired subjects can act as a hinge joint of the upper arm relative to the thorax during elevation in each measured plane.

Adult↗
PubMed2002

Scapular muscle recruitment pattern: electromyographic response of the trapezius muscle to sudden shoulder movement before and after a fatiguing exercise.

STUDY DESIGN: Test-retest reliability study and single-group repeated measures design. OBJECTIVES: To evaluate the muscle latency times of the 3 portions of the trapezius muscle to a sudden arm movement in normal shoulders and to determine if this recruitment pattern is altered as a result of fatigue. BACKGROUND: It has been suggested that shoulder impingement may be related to altered muscle activity and muscle fatigue in the scapular stabilizers. Fatigue-induced changes in latency times of the trapezius might influence scapular stability. METHODS AND MEASURES: Muscle latency times were investigated in 30 healthy shoulders with surface electromyography. Muscle activity was measured in all 3 sections of the trapezius and the middle deltoid muscle during a sudden downward falling movement of the arm. Subsequently the shoulder was fatigued on an isokinetic dynamometer, after which muscle latency time measurement was repeated. RESULTS: ANOVA for repeated measures revealed significant differences in latency times (P < 0.05) among the 4 muscles of interest. Although there were no significant differences among the 3 sections of the trapezius muscle, they all were recruited after the initialization of the deltoid muscle. The recruitment order of the shoulder muscles did not change with muscle fatigue. However, after fatigue, muscle responses were significantly slower in all muscles except for the lower trapezius (P < 0.05). CONCLUSIONS: There is a specific recruitment sequence in the shoulder muscles in response to a sudden arm movement characterized by initial activation of the middle deltoid muscle and followed by simultaneous contraction of all 3 sections of the trapezius. This muscle activation pattern is delayed but not altered with fatigue.

Adolescent↗
PubMed2003

Reliability of classifications derived from Cyriax's resisted testing in subjects with painful shoulders and knees.

STUDY DESIGN: Intrarater and interrater reliability. OBJECTIVES: Examine intrarater and interrater reliability of the resisted-testing component of Cyriax's selective tension testing for patients with painful shoulders and knees. BACKGROUND: Clinicians make diagnostic and intervention decisions about lesions in contractile tissues based on resisted testing. Diagnostic and intervention decisions require reliable data gathering, especially when more than 1 physical therapist manages a patient. No studies have examined agreement of the results of the resisted tests used in selective tension testing, either within or between physical therapists, in subjects having pathology. METHODS AND MEASURES: Subjects with pain in 1 knee (18 male, 22 female; mean age +/- SD = 31.8 +/- 9.5 years) or shoulder (21 male, 25 female; mean age +/- SD = 34.3 +/- 12.9 years) were examined twice. Referring diagnoses included ligament injuries, overuse syndromes, joint instability, and postsurgical symptoms, with some subjects seeking initial diagnosis. Two physical therapists used standardized positions to evaluate 2 knee motions or 6 shoulder and elbow motions. Evaluators applied maximal isometric manual resistance and rated the contraction as strong or weak while subjects identified the presence or absence of pain during the contraction. Evaluators did not interview the subjects and were masked to previous test results. Analyses included percentage of agreement, kappa coefficients, confidence intervals, and maximum kappa coefficients. RESULTS: Intrarater kappa coefficients ranged from 0.44 to 0.82 and interrater coefficients ranged from 0.00 to 0.46. The small number of subjects who were classified as weak affected the kappa coefficients. In the intrarater condition, evaluators averaged 91% of maximum kappa for the knee and 66.5% for the shoulder. In the interrater condition, they averaged 60.4% of the maximum kappa for both the knee and the shoulder. CONCLUSIONS: Based on 2 physical therapist evaluators with previous education in the selective tension system and an additional 6 hours of formal training on the methods, intrarater reliability of resisted tests was generally acceptable for the knee but not for the shoulder. Interrater reliability of these tests, however, was generally not acceptable. Results were limited by subjects who were younger and had mostly chronic conditions that were mildly to moderately severe and by the small subject samples in the analyses. Reliability might be improved by more intensive training of the evaluators and by standardizing the magnitude of the applied resistance and stabilization of the subjects.

Adult↗
PubMed2005

Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain.

STUDY DESIGN: Fine-wire EMG rotator cuff onset time analysis in 2 matched groups of throwers with and without pain. OBJECTIVE: To identify if there is a difference in the activation patterns of the rotator cuff muscles during a rapid shoulder external rotation task between throwers with and without pain. BACKGROUND: The coordinated action of the rotator cuff is recognized as essential for glenohumeral joint control in the throwing athlete. Identification of abnormalities occurring in muscle activation patterns for injured athletes is relevant when prescribing rehabilitative exercises. METHODS AND MEASURES: Twelve throwers with shoulder pain were compared to a matched group of 11 asymptomatic throwers. Participants were matched for age, height, body mass, and habitual activity. Fine-wire EMG electrodes were inserted into the subscapularis, supraspinatus, and infraspinatus. EMG activity was measured during a reaction time task of rapid shoulder external rotation in a seated position. The timing of onset of EMG activity was analyzed in relation to visualization of a light (reaction time) and to the onset of infraspinatus activity (relative latency). RESULTS: In the group with shoulder pain, the onset of subscapularis activity was found to be significantly delayed (reaction time, P = .0018; relative latency, P = .0005) from the onset of infraspinatus activity when compared to the control group. CONCLUSIONS: The presence of shoulder pain in these athletes was associated with a difference in the onset of subscapularis EMG activity during a rapid shoulder external rotation movement. This was an initial step in the understanding of the joint protection mechanisms of the glenohumeral joint and the problems that occur in throwers. This information may assist in providing future guidelines for more effective rehabilitation and prevention strategies for this condition.

Adult↗
PubMed1996

Hand grip increases shoulder muscle activity, An EMG analysis with static hand contractions in 9 subjects.

We examined 4 shoulder muscles--the supraspinatus, infraspinatus, the middle portion of the deltoid and the descending part of the trapezius--with electromyography (EMG) in adducted and flexed arm positions, in 9 healthy subjects. The subjects were asked to produce a static handgrip force of 30% and 50% of maximal voluntary contraction (MVC) in 8 different arm positions. In all positions, the subjects held a dynamometer in the hand. The myoelectric activity in the shoulder muscles with only the dynamometer in the hand was compared to the EMG activity when static contractions were added. There was an association between static handgrip and shoulder muscle activity, as revealed by E < G. The EMG activity increased in the supraspinatus muscle in humeral flexion from and above 60 degree in 120 degree abduction. In the infraspinatus muscle, the changes were less; a significant increase, however, was noticed in flexion. In the deltoid muscle there was a tendency towards increased activity in positions lower than 90 degree, in the higher arm positions, the activity decreased. There was no significant alteration regarding the EMG activity of the trapezius. Our findings imply that high static handgrip force, particularly in elevated arm positions, increases the load on some shoulder muscles. The stabilizing muscles (the rotator cuff) were more influenced than the motor muscles by hand activity. Handgrip activity is important to evaluate while assessing shoulder load in manual work an in clinical evaluations of patients with shoulder pain.

Adult↗
PubMed1997

Shoulder hemiarthroplasty in rheumatoid arthritis. 19 cases reexamined after 1-17 years.

We reexamined 19 shoulder hemiarthroplasties in patients with rheumatoid arthritis after a mean of 8 (1-17) years. For the evaluation, we used the Constant and Murley score and routine radiographs. At the follow-up examination, 12 of the 19 shoulders showed little, if any, pain. In 7 shoulders the pain was moderate and no patient had severe pain. The range of motion was not improved. In 7/18 shoulders proximal subluxation of the head of the humeral prosthesis and in 9/15 shoulders, progression of the glenoid erosion were seen. The increase in glenoid erosion and the postoperative pain were not correlated. Hemiarthroplasty of the shoulder effectively relieves the pain in rheumatoid patients and this seems long-lasting.

Aged↗
PubMed2004

Secondary deformities of the shoulder in infants with an obstetrical brachial plexus lesions considered for neurosurgical treatment.

OBJECT: The authors performed a prospective study in which magnetic resonance (MR) imaging was conducted in 26 consecutive infants (mean age 5.6 months, range 2.7-14.5 months) in whom recovery from an obstetric lesion of the brachial plexus had been inadequate in the first 3 months of life. The purpose was to identify early secondary deformations of the shoulder in obstetrical brachial plexus lesions (OBPLs). METHODS: Features of the shoulders were analyzed according to a standardized MR imaging protocol in patients with OBPLs. Measurements were made of the appearance of the glenoid, glenoid version, and the position of the humeral head. The appearance of the glenoid on the affected side was normal in only 11 shoulders. In the remainder it was convex in eight and biconcave in seven cases. The degree of humeral head subluxation was significantly greater (p = 0.001) in affected shoulders than in normal shoulders (152 and 170 degrees, respectively). The presence of abnormal glenoid retroversion and humeral head subluxation increased with age: there was a statistical difference (p = 0.001) between infants younger than 5 months of age and those who were older. CONCLUSIONS: Magnetic resonance imaging demonstrates shoulder-related anatomical and nerve root lesion, allowing evaluation of neural, osseous, and cartilaginous structures in younger children.

Brachial Plexus↗
PubMed1988

Manipulation in the treatment of frozen shoulder.

The treatment of frozen shoulder has been an area of controversy in orthopedics for many years. The natural history of this condition would indicate that most patients recover painless range of motion of the shoulder by 2 years after the onset of symptoms. However, work and economic pressures often make it important to establish a treatment program that can enable these patients to return to a functional, painless range of motion as soon as possible. In this retrospective study, 17 frozen shoulders in 15 patients who did not respond to physical therapy were manipulated. Of those patients not able to work prior to their shoulder problems, 70% had returned to work within an average of 2.6 months of manipulation. All of the patients in this study had a significant improvement in shoulder flexion and abduction, returning to a functional range of shoulder motion. Manipulation allowed the patients studied to return to a normal lifestyle and to work much sooner than the reported natural history of this condition would indicate.

Adult↗
PubMed1990

Shoulder shrug--a prognostic sign for recovery of hand movement after stroke.

A new clinical sign with prognostic significance for recovery of hand movements after stroke is described. Thirty-two patients with hemispheric cerebrovascular accident were assessed to determine whether the ability to shrug the hemiplegic shoulder at initial assessment correlated with the recovery of hand movements. The results of 29 of these patients with poor hand movements at initial assessment were analysed. Of 18 patients with absent shoulder shrug, only two patients (11%) showed return of good active movements in the involved hand at final evaluation, whereas eight (73%) of 11 patients who could shrug the hemiplegic shoulder at initial assessment went on to recover good movements in the hand (P = 0.00). In a subgroup of patients who demonstrated only synergistic flexion of fingers in the hemiplegic hand, one of five patients with absent shoulder shrug showed good hand movements at the final assessment in contrast to six of seven patients who initially could shrug the hemiplegic shoulder. Only one of 15 patients who showed total absence of hand movements at the initial assessment had a return of good hand movements. The data suggest that clinical assessment of shoulder shrug is a good prognostic indicator for recovery of voluntary movements in the hemiplegic hand especially when any hand movement, even if it is only synergistic finger flexion, is present at initial assessment. Total absence of hand movements at initial assessment is a poor prognostic sign.

Adult↗
PubMed2006

Subacromial decompression for shoulder impingement syndrome.

OBJECTIVE: To evaluate the results in a consecutive series of patients who underwent subacromial decompression for shoulder impingement syndrome. DESIGN: Interventional quasi experimental study. PLACE AND DURATION OF STUDY: Orthopaedic Department at St Mary s Hospital, Isle of Wight Healthcare England from May 1999 to August 2001. PATIENTS AND METHODS: Twenty-five consecutive shoulders from 22 patients who underwent subacromial decompression for shoulder impingement syndrome were studied. Nineteen out of 25 shoulders were in stage I or II and 6 had stage III disease, having rotator cuff tear. All patients had a median 10 months course of conservative treatment before surgery. Patients were followed-up for 6 to 24 months postoperatively and assessed by clinical examination and the University of California at Los Angeles (UCLA) shoulder rating scale. Results were analysed by Wilcoxon s non-parametric test for internal comparison. RESULTS: The differences in pre- and postoperative scores for pain, function, active forward flexion, strength of forward flexion and overall patient satisfaction were improved with p-values < 0.01 in for each. This was an overall improvement in 88% cases. CONCLUSION: Subacromial decompression is an effective treatment for shoulder impingement syndrome. Accurate diagnosis, careful patient selection and appropriate surgical intervention results in a successful outcome and return to normal activities in majority of patients.

Adult↗
PubMed1998

Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder.

To determine the efficacy of a combined treatment--namely hyaluronan and corticosteroid injection plus physical exercises in the management of established idiopathic capsulitis of the shoulder--30 consecutive subjects with adhesive capsulitis were selected for the study. The diagnosis of adhesive capsulitis was established on the basis of a clinical history of spontaneous shoulder pain, shoulder examination showing passive limitation in conformity with capsular pattern, cervical examination excluding significant dysfunction of this area, plain radiographs excluding other significant shoulder diseases, or sonographic examination showing capsule shrinkage in affected joint. The patients were randomly allocated to receive intraarticular injections of sodium hyaluronate (20 mg) plus steroid (20 mg triamcinolone acetonide) and physiotherapy or intraarticular injections of steroid (20 mg triamcinolone acetonide) alone and physiotherapy. The intraarticular injections were performed at 15-day intervals in the first month and then monthly for 6 months. Physiotherapy was performed for 4-12 weeks. The results indicate an improvement of pain and joint motion after 6 months in all patients, especially in the patients treated with sodium hyaluronate. Intraarticular hyaluronan combined with triamcinolone acetonide and shoulder exercises may improve adhesive capsulitis. This drug possibly acts on shoulder tissue retraction by means of its influence on osmotic pressure and synovial fluid volume control.

Adjuvants, Immunologic↗
PubMed1999

Determinants of shoulder and elbow flexion range: results from the San Antonio Longitudinal Study of Aging.

OBJECTIVE: To gain a knowledge of factors associated with impaired upper extremity range of motion (ROM) in order to understand pathways that lead to disability. METHODS: Shoulder and elbow flexion range was measured in a cohort of 695 community-dwelling subjects aged 65 to 74 years. Associations between subjects' shoulder and elbow flexion ranges and their demographic and anthropometric characteristics, as well as the presence of diabetes mellitus or self-reported physician-diagnosed arthritis, were examined using multivariate regression models. The relationship between shoulder or elbow flexion range and subjects' functional reach was examined to explore the functional significance of ROM in these joints. RESULTS: The flexion range for the 4 joints studied was at least 120 degrees in nearly all subjects (> or = 99% of the subjects for each of the 4 joints). Multivariate models revealed significant associations between male sex, Mexican American ethnic background, the use of oral hypoglycemic drugs or insulin to treat diabetes mellitus, and a lower shoulder flexion range. A lower elbow flexion range was associated with male sex, increasing body mass index, and the use of oral hypoglycemic drugs or insulin. A higher shoulder or elbow flexion range was associated with a lower likelihood of having a short functional reach. CONCLUSIONS: The great majority of community-dwelling elderly have a flexion range of shoulder and elbow joints that can be considered functional. Diabetes mellitus and obesity are two potentially treatable factors associated with reduced flexion range of these two functionally important joints.

Aged↗
PubMed2000

Modified Bankart procedure for recurrent anterior shoulder dislocation.

BACKGROUND AND PURPOSE: Recurrent anterior shoulder dislocation is a serious condition, for which the Bankart procedure is a standard treatment. Having made three modifications to the original procedure, we examined the efficacy of this modified Bankart procedure in the treatment of patients with recurrent anterior shoulder dislocation. PATIENTS AND METHODS: The medical records of 21 patients who received a modified Bankart procedure for recurrent anterior shoulder dislocation during the period from 1989 through 1998 were retrospectively analyzed. The average age at initial dislocation was 22 +/- 5 years. The average postoperative follow-up period was 41 +/- 16 months. Three of the patients complained of mild shoulder pain before their operation. RESULTS: The postoperative loss of external rotation and abduction compared with the nonoperated side was 9 +/- 4 degrees and 5 +/- 4 degrees, respectively. There were no limitations in daily activities during follow-up. No patient had shoulder pain after surgery. Redislocation occurred in one patient during the follow-up period. Patient satisfaction was rated as excellent by 20 (96%) patients and poor by one. CONCLUSION: This modified Bankart procedure is a technically easy operation with a low complication rate, a high rate of patient satisfaction, and a low redislocation rate. It is a procedure of choice for the management of traumatic recurrent anterior shoulder dislocation.

Adolescent↗
PubMed2000

Shoulder numbness in a patient with suprascapular nerve entrapment syndrome: cutaneous branch of the suprascapular nerve: case report.

OBJECTIVE AND IMPORTANCE: The ability to diagnose peripheral nerve disorders is dependent on knowledge of the anatomic course and function of the nerves in question. The classic teaching regarding the suprascapular nerve (SScN) is that it has no cutaneous branches, despite the fact that a cutaneous branch was first reported in the anatomic literature 20 years ago. CLINICAL PRESENTATION: We describe a case of a 35-year-old male patient who presented with right shoulder pain and atrophy and weakness of the right supra- and infraspinatus muscles. During the examination, he was also noted to have an area of numbness involving the right upper lateral shoulder region. Electrical study results were consistent with SScN entrapment at the suprascapular notch. INTERVENTION: The patient underwent surgical decompression 7 months after the onset of his symptoms. The patient noted resolution of his shoulder pain immediately after the procedure, and his shoulder sensory disturbance had improved by 2 weeks. At 9 months after surgery, he remained pain-free, his shoulder sensation was normal, and his motor abnormalities had improved significantly. CONCLUSION: This case provides clinical evidence for the presence of a cutaneous branch of the SScN, as described in cadaveric studies. Although shoulder numbness demands a search for alternative diagnoses, it does not necessarily exclude the diagnosis of SScN entrapment.

Adult↗
PubMed2000

[Shoulder instability: diagnostic imaging].

Shoulder instability is often diagnosed among athletes; two clinical forms are distinguished: anatomical instability, with recurrent luxation of the shoulder, and functional instability, with pain, articular "click" and sensation of instability. Lesions of periarticular soft tissues (capsula, fibrocartilaginous labrum, gleno-humeral ligaments and rotator cuff) are common in both forms, while lesions of bone structures (humeral head and glenoid of scapula) are typical of shoulder with previous dislocation. Purpose of our retrospective study was to verify the value of magnetic resonance (MRI) and computed arthrography (arthro-CT) in diagnosing these lesions in 57 patients suffering from shoulder instability. On the basis of our results and experience we think that in a preoperative evaluation of an unstable shoulder, arthro-CT and arthro-MRI are more accurate because the intra-articular injection of a contrast medium better identifies lesions of capsula, gleno-humeral ligaments and fibrocartilaginous labrum. In other circumstances, such as the study of the shoulder for legal purposes, MRI is preferable because it offers an accurate and global evaluation of periarticular structures.

Adolescent↗
PubMedDate not supplied

Pediatric shoulder instability: presentation, findings, treatment, and outcomes.

There is no one large study on pediatric shoulder instability. The purposes of this study were to characterize patients with shoulder subluxation or dislocation, the treatments provided, outcomes, and the predictors of good outcomes. Seventy shoulders in 66 patients were retrospectively reviewed, all with follow-up >2 years. The authors defined characteristics, treatment, outcomes, and associations between patient and treatment variables and outcome measures. Instability was associated with boys, adolescents, and trauma. Forty-two shoulders received physical therapy, and 28 required surgery. At follow-up, 54 of 70 described their shoulders as "better" or "much better," and 90% were performing at the same or higher levels of sports and work. Surgically treated patients were less likely to have recurrent instability or to report limitations. The current study is a large study of pediatric shoulder instability. Surgery improved stability, but overall, stability improved over time, with few patients having limitations at moderate- to long-term follow-up.

Adolescent↗
PubMedDate not supplied

[Role of magnetic resonance in shoulder disease].

Next to the knee, the shoulder is the most common joint to be referred for MRI. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsule, fat, bursae and bone marrow. In this article the most common indications for shoulder MRI are reviewed and discussed, but we focused primarily on the rotator cuff syndrome and shoulder instability. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. Moreover, technical improvements continuously augment the ability of MRI to study the shoulder; for example Magnetic Resonance arthrography is superior to the other imaging techniques in evaluation of glenohumeral joint. This interdependence between technical development in MRI and clinical advance in shoulder therapy ensures that MRI will continue to play an important role in the routine management of patients with shoulder disease.

Humans↗