Abduction Active Range Of Motion Research Articles

Effects of high-intensity laser therapy on subacromial impingement syndrome: a systematic review and meta-analysis.

This systematic review and meta-analysis aims to identify, critically appraise, and summarize the effects of high-intensity laser therapy on subacromial impingement syndrome. Three databases, PubMed, Embase, and Scopus were searched from inception to March 1, 2024. Clinical trials comparing the effects of high-intensity laser therapy to conventional therapy are eligible for inclusion. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed to determine the effects of high-intensity laser therapy. Five randomized controlled trials and one controlled clinical trial were included, with a total of 284 patients with subacromial impingement syndrome. All included studies were evaluated as good or above for quality assessment. Compared to conventional therapy, high-intensity laser therapy demonstrated significantly better outcomes for pain at both post-intervention (SMD = -1.01, 95%CI = -1.85 to -0.17) and three-month post-intervention (SMD = -0.51, 95%CI = -0.90 to -0.13); shoulder and arm function at both post-intervention (SMD = 0.40, 95%CI = 0.14 to 0.66) and three-month post-intervention (SMD = 0.45, 95%CI = 0.06 to 0.84); shoulder abduction active range of motion (SMD = 3.26, 95%CI = 0.49 to 6.03). No significant difference was found for shoulder flexion and external rotation range of motion. This review highlights the promising effects of high-intensity laser therapy for the rehabilitation of subacromial impingement syndrome. Rehabilitation professionals and policymakers should increase their awareness of high-intensity laser therapy as an emerging technology that may facilitate greater outcomes than current widespread standards.

Comparing Outcomes After Referral to Physical Therapy for Patients With Glenohumeral Osteoarthritis Based on the Radiographic Osteoarthritis Severity: A Retrospective Analysis.

Introduction Glenohumeral osteoarthritis (GHOA) is a common cause of musculoskeletal pain (MSP) that can frequently lead to pain and functional disability in patients throughout the world. GHOA can be managed with conservative or surgical interventions, although conservative interventions, such as physical therapy (PT), are generally first-line interventions depending on the severity of GHOA. The purpose of this retrospective analysis was to examine how conventional PT impacts outcomes for patients with GHOA based on the severity of radiographic GHOA findings. Methods This study is a retrospective chart review of patients who were referred to PT for MSP and received PT in the outpatient setting between 2016 and 2022. Inclusion criteria were patients who received PT in the outpatient setting, received PT for MSP, had shoulder radiograph imaging within two years of initial PT evaluation, had more than one PT visit (i.e. attended a follow-up session after initial evaluation), and did not have a history of shoulder surgery. Primary outcome measures were pain, abduction active range-of-motion (AROM), and disability via the quick disabilities of the arm, shoulder, and hand (DASH). Patients were divided into the No GHOA group (n=104), Mild GHOA group (n=61), and Moderate/Severe GHOA group (n=55) based on the radiographic GHOA severity. Results All included patients (n=220) had a mean age of 62.2 ± 12.4 years old with a mean number of PT visits of 7.8 ± 4.5 visits. There was initially a significant difference in the magnitude of pain improvement between the three groups based on radiographic severity of GHOA (Kruskal-Wallis H=6.038; p=0.049); however, post hoc testing revealed no significant difference between any of the three groups for pain improvement (p=0.061 to p=1.000). There was also no significant difference in the magnitude of abduction AROM improvement between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=2.887; p=0.236). Finally, there was no significant difference in the magnitude of disability improvement via the Quick DASH between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=0.156; p=0.925). Conclusion Patients with GHOA referred to PT experience small but statistically significant short-term improvements in pain, abduction AROM, and disability regardless of GHOA radiographic severity. There is no significant association between the magnitude of clinical improvement and the severity of radiographic GHOA. However, despite statistically significant improvements in pain, only patients with mild GHOA experienced clinically significant improvements in pain.Patients with GHOA, regardless of severity, may or may not experience clinically significant improvements in disability after PT.

Clinical Outcomes Associated With the Addition of a Physical Therapist Assistant to a Rehabilitation Team When Treating Musculoskeletal Shoulder Pain in the Outpatient Setting: A Retrospective Cohort Study.

Introduction Musculoskeletal shoulder pain (MSP) is a common condition frequently treated in an outpatient setting by a physical therapy rehabilitation team. Treatment teams can consist of physical therapists (PTs) with or without physical therapist assistants (PTAs).It is currently unknown how different physical therapy team compositions can impact patient outcomes in the outpatient setting. The purpose of this study is to examine how the addition of PTAs to a physical therapy treatment team would impact clinical outcomes when treating patients with MSP in the outpatient setting. Methods This study is a retrospective cohort analysis comparing clinical outcomes for pain, active range of motion (AROM), and disability for patients with MSP when treated by physical therapy treatment teams with or without the presence of PTAs.Inclusion criteria were patients treated for MSP in an outpatient physical therapy clinic without a history of shoulder surgery. Depending on the rehabilitation team composition, patients were divided into a PT-only group or a PTAgroup. Results Total patients (n = 238) had a mean age of 62.6 ± 12.6 years (median: 64 years) with a mean total number of physical therapy visits of 7.8 ± 4.9 visits (median: 7.0 visits). Of the entire cohort, the PT-only group had 100 patients and the PTA group had 138 patients. There was no significant difference in the magnitude of pain improvement (mean: 1.5 versus 1.9 points, p = 0.177), the magnitude of abduction AROM improvement (mean: 17.6 versus 13.9 degrees, p = 0.173), and the magnitude of disability improvement (mean: 18.9 versus 13.4 percentage points, p = 0.221) between the PT-only group and the PTA group. However, the PT-only group had significantly fewer total visits as compared to the PTA group (6.7 versus 8.6 visits, p < 0.001). Conclusion The addition of PTAs to a rehabilitation team when treating patients with MSP in the outpatient setting does not appear to adversely impact pain, AROM, or disability outcomes. However, patients treated only by PTs had significantly less visits with similar outcomes. More research is needed to determine the interplay between cost, healthcare utilization, and patient outcomes to maximize quality care.

Effectiveness, safety and patients' perceptions of an immersive virtual reality-based exercise system for poststroke upper limb motor rehabilitation: A proof-of-concept and feasibility randomized controlled trial.

This study aimed to examine the effectiveness, safety and patients' perceptions of an immersive virtual reality (VR)-based exercise system for poststroke upper limb rehabilitation. A proof-of-concept, 2-week randomized controlled trial was conducted. Fifty stroke patients were randomly assigned to either use the immersive VR-based exercise system to perform upper limb exercises for 2 weeks (intervention) or play commercial games (control). Effectiveness, safety and patients' perceptions of the exercise system were assessed at baseline and at 1- and 2-week follow-ups. Intention-to-treat analysis revealed that after 2 weeks, statistically significant improvements in shoulder flexion active range of motion (AROM), shoulder abduction AROM, perceived upper limb motor function and quality of life (QoL) were observed in one or both groups, but not between the groups. Per-protocol analysis showed that after 2 weeks: (i) statistically significant improvement in shoulder abduction AROM was obtained in the intervention group, and the difference in the mean changes between the groups was statistically significant; (ii) statistically significant improvements in coordination/speed (Fugl-Meyer Assessment for Upper Extremity), shoulder flexion AROM, perceived upper limb motor function and QoL were obtained in one or both groups, but not between the groups. The immersive VR-based exercise system is a potentially effective, safe and acceptable approach for supporting poststroke motor rehabilitation. These findings can serve as a basis for larger-scale studies on the application of VR for poststroke exercises.

Alternative Nerve Transfer for Shoulder Function: Thoracodorsal and Medial Triceps to Anterior Axillary Nerve

Introduction:We describe a reliable approach for double nerve transfer of the medial triceps branch and thoracodorsal nerve to the axillary nerve to increase axonal input. We present a review of outcomes for both end-to-end and reverse end-to-side nerve transfer.Methods:A retrospective review of patients who underwent nerve transfer for improvement of shoulder abduction at Harborview Medical Center and Northwestern Memorial Hospital between 2012 and 2021 was conducted. Patients were prospectively contacted to fill out a 30 item Disabilities of the Arm, Shoulder and Hand questionnaire, with an option to upload a video demonstrating active range of motion.Results:Twenty-one patients with 23 affected extremities were included in the final analysis. Fifteen patients completed the prospective arm of the study (71% response rate). Seventy-nine percent of patient limbs achieved a Medical Research Council Motor Scale (MRC-MS) of 4 or greater, and measured shoulder abduction active range of motion (AROM) was 139.2 degrees (range, 29–174 degrees) and 140.9 degrees (range, 60–180 degrees) (P = 0.95) for end-to-end and reverse end-to-side, respectively. Comparing end-to-end with reverse end-to-side neurorrhaphy, outcomes, including follow-up, mean postoperative MRC-MS, mean change in MRC-MS, Disabilities of the Arm, Shoulder and Hand, abduction AROM, and flexion AROM, were not statistically different.Conclusions:We showed improvements in shoulder abduction with the thoracodorsal nerve, in addition to the medial triceps branch, to increase axonal donation and power the axillary nerve without sacrificing the spinal accessory nerve. Furthermore, we demonstrated improvements with reverse end-to-side coaptation when intraoperative stimulation of the axillary nerve revealed residual function.

Five-Year Cumulative Incidence of Axillary Web Syndrome and Comparison in Upper Extremity Movement, Function, Pain, and Lymphedema in Survivors of Breast Cancer With and Without Axillary Web Syndrome

ObjectiveTo determine the cumulative incidence and natural history of axillary web syndrome (AWS) and its related postoperative risk for physical impairments in a cohort of women followed for 5 years post breast cancer surgery. DesignProspective, longitudinal study. SettingAcademic health center. ParticipantsWomen (N=36) with and without AWS after breast cancer surgery with sentinel node biopsy or axillary lymph node dissection. InterventionsNot applicable. Main Outcome MeasuresParticipants were assessed for AWS, shoulder goniometric flexion and abduction range of motion, function (Disability of the Arm, Shoulder, and Hand), lymphedema (bioimpedance spectroscopy, girth measures, tissue dielectric constant), and pain (visual analog scale) at 2, 4, 12, and 78 weeks and 5 years after breast cancer surgery. Analysis of variance compared range of motion, function, lymphedema, and pain in women identified with AWS with those without AWS across visits. Univariate logistic regression assessed if AWS was a risk factor for physical impairment at 5 years. ResultsThe cumulative incidence of AWS was 57%. Fifty percent (14/28) of the women who completed all study visits had signs of AWS at 5 years. Abduction active range of motion was significantly lower in women with AWS at 2 and 4 weeks post surgery. AWS was identified as a risk factor for reduced shoulder motion at 5 years. Regardless of AWS, 75% of the women experienced 1 or more upper extremity physical impairments at 5 years, which is an increase from 66% at 78 weeks in the same cohort. ConclusionsAWS is associated with reduced shoulder range of motion in the early postoperative time period, can persist for 5 years after breast cancer surgery, and increases the risk of long-term reduced shoulder range of motion. Long-term physical issues are apparent after breast cancer surgery regardless of AWS.

Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial

Objectives The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design Single-blind randomized clinical trial. Setting Outpatient setting. Subjects Patients with frozen shoulder. Intervention Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45–40.13) vs. 10.17 (1.02–19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. Conclusions Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.

Hip Flexibility and Pitching Biomechanics in Adolescent Baseball Pitchers.

Inadequate hip active range of motion (AROM) may stifle the energy flow through the kinematic chain and decrease pitching performance while increasing the risk for pitcher injury. To examine the relationship between hip AROM and pitching biomechanics during a fastball pitch in adolescent baseball pitchers. Cross-sectional study. Biomechanics laboratory. A sample of 21 adolescent male baseball pitchers (age = 16.1 ± 0.8 years, height = 183.9 ± 5.2 cm, mass = 77.9 ± 8.3 kg). Bilateral hip external-rotation (ER), internal-rotation, flexion, abduction, and extension AROM were measured. Three-dimensional biomechanics were assessed as participants threw from an indoor pitching mound to a strike-zone net at regulation distance. Pearson product moment correlation coefficients were used to determine relationships between hip AROM and biomechanical metrics. Negative correlations were found at foot contact between back-hip ER AROM and torso-rotation angle (r = -0.468, P = .03), back-hip ER AROM and back-hip abduction angle (r = -0.474, P = .03), and back-hip abduction AROM and lead-hip abduction angle (r = -0.458, P = .04). Back-hip extension AROM was positively correlated with increased stride length (r = 0.446, P = .043). Lead-hip abduction AROM was also positively correlated with normalized elbow-varus torque (r = 0.464, P = .03). We observed several relationships between hip AROM and biomechanical variables during the pitching motion. These findings support the influence that hip AROM can have on pitching biomechanics. Overall, greater movement at the hips allows the kinematic chain to work at maximal efficiency, increasing the pitch velocity potential.

Traumatic Brachial Plexus Injury in Indonesia: An Experience from a Developing Country.

Background Brachial plexus injuries (BPI) cause severe physical disability and major psycho-socioeconomic burden. Although various countries have reported BPI incidence, the data from Indonesia as the fourth most populated country in the world remains unknown. We aim to assess the distribution of traumatic BPI, patients' characteristics, and treatment modalities in Indonesia. Methods A retrospective investigation was performed comprising 491 BPI patients at a tertiary referral hospital in Indonesia from January 2003 to October 2019. Demographic and outcomes data were retrieved from medical records. Results The average BPI patients' age was 27.3 ± 11.6 years old, with a male/female ratio of 4.6:1. Motorcycle accidents caused the majority (76.1%) of all BPI cases. Concomitant injuries were present in 62.3% of patients, dominated by fractures (57.1%) and brain injuries (25.4%). BPI lesion type was classified into complete (C5-T1, observed in 70% patients), upper (C5-C6, in 15% patients), extended upper (C5-C7, in 14% patients), and lower type (C8-T1, in 1% patients). The average time to surgery was 16.8 months (range 1–120 months), with the majority (76.6%) of the patients was operated on six months after the trauma. Free functional muscle transfer (FFMT) was the most common procedure performed (37%). We also analyzed the functional outcomes (active range of motion (AROM) and muscle power), DASH (Disabilities of the Arm, Shoulder, and Hand) score, and VAS (Visual Analogue Scale) across four most frequent procedures involving nerve reconstruction (FFMT, nerve transfer, external neurolysis, and nerve grafting). We found that FFMT was significantly better than nerve transfer in terms of DASH score and VAS ( p = 0.000 and p = 0.016, respectively) in complete BPI (C5-T1). Moreover, we also found that nerve grafting resulted in a significantly better shoulder abduction AROM than nerve transfer and external neurolysis in extended upper BPI (C5-C7) ( p = 0.033 and p = 0.033, respectively). Interestingly, no significant differences were observed in other measurements. Conclusion This study provides an overview of traumatic BPI patients in a single tertiary trauma center in Indonesia, expressing the profile of their characteristics and functional outcomes after surgical procedures.

Defining the Reliability of Deltoid Reanimation by Nerve Transfer When Using Abnormal but Variably Recovered Triceps Donor Nerves.

Upper brachial plexus injuries to the C5/6 roots or axillary nerve can result in severe deficits in upper limb function. Current techniques to reinnervate the deltoid muscle utilise the well-described transfer of radial nerve branches to triceps to the axillary nerve. However, in around 25% of patients, there is a failure of sufficient deltoid reinnervation. It is unclear in the literature if deltoid reanimation should be attempted with a nerve transfer from a weak but functioning triceps nerve. The authors present the largest series of triceps to axillary nerve transfers for deltoid reanimation in order to answer this clinical question. Seventy-seven consecutive patients of a single surgeon were stratified and analysed in four groups: (1) normal triceps at presentation, (2) abnormal triceps at presentation recovering to clinically normal function preoperatively, (3) abnormal triceps at presentation remaining abnormal preoperatively, and lastly (4) where pre-operative triceps function was deemed insufficient for use, requiring alternative reconstruction for deltoid reanimation. The authors considered deltoid re-animation of ≥ M4 as successful for the purpose of this study. Median Medical Research Council (MRC) values demonstrate group 1 achieves this successfully (M5), while median values for groups 2–4 result in M4 power (albeit with decreasing interquartile ranges). Median post-operative shoulder abduction active range of motion (AROM) values were represented by 170° (85–180) in group 1, 117.5° (97.5–140) in group 2, 90° (35–150) in group 3, and 60° (40–155) in group 4. For both post-operative assessments, subgroup analyses demonstrated statistically significant differences when comparing group 1 with groups 3 and 4 (p < 0.05), while all the other group to group pairwise comparisons did not reach significance. The authors postulated that triceps deficiency can act as a surrogate marker of a more extensive plexus injury and may predict poorer outcomes if the weakness persists representing the trending differences between groups 2 and 3. However, given no statistical differences were demonstrated between groups 3 and 4, the authors conclude that utilising an abnormal triceps nerve that demonstrates sufficient strength and redundancy intraoperatively is preferable to alternative transfers for deltoid reanimation. Lastly, in group 4 patients where triceps nerves are damaged and unusable for nerve transfer, alternative operations can also achieve sufficient outcomes and should be considered for restoration of shoulder abduction.

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study.

The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up. The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f=2.79, p=0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4weeks and 6months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112)=0.27, p=0.004). Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

The Reliability and Validity of Wearable Inertial Sensors Coupled with the Microsoft Kinect to Measure Shoulder Range-of-Motion.

Background: Objective assessment of shoulder joint active range of motion (AROM) is critical to monitor patient progress after conservative or surgical intervention. Advancements in miniature devices have led researchers to validate inertial sensors to capture human movement. This study investigated the construct validity as well as intra- and inter-rater reliability of active shoulder mobility measurements using a coupled system of inertial sensors and the Microsoft Kinect (HumanTrak). Methods: 50 healthy participants with no history of shoulder pathology were tested bilaterally for fixed and free ROM: (1) shoulder flexion, and (2) abduction using HumanTrak and goniometry. The repeat testing of the standardised protocol was completed after seven days by two physiotherapists. Results: All HumanTrak shoulder movements demonstrated adequate reliability (intra-class correlation (ICC) ≥ 0.70). HumanTrak demonstrated higher intra-rater reliability (ICCs: 0.93 and 0.85) than goniometry (ICCs: 0.75 and 0.53) for measuring free shoulder flexion and abduction AROM, respectively. Similarly, HumanTrak demonstrated higher intra-rater reliability (ICCs: 0.81 and 0.94) than goniometry (ICCs: 0.70 and 0.93) for fixed flexion and abduction AROM, respectively. Construct validity between HumanTrak and goniometry was adequate except for free abduction. The differences between raters were predominately acceptable and below ±10°. Conclusions: These results indicated that the HumanTrak system is an objective, valid and reliable way to assess and track shoulder ROM.

Measuring upper limb function and patient reported outcomes after major breast cancer surgery: a pilot study in an Asian cohort

BackgroundBreast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer.MethodsThis is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected.ResultsMedian age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396).ConclusionThis pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.

Self-Managed Surveillance for Breast Cancer-Related Upper Body Issues: A Feasibility and Reliability Study.

Early identification of breast cancer-related upper body issues is important to enable timely physical therapist treatment. This study evaluated the feasibility and reliability of women performing self-managed prospective surveillance for upper body issues in the early postoperative phase as part of a hospital-based physical therapy program. This was a prospective, single-site, single-group feasibility and reliability study. Presurgery arm circumference measurements were completed at home and at the hospital by participants and by a physical therapist. Instruction in self-measurement was provided using a video guide. After surgery, all circumference measurements were repeated along with self-assessment and therapist assessment for shoulder flexion and abduction active range of motion. Feasibility was determined by recruitment/retention rates and participant-reported ease of performing self-measurements (1 [very difficult] to 10 [very easy]). Reliability was determined as intrarater reliability, interrater reliability, and agreement. Thirty-three women who were 53.4 (SD=11.4) years old participated, with recruitment and retention rates of 79% and 94%, respectively. Participant-reported ease of measurement was 8.2 (SD=2.2) before surgery and 8.0 (SD=1.9) after surgery. The intrarater reliability and interrater reliability were excellent before surgery (intraclass correlation coefficient [ICC]≥0.94; 95% confidence interval=0.87-0.97) and after surgery (ICC≥0.91; 95% confidence interval=0.76-0.96). Agreement between self-assessed and therapist-assessed active shoulder flexion (κ=0.79) and abduction (κ=0.71) was good. Further testing is needed using a prospective design with a longer follow-up to determine whether self-managed prospective surveillance and timely treatment can hinder the development of chronic breast cancer-related upper body issues. Self-measured arm circumference and shoulder range of motion are reliable, and their inclusion in a hospital-based program of prospective surveillance for upper body issues seems feasible. This approach may improve early detection and treatment.

Patients who are candidates for subacromial decompression have more pronounced range of motion deficits, but do not differ in self-reported shoulder function, strength or pain compared to non-candidates.

Subacromial impingement syndrome (SIS) is associated with low self-reported shoulder function, impairments in shoulder strength and range of motion (ROM), and pain. It is not known how the symptomatology associated with SIS is reflected in the choice of treatment. This study compares self-reported shoulder function, shoulder strength, ROM, and pain in patients with SIS considered candidates and non-candidates for subacromial decompression (SAD). Self-reported shoulder function (Q-DASH and SPADI), maximum isometric muscle strength in shoulder abduction (Abd-strength) and external rotation (ER-strength), active abduction ROM (Abd-ROM) and passive internal rotation ROM (IR-ROM) were measured in a consecutive cohort of patients with SIS referred to an orthopedic outpatient clinic. Additionally, pain during each test and pain levels during the last week were reported. Patients were categorized as candidates or non-candidates for SAD based on their consultation with an orthopedic specialist blinded to test results and self-reported shoulder function. All outcomes and age, gender, weight and duration of symptoms were compared using the unpaired t test or Mann-Whitney's U test as appropriate. One-hundred and fifty-seven patients were included. 25 patients were candidates for SAD, while 132 were not. SAD candidates had significantly lower Abd-ROM (87° vs. 112°, p = 0.011, effect size = 0. 15) and IR-ROM (114° vs. 123°, p = 0.026, effect size = 0.58) additional to higher pain during test of Abd-strength (5.3 vs. 3.7, p = 0.02, effect size = 0.21). No other differences were found between the groups. A decrease in abduction and internal rotation range of motion, and increased pain during maximal abduction strength effort are associated with being considered a candidate for subacromial decompression, while self-reported shoulder function, pain during the last week, and rotator cuff strength are not. As SAD candidates primarily differentiates from non-candidates by having more pronounced ROM deficits, it might be important to address ROM in pre- and postsurgical evaluations, but as the overall differences between the two groups seem minor, the relation between impairments and the choice of treatment needs further clarification. IV.

The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics.

There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion. A custom RSA implant capable of measuring forces across the joint with varying polyethylene constraint was tested in six cadaveric shoulders. Standard-, low- and high-constraint (retentive) polyethylene liners were tested, and joint kinematics, loads and muscle forces were recorded. When polyethylene constraint was altered, joint load and load angle during active abduction were not affected significantly (p > 0.19). Additionally, the force required by the deltoid for active abduction was not affected significantly by cup constraint (p = 0.144). Interestingly, active abduction range of motion was also not affected significantly by changes in cup constraint (p > 0.45). Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.

Effect of electrical stimulation to long head of biceps in reducing gleno humeral subluxation after stroke

Glenohumeral subluxation is the most frequent complication in post stroke hemiplegia and its reduction has been considered an important goal. Though it has been demonstrated that cyclical electrical stimulation of posterior deltoid and supraspinatus muscles can reduce subluxation, the role of biceps has not been given due consideration. The purpose of this study was to determine whether electrical stimulation to the long head of biceps could more effectively reduce gleno humeral subluxation. 24 patients were selected and consecutively assigned to group 1 (electrical stimulation to supraspinatus & posterior deltoid) and group II (electrical stimulation to supraspinatus, posterior deltoid & long head of the biceps) along with routine physiotherapy and occupational therapy for a period of 5 weeks. All patients were assessed for shoulder subluxation, pain and shoulder active abduction range of motion at the time of recruitment to study and after 5 weeks of therapy. Both the groups showed significant improvement in parameters measured. Tukey's post hoc analysis showed the results were more significant in Group II. Electrical stimulation to biceps along with the supraspinatus and posterior deltoid can more effectively reduce shoulder subluxation.

Gait and muscle strength characteristics in total knee arthroplasty patients with patellofemoral pain syndrome before and six months after surgery

The aim of the present study was to investigate the gait and muscle strength characteristics in total knee arthroplasty (TKA) patients with patellofemoral pain syndrome (PFPS) before and six months after surgery. Eight patients (4 men and 4 women) aged 58–77 years with PFPS following unilateral TKA who had primary degenerative knee OA participated in the study before and six months after reoperation.In patients was registered the active range of motion (AROM) of knee extension and flexion, hip abduction and adduction. Isometric maximal voluntary contraction (IMVC) force of knee flexors, extensors, abductors and adductors was measured and gait kinematic characteristics and kinetic characteristics of knee joint were recorded. Knee flexion AROM in the involved leg was significantly lower (p&lt;0.05) as compared to the uninvolved leg pre- and post-surgery. The patients had greater (p&lt;0.05) hip abduction AROM and significant increase (31%, p&lt;0.05) of IMVC force of the involved legʼs hip abductors postoperatively as compared before surgery. Six months after surgery 38 H. Gapeyeva et al. a significant (p&lt;0.05) improvement of gait spatiotemporal characteristics (increase of swing time and stride length (p&lt;0.05), together with decrease of stance time and cadence, as well increase of stride length) was noted in the involved leg. In TKA patients 6 months after reoperation due to PFPS the knee joint function in involved leg was significantly improved and the positive changes in gait with comfortablevelocity took place as compared before surgery.

Shoulder functional assessments in persons with chronic neck/shoulder pain and healthy subjects: Reliability and effects of movement repetition

Obtaining reliable functional capacity measures from injured workers is an essential part of the return to work (RTW) process. The present study compares shoulder functional outcomes between healthy individuals and others with neck/shoulder pain, assesses reliability and examines the influence of repetitive movements on shoulder function. Subjects performed trials of flexion and abduction active range of motion (ROM), and cumulative power output (PO) in a pushing/pulling task on the Baltimore Therapeutic Equipment Simulator II in two consecutive sessions. Tasks were assessed before and after performing a repetitive arm task, during which heart rate (HR) was recorded, until scoring 8 on the Borg CR-10 scale or on a 11-point numeric rating scale (NRS) for pain. Persons with chronic neck/shoulder pain (intensity ≥ 3/10 for > 3 months) (n = 16) and an age- and sex-matched control group (n = 16). Functional shoulder measures demonstrated strong inter-session reliability, except PO in the pain group. Average repetitive task duration was shorter in the pain group (4 min vs. 7 min). The protocol detected both pain- and time-related impairments, with HR and PO being sensitive to movement duration and ROM to pain.

Return of Shoulder Girdle Function After Anterior Versus Posterior Adolescent Idiopathic Scoliosis Surgery

Multicenter, prospective, cohort study. To compare minimum 2-year postoperative shoulder function after 3 different surgical approaches for the treatment of primary thoracic curves in patients with adolescent idiopathic scoliosis (AIS). Thoracic spinal instrumentation and fusion can be performed via posterior (PSF), open anterior (OASF), or thoracoscopic anterior (TASF) techniques. Although the morbidity of these 3 surgical approaches is beginning to be understood, no reports have been published comparing 2-year postoperative shoulder strength and range of motion. AIS patients who underwent selective fusion of primary thoracic curves were studied. Right-sided shoulder strength (flexion, abduction) and range of motion (flexion, extension, abduction) measurements were collected prospectively at selected intervals. An arbitrary threshold (80% of preoperative value) was defined as postoperative return of normal shoulder function. Univariate analysis of variance (P < 0.05) was used to compare differences in shoulder function for the 3 approaches at each postoperative time-point. Ninety-two patients with minimum 2-year postoperative shoulder function data were included in this study (24 PSF, 32 OASF, and 36 TASF). On average, patients who had an OASF failed to reach the 80% threshold for right shoulder forward flexion and abduction strength until 1-year and 6-months after surgery, respectively; whereas patients that had a TASF or PSF returned to normal shoulder strength by the 3-month follow-up visit. With regards to ROM, patients in all 3 groups surpassed the 80% preoperative threshold for right shoulder active forward flexion and extension by the 6-week visit, with no clinically significant differences between the groups. However, for active abduction range of motion, patients that had an OASF required 3-months to regain 80% of their preoperative motion, compared to 6-weeks for patients in both the TASF and PSF groups. Approach-related differences in shoulder morbidity do exist in the treatment of primary thoracic curves in AIS. Specifically, OASF imparts a significantly greater magnitude and duration of postoperative shoulder dysfunction than do the TASF or PSF approaches. Nonetheless, these negative effects are transient as shoulder function in those patients treated via an open thoracotomy normalized by the 1-year postoperative time-point at the latest. Accordingly, viewed in isolation, shoulder morbidity should not deter surgeons from using an open anterior approach in the surgical treatment of AIS.