Shoulder Abduction Research Articles

Comparison of the Post Treatment Outcomes of a Conservative Physiotherapy Protocol for Subacromial Impingement Syndrome in Terms of Acromion Morphology

Objective: The present study aimed to compare the results of a conservative physiotherapy (CP) protocol for subacromial impingement syndrome (SIS) in terms of the morphological types of acromion. Methods: Fifty patients participated in the present study, and they were divided into 3 groups according to the acromion morphology types. A 8-week CP (4-week treatment period at the clinic and, in addition, an exercise program at home for 4 weeks) was applied to all patients. The patients were evaluated in terms of pain (at rest and activity) by the Visual Analog Scale, range of motion (ROM), joint position sense (laser pointer), muscle strength (digital dinamometer), and functionality (the Shoulder Pain and Disability Index, SPADI) before and after the treatment. Result: In the pre- and post-treatment changes (delta), the shoulder flexion angle increased less in the type 3 group than in the type 1 and type 2 groups (p<0.05). In the shoulder abduction angle, there was a similar increase in the type 3 group compared to the type 2 group, while there was less increase in the type 1 group (p<0.05). It was determined that there was more deviation in the change value of shoulder abduction position sense in the type 3 group compared to the other groups (p<0.05). There was no difference between the groups in the change values of pain, muscle strength, or the SPADI score (p > 0.05). Conclusion: Type 3 acromion may have a handicap in improving shoulder flexion and abduction ROM and shoulder abduction position compared to other types.

Comparison of the Effects of Stretching and Splinting in Improving the Range of Motion and Functional Status for Prevention of Post-Burn Axillary Contracture

Background: Burn injuries often lead to severe complications, including axillary contractures, which can significantly restrict shoulder movement and impact quality of life. The rehabilitation strategies for managing post-burn axillary contractures, particularly stretching and splinting, have been the subject of much research, given their potential to improve shoulder range of motion and functional status. Objective: This study aims to compare the effects of stretching combined with splinting versus splinting alone on the range of motion and functional status in patients with post-burn axillary contracture, to determine the most effective treatment modality for preventing the development of contractures. Methods: A single-blinded randomized clinical trial was conducted at the Burn and Plastic Surgery Department of Mayo Hospital, Lahore, over six months. Forty patients aged 20-50 years with Type 1 to Type 3 axillary contractures and shoulder abduction ranging from 20 to 100 degrees were enrolled. Participants were randomly assigned to either Group A (stretching plus splinting) or Group B (splinting alone). Outcomes were measured using the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and goniometry for shoulder motion range, before and after the interventions. Statistical analysis was performed using SPSS version 25, with paired and independent T-tests applied for within and between-group comparisons, respectively. Results: The stretching group demonstrated significant improvements in shoulder motion ranges: flexion (91.00 ± 19.97 to 98.75 ± 19.75, p<0.000), extension (34.50 ± 12.13 to 41.85 ± 12.70, p<0.000), abduction (94.50 ± 26.84 to 103.50 ± 25.97, p<0.000), external rotation (34.15 ± 18.79 to 42.85 ± 18.87, p<0.000), and internal rotation (33.95 ± 11.05 to 42.90 ± 11.03, p<0.000). The DASH scores improved from 21.35 ± 3.58 to 31.30 ± 3.48 (p<0.000). Similar improvements were noted in the splinting group but were more pronounced in the stretching group. Between-group analysis revealed significant differences in favor of the stretching group for all measures of shoulder motion and DASH scores. Conclusion: The study concluded that stretching, when combined with splinting, is more effective than splinting alone in improving shoulder range of motion and functional status in patients with post-burn axillary contracture. These findings suggest that incorporating stretching into the rehabilitation protocols for burn survivors could significantly enhance recovery outcomes.

Prevalence of Arm Weakness, Pre-Stroke Outcomes and Other Post-Stroke Impairments Using Routinely Collected Clinical Data on an Acute Stroke Unit

Introduction The prevalence of upper limb motor weakness early post-stroke may be changing, which can have clinical and research implications. Our primary aim was to describe the prevalence of upper limb motor weakness early post-stroke, with a secondary aim to contextualize this prevalence by describing pre-stroke outcomes, other post-stroke impairments, functional activities, and discharge destination. Methods This cross-sectional observational study extracted clinical data from confirmed stroke patients admitted to a metropolitan stroke unit over 15-months. The primary upper limb weakness measure was Shoulder Abduction and Finger Extension (SAFE) score. Demographics (eg, age), clinical characteristics (eg, stroke severity), pre-stroke outcomes (eg, clinical frailty), other post-stroke impairments (eg, command following), functional activities (eg, ambulation), and discharge destination were also extracted. Results A total of 463 participants had a confirmed stroke and SAFE score. One-third of patients received ≥1 acute medical intervention(s). Nearly one-quarter of patients were classified as frail pre-stroke. Upper limb weakness (SAFE≤8) was present in 35% [95% CI: 30%-39%] at a median of 1-day post-stroke, with 22% presenting with mild-moderate weakness (SAFE5-8). The most common other impairments were upper limb coordination (46%), delayed recall (41%), and upper limb sensation (26%). After a median 3-day acute stroke stay, 52% of the sample were discharged home. Conclusion Upper limb weakness was present in just over a third (35%) of the sample early post-stroke. Data on pre-stroke outcomes and the prevalence of other post-stroke impairments highlights the complexity and heterogeneity of stroke recovery. Further research is required to tease out meaningful recovery phenotypes and their implications.

Immediate effects of Kinesio taping and Dynamic taping on acromiohumeral distance in individuals with symptomatic rotator cuff tendinopathy

BackgroundIt has been suggested that the reduction in subacromial space during arm elevation is one of the potential mechanisms in the etiology of Rotator cuff tendinopathy. While it is known that Kinesio taping reduces the narrowing of the acromiohumeral distance (AHD) during arm elevation, the effect of Dynamic taping remains unknown. PurposeThis study aimed to compare the immediate effects of Kinesio taping and Dynamic taping on AHD in individuals with symptomatic Rotator Cuff Tendinopathy. Study DesignTwo group pre-post-test repeated measures design was used. MethodsThirty-two participants were randomly assigned to two groups: Kinesio taping group (n = 16) and Dynamic taping group (n = 16). AHD measurements were taken via ultrasound at 0° (rest) and 60° shoulder abduction both before and immediately after taping. Repeated measures ANOVAs were used for statistical analyses. ResultsThe study demonstrated that both taping methods led to a significant increase in AHD at both neutral and 60° abduction. However, the increase in AHD with Dynamic taping was statistically greater than with Kinesio taping in both neutral (p < 0.05) and 60° abduction (p < 0.001). ConclusionsThe findings of this study suggest that Dynamic taping techniques may be a more effective approach for improving AHD for symptomatic patients. Therefore, Dynamic taping has the potential to be clinically beneficial before engaging in exercises.

Joint angle estimation during shoulder abduction exercise using contactless technology

BackgroundTele-rehabilitation, also known as tele-rehab, uses communication technologies to provide rehabilitation services from a distance. The COVID-19 pandemic has highlighted the importance of tele-rehab, where the in-person visits declined and the demand for remote healthcare rises. Tele-rehab offers enhanced accessibility, convenience, cost-effectiveness, flexibility, care quality, continuity, and communication. However, the current systems are often not able to perform a comprehensive movement analysis. To address this, we propose and validate a novel approach using depth technology and skeleton tracking algorithms.MethodsOur data involved 14 participants (8 females, 6 males) performing shoulder abduction exercises. We collected depth videos from an LiDAR camera and motion data from a Motion Capture (Mocap) system as our ground truth. The data were collected at distances of 2 m, 2.5 m, and 3.5 m from the LiDAR sensor for both arms. Our innovative approach integrates LiDAR with the Cubemos and Mediapipe skeleton tracking frameworks, enabling the assessment of 3D joint angles. We validated the system by comparing the estimated joint angles versus Mocap outputs. Personalized calibration was applied using various regression models to enhance the accuracy of the joint angle calculations.ResultsThe Cubemos skeleton tracking system outperformed Mediapipe in joint angle estimation with higher accuracy and fewer errors. The proposed system showed a strong correlation with Mocap results, although some deviations were present due to noise. Precision decreased as the distance from the camera increased. Calibration significantly improved performance. Linear regression models consistently outperformed nonlinear models, especially at shorter distances.ConclusionThis study showcases the potential of a marker-less system, to proficiently track body joints and upper-limb angles. Signals from the proposed system and the Mocap system exhibited robust correlation, with Mean Absolute Errors (MAEs) consistently below 10∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$10^\\circ$$\\end{document}. LiDAR’s depth feature enabled accurate computation of in-depth angles beyond the reach of traditional RGB cameras. Altogether, this emphasizes the depth-based system’s potential for precise joint tracking and angle calculation in tele-rehab applications.

DOP13 Effect of 8 weeks of combined aerobic and resistance exercise on quality of life, muscle strength, aerobic capacity, and disease activity in patients with Inflammatory Bowel Disease; a parallel group randomized clinical trial

Abstract Background Sarcopenia is prevalent in patients with IBD (inflammatory bowel disease). This study aimed to assess the effects of an 8-weeks combined aerobic and resistance training program on the quality of life, disease activity, muscle strength, and aerobic capacity in patients with IBD. (Registration ID: NCT05455762) Methods This study was a single-blind parallel-group randomized clinical trial. Inclusion criteria were patients 18 to 65 years old with a confirmed diagnosis of IBD. Exclusion criteria: active malignancy, consumption of systemic corticosteroids, and patients with moderate to severe physical activity more than 150 minutes/week. Patients were allocated to each group by block randomization with a 1:1 ratio. The intervention consisted of walking sessions on even days and six resistance exercises on odd days. The primary outcome was the patients' quality of life, measured by the Persian version of the ibdq-9 questionnaire. secondary outcomes included disease severity, muscle strength, 6-minute walk test, and 30-second sit-to-stand test. We measured muscle strength by a handheld dynamometer. Results Of 72 patients screened 64 were eligible for the study. During the follow-up period, 13 patients, 8 from the exercise group and 5 from the control group, were excluded from the study. 51 patients, 28 females and 23 males, with a mean age of 34.9 ± 10.57 were analyzed. Two groups were matched in demographic and IBD-related characteristics. Unlike the control group, the exercise group showed a significant increase in overall quality of life (40.29 to 47.75, p=0.005), particularly in intestinal and systemic symptoms domains (p=0.01 and p=0.004). the inter-group analysis found no significantly higher mean difference in QOL scores between the exercise and control groups (p=0.053). The Partial Mayo score in patients with ulcerative colitis (UC) significantly decreased in the intervention group but not in the control group. The Harvey-Bradshaw index in Crohn patients didn’t change in either group. There were no exercise-related serious complications. The 6-minute walk test distance significantly increased in the exercise group but not in the control group. The 30-second sit-to-stand test didn’t significantly change in either group. Of muscles examined (hand grip, shoulder abductor, hip flexor, knee extensor, and elbow flexor) only knee extension strength increased in both groups. Conclusion Combined resistance and aerobic exercise in patients with IBD is safe and can significantly improve the quality of life and aerobic capacity. This regimen also improved clinical severity in patients with UC but not in Crohn’s. Muscle strength did not significantly improve when comparing the two groups, possibly due to the short duration of the intervention.

Biomechanical effect of increased number of suture strands on rotator cuff repair in a bovine model.

This study aimed to investigate if there was a link between the biomechanical properties and the number of suture strands in repairing a rotator cuff (RC) tear in a bovine model using the transosseous technique. Fifty-four fresh tendons from bovine (mean age: 7.1 ± 0.5 months; range 6.5-7.5 months) and 1 humeral head from porcine (8.5 months) were used in this study. All the specimens had no apparent abnormalities. Using the transosseous structure, the RC tendon was detached from the greater tuberosity and randomly assigned to 3-strand, 4-strand, 5-strand, and 6-strand groups, with the glenohumeral abducted at 0° and 90°. Biomechanical tests were conducted to compare the groups' differences in the failure mode, pull-toextension load in the 1-, 2-, and 3-mm formations, and the maximum load. The analysis of variance test was performed to compare the results. Statistical significance was set at P < .05. No significant difference was observed among the groups concerning the tendon characteristics (all P ≥ .05). At 90° shoulder abduction, a significant difference was detected in the load between 3- and 5-strand groups for 1-mm gap formation (P=.049). No statistical differences were noted in the load at the gap displacements in the 1-, 2-, and 3-mm formations at 0° and 90° shoulder abduction (all P > .05). The maximum failure load and extension in maximal tension increased with the number of sutures. The maximum load and ultimate extension increase with the number of sutures at both positions. The number of sutures was not an influencing factor of gap formation. Regarding the tear size and tension of the RC, choosing the appropriate number of strands individually instead of excessively increasing the number of sutures is advocated for RC repair.

Self-assessment of range of motion in patients undergoing surgery for a unilateral shoulder condition.

This study aimed to investigate the agreement of patient-assessed and researcher/physician-assessed measurements of the difference in range of motion between the unaffected and affected shoulders in 55 patients undergoing arthroscopic surgery for a unilateral shoulder condition. The investigation included 55 patients (17 women and 38 men; median age=53 years; range=26-74) with a symptomatic unilateral shoulder condition and a surgically treatable diagnosis. Images of a model/researcher performing active shoulder abduction, flexion, external rotation, and internal rotation were created. Each image was paired with a degree diagram or a level system (for internal rotation) on the back for the patient to accurately self-evaluate and record. Each patient was instructed to attentively examine the figures and perform the movements with the same posture as depicted. On the day of surgery, prior to the procedure, 2 independent researchers who were not involved in the patient's care used a standard goniometer to assess the same active movements that the patient had previously self-assessed. For agreement analyses, the intraclass correlation coefficient and Bland-Altman plots were calculated for continuous data (abduction, flexion, and external rotation), and Cohen's weighted kappa was calculated for ordinal categorical data (internal rotation). The intraclass correlation coefficient for abduction, flexion, and external rotation was 0.93 (excellent) 95% CI (0.87, 0.96), 0.89 (good) 95% CI (0.81, 0.94), and 0.72 (moderate) 95% CI (0.52, 0.84), respectively. Cohen's kappa for internal rotation (measured as reaching levels on the back) was 0.63 (moderate). We believe that patient-assessed measurements of abduction (intraclass correlation coefficient 0.93) and flexion (intraclass correlation coefficient 0.89) can be used as a valid substitute (for measurements by a clinician or researcher). Patient-assessed measurements for external rotation (intraclass correlation coefficient 0.72) and internal rotation (kappa 0.63) are in moderate agreement and should be used more cautiously as substitutes. Level II, Diagnostic Study.

Comparison of Shoulder Range of Motion Quantified with Mobile Phone Video-Based Skeletal Tracking and 3D Motion Capture-Preliminary Study.

The accuracy of human pose tracking using smartphone camera (2D-pose) to quantify shoulder range of motion (RoM) is not determined. Twenty healthy individuals were recruited and performed shoulder abduction, adduction, flexion, or extension, captured simultaneously using a smartphone-based human pose estimation algorithm (Apple's vision framework) and using a skin marker-based 3D motion capture system. Validity was assessed by comparing the 2D-pose outcomes against a well-established 3D motion capture protocol. In addition, the impact of iPhone positioning was investigated using three smartphones in multiple vertical and horizontal positions. The relationship and validity were analysed using linear mixed models and Bland-Altman analysis. We found that 2D-pose-based shoulder RoM was consistent with 3D motion capture (linear mixed model: R2 > 0.93) but was somewhat overestimated by the smartphone. Differences were dependent on shoulder movement type and RoM amplitude, with adduction the worst performer among all tested movements. All motion types were described using linear equations. Correction methods are provided to correct potential out-of-plane shoulder movements. Shoulder RoM estimated using a smartphone camera is consistent with 3D motion-capture-derived RoM; however, differences between the systems were observed and are likely explained by differences in thoracic frame definitions.

Impaired muscle parameters in adults with mild to severe types of osteogenesis imperfecta: a cross-sectional study.

Impaired muscle parameters may further compromise the already compromised skeleton in individuals with OI. This cross-sectional study aimed to compare muscle function and body composition in adults with various OI types and healthy controls. Sixty-eight adults with OI (mean age 42.2yr; 27 men) and 68 healthy age- and sex-matched controls were recruited. Maximal isometric muscle force was assessed by handheld dynamometry (hand grip, hip flexors, shoulder abductors, and ankle dorsiflexors), muscle endurance by posture maintenance tests (shoulder abduction, hip flexion, and wall sit), and functional lower limb strength by 30-s chair rise test. In a sub cohort, dynamic muscle function (peak power and force) was assessed by a ground reaction force plate, and lean and fat mass, muscle and fat cross-sectional area (CSA), and muscle density by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Multiple linear regression models were fitted with group (OI type I, III, IV/V, or controls), country, sex, and age in the fixed effects part. Overall, adults with various types of OI had lower isometric, endurance, and functional muscle strength (mean difference [MD] = OI type I: 19-43%, OI type IV/V: 25-68%, OI type III: 20-72%) compared to controls. Furthermore, adults with OI type I had lower dynamic muscle function (peak force [MD = 25-29%] and power [MD = 18-60%]), lean mass (MD = 10-17%), muscle CSA (MD = 9-21%), and muscle density (MD = 2-3%) but higher adiposity indices (MD = 24-42%) compared to controls. Functional lower limb strength and maximal muscle force were significantly different between OI types, whereas muscle endurance was not. To conclude, adults with OI present with markedly impaired muscle function which may partially be explained by their altered body composition. Our findings emphasize the need for proper assessment of various muscle parameters and (research into) appropriate and safe muscle strengthening approaches in this population.

Surgical Reconstruction of Elbow Extension in Spinal Cord Injury and Tetraplegia: A Systematic Review

Surgical reconstruction of elbow extension can help restore function in patients with tetraplegia and triceps paralysis because of spinal cord injury. Both posterior deltoid-to-triceps tendon transfer and transfer of the branch of the axillary nerve to the triceps motor branch of the radial nerve have been described for triceps reanimation. This systematic review aimed at reviewing current evidence in the two schools of surgery in terms of their outcome and complication profile. A systematic review was conducted using MEDLINE (1974-2023) and EMBASE (1946-2023) databases. The keyword terms "elbow extension," "triceps," "deltoid," "nerve transfer," "spinal cord injury," "tetraplegia," "quadriplegia," and "tetraplegic" were used in the initial search, which was supplemented with manual searches of the bibliographies of retrieved articles. Twenty studies met our inclusion criteria, with 14 studies (229 limbs) on posterior deltoid-to-triceps tendon transfer, 5 studies (23 limbs) on axillary to radial nerve transfer, and 1 study (1 limb) on combined transfer. For the tendon transfer group, the majority of studies reported a median triceps power of grade 3, with a wide range of failure percentage to reach antigravity (0% to 87.5%). Common complications included gradual stretching of the musculotendinous unit, rupture of the tendon transferred, elbow contracture, and infection. For the nerve transfer group, the majority of studies also reported a median triceps power reaching grade 3. There were no reported complications or loss of power in donor action of shoulder abduction or external rotation. Transfer of the axillary nerve branch to the triceps motor branch of the radial nerve in tetraplegia shows promising results, with comparable triceps muscle power compared to traditional tendon transfer and a low incidence of complication. Systematic Review III.

Dependence of Rotator Cuff Muscle Thickness and Stiffness on Low-Level Contractions: Metrology of the Contraction Level Using Shear-Wave Imaging.

The study aimed to investigate the effects of the level of contraction during isometric shoulder abduction at different abduction angles on muscle thickness and stiffness of the shoulder girdle in asymptomatic individuals. Measurement properties study. Biomechanics and motion analysis lab. Twenty individuals volunteered to participate in this study. The subjects were tested for morphological and mechanical properties, expressed by thickness and stiffness of the supraspinatus tendon and muscle, and upper trapezius muscle. Moreover, acromiohumeral distance was also evaluated using B-mode ultrasound and shear-wave elastography. The thickness and stiffness of the supraspinatus and upper trapezius muscle were assessed at 3 angles of abduction (0°, 60°, and 90°) and 3 levels of contraction (0%, 10%, and 20% of the maximal voluntary isometric contraction) using ultrasonography with shear-wave imaging. Moreover, the acromiohumeral distance was measured to establish the occupation ratio during passive movement. The supraspinatus and upper trapezius muscle thickness and stiffness were significantly greater at 60° shoulder abduction compared with 0°, and 90° compared with 60°, as well as significantly greater at 20% maximal voluntary isometric contraction compared with 0% and 10% maximal voluntary isometric contraction. Thickness and stiffness were significantly greater in the supraspinatus compared with the upper trapezius muscle at all 3 angles of shoulder abduction for all 3 level of contractions. The acromiohumeral distance decreased significantly from 0° to 60° and from 60° to 90°. Morphological and mechanical properties of the supraspinatus and upper trapezius muscles depended on the relative level of muscle contraction and the angle of shoulder abduction.

Arthroscopic Repair of Rotator Cuff Tears in Older Adults: A Retrospective Case-Series Study.

Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old. A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6months and one subacromial corticosteroid injection. Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment. The arthroscopic repair of RCTs in patients 60years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal.

Effect of Corrective Exercises on Posture, Upper Extremity Muscle Activity, and Shoulder Kinematics in Male Handball Players With Upper Cross Syndrome

Background and Aims Abnormal posture and alterations in movement and muscle activity patterns have been reported in people with upper cross syndrome (UCS). These changes can lead to imbalance in muscle activation, altered movement patterns, and biomechanical changes. The present study aims to investigate the effect of corrective exercises on posture, upper extremity muscle activity, and shoulder kinematics in male handball players with UCS. Methods This quasi-experimental study was conducted on 30 male handball players with UCS who were randomly divided into exercise (n=15) and control (n=15) groups. The variables including upper extremity muscle activation patterns, shoulder kinematics, forward head posture, forward shoulder posture, and kyphosis were evaluated before and after intervention. Should kinematics and activation patterns of upper extremity muscles (supraspinatus, lumbar erector spinae, upper trapezius, middle trapezius, latissimus dorsi, pectoralis major) were recorded using electromyography and motion analyzer. The angles of forward head and forward shoulder were assessed using photographic method taken from lateral view, and Kyphosis angle was measured using a flexible ruler before and after exercises. The exercise group performed the comprehensive corrective exercises for 8 weeks (3 sessions per week), but the control group did not receive any intervention. To analyze the data, two-way analysis of variance and Bonferroni test were used. The significant level was set at 0.05. Results Forward head posture (P=0.001), forward shoulder posture (P=0.003), and kyphosis (P=0.002) showed significant improvements in the exercise group compared to the control group from pretest to post-test phase. In the preparatory and throw phases (slow and fast throwing), higher activities of supraspinatus, lumbar erector spinae, upper trapezius, middle trapezius, latissimus dorsi, and pectoralis major were observed in the exercise group compared to the control group (P=0.05). Moreover, in the preparatory and throw phases, higher range of motion of shoulder flexion, forward flexion of shoulder, internal rotation of shoulder, external rotation of shoulder, and shoulder abduction were observed in the exercise group compared to the control group (P=0.05). Conclusion Corrective exercises can significantly alter shoulder kinematics and upper extremity muscle activity patterns in male handball players with UCS, which can be used in future studies to prevent UCS in handball players during throwing the ball.

Cultural Innovation Path of Guanzhong Festivals and Folklore Activities for a Healthy China

Abstract In the pursuit of a healthy China, festival folk activities, as a crucial component of national fitness, significantly contribute to the enhancement of people’s physical and mental health. This paper takes Ankang dragon boat racing activities as the entry point, analyzes the cultural connotation and digital innovation path of the Guanzhong region’s Dragon Boat Festival folk activities, and explores the modern information technology-enabled cultural innovation of Ankang dragon boat racing. We examine how Ankang Dragon Boat Racing’s innovation mode improves physical and mental health. Ankang Dragon Boat Racing activity has statistically demonstrated the ability to reduce negative emotions in participants and foster mental well-being. The scores for panic and anger decreased by 19.68 and 19.72 points, respectively. Measurements of physical fitness and health, including the 30-second elbow flexion test, the 30-second sitting and standing test, the 4-minute in-situ leg raising test, seated forward bending, arm circumference, shoulder supination, shoulder abduction, and so on, also showed significant improvements. The study demonstrated that the dragon boat exercise significantly enhanced physical function, resulting in an 87.01% and 28.36% improvement in the subjects’ mean values of the 30-second sitting and standing test and seated forward bending before and after the exercise, respectively. This improvement was beneficial for individuals from various paddling levels, age groups, and living environments. This study has provided useful research on the inheritance and innovation of festival folklore activities, as well as the health effects of dragon boat racing activities in the Guanzhong region.

Functional Outcomes of Quadruple Nerve Transfer in Upper Brachial Plexus Injuries

Abstract Background: Brachial plexus injuries represent a devastating injury causing paralysis of the upper extremity. An injury to the superior plexus can cause loss of function in the shoulder and elbow. Early presentations can be well managed with nerve transfers to restore shoulder and elbow function. Our study aimed to evaluate the functional outcome of nerve transfers to restore shoulder and elbow recovery in upper brachial plexus injury. Methods: Functional outcomes of 25 patients undergoing quadruple nerve transfer using an all-anterior approach were analyzed for improvements in motor strength and range of motion in the shoulder and elbow joints. Results: Excellent results were observed in 23/25 patients with respect to elbow function and good in 15/25 for shoulder function. The first sign of clinical biceps reinnervation was 3 months 9 days (range: 2 months from 25 days to 4 months) and recovery of antigravity elbow flexion was 5 months (range 4 months–8 months). Twenty-two had M4 power and two M3. On assessment of shoulder function and abduction, eight patients had M3, and four had M4 shoulder abduction. The mean range of abduction in these eight patients was 60° (range, 45–100). Seven patients regained active external rotation, a mean of 30° (range, 15–60). Motor recovery of external rotation was M3 in five patients and M4 in two. Of 25, 7 had no active abduction/external rotation but felt their shoulder was more stable. Conclusion: Quadruple nerve transfer for shoulder function and elbow flexion produces the best results in patients with superior brachial plexus injuries. Surgeries performed earlier than 6 months can provide good functional recovery. The result on the shoulder is less compared to the functional recovery of the elbow after nerve transfer.

Intra-session reliability of isometric muscle strength of the bilateral standing press in female handball players.

Systematizing reliable protocols and procedures for strength assessment in handball has allowed for a more thorough kinetic analysis and increased precision in detecting training-induced changes in muscular strength. The evaluation of upper limb strength with a bilateral standing press (BSP) exercise in handball players approximates blocking actions in the defensive phase, pushing and fixation. The aim of this study was to analyze the relative and absolute reliability of intra-session comparisons in an isometric peak muscle strength protocol in a bilateral standing press (BSP) exercise among female handball players. Sixteen young female handball players at an international level, aged between 22 ± 4 years, with no prior experience in using functional electromechanical dynamometers (FEMD) participated in this study. The participants initiated the assessment of maximum isometric force in a bipedal stance with a forward projection of the dominant foot between 20 and 30 cm. The knees were kept semi-flexed, and the hip extension of the non-dominant limb ranged from 15 to 20°. Bilateral anterior push of the upper limb was performed with shoulder abduction and elbow flexion at 90°, maintaining a pronated hand position. Participants were instructed to exert three sets of maximal force for 5 s in BSP exercise. Relative reliability was assessed using the model intraclass correlation (ICC) and absolute reliability was assessed using the coefficient of variation (CV) and standard error of measurement (SEM). For this study, the parameters of maximum and mean muscle strength were considered. The results demonstrated high relative reliability (ICC 0.93-0.97) and absolute reliability (SEM 0.19-2.79) y (CV 4.78-9.03) for both mean force and peak force, with no significant differences between the sets (p > 0.05), indicating a negligible effect size (0.01-0.12). The mean and peak isometric muscle strength for the BSP exercise controlled with FEMD in female handball players exhibits high relative and absolute reliability between series.

Morphological changes in the interosseous membrane of the forearm during forearm rotation.

[Purpose] Changes in forearm interosseous membrane dynamics during forearm rotation relative to the shoulder joint position remain poorly understood. The purpose of this study was to clarify interosseous membrane dynamics during forearm rotation in shoulder abduction and external rotation positions. [Participants and Methods] We conducted open magnetic resonance imaging on 17 healthy forearms in the prone position. Three limb positions were set for measuring the forearm rotation angle: intermediate, maximum pronation, and maximum supination. Images were obtained with the shoulder joint abducted at 90°and externally rotated at 90°. The forearm interosseous membrane angle was measured at three points: the apex of the forearm interosseous membrane, the radius, and the ulna. The measurement of the interosseous angle was repeated thrice. [Results] Sufficient intra-rater reliability was confirmed for the forearm interosseous membrane angle measurement. The interosseous membrane of the forearm showed a mean dorsal convex shape during forearm pronation (141.7° ± 0.83°), and the mean palmar convex shape during forearm supination (-141.6° ± 0.64°). [Conclusion] This study provides useful information for future research by quantifying the dynamics of the interosseous membrane of the forearm, which is an important soft tissue for forearm rotation. The establishment of a quantitative evaluation method for forearm interosseous morphological changes will help further elucidate forearm rotation movements during sports activities.

Traditional Siddha Approach in Treating Frozen Shoulder (Kumbavatham) by Use of Varmam and Thokkanam Therapy- a Case Study

Adhesive Capsulitis or Frozen shoulder also termed as Kumbavatham in Siddha system of medicine, causes swelling and stiffness in particular shoulder capsule restricting its mobility and ROM. The pain intensity is seen to increase in night times with gradual onset of shoulder stiffness and restriction in movement of the shoulder. Conservatively, it can be treated by analgesics, oral steroids, and intra-articular corticosteroid injections. Sometimes, the symptoms persists despite taking conservative measures, initiating patients to opt for alternative therapies for reducing pain and provide flexibility to the joint. A 34-year male from Bangalore presented with severe pain and restricted movements like abduction, adduction, external rotation and flexion of right shoulder both in active and passive movements for last 6 months. The patient was in distressed condition and even small daily tasks were difficult for him. MRI report confirmed of adhesive capsulitis (kumbavatham), one of the vatha diseases mentioned in Siddha system of medicine. A one-month Siddha vaidyam theraupatic approach incorporating Varmam therapy and thokkanam was administered to him. After 25 days, vast improvement in swelling and stiffness with all movements free in Right shoulder with no pain on moving the right arm. The holistic approach of Siddha medicine has provided the reduction in pain measured on VAS and improved restricted movements which was measured using goniometer and SPADI index. The Siddha system of Medicine is a simple and traditional approach for the treatment of such painful conditions. Conservative management of Adhesive capsulitis through Siddha practices provided significant relief by reducing pain and providing better flexibility in shoulder joints without aid of any analgesics. The paper also gives the details of the method employed and lifestyle modification techniques used to treat the individual.

Reliability and validity of new isokinetic strength assessment for rotator cuff muscles in a muscle architecture-based position.

Isokinetic strength assessment of the rotator cuff muscle is frequently applied in a variety of shoulder postures, but none of these consider muscular architecture, which is one of the most important aspects of improving strength development. This study aimed to examine the test and retest reliability and validity of the muscle architecture-based position (MABP), which is 25° abduction and 20° external rotation, in healthy subjects to be able to select a better isokinetic assessment position for shoulder rotator cuff muscles. A total of 54 healthy males with a mean age of 21.0 ± 1.2 years and mean body mass index of 22.8 ± 1.7 kg/m2 completed an isokinetic measurement session. All of the tests were performed on an IsoMed 2000 isokinetic dynamometer concentrically and eccentrically for both upper limbs at 60°/s angular velocity. All of the participants completed 3 measurement sessions: the first represented the isokinetic testing and was performed in the scapular neutral position (SNP) (45° shoulder flexion and abduction), the second represented the MABP (25° abduction and 20° ER) for shoulder rotator cuff muscles, and the third represented the test and retest of the MABP. The correlations between the 2 techniques for assessing concurrent validity ranged from 0.908 to 0.994. The values obtained from the MABP were higher than those obtained in the SNP. There was no systematic bias for any measurements between the MABP and the retest of the MABP (p > 0.05). The intraclass correlation coefficients representing the test and retest reliability results for each variable measured with the MABP was higher than 0.98 and this value was considered as excellent reliability. In conclusion, the MABP can be used to assess the isokinetic strength of the rotator cuff muscles safely and confidently, with increased quantities of force being released and measurement at optimal muscle tension.