Abduction Research Articles

Individualized Analysis of Lateral Asymmetry Using Hip-Knee Angular Measures in Soccer Players: A New Methodological Perspective of Assessment for Lower Limb Asymmetry.

This study aimed to: (1) determine the magnitude and direction of lateral asymmetry in well-trained soccer players using hip and knee ROM tests; (2) inquire if asymmetry relies on the ROM test performed and/or gender; and (3) establish asymmetry thresholds for each ROM test to individualize lower-limbs asymmetry. One hundred amateur soccer players were assessed using hip–knee ROM tests: Straight Leg Raise, modified Thomas Test, hip internal rotation and external rotation, hip abduction (ABD) and adduction (ADD), Nachlas Test and Rigde Test. There are significant differences between tests when determining the magnitude of lateral asymmetry (F = 3.451; p = 0.001; ηp2 = 0.031) without significant differences between gender (F = 0.204; p = 0.651; ηp2 = 0.001). Asymmetry threshold results differ significantly between using a fixed or a specific threshold (F = 65.966; p = 0.001; ηp2 = 0.985). All tests indicate that the direction of asymmetry is towards the dominant limb. In conclusion, the ROM test used determines the magnitude and direction of the lateral asymmetry of the amateur soccer players. The ABD and ADD are the ROM tests that showed higher percentages of asymmetry, without differences between female and male soccer players. Using a specific asymmetry threshold formula can classify more players as asymmetrical than with a fixed threshold.

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

Reverse total shoulder arthroplasty with a humeral inclination of 135º for treatment of 3- and 4-part proximal humeral fractures: Clinical analysis with minimum follow-up of 2 years

Background: The reverse shoulder arthroplasty (RSA) is indicated for the treatment of proximal humerus fractures (PUF). To present day, there are limited data regarding the difference in functional outcomes of the RSA with a humeral inclination of 135º or 155º, in fracture context. The purpose of this study is to retrospectively analyze the functional outcomes of complex PUF treated with RSA with a humeral inclination of 135º. Materials and Methods: We carried out a retrospective study in which we analyzed 22 patients with PUF, who underwent RSA with a humeral inclination of 135º, between January 2017 and June 2019. Functional outcomes were measured through the Q-DASH and ASES scores. The Constant-Murley score (CS), active elevation (AA), abduction (ABD), internal rotation (IR), external rotation (ER), and abduction strength were obtained in both arms, using the contralateral shoulder as an estimative of preinjury function. Results: The patients were followed for a mean of 39.5 months. Seven patients were pain-free while performing their daily activities. Thirteen referred minor pain in their usual activities and 2 reported moderate to very severe pain. The mean ASES and Quick-DASH scores were 80% and 18.1 points, respectively. The CS was 59 points, 13 points less than the nonoperated side. The average AA was 128º, ABD 123º, ER 27º, and IR 36º. We found no correlation between the age and ASES score or Q-DASH score and between ER and ASES or Q-DASH score, but we found a positive correlation between ASES score or Q-DASH score and AA, ABD and IR. Conclusion: RSA is a valid and reliable option in selected elderly patients with complex PUF. The choice of the RSA humeral inclination (135º Vs 155º) does not currently have defined criteria, and there are no studies with sufficient statistical power to validate one of these options.

The clinical assessment of hip muscle strength in professional rugby union players

Groin/hip injuries are prevalent in rugby union (RU). Assessment of hip muscle strength is important when designing bespoke injury prevention and rehabilitation programmes. ObjectiveThe primary aim of this study was to determine normative values of hip muscle strength in elite-level RU players. A secondary aim of this study was to compare the Copenhagen Hip and Groin Outcome Score (HAGOS) between players with and without a history of groin/hip injury. DesignCross-sectional cohort study. SettingProfessional RU club. Participants58 male professional RU players competing in the PRO14 league elite club level competition. Main outcome measuresHandheld dynamometry eccentric strength values of hip abduction (ABD), adduction (ADD), internal rotation (IR) and external rotation (ER), HAGOS. ResultsPlayers' dominant (DOM) and non-dominant (NDOM) hip strength values were, 2.38 and 2.34 N m/kg for ABD, 2.79 and 2.71 N m/kg for ADD, 2.69 and 2.55 N m/kg for IR, and 2.65 and 2.54 N m/kg for ER. ADD:ABD strength ratio was 1.17 ± 0.26 for the DOM limb and 1.16 ± 0.24 for the NDOM limb. There was no clinically significant difference in strength between players’ DOM and NDOM limbs. Players with a history of groin/hip injury scored lower on four of the HAGOS subscales (pain; symptoms; sport; quality of life) compared to those without a history of groin/hip injury. ConclusionsThis study may help establish normative hip strength and HAGOS values for elite-level RU players. The results presented have important implications for the assessment of hip muscle strength and could provide clinical markers for return-to-play following injury.

Effect Of Hip Strength On Backwards Single-Legged Jump-Landing Vertical Ground Reaction Force

Commonly proposed risk factors for lower-extremity injury include high vertical peak ground reaction force (vGRF) and rate of force development (vRFD) during a backward single-legged jump-landing (SLJL), deficient hip external rotation (ER) and abduction (ABD) strength, and fatigue. PURPOSE: The purpose of this study was to evaluate the effect of ER and ABD on vGRF and vRFD following SLJL. It was hypothesized low ER and ABD coupled with fatigue would be associated with high vGRF and vRFD. METHODS: Twenty-seven healthy males (n = 10) and females (n = 17) (24.0 ± 2.8 y, 1.73 ± .08 m, 75.0 ± 14.0 kg) participated in this repeated measure study which included rest (R) and fatigue (F) protocols. ER and ABD isometric torque (Nm·kg-1) on the dominate leg were measured using a handheld dynamometer. For R, participants performed SLJL (PRE), rested for 5 minutes, and then reperformed SLJL (POST). For F, participants performed SLJL (PRE), a 7 minute fatigue protocol, and then reperformed SLJL (POST). R and F were performed in a random order. SLJL was performed by jumping backward off the test leg over a .15 m hurdle, landing on the test leg on a force plate, and stabilizing quickly. vGRF (N·kg-1) and vRFD (N·kg-1·s-1) were calculated. Participants were stratified into high-strength (HS) and low-strength (LS) groups using ER and ABD and a k-means cluster analysis. Linear mixed-models were used to assess the effect of group and protocol on vGRF and vRFD with Bonferroni corrected post-hoc tests. Significance was initially set to p < .05. RESULTS: 16 participants were stratified into HS (ER = 4.3 ± .9, ABD = 8.3 ± 1.0) and 11 into LS (ER = 3.3 ± 1.0, ABD = 5.8 ± .9). There was no effect of group on vGRF (HS = 2.98 ± .59, LS = 3.03 ± .59, p = .627) or vRFD (HS = 35.8 ± 19.8, LS = 37.1 ± 18.9, p = .735). HS and LS did not responded differently to R and F for vGRF (p = .694) or vRFD (p = .899). Further, with all subjects pooled, they did not respond differently to R and F for vGRF (p = .081), but they did for vRFD (p < .001). vRFD POST F (41.2 ± 22.3) was higher than PRE F (34.9 ± 22.3, p < .001) and POST R (32.9 ± 22.3, p < .001). CONCLUSION: There is no effect of ER and ABD on vGRF and vRFD and vGRF does not increase with fatigue, but vRFD does increase with fatigue. This may suggest a reduction in the ability to quickly attenuate forces when fatigued and may potentially increase the risk for injury.

Clinical and Radiological Outcomes in Reverse Total Shoulder Arthroplasty by Inclination Angle With a Modular Prosthesis.

The influence of the humeral inclination in reverse total shoulder arthroplasty (RTSA) is not well understood. The purpose of this study was to determine outcomes and complications after RTSA with an inclination of 135° or 155° in a modular prosthesis. American Shoulder and Elbow Surgeons (ASES), visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) scores, as well as forward elevation (FE), abduction (ABD), and external rotation (ER), were assessed after a minimum 2-year follow-up. Scapular notching and radiolucency were assessed according to Sirveaux and Lévigne. A total of 121 patients with a mean age of 69.7±7.3 years were evaluated after a mean of 36.5±8 months. The inclination was set to 135° in 80.2% and to 155° in 19.8% of patients. There was no significant difference between the groups for ASES, VAS, SANE, and SST scores. The FE (P=.022) and ABD (P=.002) were significantly higher for the 155° inclination group. Complication rates were not significantly different between the groups. Scapular notching was significantly more common with a 155° inclination (P=.01), whereas humeral radiolucency was not correlated. All outcome scores improved significantly from pre- to postoperative (P≤.001). Reverse total shoulder arthroplasty leads to significant improvements in pain, range of motion, and outcome scores after mid-term follow-up. Overall, the inclination angle does not significantly affect clinical outcomes or the complication rate after RTSA at mid-term follow-up. However, an inclination of 155° shows significantly greater FE and ABD, although it results in a significantly higher rate of scapular notching. Cases with scapular notching are associated with significantly reduced mean ASES scores and ER as well as significantly higher VAS scores. [Orthopedics. 2021;44(4):e527-e533.].

Asymptomatic Medial Elbow Ultrasound Abnormality in Youth Baseball Players Is an Independent Risk Factor for Elbow Injury: A Prospective Cohort Study.

Background:Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries.Purpose:To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for in-season elbow injuries in youth baseball players.Study Design:Cohort study; Level of evidence, 2.Methods:Youth baseball players (N = 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for ≥8 days.Results:The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P = .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P = .012).Conclusion:Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population.

Shoulder position and handedness differentially affect excitability and intracortical inhibition of hand muscles.

Individuals with stroke show distinct differences in hand function impairment when the shoulder is in adduction, within the workspace compared to when the shoulder is abducted, away from the body. To better understand how shoulder position affects hand control, we tested the corticomotor excitability and intracortical control of intrinsic and extrinsic hand muscles important for grasp in twelve healthy individuals. Motor evoked potentials (MEP) using single and paired-pulse transcranial magnetic stimulation were elicited in extensor digitorum communis (EDC), flexor digitorum superficialis (FDS), first dorsal interosseous (FDI), and abductor pollicis brevis (APB). The shoulder was fully supported in horizontal adduction (ADD) or abduction (ABD). Separate mixed-effect models were fit to the MEP parameters using shoulder position (or upper-extremity [UE] side) as fixed and participants as random effects. In the non-dominant UE, EDC showed significantly greater MEPs in shoulder ABD than ADD. In contrast, the dominant side EDC showed significantly greater MEPs in ADD compared to ABD; %facilitation of EDC on dominant side showed significant stimulus intensity x position interaction, EDC excitability was significantly greater in ADD at 150% of the resting threshold. Intrinsic hand muscles of the dominant UE received significantly more intracortical inhibition (SICI) when the shoulder was in ADD compared to ABD; there was no position-dependent modulation of SICI on the non-dominant side. Our findings suggest that these resting-state changes in hand muscle excitabilities reflect the natural statistics of UE movements, which in turn may arise from as well as shape the nature of shoulder-hand coupling underlying UE behaviors.

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 (P = .016). No significant differences were found between groups regarding clinical shoulder scores (P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

Influence of prophylactic ankle tapes on lower-extremity kinematics during a stop-jump task in chronic ankle instability

Background and objective: Numerous tape applications have been used in patients with chronic ankle instability (CAI). However, the effect of prophylactic ankle taping on lower-extremity kinematics is still not well understood. This study aimed to investigate the effects of traditional taping, fibular repositioning taping, and kinesiology taping on the peak angles of the lower extremities in patients with CAI. Materials and Methods: A total of 14 men (age, 24.07 ± 4.46 years; height, 175.06 ± 5.10 cm; weight, 82.24 ± 10.38 kg (mean ± standard deviation)) with CAI identified using screening questionnaires (Cumberland Ankle Instability Tool, 17.64 ± 4.14; Foot and Ankle Ability Measure (FAAM) Activity of Daily Living, 86.69 ± 6.71; and FAAM Sports Subscale, 75.45 ± 6.70) participated. The peak angles of the hip, knee, and ankle joints during a stop-jump task, with and without tape application, were collected using a three-dimensional motion system. Results: The following peak angles were measured: hip flexion, hip adduction (ADD), hip internal rotation (IR), knee flexion, knee abduction (ABD), knee IR, ankle dorsiflexion, ankle inversion, and ankle ADD. No significant differences were observed in the peak angle of each joint across conditions (hip flexion, F(3,39) = 0.85, p = 0.47; hip ADD, F(1.729,22.478) = 1.90, p = 0.18; hip IR, F(1.632,21.220) = 0.67, p = 0.49; knee flexion, F(3,39) = 1.24, p = 0.15; knee ABD, F(1.691,21.982) = 1.24, p = 0.30; knee IR, F(1.830,23.794) = 0.44, p = 0.63; ankle dorsiflexion, F(3,39) = 0.66, p = 0.58; ankle inversion, F(1.385,18.007) = 0.85, p = 0.40; ankle ADD, F(1.865,24.249) = 2.23, p = 0.13). Conclusion: The application of different taping techniques did not significantly change the peak joint angles of the lower extremities during a stop-jump task. These results contradict those of previous studies, suggesting that ankle taping restricts joint range of motion.

The effect of dry needling & muscle energy technique separately and in combination in patients suffering shoulder impingement syndrome and active trigger points of infraspinatus

ObjectiveThe aim of this study was to investigate the effects of a combination of dry needling (DN) and muscle energy technique (MET) on pain intensity (PI), pressure pain threshold (PPT) and shoulder active range of motion (ROM) in patients with shoulder impingement syndrome and active trigger points in the infraspinatus muscle. Methods39 patients, aged 20–50 participated in this study. All the cases were randomly assigned into three groups: group 1 (n = 13) received DN, group 2 (n = 13) received MET, and group 3 (n = 13) received DN & MET. The patients were treated for three sessions in a one-week period with at least a two-day break between sessions. ResultsThe results showed a significant improvement in visual analog scale (VAS), PPT and shoulder ROM over time (P < 0.001) in all three groups. There were no significant differences BETWEEN VAS (P = 0.406) PPT (P = 0.293), external rotation(EXT.ROT) (0.476), internal rotation (INT.ROT)(P = 0.476) and extension(EXT) (P = 0.574) ROMs in the three groups; however, DN group was significantly more effective on abduction(ABD) (P = 0.003) and flexion(FLEX) (0.012) ROM compared with other two groups. ConclusionIn line with previous studies, the present study found that the application of DN, MET and combined of these treatment on active trigger points in the infraspinatus muscle of patients with shoulder impingement syndrome helps reduce pain, increase PPT and enhance the shoulder ROM. Both techniques are effective in the treatment of trigger points. Nevertheless, DN is more effective in enhancing the ROM of flexion & abduction.

The Relationship Between Hip And Thigh Muscle Strength After Acl-reconstruction

PURPOSE: Weakness post ACL reconstruction (ACLR) of hip and thigh muscles are evaluated to track rehabilitation progress and/or inform decisions about return to sports. Lower extremity muscle adaptations are common mechanisms by patients coping with muscle weakness. Relationships among hip and thigh strength measures after reconstruction in ACLR patients may help identify potential coping mechanisms and targets for therapeutic intervention. METHODS: Thirty-four patients with primary unilateral ACLR (21.09±6.70yr, 18M, 170.82±11.95cm, 76.82±21.36kg, 7.97±5.22 mo post ACLR) performed maximum isometric contractions for hip abduction (AB) and adduction (AD) in a supine hook-lying position with the hips flexed to 45-degrees and knee flexed to 90-degrees and knee extension (EX) and flexion (FL) while seated with the hip and knee flexed to 90-degrees; average peak torque was recorded and normalized to body mass. We used Pearson correlation coefficients to determine associations among hip and knee muscle strength. RESULTS: There were statistically significant positive relationships between all hip and thigh strength values of both limbs (Table 1). Correlations between knee EX and hip AB of the ACLR limb were between 0.640 and 0; the contralateral limb was between 0.583 and 0.769. Correlations between knee FL and hip AB of the ACLR limb were between 0.600 and 0.615; the contralateral limb was between 0.583 and 0.606. Correlations between knee EX and hip AD of the ACLR limb were between 0.579 and 0.726; the contralateral limb was between 0.574 and 0.754. Correlations between knee FL and hip AD of the ACLR limb were between 0.681 and 0.702; the contralateral limb was between 0.642 and 0.700. CONCLUSION: Statistically significant, moderate to strong, positive relationships among hip and thigh strength measures were found of both limbs about 7 months post ACLR. Relationships among hip and quadricep strength are all moderate to strong, appearing slightly weaker in the ACLR limb.

Comparison of Component Placement Accuracy Using Two Intraoperative Fluoroscopic Grid Technologies During Direct Anterior Total Hip Arthroplasty

BackgroundIntraoperative fluoroscopy is beneficial when performing total hip arthroplasty (THA) via the direct anterior approach; however, image distortion may influence component placement. A manual gridding system (MGS) and a digital gridding system (DGS) are commercially available, aimed at visually representing or correcting image distortion. Therefore, the purpose of this study is to compare component placement accuracy following direct anterior approach THA when intraoperative fluoroscopy was supplemented with MGS or DGS. MethodsA retrospective evaluation of acetabular cup abduction (ABD), leg length discrepancy (LLD) and global hip offset difference (GHO) was completed for consecutive patients from 6 week post-THA weight-bearing radiographs. The predefined target LLD and GHO was <10 mm and ABD target was 45° ± 10°. Differences between MGS and DGS were determined by independent t-tests. ResultsThe MGS (250 patients, 315 hips) and DGS (183 patients, 218 hips) achieved targeted ABD in 98.7% and 96.8% of cases, respectively, and ABD was significantly lower in the MGS group (45.14 ± 4.03° and 47.01 ± 4.39°, respectively) (P < .001). Compared to MGS, the DGS group averaged significantly higher GHO (3.64 ± 2.44 and 4.45 ± 2.73 mm, respectively, P = .002) but was not significantly different regarding LLD (2.92 ± 2.55 and 3.19 ± 2.46 mm, respectively, P = .275). No significant group difference was noted for percentage within the targeted LLD and GHO; however, 93.5% of DGS and 97.6% of MGS achieved all three (P = .031). ConclusionThe use of both the MGS and DGS resulted in consistent component placement within the predefined target zone. Although the MGS appeared to be slightly more consistent, these differences are unlikely to be clinically significant.

Revisiting the Beighton Criteria: Does Ligamentous Laxity Testing Correlate With Shoulder Range of Motion Norms in a North American, Pediatric Population?

Ligamentous laxity testing using the Beighton score is frequently used as part of the pediatric shoulder examination. However, the relationship between generalized ligamentous laxity (GLL) and shoulder range of motion (ROM) remains unexamined in children, and normative data for these clinical tests have not been well established. In this study, we establish normative data for shoulder range of motion and GLL in a healthy, diverse pediatric population and investigate whether Beighton testing correlates with shoulder ROM in children. Healthy subjects age 2 to 18 years with isolated lower extremity complaints were recruited. Passive shoulder ROM measurements for forward flexion (FF), abduction (ABD), internal rotation (IR), external rotation (ER), and extension (EXT) were obtained using a long-armed goniometer. The Beighton score was obtained, with a positive test defined as ≥5. Descriptive statistics were used to stratify data on the basis of age and sex. Interclass correlation coefficients (ICCs) were calculated. Spearman's r was calculated to determine correlations between the Beighton score and shoulder ROM. Predictive indices of a positive Beighton test to identify patients with high shoulder mobility (ROM in the top 15 percentile, or 1 SD above the mean) were calculated. A total of 202 subjects were enrolled and evaluated. Passive ROM norms by age and sex were determined. Intraclass correlation coefficients for all shoulder ROM measurements were substantial to excellent. Female individuals had greater ROM than age-matched male individuals, but this trend was largely statistically insignificant. Pearson's correlation between age and shoulder ROM was significant for FF, ABD, EXT, and ER (r=-0.52 to -0.20, P<0.001). Based on a Beighton score of ≥5, the prevalence of GLL was 10% in male and 15% in female individuals. Spearman's correlation between Beighton score and shoulder ROM was significant for 3 of 5 ROM measurements: FF, ER, and EXT (r=0.30 to 0.39, P<0.001). Normative pediatric shoulder ROM and joint laxity data have been established in a healthy, diverse population of children. Beighton testing exhibits only a weak to moderate correlation, despite statistical significance, with shoulder ROM and is poorly predictive for high ROM in children. Level I- Diagnostic.

Hip Angles, Joint Moments, and Muscle Activity During Gait in Women With and Without Self-reported Stress Urinary Incontinence

Background: Women with stress urinary incontinence (SUI) have different hip strength, mobility, and unique between-leg differences compared with women without SUI. This article describes gait biomechanics in these same women to provide insight into their function and neuromuscular system. Objective: To compare gait biomechanics between women with and without self-reported SUI. Study Design: Descriptive. Methods: Hip angles, moments (net forces), and muscle activity were analyzed during 3 phases of stance (weight acceptance [WA], mid-stance [MS], and terminal stance [TS]), using 3-dimensional cameras, force plates, and surface electromyography. Values were compared between groups (SUI, n = 21; no SUI, n = 20) and limbs (dominant, D; nondominant, ND) (significance: P ≤ .05). Results: Between-Group Comparisons: Both limbs in the SUI group had greater abduction (ABD) moments (WA: D: P = .039; ND: P = .030), external rotation (ER) moments (WA: D: P = .002, ND: P = .004; and MS: D: P = .033, ND: P = .035), and gluteus maximus activity (TS: D: P < .001, ND: P = .005). The SUI group's ND-limb had greater adduction angles (WA: P = .043), internal rotation (IR) angles (WA: P = .011; MS: P = .028), flexion (FL) moments (TS: P = .050), and tensor fasciae latae activity (TS: P = .044). The SUI group's D-limb had greater ABD moments (TS: P = .034). Between-Limb Comparisons Unique to Each Group: The SUI group's ND-limb had greater IR angles (WA: P = .007, MS: P = .032, TS: P = .027), relative lesser ER angles (MS: P = .003, TS: P = .007), and lesser FL angles (MS: P = .029). The without SUI group's ND-limb had greater ER moments (MS: P = .022). Conclusions: Women with SUI demonstrate unique gait mechanics, predominantly in the transverse plane and in the ND-limb. A video abstract for this article is available at: https://links.lww.com/JWHPT/A29.

Inter-Segmental Coordination during a Unilateral 180° Jump in Elite Rugby Players: Implications for Prospective Identification of Injuries

Musculoskeletal injuries often occur during the execution of dynamic sporting tasks that involve rotation. The prescription of appropriate prevention strategies of musculoskeletal injury relies on assessments to identify risk, but current assessment tools focus on uniplanar movements. The purpose of this paper is to demonstrate the utility of the unilateral 180° jump as a potential assessment tool for injury risk in the lower body by (1) providing descriptive kinematics of the knee, thigh, and pelvis (2) conducting inter-segmental coordination analysis, and (3) comparing the knee kinematics between the dominant and non-dominant limb (NDL) during the loading (LOP) and landing phase (LAP). Elite rugby players completed one session, performing five 180° unilateral jumps on each limb while collecting kinematic data. Independent t-tests were used to compare peak angles of DL and NDL. Continuous Relative Phase (CRP) plots were constructed for thorax and pelvis in the transverse plane. At the loading phase, the non-dominant limb had greater peak knee abduction (ABD) (p = 0.01). At the landing phase, the dominant limb had greater peak knee adduction (ADD) (p = 0.05). At the landing phase, the non-dominant limb had greater peak knee ABD (p = 0.01). CRP plots indicate participants can utilize a thorax-led, pelvis-led, or synchronized rotational method. Bilateral asymmetries were observed, indicated by significant differences in the bilateral landing phase peak ADD/ABD, which is of particular interest considering all participants were healthy. Therefore, additional research is needed to determine thresholds for injury risk during rotational tasks.

The influence of a badminton competition with two matches in a day on muscle damage and physical performance in elite junior badminton players.

To investigate the effects of a badminton competition with 2 matches in a day on hip strength and range of motion (ROM) and exercise-induced muscle damage in elite junior badminton players. Twenty players (age: 17±0.8 years; body mass: 62.9±6.5 kg, height: 173.8±8.9 cm) participated in this study. Passive hip internal (IR) and external rotation (ER), abduction (ABD) and adduction (ADD) hip ROM, isometric hip ADD and ABD muscle strength, countermovement vertical jump (CMJ) height and blood creatine kinase concentration (CK) were measured before and after a badminton competition during an international tournament. Blood samples were collected 24 h after the end of the last match. Compared to baseline values, hip IR and ER ROM were significantly decreased at post-competition in the dominant (IR=-9.0%; p=0.007 and ER=-15.2%; p=0.002) and non-dominant limbs (IR=-9.08%; p=0.004 and ER=-19.4%; p<0.001). In contrast, hip ADD (13.5%; p<0.001) and ABD (14.6%; p<0.001) strength increased significantly after the competition in the dominant limb and ABD strength increased significantly in the non-dominant limb (9.2%; p=0.001). From baseline values, CK increased after the competition (430.1%) and values remained elevated over baseline values 24 h later (160.4%). Although hip muscle strength increased, a badminton competition with two consecutive matches reduced hip ROM and increased blood CK concentration. This study suggests the necessity of investigating recovery strategies after a badminton competition to return hip ROM to basal values before the next day of the competition.

IMPORTANCE OF DIAGNOSTIC IMAGING FOR INTERPRETATION OF SELF-REPORTED SURVEYS OF SHOULDER FUNCTION

Rotator cuff (RC) tear is highly prevalent in older adults. The American Shoulder and Elbow Surgeon (ASES) survey, which quantifies subjective self-reported shoulder function, was originally validated in adults <60 years, and more recently is suggested to be valid in adults ≥60 years. We tested the hypothesis that ASES score (1) discriminates between adults 60—85 years with and without RC tear and (2) correlates with self-reported health quality and objective shoulder measures. Cross-sectional study: forty-two community-dwelling-older-adult volunteers (mean age, 69.4 ± 5.7 years; range, 61-84 years; male, 45%) with no history of RC surgery completed shoulder magnetic resonance imaging (MRI), shoulder forward flexion (FF) and abduction (ABD) range-of-motion (ROM) testing; and ASES, shoulder-pain and SF-36 (pain/physical function) surveys. Four groups (group-1:-pain,-tear,n=14; group-2:+pain,-tear,n=4; group-3:-pain,+tear,n=12; group-4:+pain,+tear,n=12) were compared using one-way ANOVA with ad hoc pairwise comparisons and Spearman Rank Order Correlation (rho). Age, Charlson co-morbidity index, and SF-36 pain/physical function were not appreciably different among all groups. ASES score (p<0.001), FF-ROM (p=0.032) and ABD-ROM (p=0.018) comparing all groups. ASES score: group-1 versus group-4 (p<0.001); but no difference between group-1 versus group-3 (p=0.999), and group-2 had lowest ASES score. ASES score correlated with SF-36 physical function (rho=0.47,p=0.002), SF-36 pain (rho=0.34,p=0.028), FF-ROM (rho=0.63,p<0.001), and ABD-ROM (rho=0.66,p<0.001). Our results suggest that additional research on ASES score in older adults is needed. Although valid, interpretation of ASES score in older adults should be approached cautiously in studies without shoulder diagnostic imaging tests, since painless RC tears and painful shoulders without RC tear are not rare.

The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis

The lack of greater tuberosity (GT) healing in proximal humerus fractures has been negatively correlated with outcomes for hemiarthroplasty; however, there is still debate regarding the effects of GT healing in reverse shoulder arthroplasty (RSA). Our goal was to examine the effects of GT healing using a kinematic finite element analysis (FEA) model. Computer-aided design models of a medialized glenoid with a lateralized humerus (MGLH) RSA design were uploaded into an FEA shoulder model in 2 different configurations: healed greater tuberosity (HGT) and nonunion greater tuberosity (NGT). Deltoid muscle forces and joint reaction forces (JRFs) on the shoulder were calculated during abduction (ABD), forward flexion (FF), and external rotation (ER). Force magnitude of the anterior, middle, and posterior deltoid muscle as well as JRFs modeled in both GT scenarios were similar for ABD (muscle forces P = .91, P = .75, P = .71, respectively; and JRF P = .93) and for FF (muscle forces P = .89, P = .83, P = .99, respectively; and JRF P = .90). For ER, the force magnitude between 2 GT settings showed statistically significant differences (HGT: 9.51 N vs. NGT: 6.13 N) (P < .001). Likewise, during ER, JRFs were different, and the NGT group showed a steep drop in JRF after 10° of ER (HGT: 28.4 N vs. NGT: 18.38 N) (P < .001). GT healing does not seem to impact RSA biomechanics during abduction or forward flexion; however, it does affect biomechanics during external rotation. Overall orthopedic surgeons can expect good results for patients after RSA even with poor GT healing.

Does Combining a Suprascapular Nerve Block With an Intra-articular Corticosteroid Injection Have an Additive Effect in the Treatment of Adhesive Capsulitis? A Comparison of Functional Outcomes After Short-term and Minimum 1-Year Follow-up.

Background:No therapeutic intervention is universally accepted as the most effective treatment for adhesive capsulitis. An intra-articular corticosteroid injection (IAI) with a suprascapular nerve block (SSNB), a common treatment for this disease, is a safe and effective method for the resolution of pain and restoration of shoulder range of motion (ROM).Purpose:To compare the efficacy of combined SSNB and IAI with that of IAI alone in the treatment of adhesive capsulitis.Study Design:Cohort study; Level of evidence, 3.Methods:We performed a retrospective review of 102 patients with adhesive capsulitis who were treated at an outpatient clinic from July 2016 to January 2017. A combined SSNB with IAI was performed in 48 patients (SSNB + IAI group), and an IAI alone was performed in 54 patients (IAI group). Patients were assessed before the intervention and at 2 weeks and 2 months after the intervention. ROM and pain and function visual analog scales (PVAS and FVAS, respectively), the American Shoulder and Elbow Surgeons (ASES) score, the Korean Shoulder Scoring System (KSS), the Constant score, the Simple Shoulder Test (SST), and the Shoulder Pain and Disability Index (SPADI) were used for clinical assessments. PVAS, FVAS, and ASES scores at a minimum of 1 year after the intervention were assessed for 82 patients.Results:At the 2-month assessment, all parameters significantly improved in both the SSNB + IAI and IAI groups (P < .05), however, improvements in forward flexion (FF) and abduction (ABD) between the 2-week and 2-month assessments were better in the SSNB + IAI group. At the 2-month assessment, improvements in the FVAS, ASES, SST, and SPADI scores and FF and ABD values were statistically significantly greater in the SSNB + IAI group compared with the IAI group. Improvements in FVAS and ASES scores were significantly greater in the SSNB + IAI group at a minimum of 1 year.Conclusion:Both a combined SSNB and IAI and an IAI alone significantly improved pain and functional outcomes in patients with adhesive capsulitis. The use of an SSNB with an IAI further increased treatment efficacy, as per the FVAS, ASES, SST, and SPADI scores and FF and ABD values. Patients who underwent SSNB combined with an IAI showed better improvements in the FVAS and ASES scores compared with IAI alone at a minimum of 1 year after the intervention. Therefore, an SSNB combined with an IAI may be a good treatment choice for adhesive capsulitis.