Closed Kinetic Chain Upper Extremity Stability Test Research Articles

Is the correlation of the core muscle performance with shoulder pain and function altered by scapular dyskinesis in subjects with shoulder pain?

BACKGROUND: Daily activities that involve upper limb movements require muscle activation from different body parts by transferring forces and energy along the functional kinetic chain. The scapulae connect and transfer forces between the trunk and the upper limbs, so scapular dyskinesis may compromise the performance of the kinetic chain. OBJECTIVE: To assess the relationship between core muscle performance and shoulder pain and function in individuals with shoulder pain, with and without scapular dyskinesis. METHODS: Data was collected from 77 non-athlete adults aged between 18 and 50 years with shoulder pain, 45 had scapular dyskinesis. Core muscle performance was measured using the prone bridging test (PBT). Shoulder pain and disability were measured by the Shoulder Pain and Disability Index (SPADI), and the upper limbs’ stability was assessed by the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The peak torque of shoulder external and internal rotators was measured using an isokinetic dynamometer. Multiple linear regression models evaluated the relationship between the PBT and CKCUEST, SPADI, and shoulder rotator strength. RESULTS: Significant correlations were found between the PBT and the SPADI total score (r = – 0.522), pain domain (r = – 0.513), and disability domain (r = – 0.501); normalized score (r = 0.593), and the power (r = 0.624) of the CKCUEST; and peak torque for external (r = 0.256) and internal (r = 0.292) rotations. Scapular dyskinesis did not influence the magnitude of the correlations and predictive values. CONCLUSION: The PBT was correlated with shoulder pain and function, but scapular dyskinesis did not affect the magnitude of these relationships.

The associations of physical parameters with the Closed Kinetic Chain Upper Extremity Stability Test, the Upper Quarter Y Balance Test, and the Upper Limb Rotation Test in professional overhead athletes

ObjectiveTo investigate the associations of glenohumeral internal (IR) and external rotation (ER), horizontal adduction (HA), and thoracic spine rotation ranges of motion (ROM), isometric muscle strength of the shoulder rotators, and trunk muscle endurance with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Quarter Y Balance Test (YBT-UQ), and the Upper Limb Rotation Test (ULRT) in overhead athletes. DesignCross-sectional study. SettingsLaboratory. ParticipantsOne hundred twenty-one athletes were enrolled. Main outcome measuresIndependent variables were: IR, ER, HA, and thoracic spine rotation ROMs, isometric muscle strength of glenohumeral IR and ER muscles, and trunk muscle endurance. Dependent variables were: CKCUEST, YBT-UQ, ULRT. ResultsIR ROM of the nondominant side was associated with the CKCUEST, the YBT-UQ, and the ULRT. IR muscle strength of the dominant side was associated with the CKCUEST and the ULRT. Trunk flexor and lateral endurance of the dominant side were associated with the CKCUEST and the YBT-UQ, respectively. ConclusionsMany of the physical parameters influencing scores on the CKCUEST and the YBT-UQ are different. Common parameters influence the CKCUEST and ULRT scores, yet more parameters influence the CKCUEST score. We suggest the combined use of the CKCUEST and the YBT-UQ in overhead athletes.

The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) Performance in Elite Team Handball Players Playing with Shoulder Pain, Previous Pain, or No Pain.

Physical therapists use tests that could determine strength and weaknesses of the shoulder for overhead throwing athletes to enhance performance, prevent injury, and safely progress rehabilitation. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) has been proposed to assess muscular capacity and dynamic shoulder stability in overhead athletes, which could provide information to determine a risk of injury. To investigate if the CKCUEST is an appropriate test to implement within team elite handball players to evaluate dynamic shoulder stability across sexes and in the screening of shoulder pain. Cross-sectional study. Elite team handball players were recruited and performed the CKCUEST from which three different scores (raw, touch, and power) were calculated and compared among handball players playing with shoulder pain, previous pain, and no pain. A total of 106 handball players were included: 49 females (1.74±0.03 m, 70.4±6.7 kg, and 22±4.9 years) and 57 males (1.90±0.08 m, 91.6±11.4 kg, and 22±5.4 years), A significant difference was found between the female and male handball players when comparing all three CKCUEST scores (p<0.01). No significant differences were found in the CKCUEST scores among the three different groups (F≤1.23, p≥0.30, η2≤0.03). Among the female participants, no significant differences were found between performing the CKCUEST and the modified test. A significant correlation was found between height and the power score for men (r=0.661, p≤0.001) and women (r=0.434, p=0.01). A comparison of scores across sexes appears unsuitable, due to the possible positive influence of height on the final score. But within the female group, performances of the CKCUEST and the modified CKCUEST were comparable. Additionally, the CKCUEST was not able to differentiate among elite handball players who are playing with shoulder pain, previous shoulder pain, and no pain. 3.

Reliability and Validity of the Star Excursion Balance Test for Evaluating Dynamic Balance of Upper Extremities.

Upper extremity (UE) dynamic balance is a significant physical fitness ability, which includes high-level neuromuscular proprioception, joint mobility, force, and coordination. The evaluation methods of UE dynamic balance are insufficient and lack experimental support. The Star Excursion Balance Test (SEBT) is a reliable assessment of dynamic balance and injury risk of the lower extremity. The UE-SEBT is a reliable and reproducible approach for evaluating dynamic balance of UEs. Observational study. Level 4. This cross-sectional study recruited 65 healthy adults. All participants were required to complete UE-SEBT, UE Y-balance test (UE-YBT), maximal voluntary isometric contraction (MVIC) of UE, closed kinetic chain UE stability test (CKCUEST), trunk flexor endurance test (TFET), trunk extensor endurance test (TEET), and lateral trunk endurance test (LTET). Intra- and inter-rater reliability and the correlation of UE-SEBT with other outcomes were measured. Among the participants, the intra- and interoperator reliability of UE-SEBT in all directions and composite score achieved a moderate-to-excellent (intraclass correlation coefficients [ICC], 0.729-0.946) reliability. For validity, the UE-SEBT had a moderate to very strong correlation with UE-YBT (r = 0.315-0.755, P < 0.01) and a strong correlation with CKCUEST (r = 0.4-0.67, P < 0.01). Furthermore, the UE-SEBT performance showed weak-to-strong correlations with MVIC (r = 0.26-0.43, P < 0.05). UE-SEBT was also correlated with LTET, TEET, and TFET to varying degrees. UE-SEBT has good reliability and validity to assess UE dynamic balance compared with other tests. UE-SEBT can be used as a clinical assessment method to evaluate UE dynamic balance and injury prevention.

Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial

To investigate the effects of cross-education on RC muscle strength recovery and shoulder function in patients with arthroscopic anterior shoulder stabilization surgery. Twenty-eight patients with shoulder stabilization surgery were included in the study (age: 25±6 years and body-mass index: 24.8±3.6 kg/m2). The patients were randomly divided into either cross-education (n=14) or control (n=14) groups. All patients received a standardized rehabilitation program until the end of the postoperative 12th week. The cross-education group also received an isokinetic training with the non-operated shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and three, and six months postoperatively using an isokinetic dynamometer at 60°/sec and 180°/sec angular velocities. Shoulder function was assessed with Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and Y-balance Test for Upper Quarter (YBT-UQ). Analyses of covariance were used for the statistical analyses. At the postoperative six months and at 60°/sec angular velocity, there was higher IR strength in the cross-education group (p=0.02) and similar ER strength (p=0.62) between the groups. At 180°/sec angular velocity, both IR (p=0.04) and ER (p=0.02) strength were higher in the cross-education group. The CKCUEST (p=0.47), YBT-UQ (p=0.95) and WOSI (p=0.12) scores were similar between the groups at six months after the surgery. Cross-education in the early periods of the postoperative rehabilitation following the stabilization surgery improves the RC strength recovery. However, it has no effects on the functional outcomes. Integrating the cross-education program to the postoperative rehabilitation may help to improve dynamic shoulder stability but not the functional capacity.

Investigation of the Relationship Between Upper Extremity Neuromuscular Control and Grip Strength with Shooting Accuracy in Elite Handball Players

In sports such as handball, where the overhead throw is commonly used, athletes must be physically fit to fulfill the requirements of the throw. This fitness includes neuromuscular control, muscle strength, power, flexibility, balance, and agility. The purpose of this study was to investigate the relationship between upper extremity neuromuscular control and grip strength with shooting accuracy in elite handball players. The study was conducted with the participation of 26 male handball players with an average age of 20.23 ± 2.47 years, average body weight of 72.34 ± 8.01 kg, average height of 180.5 ± 5.90 cm, average playing experience of 8.65 ± 2.92 years, and average BMI of 22.1 ± 2.13 kg/m-2. Data collection tools contained a “Personal Information Form,” a “Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST),” a “Shooting Accuracy Test,” and a “Grip Strength Test.” Pearson Correlation Test analyzed the study data from descriptive statistics in the SPSS package program. In all analyses, p&amp;lt;.05 was considered statistically significant. According to the study’s results, no significant correlation was found between hand grip strength, upper extremity neuromuscular control, and strength with shooting accuracy in handball. A high positive correlation was found between dominant hand strength and non-dominant hand strength. As a result, it was determined that shooting performance is not only related to strength but also closely related to the player's technical skills.

Reliability of Upper Extremity Functional Performance Tests for the Non-overhead Athlete.

While there have been reliability studies conducted on several upper extremity functional performance tests (UEFPT), there are several complicating factors that inhibit the ability to draw definitive consensus about the reliability of the tests in both females and males. Having reliability estimates for UEFPT in the same cohort facilitates direct comparison of their relative and absolute reliability. To establish the test-retest reliability of the closed kinetic chain upper extremity stability test (CKCUEST), seated medicine ball chest pass test (SMBCPT) and hands-release push-up test (HRPUT) in a cohort of males and females with a history of non-overhead sport participation. A secondary purpose was to examine the associations between the three UEFPT. Test-retest reliability, single cohort study. Forty adults (20 females, 20 males) with a history of non-overhead sport participation completed three UEFPT during two data collection sessions three to seven days apart. Measures of systematic bias, absolute reliability and relative reliability were computed between the sessions. Additionally, correlational analyses were conducted between the three UEFPT. Only the UECKCST (both sexes) demonstrated significant (p≤ 0.003) second session performance improvements. All three tests exhibited excellent relative reliability (intraclass correlational coefficients ≥ 0.823) and except for the HRPUT in males, coefficients of variation were all below 8.8%. Except for a significant relationship (r=.691, p=0.001) between the UECKCST and SMBCPT for the females there were no other associations between the three UEFPT. All three UEFPT demonstrated sufficient reliability. Thus, all three assessments can be used for serial assessments to progress a patient through rehabilitation as well as contribute to the criteria used in making return to sport decisions. 3.

Impact of anthropometric data and physical activity level on the closed kinetic chain upper extremity stability test (CKCUEST) score: A cross-sectional study

ObjectiveThe aim of this study was to evaluate the impact of anthropometric data and the level of physical activity on the CKCUEST score on uninjured subjects. MethodSubjects were eligible for the study if they were aged between 18 and 25 years old. Anthropometric data were collected, and the physical activity level was assessed using the Global Physical Activity Questionnaire (GPAQ). The primary endpoint was the CKCUEST score. The CKCUEST was performed three times and the score was the mean of the 3 tries. The compared groups were posteriori dichotomized according to the median. A multivariate model has been built by step-by-step selection with a threshold set at 0.05. Results82 subjects were included. The difference between groups determined for each variable was statistically significant for CKCUEST score (p < 0.0001) and for physical activity level (p = 0.0245). The multivariate analysis showed that arm span, sex and weight are, in order, three main variables influencing the CKCUEST score. A predictive equation was established based on these 3 factors (R2 = 0.51). ConclusionThe CKCUEST score seems to be impacted by sex, weight and arm span. A predictive equation for the CKCUEST score was proposed: (0.271 × Upper Limb Span)–(0.103 × Weight)–(3.219 × Sex)–17.719.

Upper extremity physical performance tests in female overhead athletes: a test–retest reliability study

ObjectiveDespite the studies that have investigated the reliability of Upper Extremity Functional Tests(UEFTs), the reliability of Closed Kinetic Chain Upper Extremity Stability(CKCUES), Seated Medicine Ball Throw(SMBT), push-up(PU) and Unilateral Seated Shot Put(USSP) tests in overhead athletes has yet to be assessed. The objective of this study was to determine both the relative and absolute test–retest reliability of the four UEFTs in female overhead athletes.MethodsTwenty-nine female overhead athletes (age: 26.6 ± 5.29 years) underwent the four UEFTs twice within a three- day interval. The upper limb stability was assessed through PU and CKCUES tests, while the power was assessed though SMBT and USSP tests. The Intraclass Correlation of Coefficient (ICC) was applied to assess the relative reliability. Absolute reliability was determined by calculating the Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC). Furthermore, Bland–Altman plots were used to detect the agreements between the two measurements.ResultsThe relative reliability of PU, CKCUES, SMBT, and non-dominant arm USSP tests was excellent (ICC = 0.83, 0.80, 0.91, and 0.83, respectively). SEM was within a range of 1.69 to 1.72 for stability tests and a range of 13.61 to 52.12 for power (based on a 95% confidence interval). The MDC was 4.68 for PU and 4.75 for CKCUES test. At least four repetitions are needed to be considered a real improvement on PU and CKCUES tests. This value was 144.04, in SMBT and 59.03, 37.62 cm (dominant and non-dominant arm, respectively) in USSP tests, which represents the minimum change that must occur to be considered an athlete’s progression.ConclusionThis study revealed that both the upper limb stability and power tests have acceptable relative and absolute intra-rater reliability in female overhead athletes. These can be considered as reliable tools in research and clinical settings.

Stability, performance and upper and lower extremities range of motion in elite beach handball athletes: A cross sectional study

Although beach handball is a popular sport worldwide, information about the functional profile in elite athletes are lacking. This study generate a descriptive profile of stability, performance and upper and lower extremities ROM in elite beach handball athletes. Secondary proposals were to compare these outcome measures between sexes and sides, and to report the frequency of athletes “at risk” according to cutoff values for shoulder ROM and dynamic postural stability of the lower extremities. Twenty-eight (n = 16 males, 28.7 ± 5.3 years; n = 12 females, 27.5 ± 5.5 years) elite beach handball athletes were tested. Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), single hop test, modified Star Excursion Balance Test (mSEBT) and passive shoulder, hip and ankle dorsiflexion ROM were assessed. Male athletes presented greater reach distance in the anterior direction [P < .0001; Mean Difference (MD): 36%] and lower reach distance in the posteromedial direction (P < .0001; MD: −29.7%) than female athletes in the mSEBT. Bilateral differences were observed for male athletes during the mSEBT, with the dominant stance limb obtaining a smaller reach distance in the anterior direction (P < .01; MD: −38.3%) and greater reach distance in the posteromedial direction (P < .0001; MD: 30.8%). Male athletes had less upper and lower extremities ROM and reached a smaller normalized single hop distance than female athletes. Most athletes presented mSEBT asymmetries and shoulder ROM deficits which have been shown to increase injury risk. Dynamic postural stability adaptations are present in elite beach handball athletes of both sexes, with more pronounced upper and lower extremity flexibility deficits in male athletes.

The Effect of Core Stability Exercises on Lower Limb Alignment, Upper and Lower Limb Function in Kyokushin Girls

Purpose: This study was conducted to investigate the effect of 6 weeks of core stability exercises in the trunk area on lower limb alignment and lower and upper limb function in Kyokushin athletes. Methods: The statistical sample of the research included 30 female Kyokushin players aged 14-18 years, who were randomly divided into two experimental and control groups. The control group performed common Kyokushin exercises and the experimental group performed core stability exercises for 6 weeks. Analysis of covariance (ANCOVA) and paired t-tests were used to compare between groups and within groups. Results: The results of the paired t-test showed a significant effect of training programs on changes in upper and lower limb function in both experimental and control groups (P≤0.05); however, a significant difference was observed between the pre-test and post-test in both control and experimental group. The test was not observed in the Q angle (P&gt;0.05). The results of ANCOVA test showed that after controlling the effect of the pre-test, a significant difference was observed in lateral jump (P≤0.05) between the experimental and control groups. However, no difference was observed between the two groups in the changes of closed kinetic chain upper extremity stability test (CKCUEST), square jump, and Q angle (P&gt;0.05). Conclusion: Considering the nature of Kyokushin and the research results, it is suggested that people working in Kyokushin do not feel the need for core stability exercises separately.

Validity and reliability of upper extremity star excursion balance test in adolescent swimmers

Background/ObjectivesUpper limb balance is one of the important physical fitness parameters for all populations, especially overhead athletes like swimmers. Upper extremity star excursion balance test (UESEBT) is a comprehensive dynamic balance assessment, this study aims to explore the reliability and validity of UESEBT among adolescent swimmers. MethodsThis cross-sectional study recruited 70 adolescent swimmers. All participants were required to complete UESEBT, upper quarter Y-balance test (UQYBT), maximal isometric strength (MIS) tests in upper limb, closed kinetic chain upper extremity stability test (CKCUEST), trunk flexor endurance test (TFET) and lateral trunk endurance test (LTET). The intra- and inter-operator reliability and the correlation of UESEBT with other physical performances were conducted. ResultsFor reliability, the intra- and inter-operator reliability of all directions and composite score were high-to-excellent (ICC = 0.706−1.000) among all participants. For validity, the UESEBT has a moderate-to-strong correlation with UQYBT (r = 0.42−0.72, p < 0.001), and a weak-to moderate one with CKCUEST (r = 0.25−0.42, p < 0.05). Furthermore, the UESEBT performance showed weak-to-moderate correlations with MIS (r = 0.24−0.44, p < 0.05). UESEBT was correlated to LTET (r = 0.24−0.33, p < 0.05) whereas no relationship was found with TFET. ConclusionsUESEBT was a reliable and valid tool to screen upper extremity dynamic balance among adolescent swimmers. UESEBT provides more detailed information in eight directions to assess the upper limb sport performance. Further study should explore the prediction ability of UESEBT for injury.

Comparison of the upper extremity physical performance tests between asymptomatic adults with and without scapular dyskinesis

Abstract Introduction Physical performance tests (PPTs) are screening tools widely available, easy to apply, and that can be performed in different environments and contexts. Scapular dyskinesis can be related to changes in glenohumeral angulation, acromioclavicular joint strain, subacromial space dimension, shoulder muscle strength/activation and humeral position/motion. Few studies were developed to understand the influence of aspects such as strength, stability mobility, and scapular dyskinesis on the scores of the upper extremity PPTs. Objective To compare the performance in the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Seated Medicine Ball Throw Test (SMBT) and Upper Quarter Y Balance Test (UQYBT) between asymptomatic adults with and without scapular dyskinesis. Methods Cross-sectional study with 20 asymptomatic individuals: 10 with scapular dyskinesis and 10 without scapular dyskinesis. The average number of touches, number of touches normalized by height, and power score in the CKCUEST, distance covered by the ball in the SMBT, reach in the medial, inferolateral, and superolateral directions, total excursion and composite score of the UQYBT were compared between both groups. Results No significant differences were found for all variables (p &gt; 0.05). Small to moderate effect sizes were found for the scores of the CKCUEST (d = 0.16-0.78), a small effect size was found for the distance in the SBMT (d = 0.12), and small to moderate effect sizes were found for the scores of the UQYBT (d = 0.02-0.43). The scapular dyskinesis group presented better performance in all tests. Conclusion The presence of scapular dyskinesis in asymptomatic individuals is not a factor related to worse scores in upper extremity physical performance tests.

The Effect of Blood Flow Restriction Therapy on Shoulder Function Following Shoulder Stabilization Surgery: A Case Series.

Traumatic shoulder instability is a common injury in athletes and military personnel. Surgical stabilization reduces recurrence, but athletes often return to sport before recovering upper extremity rotational strength and sport-specific abilities. Blood flow restriction (BFR) may stimulate muscle growth without the need for heavy resistance training post-surgically. To observe changes in shoulder strength, self-reported function, upper extremity performance, and range of motion (ROM) in military cadets recovering from shoulder stabilization surgery who completed a standard rehabilitation program with six weeks of BFR training. Prospective case series. Military cadets who underwent shoulder stabilization surgery completed six weeks of upper extremity BFR training, beginning post-op week six. Primary outcomes were shoulder isometric strength and patient-reported function assessed at 6-weeks, 12-weeks, and 6-months postoperatively. Secondary outcomes included shoulder ROM assessed at each timepoint and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Extremity Y-Balance Test (UQYBT), and the Unilateral Seated Shotput Test (USPT) assessed at the six-month follow-up. Twenty cadets performed an average 10.9 BFR training sessions over six weeks. Statistically significant and clinically meaningful increases in surgical extremity external rotation strength (p < 0.001; mean difference, .049; 95% CI: .021, .077), abduction strength (p < 0.001; mean difference, .079; 95% CI: .050, .108), and internal rotation strength (p < 0.001; mean difference, .060; CI: .028, .093) occurred from six to 12 weeks postoperatively. Statistically significant and clinically meaningful improvements were reported on the Single Assessment Numeric Evaluation (p < 0.001; mean difference, 17.7; CI: 9.4, 25.9) and Shoulder Pain and Disability Index (p < 0.001; mean difference, -31.1; CI: -44.2, -18.0) from six to 12 weeks postoperatively. Additionally, over 70 percent of participants met reference values on two to three performance tests at 6-months. While the degree of improvement attributable to the addition of BFR is unknown, the clinically meaningful improvements in shoulder strength, self-reported function, and upper extremity performance warrant further exploration of BFR during upper extremity rehabilitation. 4, Case Series.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Upper extremity field tests and isokinetic shoulder internal and external strength and power in sports active males

BACKGROUND: In order to guide sports active subjects with musculoskeletal (MSK) shoulder dysfunctions it is essential to have precise insights of possible weak links in the kinetic chain of their shoulder girdle with access to reference data. Equally, it is uncertain whether so-called functional shoulder strength tests are complementary to an isokinetic shoulder strength test. OBJECTIVE: To establish reference values and to clarify the relationship between two upper extremity field tests – the Scapular Muscle Endurance test (SME) and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and the isokinetic strength test of the shoulder internal (IR) and external rotators (ER). METHODS: Seventy-six male sport active men performed the CKCUEST, the SME, and underwent a bilateral isokinetic strength test to establish reference values of the isokinetic shoulder relative to body mass Peak Moment (PM/kg) and Power (Power/kg) for the IR and ER. A mixed-design ANOVA calculated possible side-to-side differences and one-way ANOVA was applied for eventually age group differences. Additionally, the relationship between the three tests was examined with a Spearman rank-order correlation coefficient. RESULTS: No significant correlations were indicated between the SME and the criterion isokinetic test and between the SME and CKCUEST. CONCLUSIONS: The main outcome parameters in this study warrant individual assessment as they measure different constructs, leading to a diverse profile of the shoulder.

Role of active joint position sense on the upper extremity functional performance tests in college volleyball players.

BackgroundIt has been well established that proprioception plays a decisive role in shoulder stability and sport performance. Notwithstanding, there is a lack of clear association between active joint position sense (AJPS) and the performance of upper-extremity functional performance tests. The aim of this study was to determine whether the AJPS of the shoulder complex is associated with the performance of college volleyball players with the following functional tests: Y-Balance Test-Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). The secondary aim was to investigate whether the magnitude of the proprioception error through the AJPS had the ability to act as a predictor for functional test scores.MethodsCross-sectional study with a convenience sampling. Healthy college volleyball players (≥12 h of training/week), 30 males and 22 females, between 18 and 26 years of age were included. AJPS of the shoulder (90° of flexion (90°Flex), 90° of internal rotation at 90° of abduction (90°IR/ABD), 90° of external rotation at 90° of abduction (90°ER/ABD)) and three upper-extremity functional performance tests (YBT-UQ, CKCUEST and SMBT) were assessed. A Pearson’s test and a stepwise multiple linear regression analysis were used to determine possible associations and relationships between outcome measures, respectively.ResultsThe analysis revealed that AJPS at 90°IR/ABD and 90°ER/ABD were the only proprioceptive variables with an association to the YBT-UQ and SMBT. Despite these relationships, only the AJPS at 90°IR/ABD was associated with the performance of the YBT-UQ in; superolateral direction (β = −0.7; 95% CI [−1.3 to 0.1]; p = 0.025); inferolateral direction (β = −1.5; 95% CI [−2.1 to −0.8]; p = 0.001); and composite score (β = −0.8; 95% CI [−1.3 to −0.3]; p = 0.002). From these, AJPS at 90°IR/ABD mainly explained the variability of YBT-UQ (inferolateral direction) performance (R2 = 0.32; %R2 = 0.32). Our findings allow for a possible expanded role for proprioception as a contributing factor in upper limb motor control during functional movements. Further research is required to explore and distinguish the associations between proprioception, motor control and sport performance involving the upper limbs.

Effect of Scapular Movement Impairment on Functional Stability of Shoulder Girdle and Scapulohumeral Rhythm in Elite male Volleyball Players

Background and Aims The shoulder girdle is at higher risk of injury in overhead sports like volleyball. Repeated movements with high speed and power can cause changes in scapular position and lead to shoulder girdle dysfunction. This study aims to assess the effect of scapular movement impairment on functional stability of the shoulder girdle and the scapulohumeral rhythm in elite male volleyball players Methods In this descriptive-comparative study, 80 male volleyball players aged 18-35 years including 40 with scapular downward rotation syndrome (SDRS) (age=22±2.8 years, weight=82.50±1.3 kg, and height=193±3.2 cm) and 40 with scapular abduction syndrome (SAS) (age=24±2.1 years, weight=81.40±1.3 kg, and height=192±2.9 cm) participated who were selected purposefully. They underwent the scapular dyskinesis test and Kibler’s shoulder lateral slip test. The scapulohumeral rhythm was measured at four positions (0, 45°, 90°, and 135°) using two inclinometers. The Y-balance test-upper quarter (YBT-UQ), seated medicine ball throw test (SMBT), and closed kinetic chain upper extremity stability test (CKCUEST) were used to measure the functional stability of the upper extremity. Shapiro-Wilk test was used for examining the normality of data distribution, independent t-test was used to compare the differences between groups. Results There was a significant difference in the scapulohumeral rhythm at 45° (P=0.001), 90° (P=0.001), and 135° (P=0.001) between the two groups (Mean difference= 18.27, 21.27, and 27.87, respectively), where the SDRS group had lower scapular upward rotation than the SAS group. The results of YBT-UQ showed that the superior-lateral reach (P=0.001) and composite (P=0.001) scores of the dominant hand were significantly different between the two groups (Mean difference = 9.37 and 10.41, respectively), where the SDRS group had lower scores than the SAS group. No significant difference was found in the medial (P= 0.223) and inferior-lateral (P= 0.111) reach scores. Moreover, the results showed no significant difference between the groups in the SMBT (P=0.124) and CKCUEST (P=0.875) scores. Conclusion The occurrence of scapular movement impairment affects the YBT-UQ score and leads to scapulohumeral rhythm disturbance in volleyball players. Even if the activity is stopped, the ideal and optimal alignment will not be created unless efforts are made to improve the movement pattern.

Return to Sport Testing After Arthroscopic Shoulder Surgery in Adolescent Patients

Background:Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. However, data regarding RTS testing after arthroscopic shoulder stabilization in adolescent patients is limited.Purpose:To investigate the results of strength and functional RTS testing following arthroscopic stabilization in adolescent patients with shoulder instability.Methods:A retrospective review of medical records was performed to identify adolescent patients who underwent arthroscopic shoulder stabilization and subsequent RTS testing between April 2017 and April 2020. Surgeries were performed by a single sports medicine fellowship-trained surgeon; RTS assessments were performed at the primary institution’s sports rehabilitation clinic by a licensed physical therapist. Patient demographics, operative details, patient-reported outcome measures (PROMs) (VAS, Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences between the involved and uninvolved limbs were analyzed. Correlations between RTS testing results and PROMs were examined.Results:24 patients (62.5% male) were identified with mean age of 15.5 years (range, 13-21 years). Football was the most common primary sport played (33.3%). 58.3% of patients underwent surgery on their dominant shoulder. 21 patients had isolated anterior repairs, two had combined anterior/posterior repairs, and one had an isolated posterior repair. RTS testing was performed at a mean of 6.02 ± 0.64 months postoperatively. All PROMs improved significantly from pre-operative to the time of RTS testing (p<0.0001). All patients (n=24) failed at least one component of the RTS testing (Table 1). Pre-operative Tegner scores were positively correlated with involved isokinetic external rotation symmetry (r=0.383, p<0.05) and with closed kinetic chain upper extremity stability test (CKCUEST) performance (r=0.577, p<0.005). Post-operative Tegner and ASES scores were positively correlated with involved isometric internal rotation LSI (r=0.418, p<0.05) and CKCUEST performance (r=0.383, p<0.05), respectively. Isometric External Rotation LSI was positively correlated with the Isokinetic External Rotation LSI at 180°/sec for the surgical limb (r=0.57, p<0.01).Conclusion:At 6-months postoperative, shoulder strength and stability deficits persist in the surgical limb of adolescent patients. PROMs improve significantly from pre-operative to time of RTS testing. Tegner and ASES scores may be associated with objective shoulder strength and stability measurements.Table 1.Return-to-Sport Pass Criteria and Percentage of Patients Who Passed

Preliminary Analysis of Closed Kinetic Chain Upper Extremity Stability Test Differences Between Healthy and Previously Injured/In-Pain Baseball Pitchers.

A comprehensive examination of the kinetic chain during an overhead athlete's upper extremity assessment, such as the closed kinetic chain upper extremity stability test (CKCUEST), may help clinicians identify potential upper extremity dysfunction. Body position observed on dominant and nondominant hand touch during a CKCUEST trial differs between players with previous injury/pain history compared with healthy counterparts. Descriptive laboratory study. Level 5. Seventeen baseball pitchers were recruited to participate (18.03 ± 2.01 years; 185.40 ± 6.57 cm; 83.92 ± 13.87 kg). A medical history questionnaire was used to separate participants into groups, either previous injury/pain or healthy. Kinematic and kinetic data were collected on the participants performing the CKCUEST with an electromagnetic tracking system. Kinematics were analyzed using a pair of 1-way multivariate analyses of variance (MANOVAs). The MANOVA for nondominant hand touch in the CKCUEST revealed a significant difference in lumbopelvic-hip complex (LPHC) kinematics between previously injured/pain group and healthy group (Λ = 0.37; F4,12 = 5.12; P = 0.01). The previously injured/pain group displayed less pelvic axial rotation and dominant hip abduction during the nondominant touch indicating more LPHC stability during the nondominant touch. In conclusion, differences were observed in LPHC kinematics during the CKCUEST nondominant touch between a healthy and previously injured/pain group perhaps due to the increased awareness provided through rehabilitative programs for the previously injured/pain group. Clinicians can use this information to help address kinetic chain movement efficiency within baseball pitchers. This study provides evidence of LPHC kinematic differences during the nondominant touch of baseball pitchers and may enhance the use of the CKCUEST as a return-to-play assessment.