Elbow Flexion Strength Research Articles

Effect of high intensity in every set on strength gains in novice lifters: a randomized controlled trial

Background and Study Aim. Effective program design is essential for maximizing adaptation by balancing strength gains, minimizing stress, and enhancing recovery. However, it remains unclear whether training at high intensity in every set is necessary for optimal strength gains. This study compares the effects of two distinct 6-week resistance training programs on maximum strength in novice lifters. Material and Methods. Twenty participants were recruited and randomly assigned to either the traditional strength program (TSP) or the combined strength program (CSP), both periodized to increase the number of sets every 2 weeks over a total of 6 weeks. A two-way ANOVA was used to analyze maximum isometric strength, maximum dynamic strength, and strength ratio differences between groups and over time. Results. The results showed significant increases in maximum isometric knee extension and elbow flexion strength for both the TSP (CI 95% = 55.87-99.92 N and CI 95% = 10.93-26.86 N, respectively) and the CSP (CI 95% = 43.32-111.42 N and CI 95% = 8.54-28.96 N, respectively). Similarly, maximum dynamic knee extension and elbow flexion strength also improved significantly in both programs (knee extension: TSP CI 95% = 8.16-17.24 kg and CSP CI 95% = 9.10-28.32 kg; elbow flexion: TSP CI 95% = 6.74-11.26 kg and CSP CI 95% = 3.05-10.70 kg). Additionally, strength ratios increased significantly in both the TSP (knee extension CI 95% = 0.87-1.36 N/kg and elbow flexion CI 95% = 0.15-0.42 N/kg) and the CSP (knee extension CI 95% = 0.68-1.59 N/kg and elbow flexion CI 95% = 0.14-0.39 N/kg) from baseline. Conclusions. Both training programs led to significant increases in maximum strength metrics. Novice practitioners did not need to train at high intensity in every set to achieve substantial strength gains. This was particularly evident during the early weeks of training, when recovery and adaptation are critical.

Long-term Outcomes of Complete Tears of the Distal Biceps Tendon: An Analysis of Surgical Management at a Median Follow-up of 14.7 Years.

Surgical repair of full thickness biceps tears has demonstrated adequate outcomes in short and mid-term studies. However, data on the long-term outcomes of full thickness distal biceps injuries and their treatment are currently lacking. The purpose of this study was to report on patient demographics, injury characteristics, and long-term outcomes for patients with full-thickness distal biceps tears. It was hypothesized that complete distal biceps tears managed operatively would demonstrate robust clinical success at long-term follow-up. Case series; Level of evidence, 4. Patients with magnetic resonance imaging-confirmed, complete distal biceps tendon rupture sustained between 1996 and 2016 were identified. Patients were cross-referenced with a regional geographic database. A total of 66 patients (3 female, 63 male) with a median age of 50.8 years (IQR, 41.5-60.4) and a median clinical follow-up of 14.7 years (IQR, 9.6-17.9 years) were included. Patients who sustained a full-thickness distal biceps tendon tear were likely to be in their early 50s, male, right-hand dominant, current/former smokers, and laborers with a history of traumatic injury during an intentional movement. Most of these patients had pain and supination weakness but no loss of range of motion. All included tears were treated operatively. At final follow-up, patients maintained a majority of near-normal range of motion (median total arc of flexion/extension 140° and supination/pronation 80°), excellent elbow flexion strength (91% of patients had full strength), and adequate elbow supination strength (76% of patients had full strength). The overall complication rate was 24%, with 16 out of 66 patients experiencing some type of complication between infection, rerupture, heterotopic ossification, reoperation, and nerve complications. Overall return to work was 98%, and 85% of those who returned to work did so without restrictions. Complete tears of the distal biceps were most common in patients 50 years of age, male sex, right-hand dominant, and current/former smokers. The most common profession was laborer, and injuries were primarily traumatic in nature during intentional activity. Patients managed operatively demonstrated high rates of success at long-term follow-up with respect to elbow function and clinical outcomes.

Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy

Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30° through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus. We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30° and 80°. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation. Following a mean follow-up of 41 months, the average extension gain was 31° (range, 10°-50°). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study. Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30° flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale. Therapeutic IV.

Comparative Analysis of Bilateral Deficits in Elbow Flexion Strength: Functional vs. Analytical Assessment

Background: this study aimed to identify the influence of postural stability on upper-limb bilateral deficit (BLD), and to compare the assessment of strength generated during elbow flexion functionally vs. analytically in the dominant and nondominant arms. Methods: Twenty men participated in two sessions to evaluate the maximum isometric strength of elbow flexion. This evaluation was performed unilaterally with the dominant arm, unilaterally with the non-dominant arm, and bilaterally, both in the sitting position (SiP) and the standing position (StP). Results: The BLD when peak force was considered was lower for StP (−6.44 ± 5.58%) compared to SiP (−10.73 ± 6.17%) (p = 0.007). Regarding peak force, statistically significant differences were observed for comparisons between dominance (p < 0.001) and Position*Dominance (p = 0.02), but mean force differences were only observed for the dominance factor (p < 0.001). Greater mean and peak forces were always produced bilaterally compared to unilaterally (p < 0.001). Conclusions: a decrease in postural stability by performing elbow flexion exercises in a standing position accentuates BLD of peak force.

Changes in brain functional connectivity and muscle strength independent of elbow flexor atrophy following upper limb immobilization in young females.

Muscle disuse induces a decline in muscle strength that exceeds the rate and magnitude of muscle atrophy, suggesting that factors beyond the muscle contribute to strength loss. The purpose of this study was to characterize changes in the brain and neuromuscular system in addition to muscle size following upper limb immobilization in young females. Using a within-participant, unilateral design, 12 females (age: 20.6±2.1years) underwent 14days of upper arm immobilization using an elbow brace and sling. Bilateral measures of muscle strength (isometric and isokinetic dynamometry), muscle size (magnetic resonance imaging), voluntary muscle activation capacity, corticospinal excitability, cortical thickness and resting-state functional connectivity were collected before and after immobilization. Immobilization induced a significant decline in isometric elbow flexion (-21.3±19.2%, interaction: P=0.0440) and extension (-19.9±15.7%, interaction: P=0.0317) strength in the immobilized arm only. There was no significant effect of immobilization on elbow flexor cross-sectional area (CSA) (-1.2±2.4%, interaction: P=0.466), whereas elbow extensor CSA decreased (-2.9±2.9%, interaction: P=0.0177) in the immobilized arm. Immobilization did not differentially alter voluntary activation capacity, corticospinal excitability, or cortical thickness (P>0.05); however, there were significant changes in the functional connectivity of brain regions related to movement planning and error detection (P<0.05). This study reveals that elbow flexor strength loss can occur in the absence of significant elbow flexor muscle atrophy, and that the brain represents a site of functional adaptation in response to upper limb immobilization in young females.

Factors Affecting Outcomes After Free Functional Gracilis Muscle Transfer for Elbow Flexion in Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Free functional gracilis transfer (FFGT) is a useful option for reconstruction of elbow flexion following brachial plexus injury presenting late or with poor outcomes from previous nerve surgery. In this systematic review and meta-analysis, we aimed to investigate variables associated with superior outcomes. The efficacy of single versus double FFGT, where the first FFGT is performed to restore elbow flexion, and the choice of donor nerve for neurotization were evaluated. A meta-analysis was conducted, including studies that provided postoperative Medical Research Council (MRC) grade for elbow flexion, Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores, quantitative elbow flexion strength, and range of motion. A random effects meta-regression analysis was performed to identify factors associated with improved outcomes. Thirty-seven studies, with 1,607 patients, were analyzed. Single FFGT was reported in 34 studies (n= 1,398), and double FFGT was reported in 10 studies (n= 209). The mean follow-up duration was 37.3 ± 21.1 months. Following single FFGT, 75.4% and 48.9% achieved MRC grades ≥3 and ≥4, respectively. Following double FFGT, 100% achieved an MRC grade ≥3 and 62.7% ≥4. The likelihood of achieving M3 and M4 was significantly greater for double FFGT. Overall, FFGT innervated by the spinal accessory nerve had significantly better recovery of MRC grade ≥3. When comparing only single and double FFGT innervated by spinal accessory nerve, there was no significant difference in recovery of elbow flexion. The meta-regression analysis showed a significant negative correlation between the patient's age and the probability of achieving an MRC grade of ≥3 and4. In the overall analysis encompassing all innervating nerves, double FFGT was superior to single FFGT. Subgroup analysis of single and double FFGT innervated by the spinal accessory nerve showed no significant difference. Increasing age was a significant risk factor for poorer outcomes. Therapeutic IV.

Improving the neuromuscular fitness of patients with type 2 diabetes by aquatic exercise training - The Diabetes and Aquatic Training Study (DATS 3): a randomized controlled trial.

To compare the effects of aquatic aerobic and combined training on neuromuscular outcomes in patients with type 2 diabetes. Patients with type 2 diabetes were randomized to an aerobic aquatic training (AERO), a combined aquatic training (COMBI) or a procedure control (CON) three weekly for 15 weeks. The sessions were 50 minutes long. Maximal strength and muscle endurance were assessed by the 1RM and maximum repetitions at 60% 1RM tests, respectively, in knee extension and elbow flexion exercises. Timed up and go test, testosterone, cortisol and testosterone:cortisol ratio also were evaluated. Participants had 59.0±8.2 years, 51% women. All groups increased (P<0.001) the maximal knee extension strength (Mean Difference: AERO: 21.1 kg; COMBI: 14.6 kg; CON: 4.4 kg), while only COMBI group increased (P<0.001) the maximal elbow flexion strength (Mean Difference: 2.6 kg). Muscle endurance in both exercises were increased in all groups. The Timed Up and Go test at the usual and maximal speed decreased in all groups. Testosterone were not modified in present study, while cortisol and testosterone:cortisol were improved in COMBI group. Aquatic training, especially combined aquatic training, improve the neuromuscular fitness of patients with type 2 diabetes.

Does the Effect of Mental Fatigue Created by Motor Imagery on Upper Extremity Functions Change with Diaphragmatic Breathing Exercises? A Randomized, Controlled, Single-Blinded Trial.

Background and Objectives: This study focused on the impact of mental fatigue induced by motor imagery on upper limb function, an area with limited research compared to lower limb performance. It aimed to explore how diaphragmatic breathing exercises influence these effects. Materials and Methods: This study included 30 participants, and Group 1 participated in 12 sessions of diaphragmatic breathing exercises under the supervision of a physiotherapist; Group 2 did not receive any intervention. For all the participants, mental fatigue was induced with motor imagery before and after the intervention, and evaluations were performed before and after mental fatigue. Upper extremity functions were evaluated using isometric elbow flexion strength, hand grip strength, upper extremity reaction time and endurance, finger reaction time, the nine-hole peg test, shoulder position sense, light touch-pressure threshold, and two-point discrimination. Results: The study results showed that after mental fatigue, there was a decrease in isometric elbow flexion strength, nondominant hand grip strength, and nondominant upper extremity endurance, and an increase in nondominant tactile sensation (p < 0.05). No changes were found in two-point discrimination, nine-hole peg test time, and position sense on either side (p > 0.05). The effect of mental fatigue on isometric elbow flexion strength and nondominant grip strength showed significant improvement following diaphragmatic breathing exercises (p < 0.05). Conclusions: This study found that mental fatigue from motor imagery can impact elbow flexion, hand grip strength, upper extremity endurance, and tactile sensitivity. Breathing exercises may help improve strength parameters affected by mental fatigue. It is crucial to consider these effects on upper extremity functions in rehabilitation programs.

Association of kidney function with physical performance: the Maastricht study.

Kidney failure has been associated with decreased physical capacity, although evidence regarding the physical performance of individuals with earlier stages of chronic kidney disease (CKD)remains limited. Cross-sectional data were derived from the prospective, population-based Maastricht Study. Multivariate linear regression models were fitted to assess the association of estimated glomerular filtration rate (eGFR) and albuminuria categories with physical performance test outcomes. Overall, 7396 participants were included. Compared to eGFR 60-90ml/min/1.73m2, values < 60ml/min/1.73m2 were associated with significantly shorter 6-min walk distance (β: - 13.04m, 95% confidence intervals-CI - 19.95; - 6.13), worse timed chair rise stand test time (β: 0.91s, 95% CI 0.36; 1.47), lower maximal grip (β: - 0.83kg, 95% CI - 1.50; - 0.15) and elbow flexion (β: - 3.64 Nm, 95% CI - 7.11; - 0.16) strength. Additionally, eGFR > 90ml/min/1.73m2 was linked to significantly shorter 6-min walk distance (β: - 6.13m, 95% CI - 9.44; - 2.82). Urinary albumin excretion > 30mg/24h was associated with shorter 6-min walk distance (β: - 12.48m, 95% CI - 18.28; - 6.68), worse timed chair rise stand test time (β: 0.51s, 95% CI 0.11; 1.06), lower maximal grip (β: - 1.34kg, 95% CI - 1.91; - 0.76) and elbow flexion strength (β: - 3.31Nm, 95% CI - 5.80; - 0.82). Reduced eGFR and higher albuminuria levels were associated with worse physical performance, especially shorter 6-min walk distance and lower muscle strength. The relationship between eGFR and physical function was non-linear, with also high eGFR values being associated with worse performance, especially in the six-minute walk test.

Comparison of decrease in elbow flexion strength in patients after tenotomy and tenodesis of the long head of the biceps brachii.

The last two decades have been leading to the development of several types of surgical techniques and procedures to manage the LHB lesions. This paper analyses and compares the difference in muscle strength pre- and post-operatively in two most commonly used surgical procedures - LHB tenotomy and tenodesis. The study includes 68 patients who underwent surgery between 2016 and 2020. The patients who had met the prospective study inclusion criteria were divided into two groups based on type of surgery they had undergone (LHB tenotomy or tenodesis); each group consisted of 34. The muscle strength during elbow flexion was measured preoperatively and postoperatively using the Commander Echo Console ultrasound muscle testing device. All patients enrolled in the study had been assessed for elbow flexion strength preoperatively. The muscle strength was measured preoperatively and then 3 years postoperatively (12 to 60 months) on average. The study confirmed that the patients who had undergone LHB tenodesis show asignificantly lower decrease in elbow flexion strength and asignificantly lower incidence of "Popeye" deformity than the patients after LHB tenotomy. Moreover, in the tenodesis group, it was possible to initiate rehabilitation earlier. The incidence of postoperative complications was almost identical in both groups of patients (Tab. 10, Fig. 6, Ref. 40).

A Study on the Influence of Motor Imagery Training at Different Speeds on the Maximum Strength of Elbow Flexion

A Study on the Influence of Motor Imagery Training at Different Speeds on the Maximum Strength of Elbow Flexion

Is the Complication Rate in the Surgical Repair of the Distal Biceps Tendon Rupture Influenced by the Timing, Type of Incision and Method of Fixation?

Distal biceps tears are uncommon injuries, typically leading to significant loss of elbow flexion and supination strength; surgical repairs restore muscular strength and endurance. The aim of this study was to compare the complication rate of early (< 21 days) vs delayed (> 21 days) repair and the effect of types of incision and fixation methods used in the repair. A total of 86 cases were retrospectively reviewed, and 66 cases were included in the study after exclusion. Different preoperative and intraoperative variables and postoperative outcome measures were recorded. We analysed the effects of early and delayed repair, types of incision and fixation methods on the complications. 31 had an early, and 35 had delayed distal biceps repair. The mean follow-up was 14.92 weeks. 13.6% had major, and 40.9% had minor complications. No significant difference was noted in complications between the two groups (54.8% vs 54.3%). Higher complications were observed when surgery was done using a single anterior incision compared to 2 anterior incisions (68.8% vs 16.7%, p=0.0002). Overall, higher (76.3% vs 25.9%, p=0.0001) complications were noted in patients where fixation was done using a cortical button & interference screw in comparison to the cortical button alone. No significant difference in complication was noted between early and delayed repair. However, more complications were noted in the single anterior incision compared to the two anterior incision technique. Higher complications were also observed with the cortical button and interference screw fixation method compared to the cortical button alone.

Single-Incision Distal Biceps Tendon Repair With Bicortical Tensionable Locking Button Fixation

Acute, traumatic distal biceps tendon injuries are common among the middle-aged athletic male population. Surgical repair of distal biceps tendon remains the most effective means to restore maximal strength of forearm supination and elbow flexion with relief of antecubital pain. To date, no consensus exists on the optimal fixation method during distal biceps tendon repair and multiple techniques are accepted, including 1- and 2-incision approaches and tendon fixation with suture anchors, transosseous sutures, interference screws, and cortical buttons. In this Technical Note, we demonstrate a distal biceps tendon repair technique using a single-incision approach with bicortical, tensionable suspensory button fixation.

Home-based power training improves functional parameters and blood pressure after coronary artery bypass graft surgery: preliminary study

This study aimed to investigate the impact of remotely supervised home-muscle power training (RSHMPT) on physical function (PF), aerobic capacity (AC), autonomic cardiac control (ACC), and blood pressure (BP) in patients after coronary artery bypass grafting (CABG). The study sample consisted of 4 patients who underwent CABG. PF (dynamic balance, lower limb functional capacity, elbow flexion strength, handgrip strength), AC, ACC, and BP were evaluated before and after 8 weeks of RSHMPT. Experienced exercise physiologists administered the exercise protocol (8 weeks) virtually by WhatsApp® video calls. Remotely supervised RSHMPT consisted of multiarticular and monoarticular exercises performed by elastic bands. Clinical improvement has been demonstrated in dynamic balance (

Triceps-to-Biceps Tendon Transfer for Restoration of Elbow Flexion in Brachial Plexus Injury

Restoring elbow flexion is a reconstructive priority in patients with brachial plexus injuries. This study aimed to evaluate the results and assess factors contributing to outcomes of triceps-to-biceps tendon transfer in patients presenting with delayed or chronic upper brachial plexus injury. Patients with traumatic brachial plexus injuries undergoing triceps-to-biceps tendon transfer at a single institution's multidisciplinary brachial plexus center between 2001 and 2021 were retrospectively reviewed. The entire triceps tendon was transferred around the lateral aspect of the arm, secured to the radius with a tenodesis button, and reinforced with a side-to-side tendon transfer to the biceps tendon. Primary outcomes include the modified British Medical Research Council (mBMRC) elbow flexion strength and active elbow range of motion. Twelve patients (eight men and four women; mean age, 45.2 years) were included. The mean follow-up was 10.4 (range, 5-34) months. Nine patients achieved mBMRC ≥3. Five patients achieved mBMRC 4. Average active elbow flexion was 119°, with average extension deficit of 11°. There were three patients with unsatisfactory results, achieving mBMRC 2 elbow flexion. Triceps-to-biceps tendon transfer is an excellent tendon transfer option for restoring elbow flexion in certain patients with an adequately functioning triceps muscle, who present with a delayed or chronic brachial plexus injury. Although most patients achieved mBMRC ≥3 elbow flexion, there was an expected permanent loss of elbow active extension with a residual elbow flexion contracture. Therapeutic IV.

Optimal Distal Tendon Insertion Point for Elbow Flexion in Free-Functioning Gracilis Muscle Transfer for Panbrachial Plexus Injuries: A Cadaveric Study

Following pan-brachial plexus injuries, restoration of elbow flexion is widely accepted as the reconstructive priority. A gracilis free functioning muscle transfer (FFMT) can be used to restore elbow flexion alone with insertion into the biceps brachii (BIC) or brachioradialis (BRD) tendons or restore combined elbow and finger flexion with a more distal insertion into the flexor digitorum profundus (FDP) tendons. Using cadaveric experiments, we determined the peak instantaneous moment arm for each insertion option. Six simulated gracilis transfer surgeries were performed using both arms of three fresh-frozen full body cadaveric specimens (age: 79 + 10 years. 2 female). The gracilis muscles from both legs were harvested and transferred to the contralateral upper extremity. The elbow was manually moved through three flexion-extension cycles while the instantaneous moment arm was calculated from measurements of gracilis excursion and elbow joint angle for the three distal insertion sites. Peak instantaneous moment arm for all three insertions occurred at an elbow angle between 83° to 92° with a magnitude ranging from 33 mm to 54 mm. The more distal (FDP/BRD) insertions produced a significantly greater (∼1.5 times) peak elbow flexion instantaneous moment arm compared to the BIC insertion. Based on the instantaneous moment arm, the gracilis FFMT distal insertion locations could result in greater reconstructed elbow flexion strength. In addition, direct measurement of the shape and magnitude of the moment arm curve for differing insertion sites allows high resolution surgical planning and model testing. This study presents the first direct experimental quantification of the gracilis FFMT instantaneous moment arm. The experimental evidence supports the use of FDP/BRD insertion locations by providing a quantitative explanation for the increased elbow flexion torque observed clinically in patients with a gracilis FFMT and distal FDP insertion.

The Evolution of the Reconstructive Strategy for Elbow Flexion for Acute C5, C6 Brachial Plexus Injuries over Two Decades.

Over the course of the past two decades, improved outcomes following brachial plexus reconstruction have been attributed to newer nerve transfer techniques. However, key factors aside from surgical techniques have brought improved consistency to elbow flexion techniques in the latter decade. One-hundred seventeen patients who underwent brachial plexus reconstruction from 1996 to 2006 were compared with 120 patients from 2007 to 2017. All patients were evaluated preoperatively and postoperatively to assess the recovery time and of elbow flexion strength. In the first decade, nerve reconstruction methods included proximal nerve grafting, intercostal nerve transfer, and Oberlin-I transfer. In the second decade, newer methods such as double fascicular transfer and ipsilateral C7 division transfer to the anterior division of upper trunk were introduced. About 78.6% of the first decade group versus 87.5% of the second decade group were able to reach M3 flexion strength (p = 0.04), with shorter time recovery to reach M3 in the 2nd decade. About 59.8% of the first decade group versus 65.0% of the second decade group were able to reach M4 (p = 0.28), but no significant difference in time of recovery. In both groups, the double fascicular nerve transfer had the highest impact when introduced in the second decade. More precise magnetic resonance imaging (MRI) techniques helped to diagnose the level of injury, the roots involved and evaluate the health of the donor nerves in preparation for intraplexus transfer. In addition to modified techniques in nerve transfers, (1) MRI-assisted evaluation and surgical exploration of the roots with (2) more judicious choice of donor nerves for primary nerve transfer were factors that ensured reliable and outcomes in the second decade.

Subpectoral Biceps Tenodesis with endobutton fixation in the young population - which technique works best?

Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomical restoration of the length-tension relationship plays a central role to provide satisfying functional and cosmetic outcomes, especially in young patients. Here we report the clinical outcomes of two different subpectoral tenodesis techniques using unicortical button fixation. Patients under the age of 50 that were treated between April 2015 and January 2020 with one of the following two subpectoral tenodesis techniques were retrospectively selected and enrolled for a follow-up examination at least 2 years after surgery: Subpectoral in situ tenodesis followed by resection of the intraarticular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy first followed by resection of the stump and subpectoral tenodesis (group II). Patients that underwent concomitant rotator cuff repair, subsequent shoulder surgery or contralateral biceps surgery were excluded. Clinical outcome was evaluated using the LHB Score, Constant-Murley Score (CMS) and measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, signs of inflammation within the sulcus or around the tendon and measurements of the distalization of the myotendinous junction (MTJ) of the LHB compared to the non-operated side. Thirty-four patients in group I (24 males, mean age at the time of surgery 40.3 years, mean follow-up 57.2 months) and 24 patients in group II (19 males, mean age 39.8 years, mean follow-up 51.9 months) were evaluated. Total CMS as well as the respective subcategories did not reveal significant differences between groups. Overall LHB score was on average 10 points higher in group I (mean 94 points) compared with group II (mean 84 points) (p=0.016). In the LHB score subcategories, group I showed significantly better results regarding patient-dependent cosmesis (group I mean: 15 points; group II mean: 12 points; p=0.005) and examiner-dependent cosmesis (group I mean: 14 points; group II mean: 10 points; p=0.001). This was substantiated by a significantly higher distalization of the MTJ in group II (group I mean: 3.0 cm; group II mean: 3.8 cm; p=0.030). This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intraarticular portion provides higher LHB scores and better cosmetic outcome compared with proximal intraarticular tenotomy followed by subpectoral tenodesis.

Evaluating clinical outcomes of two biceps tenodesis techniques: Loop ‘N’ Tack and subpectoral biceps tenodesis

Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis. Patients undergoing both the subpectoral biceps tenodesis and Loop 'N' Tack biceps tenodesis will have improvements in patient-reported outcomes. Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded. One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop 'N' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively. Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.

Comparison of shoulder functions between assembly workers with and without subacromial pain syndrome.

The occurrence of subacromial pain syndrome (SPS) is associated with the frequent handling and lifting of heavy loads and excessive repetitive work. Thus, assembly workers have a high prevalence of SPS. The purpose of this study was to investigate differences in shoulder ROM, muscle strength, asymmetry ratio, function, productivity, and depression between workers with and without SPS. Sixty-seven male workers (35 workers with SPS and 32 workers without SPS) participated in this study. Shoulder internal rotation (SIR), shoulder external rotation (SER), shoulder abduction (SAB), shoulder horizontal adduction ROM and SIR, SER, elbow flexion (EF), scapular depression and adduction, scapular protraction strength were measured. The asymmetry ratio was calculated using the asymmetry ratio formula; shoulder functions were measured using the shoulder pain and disability index (SPADI), disabilities of the arm, shoulder, and hand (DASH), and visual analogue scale (VAS); and Endicott work productivity scale (EWPS). The SPADI (p = 0.001), DASH (p = 0.001), and VAS (p = 0.001) values of workers with SPS were higher than those of workers without SPS. Also, workers with SPS had lower SIR (p = 0.001) and SAB (p = 0.002) ROM compared to workers without SPS. In addition, workers with SPS exhibited lower SIR (p = 0.012) strength than workers without SPS. Workers with SPS had higher asymmetry ratio in SIR (p = 0.015), SER (p = 0.005), and EF (p = 0.008) strength than workers without SPS. The SIR, SAB ROM, SIR strength, and the asymmetry ratio of SIR, SER, EF strengths could provide an important baseline comparison for the workers with SPS.