External Rotation Movements Research Articles

Results of treatment of acromioclavicular joint injuries

Introduction. Acromioclavicular joint has an important role in the shoulder function. Loss of joint function due to injury or disease affects the biomechanics of the shoulder. The aim of this study was to evaluate the results of surgical treatment of acromioclavicular joint injuries, identify risk groups within the age groups, and to indicate the most common mechanisms of injury. Material and Methods. A retrospective study included 20 patients with acromioclavicular injury. We analyzed the results of surgical treatment in patients with acromioclavicular injury from January 2017 to January 2019. Patients were treated using Bosworth and Phemister surgical techniques. The Constant shoulder score was used to assess the results of surgeries. We compared the results of the operated and non-operated shoulders in each patient. Statistical analysis was performed using Student?s T-test and ?? test. Results. Functional assessment was done using the Constant shoulder score: 9 patients had excellent results, 7 had good results and 3 had satisfactory results; there were no patients with poor outcome. We compared the total Constant shoulder score of the operated shoulder with the results of the opposite healthy shoulder, as well as the range of motion of external rotation, and internal rotation range of motion of the operated and the opposite healthy shoulder. There was a statistically significant difference (p < 0.05) in all compared parameters. The total Constant shoulder score of the operated shoulder was by 14% lower in relation to the healthy shoulder. Conclusion. The basic precondition for positive treatment results is timely diagnosis and early surgical intervention. Shoulder function was surgically restored and 95% of patients can perform all activities of daily living.

Comparison between long and lower medial head triceps branches in dual neurotization for shoulder function restoration in upper brachial plexus palsy.

In upper brachial plexus injury (UBPI), restoring shoulder function is crucial. This study compares the transfer of long and lower medial heads of triceps branches to the axillary nerve to achieve proper restoration of function. A retrospective comparative study was conducted between two groups of patients with (UBPI). Group I patients (10) [mean age: 19 ± 10.6 years] were managed by transferring triceps long head branch to axillary nerve while group II patients (8) [mean age: 26 ± 9.6 years] were managed by triceps lower medial head branch transfer. The mean time from injury to surgery was 6 ± 1.3 and 5 ± 1.7 months respectively. All patients were followed up for a minimum of 12 months with the assessment of VAS, DASH score, active range of motion (AROM) and strength of shoulder abduction and external rotation; in addition to shoulder endurance and strengths of donors. Postoperative, three-monthly, electrodiagnostic assessments were performed. Postoperatively, the mean VAS and DASH scores; in addition to endurance time, showed significant enhancement in both groups. Patients in both groups have accomplished a mean abduction (AROM) of 98° ± 27.9 and 97° ± 11.9 respectively. The mean external rotation (AROM) was 48° ± 18.4 and 47° ± 9.2 respectively. Furthermore, group II patients had less triceps morbidity in addition to earlier and enhanced electrophysiological recovery. Dual neurotization for shoulder function restoration in (UBPI) is capable of providing proper functional results with minimal donor morbidity. The triceps lower medial branch provides an excelling donor due to less triceps morbidity, extra length; yet, earlier and enhanced electrophysiological recovery.

Visual Observation of Apparent Infraspinatus Muscle Atrophy in Male Professional Tennis Players.

Background:Previous studies have reported visually observed apparent muscle atrophy in the infraspinous fossa of the dominant arm of overhead athletes. Several mechanisms have been proposed as etiological factors, including eccentric overload, compressive spinoglenoid notch paralabral cysts, and cumulative tensile suprascapular neurapraxia.Purpose:To report the prevalence of apparent infraspinatus atrophy in male professional tennis players and to determine whether the suspected atrophy correlates with objectively measured weakness of external rotation.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 153 male professional tennis players underwent a musculoskeletal screening examination that included visual inspection of the infraspinous fossa. Infraspinatus atrophy was defined as hollowing or loss of soft tissue bulk inferior to the scapular spine in the infraspinous fossa of one extremity that was visibly different from the contralateral extremity. This finding was observed and independently agreed upon by both an orthopaedic surgeon and a physical therapist during the examination. Also assessed were rotator cuff instrument-assisted manual muscle testing, visual observation of scapular kinesis (or motion), and glenohumeral joint range of motion for internal and external rotation and horizontal adduction.Results:In the 153 players, dominant-arm infraspinatus atrophy was observed in 92 players (60.1%), and only 1 player (0.7%) was identified with nondominant infraspinatus atrophy. A Pearson correlation showed a significant relationship between the presence of dominant-arm infraspinatus atrophy and dominant-arm external rotation strength measured in neutral abduction/adduction (at the side) (P = .001) as well as between the presence of dominant-arm infraspinatus atrophy and bilateral external rotation strength measured at 90° of glenohumeral joint abduction (P = .009 for dominant arm and .002 for nondominant arm). No significant correlation was found with scapular dyskinesis, glenohumeral range of motion, or instrument-assisted manual muscle testing of the supraspinatus (empty-can test).Conclusion:Visually observed infraspinatus muscle atrophy is a common finding in the dominant shoulder of asymptomatic male professional tennis players and is significantly correlated with external rotation weakness. This condition is present in uninjured players without known shoulder pathology and is not related to glenohumeral joint internal rotation, total rotation range of motion, or scapular dysfunction. Players with visually observed infraspinatus atrophy should be evaluated for external rotation strength and may require preventive strengthening.

Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

Abstract Introduction Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint. In recent years, implant designs and configurations have been modified in order to improve function and avoid complications. Lateralization on the glenoid and the humeral side has been described to improve function and decrease radiographic scapular notching. Data on the clinical and radiographic results of bipolar lateralization in RSA are lacking. Methods In 38 cases, RSA was performed using an uncemented humeral short-stem component with a 145° neck–shaft angle in combination with bone lateralization on the glenoid side (Bony Increased-Offset Reversed Shoulder Arthroplasty, BIO-RSA; Wright Medical Inc., Memphis, TN, USA). Mean follow-up was 19 months (range 12–34 months). Patients were followed clinically using the Constant score as well as range of motion for shoulder flexion and external rotation. Radiographs in two different plains were analyzed for implant seating and the occurrence of scapular notching. Results There was a significant increase in all measured clinical parameters. Forward flexion increased from a mean of 75° preoperatively to 151° postoperatively, and mean Constant score increased from 21 to 71 points postoperatively (p < 0.001). Glenoid notching of grade 1 according to Sirveuax was observed in 3 out of 35 cases (9%); no grade 2, 3, or 4 notching was present. Revision surgery was necessary in one case (3%). Conclusion RSA with bipolar lateralization leads to excellent clinical outcomes, low complication rates, and low rates of radiographic scapular notching. Longer follow-up and prospective randomized trials are needed. Level of evidence Level IV.

THE USE OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION FOR INCREASING THROWING PERFORMANCE

ABSTRACT Introduction Throwing is considered the most important technical skill in Handball. However, it requires the athlete to perform this movement with maximum speed and accuracy, as it can define the final score of the game. Objective The aim of this study was to evaluate the effect of Proprioceptive Neuromuscular Facilitation, known as the Kabat method, on the throwing performance of handball athletes. Methods An experimental study of 18 male handball athletes with a mean age of 14 ± 1.13 years. The athletes were divided into two groups: control group (CG) and Kabat method group (KG). The athletes performed 16 training sessions, with analyses at the beginning and end of each session. Range of motion (ROM) of internal and external shoulder rotation, strength, muscle imbalance, throwing speed and accuracy were measured. The results were compared by the Student t-test of repeated measures. Results KG significantly increased external shoulder rotation and muscle strength in all the analyzed shoulder complex muscles. CG also increased strength, but not in all muscles. KG significantly increased the speed and accuracy of the pitch. Conclusion The Kabat method, through proprioceptive neuromuscular facilitation, significantly increased throwing performance, speed and accuracy in handball athletes when compared to the control group. Level of evidence III; Randomized Experimental Study.

Reverse versus anatomical shoulder arthroplasty in patients with intact rotator cuff.

The study objective was to compare the clinical results of reverse total shoulder arthroplasty (rTSA) and anatomical total shoulder arthroplasty (aTSA) in patients with osteoarthritis and intact rotator cuff. We hypothesised that the clinical results using rTSA would be comparable with those obtained with aTSA in this group of patients. The study included 51 patients with shoulder osteoarthritis and intact rotator cuff who underwent rTSA or aTSA. The range of motion, Constant-Murley score and strength in external rotation were recorded pre-operatively and at the twoyear follow-up. Subjective post-operative results were measured using the subjective shoulder value (SSV) score and a satisfaction questionnaire. The post-operative improvement was significant in both groups, subjectively and concerning all parameters of the Constant-Murley score. Post-operatively, no significant difference was noted between the two groups for active anterior elevation (AAE), active external rotation (ER), internal rotation (IR) or Constant-Murley score (67 ± 12 in the rTSA group vs 71 ± 11 in the aTSA group). An exception was the Constant-Murley range of motion sub-score, which was better in the aTSA group (p = 0.028). No significant complications necessitating revision surgery were encountered. Our findings are consistent with previous studies showing good results of rTSA with shoulder osteoarthritis and intact rotator cuff with a good restoration of the IR, similar to that obtained with aTSA. The rTSA is a valid option for shoulder osteoarthritis and intact rotator cuff in older adult patients.

Effectiveness of Mobilization with Movement in weight bearing position on pain, shoulder range of motion and function in patients with shoulder dysfunction

The purpose of the study was to investigate the effectiveness of mulligan mobilization with movement in weight bearing position on pain, shoulder range of motion and function in patients with shoulder dysfunction. The study was conducted on 32 patients of age between 18-50 years, who are diagnosed with shoulder dysfunction and follow the inclusion and exclusion criteria. Subjects were randomly allocated to two groups. The control group (n=16) received stretching, strengthening and shoulder active range of motion exercises with hot pack. The experimental group (n=16) received the same with an additional mulligan’s mobilization with movement in weight bearing. Clinical outcome measures were pain intensity on numeric pain rating scale, pain free shoulder range of motion in flexion, abduction, internal rotation and external rotation as measured with a goniometer and disability of the shoulder with the help of shoulder pain and disability index. Data was collected at baseline and after 2 weeks of intervention in both groups. The results revealed that there was a statistically significant improvement in pain scores and flexion range of motion of shoulder in the experimental group when compared with control group, however no significant change was observed in disability and other ranges measured.

Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder

To evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder. Between January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space. There was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones ( P<0.05). Manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.

Genetic factors in rotator cuff pathology: potential influence of col 5A1 polymorphism in outcomes of rotator cuff repair

BackgroundInvestigations in genetics have provided valuable information about the correlation between gene variants and tendinopathy. Single Nucleotide Polymorphisms of COL5A1 gene are reported to be involved in Achilles tendinopathy, chronic degenerative tendon changes at the elbow, and other tendinopathies. The influence of Single Nucleotide Polymorphisms of COL5A1 was previously analyzed in rotator cuff disease with confounding results. Moreover, the rs12722 polymorphism in COL5A1 gene has been implicated in the aetiology of musculoskeletal soft tissue injuries in several association studies. This study aims to analyse the possible influence of rs12722 polymorphism in COL5A1 in the outcomes of rotator cuff repair.MethodsSeventy-nine patients were included in the study. DNA was extracted from 1.2 ml of venous blood and genotyped for COL5A1 SNPs rs12722. Rotator cuff muscle strength and range of motion (ROM) in anterior elevation, external and internal rotation of the shoulder were evaluated.ResultsPatients presenting COL5A1 SNP rs12722 CC showed a ROM of passive external rotation statistically significantly higher compared to patients with CT genotype and TT genotype.ConclusionsCOL5A1 SNP rs12722 may influence the functional outcomes of RCRs, even though further studies are required to confirm these preliminary results.

A prospective study on role of hydraulic distension along with steroid under local anaesthesia in the management of frozen shoulder

Introduction: Frozen shoulder” is a chronic condition characterized by gradually progressive, painful restriction of all shoulder joint movement, with slow spontaneous recovery of either partial or complete movement over a period of time. Although many treatment options have been proposed for the frozen shoulder syndrome, each has limitations. Hydro dilation technique was developed in order to loosen the reported contraction and adhesion. we evaluated the Range of movement and pain relief of shoulder following “Hydraulic distension under local anaesthesia along with a steroid” pre and post distension. Material and methods: A prospective observational study was conducted in the department of orthopaedics at RLJ hospital attached to Sri Devaraj Urs Medical College between June 2018 to November 2019 for a period of 1.5 year. All the Patients with Peri arthritis shoulder and age above 30 years were included in the study. After obtaining the informed consent from the patients, Demographic data, History, Clinical Examination and details of investigations were recorded in study proforma. The pain and functional scoring used as per “The society of American Shoulder and elbow surgeons” and follow-up was done at 3 weeks, 6 weeks and 12 weeks after procedure. IBM SPSS version 22 was used for statistical analysis. Results: Total 50 patients were included in the study. The average age of the study population was 52.68 ± 9.79. There were no patients with complete disability. Marked pain (grade 1) was observed on presentation in 46(92%) of the subjects. Post distension only 9(18%) had pain. Flexion, abduction, internal rotation, external rotation movements of the shoulder have improved post distention and were statistically significant at 3rd, 6th, 12 th week. The mean ASES was 36.04 ± 5.84 at base line, it was 67.6 ± 7.64 at 6th week and 91.04 ± 8.68 at 12th week. The differences in the ASES score at 6th week and 12th week follow up period with baseline value were statistically significant (P value

Clinical Outcomes of Augmented rTSA Glenoid Baseplates

Abstract Background Glenoid wear is a common challenge in patients undergoing reverse total shoulder arthroplasty (rTSA). Augmented baseplates have recently been designed to address this. The purpose of this study is to determine the clinical outcomes, complications, and revision rates of patients undergoing rTSA with an augmented baseplate compared to those that received a standard, non-augmented baseplate. Methods Preoperative and postoperative data were analyzed for 414 patients with glenoid bone loss who underwent primary rTSA with either an 8° posterior augmented glenoid baseplate, a 10° superior augmented baseplate (SAB), or an 8° posterior/10° superior augmented baseplate (P/SAB). These patients were compared to 1547 primary rTSA patients who received a standard baseplate. Clinical outcomes were scored using the Simple Shoulder Test (SST), UCLA, ASES, Constant and SPADI clinical outcome scoring metrics. Range of motion for active abduction, forward flexion, internal rotation and external rotation were used to quantify function. Complication and revision rates were also documented, and postoperative radiographs were analyzed for scapular notching. A two-tailed, unpaired t-test was used to identify differences between continuous parameters and a Chi Square test was used for categorical parameters, with P Results At an average follow-up of 47.1 ± 23.1 months, the augmented baseplates performed as well, or better, than standard baseplates, with a similar complication rate, revision rate, aseptic glenoid loosening rate, and scapular notching rate. Discussion Augmented baseplates are a safe and effective option for patients with glenoid bone loss in the setting of rTSA at mid-term follow-up. For each baseplate type, the outcomes were similar, and the complication/revision and scapular notching rates were low and comparable to that of the standard baseplate cohort. Level of evidence Level III

In vivo volumetric and linear wear measurement of reverse shoulder arthroplasty at minimum 5-year follow-up

Reverse shoulder arthroplasty is quickly becoming the most frequently performed glenohumeral joint replacement. The purpose of this study was to evaluate the volumetric and linear wear rates of ultrahigh-molecular-weight polyethylene humeral liners invivo at a minimum 5-year follow-up. Radiostereometric analysis was used to image 15 patients at terminal range of motion in forward flexion, abduction, external rotation, and internal rotationand with the arm at the side. The relative position and orientation of the glenosphere and polyethylene were identified for each arm position. The apparent intersection of the glenosphere into the polyethylene was recorded as wear. Mean volumetric and linear wear rates were recorded, and Pearsoncorrelation coefficients were applied to the 36-mm liners to assess the relationship between the wear rate and term of service. The mean reverse shoulder arthroplasty term of service at the time of imaging was 8 ± 1 years (range, 6-11 years). The mean volumetric and linear wear rates for the 36-mm liners (n = 13) were 42 ± 22 mm3/yr (r = 0.688, P = .009)and 0.11 ± 0.03 mm/yr (r = 0.767, P = .002), respectively. The mean volumetric and linear wear rates for the 42-mm liners (n = 2) were 114 ± 44 mm3/yr and 0.17 ± 0.01 mm/yr, respectively. No single arm position was able to capture all recorded wear individually. This study showed volumetric and linear wear rates of approximately 40 mm3/yr and 0.1 mm/yr, respectively, for the 36-mm polyethylene liners. The 42-mm liners showed higher wear rates, although a greater number of subjects is required for conclusive results. Invivo wear of reverse total shoulder arthroplasty is multidirectional and perceptible.

Type E2 glenoid bone loss orientation and management with augmented implants

The purpose of this study was 2-fold: (1) to quantify type E2 bone loss orientation and its association with rotator cuff fatty infiltration and (2) to examine reverse baseplate designs used to manage type E2 glenoids. Computed tomography scans of 40 patients with type E2 glenoids were examined for pathoanatomic features and erosion orientation. The rotator cuff fatty infiltration grade was compared with the erosion orientation angle. To compare reconstructive options in light of the pathoanatomic findings, virtual implantation of 4 glenoid baseplate designs (standard, half wedge, full wedge, and patient-matched) was conducted to determine the volume of bone removal for seating and impingement-free range of motion. The mean type E2 erosion orientation angle was 47° ± 17° from the 0° superoinferior glenoid axis, resulting in the average erosion being located in the posterosuperior quadrant directed towardthe 10:30 clock-face position. The type E2 neoglenoid, on average, involved 67% of the total glenoid surface (total surface area, 946 ± 209 mm2; neoglenoid surface area, 636 ± 247 mm2). The patient-matched baseplate design resulted in significantly (P ≤ .01) less bone removal (200 ± 297 mm3) for implantation, followed by the full-wedge design (1228 ± 753 mm3), half-wedge design (1763 ± 969 mm3), and standard (non-augmented) design (4009 ± 1210 mm3). We noted a marked difference in erosion orientation towarda more superior direction as the subscapularis fatty infiltration grade increased from grade 3 to grade 4 (P < .001). The average type E2 erosion orientation was directed towardthe 10:30 clock-face position in the posterosuperior glenoid quadrant. This orientation resulted in the patient-matched glenoid augmentation requiring the least amount of bone removal for seating, followed by the full-wedge, half-wedge, and standard designs. Implant selection also substantially affected computationally derived range of motion in external rotation, flexion, extension, and adduction.

Physiotherapy Program for Managing Adhesive Capsulitis in Patients with Diabetes: A Protocol for a Pilot Randomized Trial

Background: Adhesive capsulitis (AC) occurs five times more often in people with diabetes and leads to prolonged disability. Exercises and joint mobilization are usually used to manage AC. However, the recovery is slow and often incomplete. Aerobic exercises improve hyperglycemia and insulin sensitivity. Currently, no research has formally assessed the benefits of incorporating an aerobic training program into the treatment plan of AC in patients with diabetes. This single blind pilot randomized trial will compare the preliminary effect of a regular physiotherapy program (PT), to a regular PT program combined with a progressive walking program (PT+) in patients with and without diabetes who have AC. Methods: Patients (n= 40) will be recruited from St. Joseph's HealthCare Centre and associated primary care practices. Patients will be randomly assigned into either the regular PT program or regular PT combined with a progressive walking program. Patients will be referred to physical therapy facilities and the intervention will be chosen by the treating physical therapist. In the PT+ group, patients will be asked to perform free walking at their own pace for 30-45 minutes, five days per week, for six consecutive weeks. The primary outcome will be testing the functional performance of the shoulder using the Functional Impairment Test- Hand and Neck/ Shoulder/Arm (FIT-HaNSA) test. Secondary outcomes will include shoulder pain and function using the Shoulder Pain and Disability Index (SPADI) questionnaire; shoulder range of motion in flexion, abduction, and external rotation; muscles strength of shoulder flexors and abductors; and physical activity level using an accelerometer and the Rapid Assessment of Physical Activity (RAPA) questionnaire. The primary outcome will be evaluated at baseline and after six weeks. Secondary outcomes will be evaluated at baseline, and after three, six and 12 weeks from enrolment. Discussion: The novel approach taken in this pilot trial will establish the preliminary effect of a regular PT program combined with a progressive walking program and will evaluate a study design prior to the performance of a full-scale research project that may lead to better outcomes for managing adhesive capsulitis in people with diabetes.

Ultrasound Microflow Imaging Technology for Diagnosis of Adhesive Capsulitis of the Shoulder.

To assess the diagnostic accuracy of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) at the subcoracoid triangle for adhesive capsulitis of the shoulder, to compare the diagnostic value of SMI with that of conventional ultrasound (US) and power Doppler ultrasound (PDUS) findings, and to investigate the correlation between vascular flow on SMI with clinical features. Our study included 39 patients with a diagnosis of adhesive capsulitis and 35 healthy patients as a control group. The echogenicity in the rotator interval and coracohumeral ligament thickness were assessed with conventional US. Vascular flow in the subcoracoid fat triangle was evaluated with SMI and PDUS (SMI and PDUS areas). A receiver operating characteristic curve analysis was performed to evaluate diagnostic accuracy. The correlation between US findings and the range of motion, pain intensity, and duration of symptoms was also evaluated. The SMI area was higher in the adhesive capsulitis group than in the control group (2.95 versus 0 mm2 ; P < .01). The visualization of vascular flow at the subcoracoid fat triangle was superior with SMI compared with PDUS (P < .01). In the receiver operating characteristic analysis, the SMI area showed higher diagnostic performance, with an area under the curve of 0.90 compared with other US findings. The area of SMI vascular flow was also negatively correlated with external rotation and forward flexion (P < .05) in the adhesive capsulitis group. Measurement of vascular flow at the subcoracoid fat triangle using SMI facilitated the diagnosis of adhesive capsulitis. Superb Microvascular Imaging was superior to PDUS in diagnostic performance. Vascular flow was negatively correlated with the range of motion of external rotation and forward flexion.

Arthrolyse arthroscopique dans les raideurs de l’épaule séquellaires de paralysie néonatale du plexus brachial: Résultats cliniques d’une série prospective de 28 enfants sur 2 ans de suivi

The primary objective of this study was to evaluate improvements in external rotation after isolated arthroscopic capsular release in children with shoulder contracture due to brachial plexus birth palsy. This study included all children older than 2 years with a range of active external rotation limited to 30° or less and/or active anterior elevation (AE) limited to 90° or less secondary to brachial plexus palsy treated between 2011 and 2015. Passive glenohumeral motion, passive global (gle- nohumeral plus scapulothoracic) motion, active global motion for external rotation with the elbow at the side (ER1), AE, and internal rotation with the elbow at the side were recorded before and 2 years after surgery. Improvement was evaluated by comparing the preoperative and follow-up values. The operation performed was subscapularis-sparing arthroscopic capsular release. Thirty-five patients were included, and 28 completed 2 years of follow-up. The average changes in active global ER1, passive glenohumeral ER1, and passive global ER1 were + 35 (range, 20 to + 100; p > 0.0001), + 35 (range, + 0 to + 75°; p > 0.0001), and + 26° (range, 15 to + 60; p > 0.0001), respective- ly. There were no significant changes in internal rotation with the elbow at the side or AE. The mean improvement in the aggregate Mallet score was 3.9 points (range,?3 to + 9 points; p > 0.0001). For children with shoulder contracture secondary to brachial plexus palsy, subscapularis- sparing isolated capsular release improves external rotation and functional scores and avoids any loss of active internal rotation but does not improve AE.

Effect of transtrochanteric rotational osteotomy on impingement and contact state of a femoral implant in conversion total hip arthroplasty — Retrospective simulation study

BackgroundThe transtrochanteric rotational osteotomy is a common osteotomy for osteonecrosis of the femoral head, although the results of conversion total hip arthroplasty after the osteotomy are controversial. We evaluated how deformities in the proximal femur after the osteotomy affect hip impingement and the contact state of the stem in total hip arthroplasty. MethodsWe retrospectively reviewed 35 hips (24 men) that had undergone the transtrochanteric rotational osteotomy for osteonecrosis of the femoral head (TRO-group) and compared them with 31 contralateral, unoperated hips (Primary group). The distance between the anterior and posterior greater trochanter at the cutting point of the femur, defined as the greater trochanter width and the contact area of the femoral implant surface with cortical bone were measured by CT-based three-dimensional templating software. We also calculated the hip range of motion in conversion total hip arthroplasty and analyzed the correlations between the greater trochanter width and the range of motion. FindingsThe number of bony-impingement cases was significantly greater, and the range of motion in flexion, internal rotation and external rotation was significantly less in TRO-group. There was a significant negative correlation between the greater trochanter width and range of motion of internal rotation. There were no significant differences between two groups in percentages of femoral-implant contact area. InterpretationsThe femoral implant fixation appears to be satisfactorily fixed in all zones in conversion total hip arthroplasty. However, the greater attention should be paid to minimizing bony impingement, especially on the anterior side, in conversion total hip arthroplasty.

Arthroscopic Latarjet for Recurrent Shoulder Instability.

Background and Objectives: The all-arthroscopic Latarjet (aL) procedure was introduced to manage recurrent shoulder instability. Our study aimed to report the outcomes of aL procedures with the Rowe, University of California-Los Angeles (UCLA), simple shoulder test (SST) scores, and range of motion (ROM) in external rotation at a minimum follow-up of 2 years. Material and Methods: A total of 44 patients presenting recurrent shoulder instability were managed with aL procedure. Clinical outcomes were assessed at a mean follow-up of 29.6 ± 6.9 months. The postoperative active ROM was measured and compared with the contralateral shoulder. The Rowe, UCLA, and SST scores were administered preoperatively and postoperatively. Results: No patients experienced infections or neuro-vascular injuries. Seven (15%) patients required revision surgery. After surgery, the external rotation was statistically lower compared to the contralateral shoulder, but it improved; clinical outcomes also improved in a statistically significant fashion. Conclusions: The aL produced good results in the management of recurrent shoulder instability, but the complication rate was still high even in the hands of expert arthroscopist.

Age and sex-related upper body performance differences in competitive young tennis players.

ObjectiveThe aims of this study were to analyze the shoulder functional profile of young male and female tennis players and to establish the relationship among physical variables and serve speed.MethodsA total of 128 Spanish tennis players (Under-13 (n = 32/32 males/females) and Under-15 (n = 36/28 males/females), were tested during National training camps. Tests included passive shoulder range of motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, medicine ball throws (MBT), and serve speed. Age and sex pairwise comparisons were carried using the Hedges’ g index (dg).ResultsResults showed age and sex effects on serve speed and all MBT, with males showing greater changes (1.51≤dg≤1.98) with age than females (0.92≤dg≤1.35; p<0.05). U15 males showed higher (p<0.05) absolute shoulder IR and ER strength than U13, with only significant differences between males and females in the U15. Regarding ROM, U15 males showed a decreased IR ROM compared to U13 (dg = -0.84; p<0.05) and higher significant IR bilateral deficit (dg = 0.51; p<0.05). The distances obtained in the different MBT were the variables more correlated to serve speed.ConclusionThe present results suggest that shoulder strength, medicine ball throws and serve speed increased along with age in young elite tennis players of both sexes. However, a decreased range of motion and bilateral deficit for glenohumeral internal rotation is evident in male under-15 tennis players. Muscle strength, power and shoulder range of motion are key factors for serve speed in young tennis players.

Variations in kinematic variables and performance in the tennis serve according to age and skill level

ABSTRACTTo analyse the influence of age and skill level on tennis serve performance, 99 male participants took part in a study of maximum effort serves to a target (50 x 50 cm) in the add service box. Participants were divided into two skill level groups (elite and recreational) and three age groups (under 12 years old [U12], under 16 years old [U16] and +18). During testing, kinematic data were recorded and serving performance (accuracy and speed) was measured. A single-way analysis of variance (ANOVA) was used to analyse the differences for kinematic and performance variables between the six groups. Correlation analysis was performed to establish the relationships between kinematics variables and serve performance. Results highlighted the influence of both age and skill level on performance (speed and accuracy), as well as on kinematics (hand, arm, hip peak velocities) of the tennis serve. The spatial position of the hand in respect to the hip in the moments previous to ball impact in the medio-lateral, and the vertical axes was significantly correlated with serving performance in all the age groups. These results suggested that an increased range of motion of shoulder external rotation and wrist flexion, as well as higher velocities of shoulder internal rotation and elbow extension should be developed to increase tennis serve speed.