External Rotator Muscle Strength Research Articles

Golfers' Performance Is Improved More by Combining Foam Rolling and Dynamic Stretch to the Lead Hip Than Practice Golf Swinging.

Hamada, Y, Akasaka, K, Otsudo, T, Sawada, Y, Hattori, H, Kikuchi, Y, and Hall, T. Golfers' performance is improved more by combining foam rolling and dynamic stretch to the lead hip than practice golf swinging. J Strength Cond Res 38(7): e391-e397, 2024-Warming up is considered effective in improving performance and preventing injury. Despite this, there have been few studies investigating warm-up programs in golf and whether specific factors contribute to improved performance. The purpose of this study was to examine the immediate effects of combined foam rolling and dynamic stretch (FR + DS) to the lead hip on golf swing performance, hip range of motion (ROM), and muscle strength in amateur golfers using a randomized crossover design. The study sample comprised 22 men (mean ± SD ; age, 32.6 ± 8.5 years, body mass index (BMI), 23.4 ± 2.7 kg·m -2 ). Subjects were assigned to receive either FR + DS or repetitive golf swing practice (SW) before crossing over to the other intervention for another day. Measurements included golf swing performance (ball speed, club head speed, flight distance ["carry"], spin rate, and launch angle), hip internal rotation (IR), and external rotation (ER) ROM, as well as hip IR and ER muscle strength. Comparisons between groups were made before and after each intervention. For golf swing performance, FR + DS improved "carry" significantly more than SW ( p < 0.05). No significant differences in golf swing performance other than "carry" were found. In addition, IR ROM and IR muscle strength of the lead hip were significantly increased in the FR + DS group ( p < 0.05). FR + DS has effects on improving lead hip IR ROM and IR muscle strength, which may facilitate golfers' swing and "carry." FR + DS shows promise as a warm-up method for amateur golfers who want to improve golf performance.

What is the influence of biomechanical variables on the Y balance test performance in recreational runners?

BackgroundAsymmetries and poor Y balance test (YBT) performance are associated with an increased risk of injuries in athletes. The aim of this study was to investigate the association between YBT performance with biomechanical variables in runners. MethodsThe runners underwent the YBT, followed by the assessment of center of pressure, plank position, muscle strength (MS) of hip flexors, extensors, abductors, and external rotators, knee extensors, ankle dorsiflexion range of motion (ROM), Q angle, forefoot alignment, and passive hip internal rotation. Associations between variables were examined using multiple linear regression models with the Bayesian Information Criterion. Results122 cases were analyzed. The R2 values were 0.38; 0.05; 0.06; and 0.15 for the anterior, posteromedial, posterolateral and composite directions models, respectively. The anterior reach in the YBT was associated with ankle dorsiflexion ROM [Sβ 95%IC: 0.43 (0.32–0.55)], passive hip internal rotation [Sβ 95%IC: 0.35 (0.24–0.47)], MS of the hip extensors [Sβ 95%IC: 0.19 (0.07–0.31)] and forefoot alignment [Sβ 95%IC: 0.14 (-0.25-0.02)]. The posteromedial and posterolateral reach were associated with MS of the hip flexors [Sβ 95%IC: 0.23 (0.09–0.37) and 0.24 (0.11–0.38)], respectively. The composite score was associated with MS of the hip flexors [Sβ 95%IC: 0.31 (0.18–0.45)], ankle dorsiflexion ROM [Sβ 95%IC: 0.24 (0.10–0.37)] and Q angle [Sβ 95%IC: 0.18 (0.04–0.31)]. ConclusionYBT performance in different directions demonstrated specific associations with key biomechanical factors.

Acute Effects of Handheld Vibration Massage on Posterior Shoulder Soft Tissues.

Interventions using vibration stimulation have been recognized for their potential for increasing range of motion (ROM) without compromising muscle strength. Handheld vibration massagers can efficiently deliver vibration therapy to the shoulder joint and may be a potential treatment. To evaluate the effects of vibration massage using a handheld device on the soft tissues of the posterior shoulder joint, particularly on internal rotation (IR) passive ROM and external rotation (ER) muscle strength. Crossover study design. A crossover study with a 5-min vibration massage and passive control condition was conducted in healthy male volunteers (mean age 20.5 ± 1.7 years). Vibration massage was applied to the posterior shoulder soft tissues of the dominant arm, with no intervention under control conditions. IR-ROM (vertebral level and in abduction) and strength of the external rotators (isometric and isokinetic) were measured before and immediately after the intervention. Vertebral levels were calculated as a ratio of lengths (ratio decreases with increased mobility). IR-ROM in abduction, the angle was measured. Statistical analysis was performed with two-way repeated measures ANOVA and paired t-test (Bonferroni correction). Vibration application decreased (improved) vertebral level IR ROM by -4.1% (p < 0.01, d = 0.445) and increased abduction position IR ROM by 11.4° (p < 0.01, d = 0.694). These changes exceeded the 95% confidence interval for the minimum detectable change. By contrast, the control condition produced no changes. IR-ROM (vertebral level and abduction) immediately after the intervention showed significant differences between the control and vibration conditions (p = 0.036, d = 0.273; p = 0.048, d = 0.483, respectively). Muscle strength did not show any interaction, time, or between-condition effects. A massage using a handheld vibration massager applied to the posterior shoulder soft tissues increased IR-ROM without negatively affecting muscle strength, suggesting its potential use as a means of warming up. Level 3.

Shoulder vibratory exercises improves shoulder external rotation muscle strength and shoulder function: Randomized comparison trial.

Based on electromyography measurements, shoulder vibratory exercises efficiently stimulate shoulder muscles activity. Yet very few studies have supported that shoulder vibratory exercises increased shoulder muscles strength and function, and the noninferiority compared with conventional elastic resistance exercises remains unknown. This study investigated the effect of vibratory exercises versus conventional elastic resistance exercises with elastic bands on shoulder external rotation muscles strength and functional performance in young adults. 26 young adults (7 males and 19 females, with age 23.89 ± 3.02) were recruited and randomly allocated to shoulder vibratory exercises with FLEXI-BAR (FLEXI-BAR group) or conventional resistance exercises with elastic band (TheraBand group) for 3 times/week, 4 weeks totally. Shoulder external rotator muscles strength test and Underkofler softball distance throw test (USDTT) were performed before and after the training period. After 4 weeks training, shoulder external rotator muscles strength increased 22.25 ± 15.06 N (P= 0.004, effect size = 1.48) within FLEXI-BAR group and 22.81 ± 14.94 N (P= 0.007, effect size = 1.53) within TheraBand group. There were no statistically significant differences between groups in the three muscle strength tests (P> 0.65). Regarding shoulder function, FLEXI-BAR exercises increased the throw distance 0.81 ± 0.92 meters in USDTT (P= 0.041, effect size = 0.88) while TheraBand exercise did not (P= 0.284), yet there was no statistically significant between group effects (P= 0.608). These findings suggest that shoulder vibratory exercises can improve shoulder muscles strength in young adults and can be a useful alternative to the conventional elastic resistance exercises to improve the shoulder muscles strength and function. This provides therapists with more options in terms of choosing training equipment for rehabilitation programs.

Influence of Hip Mobility and Strength on Gait Parameters among Young Females—A Cross-Sectional Study

Abstract Background The hip's primary function is to dynamically support the weight of the trunk while allowing the force and load transmission axial skeleton to the lower extremity and henceforth allowing mobility. The function of the hip is not only to take the load of the trunk to the lower extremity but also to perform daily activities which include walking, running, jumping, sitting, etc. Hip muscle strength is required to stabilize the pelvic and trunk during squatting and walking (single stance) and to perform other daily living activities. The prevalence rate reports that males are more physically active than females. The number of physical activities has shown to be decreased in teens and young adults between the ages of 14 and 22 years due to transitions in their lifestyle. These changes can be behavioral and due to body composition. The objectives of the study are to determine the influence of hip mobility and strength on the spatial and temporal parameters of gait. Methodology This is a cross-sectional study involving a total of 50 young female populations that have been selected based on the inclusion criteria. Hip range of motion using a universal goniometer was measured in three trials with 30 seconds of rest between each measurement. The hip muscle strength was measured using a handheld dynamometer with 5 seconds hold and three trials taking 30 seconds of rest between each measurement. Spatial parameters of gait were measured by using Kinovea software V.0.8.15, and temporal parameters of gait were measured by asking the subject to walk comfortably in their own speed for 1 minute and the video was taken and measured. Result The hip internal rotation and external rotation has shown to have a statistical significance with spatial and temporal parameters of gait. The hip abductors, adductors, internal rotators, and external rotator muscle strength have shown to have statistical significance with spatial and temporal parameters of gait. Descriptive statistics were used for demographic characteristics, and Pearson's correlation coefficient is used for determining association between outcome variables. Conclusion The hip abductors, adductors, internal rotators, and external rotators have shown to have influence on gait parameters specially with walking speed. The hip internal and external rotation has shown to have influence on gait parameters.

A Comparison Study of the Western Ontario Rotator Cuff Index, and the Constant-Murley Score with Objective Assessment of External Rotator Muscle Strength and Pain in Patients after Arthroscopic Rotator Cuff Repair.

Although rotator cuff injures are often associated with a limited range of motion and muscle weakness, being able to conduct pain-free and efficient performances of the activities as part of daily living seems to be more important for patients. The aim of this study was to investigate the correlation between two questionnaires-the disease-specific, subjective questionnaire termed the Western Ontario Rotator Cuff Index (WORC), and the shoulder-specific, subjective-objective questionnaire Constant-Murley score (CMS), with the objective assessment of external rotator muscle strength, and the subjective assessment of pain according to the visual analog scale (VAS) in patients after arthroscopic rotator cuff repair. The study was carried out among 47 patients twice-6 and 12 months after surgery, respectively. All patients completed the WORC, the CMS, and the VAS. Isokinetic evaluation of the external rotators was performed using the Biodex 4 ProSystem. The correlations of all assessed muscle strength parameters with both the CMS and the WORC were found to be statistically significant, being mostly average during the 1st examination and mostly strong during the 2nd examination. There was a significant improvement in all assessed tools as a result of the undertaken rehabilitation. There were weak correlations present between changes in the WORC and changes in the external rotator muscle strength, with correlations between WORC-Sport and EXT900-AVERAGE-POWER and PEAK-TORQUE also being found statistically significant. Correlations of changes in the CMS scale with changes in the external rotator muscle strength were weak and statistically insignificant. It seems that the WORC questionnaire can be recommended more for the population after rotator cuff repair, which allows for a reliable assessment of patients' ability to function and its changes in various areas of life, and at the same time does not require a direct assessment by a clinician or researcher.

The Effect of 8-week Online Scapular-focused Training on Scapular Kinematics, Proprioception, and Selected Muscles Strength in Female Volleyball Players With Glenohumeral Internal Rotation Deficit

Purpose: One of the most significant risk factors for throwing athletes is an internal rotation deficit of the shoulder joint. This study aims to investigate 8-week online scapular-focused training on the scapular kinematics, proprioception, and strength of particular shoulder muscles in female volleyball players with glenohumeral internal rotation deficit. Methods: The present study was conducted using a two-group with pre and post-test design. Based on the inclusion and exclusion criteria, 30 female athletes with abnormalities in the shoulder joint’s internal rotation were split into two groups, experimental (n=15) and control (n=15). In the pre-test, goniometers were used to measure shoulder range of motion, isokinetic devices were used to measure proprioception and rotator cuff muscle strength, and inclinometers were used to measure scapular kinematics. The experimental group’s participants underwent 8-week online scapular-focused training, lasting 30 minutes over three sessions each week. These exercises encompassed strength (with TheraBand) and stretching activities. Ultimately, intra-group and inter-group differences were examined using SPSS software, version 20 using paired t-tests and analysis of covariance (ANCOVA) at a significance level of 0.95. Results: The results of paired t-test revealed that only the experimental group and the pre-test and post-test had a significant difference in all study variables (P&lt;0.05). Additionally, the results of the analysis of covariance (ANCOVA) demonstrated a significant difference between the two groups’ shoulder proprioception at 45° and 90° in the post-test (P=0.001 and P=0.01, respectively). The two groups also differed significantly in the scapular kinematics at all angles of 45°, 90°, and 135° as well as at the limit of the shoulder’s range of motion (P=0.01, P=0.04, P=0.001, and P=0.001, respectively). Additionally, significant differences were observed between the two groups in all variables of isokinetic strength of concentric internal rotation, isokinetic strength of concentric external rotation, isokinetic strength of eccentric internal rotation, and isokinetic strength of eccentric external rotation (P=0.001, P=0.02, and P=0.001, respectively). Conclusion: Based on the results, it can be concluded that 8-week online scapular-focused training improves scapular kinematics, proprioception, and shoulder internal and external rotator muscle strength in female volleyball players experiencing internal rotation deficiencies of the shoulder joint. It is advised that coaches, experts, and occupational therapists employ these workouts to enhance the aforementioned factors in female volleyball players experiencing shoulder internal rotation deficiencies.

Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments

BackgroundContradictory evidence exists regarding the clinical course of frozen shoulder (FS). ObjectivesTo explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. MethodsPatients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. ResultsInitially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). ConclusionAlmost all factors improved in the early phase (3–6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.

Effects of gender and fatigue on strength and activity of gluteus medius muscle during a controlled cutting maneuver in preadolescent athletes

The present study aimed to investigate the effects of gender on hip muscle strength and activity during a controlled cutting maneuver in preadolescent athletes. Fifty-six football and handball preadolescent players participated (35 females and 21 males). Normalized mean activity of the gluteus medius (GM) muscle was measured using surface electromyography during cutting maneuvers in pre-activation and eccentric phases. The stance duration and the strength of hip abductors and external rotators were recorded with a force plate and a handheld dynamometer, respectively. Descriptive statistics and mixed model analysis were used to assess statistical difference (α=0.05). The results showed that boys activate the GM muscle significantly more than girls during the pre-activation phase (P=0.022). Boys also demonstrated greater normalized strength of hip external rotation than girls (P=0.038), but not for hip abduction or duration of stance (P>0.05). When adjusted for abduction strength, however, boys had significantly shorter stance duration than girls (P=0.006). It seems that sex-dependent differences are present in preadolescent athletes as observed in the strength of hip external rotator muscles and neuromuscular activity of the GM muscle during a cutting maneuver. Future studies are needed to investigate whether these changes influence risk of lower limb/ACL injury during sport activities.

EFFECTS ON EXTERNAL ROTATOR MUSCLE STRENGTH IN NECK OF FEMUR FRACTURE PATIENTS OPERATED WITH SOUTHERN MOORE APPROACH FOR BIPOLAR HEMIARTHROPLASTY OF HIP

Introduction: Neck of femur fracture is one of the most common fractures of elderly age group. Bipolar Hemiarthroplasty of Hip is most widely accepted treatment protocol. Posterior (Southern moore) approach is one of the widely used approach all over the world. In this approach Short external rotators are detached from their insertion and reattached. Hence there is a need to assess the function of External rotation of Hip post operatively. A Methods: Prospective study was carried out in patients with Neck of femur fracture who underwent Bipolar Hemiarthroplasty of Hip with Southern moore approach from May 2021 to May 2022 in a single institution. All patients were followed up and assessed at 6 weeks, 3 months and 6 months and function of short external rotators was assessed with Augustssons Strength test. Control for the muscle strength was considered opposite (Normal) side of hip. Patients with Any other ipsilateral fractures were excluded. Analysis of the data was done for the external rotator muscle strength at 6 weeks, 3 months and 6 months with comparison to normal hip of patient. The overall mean age was 69 years. Results: All the patient were followed up till 6 months post operatively. There was reduced strength of short external rotators in all the patients compared to normal hip at 6 weeks, with no significant difference in strength at 3 months. 12 out of 13 had equal muscle strength at 6 months. This study concludes that Detaching of Short external rotator in southe Conclusion: rn moore approach does not affect the muscle strength at 6 months. However it is found to be weaker in initial month.

Effectiveness of Manual Therapy and Specific Exercise Conditioning on Clinical Outcome Measures among Participants with Subacromial Impingement Syndrome

Shoulder subacromial impingement syndrome (SIS) is a mechanical disturbance caused by a multifactorial aetiology, and conservative treatment is the first choice. This study aims to investigate the combined short-term effect of manual therapy and eccentric exercise conditioning on clinical outcomes in the acute phase. We recruited 126 subjects with a SIS of 3 months' duration and divided them into two groups of 63 people each. The experimental group received manual therapy and eccentric exercise; the control group received concentric exercise, spread over 3 weeks, followed by a home program for another 9 weeks. Pain intensity, shoulder elevation range, abductor and external rotator muscle strength, and regional function were obtained at baseline, after 10 sessions of treatment and follow-up at 12 weeks. After the first session and by the end of 3 weeks, a global rating of change (GRC) questionnaire was administered to determine self-perceived improvement. An analysis of variance with repeated measures was applied, and the results showed that there were statistically significant differences in both groups; all outcomes improved after treatment and during follow-up (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.005). However, on intergroup analysis, significant improvement was observed with pain intensity (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.0005), elevation range of motion (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.05) and external rotator muscle strength (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.016) after treatment, and external rotator muscle strength and SPADI score (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.0005) at follow-up by 12 weeks in the experimental group. The between-group comparison revealed that pain reduction by 3 weeks, external rotator muscle strength by 3 and 12 weeks, had resulted in a large effect size. Manual therapy and eccentric exercise can reduce pain intensity, improve shoulder elevation range, and gleno-humeral muscle strength after 12 weeks of training better than concentric exercises. The improvement in shoulder function with the experimental group exceeded the MCID of 13 points, resulting in a large and significant effect size (d &amp;#61; 1.08). The self-perceived improvement (GRC) was significant in the experimental group (&lt;i&gt;P&lt;/i&gt; &amp;#60; 0.001) with a clinically significant change greater than the MCID (3 points).

Shoulder stretching versus shoulder muscle strength training for the prevention of baseball-related arm injuries: a randomized, active-controlled, open-label, non-inferiority study

Glenohumeral internal rotation deficit (GIRD) and weakness in prone external rotation are risk factors for shoulder and elbow injuries in high school baseball pitchers. While a shoulder-stretching prevention program to improve GIRD decreases the injury rate, the effects of external rotation strength remain unclear. This non-inferiority (NI) study investigates the hypothesis that external rotation strength training is not inferior to sleeper stretching for shoulder and elbow injury prevention in high school baseball pitchers. Participants were randomly allocated to the stretching (n = 62; active control group) and muscle-training (n = 51) groups. Specific exercises were performed each night. Elbow and shoulder injuries were monitored for 150 days. Kaplan–Meier survival curves were generated, and the hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. The log-rank test was used to compare the injury-free time. A one-sided NI test using a fixed NI margin was performed (significance level, P = 0.025). The injury rates were 22.6% (n = 14) in the stretching group and 9.8% (n = 5) in the muscle-training group. The muscle-training group had a lower injury rate (P < 0.001) and a lower risk of injury than the stretching group (HR = 0.489). Therefore, external rotation muscle strength training is not inferior to stretching for preventing baseball-related arm injuries.

The effectiveness of the comprehensive corrective exercise program on kinematics and strength of lower extremities in males with dynamic knee valgus: a parallel-group randomized wait-list controlled trial

BackgroundDynamic knee valgus (DKV) is a prevalent movement impairment widely regarded as a risk factor for lower extremity disorders such as patellofemoral pain syndrome. The present study aimed to investigate the effectiveness of the comprehensive corrective exercise program (CCEP) on kinematics and strength of lower extremities in males with DKV.MethodsThirty asymptomatic young men with DKV between the ages of 18 and 28 years participated in this study. They were randomly assigned to the intervention (n = 15) and control groups (n = 15). The intervention group performed the CCEP for three sessions per week for eight weeks, while the control group only did activities of daily living. Hip external rotator and abductor muscle strength and three-dimensional lower extremity kinematics consisting of knee varus/valgus, femur adduction/abduction, femur medial/lateral rotation, and tibial medial/lateral rotation were measured at the baseline and post-test. The data were analyzed using the analysis of covariance (ANCOVA).ResultsThere were significant improvements in all kinematics variables in the intervention group after the 8-week CCEP. Moreover, the strength of abductor and external rotator muscle improved in the intervention group (P < 0.05).ConclusionsThe CCEP led to substantial improvements in the selected variables of lower extremity kinematics and muscle strength in participants with DKV during a single-leg squat. These results imply that practitioners should adopt a comprehensive approach to pay simultaneous attention to both proximal and distal segments for improving DKV.Trial registrationThe protocol has been approved in the Registry of Clinical Trials (Registration N: IRCT20180821040843N1) on 2018-12-30.

Poster 128: Association Between Postoperative Graft Integrity and Clinical Outcomes After Superior Capsule Reconstruction: A Multicenter Study

Objectives:Superior capsule reconstruction (SCR) was developed as a joint-preserving surgical option for patients with irreparable rotator cuff tears (RCTs). Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing the clinical outcomes of SCR. However, the correlation between postoperative graft integrity and clinical outcomes after SCR remains unclear. The objective of this study was to assess the correlation between postoperative graft integrity and clinical outcomes after SCR in patients with irreparable RCTs.Methods:This retrospective multicenter study enrolled 188 patients (86 women and 102 men; mean age, 69.2 years; range, 49–87 years) who underwent arthroscopic SCR using fascia lata autografts for irreparable RCTs from five different centers. Postoperative graft integrity was evaluated using magnetic resonance imaging and was classified into five categories: type I, sufficient graft thickness with homogeneously low intensity; type II, sufficient graft thickness with partial high intensity; type III, insufficient graft thickness (4 mm or less) without discontinuity; type IV, presence of a minor discontinuity in less than four slices on both oblique coronal and sagittal images, suggesting a small graft tear; type V, presence of a major discontinuity in four or more slices on both oblique coronal and sagittal images, suggesting a large graft tear. We compared the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion (ROM), muscle strength (assessed with manual muscle test), and acromiohumeral distance (AHD) among the five groups based on postoperative graft integrity. For the statistical analyses, Kruskal-Wallis test (nonparametric one-way analysis of variance) followed by pairwise group comparisons using the Dwass-Steel-Critchlow-Fligner procedure was used to compare the values among the five groups based on the postoperative graft integrity assessment. Paired t-test or Wilcoxon signed-rank test was used to compare the preoperative and postoperative clinical outcome measures and AHD. Statistical significance was defined as P <0.05.Results:VAS and ASES score significantly improved after SCR in all graft types (all P<.05) (Table 1). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES score compared to those with type I and II grafts (all P<.05). Shoulders with intact grafts (types I, II, and III) showed significant improvements in shoulder ROM (all P<.05) (Table 2) and muscle strength after SCR (all P<.05) (Table 3). In contrast, shoulders with graft tears (types IV and V) showed no significant improvement in the range of external and internal rotation and shoulder muscle strength in any direction. Postoperative AHD was significantly increased only in shoulders with sufficient graft thickness (types I and II) (both P<.0001) (Table 4).Conclusions:Arthroscopic SCR provided pain relief even in patients with graft tears. However, patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact graft of sufficient thickness. Shoulder ROM and muscle strength were increased after SCR in shoulders with intact grafts but not in those with large graft tears. Postoperative AHD was significantly increased only in shoulders with intact graft of sufficient thickness. These results suggest that postoperative graft integrity affect clinical outcomes after SCR. An intact graft of sufficient thickness restored glenohumeral stability and substantially improved clinical outcomes.Table 1.Change in Visual Analog Scale and American Shoulder and Elbow Surgeons score after Superior Capsule ReconstructionTable 2.Change in Active Shoulder Ranges of Motion from Preoperative to Postoperative EvaluationTable 3.Change in Shoulder Muscle Strength after Superior Capsule ReconstructionTable 4.Change in Acromiohumeral distance after Superior Capsule Reconstruction

Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study

BackgroundThe primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome.MethodsOne hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes.FindingsIndividuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06–0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49–0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05).InterpretationIndividuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.

Surgical treatment of scapula body fractures extending glenoid fossa: Surgical technique and early results.

The aim of this study was to describe the surgical technique and evaluate functional outcomes following open reduction and internal fixation in patients with scapular fractures. In this study, ten patients with scapular fractures with Ideberg type four and five, who had undergone operatively with the Judet approach in three different orthopedic centers between March 2014 and October 2018, were evaluated retrospectively. By the end of at least a 2-year follow-up period, postoperative Disabilities of the Arm, Shoulder and Hand (DASH), Constant questionnaires were evaluated by all participating patients. Three of these patients had fractures on the left; seven patients had fractures on the right side, and the average patient age was 35.1±9.75. Mean Constant and DASH scores were 87.9±13.68 and 5.57±5.21, respectively. In two patients, about 2 cm adjacent to the suprascapular notch, perioperative suprascapular nerve injury was stated and sutured using the epineural technique. By the end of the 2-year follow-up of these two patients, infraspinatus muscle atrophy had occurred. However, external rotation muscle strength was 4/5 in both patients. This study suggests that scapula fractures extending glenoid articular surface can be safely fixed through the Judet approach and had satisfactory results. In addition, two patients with traumatic suprascapular nerve injury were encountered during the surgery and repaired which may be hard to diagnose with modified or minimal incisional approaches.

The effect of shoulder injury prevention program on glenohumeral range of motion and upper extremity performance in adolescent throwers: A pilot study

Background: The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Program is an exercise program developed to increase the internal rotation (IR) range of motion (ROM), external rotator muscle strength and scapular muscle strength and to improve kinetic chain involvement and thoracic mobility. The purpose of this study is to investigate the effect of this program on glenohumeral ROM and upper extremity functional performance in adolescent throwers. Material and Methods: Ten adolescent throwers (discus, shot put and javelin throwers) were involved in the study. The OSTRC Shoulder Injury Prevention Program was applied three times a week for 8 weeks as a handball warm-up. Glenohumeral IR and external rotation (ER) ROM were evaluated with a goniometer. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) was used to evaluate the upper extremity functional performance. Results: It was found that there was a statistically significant difference in the dominant side IR ROM and CKCUEST between the pre-test and post-test (p&lt;0.05); however, there was no difference in terms of other parameters (p&gt;0.05). Conclusions: This study shows that the glenohumeral IR ROM and upper extremity functional performance increases after the 8-week OSTRC Shoulder Injury Prevention Program. For these purposes, physiotherapists and trainers can include this program in their training programs.

Change in shoulder external rotation strength and motion after lower trapezius transfer to the infraspinatus in children with obstetric brachial plexus palsy.

Quantifying changes in shoulder external rotation range of motion and strength after lower trapezius transfer in children with obstetric brachial plexus palsy (OBPP). This prospective study included five children with sequelae of OBPP, with a mean age of 6.4 years (range: 4-12 years) who underwent lower trapezius tendon transfer to restore active external rotation (ER) of the shoulder. Pre-operatively and at a 12-month follow-up assessment, we analyzed the passive and active shoulder ER, the modified Mallet score, and the shoulder rotator muscles strength using an isokinetic device. Clinical parameters improved significantly after trapezius transfer pre-operative passive ER from -8° (range: -20-0°) to 37° (range: 15-50°) (p = 0.035), the modified Mallet score from 13 (range: 10-15) to 18 (range: 17-19) (p = 0.035). Strength testing revealed improved ER muscle strength in all five cases; the mean Peak Torque increased from 1.95 to 4.46 N·m, albeit non-significantly (p = 0.062). Two patients exhibited a winged scapula post-operatively. Lower trapezius transfer seems encouraging to restore shoulder external rotation in OBPP children but with non-significant strength improvement. 18/07/31/5783, December 22, 2018.

Impaired Lower Extremity Biomechanics, Hip External Rotation Muscle Weakness, and Proximal Femoral Morphology Predict Impaired Single-Leg Squat Performance in People With FAI Syndrome

Background: Impairments in squat depth have been reported in patients with femoroacetabular impingement syndrome (FAIS). However, little is known about single-leg squat (SLS) performance in these patients, despite this task being commonly used in the rehabilitation and training settings. Purpose/Hypothesis: The aims of this study were (1) to investigate whether patients with FAIS demonstrate differences in SLS performance compared with healthy controls and (2) to determine whether dynamic range of motion (ROM), muscle strength, hip morphologic measures, hip pain, and hip-specific function predict SLS performance in patients with FAIS. We hypothesized that patients with FAIS would demonstrate impaired SLS performance and that impaired hip biomechanics, muscle strength, and hip-specific function would predict squat performance in patients with FAIS. Study Design: Controlled laboratory study. Methods: Three-dimensional (3D) kinematic data were collected at 100 Hz using a 20-camera 3D motion capture system during 3 SLS trials in 34 patients with FAIS and 26 healthy controls. Isometric muscle strength was tested with a stationary handheld dynamometer in all participants. Squat performance was quantified by squat depth (in meters), and the biomechanical variables of dynamic ROM of the pelvis, the hip, the knee, and the ankle in all planes were calculated. In patients with FAIS, femoral and acetabular morphology were measured using radiographic alpha angles and lateral center-edge angles. Hip pain and hip-specific function were measured using the visual analog scale for pain and the Hip Outcome Score Activities of Daily Living subscale, respectively. Two-tailed independent-samples t tests were used to determine between-group differences for squat depth, dynamic ROM variables, and muscle strength. A hierarchical multiple linear regression (MLR) model was used to determine whether biomechanical variables, muscle strength, hip morphology measures, hip pain, and hip-specific function were predictors of squat depth. All statistical analyses were performed using SPSS Version 26. Results: There were no between-group differences in age (FAIS, 30.0 ± 7.0 years vs controls, 27.3 ± 7.0 years; P = .18) or body mass index (FAIS, 23.1 ± 2.8 vs controls, 22.6 ± 3.2; P = .51). Squat depth was less in patients with FAIS compared with healthy controls (FAIS, 0.24 ± 0.4 m vs controls, 0.29 ± 0.05 m; P < .001). In the sagittal plane, patients with FAIS demonstrated less dynamic ROM of the hip (FAIS, 67.8°± 12.4° vs controls, 79.2°± 12.5°; P = .001) and the knee (FAIS, 71.9°± 9.4° vs controls, 78.9°± 13.2°; P = .02) compared with controls. Patients with FAIS also demonstrated a less dynamic coronal plane pelvis ROM (FAIS, 11.3°± 5.0° vs controls, 14.4°± 6.7°; P = .044). Patients with FAIS had reduced hip muscle strength of the hip external rotator (FAIS, 1 ± 0.3 N/kg vs controls, 1.2 ± 0.3 N/kg; P = .034), hip internal rotator (FAIS, 0.8 ± 0.3 N/kg vs controls 1 ± 0.3 N/kg; P = .03), and hip flexor (FAIS, 4 ± 1.1 N/kg vs controls, 4.8 ± 1.2 N/kg; P = .013) muscle groups. The hierarchical MLR revealed that the dynamic ROM of the hip, the knee, and the pelvis, the hip external rotation muscle strength, and the femoral alpha angles were all significant predictors of squat performance, and the final MLR model explained 92.4% of the total variance in squat depth in patients with FAIS. Conclusion: Patients with FAIS demonstrate impaired SLS squat performance compared with healthy controls. This impaired squat performance is predominantly predicted by sagittal plane knee and hip biomechanics and hip external rotator strength, and less by frontal plane pelvic ROM and hip morphology in patients with FAIS. Clinical Relevance: Clinicians should focus treatment on improving dynamic ROM and hip external rotator muscle strength to improve squat performance; however, femoral morphology should also be considered in the treatment paradigm.

Is Hip Muscle Strength Associated with Dynamic Knee Valgus in a Healthy Adult Population? A Systematic Review.

This study aimed to systematically review research investigating the association between hip muscle strength and dynamic knee valgus (DKV). Four databases (MEDLINE, PubMed, CINAHL, and SPORTDiscus) were searched for journal articles published from inception to October 2020. Seven studies investigating the association between hip muscle strength and DKV using a two-dimensional motion analysis system in healthy adults were included. The relationship between hip abductor muscle strength and DKV was negatively correlated in two studies, positively correlated in two studies, and not correlated in three studies. The DKV was associated with reduced hip extensor muscle strength in two studies and reduced hip external rotator muscle strength in two studies, while no correlation was found in three and five studies for each muscle group, respectively. The relationship between hip muscle strength, including abductors, extensors, and external rotators and DKV is conflicting. Considering the current literature limitations and variable methodological approaches used among studies, the clinical relevance of such findings should be interpreted cautiously. Therefore, future studies are recommended to measure the eccentric strength of hip muscles, resembling muscular movement during landing. Furthermore, high-demand and sufficiently challenging functional tasks revealing lower limb kinematic differences, such as cutting and jumping tasks, are recommended for measuring the DKV.