External Rotator Muscle Strength Research Articles

Rotator Cuff Strength in Recurrent Anterior Shoulder Instability

Although rotator-cuff muscle contraction plays an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in the pathophysiology of recurrent anterior instability. We intended to analyze the association between isokinetic internal rotator and external rotator muscle strength and glenohumeral joint instability in patients with recurrent anterior instability that was not previously treated surgically. We enrolled thirty-seven patients with unilateral recurrent anterior posttraumatic shoulder dislocation and eleven healthy nonathletic subjects in this controlled study. The association between internal rotator and external rotator strength and shoulder instability was analyzed by side-to-side comparisons and comparisons with a control group. Isokinetic internal rotator and external rotator strength was evaluated with a Con-Trex dynamometer, with the subject seated and the shoulder abducted 45° in the scapular plane. Tests were performed at 180°/s, 120°/s, and 60°/s in concentric mode for both sides. Peak torque normalized to body weight and external rotator to internal rotator ratio were calculated for each angular velocity. Clinical and isokinetic evaluation was done by the same rehabilitation physician. The association between shoulder instability and internal rotator and external rotator strength was associated with side-to-side differences (p < 0.05). Compared with a control group, strength values were lower on the pathological shoulder side of the patients with shoulder instability than on the healthy contralateral shoulder of control subjects at 180°/s and 120°/s (p < 0.05). The side-to-side differences were increased when the nondominant upper-extremity side was involved and were decreased when the dominant side was involved. There was no association between glenohumeral joint instability and external rotator to internal rotator ratio. Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Rotator cuff strength weakness in recurrent anterior shoulder instability physiopathology

BackgroundAlthough rotator cuff contractions play an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in physiopathological recurrent anterior instability.ObjectiveTo analyze the association...

Effect of the Positions of Female Pro-Volleyball Players on the Stability of Shoulder Joints of the Dominant and Non-dominant Arms

The purpose of this study was to comparatively analyze the active stability of shoulder joints according to the frequency of overhead motions, such as serving and spiking, engaged in by female professional volleyball athletes who play different positions, and to provide the results as the basic data for developing exercise programs to prevent shoulder joint injuries. The subjects of this study were 50 Korean female professional volleyball players and positions were as follows: left and right attackers, centers, setters, and liberos. The external rotation and internal rotation muscle strength and muscle strength ratios of the dominant and non-dominant arms of all subjects were measured using Biodex. The results of this study are as follows: Frist, no significant differences were found in the internal and external rotation muscle strength of the dominant and non-dominant arms between positions. Second, for the shoulder joint muscle strength ratio of the dominant arm, by position, the setter showed significantly greater stability compared to the other positions. Third, for the shoulder joint muscle strength ratio of the non-dominant arm, by position, no significant difference in stability between positions was found. Fourth, it was found that the dominant arm had significantly greater instability of the shoulder joint than the non-dominant arm for attackers and centers, but no significant difference was found for setters and liberos. This study comparatively analyzed the muscle strength ratios of the external/internal rotations and dominant/non-dominant arms, which can determine the stability of the shoulder joints between female professional volleyball playing positions that engage in jumps and spikes using only the dominant hand and positions that do not.

Relationship Between Hip Muscle Strength and Kinematics of the Knee Joint during Single Leg Squatting and Dropping

[Purpose] The aim of this study was to determine relationship between hip muscle strength and kinematics of the knee joint during single leg squatting and dropping. [Subjects] Twelve healthy subjects participated in this study. [Methods] The knee medial displacement was measured during single leg squatting and dropping using a high-speed camera. Peak isometric muscle strengths of the following muscles were measured hip abductors, hip adductors, hip external rotators, hip internal rotators, knee extensors and knee flexors. [Results] Muscle strength of hip external rotators was associated with knee medial displacement during both single leg squatting (r=-0.69) and dropping (r=-0.59), and muscle strength of knee flexors was associated with knee medial displacement during dropping (r=-0.58). [Conclusion] The present results suggest that hip muscles' strength, particularly hip external rotators' strength are closely associated with knee medial displacement.

Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique

IntroductionThe rotator cuff muscles help stabilize the glenohumeral joint. Postoperative recovery of rotator cuff muscle strength appears to be an important factor for optimal joint stabilization and the resumption of professional and/or sports activities. ObjectiveTo study the relationship between internal rotator (IR) and external rotator (ER) muscle strength, shoulder function and the resumption of sports activities (as typically evaluated with functional scores) following surgical stabilization with the Bristow-Latarjet procedure in cases of chronic shoulder instability. Patients and methodsTwenty patients with anterior, post-traumatic, chronic shoulder instability were included prospectively in a cohort study. The Rowe and Walch-Duplay functional scores were rated for the operated shoulder and the isokinetic IR and ER peak torque values were evaluated with a Con-Trex® dynamometer before surgery and then 3, 6 and 21months afterwards. The isokinetic evaluation was performed (at 180°/s, 120°/s and 60°/s) in the seated position, with the arms in 45° of abduction and 30° of antepulsion in the plane of the scapula. ResultsThere were no significant postoperative correlations between shoulder function (as judged by the Rowe and Walch-Duplay scores) and IR or ER muscle strength. ConclusionThis study did not provide evidence for a correlation between IR and ER muscle strength and functional scores after surgical stabilization of the shoulder. However, it is necessary to objectively measure the rotator cuff strength recovery to adequate the strengthening of rotator muscle prior to the resumption of sports activities. Isokinetic strength assessment may thus be a valuable decision support tool for the resumption of sports activities and would complement the functional scores studied here.

Immediate and Carryover Changes of C5-6 Joint Mobilization on Shoulder External Rotator Muscle Strength

Objective Clinical evidence has shown that extremity dysfunction, such as muscle weakness or inhibition, is associated with spinal disorders. Spinal manual therapy is a common therapeutic approach used to address extremity muscle weakness. The purpose of the study was to assess changes in the maximal muscle strength of the shoulder external rotators immediately and at 10, 20, and 30 minutes after cervical joint mobilization at the C5-6 segment. Methods Eighteen participants with existing or a history of neck pain were screened by 2 investigators independently for muscle weakness of shoulder external rotators. Fifteen qualified participants underwent shoulder external rotator strength testing with a handheld dynamometer. Each participant was tested 6 times, twice before, immediately after, and at 10, 20, and 30 minutes after a C5-6 joint mobilization on the involved side. The 2 strength data collected before the mobilization were used to determine intratester reliability. Results The intratester reliability of the shoulder external rotator strength was excellent (intraclass correlation coefficient 3,2 = 0.985). One-way analysis of variance with repeated measures showed a statistical significance in strength data ( P = .002). Post hoc tests revealed a significant increase between prejoint mobilization and immediately postjoint mobilization ( P = .003) and between pre joint mobilization and 10-minute post joint mobilization ( P < .001). Conclusions The results of the study suggest that C5-6 joint mobilization increases muscle strength of the shoulder external rotators immediately and its effect carries over for 10 minutes but not after 20 minutes.

External rotation strength deficit after hip resurfacing surgery

Purpose: The aim was to assess the effect of resurfacing hip arthroplasty on hip muscle function, when, in the posterior approach, the piriformis tendon and outer rotators of the hip joint were divided. The unoperated side was used as a control.Methods: Thirty-three consecutive patients (mean age 55 years, 73% males) were operated using the posterior approach. Main outcome measures were isometric muscle strength of external and internal rotators and extensors of the hip and hip pain.Results: Hip external rotation strength (p > 0.001) and leg extension strength (p < 0.001) were significantly lower on the operated side compared with the un-operated side prior to the surgery. On the operated side external rotation strength decreased by 29% (p < 0001) and internal rotation strength increased by 28% (p < 0.001). The changes of 12% in leg extension strength of the operated side and the changes of 3–10% in all strength measurements in the un-operated side were not significant. Three months post-operatively, the external rotation strength and leg extension strength values were 50% and 26% lower (p < 0.001) on the operated side compared with those in the un-operated side. The decreases in pain values during the rest, loading as well as during the strain of strength measurements were all significant (p < 0.001).Conclusion: Although hip resurfing surgery gives excellent relief of pain, significant strength deficit was found in the external rotators 3 months post-operatively.

Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial

Objective To evaluate effectiveness and long-term benefits of a specific balance-strategy training program in sedentary women aged 40–60 years and whether participation leads to adoption of a more active lifestyle.Method Fifty healthy women were admitted to the randomized, controlled trial on the basis of their activity level. Subjects were randomly assigned to an intervention or control group, with the former attending twice-weekly for 12 weeks. Assessments made pre- and post-intervention and at 9 months follow-up included: personal demographics, hormone replacement therapy medication, activity level, balance measures, somatosensory function, ankle flexibility and leg muscle strength.Results The intervention group showed improvement in balance measures (p < 0.030), right ankle tactile sensation (p = 0.027), ankle flexibility (p < 0.000) and muscle strength (p < 0.018) of quadriceps, hip abductors and external rotators, compared with the control group immediately after intervention. At 9 months follow-up, the intervention effect was maintained for all measures and a latent improvement of somatosensory measures (tactile acuity of foot (p < 0.05), joint repositioning sense (p < 0.010), and vibration threshold of the left knee (p < 0.016)) revealed. The intervention group also adopted a more active lifestyle (p = 0.000).Conclusion These results provide evidence that this physiotherapist-designed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle.

Axillary Mononeuropathy After Herpes Zoster Infection Mimicking Subacromial Impingement Syndrome

Subacromial impingement syndrome is a frequent cause of shoulder pain and it is readily confused with other shoulder problems. We present a patient with herpes zoster infection associated with axillary mononeuropathy that was initially misdiagnosed as subacromial impingement syndrome. A 75-yr-old female patient was admitted to the internal medicine clinic because of pain and weakness in her right shoulder. As she did not respond to medical treatment and local injection therapy, magnetic resonance imaging of the right shoulder was ordered. As the magnetic resonance imaging revealed subacromial impingement of the supraspinatus tendon, the patient was referred to the physical medicine and rehabilitation department for rehabilitation. In our initial physical examination, her shoulder abductor muscle strength was 2/5 and her shoulder external rotator muscle strength was 3/5. A subacromial injection test with 10 ml of 1% lidocain was negative and the magnetic resonance imaging did not show a complete rotator tendon rupture that could explain such a muscle strength loss. So, an electrodiagnostic evaluation was performed and the patient was diagnosed to have a right axillary neuropathy. A more detailed questioning of the patient disclosed a history of herpes zoster approximately 3 mos ago. Herpes zoster-associated axillary neuropathy can mimic subacromial impingement syndrome, and magnetic resonance imaging examination alone may lead to a misdiagnosis. Therefore, we imply that clinical and electrophysiological evaluations would be of great importance in relevant patients with shoulder problems.

Muscle Strength and Range of Motion in Adolescent Pitchers with Throwing-Related Pain

Background A high prevalence of throwing-related shoulder and elbow pain has been documented in adolescent baseball pitchers. Hypothesis Pitchers with a history of throwing-related pain will have weakened dominant-arm posterior shoulder musculature and greater dominant-arm glenohumeral total range of motion (ROM) loss compared with pitchers without throwing-related pain. Study Design Controlled laboratory study. Methods Twenty-three adolescent pitchers (age 15.7 ±1.4 years) were tested. Twelve pitchers had throwing-related pain in the prior season and were currently symptom-free, while the remaining 11 pitchers had no such history of pain. Internal and external rotation ROM and muscle strength (lower trapezius, middle trapezius, rhomboids, latissimus dorsi, supraspinatus, internal rotators, external rotators) were measured bilaterally. Dominant versus nondominant differences in ROM and strength were compared between pitchers with and without throwing-related pain. Results As a whole, the group of 23 pitchers had a loss of internal rotation ROM (13° ± 10°, P < .001) and gain in external rotation ROM (11° ± 10°, P < .001) on the dominant versus nondominant arm, with no effect on total ROM (2° ± 7° loss, P = .14). There was no difference in bilateral comparison of total ROM between pitchers with and without throwing-related pain. Dominant versus nondominant muscle strength was lower (P < .05) for the pain group versus nonpain group for the middle trapezius (7% ± 19% vs 22% ± 12%) and supraspinatus (−4% ± 27% vs 14% ± 14%) and higher (P < .05) for the internal rotators (19% ± 14% vs 6%±12%). Conclusion Throwing-related pain in this population may be due to the inability of weakened posterior shoulder musculature to tolerate stress imparted on it by adaptively strengthened propulsive muscles. Clinical Relevance Selective posterior shoulder strengthening may be indicated in rehabilitative and injury prevention programs for adolescent pitchers.

Effects of a Shoulder Injury Prevention Strength Training Program on Eccentric External Rotator Muscle Strength and Glenohumeral Joint Imbalance in Female Overhead Activity Athletes

Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes.

The effect of posterolateral reconstruction on range of motion and muscle strength in total hip arthroplasty

Posterolateral reconstruction of the posterior capsule, piriformis tendon, and external rotators in total hip arthroplasty improves the stability of the hip joint. This study was performed to evaluate the effect of this reconstruction on range of motion (ROM) and circumferential muscle strength. We selected 58 limbs of 29 patients. Posterolateral reconstruction was performed in 13 patients (reconstruction group). Posterolateral reconstruction was not performed in 16 patients (nonreconstruction group). No significant differences were seen in preoperative and postoperative ROM between the 2 groups. The reconstruction group had significantly higher abduction muscle strength (P<.0001) and external rotation muscle strength (P<.01) than the nonreconstruction group. Posterolateral reconstruction may be effective in promoting the recovery of abduction and external rotator muscle strength, and it can improve joint stability without limiting ROM. © 2003 Elsevier Inc. All rights reserved.

MUSCLE STRENGTH AND FLEXIBILITY IN YOUNG ELITE SWIMMERS

Research indicates that collegiate and Olympic swimmers display increased shoulder joint external rotation (ER) and decreased shoulder joint internal rotation (IR) ranges of motion (ROM). Swimmers show normal values for ER muscle strength but are proportionately overdeveloped regarding their IR muscle strength. These imbalances may predispose an athlete to shoulder injuries. Our goal was to determine if the physical characteristics of high school swimmers is consistent with the current body of knowledge regarding shoulder strength and ROM of elite level swimmers. Twenty-four subjects (age 14.5 ± 1.8) were recruited from a local swim club and reported to Blythedale Children's Hospital's Sports Medicine Center. Twenty-four subjects were evaluated for: body composition using bioelectrical impedance, shoulder IR and ER ROM using a hand-held goniometer, nd one-minute push-up repetition maximum (RM). Bilateral shoulder IR and ER torque (ft-lb) in the abducted position was assessed in eight subjects using an isokinetic dynamometer. Evaluations were made at speeds of 180 and 300 deg/sec. The results were as follows: percent body fat, 17.1 ± 5.6; push-up RM, 33.3 ± 12.1; IR ROM, 66.0 ± 13.3; ER ROM,89.6 ± 9.0; 180 deg/sec IR peak torque, 50.0 ± 19.2; 180 deg/sec ER peak torque, 21.2 ± 8.8; 300 deg/sec IR peak torque, 57.5 ± 27.2; 300 deg/sec ER peak torque, 31.9 ± 9.4; 180 deg/sec ER:IR peak torque ratio, 0.42:1; 300 deg/sec ER:IR peak torque ratio, 0.55:1. Normal ROM for IR is 70 and ER is 90. IR limitations may indicate a tight posterior capsule. A normal ER:IR torque ratio is 0.67. Abnormal ER:IR torque ratios indicate muscle strength imbalances. Our findings are consistent with the current literature and warrant investigation whether a strength and flexibility program can prevent these imbalances.

Eccentric and concentric strength of the shoulder and arm musculature in collegiate baseball pitchers.

Many pitching injuries occur during deceleration of the upper extremity when the muscles of the shoulder and arm are acting eccentrically. Published information regarding eccentric muscular strength in baseball pitchers is nonexistent. The purpose of this study was to assess bilateral isokinetic eccentric and concentric muscular strength of the shoulder's external and internal rotator muscles and the elbow's flexor and extensor muscles in a group of collegiate baseball pitchers (N = 25). Isokinetic strength was assessed at 1.6, 3.7, and 5.2 rad/sec. Our findings indicate that the internal rotator muscles were always stronger than the external rotator muscles and that the concentric and eccentric external-to-internal strength ratios ranged from 62% to 81%. The eccentric strength of the shoulder rotator muscles averaged 114% that of concentric strength. The concentric and eccentric elbow extension-to-flexion strength ratios ranged from 71% to 110%; eccentric strength averaged 33% higher than concentric strength. No differences were noted between dominant and nondominant limbs for any of the strength measures or ratios. Clinically, the findings of this study can serve as a reference during the evaluation, rehabilitation, and conditioning of throwing athletes.

Strength profiles and performance in Masters' level swimmers.

The purpose of this study was to profile shoulder, trunk, and thigh strength and shoulder range of motion in competitive Masters' level swimmers and to see if these variables were related to swimming performance. Twenty-four Masters' level swimmers (13 men and 11 women) were tested for isometric trunk flexion and extension, isokinetic knee extension and flexion, shoulder abduction, internal rotation, external rotation, and supraspinatus muscle strength; shoulder internal and external rotation range of motion; and 50-yard swimming time. Strength scores were adjusted for weight. The men were significantly stronger than the women in trunk extension and flexion. Shoulder range of motion, shoulder abduction strength, and thigh strength were equal for both the men and the women. The men were stronger than the women in internal and external shoulder rotation. Conversely, the women tested were significantly stronger than the men in the supraspinatus muscle test. The men were significantly faster than the women in the 50-yard swim. Inverse relationships existed between swimming time and trunk flexion, trunk extension, and shoulder internal rotation strength. Trunk flexion strength remained the only significant predictive variable of swimming time in a multiple regression analysis.

反復性肩関節前方脱臼に対するＢｒｉｓｔｏｗ変法術後の筋力評価

Modified Bristow's procedure is a satisfactory operation for recurrent anterior dislocation of the shoulder. However it restricts external rotation and there is a probability of weakness of the internal rotator muscle strength postoperatively. This report analyzed the influence of modified Bristow's procedure on muscular strength on the shoulder post-operatively.Twenty patients (13 male, 7 female) were evaluated postoperatively. Out of 13 males, 8 cases were operated on the non-dominant side and 5 cases were operated on the dominant side. All 7 females were operated on the dominant side. Age at the final examination ranged from 15 to 48 years with an average of 29.1 years. The average follow-up period was 63 months (range, 10 to 176 months). As a control group, 19 normal individuals were also examined.Using CYBEX 340, we examined internal and external rotator muscle strength at 90° abduction (the angular testing velocity was 60deg./sec, 120deg./sec. and 180deg./sec.), adductor and dbductor muscle strength (60deg./sec, 180deg./sec. and 240deg./sec.).In normal cases, no statistical differences in the peak torque and endurance between the dominant and non-dominant side were noted. In operated cases, there was no statistical difference in the peak torque and endurance between the sound side and the involved side.These results show that modified Bristow procedure does not decrease the muscular strength on the shoulder postoperatively.

Ｃｙｂｅｘを用いた肩関節の筋力評価 反復性肩関節脱臼において

Modified Boytchev's procedure was found to be a satisfactory operation for treatment of recurrent anterior shoulder dislocation, with a 4% re-dislocation rate in our series and a 92% rate of return to sports activity among those cases who wanted to play sports.Muscular strength before and one year after modified Boytchev's procedure was evaluated in nine men with a mean age at the time of operation of 25.2 years (range; 17 to 42 years). Using Cybex 340, we examined internal and external rotation muscle strength in the standing position. The angular testing velocity was 60deg./sec, 180deg./sec and 240deg./sec.Post-operative peak torque increased in both the uninvolved and involved side. In order to assess the post-operative probability for recurrent anterior dislocation, examinations should be carried out pre-and post-operatively. Peak torque during internal rotation in the preoperative state was lower on the involved side (Ave. 4ftlb p<0.05). In comparison there was no statistical difference in the postoperative peak torque during internal rotation between the involved or non-involved side. Peak torque of internal rotation on the involved side increased an average of 4 ft lb postoperatively compared with the preoperative level. Preoperatively the endurance ratio of internal rotation on the involved side (56%) was lower than on the uninvolved side (62.5%). Post-operatively, there was no statistical difference between the uninvolved and involved side.

SHOULDER WEAKNESS IN PROFESSIONAL BASEBALL PITCHERS

The purposes of this study were to: 1) compare shoulder range of motion and strength in professional baseball pitchers (N = 47) compared with age-matched controls (N = 16), and 2) examine the relationship of injury history to strength and range of motion. Based on injury history pitchers were categorized as: 1) none (N = 26), 2) injury requiring conservative intervention (N = 9), or 3) injury requiring surgical intervention (N = 12). Range of motion was measured for internal rotation (IROM) and external rotation (EROM). Eccentric strength was measured by hand-held dynamometer for internal rotation (IR), external rotation (ER), abduction (ABD), and supraspinatus muscle (SUP) strength. Injury history had no effect on strength and range of motion. Dominant EROM was greater in pitchers, P < 0.0001, and controls, P < 0.05, with pitchers having greater EROM motion bilaterally, P < 0.0001. Pitchers were weaker in SUP on the dominant vs nondominant side, P < 0.0001, and on the dominant side for weight adjusted ER, ABD, P < 0.01, and SUP, P < 0.0001, compared with controls. In conclusion, dominance and pitching resulted in soft tissue adaptation. Pitchers displayed weakness in three of four tests by comparison with controls, suggesting that the demands of pitching are insufficient to produce eccentric strength gains and may in fact lead to weakness. Dominant-side SUP weakness in pitchers may reflect subclinical pathology or chronic fatigue.

Relationship between Shoulder Pain and Selected Variables in Patients with Hemiplegia

This investigation was performed to clarify the relationship between six independent variable categories and shoulder pain (SP) in hemiplegia. In this study, 30 hemiplegic patients served as subjects. The Ritchie articular index was used to measure SP. The independent variables were age, body weight, time since onset of stroke, shoulder subluxation, range of shoulder external rotation, and plegic shoulder muscle group strength. Subluxation was judged by palpation. Range of shoulder external rotation was measured goniometrically. Strength of the shoulder internal and external rotator, abductor and extensor muscles was measured with a hand-held dynamometer and normalized against body weight. A strength balance ratio of the shoulder was also determined (external rotators + abductors/internal rotators + extensors). Variables were measured on admission and prior to discharge. Spearman correlations or chi-squares were determined between the initial and final measurements of the independent variables and SP. More than 80% of the patients had SP. Correlated significantly with SP at both assessments and across time were range of shoulder external rotation (−.574 to −.797), and strength of the shoulder external rotator (−.523 to −.583) and abductor (−.375 to −.519) muscles. Correlated significantly at one or more of the assessments were body weight, time since onset and the strength of the other muscle groups (including the strength ratio). Shoulder subluxation was not correlated with SP. Patients with greater weakness may be more prone to the development of pain because their muscles lack adequate strength to move the joint enough to prevent the development of adhesive capsulitis.