External Rotation Range Of Motion Research Articles

Optimizing range of motion in reverse shoulder arthroplasty.

Optimal glenoid positioning in reverse shoulder arthroplasty (RSA) is crucial to provide impingement-free range of motion (ROM). Lateralization and inclination correction are not yet systematically used. Using planning software, we simulated the most used glenoid implant positions. The primary goal was to determine the configuration that delivers the best theoretical impingement-free ROM. With the use of a 3D planning software (Blueprint) for RSA, 41 shoulders in 41 consecutive patients (17 males and 24 females; means age 73 years (SD 7)) undergoing RSA were planned. For the same anteroposterior positioning and retroversion of the glenoid implant, four different glenoid baseplate configurations were used on each shoulder to compare ROM: 1) no correction of the RSA angle and no lateralization (C-L-); 2) correction of the RSA angle with medialization by inferior reaming (C+M+); 3) correction of the RSA angle without lateralization by superior compensation (C+L-); and 4) correction of the RSA angle and additional lateralization (C+L+). The same humeral inlay implant and positioning were used on the humeral side for the four different glenoid configurations with a 3 mm symmetric 135° inclined polyethylene liner. The configuration with lateralization and correction of the RSA angle (C+L+) led to better ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001). Only internal rotation was not significantly different between groups (p = 0.388). The configuration where correction of the inclination was done by medialization (C+M+) led to the worst ROM in adduction, extension, abduction, flexion, and external rotation of the shoulder. Our software study shows that, when using a 135° inlay reversed humeral implant, correcting glenoid inclination (RSA angle 0°) and lateralizing the glenoid component by using an angled bony or metallic augment of 8 to 10 mm provides optimal impingement-free ROM.

The Clinical Utility of the Seated Wall Angel as a Test with Scoring.

The seated wall angel (SWA) is an intervention to improve upper quarter mobility but has not been described as a clinical test with scoring. To explore the clinical utility of the SWA as a test with scoring. The authors hypothesized that SWA test scores would be lower on the injured than uninjured side, improve over time, and show stronger association with patient-reported shoulder function than shoulder mobility tests. Prospective cohort. Patients diagnosed with anterior shoulder instability and referred to physical therapy participated. Testing occurred after physical therapy examination (initial) and six weeks later (follow-up). Rehabilitation was not controlled. Testing included clinical tests (SWA, passive shoulder external rotation range of motion, total arc of motion) and patient-reported outcomes including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, (ASES) and the Western Ontario Shoulder Instability Index (WOSI). The SWA test was scored 0 to 3 points bilaterally based on number of body contacts with the wall (i.e., elbows and fingertips, posterior fingers, posterior forearm). Passive range of motion was measured with a standard goniometer. SWA scores were compared between sides at initial testing and compared between testing timepoints on the injured side. Associations among injured side clinical test values and patient-reported outcome scores were examined. Mean (SD) SWA score on the injured side was significantly lower than the uninjured side at initial testing [1.6 (1.0) vs 2.2 (1.1), p = 0.045] and significantly increased at follow-up testing [2.4 (1.0), p = 0.041]. Only SWA test score was significantly correlated with ASES (r=0.597) and WOSI (r=-0.648) scores at initial testing, and SWA test score was significantly correlated with WOSI score at follow-up testing (r=-0.611). The clinical utility of the SWA test is supported by distinguishing the injured and uninjured sides and having stronger associations with patient-reported shoulder function than shoulder mobility tests.

Relationship Between Hip and Groin Pain and Hip Range of Motion in Amateur Soccer and Australian Rules Football Players

Background: The relationship between hip/groin pain and hip range of motion (ROM) is unclear. Purpose: To explore the relationship between hip/groin pain and hip joint ROM and examine the influence of sex and cam morphology on this relationship. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 184 amateur soccer and Australian Rules football players (276 hips; 20% women; median age, 26 years; interquartile range, 24-30 years) with hip/groin pain >6 months and a positive flexion-adduction-internal-rotation (FADIR) test, and 50 matched asymptomatic control players (98 hips; 28% women, median age, 26 years; interquartile range, 23-31 years). Hip ROM measures were flexion, internal and external rotation at 90° of hip flexion, total rotation (internal and external), and bent-knee fall out (BKFO). Cam morphology was determined from anteroposterior pelvis or 45° Dunn radiographs, defined by an alpha angle ≥60°. Linear regression models with generalized estimating equations were used to examine the relationship between group (symptomatic and asymptomatic) and each ROM measure. Interaction terms (group × cam morphology or group × sex) were included to examine if relationships between group and hip ROM were influenced by cam morphology or sex. Where appropriate, models were adjusted for sex, age, and cam morphology. Results: An interaction between the relationship between group × cam and internal rotation ROM was found. Symptomatic players with cam morphology had lower internal rotation ROM than controls with cam morphology (adjusted mean difference [AMD] = −4.5°; 95% CI, −7.4° to −1.6°). Hip/groin pain was not associated with internal rotation ROM if cam morphology was absent. A significant interaction was also found for group × sex and BKFO and total rotation ROM. Symptomatic women had lower total rotation ROM than control women (AMD = −8.2°; 95% CI, −14.1° to −2.2°), but no difference was seen in men. BKFO range was lower in men with hip/groin pain compared with control men (AMD = 1.6 cm; 95% CI, 0.3-3.0 cm), but no difference was seen in women. Flexion and external rotation ROM did not differ between symptomatic and control hips. Conclusion: Cam morphology was an effect modifier of the relationship between hip/groin pain and internal rotation ROM. Sex-related differences were also observed in the relationship between hip/groin pain and hip ROM.

Scapular external rotation position during arm elevation related to increased glenohumeral external rotation range of motion in high school baseball players

Scapular external rotation position during arm elevation related to increased glenohumeral external rotation range of motion in high school baseball players

Anatomic restoration of lateral humeral offset and humeral retroversion optimizes functional outcomes following reverse total shoulder arthroplasty

Cadaveric and computer simulations suggest lateral humeral offset (LHO) and humeral retroversion (HR) are associated with strength and range of motion (ROM) after reverse total shoulder arthroplasty (rTSA), butin vivodata is lacking. This study aimed to evaluate the effects of implant parameters (i.e. LHO and HR) on strength and ROM. LHO and HR were measured using pre-operative and post-operative computed tomography (CT) scans. Postoperative strength was measured across three planes of motion using a Biodex isokinetic dynamometer. Postoperative active and passive ROM during forward elevation, external rotation (ER), and internal rotation (IR) were assessed using a goniometer or spinal level. 30 rTSA patients (14 M, 16F, age: 71.8 ± 6.7yrs) participated with an average postoperative follow-up of 2.4 ± 1.1 years. Regarding strength, higher post-op LHO values were predictive of greater postoperative strength across all movements. However, lateralization of the implant beyond pre-op values (i.e. post-op LHO > pre-op LHO) was associated with poorer strength performance across all ranges of motion. Similar to strength outcomes, greater deviations from pre-op LHO was predictive of poorer IR ROM. Lastly, patients with minimal deviations in HR (post-op HR within 10° of pre-op HR) and minimal deviations in LHO (post-op LHO ≤ pre-op LHO) displayed the greatest postoperative ER ROM. Anatomic restoration of LHO combined with anatomic restoration of HR may be ideal for maximizing strength and ROM following rTSA. Overlateralization beyond anatomic may have negative consequences. Optimal implant lateralization and version may need to be individualized based on preoperative values.

Effects of high-intensity laser therapy on subacromial impingement syndrome: a systematic review and meta-analysis.

This systematic review and meta-analysis aims to identify, critically appraise, and summarize the effects of high-intensity laser therapy on subacromial impingement syndrome. Three databases, PubMed, Embase, and Scopus were searched from inception to March 1, 2024. Clinical trials comparing the effects of high-intensity laser therapy to conventional therapy are eligible for inclusion. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed to determine the effects of high-intensity laser therapy. Five randomized controlled trials and one controlled clinical trial were included, with a total of 284 patients with subacromial impingement syndrome. All included studies were evaluated as good or above for quality assessment. Compared to conventional therapy, high-intensity laser therapy demonstrated significantly better outcomes for pain at both post-intervention (SMD = -1.01, 95%CI = -1.85 to -0.17) and three-month post-intervention (SMD = -0.51, 95%CI = -0.90 to -0.13); shoulder and arm function at both post-intervention (SMD = 0.40, 95%CI = 0.14 to 0.66) and three-month post-intervention (SMD = 0.45, 95%CI = 0.06 to 0.84); shoulder abduction active range of motion (SMD = 3.26, 95%CI = 0.49 to 6.03). No significant difference was found for shoulder flexion and external rotation range of motion. This review highlights the promising effects of high-intensity laser therapy for the rehabilitation of subacromial impingement syndrome. Rehabilitation professionals and policymakers should increase their awareness of high-intensity laser therapy as an emerging technology that may facilitate greater outcomes than current widespread standards.

The relationship between lower extremity range of motion and dynamic balance

<p>目的：本研究欲探討，青少年運動員下肢關節活動度與動態平衡表現的相關性，以及兩者在測量表現上的差異。方法：招募 20 名國高中男性運動員，測量下肢髖關節及踝關節活動度、改良版星狀偏移平衡測試 (modified star excursion balance test, mSEBT) 和 Y 字平衡測試 (Y balance test, YBT)。以皮爾森積差相關係數，比較慣用腳 mSEBT、YBT 與下肢關節活動度之相關性。透過多元迴歸分析，分析下肢關節活動度對 mSEBT 和 YBT 的預測性，以成對樣本 t 檢定比較 mSEBT 和 YBT 之差異。結果：mSEBT 與踝背屈、髖外展和髖外轉活動度呈顯著正相關，前側以踝背屈活動度解釋力最大 (R2 ＝ .506)，後內側 (R2 ＝ .544) 和後外側 (R2 ＝ .399) 以髖外轉活動度解釋力最大。YBT 前側與踝背屈活動度 (r ＝ .519，p < .05)；YBT後外側與髖外轉活動度 (r ＝ .561，p < .05)；YBT後內側與髖外展活動度 (r ＝ .558，p < .05) 呈顯著正相關。mSEBT 和 YBT 在 3 個方向上皆有中至高度相關 (r = .473 - .736，p < .05)，測量距離在前側、後外側和總分達顯著差異。結論：mSEBT 受多關節活動度影響，而 YBT 僅和單一關節活動度有關。mSEBT 和 YBT 雖有中至高度相關，但測量距離表現上並不相同。日後實驗設計及臨床應用上，應考量測試之差異，針對受試者的動態平衡能力，選擇適合的評估方法。</p> <p> </p><p>Purpose: To examine the relationships of lower extremity range of motion (ROM), modified star excursion balance test (mSEBT) and Y balance test (YBT) and to compare the differences between mSEBT and YBT. Methods: Twenty adolescent high school male athletes were recruited to measure hip ROM, ankle ROM, mSEBT, and YBT. Pearson’s product-moment correlation coefficient were used to analyze the relationship between lower extremity ROM and dynamic balance. Multiple regression analysis were used to determine the predictors in explaining the variance to dynamic balance outcomes. Paired t test was used to compare the differences between mSEBT and YBT. Results: mSEBT was significantly correlated with ankle dorsiflexion, hip abduction and hip external rotation ROM. Ankle dorsiflexion ROM was the strongest predictor for anterior direction (R2 ＝ .506). Hip external rotation ROM was the strongest predictor for posteromedial direction (R2 ＝ .544) and posterolateral direction (R2 ＝ .399). Anterior YBT was correlated with ankle dorsiflexion ROM (r ＝ .519, p < .05). Posterolateral YBT was correlated with hip external rotation ROM (r ＝ .561, p < .05), and posteromedial YBT was correlated with hip abduction ROM (r ＝ .558, p < .05). There were significant correlations in all three directions between mSEBT and YBT (r = .473 - .736, p < .05). Conclusion: There were significant differences in anterior, posterolateral and composite performance between YBT and mSEBT. mSEBT performance was affected by multi-joint ROM and YBT performance was affected by single-joint ROM. Even though mSEBT and YBT were highly correlated, the absolutely reach distances are different. Future works should consider the differences between two dynamic balance measures and select the proper tool while examining dynamic balance in different sports.</p> <p> </p>

Defining the glenohumeral range of motion required for overhead shoulder mobility: an observational study.

Recovery of overhead mobility after shoulder surgery is time-consuming and important for patient satisfaction. Overhead stretching and mobilization of the scapulothoracic and glenohumeral (GH) joints are common treatment interventions. The isolated GH range of motion (ROM) of flexion, abduction, and external rotation required to move above 120° of global shoulder flexion in the clinical setting remains unclear. This study clarified the GH ROM needed for overhead mobility. The timely development of shoulder ROM in patients after shoulder surgery was analyzed. Passive global shoulder flexion, GH flexion, abduction, and external rotation ROM were measured using goniometry and visually at 2-week intervals starting 6-week postsurgery until the end of treatment. Receiver operating characteristic curves were used to identify the GH ROM cutoff values allowing overhead mobility. A total of 21 patients (mean age 49 years; 76% men) after rotator cuff repair (71%), Latarjet shoulder stabilization (19%), and arthroscopic biceps tenotomy (10%) were included. The ROM cutoff value that accurately allowed overhead mobility was 83° for GH flexion and abduction with the area under the curve (AUC) ranging from 0.90 to 0.93 (p < 0.001). The cutoff value for GH external rotation was 53% of the amount of movement on the opposite side (AUC 0.87, p < 0.001). Global shoulder flexion above 120° needs almost full GH flexion and abduction to be executable. External rotation ROM seems less important as long as it reaches over 53% of the opposite side.

Health-related outcomes with supervised exercise and myofascial release versus only supervised exercise in subacromial pain syndrome: a randomized controlled single-blind study

BackgroundMyofascial tissue plays a critical role in shoulder joint mobility disorders. Myofascial release therapy (MFR) is frequently utilized to restore the extensibility of fascial tissue and is considered beneficial for various clinical conditions such as low back pain and ankle injuries. However, no studies have yet evaluated the effects of MFR on periscapular muscles activation and shoulder mobility in patients with subacromial pain syndrome(SAPS).ObjectiveThe purpose of this study was to compare the effectiveness of MFR combined with supervised exercise(SE) and SE alone in patients with SAPS.DesignAssessor-blinded randomized controlled trial.SettingSir Run Run Shaw Hospital, Zhejiang University School of Medicine.SubjectsSubacromial pain syndrome patients.MethodsFifty participants were divided into two groups: SE group and MFR + SE group, each group 25 cases. Both treatment methods were performed 5 times a week for 4 weeks.Main measuresShoulder pain severity was assessed by visual analog scale (VAS); shoulder range of motion (ROM) by a goniometer; functionality by shoulder Pain and Disability Index (SPADI); and periscapular muscles activation by sEMG. All measurements were evaluated both pre- and post-treatment.ResultsAn ANOVA analysis indicated no significant group by time interactions for flexion ROM and resting VAS (p > 0.05). However, significant group by time interactions were found for SPADI, abduction and external rotation ROM, and activity VAS (p < 0.05). Post-hoc tests revealed significant improvements in SPADI, abduction and external rotation ROM, and activity VAS in both groups compared to pre-treatment (p < 0.05). Additionally, there were significant group by time interactions for the sEMG values of the upper trapezius and serratus anterior (p < 0.05). Post-hoc tests showed that compared to pre-treatment, the MFR + SE group had decreased upper trapezius sEMG values and increased serratus anterior sEMG values(p < 0.05), while the SE group showed increased serratus anterior sEMG values(p < 0.05). After the 4-week intervention, there were significant between-group differences in SPADI, abduction and external rotation ROM, activity VAS, and sEMG values of the upper trapezius and serratus anterior(p < 0.05).ConclusionFour weeks of MFR combined with SE can increase shoulder ROM, improve pain, and thus enhancing functional activities in patients with SAPS. Additionally, it can further improve the balance between the upper trapezius and serratus anterior to improve the dynamics of the periscapular muscles.Trial registry numberChiCTR2200061054. Date of registration 15/06/2022.

Superior Capsular Reconstruction Using an Acellular Dermal Xenograft or Allograft Improves Shoulder Function but Is Associated with a High Graft Failure Rate.

Objectives: The purpose of the present study was to evaluate clinical and functional outcomes, graft integrity rate and progression of osteoarthritis after superior capsular reconstruction (SCR) at short-term follow-up. Methods: Consecutive patients that underwent SCR using an acellular dermal xeno- or allograft between May 2018 and June 2020 for the treatment of irreparable posterosuperior rotator cuff tears were included. Shoulder function (American Shoulder and Elbow Surgeons [ASES] score), pain (Visual Analog Scale [VAS] for pain) and active shoulder range of motion (ROM) were evaluated preoperatively and after a minimum of 24 months postoperatively. Isometric strength was measured at follow-up and compared to the contralateral side. Magnetic resonance imaging was performed to evaluate graft integrity and osteoarthritis progression (shoulder osteoarthritis severity [SOAS] score). Results: Twenty-two patients that underwent SCR using a xeno- (n = 9) or allograft (n = 13) were evaluated 33.1 ± 7.2 months postoperatively. Four patients in the xenograft group underwent revision surgery due to pain and range of motion limitations and were excluded from further analysis (revision rate: 18.2%). Shoulder function (ASES score: 41.6 ± 18.8 to 72.9 ± 18.6, p < 0.001), pain levels (VAS for pain: 5.8 ± 2.5 to 1.8 ± 2.0, p < 0.001) and active flexion (p < 0.001) as well as abduction ROM (p < 0.001) improved significantly from pre- to postoperatively. Active external rotation ROM did not improve significantly (p = 0.924). Isometric flexion (p < 0.001), abduction (p < 0.001) and external rotation strength (p = 0.015) were significantly lower in the operated shoulder compared to the non-operated shoulder. Ten shoulders demonstrated a graft tear at the glenoid (n = 8, 44.4%) or humerus (n = 2, 11.1%). Graft lysis was observed in seven shoulders (38.9%). The graft was intact in one shoulder (5.6%), which was an allograft. A significant progression of shoulder osteoarthritis was observed at follow-up (SOAS score: 42.4 ± 10.1 to 54.6 ± 8.4, p < 0.001). Conclusions: At short-term follow-up, SCR using an acellular dermal xeno- or allograft resulted in improved shoulder function and pain with limitations in active external rotation ROM and isometric strength. Graft failure rates were high and osteoarthritis progressed significantly. Level of Evidence: Retrospective cohort study, Level III.

Absence of scapular notching in lateralized reverse shoulder arthroplasty: a mid-term clinical and radiological evaluation

BackgroundLateralized reverse shoulder arthroplasty (LRSA) has been conceived to improve clinical and functional outcomes and reduce complication rates and scapular notching in comparison with medialized implant. The purpose of this study was to evaluate the mid-term clinical and radiological outcomes, the survival rate, and the health-related quality of life in a prospective series of patients who underwent LRSA, and to identify the possible predictors of clinical outcomes. MethodsWe conducted a retrospective study on prospectively collected data of 29 patients who underwent LRSA. Thirteen (45%) patients suffered from primary osteoarthritis (OA), 12 (41%) patients suffered from cuff tear arthropathy (CTA), and 4 (14%) patients suffered from secondary OA due to fracture sequelae. Each patient was evaluated preoperatively and at follow-up by radiological and computed tomography (CT) and by assessing the range of motion (ROM), the Constant-Murley Score (CMS), and the Short Form 12 (SF-12). ResultsAfter a mean follow-up of 52.3±17.4 (range, 24-101) months, a statistically significant recovery of the forward flexion, abduction, and external rotation ROM as well as the CMS and SF-12 physical component values was reported. Higher postoperative functional outcomes were noted in patients suffering from primary OA in comparison with patients suffering from CTA or secondary OA. No cases of scapular notching (0%) and just one case (3.4%) of grade 1 heterotopic ossification were observed. ConclusionsSatisfactory clinical and radiological outcomes of LRSA can be expected after a mean 52.3-month follow-up, with no cases of scapular notching and exceptionally low rates of radiological complications.

Ultrasonography-guided corticosteroid injection in the coracohumeral ligament in patients with adhesive capsulitis of the shoulder: a double-blinded, sham-controlled randomized study

BackgroundContracture and thickening of the coracohumeral ligament (CHL) occur in patients with adhesive capsulitis. This adversely affects the movement and function of the shoulder joint. There is limited evidence that explores the effectiveness of an isolated steroid injection into CHL in combination with physical therapy. This prospective randomized control trial aimed to evaluate the clinical effects of ultrasound-guided corticosteroid injection compared to a sham injection into the CHL in subjects with adhesive capsulitis. MethodsForty patients (23 males, 52.2 ± 8 years of age) with unilateral adhesive capsulitis (with 5.4 ± 2 months mean duration of symptoms) were randomly assigned to either the experimental or control group. Both groups received ultrasound-guided injections into the CHL. The experimental group (n=20) received corticosteroids and the control group (n=20) received a sham lidocaine injection. All subjects underwent supervised conventional physical therapy three times a week for 3 months. Subjects were evaluated for improvements in pain, range of motion, and disability at 6 and 12 weeks as compared to pre-injection baseline measurements. Data were compared statistically across groups and times at p<0.05. The CHL thickness was compared at baseline across sides using paired t-tests. ResultsThe experimental group showed statistically greater improvements in pain, functional scores, flexion, abduction, internal and external rotation range of motion at 12 weeks compared to the control group. Pain reduction was observed in both groups at 6 and 12 weeks, but the experimental group exhibited significantly greater reductions. The CHL was significantly thicker on the affected side as compared to the unaffected side (p<0.001). Discussion and ConclusionThis study partially supported the hypothesis. Notably, significant improvements in pain, range of motion, and functional scores were observed at 12 weeks in the experimental group. The greater improvements in pain and external rotation may have resulted in lower disability scores in the experimental group. The results emphasize the importance of targeted intervention into the CHL.

Association Between Dominant-Shoulder Internal-Rotation Restriction and Low-Back Pain in Elite Male High School Soft Tennis Players.

The incidence of low-back pain (LBP)is high among elite male high school soft tennis players. A previous report showed that hip internal-rotation (IR) restriction in the non-dominant leg could increase the risk of LBP. Moreover, IR in the dominant shoulder is important for serve and stroke movements, suggesting that IR restriction in the dominant shoulder can contribute to LBP. The simultaneous incidence of non-dominant-hip IR restriction may help in developing a good LBP-related factor model; therefore, this study aimed to investigate the association between dominant-shoulder IR restriction and LBP in elite male high school soft tennis players. This is a single-center cross-sectional study. This study included 176 male high school soft tennis players from 14 elite teams. The main measures were IR and external-rotation range of motion (ROM) in the dominant and non-dominant shoulders and hip, assessed using a goniometer with a bubble attached. Multiple logistic regression analyses were performed with the presence of LBP as a categorical variable (LBP, 1; non-LBP (NLBP), 0). Multiple logistic regression models were created as follows: Model 1 included dominant-shoulder IR restriction (loss of glenohumeral IR (GIRLoss)), Model 2 included non-dominant-hip IR ROM, and Model 3 included both GIRLoss and non-dominant-hip IR ROM as the main explanatory variables to test the association between dominant-shoulder IR restriction and LBP, compare its suitability as an associated factor with non-dominant-hip IR restriction, and determine if either or both should be considered in an LBP association model based on model fit. The significance of each multiple logistic regression model was examined using the model χ2 test, and a model with P<0.05 was judged as a significant model. Model fit was examined using the Hosmer-Lemeshow test, and P≥0.05 was judged as a good model fit. The Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare the goodness-of-fit among multiple logistic regression models. Results: The LBP and non-LBP groups comprised 59 and 117 players, respectively. GIRLoss in the dominant shoulder was a significant independent factor (odds ratio: 1.06, 95% CI: 1.02-1.09; P<0.01) in Model 3, which included hip IR restriction in the non-dominant leg (odds ratio: 0.90, 95% CI: 0.86-0.94; P<0.01).In all models, the explanatory variables fitted were significantly associated with LBP, indicating that the models were significant and fitted well: the AICs (and BICs) for Models 1, 2, and 3 were 198.4 (207.6), 178.6 (187.9), and 168.8 (181.1), respectively, indicating that Model 3 was the best fit. In elite male high school soft tennis players, IR restriction in the dominant shoulder was associated with LBP. IR restriction in the dominant shoulder and non-dominant hip as a significant factor for LBP may contribute to developing an optimal multiple logistic regression model for LBP.

Increased Humeral Retrotorsion is not a Risk Factor for Overuse Injury of the Throwing Shoulder in Elite Youth Handball Athletes

PurposeTo identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury. MethodsOver two seasons, 258 elite youth handball players (52% boys; age:14±0.8years) were included. Pre-season assessment included HRT and glenohumeral internal (IR) and external (ER) rotational ROM using ultrasound and a manual goniometer. Sports-specific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire. ResultsComparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (p≤0.027). No other difference was found. Significant side-to-side differences between the dominant and non-dominant shoulder were found for HRT, IR, and ER, regardless of sex (p<0.001). For total range of motion (TROM), only female athletes showed a significant increase in the dominant arm (p=0.032). The dominant side showed a significantly higher glenohumeral internal rotation deficit (GIRD) in male athletes than in female athletes (10°±17° vs. 5°±10°, p=0.011). Adaptations in HRT, ER gain, and TROM gain were not significant. Over the course of the two seasons, 20 athletes reported shoulder overuse injuries. Although GIRD was borderline non-significant (p=0.056), none of the parameters tested were significantly associated with shoulder overuse injuries. ConclusionDespite significant side-to-side differences and sport-specific adaptations, individual pre-season screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury.

Comparison of mid-term effectiveness between diabetic secondary stiff shoulder and primary frozen shoulder after arthroscopic shoulder capsular release combined with acromiohumeral distance restoration

To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films. All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P<0.05), there was no significant difference in other indicators between the two groups ( P>0.05). Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.

Glenohumeral Internal Rotation Deficit in Young Asymptomatic Elite Swimmers.

Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury. To assess data on passive shoulder range of motion (ROM) in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD, respectively) in a large sample size of asymptomatic elite swimmers with a new classification method. Cross-sectional study. Research laboratory. A total of 752 asymptomatic elite swimmers were recruited by voluntary participation (391 males and 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition. Glenohumeral internal rotation deficit and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure. Glenohumeral internal rotation deficits were found in 136 participants (18.1%). Anatomical GIRD was present in 28 cases (3.7%), whereas pGIRD was observed in 108 cases (14.4%). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side, and distance. Swimmers with pGIRD showed significantly less dominant internal rotation, total ROM, and external rotation gain (P < .01) than swimmers with aGIRD; conversely, swimmers with aGIRD showed significantly less nondominant internal rotation, external rotation, and total ROM than swimmers with pGIRD (P < .01). Glenohumeral internal rotation deficit is a relatively common condition in asymptomatic elite youth swimmers; as to not overestimate this condition, aGIRD and pGIRD have to be distinguished. Although they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact on an elite swimmer with GIRD.

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial

BackgroundHemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.MethodsThis study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.DiscussionUltrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.Trial registrationChinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722.

Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis.

The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Eight studies (N=604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p<0.01, HG = -1.30), external rotation (I2 = 83.2%, p<0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p<0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p<0.05, HG = -0.3). There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.

Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years

IntroductionThe utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MaterialsThis retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with ISA Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion (ROM), Constant score, and Subjective Shoulder Value (SSV). Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized Computed Tomography Scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). ResultsFifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and SSV improved significantly from 38 ± 11 to 76 ± 11 (p<0.001) and from 31% ± 16 to 88% ± 15 (p<0.001) respectively at the last follow-up. Forward elevation, external rotation and internal rotation ROM increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference (MCID) after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. ConclusionAt an average follow-up of 31 months, ISA Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.

Differences in shoulder function among badminton players broken down by age and sex

BackgroundImproving the understanding of shoulder function for badminton players would develop injury preventive programs. However, no studies on shoulder function reference parameters of badminton players when controlling for age and sex have been found. ObjectivesTo examine the differences in shoulder function between elementary school-age badminton players and university badminton players using shoulder range of motion. DesignCross-sectional study. SettingTesting at elementary school and university. Participants67 players (7-12 year-old players and 18-22 year-old players) without shoulder injury experience. Main outcome measuresShoulder range of motion (ROM) included internal rotation (IR), external rotation (ER), and total ROM (TROM). ResultsSignificant differences in shoulder IR of both sides (dominant: 97.67° vs 77.78°, p < 0.001; nondominant:104.70° vs 88.89°, p < 0.001), dominant ER (126.30° vs 115.98°, p = 0.013), TROM of both sides (dominant: 222.97° vs 193.76°, p < 0.001; nondominant: 222.90° vs 200.10°, p = 0.001), and TROM loss (-0.06° vs 6.34°, p = 0.047) existed between elementary school-age and university players. Significant differences in IR of both sides existed between male elementary school-age and university players (dominant: 98.38° vs 72.50°, p < 0.001; nondominant: 106.72° vs 83.99°, p < 0.001) as well as in female players (dominant: 95.25° vs 82.84°, p = 0.007; nondominant: 103.01° vs 93.57°, p = 0.035). Additionally, significant differences in IR of both sides (dominant: 72.50° vs 82.84°, p = 0.016; nondominant: 83.99° vs 93.57°, p = 0.012) and TROM of both sides (dominant: 188.24° vs 199.05°, p = 0.025; nondominant: 192.43° vs 207.44°, p = 0.002) existed between male and female university players. ConclusionsCompared with university badminton players, elementary school-age badminton players showed significantly greater shoulder IR and TROM of both sides and dominant ER while significantly smaller TROM loss. However, regardless of sex, no significant differences of bilateral deficit for glenohumeral rotation existed between elementary school-age and university badminton players.