Glenohumeral Joint Range Of Motion Research Articles

Adhesive Capsulitis of the Shoulder: Current Concepts on the Diagnostic Work-Up and Evidence-Based Protocol for Radiological Evaluation.

Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pain and progressive limitation of active and passive glenohumeral joint range of motion. Although adhesive capsulitis has been traditionally considered a diagnosis of exclusion that can be established based on a suggestive medical history and the detection of supporting findings at the physical exam, imaging studies are commonly requested to confirm the diagnostic suspicion and to exclude other causes of shoulder pain. Indeed, clinical findings may be rather unspecific, and may overlap with diseases like calcific tendinitis, rotator cuff pathology, acromioclavicular or glenohumeral arthropathy, autoimmune disorders, and subacromial/subdeltoid bursitis. Magnetic resonance imaging, magnetic resonance arthrography, and high-resolution ultrasound have shown high sensitivity and accuracy in diagnosing adhesive capsulitis through the demonstration of specific pathological findings, including thickening of the joint capsule and of the coracohumeral ligament, fibrosis of the subcoracoid fat triangle, and extravasation of gadolinium outside the joint recesses. This narrative review provides an updated analysis of the current concepts on the role of imaging modalities in patients with adhesive capsulitis, with the final aim of proposing an evidence-based imaging protocol for the radiological evaluation of this condition.

Effects of a High-Volume 7-Week Pectoralis Muscle Stretching Training on Muscle Function and Muscle Stiffness

BackgroundThere is evidence that high-volume static stretching training of the lower limbs can increase the range of motion (ROM) while decreasing muscles stiffness. However, to date, there is no evidence on the effects of upper limb stretching training or its effect mechanism. Therefore, this study aimed to investigate the effects of a comprehensive 7-week static stretching training program of the pectoralis major muscle (PMa) on glenohumeral joint ROM, muscle force, and muscle stiffness.MethodsThirty-eight healthy, physically active participants (23 male, 15 female) were randomly assigned to either the PMa-static stretching intervention (PMa-SS) group or the control group. The PMa-SS group performed a 7-week intervention comprising three sessions a week for 15 min per session, including three static stretching exercises of the PMa for 5 min each. Before and after the intervention period, shoulder extension ROM, muscle stiffness of the PMa (pars clavicularis), and maximal voluntary isometric contraction (MVIC) peak torque (evaluated at both long (MVIClong) and short (MVICshort) muscle lengths) were investigated on a custom-made testing device at 45° shoulder abduction.ResultsIn the PMa-SS group, the shoulder extension ROM (+ 6%; p < 0.01; d = 0.92) and the MVIClong (+ 11%; p = 0.01; d = 0.76) increased. However, there were no significant changes in MVICshort or in PMa muscle stiffness in the PMa-SS group. In the control group, no changes occurred in any parameter.ConclusionIn addition to the increase in ROM, we also observed an improved MVIC at longer but not shorter muscle lengths. This potentially indicates an increase in fascicle length, and hence a likely increase in sarcomeres in series.

History of Ulnar Collateral Ligament Injury and College Pitcher Fastball Profiles: A Retrospective, Observational, Live Pitching Analysis

The aim of this study was to retrospectively compare the fastball profiles of pitchers who had previously sustained grade I or II ulnar collateral ligament (UCL) injuries, were rehabilitated, and released back for competition with those of pitchers with no history of elbow injury. Eighteen pitchers from the pitching staff of 1 National Collegiate Athletic Association Division III team participated in this study. Group 1 had a history of grade I or II UCL injury (n= 8), and group 2 (n= 10) did not. A computerized pitch tracking device was used to analyze ball movement and pitching mechanics. The hypothesis was that the pitchers with a history of injury (group 1) would display differing fastball velocity-ball movement relationships compared to those without (group 2). The groups had similar heights, weights, pitching experiences, and arm slot positions at ball release. The pitching coach-determined preinjury arm slot position and the postinjury computerized pitch tracking device measurements after return to competition displayed strong agreement (r= 0.83), suggesting comparable pre and postinjury pitching techniques. The groups had comparable glenohumeral joint range of motion and fastball profiles, except that group 1 released the ball at a 2.5 times lesser horizontal distance away from the pitching rubber center. Group 2 also displayed consistently more robust and more frequent fastball movement relationships with velocity, horizontal break, and vertical break than group1. Reduced horizontal ball release distances at comparable vertical ball release heights without changes in the arm slot position suggest that pitchers with a history of grade I or II UCL injury have greater contralateral trunk tilt and elbow flexion at ball release. Increased contralateral trunk tilt may occur to increase pitch velocity at the expense of ball movement while placing the pitching elbow in a potentially injurious position. Computerized fastball profile analysis using a computerized pitch tracking device, in conjunction with coach pitching technique observation, and team medical staff clinical examination may help better identify pitchers with an increased risk of UCL injury. Diagnostic II.

National Collegiate Athletic Association Swimmers With Glenohumeral Multidirectional Laxity Have an Increased Glenohumeral Joint Range of Motion Profile.

Adaptations in glenohumeral joint laxity and range of motion (ROM) are prevalent in competitive swimmers. Increased glenohumeral laxity in swimmers has been found to exist in multiple directions. However, it is unclear if swimmers with multidirectional laxity (MDL) possess altered glenohumeral ROM compared with swimmers without MDL. The purpose of this study was to compare the glenohumeral ROM characteristics of external rotation (ER), internal rotation (IR), total arc of motion (ER + IR), and total arc of motion ratio (ER/IR) between swimmers with MDL and without MDL. Our secondary objective was to investigate the effect of MDL on self-reported pain and function. Observational study. Twenty-nine NCAA Division I swimmers (females: 15 and males: 14; age 19.5 [1.2]y; body mass index 23.9 [2.0]km/m2) participated in a preseason physical assessment including measures of glenohumeral ROM and joint laxity. These measures were used to determine the presence or absence of MDL for both shoulders of each participant. Glenohumeral ROM characteristics were compared between shoulders with MDL and shoulders without MDL with independent t tests. Self-reported pain and function scores were recorded biweekly across the season with a modified Kerlan-Jobe Orthopedic Clinic questionnaire. The seasonal average Kerlan-Jobe Orthopedic Clinic questionnaire scores were compared between swimmers with MDL and swimmers without MDL with analysis of variance, with factors of sex and MDL status. Shoulders with MDL possessed increased glenohumeral IR (P < .001; effect size: 0.65) and total arc of motion (P < .004; effect size: 0.45) compared with shoulders without MDL. There were no differences in ER. There was no difference in self-reported pain and function between groups. Shoulders with MDL possess increased glenohumeral IR and total arc of motion compared with shoulders without MDL. The presence of MDL may not affect self-reported pain and function in competitive swimmers.

The Effectiveness of Shoulder Mobility and Strength Programs in Competitive Water-Polo Players.

Background: Water-polo is the water sport with the highest incidence of injuries, with shoulder pain being the most common one. The understanding of risk factors and guidance on preventive measures is essential in this sport discipline. The aim of this study was to determine the effects of a specific 6-week training plan on range of motion (ROM) and joint strength levels in a group of professional water-polo players. Methods: Quasi-experimental study with a sample of 28 participants (age: 20.1 ± 2.5 years; height: 176.9 ± 6.2 cm; body mass: 74.6 ± 8.1 kg). Three study groups, which consisted of one control group and two experimental groups, were established. Two repeated measurements, pre and post intervention, were performed. During these measurements, ROM of the glenohumeral joint was analyzed both in external (ER) and internal (IR) rotation, as well as the maximal isometric strength. Conclusions: The application of a training program improved glenohumeral joint ROM. ER and IR evolve differently in both shoulders. ER improved only in the throwing arm only in the group undergoing intervention but for the non-dominant side, improvements were observed in both ER and IR, regardless of whether or not they had followed the intervention plan. No improvements were observed in either the isometric strength or contralateral asymmetries.

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

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

Assessment of Scapulothoracic, Glenohumeral, and Elbow Motion in Adhesive Capsulitis by Means of Inertial Sensor Technology: A Within-Session, Intra-Operator and Inter-Operator Reliability and Agreement Study.

Adhesive capsulitis (AC) is a glenohumeral (GH) joint condition, characterized by decreased GH joint range of motion (ROM) and compensatory ROM in the elbow and scapulothoracic (ST) joint. To evaluate AC progression in clinical settings, objective movement analysis by available systems would be valuable. This study aimed to assess within-session and intra- and inter-operator reliability/agreement of such a motion capture system. The MVN-Awinda® system from Xsens Technologies (Enschede, The Netherlands) was used to assess ST, GH, and elbow ROM during four tasks (GH external rotation, combing hair, grasping a seatbelt, placing a cup on a shelf) in 10 AC patients (mean age = 54 (±6), 7 females), on two test occasions (accompanied by different operators on second occasion). Standard error of measurements (SEMs) were below 1.5° for ST pro-retraction and 4.6° for GH in-external rotation during GH external rotation; below 6.6° for ST tilt, 6.4° for GH flexion-extension, 7.1° for elbow flexion-extension during combing hair; below 4.4° for GH ab-adduction, 13° for GH in-external rotation, 6.8° for elbow flexion-extension during grasping the seatbelt; below 11° for all ST and GH joint rotations during placing a cup on a shelf. Therefore, to evaluate AC progression, inertial sensors systems can be applied during the execution of functional tasks.

Effects of a Sport-Specific Upper-Body Resistance-Band Training Program on Overhead Throwing Velocity and Glenohumeral Joint Range of Motion.

Oranchuk, DJ, Ecsedy, EN, and Robinson, TL. Effects of a sport-specific upper-body resistance-band training program on overhead throwing velocity and glenohumeral joint range of motion. J Strength Cond Res 35(11): 3097-3103, 2021-Practitioners seek optimal, yet practical means to enhance performance while aiming to minimize injury risk. Resistance bands offer portability and safety and enable similar movements to competition. However, the effect of movement-specific resistance-band training on throwing performance and markers of injury risk has yet to be elucidated. Therefore, the purpose of this study was to compare the effects of a resistance training program using resistance bands with sport-specific (SS), or general-training (GT) exercises. Twenty-eight collegiate female softball players were randomly allocated to an SS (n = 15) or GT (n = 13) 8-week resistance-band program. Dependent variables included peak and mean throwing velocity, 1 repetition maximum (1RM) cable Chop-test, and glenohumeral internal and external rotation range of motion (ROM). No significant (p ≤ 0.338) differences were found between groups at baseline. Improvements in peak (p = 0.006, 4.9%, effect size [ES] = 0.61) and mean (p = 0.004, 3.1%, ES = 0.49) throwing velocity were seen after SS training, while the 1RM Chop-test increased in both SS (p < 0.001, 23.5%, ES = 1.06) and GT (p = 0.049, 26.1%, ES = 0.57) groups. However, no between-group differences (p ≥ 0.109, ES ≤ 0.17) were present in any variable. Neither the Chop-test nor shoulder internal or external ROM had more than moderate correlations with throwing velocity (r ≤ 0.30, p ≥ 0.119). Therefore, practitioners should not depend solely on SS resistance-band training when aiming to improve throwing velocity or measures of shoulder rotational health. However, resistance bands appear to be a practical alternative when traditional means of resistance training are not available. In addition, strength and conditioning coaches should not use the Chop-test or shoulder ROM to predict throwing performance.

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study

Background: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. Purpose: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. Study Design: Controlled laboratory study. Methods: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. Results: There was a significant main effect of condition for bicipital forearm angle (P = .02, F = 4.03), low flexion (P = .02, F = 3.86), internal rotation (P = .03, F = 3.65), and external rotation (P < .001, F = 15.15) but not for horizontal adduction (P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. Conclusion: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. Clinical Relevance: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

Acute effects of softball pitching to fatigue on the glenohumeral internal rotation range of motion

BACKGROUND: The effects of baseball pitching on the glenohumeral joint (GHJ) range of motion (ROM) have been widely studied. Specifically, internal rotation (IR) ROM reduction of the pitching arm, an adaptation to repeated overhead throwing, is linked to increased risk of injuries in baseball pitchers. However, there is a lack of literature on the effects of softball pitching on the GHJ ROM. HYPOTHESIS: Softball pitching to fatigue will result in significant reduction of GHJ supine IR ROM. DESIGN: Test–retest, quasi-experimental study. METHODS: Twelve softball pitchers (age: 19.5 ± 1.8 years) volunteered to participate in this study. GHJ ROM in supine IR, horizontal adduction, low flexion (shoulder joint flexed to 60°; added IR), extension with IR (shoulder joint abducted to 60° in the plane of scapula and then horizontally abducted 90° with the elbow maintained in 90° flexion; add GH IR), and supine external rotation were compared before and after a single bout of softball pitching to fatigue or a maximum of 100 pitches, whichever occurred first. RESULTS: Maximum ROM change post softball pitching was observed in horizontal adduction but not in supine IR. CONCLUSIONS: Maximum ROM change was observed in horizontal adduction. Supine IR ROM measurement may not be appropriate for assessing softball pitchers' shoulder ROM because this measurement was not affected by the softball pitching.

Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study.

To determine whether rotator cuff strength, glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male handball players. A total of 206 players in the Norwegian elite handball league for men were tested prior to the 2011-2012 season. Measures included: (1) glenohumeral internal and external rotation range of motion, (2) isometric internal rotation, external rotation and abduction strength and (3) assessment of scapular dyskinesis. Players were followed prospectively for the entire regular season (30 weeks), with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A cumulative severity score was calculated for each player based on their questionnaire responses. This was used as the outcome measure in risk factor analyses. The average prevalence of shoulder problems throughout the season was 28% (95% CI 25% to 31%). The prevalence of substantial shoulder problems, defined as those leading to moderate or severe reductions in handball participation or performance, or to time loss, was 12% (95% CI 11% to 13%). Significant associations were found between obvious scapular dyskinesis (OR 8.41, 95% CI 1.47 to 48.1, p<0.05), total rotational motion (OR 0.77 per 5° change, 95% CI 0.56 to 0.995, p<0.05) and external rotation strength (OR 0.71 per 10 Nm change, 95% CI 0.44 to 0.99, p<0.05) and shoulder injury. Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control.

RISK FACTORS FOR OVERUSE SHOULDER INJURIES AMONG MALE PROFESSIONAL HANDBALL PLAYERS

BackgroundOveruse shoulder injuries are common among professional male handball players. However, little is known about risk factors for the development of injury.ObjectiveTo determine whether rotator cuff strength, glenohumeral joint range...

Radioulnar Range of Motion Normative Values for Elite Baseball Players

Context:Numerous studies have documented reduced glenohumeral joint range of motion (ROM) of the dominant extremity among baseball players, which may be caused by throwing-related factors that also affect the radioulnar joint.Objective:To measure pronation and supination ROM in competitive baseball pitchers and position players.Participants:Asymptomatic professional and collegiate baseball pitchers (N = 59) and position players (N = 43).Outcome Measures:Bilateral radioulnar pronation and supination ROM.Results:Pitchers demonstrated significantly less pronation and total ROM in the throwing arm than the nondominant arm. The position players demonstrated significantly less total ROM in the throwing arm than the nondominant arm.Conclusions:The reported normative values may provide useful standards for interpretation of radioulnar ROM measured in both asymptomatic and symptomatic baseball players.

An Analysis of the Correlation between Humeral Head Anterior Glide Posture and Elbow Joint Angle, Forward Head Posture and Glenohumeral Joint Range of Motion

[Purpose] The purpose of this study was to examine the correlation between the humeral head anterior glide posture (HHAGP) and elbow joint angle (EJA), forward head posture (FHP), and glenohumeral joint (GHJ) range of motion (ROM). [Subjects] The subjects were 47 college students (10 male, 37 female) in whom more than one third of the humeral head was anteriorly translated against the acromion. [Methods] Humeral head distance (HHD) was measured with vernier calipers and EJA and FHP were measured using NIH Image J software for lateral body imaging obtained with a digital camera. GHJ ROM was measured with a goniometer. [Results] Increases in HHD were accompanied by decreases in internal rotation (IR) and abduction (AB), while increases in forward head angle (FHA) accompanied decreases in EJA. Increases in EJA occurred together with increases in external rotation (ER). IR and ER increased with increases in AB. [Conclusion] HHD influences EJA, IR, and AB; therefore, HHD should be considered in therapeutic approaches for these factors.

Physical Examination of the Overhead Athlete’s Shoulder

Overhead athletes seek the services of an orthopedic surgeon because of pain and/or dysfunction. It is important to address the cause of the symptoms more so than the source of the patient's pain, so that treatment will eliminate the problem rather than merely ameliorate symptoms temporarily. In order to accomplish a thorough assessment of shoulder function, the examiner must expand his/her view from isolated assessment of the glenohumeral joint range of motion, stability, assessment of rotator cuff strength, palpation and provocative maneuvers, and add assessment of the shoulder in the context of the kinetic chain. The examination of the thrower's shoulder, coupled with a thorough history, will usually provide a solid functional diagnosis and provide a good idea as to the presence of structural damage. As a result, the value of rehabilitation and the benefit of surgical intervention are made more predictable.

The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up

BackgroundTo prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears.MethodsFifty-two patients underwent "mini-open" or all arthroscopic repair of a full thickness tear of the rotator cuff. Patients who complained of shoulder pain and/or weakness and who had failed a minimum of 6 weeks of physical therapy and had at least one sub-acromial injection were surgical candidates. Pre and post-operative clinical evaluations included the following: 1) demographics; 2) Simple Shoulder Test (SST); 3) University of California, Los Angeles (UCLA) rating scale; 4) visual analog pain assessment (VAS); and 5) pre-op SF12 assessment. Descriptive analysis was performed for patient demographics and for all variables. Pre and post outcome scores, range of motion and pain scale were compared using paired t-tests. Analysis of variance (ANOVA) was used to evaluate any effect between dependent and independent variables. Significance was set at p is less than or equal to 0.05.ResultsThere were 31 females and 21 males. The average follow-up was 50.6 months (27 – 84 months). The average age was similar between the two groups [arthroscopic x = 55 years/mini-open x = 58 years, p = 0.7]. Twenty-seven patients underwent arthroscopic repair and 25 underwent repair with a mini-open incision. The average rotator cuff tear size was 3.1 cm (range: 1–5 centimeters). There was no significant difference in tear size between the two groups (arthroscopic group = 2.9 cm/mini-open group = 3.2 cm, p = 0.3). Overall, there was a significant improvement from pre-operative status in shoulder pain, shoulder function as measured on the Simple Shoulder test and UCLA Shoulder Form. Visual analog pain improved, on average, 4.4 points and the most recent Short Shoulder Form and UCLA scores were 8 and 26 respectively. Both active and passive glenohumeral joint range of motion improved significantly from pre-operatively.ConclusionBased upon the number available, we found no statistical difference in outcome between the two groups, indicating that either procedure is efficacious in the treatment of small and medium size rotator cuff tears.Level of EvidenceType III