Kinetic Chain Upper Extremity Stability Research Articles

Impact of anthropometric data and physical activity level on the closed kinetic chain upper extremity stability test (CKCUEST) score: A cross-sectional study

ObjectiveThe aim of this study was to evaluate the impact of anthropometric data and the level of physical activity on the CKCUEST score on uninjured subjects. MethodSubjects were eligible for the study if they were aged between 18 and 25 years old. Anthropometric data were collected, and the physical activity level was assessed using the Global Physical Activity Questionnaire (GPAQ). The primary endpoint was the CKCUEST score. The CKCUEST was performed three times and the score was the mean of the 3 tries. The compared groups were posteriori dichotomized according to the median. A multivariate model has been built by step-by-step selection with a threshold set at 0.05. Results82 subjects were included. The difference between groups determined for each variable was statistically significant for CKCUEST score (p < 0.0001) and for physical activity level (p = 0.0245). The multivariate analysis showed that arm span, sex and weight are, in order, three main variables influencing the CKCUEST score. A predictive equation was established based on these 3 factors (R2 = 0.51). ConclusionThe CKCUEST score seems to be impacted by sex, weight and arm span. A predictive equation for the CKCUEST score was proposed: (0.271 × Upper Limb Span)–(0.103 × Weight)–(3.219 × Sex)–17.719.

Upper extremity physical performance tests in female overhead athletes: a test–retest reliability study

ObjectiveDespite the studies that have investigated the reliability of Upper Extremity Functional Tests(UEFTs), the reliability of Closed Kinetic Chain Upper Extremity Stability(CKCUES), Seated Medicine Ball Throw(SMBT), push-up(PU) and Unilateral Seated Shot Put(USSP) tests in overhead athletes has yet to be assessed. The objective of this study was to determine both the relative and absolute test–retest reliability of the four UEFTs in female overhead athletes.MethodsTwenty-nine female overhead athletes (age: 26.6 ± 5.29 years) underwent the four UEFTs twice within a three- day interval. The upper limb stability was assessed through PU and CKCUES tests, while the power was assessed though SMBT and USSP tests. The Intraclass Correlation of Coefficient (ICC) was applied to assess the relative reliability. Absolute reliability was determined by calculating the Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC). Furthermore, Bland–Altman plots were used to detect the agreements between the two measurements.ResultsThe relative reliability of PU, CKCUES, SMBT, and non-dominant arm USSP tests was excellent (ICC = 0.83, 0.80, 0.91, and 0.83, respectively). SEM was within a range of 1.69 to 1.72 for stability tests and a range of 13.61 to 52.12 for power (based on a 95% confidence interval). The MDC was 4.68 for PU and 4.75 for CKCUES test. At least four repetitions are needed to be considered a real improvement on PU and CKCUES tests. This value was 144.04, in SMBT and 59.03, 37.62 cm (dominant and non-dominant arm, respectively) in USSP tests, which represents the minimum change that must occur to be considered an athlete’s progression.ConclusionThis study revealed that both the upper limb stability and power tests have acceptable relative and absolute intra-rater reliability in female overhead athletes. These can be considered as reliable tools in research and clinical settings.

Stability, performance and upper and lower extremities range of motion in elite beach handball athletes: A cross sectional study

Although beach handball is a popular sport worldwide, information about the functional profile in elite athletes are lacking. This study generate a descriptive profile of stability, performance and upper and lower extremities ROM in elite beach handball athletes. Secondary proposals were to compare these outcome measures between sexes and sides, and to report the frequency of athletes “at risk” according to cutoff values for shoulder ROM and dynamic postural stability of the lower extremities. Twenty-eight (n = 16 males, 28.7 ± 5.3 years; n = 12 females, 27.5 ± 5.5 years) elite beach handball athletes were tested. Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), single hop test, modified Star Excursion Balance Test (mSEBT) and passive shoulder, hip and ankle dorsiflexion ROM were assessed. Male athletes presented greater reach distance in the anterior direction [P < .0001; Mean Difference (MD): 36%] and lower reach distance in the posteromedial direction (P < .0001; MD: −29.7%) than female athletes in the mSEBT. Bilateral differences were observed for male athletes during the mSEBT, with the dominant stance limb obtaining a smaller reach distance in the anterior direction (P < .01; MD: −38.3%) and greater reach distance in the posteromedial direction (P < .0001; MD: 30.8%). Male athletes had less upper and lower extremities ROM and reached a smaller normalized single hop distance than female athletes. Most athletes presented mSEBT asymmetries and shoulder ROM deficits which have been shown to increase injury risk. Dynamic postural stability adaptations are present in elite beach handball athletes of both sexes, with more pronounced upper and lower extremity flexibility deficits in male athletes.

The Effect of Core Stability Exercises on Lower Limb Alignment, Upper and Lower Limb Function in Kyokushin Girls

Purpose: This study was conducted to investigate the effect of 6 weeks of core stability exercises in the trunk area on lower limb alignment and lower and upper limb function in Kyokushin athletes. Methods: The statistical sample of the research included 30 female Kyokushin players aged 14-18 years, who were randomly divided into two experimental and control groups. The control group performed common Kyokushin exercises and the experimental group performed core stability exercises for 6 weeks. Analysis of covariance (ANCOVA) and paired t-tests were used to compare between groups and within groups. Results: The results of the paired t-test showed a significant effect of training programs on changes in upper and lower limb function in both experimental and control groups (P≤0.05); however, a significant difference was observed between the pre-test and post-test in both control and experimental group. The test was not observed in the Q angle (P&gt;0.05). The results of ANCOVA test showed that after controlling the effect of the pre-test, a significant difference was observed in lateral jump (P≤0.05) between the experimental and control groups. However, no difference was observed between the two groups in the changes of closed kinetic chain upper extremity stability test (CKCUEST), square jump, and Q angle (P&gt;0.05). Conclusion: Considering the nature of Kyokushin and the research results, it is suggested that people working in Kyokushin do not feel the need for core stability exercises separately.

Association of Selected Fitness Variables with Perceived Performance Levels in Lawn Tennis Players

Abstract Objectives Lawn tennis is an explosive sport that involves various fitness parameters such as explosive strength, endurance, power, and agility. Improved physical fitness leads to superior athletic performance. The coach's perception is contingent upon his perception of the player at the time the athlete is comparing himself to the coach. Thus, this study aimed to determine the association between chosen fitness factors and perceived performance by coach in lawn tennis players. Thus, the study aims to detect the relationship between different fitness variables and perceived level of performance in lawn tennis player. Materials and Methods Fifty-two lawn tennis players from two sports academies were measured for various parameters of fitness and perceived performance level as rated by the coach. Statistical Analysis The association between selected fitness metrics and perceived performance in lawn tennis players was investigated using Pearson's correlation test. Furthermore, the data were analyzed with paired t-test for male and female group, and ANOVA was used to analyze the difference between the levels of performance. Results Fatigue index, closed kinetic chain upper extremity stability (CKCUEST) test, and peak power and energy expenditure taken by metabolic equivalent (MET) calculation was found to be statistically different between males and females. While comparing BMI with the peak power, there was a weak positive correlation for males, while for female there was no correlation. Metabolic equivalent, energy expenditure, and peak power were positively correlated with the level of performance; however, fatigue index and level of performance had a negative nonsignificant correlation. Conclusion Peak power, fatigue index, energy expenditure, and BMI were found to be associated in males, but not in females. Peak power and energy expenditure were connected to performance in both genders.

Validity and reliability of upper extremity star excursion balance test in adolescent swimmers

Background/ObjectivesUpper limb balance is one of the important physical fitness parameters for all populations, especially overhead athletes like swimmers. Upper extremity star excursion balance test (UESEBT) is a comprehensive dynamic balance assessment, this study aims to explore the reliability and validity of UESEBT among adolescent swimmers. MethodsThis cross-sectional study recruited 70 adolescent swimmers. All participants were required to complete UESEBT, upper quarter Y-balance test (UQYBT), maximal isometric strength (MIS) tests in upper limb, closed kinetic chain upper extremity stability test (CKCUEST), trunk flexor endurance test (TFET) and lateral trunk endurance test (LTET). The intra- and inter-operator reliability and the correlation of UESEBT with other physical performances were conducted. ResultsFor reliability, the intra- and inter-operator reliability of all directions and composite score were high-to-excellent (ICC = 0.706−1.000) among all participants. For validity, the UESEBT has a moderate-to-strong correlation with UQYBT (r = 0.42−0.72, p < 0.001), and a weak-to moderate one with CKCUEST (r = 0.25−0.42, p < 0.05). Furthermore, the UESEBT performance showed weak-to-moderate correlations with MIS (r = 0.24−0.44, p < 0.05). UESEBT was correlated to LTET (r = 0.24−0.33, p < 0.05) whereas no relationship was found with TFET. ConclusionsUESEBT was a reliable and valid tool to screen upper extremity dynamic balance among adolescent swimmers. UESEBT provides more detailed information in eight directions to assess the upper limb sport performance. Further study should explore the prediction ability of UESEBT for injury.

Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients

Background: Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. Purpose: To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. Results: A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side (P < .001) and for the nondominant side (P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side (P < .001) and for the dominant side (P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. Conclusion: Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. Registration: NCT05150379 (ClinicalTrials.gov identifier).

Assessment of return to play after an acute shoulder injury: protocol for an explorative prospective observational German multicentre study

IntroductionTo date, there is no valid single test or battery of tests for informing return-to-play (RTP) decisions following an acute shoulder injury. The purpose of this exploratory study is to...

Comparison of the upper extremity physical performance tests between asymptomatic adults with and without scapular dyskinesis

Abstract Introduction Physical performance tests (PPTs) are screening tools widely available, easy to apply, and that can be performed in different environments and contexts. Scapular dyskinesis can be related to changes in glenohumeral angulation, acromioclavicular joint strain, subacromial space dimension, shoulder muscle strength/activation and humeral position/motion. Few studies were developed to understand the influence of aspects such as strength, stability mobility, and scapular dyskinesis on the scores of the upper extremity PPTs. Objective To compare the performance in the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Seated Medicine Ball Throw Test (SMBT) and Upper Quarter Y Balance Test (UQYBT) between asymptomatic adults with and without scapular dyskinesis. Methods Cross-sectional study with 20 asymptomatic individuals: 10 with scapular dyskinesis and 10 without scapular dyskinesis. The average number of touches, number of touches normalized by height, and power score in the CKCUEST, distance covered by the ball in the SMBT, reach in the medial, inferolateral, and superolateral directions, total excursion and composite score of the UQYBT were compared between both groups. Results No significant differences were found for all variables (p &gt; 0.05). Small to moderate effect sizes were found for the scores of the CKCUEST (d = 0.16-0.78), a small effect size was found for the distance in the SBMT (d = 0.12), and small to moderate effect sizes were found for the scores of the UQYBT (d = 0.02-0.43). The scapular dyskinesis group presented better performance in all tests. Conclusion The presence of scapular dyskinesis in asymptomatic individuals is not a factor related to worse scores in upper extremity physical performance tests.

Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery.

Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. Prospective cohort study. Level 3. A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery.

Effects of a 6 week core strengthening training on measures of physical and athletic performance in adolescent male sub-elite handball players.

The objective was to investigate the effects of a 6-week core strengthening training within the regular handball training sessions compared to regular handball training only. Male sub-elite handball players were randomly assigned to an intervention (INT: n = 13; age: 16.9 ± 0.6 years) or a control (CON: n = 13; age: 17.2 ± 0.8 years) group. The INT group performed the "big 3" core exercises cross curls-up, side bridge (both sides), and the quadrupedal stance ("birddog exercise") triweekly for 20-30 min while the CON group conducted regular handball training only. Pre- and post-training assessments included measures of muscular endurance (Closed Kinetic Chain Upper Extremity Stability Test [CKCUEST] and the Bourban test), shoulder mobility/stability (Upper Quarter Y Balance [YBT-UQ] test), and throwing velocity. The ANCOVA revealed significant differences between means in favour of the INT group for the dorsal chain (p < 0.001, = 0.46) and the lateral chain (left side: p = 0.015, = 0.22; right side: p = 0.039, = 0.17) of the Bourban test, the composite score (p = 0.024, = 0.20) of the throwing arm reach and the inferolateral reach direction (p = 0.038, = 0.17), and the composite score (p = 0.027, = 0.19) of the non-throwing arm reach of the YBT-UQ. However, performance in the CKCUEST and throwing velocity did not show any group-specific changes. Therefore, 6 weeks of core strengthening training were effective in improving some components of physical but no handball-specific athletic (i.e., throwing velocity) performance in adolescent male sub-elite handball players. Practitioners may still opt for this training regimen when stimulus variability is sought or when a low load/low movement approach (e.g., during rehabilitation) is favoured.

The Effect of Blood Flow Restriction Therapy on Shoulder Function Following Shoulder Stabilization Surgery: A Case Series.

Traumatic shoulder instability is a common injury in athletes and military personnel. Surgical stabilization reduces recurrence, but athletes often return to sport before recovering upper extremity rotational strength and sport-specific abilities. Blood flow restriction (BFR) may stimulate muscle growth without the need for heavy resistance training post-surgically. To observe changes in shoulder strength, self-reported function, upper extremity performance, and range of motion (ROM) in military cadets recovering from shoulder stabilization surgery who completed a standard rehabilitation program with six weeks of BFR training. Prospective case series. Military cadets who underwent shoulder stabilization surgery completed six weeks of upper extremity BFR training, beginning post-op week six. Primary outcomes were shoulder isometric strength and patient-reported function assessed at 6-weeks, 12-weeks, and 6-months postoperatively. Secondary outcomes included shoulder ROM assessed at each timepoint and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Extremity Y-Balance Test (UQYBT), and the Unilateral Seated Shotput Test (USPT) assessed at the six-month follow-up. Twenty cadets performed an average 10.9 BFR training sessions over six weeks. Statistically significant and clinically meaningful increases in surgical extremity external rotation strength (p < 0.001; mean difference, .049; 95% CI: .021, .077), abduction strength (p < 0.001; mean difference, .079; 95% CI: .050, .108), and internal rotation strength (p < 0.001; mean difference, .060; CI: .028, .093) occurred from six to 12 weeks postoperatively. Statistically significant and clinically meaningful improvements were reported on the Single Assessment Numeric Evaluation (p < 0.001; mean difference, 17.7; CI: 9.4, 25.9) and Shoulder Pain and Disability Index (p < 0.001; mean difference, -31.1; CI: -44.2, -18.0) from six to 12 weeks postoperatively. Additionally, over 70 percent of participants met reference values on two to three performance tests at 6-months. While the degree of improvement attributable to the addition of BFR is unknown, the clinically meaningful improvements in shoulder strength, self-reported function, and upper extremity performance warrant further exploration of BFR during upper extremity rehabilitation. 4, Case Series.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Upper extremity field tests and isokinetic shoulder internal and external strength and power in sports active males

BACKGROUND: In order to guide sports active subjects with musculoskeletal (MSK) shoulder dysfunctions it is essential to have precise insights of possible weak links in the kinetic chain of their shoulder girdle with access to reference data. Equally, it is uncertain whether so-called functional shoulder strength tests are complementary to an isokinetic shoulder strength test. OBJECTIVE: To establish reference values and to clarify the relationship between two upper extremity field tests – the Scapular Muscle Endurance test (SME) and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and the isokinetic strength test of the shoulder internal (IR) and external rotators (ER). METHODS: Seventy-six male sport active men performed the CKCUEST, the SME, and underwent a bilateral isokinetic strength test to establish reference values of the isokinetic shoulder relative to body mass Peak Moment (PM/kg) and Power (Power/kg) for the IR and ER. A mixed-design ANOVA calculated possible side-to-side differences and one-way ANOVA was applied for eventually age group differences. Additionally, the relationship between the three tests was examined with a Spearman rank-order correlation coefficient. RESULTS: No significant correlations were indicated between the SME and the criterion isokinetic test and between the SME and CKCUEST. CONCLUSIONS: The main outcome parameters in this study warrant individual assessment as they measure different constructs, leading to a diverse profile of the shoulder.

Role of active joint position sense on the upper extremity functional performance tests in college volleyball players.

BackgroundIt has been well established that proprioception plays a decisive role in shoulder stability and sport performance. Notwithstanding, there is a lack of clear association between active joint position sense (AJPS) and the performance of upper-extremity functional performance tests. The aim of this study was to determine whether the AJPS of the shoulder complex is associated with the performance of college volleyball players with the following functional tests: Y-Balance Test-Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). The secondary aim was to investigate whether the magnitude of the proprioception error through the AJPS had the ability to act as a predictor for functional test scores.MethodsCross-sectional study with a convenience sampling. Healthy college volleyball players (≥12 h of training/week), 30 males and 22 females, between 18 and 26 years of age were included. AJPS of the shoulder (90° of flexion (90°Flex), 90° of internal rotation at 90° of abduction (90°IR/ABD), 90° of external rotation at 90° of abduction (90°ER/ABD)) and three upper-extremity functional performance tests (YBT-UQ, CKCUEST and SMBT) were assessed. A Pearson’s test and a stepwise multiple linear regression analysis were used to determine possible associations and relationships between outcome measures, respectively.ResultsThe analysis revealed that AJPS at 90°IR/ABD and 90°ER/ABD were the only proprioceptive variables with an association to the YBT-UQ and SMBT. Despite these relationships, only the AJPS at 90°IR/ABD was associated with the performance of the YBT-UQ in; superolateral direction (β = −0.7; 95% CI [−1.3 to 0.1]; p = 0.025); inferolateral direction (β = −1.5; 95% CI [−2.1 to −0.8]; p = 0.001); and composite score (β = −0.8; 95% CI [−1.3 to −0.3]; p = 0.002). From these, AJPS at 90°IR/ABD mainly explained the variability of YBT-UQ (inferolateral direction) performance (R2 = 0.32; %R2 = 0.32). Our findings allow for a possible expanded role for proprioception as a contributing factor in upper limb motor control during functional movements. Further research is required to explore and distinguish the associations between proprioception, motor control and sport performance involving the upper limbs.

Factors affecting the shoulder functional profile in elite judo athletes

ABSTRACT The aim was to investigate the effects of sex, age, preferred judo technique, dominance, and injury history on the shoulder functional status of elite judo athletes. Sixty-one elite judo athletes (38 males, age: 18.1 ± 1.2 years, body mass: 69.3 ± 13.3 kg, body height: 172.2 ± 9.8 cm, brown belt to second-degree black belt) completed three questionnaires: Western Ontario Shoulder Instability, Western Ontario Rotator Cuff, and Shoulder Instability-Return to Sport after Injury. They performed four physical tests: the glenohumeral rotator isometric strength test, upper quarter Y-balance test, unilateral seated shot put test, and modified Closed Kinetic Chain Upper Extremity Stability Test. The results showed that the female athletes had less shoulder functional abilities than the male athletes (p < 0.001 to p = 0.02). The younger athletes had poorer shoulder stability and upper extremity power than the older athletes (p < 0.001 to p = 0.02), but their glenohumeral muscles were stronger in both internal (p = 0.03) and external (p = 0.005) rotations. All the judo athletes had similar bilateral differences in shoulder functional status, except for judokas who preferred throwing techniques (p = 0.01). Injury history affected self-perceived functional status (p < 0.001), as well as upper extremity muscle capacity and neuromuscular control (p = 0.01 to p = 0.05). This study provides new insight into the shoulder functional status of elite judo athletes, which may aid in the development of sports-specific injury prevention and return-to-sport programmes to reduce the risk of shoulder injury occurrence and recurrence. Highlights Normalized levels of upper extremity abilities must be sex- and age-specific in prevention programmes. Prevention programmes may focus on muscle bilateral and anteroposterior symmetry. Prevention programmes may include psychological training tailored to the sex of judo athletes.

Effect of Scapular Movement Impairment on Functional Stability of Shoulder Girdle and Scapulohumeral Rhythm in Elite male Volleyball Players

Background and Aims The shoulder girdle is at higher risk of injury in overhead sports like volleyball. Repeated movements with high speed and power can cause changes in scapular position and lead to shoulder girdle dysfunction. This study aims to assess the effect of scapular movement impairment on functional stability of the shoulder girdle and the scapulohumeral rhythm in elite male volleyball players Methods In this descriptive-comparative study, 80 male volleyball players aged 18-35 years including 40 with scapular downward rotation syndrome (SDRS) (age=22±2.8 years, weight=82.50±1.3 kg, and height=193±3.2 cm) and 40 with scapular abduction syndrome (SAS) (age=24±2.1 years, weight=81.40±1.3 kg, and height=192±2.9 cm) participated who were selected purposefully. They underwent the scapular dyskinesis test and Kibler’s shoulder lateral slip test. The scapulohumeral rhythm was measured at four positions (0, 45°, 90°, and 135°) using two inclinometers. The Y-balance test-upper quarter (YBT-UQ), seated medicine ball throw test (SMBT), and closed kinetic chain upper extremity stability test (CKCUEST) were used to measure the functional stability of the upper extremity. Shapiro-Wilk test was used for examining the normality of data distribution, independent t-test was used to compare the differences between groups. Results There was a significant difference in the scapulohumeral rhythm at 45° (P=0.001), 90° (P=0.001), and 135° (P=0.001) between the two groups (Mean difference= 18.27, 21.27, and 27.87, respectively), where the SDRS group had lower scapular upward rotation than the SAS group. The results of YBT-UQ showed that the superior-lateral reach (P=0.001) and composite (P=0.001) scores of the dominant hand were significantly different between the two groups (Mean difference = 9.37 and 10.41, respectively), where the SDRS group had lower scores than the SAS group. No significant difference was found in the medial (P= 0.223) and inferior-lateral (P= 0.111) reach scores. Moreover, the results showed no significant difference between the groups in the SMBT (P=0.124) and CKCUEST (P=0.875) scores. Conclusion The occurrence of scapular movement impairment affects the YBT-UQ score and leads to scapulohumeral rhythm disturbance in volleyball players. Even if the activity is stopped, the ideal and optimal alignment will not be created unless efforts are made to improve the movement pattern.

Return to Sport Testing After Arthroscopic Shoulder Surgery in Adolescent Patients

Background:Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. However, data regarding RTS testing after arthroscopic shoulder stabilization in adolescent patients is limited.Purpose:To investigate the results of strength and functional RTS testing following arthroscopic stabilization in adolescent patients with shoulder instability.Methods:A retrospective review of medical records was performed to identify adolescent patients who underwent arthroscopic shoulder stabilization and subsequent RTS testing between April 2017 and April 2020. Surgeries were performed by a single sports medicine fellowship-trained surgeon; RTS assessments were performed at the primary institution’s sports rehabilitation clinic by a licensed physical therapist. Patient demographics, operative details, patient-reported outcome measures (PROMs) (VAS, Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences between the involved and uninvolved limbs were analyzed. Correlations between RTS testing results and PROMs were examined.Results:24 patients (62.5% male) were identified with mean age of 15.5 years (range, 13-21 years). Football was the most common primary sport played (33.3%). 58.3% of patients underwent surgery on their dominant shoulder. 21 patients had isolated anterior repairs, two had combined anterior/posterior repairs, and one had an isolated posterior repair. RTS testing was performed at a mean of 6.02 ± 0.64 months postoperatively. All PROMs improved significantly from pre-operative to the time of RTS testing (p<0.0001). All patients (n=24) failed at least one component of the RTS testing (Table 1). Pre-operative Tegner scores were positively correlated with involved isokinetic external rotation symmetry (r=0.383, p<0.05) and with closed kinetic chain upper extremity stability test (CKCUEST) performance (r=0.577, p<0.005). Post-operative Tegner and ASES scores were positively correlated with involved isometric internal rotation LSI (r=0.418, p<0.05) and CKCUEST performance (r=0.383, p<0.05), respectively. Isometric External Rotation LSI was positively correlated with the Isokinetic External Rotation LSI at 180°/sec for the surgical limb (r=0.57, p<0.01).Conclusion:At 6-months postoperative, shoulder strength and stability deficits persist in the surgical limb of adolescent patients. PROMs improve significantly from pre-operative to time of RTS testing. Tegner and ASES scores may be associated with objective shoulder strength and stability measurements.Table 1.Return-to-Sport Pass Criteria and Percentage of Patients Who Passed

Preliminary Analysis of Closed Kinetic Chain Upper Extremity Stability Test Differences Between Healthy and Previously Injured/In-Pain Baseball Pitchers.

A comprehensive examination of the kinetic chain during an overhead athlete's upper extremity assessment, such as the closed kinetic chain upper extremity stability test (CKCUEST), may help clinicians identify potential upper extremity dysfunction. Body position observed on dominant and nondominant hand touch during a CKCUEST trial differs between players with previous injury/pain history compared with healthy counterparts. Descriptive laboratory study. Level 5. Seventeen baseball pitchers were recruited to participate (18.03 ± 2.01 years; 185.40 ± 6.57 cm; 83.92 ± 13.87 kg). A medical history questionnaire was used to separate participants into groups, either previous injury/pain or healthy. Kinematic and kinetic data were collected on the participants performing the CKCUEST with an electromagnetic tracking system. Kinematics were analyzed using a pair of 1-way multivariate analyses of variance (MANOVAs). The MANOVA for nondominant hand touch in the CKCUEST revealed a significant difference in lumbopelvic-hip complex (LPHC) kinematics between previously injured/pain group and healthy group (Λ = 0.37; F4,12 = 5.12; P = 0.01). The previously injured/pain group displayed less pelvic axial rotation and dominant hip abduction during the nondominant touch indicating more LPHC stability during the nondominant touch. In conclusion, differences were observed in LPHC kinematics during the CKCUEST nondominant touch between a healthy and previously injured/pain group perhaps due to the increased awareness provided through rehabilitative programs for the previously injured/pain group. Clinicians can use this information to help address kinetic chain movement efficiency within baseball pitchers. This study provides evidence of LPHC kinematic differences during the nondominant touch of baseball pitchers and may enhance the use of the CKCUEST as a return-to-play assessment.

Shoulder Strength and Upper Body Field Performance Tests in Young Female Handball and Volleyball Athletes: Are There Differences Between Sports?

Volleyball and handball players have usually been studied collectively as "overhead athletes," since throwing present similarities in the proximal to distal movement sequencing and upper limb joints ranges of motion. However, each sport presents specificities in the objectives when accelerating the ball and a variety of possible throwing techniques. Therefore, it is expected there may be differences in the shoulder and upper body physical performance between sports. The aim of this study was to determine if there are differences in shoulder muscle strength and upper body field performance tests between volleyball and handball athletes. Cross-sectional. Ninety-nine volleyball and handball female athletes aged between 13 and 20years were evaluated for isometric shoulder abductor and rotator strength (handheld dynamometer) and upper body field performance tests: Y Balance Test-Upper Quarter, modified Closed Kinetic Chain Upper-Extremity Stability Test, and unilateral and bilateral Seated Medicine Ball Throw. Handball athletes presented greater shoulder internal rotation strength (between-group difference: 2.84; effect size 0.70), higher medial (between-group difference: 9.54; effect size 0.90), superolateral (between-group differences: 8.9; effect size 0.68), and composite scores (between-group difference 5.7; effect size 0.75) of the Y Balance Test-Upper Quarter and higher unilateral (between-group difference: 41.92; effect size 0.91) and bilateral (between-group difference: 46.11; effect size 0.83) Seated Medicine Ball Throw performance. Groups were not different for Closed Kinetic Chain Upper-Extremity Stability Test, external rotation, and abduction isometric strength. Our findings suggest that young female handball athletes present greater internal rotator strength and better performance in Y Balance Test-Upper Quarter and Seated Medicine Ball Throw compared to volleyball players. These differences may be related to the different demands required in the throwing movements performed in each sport and should be considered when assessing these populations.