Nondominant Shoulder Research Articles

Reciprocal inhibition improves posterior shoulder tightness and shoulder range of motion in youth baseball players.

BackgroundThe aim of this study was to evaluate the efficacy of reciprocal inhibition for posterior shoulder tightness (PST), internal rotation at 90° abduction (ABIR) limitation, and subacromial impingement in elementary and junior high school baseball players.MethodsThe present study included 290 elementary school and junior high school baseball players who were members of an organized baseball team and attended a medical checkup in 2014. Seventeen participants were excluded because they were left-handed. We applied a sit-up exercise as a tool of reciprocal inhibition to all participants. Before and after the sit-up exercise, we evaluated the shoulder range of motion (ROM) in external rotation at 90° abduction (ABER), ABIR, and horizontal flexion (HF) in both shoulders and the prevalence of subacromial impingement in the dominant shoulder. We defined PST as a ≧15°decrease in the HF angle of the dominant shoulder in comparison to the nondominant shoulder before the sit-up exercise and divided participants into two groups (the PST group and the non-PST groups). An independent t-test was performed to compare the shoulder ROM, and a chi-squared test was performed to compare the prevalence of subacromial impingement between the two groups. A dependent t-test was performed to compare intragroup changes in the shoulder ROM. The McNemar test was performed to compare intragroup changes in the prevalence of subacromial impingement.ResultsFifty-six of 273 participants had PST in the initial examination. The initial examination revealed that the ROM of ABIR and HF in the dominant shoulder were significantly lower in the PST group than those in the non-PST group, whereas the ROM of ABER and total arc were significantly higher in the PST group. The prevalence of subacromial impingement in the PST group was significantly higher than that in the non-PST group. The sit-up exercise improved ABER, ABIR, total arc, HF, and the prevalence of subacromial impingement in both groups. However, the amount of ROM change did not differ between the two groups for any parameter with the exception of HF.ConclusionThe presence of PST affects the prevalence of subacromial impingement but was not related to the loss of ABIR or the prevalence of pathological glenohumeral internal rotation deficit. The sit-up exercise, as reciprocal inhibition, can transiently improve the prevalence of subacromial impingement via the improvement of PST.

ACUTE EFFECT OF KINESIOTAPE APPLICATION ON SHOULDER MUSCLE STRENGTH IN MALE WHEELCHAIR BASKETBALL PLAYERS

Purpose: This research aims to determine the effect of kinesiotaping application on wheelchair basketball players’ shoulders. 
 Methods: A total of twelve wheelchair basketball players from TSK Karagücü team were involved in this research. The average age of the subjects was 31.17±7.90 years and mean body mass index was 25.41±6.96 kg/cm2. Subjects were assessed before and after combined kinesiotape application on deltoideus muscle. Muscle facilitation technique was applied to deltoideus muscle. Isokinetic parameters of the subjects’ shoulder joints were measured with Cybex NORM isokinetic dynamometer. It was taken the dominant shoulders' flexion and abduction movements into consideration for the isokinetic measurements. Measurements were repeated before and after kinesiotape applications. In isokinetic measurement, 5 repetitions at 60°/sec and 10 repetitions at 180°/sec for shoulder's muscle strength were performed. Peak torques and total works were calculated. In statistical analyses of the data, SPSS for Windows 25.0 packet program was used. Wilcoxon Test was performed in the pretest and posttest comparisons. The results were evaluated in 0.05 precision. 
 Results: After the evaluation of the study, an increase of the peak torques, and total works have been found out of all the players’ dominant and non-dominant shoulders’ flexions and abductions at 60o/sec and 180o/sec in favor of the kinesiotaping application (p

Limb Dominance Effects On Seated Single Arm Shot Put Limb Symmetry Indices Following Shoulder Rehabilitation

The seated single arm shot put test (SSASPT) is one of the few upper extremity functional performance tests (UEFPT) available with good psychometric properties to assist clinicians with return to activity (RTA) decisions. Previous investigations have demonstrated SSASPT limb symmetry indices (LSI) in healthy persons to range from 103% to 111%, favoring the dominant (D) limb. Typically, most clinical RTA guidelines recommend that an injured shoulder achieve a 90-100% UEFPT LSI. To date, SSASPT LSI have not been examined in patients with shoulder pathologies. PURPOSE: To evaluate a LSI in patients being discharged from rehabilitation following shoulder injuries or surgeries. We hypothesized there would be LSI differences between the D and nondominant (ND) limbs. METHODS: Six Board Certified Clinical Specialist Physical Therapists who regularly use SSASPT as part of their RTA criteria from 6 different clinical sites provided SSASPT scores on 78 patients being discharged from rehabilitation following shoulder injury or surgery. LSI were computed from the SSASPT scores (injured/uninjured *100) and patients were grouped according to whether the involved shoulder was on the D (n = 44) or ND (n = 34) limb. An independent t-test compared LSI between the two groups while a chi square compared the number of patients in each group with LSI <90%, 90-100%, 100-110% and > 110%. RESULTS: LSI for the D shoulder group (105.0 ± 11.0%) were significantly greater (P < .001, 95% CIdiff = 10.8 to 21.2%) than the ND group (89.0 ± 12.1%). Significant group differences (P < .001) were also revealed in the LSI intervals. While 55.9% of the ND shoulder patients demonstrated LSI <90%, 77.3% of D shoulder patients demonstrated LSI >100%. CONCLUSIONS: The results supported our hypothesis. Based on the significant limb LSI differences, we recommend when establishing RTA criteria for the SSASPT following shoulder injury or surgery, the D versus ND limb be considered. Specifically, the D limb should strive to be ~105%, whereas the ND limb should be ~100%. The results also indicate the ND arm may require more rehabilitation because many ND injured patients demonstrated LSI <90%. There is a need for more research to confirm the results of this study, as well as consider other RTA metrics.

Normal Baseline Values for Isometric Shoulder Strength in Scaption for Healthy Filipino Individuals in the 20-30 year Age Group.

Introduction:Isometric shoulder strength is vital in the management of individuals suffering from shoulder diseases such as rotator cuff tears. Normal values for the working Filipino population who are at risk of developing shoulder problems are lacking. The objective of this study was to determine the isometric baseline isometric shoulder strengths in scaption of healthy Filipino individuals aged 20-30 years old without a history of a shoulder injury.Material and Methods:This is a cross-sectional descriptive study measuring the isometric strength values using the handheld IDO isometer of dominant and non-dominant shoulder of healthy Filipino individuals aged 20 to 30 years old.Results:There is no significant difference in the mean isometric shoulder strength between the dominant and non-dominant arm for both sexes. The male gender scored higher values compared to the female gender and is statistically significant.Conclusion:There is no difference in isometric shoulder strength between the dominant and non-dominant shoulder. Strength differences favour the male gender.

The Relationship between Clinical Tests, Ultrasound Findings and Selected Field-Based Wheelchair Skills Tests in a Cohort of Quadriplegic Wheelchair Rugby Athletes: A Pilot Study

Manual wheelchair use may determine shoulder joint overload and rotator cuff injury. Chronic shoulder pathologies can also influence the propulsion ability of wheelchair athletes with spinal cord injury (SCI) during sport activities. However, the relationship between shoulder pathology and wheelchair performances has never been explored. Therefore, the study aimed to investigate the correlation between shoulder pathologic findings with clinical tests and ultrasonography evaluation and the results of wheelchair performance tests. Nineteen quadriplegic wheelchair rugby players were evaluated to investigate the association between clinical and ultrasound shoulder pathologic findings and their correlation with the performance of field-based selected wheelchair skills tests (WSTs). The outcome measures were the International Wheelchair Rugby Classification Score, dominant and non-dominant Physical Examination Shoulder Score, and dominant and non-dominant Ultrasound Shoulder Pathology Rating Scale (USPRS). The WST was measured at the beginning and at one-year follow-up. A statistically significant correlation was found between the time since SCI and dominant USPRS (p &lt; 0.005). The non-dominant USPRS was strongly related to WST at the beginning (p &lt; 0.005) and the end of the study (p &lt; 0.05). Data suggest that the severity of the non-dominant shoulder pathology detected on the ultrasound is related to lower performance on the WST. Chronic manual wheelchair use could be responsible for dominant SCI shoulder joint and rotator cuff muscle damage, while non-dominant USPRS could be related to performance on the WST.

Analysis of factors related to shoulder instability in young handball players

Introduction The shoulder of handball players suffers from the ongoing repetition of movement that may lead to the development of joint instability and modification of proprioceptive condition [1]. Because the articular components of the shoulder joint are considered to have extreme importance on the static and dynamic stabilisation and quality of proprioceptive information, they may compromise the athlete’s performance [2]. The purpose of our study was to verify if shoulder strength parameters (SSP) and joint position sense (JPS) of shoulder internal and external rotation may contribute to the development of shoulder instability in handball players. Materials and methods A cross-sectional design was implemented. The sample was composed by eleven handball players of both genders (4 females and 7 males), under 18 years of age, that practiced the sport for at least 3 years. For the data collection, an isokinetic dynamometer (Biodex System 3) was used. The evaluation of SSP was implemented prior to JPS at a speed of 60°|sec (3 reps) and 180°|sec (20 reps) of internal rotation (IR) and external rotation (ER), with the shoulder positioned at 90° of abduction. The JPS was evaluated using active and passive positioning, 6 repetitions each, at 3 given external shoulder rotation amplitudes (20, 35 and 75 degrees). Prior to the data collection, all subjects signed an informed consent. This study follows all the principles of the Declaration of Helsinki. Results For the dominant shoulder, the peak torque (PT) at 60°|sec was 41.4 Nm (±12.2) of ER and 40,6 Nm (±17.5) in IR. For the non-dominant shoulder at 60°|sec, the PT was 34.3 Nm (±10.7) of ER and 42.0 Nm (±2.8) in IR. For the dominant shoulder, the PT at 180°|sec was 37.2 Nm (±12.2) of ER and 37.9 Nm (±15.0) in IR. At the non-dominant shoulder, the PT at 180°|secr was 29.8 Nm (±10.8) of ER and 37.2 Nm (±11.6) in IR. At 60°|sec, the range of motion (ROM) was of 89.6° (±3.2) and at 180°|sec, 88.8° (±0.6). On the dominant shoulder, for the passive positioning, a difference was obtained of 6.7° (±5.8) at 75°, of 1.7° (±2.4) at 35°, and of 0° (±2.3°) at 20°. In the active positioning, a difference was obtained of 1.3° (±3.1) at 75°, of 1.0° (±3.6) at 35°, and 1.2° (±2.7) at 20°. On the non-dominant shoulder, we observed the following results, in the passive positioning, 4.7° (±3.7) at 75°, 1.3° (± 4.1) at 35°, and 0.7° (±3.5) at 20°. Finally, in the active positioning we obtained the following results: 0.5 ± 3.4 (75°), 0.7 ± 2.0 (35°) and 2.7 ± 2.4 (20°). Discussion and conclusions Our preliminary results seem to point out that the dominant shoulder improved JPS when compared to the non-dominant. Additionally, we found that during the active positioning athletes had a greater perception of JPS, in comparison to the passive positioning. These results should help on the development of training protocols in handball, to improve shoulder proprioception and help to reduce the risk of injury. Although the results on SSP were not statistically treated, throughout the study protocol the PT seems to decrease significantly. Further studies should help to confirm our results.

Shoulder Rotational Strength Profiles of Danish National Level Badminton Players.

BackgroundIncreased age has been shown to be associated with weaker external rotators and stronger internal rotators of the shoulder in pitchers and tennis players. Whether this age-associated change is present in elite badminton players is unknown.PurposeTo compare the internal and external rotation strength of the shoulder in adolescent and adult elite badminton players.Study designCross-sectional.MethodsThirty-one adolescent (12 females aged 16.8 ± 1.6 years and 19 males aged 17.1 ± 1.6 years) and 29 adult (10 females aged 25 ± 2.9 years and 19 males aged 26.2 ± 4.6 years) national level badminton players were tested pre-seasonally for external rotation (ER) and internal rotation (IR) isometric muscle strength bilaterally, using a hand-held dynamometer. Within-group ER to IR strength ratios were calculated (ER/IR×100%).ResultsThe adolescents had stronger shoulder ER than the adults on both sides (p < 0.05). The adult males tended to have stronger IR of the dominant shoulder than the adolescent males (p = 0.071). In the dominant shoulders, the strength ratios for adult females and males were 77% and 78%, respectively, while the same ratio for adolescent females and males were 85% and 99%, respectively. In the non-dominant shoulders, the ER/IR strength ratios for adult females and males were 90% and 87%, respectively, while the ratios for adolescent females and males were 116% and 102%, respectively.ConclusionThis study is the first to demonstrate that in shoulder injury-free national team badminton players, adolescents have stronger shoulder ER than adults on both sides. Therefore, increased age appears to be associated with weaker shoulder ER muscles in elite badminton players.Level of evidence3b.

Shoulder Rotation Range of Motion and Serve Speed in Adolescent Male Volleyball Athletes: A Cross-Sectional Study.

BackgroundThrowing athletes present alterations in shoulder rotation range of motion (ROM), but not much is known about the relationship between these alterations and performance measurements in volleyball practitioners.PurposeTo compare the passive ranges of motion of internal rotation (IR), external rotation (ER), and total rotation motion (TRM) of the shoulder in dominant and nondominant limbs of young volleyball athletes and to investigate their relationship with ball speed during serves with and without precision (inside and outside court, respectively). The possible association of anthropometrics and competitive practice time with these velocities was also investigated.Study DesignCross-sectional study.MethodsFifty-seven male volleyball athletes (mean age 17.11 ± 1.88 y; weight 74.68 ± 9.7 kg; height 1.87 ± 0.09 cm) were evaluated for shoulder IR and ER with a bubble goniometer and serve speed inside and outside court was measured with a radar gun. Simple and multiple regression analyses were applied to investigate associations of ROM, anthropometrics, and competitive practice time with serve speed.ResultsDominant shoulders had diminished IR ROM compared to nondominant shoulders (59.1º ± 16.7º vs 66.4º ± 16.9º; p < 0.001) as well as diminished TRM (173.5º ± 31.8º vs 179.1º ± 29.9º; p < 0.001). Simple regression showed negative association between dominant ER and serve speed outside the court (p = 0.004). Positive associations existed between age and serve speed in both conditions (p < 0.001), BMI and speed inside (p = 0.009) and outside the court (p = 0.008), and between competitive practice time and speed inside (p = 0.008) and outside court (p = 0.003). However, multiple analysis confirmed only age (p < 0.001) and BMI to be associated with ball velocities (inside court p = 0.034; outside court p = 0.031).ConclusionThe results of this study demonstrated that young volleyball athletes presented lower IR and TRM of the shoulder in the dominant upper limb. Age and BMI were directly associated with ball velocities when serving. Passive rotation ROM did not have a relationship with this performance measurement.Level of Evidence3b

Relationship Between Clinical Scapular Assessment and Scapula Resting Position, Shoulder Strength, and Baseball Pitching Kinematics and Kinetics.

Background:Scapular assessment is important in examining overhead athletes, but there is inconsistency in scapular clinical assessment and its relation to pathology.Purpose:To determine the relationship between clinical scapular assessment and biomechanical scapula resting position, shoulder strength, and pitching shoulder kinematics and kinetics.Study Design:Descriptive laboratory study.Methods:Two clinicians performed scapular assessments and graded the scapula as presence or absence of scapular dyskinesis. Shoulder external rotation (ER) and internal rotation (IR) strength were collected. The 3-dimensional biomechanics of the scapula resting position (upward/downward rotation, IR/ER, and anterior/posterior tilt) were assessed while participants stood at rest, and pitching kinematics (maximum shoulder ER, shoulder abduction, shoulder horizontal abduction, shoulder rotation velocity) and kinetics (maximum shoulder distraction force) were assessed when participants pitched off the portable pitching mound that was engineered to meet major league specifications.Results:A total of 33 high school baseball pitchers (age, 16.3 ± 1.2 years; height, 184.0 ± 6.9 cm; weight, 76.8 ± 20.8 kg; hand dominance: left, 9 [27%]; right, 24 [73%]; pitch velocity, 34.7 ± 2.3 m/s) participated in this study. Of them, 15 participants had scapular dyskinesis, and 18 had normal scapulothoracic rhythm. No differences were observed for upward/downward rotation or anterior/posterior tilt, shoulder ER, shoulder abduction, or shoulder distraction force, based on the presence of scapular dyskinesis. Pitchers with scapular dyskinesis demonstrated significantly greater scapular resting IR position (effect size [ES], 0.80; 95% CI, 0.06 to 1.54; P = .020), greater nondominant shoulder ER to IR strength ratio (ES, 0.49; 95% CI, –0.02 to 1.00; P = .018), and decreased shoulder rotation velocity (ES, 14.66; 95% CI: 12.06 to 17.25; P = .016). Pitchers with greater anterior tilt demonstrated greater shoulder rotation velocity (r = –0.48; P = .006).Conclusion:Pitchers with scapular dyskinesis had greater scapular IR, greater nondominant shoulder ER to IR strength ratio, and reduced shoulder rotation velocity.Clinical Relevance:Scapular assessment may be more influenced by differential IR than upward rotation or anterior tilt. Scapular dyskinesis has no competitive performance advantage among amateur athletes. Greater understanding is needed to decipher the critical threshold between beneficial and maladaptive scapular movement patterns.

Primary Synovial Chondromatosis of the Shoulder

A 35-year-old man was referred to physical therapy with nondominant right shoulder pain. Due to chronicity of symptoms and impairment of strength and mobility, the physical therapist ordered radiographs. An orthopaedic consultation was initiated, and the patient was diagnosed with primary synovial chondromatosis. Magnetic resonance imaging was ordered in preparation for surgery. JOSPT Cases 2021;1(1):40–41. doi:10.2519/josptcases.2021.9733

The Effect of a Corrective Exercise Program Based on Scapula Stability on Scapular Upward Rotation and Scapulohumeral Rhythm in Wheelchair Basketball Athletes With Bilateral Scapula Rotational Syndrome

Objective The present study aimed to investigate the effect of scapular stability-based corrective exercise program on scapular upward rotation and scapulohumeral rhythm in Wheelchair Basketball (WB) players with bilateral scapular downward rotation syndrome. Materials &amp; Methods: According to the research conditions, 24 wheelchair basketball athletes with spinal cord injury voluntarily participated in this study. Initially, eight players were selected from each sport class (1 to 1.5 class, 2 to 2.5 class, and 3 to 4.5 class). Then, four subjects in each group were randomly assigned to each group (12 control subjects with Mean±SD age of 43.23±11.0 years and 12 experimental subjects with Mean±SD age of 39.08±5.08 years). Thus, the control and experimental groups were present in an equal number of three sport classes. WB athletes were professional players in Mashhad City league, Iran. The participants were classified according to the Classification Committee of the IWBF, as well as the corresponding national classification from the Islamic Republic of Iran Sports Federation for the Disabled (IRISFD). Two digital inclinometers were used to measure the humeral range of motion and scapular upward rotation and scapulohumeral rhythm in resting position, 45°, 90°, and 135° shoulder abduction in scaption plane. The exercise group performed scapular stability-based corrective exercises based on the Gym training principles and following ACSM guidelines for eight weeks. The independent t-test, analysis of variance, and analysis of covariance were used for statistical analysis at the significant level of less or equal to 0.05. Results: The results showed no significant asymmetry between dominant and non-dominant shoulders in the scapula’s upward rotation at different angles of shoulder abduction. Contrary to the non-dominant shoulder, the dominant shoulder’s scapula had a less downward rotation at the resting position and a higher upward rotation at 45° of shoulder abduction. Also, in 45° humeral abduction, the dominant shoulder has a less scapulohumeral rhythm ratio than the non-dominant shoulder. WB athletes’ dominant shoulders in lower classes (2-2.5 and 3-4.5) have less scapular downward rotation in scapular resting position and more scapular upward rotation in 45°, 90° 135° humeral abduction. There was no significant difference in scapulohumeral rhythm ratio between WB players with different classes. Scapular upward rotation increased significantly after eight weeks of scapular stability-based corrective exercise program (P≤0.05). Also, a significant decrease in the scapular upward rotation was observed at post-program in resting position (P=0.001) and significantly increased in 45° (P=0.01), 90° (P=0.001), and 135° (P=0.001) humeral abduction compared with pre-program in dominant and non-dominant shoulders. However, the ratio of scapulohumeral rhythm in the dominant shoulder did not improve significantly, and the ratio of scapulohumeral rhythm in the non-dominant shoulder improved at 90° and 135°. Conclusion: Scapular stability-based corrective exercises can be used as one of the training methods to restore muscle balance, prevent and correct scapular upward rotation and scapulohumeral rhythm in wheelchair basketball athletes. Therapists should know that some degrees of scapular upward rotation and scapulohumeral rhythm asymmetry may be common in WB players. This asymmetry should not always be considered a pathological symptom but may be an adaptation to exercise training and frequent use of the upper extremity.

INFLUENCE OF LIMB DOMINANCE AND SHOULDER INJURY ON STRENGTH AND EXPLOSIVE FORCE IN US MARINES.

The specialized roles of many military personnel require specific skills and high physical demands, placing unique stresses on the shoulders and increasing risk of injury. As normal dominant/nondominant shoulder asymmetries have been established in military personnel, bilateral strength comparisons must be understood in context of daily physical demands to monitor patients' progress or readiness to return to duty. This study aims to assess bilateral differences in strength and explosive force in United States Marines with a history of dominant or nondominant shoulder pathology. Cross-Sectional. A total of 52 full-duty, male US Marines with a shoulder injury within the prior year participated. Bilateral isokinetic shoulder internal (IR) and external (ER) rotation strength, and peak force (Peak Force) and average rate of force production (Avg Rate) during an explosive push-up were collected. Dominant versus nondominant side data were independently examined within each group (DOM: dominant injury, NOND: nondominant injury). Comparison between DOM and NOND, as well as previously published CON (no history of shoulder injury) was also completed. NOND (n = 26) demonstrated significantly less IR (p < 0.001) and ER (p = 0.003) strength and Peak Force (p = 0.001) and Avg Rate (p = 0.047) on the injured side, while DOM (n = 26) demonstrated no bilateral differences in strength or push-up performance. Comparison between the three groups showed that NOND demonstrated significantly less ER strength than CON (p = 0.022). Military personnel demonstrate asymmetric strength patterns likely due to increased demand of the dominant shoulder. US Marines with a history of injury to the nondominant shoulder performed differently than those with a dominant side injury, presenting with both strength and push-up asymmetries. They also demonstrated significant ER strength deficits compared to CON. Common clinical practice and previous literature often compare injured and uninjured limbs or injured individuals to healthy controls, but further distinction of dominant or nondominant side may provide more accurate information needed to develop targeted treatment strategies. Recognizing unique occupational demands and how patients may present differently with dominant versus nondominant side shoulder injuries are important considerations for ensuring accurate assessment and effective individualized rehabilitation. 3.

ASSESSMENT OF HUMERAL TORSION BY PALPATION IN BASEBALL PITCHERS: A VALIDATION STUDY.

Greater humeral retroversion has been associated with shoulder and elbow injuries. Methods for measuring torsion include radiography, computed tomography (CT) and sonography (US) which may be costly or unavailable. A palpation method might be a reliable alternative to imaging techniques. The purpose of the current study was to examine the construct validity of the palpation technique for humeral torsion by (1) determining if a side-to-side difference in humeral torsion (HT) could be detected in a cohort of baseball pitchers using the palpation technique and (2) compare the side-to-side difference in HT obtained through the palpation method to the US method. Clinical assessment of HT by palpation is reliable and is as accurate as sonographic HT measurements among overhead athletes. Twenty collegiate and high school pitchers were assessed. Bilateral shoulder passive external rotation (ER) and internal rotation (IR) range of motion were measured. Humeral torsion was indirectly measured using sonographic and palpatory methods. Paired t-tests were used to determine HT side-to-side difference measured by US versus palpation. Pearson's correlation coefficient (r) was used to determine the relationship between HT side-to-side difference detected by palpation and US, and relationships among IR and ER of the shoulder and HT side to-side difference measurements. There was significantly greater HT in dominant versus nondominant arm assessed by both palpation (5°±5, p=0.0004) and ultrasound (9°±11, p=0.0007). There was a positive correlation between both methods of HT measurement (r = 0.522, p=0.018). Palpation significantly underestimated HT as compared to US measurements (difference 4°±9, p=0.048). Difference in IR between shoulders correlated with HT measured by palpation (r=-0.651, p=0.002) and US (r=0.569, p=0.009). Increased ER in the dominant versus nondominant arm correlated with the side-to-side difference in HT measured by both palpation (r = 0.509, p=0.02) and US (r = 0.602, p=0.005). Greater HT on the dominant versus nondominant shoulder via palpation indicated this method can be used to assess HT in pitchers. HT assessed by palpation correlated with HT assessed by US. However, the magnitude of side-to-side difference in HT was smaller with palpation compared to US, and the two techniques should not be used interchangeably. Nevertheless, assessment of HT via palpation is a reliable and practical method and its use should be encouraged. Level 3, measurement study.

Effect of Fascial Manipulation on Glenohumeral Internal Rotation Deficit in Overhead Athletes - A Randomized Controlled Trial

Background. Glenohumeral Internal Rotation Deficit (GIRD) is common among overhead athletes and is considered as one of the risk factors for upper extremity injuries.GIRD is usually managed by stretching and soft tissue release of the posterior shoulder capsule. Fascial manipulation is a manual therapy technique used in the management of musculoskeletal disorders. This study compared the efficacy of fascial manipulation (FM)with posterior capsular ball release and stretching on GIRD.Purpose. The purpose of this study is to determine the effect of Fascial Manipulation (FM) on the Internal Rotation Range of Motion (IRROM) in athletes with GIRD. Since studies have shown a possible association between GIRD and shoulder injuries, improving the IRROM in athletes with GIRD may help in reducing the risk of shoulder injuries. Thus,FM may be used as an effective strategy in increasing IRROM in overhead athletes with GIRD, thus preventing upper extremity injuries.Study Design. Randomized controlled trial.Methods. Asymptomatic overhead athletes with GIRD more than 20° when compared with the non-dominant shoulder were randomly assigned to two groups. The experimental group has received three sessions of FM treatment in two weeks. FM applied to densified Centre of Coordination (CC) points located on the myofascial sequences for 5 to 8 minutes at each CC point. The control group has received three sessions of posterior shoulder capsule release using a tennis ball under supervision. Along with the ball release, the therapist taught home-based, unsupervised sleeper, and cross-body adduction stretches, for the control group. A universal goniometer was used to measure the IRROM before and after all three treatment sessions in both groups. Results. There were no statistically significant differences between the control and experimental groups (p< 0.05). However, immediate improvement in the IRROM following FM was more substantial in the experimental group following each session.Conclusions. This study indicates that FM may be used as an adjunct to stretching in asymptomatic participants with GIRD to increase the IRROM. There is a scope for future studies to be done to investigate the effect of FM on symptomatic overhead athletes with GIRD

Ultrasonographic evaluation of shoulder tendons in patients with Hashimoto's disease.

To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD). Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured. Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P=.839, P=.205, P=.374, P=.430 and P=.497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P=.003, P=.030, P<.001; P=.035, P=.042, P<.001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P=.025; P=.046, P=.017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P<.05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r=.272 P=.030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD. This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.

국궁 활쏘기 동작에서의 체중이동과 수행속도, 관절 근력의 관련성

The changes of kinematic factors during archery shooting motion are still unknown in Korean traditional archery. This study investigated to evaluate of kinematic factors and each joint muscle strength during archery shooting motion in Korean traditional archers. Ten men Korean traditional archers were divided into two groups according to the shooting stance; parallel stance group (PSG, n=5) and oblique stance group (OSG, n=5). The 3-phase time of PSG was significantly longer than that of OSG during shooting motion (p.01). On the other hand, there was no difference between the two groups in body weight movement measured by ground reaction force (NS). In the comparison of joint muscle strengths, dominant arm (draw arm) had significantly higher means in total upper limb muscle (TULS) with shoulder flexion+extension (SFES), shoulder external+internal rotation (SERIRS), total shoulder (TSS), wrist flexion+extension strength (WFES) than non-dominant arm(bow arm), respectively (p.05, p.001). As for the correlation between each variable, significant negative correlation was found between highest score and dominant body weight movement in the 3-phase time (p.01). However, significant correlation was found among bowstring tension and average hand grip strength, non-dominant hand grip (NDhand grip), wrist extension (NWES), and shoulder external rotation strength (NSERS), respectively (p.01). These results suggest that the muscular strength of joints in the dominant arms is an important factor for Korean traditional archery, and the parallel stance is might more advantageous to shoot than oblique stance.

Effect of a 12-Week Rehabilitation Exercise Program on Shoulder Proprioception, Instability and Pain in Baseball Players with Shoulder Instability.

Background:The shoulder joint has a wide range of motion, but is vulnerable to sport-related injuries. We aimed to evaluate the differences in the proprioception of the shoulder should instability, and shoulder pain in high school baseball players with shoulder instability following a 12-week rehabilitation exercise program.Methods:We enrolled 13 baseball players with shoulder instability who visited the Orthopedics Department at Konkook University Hospital in Seoul, South Korea and 12 controls without shoulder instability. We examined the dominant shoulder and the non-dominant shoulder for both groups. We restricted participation to individuals who had no other orthomechanical disease in the past six months, except for instability of the shoulder, and no physical limitation to participate in the exercise. We measured the proprioception of the shoulder and shoulder instability, and we also evaluated pain with the Visual Analog Scale before and after the rehabilitation program. To verify the differences between groups, we used a two-way analysis of variance, and a two-way analysis of covariance was used when a significant difference was found at the pretest (baseline between groups).Results:Proprioception was associated with shoulder instability. The Visual Analog Scale rating improved in the dominant shoulder with instability; and a positive change was found in the dominant shoulder without instability after the rehabilitation program (P < 0.05).Conclusion:The 12-week rehabilitation exercise program might improve the proprioception and pain of patients with shoulder instability. However, further studies with more participants and a rehabilitation exercise program should be undertaken.

What's Important: What I Learned as My Spouse's "Recovery Partner" Following Rotator Cuff Surgery.

What's Important: What I Learned as My Spouse's "Recovery Partner" Following Rotator Cuff Surgery.

Relationship Between Seated Single Arm Shot Put And Isokinetic Shoulder Flexion And Elbow Extension Strength

PURPOSE: Previous studies have demonstrated a strong correlation between isokinetic pushing force and seated single-arm shot-put (SSASP) test performance. However, there is limited research on the contribution of shoulder flexion and elbow extension strength on SSASP test outcomes. Therefore, the purpose of this study was to examine the relationship between isokinetic shoulder flexion and elbow extension strength and SSASP test performance and compare limb symmetry indexes (LSI) between the two tests. METHODS: Healthy, physically active men (n=16, ages=21-34 yrs) and women (n=15, age=18-29 yrs) performed dominant (DOM) and nondominant (NDOM) shoulder flexion and elbow extension isokinetic tests (System 4, Biodex, Shirley, NY) at 60°/s (5 repetitions) and 180°/s (10 repetitions) to determine peak torque production. The average horizontal range from three SSASP (2.0kg ball) trials were computed separately for each limb. In addition to conducting correlational analyses between the peak torques and SSASP distances, the differences in LSI computed between each of the peak torques and SSASP distances were statistically compared at each velocity by joint analysis of variance. RESULTS: Significant (P<.001) relationships were revealed between DOM and NDOM SSASP performance and shoulder (r=.819 to .853) and elbow (r=.803 to .820) peak torques at both velocities. LSI for the SSASP (104.4±7.1%) were similar to the isokinetic LSI at both 60°/s (Elbow: 101.3±10.2%, Shoulder: 102.2±13.8%) and 180°/s (Elbow: 100.4±9.7%, Shoulder: 103.5±12.8%), with no statistically significant differences (P=.364 to .844, η2p=.001 to .028). CONCLUSIONS: Results demonstrate shoulder and elbow isokinetic torques are strongly associated with SSASP distances. Moreover, LSI for both tests were not significantly different from each other, thereby supporting the utilization of the SSASP for making bilateral comparisons in healthy individuals.

Relationship between humeral retroversion and baseball positions during elementary and junior-high school

Humeral retroversion is greater in the dominant shoulder than in the nondominant shoulder in baseball players. However, the effect of different baseball positions during childhood on humeral retroversion remains unknown. The purpose of this study was to investigate the following: (1) the relationship between humeral retroversion and baseball positions played during elementary and junior-high schools; (2) the association between humeral retroversion and the prevalence of pain during the medical checkup and self-reported history of injuries in the dominant shoulder or elbow. We enrolled 149 male high-school baseball players who started playing baseball in elementary school. The subjects were classified into 3 groups according to their baseball positions in elementary and junior-high schools. All participants completed questionnaires regarding their current and past positions, current incidence and history of injuries in their shoulder or elbow joints, and the age they started playing baseball. Shoulder range of motion, humeral retroversion on ultrasonographic-assisted measurement, and the association between humeral retroversion and shoulder and elbow pain were evaluated. Humeral retroversion was significantly greater in the dominant shoulder than in the nondominant shoulder in all groups (P < .001). In addition, humeral retroversion in the dominant shoulder was significantly greater in players who were pitchers in both elementary and junior-high schools than in those who were fielders during both periods (96.2° and 89.4°, respectively; P = .02). Humeral retroversion in the dominant shoulder was positively correlated (P = .005, r = 0.23) with the length of career as a pitcher during elementary and junior-high schools. Humeral retroversion was not correlated with the prevalence of pain during the medical checkup or self-reported history of injuries in the dominant shoulder or elbow (P values ranging from 0.09-0.99). These results suggest that playing baseball as a pitcher during elementary school and junior-high school affects the increase in humeral retroversion in the dominant shoulder. Increased humeral retroversion in the dominant shoulder by repetitive throwing motion is an adaptive change, rather than a pathologic change.