Overuse Shoulder Injuries Research Articles

Increased humeral retrotorsion is not a risk factor for overuse injury of the throwing shoulder in elite youth handball athletes

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

Differences in Glenohumeral Joint Contact Forces Between Recovery Hand Patterns During Wheelchair Propulsion With and Without Shoulder Muscle Weakness: A Simulation Study.

The majority of manual wheelchair users (MWCU) develop shoulder pain or injuries, which is often caused by impingement. Because propulsion mechanics are influenced by the recovery hand pattern used, the pattern may affect shoulder loading and susceptibility to injury. Shoulder muscle weakness is also correlated with shoulder pain, but how shoulder loading changes with specific muscle group weakness is unknown. Musculoskeletal modeling and simulation were used to compare glenohumeral joint contact forces (GJCFs) across hand patterns and determine how GJCFs vary when primary shoulder muscle groups are weakened. Experimental data were analyzed to classify individuals into four hand pattern groups. A representative musculoskeletal model was then developed for each group and simulations generated to portray baseline strength and six muscle weakness conditions. Three-dimensional GJCF peaks and impulses were compared across hand patterns and muscle weakness conditions. The semicircular pattern consistently had lower shear (anterior-posterior and superior-inferior) GJCFs compared to other patterns. The double-loop pattern had the highest superior GJCFs, while the single-loop pattern had the highest anterior and posterior GJCFs. These results suggest that using the semicircular pattern may be less susceptible to shoulder injuries such as subacromial impingement. Weakening the internal rotators and external rotators resulted in the greatest increases in shear GJCFs and decreases in compressive GJCF, likely due to decreased force from rotator cuff muscles. These findings suggest that strengthening specific muscle groups, especially the rotator cuff, is critical for decreasing the risk of shoulder overuse injuries.

Prevalence of Shoulder and Elbow Overuse Injuries Among Competitive Overhead Youth Athletes in Singapore.

There is a dearth of information related to shoulder and elbow overuse injuries in Asian overhead youth athletes. To determine the prevalence and severity of shoulder and elbow overuse injuries, as well as their associated factors, among competitive overhead youth athletes in Singapore. Descriptive epidemiology study. Participants completed a survey consisting of 4 multiple-choice questions and 1 open-ended question. Data on sex, age, playing experience, and weekly training hours were also collected. Separate injury severity scores (range, 0-100, with higher scores indicating greater severity) for the shoulder and elbow were tabulated from the responses to the multiple-choice questions. The association between participant characteristics and presence of shoulder and elbow overuse injuries was determined using the chi-square test. Crude odds ratios (ORs) and 95% CIs were also calculated. 532 overhead youth athletes (age, 12-18 years) responded, of which 434 responses were included for analysis. Badminton, cricket, softball, swimming, and volleyball were some of the sports studied. The prevalence of shoulder and elbow overuse injuries was 31.3% and 9.2%, respectively. The respective severity scores were 30.4 ± 14.4 and 38.4 ± 22.4. Age was associated with the presence of both shoulder (P = .016) and elbow (P = .037) overuse injuries. Years of experience was associated with the presence of substantial elbow injuries (P = .049). Weekly training hours was associated with the presence of shoulder (P = .016) and substantial shoulder (P = .020) injuries. Being older (15-18 years) increased the odds of shoulder (OR, 1.65; 95% CI, 1.10-2.49) and elbow (OR, 2.04; 95% CI, 1.03-4.01) overuse injuries. Having >8 years of experience increased the odds of substantial shoulder (OR, 2.71; 95% CI, 1.01-7.29) and substantial elbow (OR, 3.92; 95% CI, 1.01-15.24) overuse injuries. Training >11 hours per week increased the odds of shoulder overuse injuries (OR, 2.64; 95% CI, 1.31-5.30). Shoulder overuse injuries were more prevalent, but elbow injuries tended to be of greater severity among competitive overhead youth athletes in Singapore. Coaches working with older and experienced youth athletes, especially those training >11 hours per week, should be cognizant of the risk of shoulder and elbow overuse injuries.

Evaluation of a spring-loaded upper-limb exoskeleton in cleaning activities

In the past few years, companies have started considering the adoption of upper-limb occupational exoskeletons as a solution to reduce the health and cost issues associated with work-related shoulder overuse injuries. Most of the previous research studies have evaluated the efficacy of these devices in laboratories by measuring the reduction in muscle exertion resulting from device use in stereotyped tasks and controlled conditions. However, to date, uncertainties exist about generalizing laboratory results to more realistic conditions of use. The current study aims to investigate the in-field efficacy (through electromyography and perceived exertion), usability, and acceptance of a commercial spring-loaded upper-limb exoskeleton in cleaning job activities. The operators were required to maintain prolonged overhead postures while holding and moving a pole equipped with tools for window and ceiling cleaning. Compared to the normal working condition, the exoskeleton significantly reduced the total shoulder muscle activity (∼17%), the activity of the anterior deltoid (∼26%), medial deltoid (∼28%), and upper trapezius (∼24%). With the exoskeleton, the operators perceived reduced global effort (∼17%) as well as a reduced local effort in the shoulder (∼18%), arm (∼22%), upper back (∼14%), and lower back (∼16%). The beneficial effect of the exoskeleton and its suitability in cleaning settings are corroborated by the acceptance and usability scores assigned by operators, which averaged ∼5.5 out of 7 points. To the authors' knowledge, this study is the first to present an experience of exoskeleton use in cleaning contexts. The outcomes of this research invite further studies to test occupational exoskeletons in various realistic applications to foster scientific-grounded ergonomic evaluations and encourage the informed adoption of the technology.

Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study.

ObjectivesOur primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.MethodsA cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).ResultsThe adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36–2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74–8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.ConclusionsOur results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

The Prevalence of Shoulder Disorders among Professional Bullfighters: A Cross-Sectional Ultrasonography Study.

We aimed to investigate clinical and ultrasound signs of shoulder overuse injuries in professional bullfighters; side-to-side differences (dominant vs. non-dominant); and to determine potential differences according to bullfighters’ categories. An observational cross-sectional study was conducted. Thirty professional and active bullfighters were assessed. A bilateral ultrasound assessment of the subacromial bursa, long biceps head tendon (LHBT), and rotator cuff was performed to determine the presence of bursitis, subluxation, partial or total tendon rupture, tenosynovitis, or calcification. Supraspinatus tendon thickness was measured. Finally, a battery of clinical orthopedic tests (Yergason, Jobe, infraspinatus, Gerber, and bursa tests) were also performed. Most identified ultrasound findings were located in the dominant side, being the presence of bursitis (n = 9; 30%), LHBT tenosynovitis (n = 8; 26.7%), and subscapularis tendon calcification (n = 5; 16.7%) the most prevalent. No side-to-side or between-categories differences were found for supraspinatus tendon thickness (all, p > 0.05). The most frequent positive signs were the infraspinatus test (40.0%), Gerber lift-off test (33.3%), and bursitis, Jobe, and Yergason tests (all, 26.7%). Ultrasound signs were commonly found at LHBT, subacromial bursa, and rotator cuff in professional bullfighters without difference between categories and sides. No side-to-side or between-categories differences were found. Positive clinical test signs suggestive of bursitis, LHBT, and rotator cuff tendinopathy were frequently observed.

Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes

ObjectivesHandball is associated with a high risk of overuse shoulder injury. This study investigated if an injury prevention programme effectively reduces overuse injury to the throwing shoulder of handball athletes.Methods61...

Analysis of common shoulder injuries in collegiate baseball players

ABSTRACT Objectives: Baseball players are highly susceptible to shoulder injuries due to repetitive overhead throwing. The purpose of this study was to investigate men’s collegiate baseball shoulder injury rates and associated risk factors. Methods: Using the NCAA Injury Surveillance Program (ISP) database, shoulder injury data for men’s baseball players was analyzed from 2009-2010 through 2013–2014. Only the most common shoulder injuries were examined, including acromioclavicular (AC) sprain, anterior dislocation, biceps tear, biceps tendinitis, SLAP (superior labrum from anterior to posterior) tear, non-SLAP labral tear, rotator cuff tear, rotator cuff tendinitis, and shoulder impingement. Statistical analysis was performed using proportion ratios (PR). Statistical significance was initially defined as p < 0.05; a post-hoc Bonferroni adjustment was applied using a p < 0.005 threshold balancing the likelihood of false positive and false negative findings. Results: Overall, 138 shoulder injuries were identified of which 51.4% occurred during practice. Rotator cuff pathology represented 45.6% of all injuries, with rotator cuff tears significantly more likely to be season-ending injuries (PR 2.5, 95% CI 1.2–5.6, p = 0.019). Pitching or throwing was the mechanism of injury in 100% of players with rotator cuff tendonitis, 87.5% of SLAP tears, 70% of players with biceps tendinitis, and 67% of players with rotator cuff tears. Biceps tendinitis (PR 3.9, 95% CI 1.2–12.5, p = 0.024) and SLAP tears (PR 6.4, 95% CI 1.6–25.0, p = 0.008) were significantly more likely to be chronic. SLAP tears were significantly more likely to be recurrent (PR 5.5, 95% CI = 1.5–20.4, p = 0.010). Being a freshman or sophomore was significantly associated with a lower proportion of biceps tendinitis (PR = 0.2, 95% CI = 0.04–0.8, p = 0.028). All anterior shoulder dislocations occurred while running the bases or sliding, and AC sprains were significantly associated with contact (PR 20.6, 95% CI = 2.5–168.7, p = 0.0048). Conclusions: Repetitive overhead throwing in college baseball is a common cause of overuse shoulder injuries. These athletes are especially susceptible to rotator cuff pathology, which is significantly more likely to cause season-ending injuries. While we have to interpret these results in light of both adjusted and unadjusted p-values, this information signifies the importance of shoulder injury prevention strategies by physicians and trainers taking care of collegiate baseball players.

Beach volleyball spike arm swing techniques of Olympics and world championships winners (1996–2019) reveal gender differences

The spike attack is one of the most important skills in beach volleyball, and as an overarm movement, places significant load on the shoulder joint that could lead to increased risk of injury. An analysis of the different techniques used by elite athletes could provide important insights regarding the etiology of these injuries. This study aimed to assess the spike attack arm swing techniques of Olympics and World Championships (1996-2019) beach volleyball winners and to investigate possible gender differences. Twenty-five male and twenty female winners were assessed on video recordings from eighteen competitions. The different arm swing techniques in the cocking phase (Straight, Bow-and-arrow high, Bow-and-arrow low, Snap, and Circular) were classified by two experts. Intra-rater reliability of both experts (κ = 1.000, P &lt; .001 and κ = .969, P &lt; .001 respectively) and inter-rater reliability (κ = .969, P &lt; .001), assessed by Cohen’s Kappa, were almost perfect. There were significant gender differences in arm swing techniques ( P &lt; .001) with a large size effect (Cramer’s V = .650). The most frequent technique for men was the Bow-and-arrow low (56%) followed by Circular (24%) and Bow-and-arrow high (20%), while for women were the Bow-and-arrow high (30%) and Snap (30%), followed by Bow-and-arrow low (25%) and Straight (15%). The results showed a great variation in arm swing techniques even among world class beach volleyball players as well as significant gender differences, and could allow us to develop interesting hypotheses regarding the mechanisms that could lead to shoulder overuse injuries.

A Primary Care Provider's Guide to Shoulder Pain After Spinal Cord Injury.

Shoulder pain is a common occurrence after spinal cord injury (SCI) and can have significant negative effects on health and function as many individuals with SCI are reliant on their upper extremities for mobility and self-care activities. Shoulder pain after SCI can be caused by acute injury or chronic pathology, but it is most often related to overuse injuries of the rotator cuff. Both acute strain and chronic overuse shoulder injuries in persons with SCI typically result from increased weight bearing on the upper extremities during transfers, weight-relief raises, and wheelchair propulsion, which are often performed in poor postural alignment owing to strength deficits. This article discusses management of patients with SCI who present with shoulder pain from the perspective of primary care physicians including evaluation and diagnostic procedures, interventions appropriate for both acute and chronic shoulder pain, and strategies for prevention.

Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review.

Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking. To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature. A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus. Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis. Systematic review. Level 3. Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score. Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries. Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes.

Overuse shoulder injuries are common in youth handball, but research is limited. The purpose of this study was to identify pre-season risk factors associated with overuse shoulder injuries in this population. One-hundred and thirty-eight (70 boys and 68 girls) youth elite players (age 14.1 ± 0.8 years, height 175.2 ± 8.2cm, weight 64.0 ± 9.6kg) completed a pre-season screening protocol. Passive glenohumeral range of motion and maximum external (ER) and internal rotation (IR) strength were measured with a manual goniometer and a hand-held dynamometer. Scapular dyskinesia and maximum throwing velocity were also assessed. Players completed standardised questionnaires over the 2017-2018 season and reported any overuse shoulder symptoms. Decreased isometric and eccentric ER strength was identified as a risk factor for overuse shoulder injury, both for absolute (OR 10.70, 95% CI 1.2-95.6, p = 0.034) and normalised ER strength (OR 1.2, 95% CI 1.0-1.4, p = 0.015) and the ER:IR strength ratio (OR 1.2, 95% CI 1.1-1.5, p = 0.012). ER gain of more than 7.5° (p = 0.025) and GIRD of more than 7.5° (p = 0.014) were identified as risk factors for overuse shoulder injury in girls. Scapular dyskinesia (OR 1.1, n.s.) and maximum throwing velocity did not seem to contribute to injury risk. The average response rate was 63%. In elite youth handball, deficits in ER strength is a risk factor for overuse shoulder injury for both sexes; ER gain and GIRD are only risk factors for girls. Focused pre-season assessments may aid the identification of risk factors for shoulder overuse injuries and the application of specific programmes to reduce risk. II.

Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review

Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review

Taping to Improve Scapular Dyskinesis, Scapular Upward Rotation, and Pectoralis Minor Length in Overhead Athletes.

Deviations in scapular motions and subsequent alterations in associated soft tissues are thought to contribute to overuse shoulder injuries in overhead athletes. Whereas rigid and Kinesio taping are recommended for preventing these injuries, high-level evidence from clinical trials is still needed. To determine and compare the short-term effects of rigid and Kinesio taping on scapular dyskinesis, scapular upward rotation, and pectoralis minor length in asymptomatic overhead athletes. Randomized controlled trial. Athletic training rooms. Seventy-two elite asymptomatic overhead athletes (age = 17.00 ± 4.09 years, height = 1.75 ± 0.11 m, mass = 67.26 ± 15.25 kg, body mass index = 21.80 ± 3.00). We randomly assigned participants to 1 of 4 groups: rigid taping, Kinesio taping, placebo, or control (no taping). For the first 3 groups, we applied tape to the shoulder and scapular region. We evaluated all groups for observable scapular dyskinesis using the scapular dyskinesis test, scapular upward rotation using a digital inclinometer, and pectoralis minor length using the pectoralis minor index at baseline, immediately after taping, and at 60 to 72 hours after taping. The scapular dyskinesis percentage ( P < .05) decreased and the pectoralis minor index ( P < .001) increased immediately and at 60 to 72 hours after taping in the rigid-taping and Kinesio-taping groups. We observed no differences among groups for the change in the pectoralis minor index ( P > .05). Scapular upward rotation did not change after taping in any group ( P > .05). Rigid or Kinesio taping of the shoulder and scapular region improved scapular dyskinesis and pectoralis minor length but did not alter scapular upward rotation. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.

Arthroscopic management of work-related overhead shoulder injuries: A retrospective case series

Objective This study was conducted to review the results of arthroscopic management of different work-related overhead shoulder injuries. Background Acute and overuse shoulder injuries are common among overhead workers, usually with secondary compromised glenohumeral stability due to mechanical damage, muscular fatigue, and neuromuscular control deficits. Patients and methods This study was conducted retrospectively on 30 patients who underwent shoulder arthroscopy for the diagnosis and management of different work-related overhead shoulder injuries with minimum postoperative follow-up of 6 months. Patients had been reviewed for history, examination, arthroscopic findings, and lines of management. Patients had been evaluated using University of California Los Anglos score. Results The mean age of patients was 47.7 years. There were 14 male and 16 female patients. The mean duration of postoperative follow-up was 27 months. Subacromial impingement was evident in all 30 (100%) patients. Rotator cuff tear was found in 26 (86.7%) patients. Pathology of the long head of the biceps tendon was found in 19 (63.3%) patients. Superior labrum anterior posterior lesions were found in all 30 (100%) patients. The active range of motions showed highly significant postoperative improvement (P = 0.000). The mean overall University of California Los Anglos score showed highly significant improvement from 11.9 ± 4.088 preoperatively to 32.37 ± 2.141 postoperatively (P = 0.000). Conclusion Overhead work can cause different shoulder injuries; the most common lesions are superior labrum anterior posterior lesions, rotator cuff tears 'partial-thickness more than full-thickness', and less commonly biceps tendon lesions. Arthroscopic management even of concurrent procedures can achieve satisfactory outcomes.

Incidence of Shoulder Injury in Elite Wheelchair Athletes Differ Between Sports: A Critically Appraised Topic.

Clinical Scenario: Until recently, injury epidemiology data on elite Paralympic athletes were limited. Current data suggest high rates of shoulder injury in wheelchair athletes. Differences in shoulder injury rates between sports have not been reported in this population. Clinical Question: Is the incidence of shoulder injury in elite wheelchair athletes different between sports? Summary of Key Findings: Shoulder injury rates are high in elite wheelchair athletes, particularly in sports such as field events and fencing that require a stable base (eg,trunk, core control) from which to perform. Wheelchair racing requires repetitive motions that contribute to shoulder injuries, but rates are lower than field sports and fencing. Wheelchair curling and sledge hockey have low shoulder injury risk. Clinical Bottom Line: Shoulder injury rates vary based on sport in elite wheelchair athletes. In addition to incorporating shoulder complex specific rehabilitation for overuse shoulder injuries, clinicians should focus on core and trunk stabilization in elite wheelchair athletes competing in sports, such as field events and fencing. Strength of Recommendation: Grade C evidence exists that reports shoulder injury rates among elite wheelchair athletes differ based on sport participation.

Isolated Infraspinatus Atrophy Secondary to Suprascapular Nerve Neuropathy Results in Altered Shoulder Muscles Activity.

Isolated infraspinatus atrophy (IIA) is a common condition among overhead activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. The loss of infraspinatus function could lead to altered activity of the glenohumeral and scapulothoracic (ST) muscles and compromise the optimal shoulder function. To assess the surface electromyographic (sEMG) activity patterns, relationships, and response latencies of relevant shoulder girdle muscles in professional volleyball players with IIA and in healthy control players. Cross-sectional study. Research laboratory. Twenty-four male professional volleyball players (12 players with diagnosed IIA and 12 healthy players) recruited from local volleyball teams. sEMG activity of anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; and serratus anterior (SA) was recorded and evaluated during a movement of shoulder abduction in the scapular plane, monitored with an optoelectronic motion capture system. sEMG activity, relationships, and response latencies of the selected muscles were analyzed with analysis of variance models to highlight statistical differences within and between groups. Athletes with IIA demonstrated significant higher deltoid and trapezius muscles activity and lower SA activity compared with the contralateral shoulder and healthy athletes. The shoulder with IIA also showed a higher activity ratio between the upper trapezius and other ST muscles in addition to anticipated activation of the upper trapezius and delayed activation of the SA, with regard to the onset of shoulder movement. This study highlighted altered shoulder muscle activity levels, ST muscles imbalances, and abnormal ST recruitment patterns in the hitting shoulder of professional volleyball players with IIA, secondary to suprascapular nerve neuropathy. Such shoulder girdle muscles' impairments may compromise the optimal scapulohumeral rhythm and function, increasing the risk of acute and overuse shoulder injuries.

Range of Motion Changes in Female Elite Swimmers Throughout a Competitive Season

Upper extremity injuries are the most common injury in swimming athletes specifically in the collegiate setting. Females in particular, are more likely to suffer these injuries when comparing to male collegiate swimmers. “Swimmer Shoulder”, a generic term for overuse shoulder injuries in the swimming population occurs with high rate and intensity of training. Significant factors that have been found to contribute to this pathology are deficits in internal rotation, lack of stability, and increased demands on the shoulder. The aim for this clinical outcomes project was to evaluate changes in range of motion (ROM) total arc of the shoulder, and patient-perceived function in female elite swimmers throughout a competitive season. Shoulder total arc ROM was measured passively with the student-athlete supine. A digital inclinometer was used to make it simpler for the clinician to assess ROM on their own. The Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (KJOC) was used to measure self-perceived upper extremity function in sport. It consisted of a set of demographic and participation questions followed by 10 visual analogue scale questions about upper extremity function during sport. Upper extremity stability was also measured using the closed-kinetic chain upper extremity stability test (CKCUE). Results showed shoulder ROM (total arc) restrictions occurred during times of increased training intensity and volume. When patients had smaller total arc measurements, the student-athletes reported lower KJOC scores for sport related function. There was an increase in ROM at a time where intensity, and distance of training were decreased. Overall upper extremity stability gradually improved over the course of a competitive season.

Shoulder complaints in wheelchair athletes: A systematic review.

BackgroundIn recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures.MethodsA literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles were excluded if they did not include any statistical analysis. Articles that included studies with wheelchair athletes in combination with athletes of other disability sports were excluded in order to be able to differentiate between the two. Narrative, exploratory and case studies were also excluded. Two reviewers independently assessed articles for inclusion. Thirteen articles matched the selection criteria. These were judged on their quality by use of an adapted version of the Webster checklist.ResultsOf the included studies the overall quality was low. A relatively high prevalence of complaints was found, ranging from 16% to 76%. Pain was found to be a common complaint in wheelchair athletes. Based on the current literature the cause of shoulder problems is difficult to identify and is likely multifactorial, nevertheless characteristics of the user (i.e. increased years of disability, age and BMI) were shown to increase risk. Preventative measures were indistinct. There may be a role for balanced strength training regimens to decrease risk.ConclusionShoulder complaints in wheelchair athletes are a common problem that must be addressed further. Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects.

Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed

BackgroundShoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among...