Posterior Capsular Tightness Research Articles

Glenohumeral Translations in Overhead Workers with Sub-Acromial Impingement Syndrome: A Review

Introduction: The third most common musculoskeletal condition is shoulder pain with a prevalence of up to 70%. The second most frequent shoulder condition is subacromial impingement syndrome. Impingement can be classified as either anterosuperior or posterosuperior. Faulty posture, altered scapular or glenohumeral kinematics, posterior capsular tightness, and acromial or coracoacromial arch pathology are all potential extrinsic mechanics that can lead to Subacromial impingement syndrome. The purpose of this review is to find the different variation in translation that takes place in the glenohumeral joint in Subacromial impingement syndrome in overhead workers. Methods: We performed a review of the various translations observed in the glenohumeral joint in subacromial impingement syndrome and discussed the evidence-based studies. For the review, an electronic search for relevant articles using PUBMED, Pedro, Research Gate, and Google Scholar databases up to Dec 2022 was done wherein MeSH search terms and free words were used. Articles underwent the selection process and were selected on the basis of inclusion criteria. Articles were selected based on the author's expertise, self-knowledge and reflective practice. Results: The current study included 11 articles that fulfilled the inclusion criteria suggesting that various humeral translations in overhead workers. The above-reviewed studies provided evidence that based on occupational demands abnormal variations occur. Conclusion: This review has provided an overview of the previous and recent literature on humeral head translation seen in sub-acromial impingement. This study concludes that superior translation is more common as compared to anterior-superior translation and posterior-superior translation.

Inter-tester and intra-tester reliability of physical examination test used to measure positional faults of the shoulder girdle in healthy individuals

Introduction Sustained, repetitive, prehensile activities that require precision and stability, necessitate a sustained static shoulder girdle posture over long periods of time, which can result in abnormal activation of the shoulder girdle musculature and consequent scapular misalignments. Aim, Aim of this study was to establish test-retest and inter-tester reliability of six (6) clinical tests commonly used to measure parameters related to shoulder girdle positional faults and or asymmetries. Material and Methods A convenience sample of 100 healthy 18–25-year-old, male college students were evaluated on the following tests: Pectoralis minor index, Lateral scapular slide test, Posterior capsular tightness, Forward shoulder posture, cervical range of motion, and shoulder muscle Isometric strength. Result Intra-class correlations (ICC) were calculated across trials (test-retest) and across testers (inter-rater) in a repeated measure ANOVA.Test-retest ICC for forward shoulder posture (0.998), Cervical range of motion (0.987 to 0.999), Isometric shoulder strength (0.986-0.997), Pectoralis minor index (0.982 to 0.984), Lateral scapular slide test (0.997- 0.969) and Posterior Capsular Tightness (0.967 to 0.974) was found to be excellent but Inter-rater and reliability values were in the poor to moderate ranges.

L-Shaped Arthroscopic Posterior Capsular Release in Frozen Shoulder

Background: The inadequate arthroscopic release of the tight posterior capsule in frozen shoulder may result in limited postoperative shoulder internal rotation. Indication: The purpose of this article is to describe an L-shaped arthroscopic posterior capsular release to overcome the limited internal rotation that may be encountered following the standard longitudinal technique. Operative intervention is indicated in patients with refractory shoulder stiffness with limitation of internal rotation of grade 0, +2, +4 (according to the Constant-Murley Score), after failure of conservative measures for 3 to 6 months. The technique is contraindicated if less than 3 months of physical therapy, shoulder stiffness due to osseous deformity, infection, or cuff tear arthropathy. Technique: After performing a standard anterior capsular release, the scope is shifted to the anterior portal to perform posterior capsular release by introducing the radiofrequency ablation device through the posterior portal. Posterior release begins from the glenoid level down to the 6 o’clock position until the back fibers of the infraspinatus muscle appear. Then the hook-tip part of the radiofrequency ablation device is used to perform a transverse release in the posterior capsule, starting from the beginning of the longitudinal limb. The transverse limb is performed in a stepwise manner going step-by-step laterally but ending before reaching the rotator cuff to avoid any damage of the cuff. After that, the shoulder was manipulated according to Codman technique. Results: A comparative study was performed on 43 patients with primary frozen shoulder to compare the standard longitudinal (22 patients) and L-shaped (21 patients) posterior capsular release. At the final follow-up, there was a statistically significant improvement in the internal rotation range of motion in the L-shaped group ( P < .001). There was no loss of function over time. Moreover, there were no infections, instability, or axillary nerve injury in either group. Discussion/Conclusion: Restriction of internal rotation in frozen shoulder has been attributed to posterior capsular tightness. The L-shaped arthroscopic posterior capsular release in patients with primary frozen shoulder significantly improves the postoperative internal rotation range of motion.

Correlation of glenohumeral internal rotation deficit with shear wave ultrasound elastography findings for the posterior inferior shoulder capsule in college baseball players

The glenohumeral internal rotation deficit (GIRD), primarily caused by the tightness of the posterior capsule, is a major risk factor for shoulder injuries in overhead throwing athletes. Quantitative evaluation of posterior capsular thickness and tightness can help determine the relationship between the posterior inferior capsule and GIRD. One previous study has assessed posterior capsule tightness using shear wave elastography (SWE), in college baseball players; however, it did not address the cutoff value of capsular elasticity that could be considered as abnormal capsular tightness. We aimed to re-evaluate effectiveness of SWE in quantifying posterior shoulder capsule tightness in college baseball players and determine the cutoff value of abnormal capsular elasticity that can predict impending throwing-related shoulder injuries associated with GIRD. Twenty-four college baseball players were enrolled in this study. External and internal rotation of the shoulder joint was assessed. The participants were classified into the GIRD group if their throwing shoulder showed >20° of internal rotation loss compared with their nonthrowing shoulder. In a longitudinal ultrasonographic scan of the posterior inferior capsule, shear wave (SW) velocity and thickness were measured at the point nearest to the labrum on both shoulders. Of the 24 subjects, 6 had a GIRD. The mean value of the SW velocity in the throwing shoulder was greater in the GIRD group than in the non-GIRD group (P = .006). The SW velocity difference between the throwing and nonthrowing shoulder was also greater in the GIRD group than in the non-GIRD group (P < .001). There was no significant difference in the thickness of the posterior inferior capsule between both groups. In correlation analysis, the difference in the SW velocity was more strongly correlated with the GIRD than with the SW velocity in the throwing shoulder. When we assume that a 20° GIRD is indicative of a shoulder at risk, the cutoff SW velocity in the throwing shoulder is 4.81 m/s and the SW velocity difference is 0.77 m/s. The SW velocity is closely associated with posterior shoulder capsular tightness and may be of quantitative value in baseball players.

Glenohumeral internal rotation deficit in throwing athletes: current perspectives

Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.

A Thickened Coracohumeral Ligament and Superomedial Capsule Limit Internal Rotation of the Shoulder Joint: Report of Three Cases

Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a painful and disabling disorder with an estimated prevalence ranging from 2% to 5% in the general population. Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations. The thickened CHL has been understood to limit external rotation of the shoulder, and restriction of internal rotation of the shoulder has been believed to be related to posterior capsular tightness. In this paper, three cases of refractory frozen shoulder treated through arthroscopic release of a contracted capsule including CHL were reported. Two cases in which there is recalcitrant severe restriction of internal rotation after manipulation under anesthesia (MUA) were finally treated with arthroscopic surgery. Although MUA could release the posterior capsule, internal rotation did not improve in our cases. After release of the thickened CHL, range of motion of internal rotation was significantly improved. This report demonstrates the role of the thickened CHL in limiting the internal rotation of the shoulder. We highlight the importance of release of thickened CHL in addition to the pancapsular release, in case of severe limitation of internal rotation of shoulder.

Effectiveness of sleeper Stretch In Shoulder Posterior Capsular Tightness - A Case Report

A single case study design was selected to evaluate the effect of sleeper stretch on the pain and dysfunction due to posterior capsular tightness in shoulder joint. The technique involves sustained passing stretching of posterior capsule in a prescribed position and exercise regimen. Pre and post evaluation of treatment was evaluated using different outcome measures. The study involved three phases, pre treatment phase, treatment phase and post treatment phase. The technique’s effect was to reduce the pain and improve function during activities of daily living. A structured exercise regimen of sleeper stretch was given to the patient for two weeks, 10 repetitions, and three sets for three times a day. The technique shown to be effective in treating patient with posterior capsular tightness.

Analyzing shoulder translation with navigation technology

Asymmetric stress imposed on the shoulder can lead to anterior shoulder instability in young athletes who perform repetitive overhead motions. A common treatment, surgical anterior capsule tightening, assumes that the instability is caused by abnormal anterior laxity. This study investigated the possibility that one element of overall imbalance, posterior capsular tightness, could be an underlying reason for shoulder instability. Surgical navigation technology, which is more accurate than whole-body motion-capture systems, was used to study anterior translational motions. The study was used four cadaver shoulders, with the scapula and rotator cuff muscles intact. Opto-electronic surgical navigation localization devices were mounted on the scapula and humerus to accurately capture positions and orientations. The shoulders were passively moved through 7 motions, 5 of simple angulation and 2 combinations of clinical interest. Each motion was repeated in 4 different soft-tissue states: rotator cuff intact, capsule intact, and surgically induced capsular tightnesses of 5 and 10mm. The shoulders had significantly greater anterior translation when the posterior capsule was artificially tightened (p < 0.05); this was particularly in movements that combined abduction with internal or external rotation, which are typical overhead sports motions. Overall translation was indifferent to whether the shoulders were intact or dissected down to the capsule, as was translation during flexion was indifferent to dissection state (p > 0.95). Surgical navigation technology can easily be used to analyze cadaveric shoulder motion, with opportunities for adaptation to anesthetized patients. Results suggest that the inverse of artificial tightening, such as surgical release of the posterior capsule, may be an effective minimally invasive treatment of chronic shoulder dislocation subsequent to sports motions.

Paper 32: Arthroscopic Capsular Release for Painful Throwing Shoulder With Posterior Capsular Tightness

Paper 32: Arthroscopic Capsular Release for Painful Throwing Shoulder With Posterior Capsular Tightness

Influence of posterior capsular tightness on throwing shoulder injury

The role of posterior capsular tightness in throwing shoulder injury has not yet been clarified. Accordingly, the influence of posterior capsular tightness on the occurrence of throwing shoulder injury was investigated. Sixty-one shoulders with throwing injury were retrospectively reviewed, including 50 tight shoulders and 11 non-tight shoulders. Occurrence of long head of biceps (LHB) lesions, superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) injuries, type 2 SLAP lesions, and supraspinatus and subscapularis tendon injuries was compared between the tight and non-tight groups. There were LHB lesions in 8 tight shoulders and 6 non-tight shoulders, SGHL injury in 14 and 8 shoulders, and subscapularis tendon injury in 6 and 5 shoulders, respectively, showing significant differences between tight and non-tight shoulders. In contrast, MGHL injury, type 2 SLAP lesions, and supraspinatus tendon injury showed no significant differences. The SLAP lesion was located anteriorly in 6 tight shoulders, posteriorly in 5, and combined in 4 versus 0, 3, and 0 for the non-tight shoulders, respectively, so anterior SLAP lesions only occurred in tight shoulders. Similarly, anterior supraspinatus tendon injuries had a higher incidence in tight shoulders than in non-tight shoulders (19 vs 3). Rotator interval lesions were frequent in non-tight shoulders, while anterior SLAP lesions and anterior supraspinatus tendon injuries were predominant in tight shoulders. The significance of posterior capsular tightness should be reconsidered. Retrospective, Level IV.

Diagnosis and management of superior labrum anterior posterior lesions in overhead athletes

Shoulder pain is a common complaint in overhead athletes, and superior labrum anterior posterior (SLAP) lesions are a common cause of this pain. The pathological cascade which results in the...

The effect of posterior capsular tightening on peak subacromial contact pressure during simulated active abduction in the scapular plane

Our hypothesis was that tightening of the posterior capsule would lead to increased subacromial pressure and increased superior translation during active abduction in the scapular plane. Subacromial impingement syndrome is a painful condition that occurs during overhead activities as the rotator cuff is compressed in the subacromial space. Unrecognized secondary causes of subacromial impingement may lead to treatment failure. Posterior capsular tightness, believed to alter glenohumeral joint kinematics, is often cited as a secondary cause of SI; however, scientific evidence is lacking. The primary objective of this study was to evaluate the effect of posterior capsular tightening on peak subacromial pressure during abduction in the scapular plane. Ten fresh frozen shoulder specimens from deceased donors were mounted on a custom shoulder simulator. With the scapula fixed, the deltoid and rotator cuff muscles were loaded in discrete static steps with a constant ratio to elevate the humerus in the scapular plane. The treatment order (no tightening, 1-cm, and 2-cm tightening of the posterior capsule) was randomly assigned to each specimen. Peak subacromial contact pressure and glenohumeral kinematics at the peak pressure position were compared using a repeated measures analysis of variance. Peak subacromial pressures (mean +/- standard deviation) were similar between treatment groups: 345 +/- 152, 410 +/- 213, and 330 +/- 164 kPa for no tightening, 1-cm, and 2-cm tightening of the posterior capsule respectively (P > .05). No significant differences were found for superior or anterior translations at the peak pressure position (P > .05). Posterior capsular tightening, as a sole variable, did not contribute to a significant increase in peak subacromial pressure during abduction in the scapular plane. A similar study simulating active forward flexion is necessary to fully characterize the contribution of posterior capsular tightness to subacromial impingement. Tightening of the posterior capsule did not increase subacromial pressure, or increase superior or anterior translation during abduction in the scapular plane.

Pain Provocation Test to Detect Posterior Capsular Tightness in Throwing Shoulder Injury

Pain Provocation Test to Detect Posterior Capsular Tightness in Throwing Shoulder Injury

Effect of Posterior Capsule Tightness on Glenohumeral Translation in the Late-Cocking Phase of Pitching

Throwing injuries. To study the effects of posterior capsule tightness on humeral head position in late cocking simulation. Eight fresh frozen shoulders were placed in position of "late cocking," 90 degrees abduction, and 10 degrees adduction and maximal external rotation. 3D measurements of humeral head relationship to the glenoid were taken with an infrared motion sensor, both before and after suture plication of the posterior capsule. Plications of 20% posterior/inferior capsule and 20% entire posterior capsule were performed, followed by plications of 40% of the posterior/inferior capsule and 40% entire posterior capsule. Cadaver Lab. Posterior capsular placation. Humeral head position. 40%, but not 20%, posterior/inferior and posterior plications demonstrated a trend to increased posterior-superior humeral head translation relative to controls. Surgically created posterior capsular tightness of the glenohumeral joint demonstrated a nonsignificant trend to increased posterior/superior humeral head translation in the late cocking position of throwing.

Throwing Shoulder Injury Involving the Anterior Rotator Cuff: Concealed Tears Not as Uncommon as Previously Thought

In throwing athletes, partial rotator cuff tears are usually located posterior to the site of the common rotator cuff tears seen in the general nonthrowing population. However, they sometimes have tears located around the anterior aspect of the supraspinatus tendon. In this study we investigated the characteristics of anterior rotator cuff tears in throwing athletes. We then compared several factors between anterior tears and posterior tears to investigate those related to the presence of anterior tears or the occurrence of such tears. We divided 37 athletes with partial rotator cuff tears into those with anterior tears (n = 17) and those with posterior tears (n = 20). The clinical profile, range of motion and joint laxity with patient under general anesthesia, and operative findings were retrospectively compared between the 2 groups. Among the 17 anterior rotator cuff tears, 12 tears were confined to the anterior one third of the supraspinatus tendon. Interestingly, concealed intratendinous degenerative tears were found in 6 shoulders. These appeared to be very shallow articular-side tears located around the attachment of the greater tuberosity, but severe tears were exposed after resection of the residual capsular portion of the tendon. Posterior capsular tightness was significantly related to the occurrence of anterior tears, whereas a greater tuberosity notch was significantly related to posterior tears. Anterior rotator cuff tears are not uncommon in throwing athletes, and a concealed type of tear was a representative lesion. Different mechanisms may be involved in the development of anterior and posterior rotator cuff tears resulting from throwing injuries. Posterior capsular tightness might influence the occurrence of anterior tears. Level IV, prognostic case series.

Superior Bennett Lesion: A Bone Fragment at the Posterosuperior Glenoid Rim in 5 Athletes

In throwing athletes, a Bennett lesion is a bony spur that usually forms at the posteroinferior glenoid rim and sometimes becomes painful. We encountered superior Bennett lesions in the shoulders of 5 athletes, which were detected at the posterosuperior glenoid rim as a separate bone fragment. In all 5 athletes this lesion appeared to be the main cause of shoulder pain during throwing or overhead activity. The lesions were easily visualized on plain radiographs (axial view, scapular Y view, and 45° craniocaudal view) or computed tomography scans. Tenderness was detected over the posterior aspect of the glenohumeral joint, the pain provocation test specific for SLAP lesions was positive, and posterior shoulder pain was elicited by forced external rotation at 90° of abduction in all 5 cases. The pain was diminished or decreased by injection of local anesthetic around the lesion. At arthroscopy, detachment of the posterosuperior labrum and posterior capsular tightness were detected in all 5 cases. Through the detached portion of the posterosuperior labrum, we could easily reach an unstable mobile bone fragment, which was resected arthroscopically. Although the pathologic mechanism is unclear, the mobility of the bone fragment appeared to be related to the occurrence of symptoms.

Path of Glenohumeral Articulation Throughout the Rotational Range of Motion in a Thrower's Shoulder Model

Background Overhead-throwing athletes have increased external and diminished internal glenohumeral rotation that may alter glenohumeral kinematics. Purpose To quantify the kinematic changes present in a cadaveric model of a thrower's shoulder. Study Design Controlled laboratory study. Methods In 8 fresh-frozen cadaveric shoulders, the rotator cuff and overlying muscles were removed, and the glenohumeral capsule, coracoacromial ligament, and coracohumeral ligament were left intact. The scapula was fixed, and the humerus was placed in 90° of shoulder abduction in a 6 degrees of freedom testing device. A compressive force of 44 N was applied. A thrower's shoulder model was created, and sequential conditions were examined: intact, after anterior stretching, and after the addition of posterior-inferior capsular plication. Kinematic measurements were obtained through a complete range of glenohumeral rotation. Results Glenohumeral external rotation increased 16%, from 149° to 173° (P <. 001), after stretching in external rotation and remained increased by 11% to 166° (P <. 001) after posterior-inferior capsular plication. With the addition of the posterior-inferior capsular plication, internal rotation averaged 7°, which was not significantly different from the intact state (11°, P =. 55) or the stretched state (16°, P =. 07). The total glenohumeral rotation after stretching followed by posterior-inferior capsular plication did not differ significantly from intact state (P =. 25). At maximum external rotation, the humeral head apex was shifted posteriorly in the stretched (P =. 003) and plicated (P <. 001) states compared with the intact state. The humeral head apex was posteriorly displaced at 135° and 150° of external rotation compared with the intact condition (P =. 039 and. 049, respectively). In maximum internal rotation, anterior stretching had no significant effect on the humeral head apex position. However, after posterior-inferior capsular plication, the humeral head apex was significantly shifted inferiorly (P =. 005) and anteriorly (P =. 03) in maximum internal rotation compared with the intact state. Conclusion Significant changes in glenohumeral motion occur in this model during the simulated late-cocking and follow through phases of throwing. In this model, posterior capsular tightness alters the humeral head position most profoundly during the deceleration and follow-through phases of throwing.

Arthroscopic Capsular Release for Painful Throwing Shoulder With Posterior Capsular Tightness

Posterior capsular tightness with glenohumeral internal rotation deficit is usually considered to be an acquired condition of the throwing shoulder and is usually treated conservatively. However, because posterior capsular tightness is sometimes irreversible, we have performed arthroscopic capsular release for painful throwing shoulder with posterior capsular tightness. The true loss of internal rotation and posterior stiffness was confirmed by examination with the patient under anesthesia, and contracture of the posterior capsule and the posterior band of the inferior glenohumeral ligamant was observed arthroscopically. Because an extensive adhesion between the capsule and the fascia of the external rotators was noted, a capsular release was performed from 6 o’clock to 11 o’clock (in the right shoulder) to completely expose the muscle belly of the external rotators. Of the first 16 consecutive patients, 4 had no concomitant lesions and underwent posterior capsular release alone. With a minimum of 2 years’ follow-up, it was ascertained that the throwing pain completely disappeared in 14 patients and improved in 2. In all, 11 patients returned to their preinjury performance level, and 5 returned to a lower level of function. In the 4 patients who had no concomitant lesions, throwing pain completely disappeared, and all were able to return to their preinjury performance level.

Influence of Posterior Capsular Tightness on Anterior. Instability and Pathogenesis of Several Lesions in Throwing Injury of the Shoulder

Influence of Posterior Capsular Tightness on Anterior. Instability and Pathogenesis of Several Lesions in Throwing Injury of the Shoulder

Arthroscopic Capsular Release for a Throwing Shoulder with Refractory Posterior Capsular Tightness

Arthroscopic Capsular Release for a Throwing Shoulder with Refractory Posterior Capsular Tightness