Shoulder External Rotation Range Research Articles

Measuring the Average Peak Timing of Kinematic Variables in Youth and Adolescent Baseball Pitchers.

Previous studies have examined the timing of peak kinematic variables during the pitching cycle in high school, collegiate, and professional pitchers. These same variables have been studied less in younger populations. To determine whether youth and adolescent baseball pitchers will experience peaks in certain kinematic variables at different times throughout the pitching cycle compared to professional/collegiate pitchers. Cross-sectional, descriptive study. Twenty-four participants were recruited for testing consisting of five recorded pitches using 3-Dimensional VICON® motion analysis system. The maximum values and timing of the peak kinematic variables were averaged across all trials using VICON Polygon® data analysis software. These values were recorded as percentages of the pitching cycle, defined from foot contact (0%) to ball release (100%). The following variables were examined: shoulder external rotation range of motion, shoulder internal rotation velocity, trunk rotation range of motion, trunk rotation velocity, pelvic rotation velocity, and stride length. Descriptive outcomes were calculated and results were compared to previous studies examining the same variables in collegiate and professional pitchers. Twenty-four male participants (mean age 12.75 years, SD ± 2.02) were included in the study. Mean and standard deviations were identified for peak kinematic variables of shoulder external rotation ROM (158.71°, ±9.32), shoulder internal rotation velocity (92.26 rad/sec, ±19.29), trunk rotation velocity (15.94 rad/sec, ±1.68), trunk rotation ROM (23.57°, ±8.14), and average stride length (81.97% height ±4.57). Additionally, mean and standard deviations of peak kinematic variables were expressed as percentages to reflect when they occurred in the pitching cycle and included trunk rotation ROM (8.45%, ±12.72), pelvic rotation velocity (33.26%, ±16.42), trunk rotation velocity (41.59%, ±9.27), shoulder external rotation ROM (71.34%, ±6.61), and shoulder internal rotation velocity (86.93%, ±6.45). The sequential order of each variable was similar in youth and adolescents in comparison to collegiate and professional pitchers. However, the timing of each variable within the pitching cycle occurred approximately 10% earlier in the younger pitchers. The findings suggest differences in pitching mechanics exist between younger and more experienced populations. Level 3.

The Effects Of Differing Density Of Swim-Training Sessions On Shoulder Range Of Motion and Isometric Force Production In National and University Level Swimmers.

Well-developed physical qualities (i.e., greater load capacity) in athletes can provide protection against injuries. Although higher competitive level swimmers have more developed physical qualities, no studies have investigated how physical qualities of the shoulder respond to a swim-training session in different competitive levels. To compare baseline shoulder external rotation range of motion (ER ROM) and isometric peak torque of the shoulder internal rotators (IR) and external rotators (ER) between national and university level swimmers with differing training volumes. To compare the post-swim changes of these physical qualities between groups. Cross-sectional. Ten male swimmers (age= 18.7 ± 1.2 years) were divided into high-load (N= 5 national-level, weekly swim-volume= 37.0 ± 2.7 km) and low-load groups (N= 5 university-level, weekly swim-volume= 6.8 ± 1.8 km). For each group, shoulder active ER ROM and isometric peak torque of the shoulder IR and ER were measured before and immediately after a high-intensity swim-training session (for each group, the hardest swim-session of the week was analyzed). The results were evaluated by the level of significance (p-value), effect size, and whether changes exceeded the measurement error. University-level swimmers had lower baseline ER torque (p= 0.006; d= 2.55) and IR torque (p= 0.011; d= 2.42) than national-level swimmers. For post-swim analysis, ER ROM decreased more in university swimmers (change= -6.3° to -8.4°; d= 0.75-1.05) than national counterparts (change= -1.9° to -5.7°; d= 0.43-0.95). Greater drops in rotation torque were found in university swimmers (IR change= -15% to -21.0%; d= 0.83-1.66; ER change= -9.0% to -17.0%; d= 1.14-1.28) compared to national swimmers (IR change= -10.0% to -13.0%; d= 0.61-0.91; ER change= -3.7% to -9.1%; d= 0.50-0.96). The average change of all tests in university swimmers exceeded the minimal detectable change (MDC), whereas in national level swimmers some tests exceeded the MDC. Despite this, only post-swim ER torque in the dominant side (p= 0.003; d= 1.18) was significantly lower in university swimmers (possibly due to the small sample size). University swimmers have less baseline shoulder external and internal rotator torque and had greater drops of all shoulder physical qualities after a swim-training session, which may have implications for injury risk. However, due to the sample size, the results have to be interpreted with caution. 3.

Strength after the arthroscopic Latarjet procedure: Are shoulder internal rotation, elbow flexion & supination strength decreased?

The Latarjet procedure is an effective shoulder stabilizing surgery, however, the procedure results in an alteration of anatomy that may result in shoulder and elbow weakness. Thus, the purpose of this study was to assess post-operative shoulder and elbow strength after the Latarjet procedure. We hypothesized that shoulder and elbow strength are not affected after the procedure. The study group consisted of patients that had undergone the arthroscopic Latarjet procedure. An isokinetic dynamometer was used to evaluate the strength of bilateral shoulder internal rotation, elbow flexion, forearm supination using peak torque (N/m), as well as grip strength (kilograms). Shoulder range of motion and the potential effects of hand dominance were further analysed. Nineteen patients with a mean age of 29 years and an average follow up of 47 months were included. Shoulder internal rotation strength, elbow flexion and forearm supination strength and grip strength were not significantly different when compared to the non-operative side (p > 0.13). The range of shoulder external rotation was significantly reduced (p < 0.001) on the Latarjet side. The results from this study demonstrate no statistically significant differences in the strength of shoulder internal rotation, elbow flexion, forearm supination or grip strength despite the surgical alterations to the subscapularis and conjoint tendon.

Effect of exercise on rehabilitation of breast cancer surgery patients: A systematic review and meta-analysis of randomized controlled trials.

To determine the effective exercise methods for different complications of breast cancer patients after surgery. Systematic review and meta-analysis. A comprehensive electronic search was carried out with no time limit until May 2020. Studies must have been randomized controlled trials of patients after breast cancer surgery, without limit to the way of exercise. Literature quality was evaluated by the modified Jadad scale. The meta-analysis was conducted with CMA2.0 software. Aerobic exercise reduced the intensity of the pain (MD=-1.043), improved shoulder flexion (MD=3.398) and internal rotation range (MD=3.868), lessened upper limb dysfunction (MD=-5.231) and improved muscle strength during flexion (MD=1.076) and abduction (MD=0.991). Shoulder elbow movement improved the range of shoulder external rotation (MD=2.691) and reduced the incidence of arm lymphedema (RR=0.343). Anti-resistance exercise also lessened upper limb dysfunction (MD=- 4.094).

Paper 09: Differences in Glenohumeral Range of Motion and Humeral Torsion Between Right-Handed and Left-Handed Major League Baseball Pitchers.

Objectives:Substantial differences in throwing metrics, like velocity, spin rate and pitcher break, have been observed between left and right-handed pitchers. Elite pitchers have demonstrated significant changes in glenohumeral range of motion and humeral torsion compared to the normal population. Differences in these anatomical parameters between left and right-handed pitchers may explain these performance trends. Furthermore, changes in shoulder range of motion measurements have been associated with different injury risks and challenges in assessing rehabilitation progress. This study seeks to determine if differences in glenohumeral range of motion and humeral torsion exist between left-handed and right-handed pitchers.Methods:217 MLB pitchers from a single organization were evaluated over a 7-year period from 2013-2020. Range of motion was evaluated by three trained examiners using a Standard Goniometer. Ultrasound scanning was used to determine neutral position of the shoulder and the degree of humeral torsion was measured with a goniometer. The mean and standard deviation were assessed for normality using Shapiro Wilk. Differences between right and left-handed pitchers were assessed using one-way ANOVA. Arm effects were assessed using paired samples t-tests.Results:Right-handed pitchers showed, on average, 13.9 degrees more shoulder external rotation range in their dominant arm compared with their non-dominant arm, whereas left-handers averaged only 2.2 degrees. RHPs showed greater asymmetries in shoulder internal rotation range (13.9 vs 4.8 degrees) and humeral torsion (-23.1 vs -2.2 degrees). Left-handed pitchers showing significantly greater range of non-dominant shoulder flexion (165.8 vs 160.7 degrees) leading to greater flexion deficits in the dominant arm compared to their right-handed counterparts, (7.5 vs 0.0 degrees).Conclusions:Right-handed pitchers demonstrate significantly greater measures of external rotation, humeral retrotorsion, and shoulder flexion compared to left-handed counterparts. The correlation between humeral retrotorsion and increased external rotation indicate that osseus adaptations are a major contributor to range of motion differences associated with handedness. Additionally, these findings may explain observed differences in several throwing metrics between right and left-handed pitchers. Furthermore, knowledge of these differences can inform rehabilitations programs and shoulder maintenance regimens.Table 1.Range of Motion Variables for Right Handed (RHP) and Left Handed (LHP) Professional Baseball Pitchers.*Table 2.Average Velocity in Miles per Hour by Pitch Type and Pitcher Handedness, 2017-2020.a Figure 1.Scatter chart showing the correlation between dominant-arm retrotorsion and external rotation gain in the throwing arm of all pitcher’s studied. As retrotorsion increased, the degree of external rotation also increased. Right-handed pitchers were more likely to have higher degrees of both retrotorsion and external rotation gain. Negative values indicate retrotorsion.Figure 2.Box and whisker plot showing the difference in dominant-arm retrotorsion in the dominant throwing arm in left and right-handed pitchers. Dominant-arm| retrotorsion is the difference in torsion between the dominant throwing and non-throwing arm. Right-handed pitchers demonstrated significantly more retrotorsion (negative torsion) in the dominant throwing arm compared to left-handed pitchers.

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study.

Background:The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.Methods:This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.Results:A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).Conclusion:The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.

Effects of sequential approach of positional release for subscapularis and OLA Grimsby technique on shoulder external rotation in adhesive.

A sample of 34 patients was randomly assigned to two Groups A and B (17 in each group). Positional release of subscapularis technique to Group A participants and Proprioceptive Neuromuscular Facilitation (PNF) (hold-relax) and anterior mobilisation technique were simultaneously applied to Group B participants. Data was collected from Nusrat Abdul Rauf Centre for Enablement and Faisal Hospital, Faisalabad, from August 30, 2018 to November 27, 2018. The duration of the treatment was four weeks with three sessions per week. The main outcome measures were Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), and shoulder external rotation range of motion. The differences between Ola Grimsby group (Group B) and subscapularis release group (Group A) were statistically significant for pain, disability and shoulder range of motion (p-value<0.05) with higher mean values for Ola Grimsby group. This study concluded that the sequential effects of Ola Grimsby technique are better as compared to positional release of subscapularis in terms of reducing pain and improving shoulder external rotation range of motion.

Change in shoulder external rotation strength and motion after lower trapezius transfer to the infraspinatus in children with obstetric brachial plexus palsy.

Quantifying changes in shoulder external rotation range of motion and strength after lower trapezius transfer in children with obstetric brachial plexus palsy (OBPP). This prospective study included five children with sequelae of OBPP, with a mean age of 6.4 years (range: 4-12 years) who underwent lower trapezius tendon transfer to restore active external rotation (ER) of the shoulder. Pre-operatively and at a 12-month follow-up assessment, we analyzed the passive and active shoulder ER, the modified Mallet score, and the shoulder rotator muscles strength using an isokinetic device. Clinical parameters improved significantly after trapezius transfer pre-operative passive ER from -8° (range: -20-0°) to 37° (range: 15-50°) (p = 0.035), the modified Mallet score from 13 (range: 10-15) to 18 (range: 17-19) (p = 0.035). Strength testing revealed improved ER muscle strength in all five cases; the mean Peak Torque increased from 1.95 to 4.46 N·m, albeit non-significantly (p = 0.062). Two patients exhibited a winged scapula post-operatively. Lower trapezius transfer seems encouraging to restore shoulder external rotation in OBPP children but with non-significant strength improvement. 18/07/31/5783, December 22, 2018.

Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analogue scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analogue scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analogue scale, -1.39 [95% CI, -2.41 to -0.36]; P=0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, -0.72 [95% CI, -1.10 to -0.35]; P=0.001; modified Ashworth scale score for shoulder abduction, -0.44 [95% CI, -0.90 to -0.01]; P=0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70-21.41]; P<0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P=0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point (P=0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analogue scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900023513.

Comparison of the efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability:a Meta-analysis

To compare the clinical efficacy between open and arthroscopic Latarjet procedure in the treatment of anterior shoulder instability by using Meta-analysis. Search PubMed, Medline, Embase, Cochrane, China National Knowledge Infrastructure(CNKI), Wanfang database, China Biological Literature system(CBM) and VIP database. Review all retrospective or prospective cohort studies and randomized controlled trials on open and arthroscopic Latarjet procedure for anterior shoulder instability. Binary variables (postoperative recurrence rate, incidence of intraoperative and postoperative complications) and continuousvariables [shoulder external rotation range of motion, Walch-Duplay score, Rowe score, WOSI score, postoperative visual analogue scale (VAS), postoperative anxiety degree and operation time] were selected for analysis. NOS bias risk assessment criteria (recommended by Cochrane collaboration Network) were used to evaluate the literature quality of retrospective or prospective cohort studies, and modified Jadad scale was used to evaluate the quality of randomized controlled trials. Literature screening, literature quality evaluation and data extraction were carried out independently by two observers. RevMan 5.3 software was used for Meta analysis. (1)A total of 9 studies were included, including 8 retrospective cohort studies and 1 prospective cohort study. A total of 956 patients were included in this study, including open Latarjet procedure(n=436) and arthroscopic Latarjet procedure(n=520). (2)The postoperative WOSI score in the open group was better than that of arthroscopic group (MD=93.74, 95%CI:26.00 to 161.49, P=0.007), and the α angle was smaller than arthroscopic group(MD=-6.44, 95%CI:-12.08 to 0.81, P=0.02). (3)The recurrence rate of open Latarjet group was lower than that of arthroscopic Latarjet group, but there was no significant difference between the two groups (OR=0.84, 95%CI:0.23 to 3.05, P=0.79). (4)There were no significant difference in shoulder external rotation, Walch-Duplay score, Rowe score, postoperative visual analogue score, postoperative anxiety degree and operation time between open and arthroscopic Latarjet group. The arthroscopic Latarjet stabilisation shows satisfactory and comparable results to open procedure, and the postoperative recurrence and complication rates are low in both group. Both open and arthroscopic Latarjet procedure are reliable surgical procedures in the treatment of anteriorly shoulder instability. Arthroscopic procedure has longer learning curve than open procedure, the doctors may either choose arthroscopic or open Latarjet procedure based on personal skills and preference, as well as the patient's condition. However, all the literatures included in this study are cohort studies with low level of evidence. The research lack randomized controlled trials, and small sample size is small. In the future, randomized controlled studies with large sample size and high level of evidence are still needed to determine the efficacy difference between the two.

The Comparison of Shoulder External Rotation Range and Upper and Lower Trapezius Muscular Strength in Accordance With the Methods of Stretching the Pectorlis Major Muscles

The aim of this study was to compare and investigate the effects of increased shoulder external rotation range of motion (ROM) and trapezius muscles activities after three different pectoralis major stretching methods. A total of thirty healthy male subjects participated in this study. They were split into three groups. Each group performed one of the three different stretching methods: 1) Manual stretching by a physical therapist (MS), 2) Active stretching using a ball (BS), and 3) Active stretching be themselves (SS). Trapezius muscle activities were measured by using surface electromyogram (S-EMG). The results were measured using Goniometer equipment for the change of ROM and using EMG equipment for the measurement of muscles activities before and after stretching. The stretches were performed three times, and held for 20 seconds on each occasion. The maximal voluntary isometric contraction (MVIC) was determined for each muscle group in order to represent each stretching as a percentage of MVIC, and allow for standardized comparison among subjects. A one-way ANOVA of variance was used to compare the ΔROM (the change between post- and pre-stretching ROM) and Δ%MVIC (the change between post- and pre-stretching muscle activities) among the three groups. The statistical significance level was set at α=0.05. The results showed that the shoulder external rotation ΔROM values did not produce a significant (p>0.05) difference among the three groups, however the Ball Stretching (BS) group showed the largest increase in ΔROM. All of the groups had lower muscle activity after stretching the upper trapezius and higher muscle activity after stretching the middle and lower trapezius. There was no significant difference among the three groups in muscle EMG activity on the upper and lower trapezius. However, the standardized EMG activity on the middle trapezius was markedly higher (p<0.05) for pectoralis muscle Manual Stretching (MS) than BS or SS. These results suggest that pectoralis muscle Ball Stretching (BS) is useful for shoulder external rotation ROM, while Manual Stretching (MS) is more effective for correcting shoulder posture.

Injuries and physical characteristics affecting swimmer participation in the Olympics: A prospective survey

ObjectiveTo identify injuries and physical characteristics affecting swimmers’ performance. DesignProspective study. SettingLaboratory-based. ParticipantsSixty-four Rio Olympic candidates (36 men, 28 women), who were high level swimmers ranked among the top 32 in the 2014 World Ranking in swimming. The participants were categorized into the Olympian group (n = 25), swimmers who were consecutively selected for the Olympic team, and the non-Olympian group (n = 39), swimmers who were not. Main outcome measuresFour months prior to the Olympic qualification in 2016, an orthopedist and two physical therapists evaluated injuries and 11 physical characteristics of the swimmers. The prevalence of total overuse injuries, shoulder and low back injury, and physical characteristics were compared between the two groups. ResultsThe female swimmers in the non-Olympian group had a 53.3% prevalence of total overuse injuries, which was significantly higher than that of those in the Olympian group with 15.4% (p = 0.037). The prevalence of total over use injuries in male swimmers in both the Olympian and non-Olympian groups was 41.7%. Female Olympian group showed that the shoulder external rotation range of motion was significantly less than that of non-Olympian group (97.8 ± 5.7 and 103.6 ± 7.3, p = 0.046). ConclusionsIn female swimmers, total overuse injuries four months before an important competition influence their performance at the event.

“THE EFFECTS OF ANTERIOR VERSUS INFERIOR GLIDE IN IMPROVING FUNCTIONAL ACTIVITY OF THE SHOULDER IN PATIENTS WITH ADHESIVE CAPSULITIS”

Adhesive capsulitis is a self‐limiting condition of elderly people with marked deterioration of activities of daily living (ADL) leading to restriction of psychosocial movement (functional limitation). This article determines the improvement of signs of adhesive capsulitis as per force of direction of application (anterior glide versus posterior glide) on glenohumeral joint that would result in the considerable improvement in shoulder external rotation range of motion, abduction and the functional activity in individuals with adhesive capsulitis. The outcome of this study could potentially guide clinical decision making regarding the most effective direction of mobilization to facilitate functional activity of the patients. During this study it is evident that anterior glide overtakes the inferior glide with considerable mean improvement in the patient’s ROM of shoulder joint being marked decrease in pain of both the joints. From the study in a nutshell, it is evident that all measurable parameters such as Range of motion (ROM) through goniometer, pain through visual analog scale (VAS), sensory intensity, emotional impact and the cognitive evaluation of pain through McGill Pain Questionnaire (implies to multidimensional assessment of pain) were towards the positive side. Thirty patients were randomly selected from the community excluding diabetic patients to avoid the bias, effect of diabetic medication over the joint mobilization. All subjects were evaluated with Goniometer, McGill questionnaire and VAS scale before the mobilization techniques implemented. Divided into two groups and were treated with anterior and inferior mobilization techniques characterized as low‐rate, low‐amplitude techniques with sustained loading of restricting tissue at the end ranges of abduction and/or external rotation with a uniform, gliding movement. Each glide (“after the slack of the joint has been taken up”) was given for 1 minute for a total of 15 minutes of sustained stretch, without giving any oscillatory glides after each set and the patient rested in a neutral position for approximately 10 seconds. On an average of 30 degrees of mean ROM increment was observed whereas for pain scale mean reduction in the values from an average of 8 to 3 were seen. Mean and standard deviation for ROM before the joint mobilization (pre‐treatment) as well as the values after the joint mobilization (post‐treatment) were calculated for both anterior and inferior mobilization techniques and progressed to t‐test for each mobilization technique. The same is repeated for pain scale as well. To conclude, there is a strong evidence of improvement in the joint disability as a result of anterior mobilization technique over inferior.Support or Funding InformationAmerican Association for Anatomists S.NO GROUP A (ROM) MEAN STANDARD DEVIATION t‐TEST 1 Pre‐treatment 22.5 0.973 5.37 2 Post‐treatment 43.4 4.939 S.NO GROUP A (VAS) MEAN STANDARD DEVIATION t‐TEST 1 Pre‐treatment 7.8 1.08 3.65 2 Post‐treatment 3.85 0.99

Is Shoulder Joint Rom Or Ucl Thickness A Predictor Of Medial Elbow Joint Space?

UCL injuries among baseball athletes are an extremely common pathology. It is well documented that baseball athletes typically exhibit an increase in shoulder external rotation range of motion (ERRM) and a decrease in internal rotation range of motion (IRRM) while maintaining total rotational range of motion (TROM). Loss of TROM and ERRM may be associated with increased risk for UCL injury. Ultrasound imaging allows clinicians to evaluate UCL thickness and medial joint space (MJS) opening non-invasively. PURPOSE:To examine if shoulder joint motion (ERRM, IRRM, TROM), or the thickness of the UCL at the mid substance and apex of trochlea predicts medial elbow joint space (MJS) in asymptomatic collegiate baseball pitchers. METHODS:Twenty-nine NCAA Division I pitchers participated in this follow-up study. Ultrasound images were obtained of the MJS and UCL on the participant’s throwing arm using a GE LOGIQ e ultrasound unit. Participants were placed supine with a wedge placed underneath their pitching hand to maintain elbow position at 30 degrees. A 3 kg valgus force, as measured by a hand-held dynamometer, was applied 20 cm distal to the medial epicondyle. Ligament thickness measurements were performed at the mid-substance of UCL and at the apex of the trochlea. Imaging measurements to evaluate MJS opening were performed from the apex of the trochlea to the apex of the ulna. Standard goniometric procedures were performed with the athlete in a supine position to obtain ERRM, IRRM, and TROM values. Three stepwise linear multiple regression analyses were performed to determine if shoulder ROM or UCL thickness measures of the mid-substance and apex of the trochlea could predict MJS. RESULTS:Shoulder joint range of motion were not able to significantly predict MJS [R2= .05, F (2,25) = 0.58, p=0.56,]. UCL thickness at the mid-substance [R2= .04, F (1,25) = 0.10, p=0.76], and at apex of the trochlea [R2= .00, F (1, 25) = 0.03, p=0.95] were not able to significantly predict MJS. CONCLUSIONS:Results further supported prior research that shoulder ROM did not predict MJS, and new to this study, UCL thickness measured at two points were unable to predict MJS in asymptomatic baseball pitchers. Further research is recommended to perform multiple imaging sessions throughout the competitive season to further determine predictors of UCL injuries.

Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial.

In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture? Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty adults undergoing rehabilitation after stroke who were unable to actively extend the affected wrist past neutral or were unable to flex the affected shoulder to 90 deg. Three inpatient rehabilitation units in Australia. Both groups received usual upper limb therapy 5 days a week for 5 weeks. In addition, the experimental group received up to 1 hour a day of active, intensive, repetitive upper limb training using the SMART Arm device 5 days a week for 5 weeks. Measures were collected at baseline (Week 0), after intervention (Week 5) and at follow-up (Week 7). The primary outcomes were passive range of wrist extension, elbow extension, and shoulder flexion at Week 5. The secondary outcomes were: the three primary outcomes measured at Week 7; passive range of shoulder external rotation; arm function; and pain at rest, on movement and during sleep measured at Weeks 5 and7. Following an average of 2310 reaching repetitions, the mean effect at Week 5 on passive range of wrist extension was 1 deg (95% CI -6 to 8), elbow extension -6 deg (95% CI -12 to -1), and shoulder flexion 5 deg (95% CI -8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes. In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles. ACTRN12614001162606.

Effects of a six-week weighted-implement throwing program on baseball pitching velocity, kinematics, arm stress, and arm range of motion.

BackgroundWeighted-baseball training programs are used at the high school, collegiate, and professional levels of baseball. The purpose of this study was to evaluate the effects of a six-week training period consisting of weighted implements, manual therapy, weightlifting, and other modalities on shoulder external rotation, elbow valgus stress, pitching velocity, and kinematics.HypothesisA six-week training program that includes weighted implements will increase pitching velocity along with concomitant increases in arm angular velocities, joint kinetics, and shoulder external rotation.MethodsSeventeen collegiate and professional baseball pitchers (age range 18–23, average: 19.9 ± 1.3) training at Driveline Baseball were evaluated via a combination of an eight-camera motion-capture system, range-of-motion measurements and radar- and pitch-tracking equipment, both before and after a six-week training period. Each participant received individualized training programs, with significant overlap in training methods for all athletes. Twenty-eight biomechanical parameters were computed for each bullpen trial, four arm range-of-motion measurements were taken, and pitching velocities were recorded before and after the training period. Pre- and post-training period data were compared via post-hoc paired t tests.ResultsThere was no change in pitching velocity across the seventeen subjects. Four biomechanical parameters for the holistic group were significantly changed after the training period: internal rotational velocity was higher (from 4,527 ± 470 to 4,759 ± 542 degrees/second), shoulder abduction was lower at ball release (96 ± 7.6 to 93 ± 5.4°), the shoulder was less externally rotated at ball release (95 ± 15 to 86 ± 18°) and shoulder adduction torque was higher (from 103 ± 39 to 138 ± 53 N-m). Among the arm range of motion measurements, four were significantly different after the training period: the shoulder internal rotation range of motion and total range of motion for both the dominant and non-dominant arm. When the group was divided into those who gained pitching velocity and those who did not, neither group showed a significant increase in shoulder external rotation, or elbow valgus stress.ConclusionsFollowing a six-week weighted implement program, pitchers did not show a significant change in velocity, joint kinetics, or shoulder external rotation range of motion. When comparing pitchers who gained velocity versus pitchers who did not, no statistically significant changes were seen in joint kinetics and shoulder range of motion.

The short-term effect of swimming training load on shoulder rotational range of motion, shoulder joint position sense and pectoralis minor length

Shoulder pain or injury is the most common issue facing elite competitive swimmers and the most frequent reason for missed or modified training. Literature suggests that highly repetitive upper limb loading leads to inappropriate adaptations within the shoulder complex. The most likely maladaptations to occur are variations in shoulder rotational range of motion, reduction in joint position sense and shortened pectoralis minor length. This has yet to have been confirmed in experimental studies. The aim of this study was to investigate the short-term effects of swimming training load upon internal and external rotation range of motion, joint position sense and pectoralis minor length. Sixteen elite swimmers training in the British Swimming World Class programme participated. Measures of internal and external range of motion, joint position sense error score and pectoralis minor length were taken before and after a typical 2 h swimming session. Following swimming training shoulder external rotation range of motion and pectoralis minor length reduced significantly (-3.4°, p = <0.001 and -0.7 cm, p = <0.001, respectively), joint position sense error increased significantly (+2.0° error angle, p = <0.001). Internal rotation range of motion demonstrated no significant change (-0.6, p = 0.53). This study determined that elite level swimming training results in short-term maladaptive changes in shoulder performance that could potentially predispose them to injury.

Does Shoulder Joint ROM Predict Medial Elbow Joint Space and UCL Thickness?

Baseball athletes, especially pitchers, are prone to ulnar collateral ligament (UCL) injuries of the elbow. It is well documented that baseball athletes typically exhibit an increase in shoulder external rotation range of motion (ERRM) and a decrease in internal rotation range of motion (IRRM) while maintaining total rotational range of motion (TROM) in the throwing extremity. Furthermore, loss of TROM and ERRM may be associated with increased risk for UCL injury. Ultrasound imaging allows clinicians to evaluate UCL thickness and medial joint space (MJS) opening non-invasively. PURPOSE: To examine if shoulder joint motion (ERRM, IRRM, TROM), predicts medial elbow joint space (MJS) opening and UCL thickness in asymptomatic collegiate baseball pitchers at the start of the pre-season. METHODS: Nineteen asymptomatic NCAA Division I collegiate baseball pitchers (age 20.4 ± 1.45 yrs) participated in this study. Ultrasound images were obtained of the medial joint space and UCL on the participant’s throwing arm using a GE LOGIQ e ultrasound unit. Participants were placed supine with a wedge placed underneath their pitching hand to maintain elbow position at 30 degrees. A 3 kg valgus force, as measured by a hand held dynamometer, was applied 20 cm distal to the medial epicondyle. Ligament thickness measurements were performed at the mid-substance of UCL and at the apex of the trochlea. Imaging measurements to evaluate MJS opening were performed from the apex of the trochlea to the apex of the ulna. Standard goniometric procedures were performed with the athlete supine to obtain ERRM, IRRM, and TROM values. Three stepwise linear multiple regression analyses were performed to determine if shoulder joint motion could predict UCL thickness and MJS. RESULTS: Shoulder joint range of motion did not significantly predict MJS [R2 = .05, F (2,16) = 0.44, p=0.65,], UCL thickness at the mid-substance [R2 = .01, F (2,16) = 0.12, p=0.89], or UCL thickness at the apex of the trochlea [R2 = .04, F (2, 16) = 0.36, p=0.70]. CONCLUSIONS: Measures of shoulder joint ROM do not predict MJS or UCL thickness in asymptomatic baseball pitchers at the start of the season. Further research is recommended to perform multiple imagining sessions throughout the competitive season to further evaluate relationships between shoulder ROM and medial elbow structures.

The Effect of Peripheral Nerve Stimulation on Shoulder Biomechanics: A Randomized Controlled Trial in Comparison to Physical Therapy.

To establish the effects on shoulder biomechanics from a peripheral nerve stimulation (PNS) treatment compared to physical therapy (PT) in stroke survivors with chronic hemiplegic shoulder pain. Single-site, pilot, randomized controlled trial for adults with chronic shoulder pain after stroke. Participants were randomized to receive a 3-week treatment of single-lead PNS or physical therapy (PT). The outcomes included isometric shoulder abduction strength, pain-free shoulder external rotation range of motion (ROM), delay in initiation and termination of shoulder abduction electromyogram (EMG) activity, and the Fugl-Meyer Motor Assessment (upper extremity section). Outcomes were measured at baseline, and at weeks 1, 4, 12, and 16. Twenty-five participants were recruited, 13 to PNS and 12 to PT. There were significant improvements for both PNS and PT in maximum isometric shoulder abduction strength, pain-free external rotation ROM, and Fugl-Meyer Motor Assessment. There were no significant changes in delay of initiation or termination of deltoid EMG with either treatment. Both PNS and PT are capable of improving shoulder biomechanics in those with HSP, though changes in biomechanics alone do not account for the greater pain relief associated with PNS than PT.

Impact of a competition with two consecutive matches in a day on physical performance in young tennis players.

The purpose of this study was to analyze the effects of playing 2 tennis matches on the same day on physical performance in young tennis players. Twelve well-trained young tennis players took part in a simulated tennis competition consisting of 2 tennis matches on the same day (morning and afternoon sessions). Before and the day after the competition, physical performance was measured using a battery of countermovement jumps; a 10 m sprint; the 5-0-5 agility test; hip, grip and shoulder maximal isometric strength; shoulder range of motion; and a serve velocity test. Postcompetition results showed reduced performance in 10 m (-3.3%, effect size (ES) = small), dominant and nondominant 5-0-5 agility test (-4.6%, ES = moderate; -4.2%, ES = moderate, respectively), bilateral (-5.2%, ES = small), and unilateral countermovement jumps (dominant leg: -7.2%, ES = small; non-dominant leg: -9.1%, ES = small). Both dominant and nondominant shoulder external rotation range of motion increased (12.2%, ES = moderate; 5.6%, ES = small), whereas internal rotation decreased (-4.2%, ES = small; -3.3%, ES = small) in the postcompetition tests, together with the dominant shoulder external rotation (-10.7%, ES = moderate) and internal rotation (-9.3%, ES = small) strength. Physical impairments occurred in neuromuscular performance variables involving lower (e.g., jumping, sprinting, and change of direction) and upper (e.g., isometric strength and range of motion) limbs the day after playing a competition with 2 consecutive matches on the same day. These alterations in neuromuscular and sport-specific performance need to be taken into consideration when planning tournament schedules for young tennis players, as well as preparing match and recovery strategies.