Rotation Deficit Research Articles

GLENOHUMERAL INTERNAL ROTATION DEFICIT (GIRD) – DOES IT REALLY EXISTS IN HANDBALL PLAYERS?

BackgroundGIRD is a condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side. Mechanism of GIRD is caused by repetitive throwing such...

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During the throwing motion high forces are placed on the athlete's shoulder and extreme positions of external rotation and abduction are reached. The dynamic and static stabilizers of the glenohumeral joint need to handle a delicate balance between shoulder mobility and stability. Repetitive forces lead to adaptive osseous, capsular, ligament and muscular changes. This should increase external rotation of the shoulder and thus initially help to improve performance but ultimately could cause shoulder pathologies. For instance, tissue overuse can result in muscular imbalance, functional instability and posterior capsular contracture with the development of a glenohumeral internal rotation deficit. An internal impingement is often observed in throwing athletes which can be subdivided into the more common posterosuperior type and the rarer anterosuperior type. Typical lesions in the throwing shoulder are articular-sided partial rotator cuff tears, labrum and biceps tendon lesions and edema, cysts or osteochondral lesions of the humeral head or glenoid. For an accurate diagnosis it is important to include the history, a thorough physical examination and magnetic resonance arthrography. The correlation of clinical examination and imaging is critical to identify symptomatic lesions. If conservative therapy fails or in cases of significant structural damage resulting in clinical symptoms, surgical treatment should be considered based on the underlying pathology and carried out using established techniques and criteria.

Abnormalities of mental rotation of hands associated with speed of information processing and executive function in chronic schizophrenic patients.

Deficits in mental imagery ability have been reported in patients with schizophrenia. However, there is scarce evidence about the correlation between impairment in mental rotation and other cognitive deficits in the patients. The aim of this study was to assess mental rotation ability, along with other measures of cognitive function in patients with schizophrenia. The performance of 29 patients with schizophrenia was compared with 29 healthy controls. Mental rotation was measured with the Hand Rotation Task, and cognitive functions were measured with the Brief Assessment of Cognition in Schizophrenia (BACS). On Hand Rotation Task, the patients were significantly slower and less accurate compared to controls. Moreover, mental rotation accuracy was significantly correlated with all the BACS domains except verbal memory. In multiple regression analysis, the two BACS subscales, Tower of London and Symbol Coding tasks, were significant predictors and accounted for 41% of the variance in accuracy in the patients. These results support previous findings showing dysfunction of the posterior parietal cortex in schizophrenia, which is involved in general mental rotation, as well as other cognitive processes.

Increase in Humeral Retrotorsion Accounts for Age-Related Increase in Glenohumeral Internal Rotation Deficit in Youth and Adolescent Baseball Players

Background: Glenohumeral internal rotation deficit (GIRD) is the difference in internal rotation range of motion (IRROM) between the dominant and nondominant limbs. Pathological GIRD of greater than 15° to 25° has previously been linked to shoulder and elbow injuries in baseball players. Because of its relationship to shoulder and elbow disorders, research has focused on understanding the underlying factors that contribute to changes in IRROM and ultimately GIRD. The rotation deficit reportedly increases during adolescence, but it remains unclear whether this change is caused by changes in osseous properties or soft tissue tightness. Purpose: To evaluate the influence of age group on GIRD, humeral retrotorsion, retrotorsion-adjusted GIRD, and total range of motion (TROM) in healthy baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Four groups of healthy baseball players participated in the study: 52 youth (aged 6-10 years), 52 junior high school (JH) (aged 11-13 years), 70 junior varsity (JV) (aged 14-15 years), and 113 varsity (aged 16-18 years) players. Internal rotation range of motion, external rotation range of motion (ERROM), and humeral retrotorsion were measured bilaterally using a digital inclinometer and diagnostic ultrasound. Retrotorsion-adjusted IRROM was calculated as the available IRROM from the humeral retrotorsion position; TROM was calculated as the sum of IRROM and ERROM; and GIRD, the difference in humeral retrotorsion between limbs, adjusted GIRD, and the difference in TROM between limbs were calculated as the difference between the dominant and nondominant sides. Four separate analyses of variance were used to compare these variables between age groups. Results: There was a significant group difference in GIRD (F3,284 = 8.957; P < .001) and a difference in humeral retrotorsion between limbs (F3,284 = 9.688; P < .001). Also, GIRD was greater in varsity participants compared with youth (mean difference [MD], 5.05°) and JH (MD, 4.95°) participants and in JV participants compared with JH (MD, 5.36°) and youth (MD, 5.47°) participants. The difference in humeral retrotorsion between limbs was greater in varsity participants compared with youth (MD, 8.79°) and JH (MD, 5.52°) participants and in JV participants compared with youth participants (MD, 7.88°). There were no significant differences in adjusted GIRD (F3,284 = 1.136; P = .335) or TROM (F3,284 = 1.214; P = .305). Conclusion: Glenohumeral internal rotation deficit and humeral retrotorsion increased with age in youth/adolescent baseball players, while retrotorsion-adjusted GIRD and TROM remained unchanged. An age-related increase in GIRD is primarily attributed to humeral retrotorsion rather than soft tissue tightness. Clinical Relevance: While there was an increase in GIRD from youth league to high school participants, TROM and retrotorsion-adjusted GIRD remained constant across the age groups, indicating that this increase between the age groups is not pathological GIRD and may not contribute to an increased injury risk.

Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances.

Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future.

Obstetric Brachial Plexus Palsy: The Mallet Grading System for Shoulder Function—Revisited

The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb's palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems.

Implementation of a generalized actuator disk wind turbine model into the weather research and forecasting model for large-eddy simulation applications

A generalized actuator disk (GAD) wind turbine parameterization designed for large-eddy simulation (LES) applications was implemented into the Weather Research and Forecasting (WRF) model. WRF-LES with the GAD model enables numerical investigation of the effects of an operating wind turbine on and interactions with a broad range of atmospheric boundary layer phenomena. Numerical simulations using WRF-LES with the GAD model were compared with measurements obtained from the Turbine Wake and Inflow Characterization Study (TWICS-2011), the goal of which was to measure both the inflow to and wake from a 2.3-MW wind turbine. Data from a meteorological tower and two light-detection and ranging (lidar) systems, one vertically profiling and another operated over a variety of scanning modes, were utilized to obtain forcing for the simulations, and to evaluate characteristics of the simulated wakes. Simulations produced wakes with physically consistent rotation and velocity deficits. Two surface heat flux values of 20 W m−2 and 100 W m−2 were used to examine the sensitivity of the simulated wakes to convective instability. Simulations using the smaller heat flux values showed good agreement with wake deficits observed during TWICS-2011, whereas those using the larger value showed enhanced spreading and more-rapid attenuation. This study demonstrates the utility of actuator models implemented within atmospheric LES to address a range of atmospheric science and engineering applications. Validated implementation of the GAD in a numerical weather prediction code such as WRF will enable a wide range of studies related to the interaction of wind turbines with the atmosphere and surface.

The Effect of Glenohumeral Internal Rotation Deficit Improving Rehabilitation Program in the Male High-School Baseball Players

To investigate the effect of the glenohumeral internal rotation deficit (GIRD) improving rehabilitation program in high school baseball players on the change in muscle strength balance and pain of their shoulders. Seventy-six players (35 control group, 41 experimental group) participated in this 6-month study, from April, 2012 to September, 2012. The rehabilitation program (sleeper stretch) was carried out by coaches of experimental group. The experimental group showed a significant decrease, while the control group didn't show significant change in GIRD. The shoulder flexion-extension isokinetic strength ratio of experimental group changed only slightly, while that of control group experienced a bigger change. Experimental group players initially had high frequency of shoulder pain, but decreased to 53% at the end. Also, the Short Form-36 Health Survey showed the increase of total score. GIRD improving rehabilitation program helps to maintain the balance of shoulder extension-flexion strength ratio and relieve shoulder pain in the baseball players.

Evaluation of the Kinetic Chain in Little League Elbow

This study is to evaluate the abnormalities in the kinetic chain in the players with little league elbow during the medical screening of middle school baseball teams. Ninety-three players were examined with elbow ultrasonography in the field. Using kinetic chain evaluation test, 27 players sonogrphically diagnosed of little league elbow in dominant arm were compared with 25 players who were normal as control. Scapular-spine distance, horizontal flexion test, combined abduction test, and glenohumeral internal rotation deficit were used for evaluating kinetic chain in the upper extremities, while tightness of quadriceps and hamstring muscles, internal rotation of stance leg, and external rotation of stride leg were used for lower extremities. Also, the single leg stance test and finger-floor distance were used for core stability and flexibility. Twenty-five of 27 players (93%) having little league elbow showed kinetic chain abnormalities of either upper or lower extremities or trunk. This rate was significantly higher for the players having the little leaguer’s elbow than control (28%) (p=0.017). Each specific tests for evaluating kinetic chain were also more prevalent in little league elbow group than control, and the abnormalities in the upper extremity were more common than those in lower extremity (p=0.026). Combined abduction test (23/27) and limitation of internal rotation of stance leg (16/27) were the most prevalent abnormalities in upper and lower extremity test, respectively. Our findings showed that there are many abnormalities in kinetic chain in players having the little league elbow and it may be associated with pathogenesis of little league elbow.

Revisit to scapular dyskinesis: three-dimensional wing computed tomography in prone position

Three-dimensional (3D) wing computed tomography (CT) showed a high inter-rater reliability in assessing scapular dyskinesis. The 330 scapular movements of 165 patients were classified into 4 types by 7 blinded observers. Then, 3D wing CT was performed with patients prone, and 4 blinded observers measured 5 angles, consisting of upward rotation (UR) superior translation (ST), anterior tilting (AT), protraction (PRO), and internal rotation (IR). The inter-rater reliability (IRR) of 2 methods was calculated, and cutoff values were determined for the 5 angles on the 3D wing CT images. The IRR was 0.783 for the observational method of scapular dyskinesis and 0.981 for 3D wing CT in the prone position. UR and ST angles were significantly larger in type 3 more than in the other types (P < .001, P < .001), and the AT angle showed a similar pattern in type 1 (P < .001). The PRO angle was significantly larger in types 1, 2, and 3 more than in type 4 (P < .001, P < .001, P = .013), and the IR angle was significantly larger in type 2 more than in the other types (P < .001). The cutoff values of the 5 angles were UR, 117°; ST, 90°; AT, 8°; PRO, 99°; and IR, 51°. The UR angle showed a significant correlation with glenohumeral internal rotation deficit (odds ratio, 0.436; P = .029) and the IR angle with MDI (odds ratio, 8.947; P = .048). The patients with a high UR angle showed a low rate of glenohumeral internal rotation deficit and those with a high IR angle had a high rate of the MDI in affected shoulder by the determinant of the cutoff value of the 5 angles. Level III, development of diagnostic criteria with nonconsecutive patients, diagnostic study.

Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up

BackgroundStudies dealing with acute osseous Bankart lesions and corresponding treatment strategies are rare. The purpose of this study is to analyze the results after applying our treatment algorithm for acute glenoid rim fractures caused by first time traumatic anterior shoulder dislocations.Methods25 patients were included in this retrospective case series. All patients sustained a first time shoulder dislocation caused by ski or snowboard accidents. An osseous Bankart lesion was detected in all shoulders. Operative therapy was performed in patients with osseous defects of 5% or more, otherwise conservative therapy was initiated. Primary study outcome parameter was the Rowe score. Additionally, the outer rotation deficit and operative complications were analysed.Results12 patients showed a defect size of less than 5% and were treated conservatively. The average lesion size was 2%. For these patients, the Rowe score was excellent in 58%, good in 25%, and moderate in 17% of patients. Three patients (25%) complained about a feeling of instability. 13 patients had a lesion size of more than 5%, average 15%, and were treated operatively. The Rowe score for this group was excellent in 54%, good in 31%, and moderate results in 15% of patients. One patient (8%) complained about a feeling of instability, without recurrent dislocations. There were no statistically significant differences between both study groups (ROWE score: p = 0.98).ConclusionsApplying our treatment algorithm for acute osseous Bankart lesions consisting of a conservative strategy for small defect sizes and a surgical approach for medium-sized and large defects leads to encouraging mid-term results and a low rate of recurrent instability in active patients.

Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls

Cross-sectional. To compare lower extremity balance and shoulder range of motion in baseball players with ulnar collateral ligament (UCL) tears to a healthy cohort. Background Throwing is a complex motion that requires balance and coordination to effectively transfer energy through the kinetic chain. In theory, poorer balance could negatively affect throwing mechanics and lead to injury. Thirty baseball players (mean ± SD age, 18.5 ± 1.9 years) with a diagnosis of a UCL tear of their throwing arm were compared to 30 players (age, 19.0 ± 1.1 years) without a UCL tear. All participants were competing at either the high school or collegiate level and reported an average ± SD of 13.5 ± 1.7 years of playing experience. The Y Balance Test composite scores were calculated for the stance and lead lower extremities of all players. Shoulder range of motion was used to calculate glenohumeral internal rotation deficit and side-to-side differences in total rotational motion. Group comparisons were made between participants with and without UCL tears using independent t tests. Baseball players with UCL tears scored significantly lower on the Y Balance Test for both the stance (P<.001) and lead (P<.001) lower extremities compared to the noninjured cohort. No between-group differences were noted in glenohumeral internal rotation deficit (P = .453), whereas the mean ± SD side-to-side difference in total rotational motion was -6.0° ± 9.6° for the injured group, compared to -0.4° ± 9.6° for the control group (P = .028). Participants with a UCL tear demonstrated decreased performance for their stance and lead lower extremities during the Y Balance Test. These data are consistent with a clinical hypothesis of a potential association between impaired balance and UCL tears in high school and collegiate baseball players. The lower total rotational motion of the dominant shoulder in participants with UCL tears needs to be considered in the interpretation of those results.

Meta-analysis of Function After Secondary Shoulder Surgery in Neonatal Brachial Plexus Palsy

Shoulder internal rotation contracture, active abduction, and external rotation deficits are common secondary problems in neonatal brachial plexus palsy (NBPP). Soft tissue shoulder operations are often utilized for treatment. The objective was to conduct a meta-analysis and systematic review analyzing the clinical outcomes of NBPP treated with a secondary soft-tissue shoulder operation. A literature search identified studies of NBPP treated with a soft-tissue shoulder operation. A meta-analysis evaluated success rates for the aggregate Mallet score (≥ 4 point increase), global abduction score (≥ 1 point increase), and external rotation score (≥ 1 point increase) using the Mallet scale. Subgroup analysis was performed to assess these success rates when the author chose arthroscopic release technique versus open release technique with or without tendon transfer. Data from 17 studies and 405 patients were pooled for meta-analysis. The success rate for the global abduction score was significantly higher for the open technique (67.4%) relative to the arthroscopic technique (27.7%, P<0.0001). The success rates for the global abduction score were significantly different among sexes (P=0.01). The success rate for external rotation was not significantly different between the open (71.4%) and arthroscopic techniques (74.1%, P=0.86). No other variable was found to have significant impact on the external rotation outcomes. The success rate for the aggregate Mallet score was 57.9% for the open technique, a nonsignificant increase relative to the arthroscopic technique (53.5%, P=0.63). Data suggest a correlation between increasing age at the time of surgery and a decreasing likelihood of success with regards to aggregate Mallet with an odds ratio of 0.98 (P=0.04). Overall, the secondary soft-tissue shoulder operation is an effective treatment for improving shoulder function in NBPP in appropriately selected patients. The open technique had significantly higher success rates in improving global abduction. There were no significant differences in the success rates for improvement in the external rotation or aggregate Mallet score among these surgical techniques.

Is Craniofacial Asymmetry Progressive in Untreated Congenital Muscular Torticollis?

Although craniofacial asymmetry is frequently involved in patients with congenital muscular torticollis, it has not been evaluated appropriately. The authors analyzed preoperative craniofacial asymmetry objectively and confirmed the relationship between craniofacial asymmetry and aging in congenital muscular torticollis patients who underwent surgical release. The authors retrospectively measured preoperative craniofacial asymmetry using the Cranial Vault Asymmetry Index and intercommissural angle and reviewed preoperative rotational and flexional deficit of neck movement for 123 congenital muscular torticollis patients who underwent surgical release at Ajou Medical Center from February of 2007 to February of 2011. The relationships among Cranial Vault Asymmetry Index, intercommissural angle, rotational deficit, flexional deficit, and age were analyzed. Mean values of dependent variables were compared after patients were grouped by age. Mean age at operation was 82.5 months (range, 5 to 498 months). Seventy-one percent (n=87) of patients had a significant cranial asymmetry and 87 percent (n=107) had a significant facial asymmetry. In correlation analysis, intercommissural angle increased proportional to age (r=0.334, p=0.000), especially before 3 years (r=0.42, p=0.001). Cranial Vault Asymmetry Index was unrelated to age or rotational or flexional deficit. Rotational deficit decreased proportional to age (r=-0.229, p=0.032). By analysis of variance test, intercommissural angle and rotational deficit between the age groups were statistically significantly different (p<0.05). In congenital muscular torticollis, facial asymmetry is progressive if the contracted sternocleidomastoid muscle is not released, although cranial asymmetry is already determined in those younger than 6 months. Early correction of torticollis should be considered to prevent progression of facial asymmetry in congenital muscular torticollis patients. Risk, III.

Comparison of shoulder range of motion, strength, and endurance in amateur pitchers practicing repetitive overhead throwing

BACKGROUND: A decrease in the range of internal rotation known as glenohumeral internal rotation deficit (GIRD) which caused by repetitive overhead throwing is known to take place in elite baseball players. However few attempts at studying the differences in the range of motion (ROM), muscle strength, and endurance according to the duration of the involvement of players have been made. OBJECTIVE: To investigate the difference in ROM, muscle strength, endurance of shoulder among amateur pitchers. METHOD: Forty-two right-handed amateur pitchers in their 20 s and 30 s, with similar physical characteristics participated in the study. They were divided into three groups according to their pitching experience. Range of motion, shoulder external and internal strength and endurance and grip strength were measured and compared. RESULTS: The ROM was significantly different among the 3 groups (P < 0.05), especially with respect to external rotation, internal rotation, and external rotation on side-lying. The peak torque of the right external rotators differed significantly between 2 and 3 year experience groups (P < 0.05). Further, the peak torque and the endurance of external rotator significantly differed between dominant and non-dominant shoulders in between 1 year group and 2 years group (P < 0.05). In external rotation endurance, there were significant differences between the 1 and 2 years groups, and between the 2 and 3 years group (P < 0.05). CONCLUSIONS: In conclusion, repetitive overhead throwing for more than a year caused structural changes in shoulder joints, which were possible responsible for changes in the range of motion and decrease external rotators performance. Such changes in the shoulder could generate a pattern shift in motion and cause secondary injuries such as internal impingement syndrome.

Weber Osteotomy for Large Hill-Sachs Defects: Clinical and CT Assessments

The Weber derotation osteotomy is an uncommon procedure that typically is reserved for patients with engaging Hill-Sachs defects who have had other surgical treatments for shoulder instability fail. It is unknown whether the desired humeral derotation actually is achieved with the Weber osteotomy. The purposes of this study were to answer the following questions: (1) What are the complication (including redislocation) and reoperation rates of the Weber osteotomy? (2) What are the American Shoulder and Elbow Surgeons (ASES) and functional (ROM in internal rotation, self care) results? (3) What fraction of the patients had humeral derotation within 10° of the desired rotation? A chart review of 19 Weber osteotomies and clinical assessment of 10 Weber osteotomies were performed by independent clinicians. The chart review, at a mean followup of 51 months (range, 13-148 months), focused on the complication rate and the frequency of redislocation. The clinical and CT assessments, at a mean followup of 54 months (range, 26-151 months), focused on ASES scores, ability of patients to perform self care with the affected arm, and CT scans to measure change in humeral retroversion. There were 25 complications and nine reoperations in 17 patients (19 shoulders), including pain (six patients, of whom one had complex regional pain syndrome), hematoma, infection, nonunion, delayed union, reoperations related to hardware and other noninstability-related causes (five patients), and internal rotation deficit. Redislocation occurred in one patient, who underwent repeat surgery, and subjective instability developed in two others. The mean ASES score was 78 points (of 100 points); six of the 10 patients (11 procedures) evaluated in person found it difficult or were unable to wash their backs with the affected arm. Humeral derotation varied from 7° to 77°; only three of the nine patients for whom CT scans were available had derotation within 10° of the desired rotation. Complication rates with the Weber osteotomy were much higher than previously reported. Because seven of 17 patients were lost to followup, the redislocation rate may be higher than we observed here. Given the unpredictable variability in humeral derotation achieved with a Weber osteotomy, an improved surgical technique is critical to avoid osteoarthritis and loss of internal rotation associated with overrotation.

Isolated latissimus dorsi transfer to restore shoulder external rotation in adults with brachial plexus injury

In adults with brachial plexus injuries, lack of active external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper limb function. There is a paucity of evidence to address this complex issue. We present our experience of isolated latissimus dorsi (LD) muscle transfer to achieve active external rotation. This is a retrospective review of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All patients were male with a mean age of 34 years (21 to 57). All the patients underwent isolated LD muscle transfer using a standard technique to correct external rotational deficit. Outcome was assessed for improvement in active external rotation, arc of movement, muscle strength and return to work. The mean improvement in active external rotation from neutral was 24° (10° to 50°). The mean increase in arc of rotation was 52° (38° to 55°). Mean power of the external rotators was 3.5 Medical Research Council (MRC) grades (2 to 5). A total of 21 patients (88%) were back in work by the time of last follow up. Of these, 13 had returned to their pre-injury occupation. Isolated latissimus dorsi muscle transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial plexus injuries with internal rotational deformity.

Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. Assessment of the shoulder range of motion (ROM), strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22) and Painful Group (n=27). The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation), isometric shoulder strength (internal and external rotation) and posterior shoulder tightness by blind evaluators. The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05). The intragroup analysis (dominant versus non-dominant) in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05). The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM), external rotation gain (ROM) and deficits in external rotation strength than the tennis players without pain.

Subscapularis Slide Correction of the Shoulder Internal Rotation Contracture After Brachial Plexus Birth Injury

Internal rotation contracture is the most common shoulder deformity in patients with brachial plexus birth injury. The purpose of this investigation is to describe the indications, technique, and results of the subscapularis slide procedure. The technique involves the release of the subscapularis muscle origin off the scapula, with preservation of anterior shoulder structures. A standard postoperative protocol is used in all patients and includes a modified shoulder spica with the shoulder held in 60 degrees of external rotation and 30 degrees of abduction, aggressive occupational and physical therapy, and subsequent shoulder manipulation under anesthesia with botulinum toxin injections as needed. Seventy-one patients at 2 institutions treated with subscapularis slide between 1997 and 2010, with minimum follow-up of 39.2 months, were identified. Patients were divided into 5 groups based on the index procedure performed: subscapularis slide alone (group 1); subscapularis slide with a simultaneous microsurgical reconstruction (group 2); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide (group 3); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide combined with tendon transfers for shoulder external rotation (group 4); and subscapularis slide with simultaneous tendon transfers, with no prior brachial plexus surgery (group 5). Full passive external rotation equivalent to the contralateral side was achieved in the operating room in all cases. No cases resulted in anterior instability or internal rotation deficit. Internal rotation contracture of the shoulder after brachial plexus birth injury can be effectively managed with the technique of subscapularis slide.

Behavioural recovery on simple and complex tasks by means of cell replacement therapy in unilateral 6‐hydroxydopamine‐lesioned mice

Before cell replacement therapies can enter the clinic, it is imperative to test the therapeutic benefits in well-described animal models. In the present study, we aimed to investigate the effects of 6-hydroxydopamine lesions to the medial forebrain bundle and subsequent grafting of embryonic day (E)12.5 ventral mesencephalon into the denervated striatum in C57/Bl6 mice on a battery of simple motor tests (drug-induced rotation, rotarod, and corridor) and the lateralised choice reaction time task conducted in the mouse nine-hole box. Histological analysis confirmed effective lesions and good graft survival. The lesion induced marked deficits in the choice reaction time task, the rotarod test, and corridor test, and these deficits were partially but significantly alleviated in the grafted mice. Although the lesions induced significant rotation following injections of amphetamine and apomorphine, respectively, the grafts did not, suprisingly, alleviate the rotation deficit. This study shows the ability of ventral mesencephalic tissue to ameliorate some of the lesion-induced deficits, and the power of operant testing in detecting small but significant improvements. The behavioural tests presented are useful drug-free approaches for evaluating cell-based therapies.