Shoulder Abduction Research Articles

Effect of Glenohumeral Abduction on Supraspinatus Tendon Strain: A Cadaveric Study

Objectives Rotator cuff tears are among the most common causes of shoulder pain and loss of function in adults. The supraspinatus tendon plays a crucial role in shoulder abduction, where a better understanding of the mechanical environment could lead to more informed clinical decisions. This study aimed to examine the heterogeneous nature of the supraspinatus tendon to understand the differences in regional strain patterns. Methods Five fresh frozen cadaveric shoulders were abducted from 60° to 90°. The supraspinatus tendon was loaded at 30 newtons to simulate motion in a subject operating at roughly 26% of the maximum glenohumeral abduction force. The surface strain at the supraspinatus tendon insertion, where tears most commonly occur, was evaluated in the tendon’s anterior, middle, and posterior regions to identify the heterogeneous deformation during abduction. Results Surface strain increased with increasing abduction angle (R2 = 0.697, P < 0.001). The posterior regions exhibited larger strains compared to the anterior regions at 70° (P = 0.037), 75° (P = 0.028), and 90° (P = 0.011) of abduction. Conclusion During abduction, the strain on the bursal surface of the supraspinatus tendon insertion increases with increasing abduction angle, and the posterior region experiences the largest strains.

The Lycra arm sleeve for treatment of glenohumeral subluxation in people with sub-acute stroke: a randomized controlled (RC) feasibility study

ABSTRACT Background A Lycra arm sleeve has the potential to reduce glenohumeral subluxation (GHS) in people with stroke (PwS). Aims were (1) to provide feasibility data to inform a future fully powered randomized controlled trial, (2) to understand whether patients would be willing to be randomized, (3) to measure changes in GHS at 3 months after wearing the sleeve when compared to not wearing the sleeve. Method PwS ≥18 years with ≤3/5 shoulder abduction strength and able to give informed consent were recruited. The feasibility data on recruitment, screening, and retention rate at 12 weeks were collected. Participants were asked if they would be happy to be randomized into one of the two groups. The immediate group received the Lycra sleeve on recruitment and wore for up to 10 hours/day for 3 months. The delayed group received the sleeve after follow-up assessment at 3 months. GHS was assessed using diagnostic ultrasound method. Results Over one year, 257 patients were screened, 34 patients were eligible, and 31 (91%) were recruited. Retention at 3 months was 27 (87%). Of those eligible, all found randomization to be acceptable. In the immediate group, GHS showed reduction from 2.6 ± 0.7 cm (95% CI 2.0–3.1 cm) at baseline to 2.2 ± 0.4 cm (CI 2.0–2.5 cm) at 12 weeks. In the delayed group, mean GHS remained unchanged over 3 months period (2.3 ± 0.5 cm, CI 1.9–2.7 cm). Conclusion Recruitment was harder than anticipated, but there was high retention demonstrating feasible methodology. There is some indication of a clinical effect of Lycra sleeve on GHS early after stroke.

The Disease-Modifying Effects of a Single Intra-Articular Corticosteroid Injection during the Freezing Phase of Frozen Shoulder in an Animal Model.

Although frequently prescribed for frozen shoulder, it is not known if corticosteroid injections improve the course of frozen shoulder. This study aimed to assess the disease-modifying effects of an intra-articular corticosteroid administration at the freezing phase of frozen shoulder. Twenty-four Sprague-Dawley rats were divided into four groups. Their unilateral shoulders were immobilized for the first 3 days in all groups, followed by an intra-articular corticosteroid injection in Group A, an injection and the cessation of immobilization in Group B, no further intervention in Group C, and the cessation of immobilization in Group D. All rats were sacrificed in Week 3 of study, at which point the passive shoulder abduction angles were measured and the axillary recess tissues were retrieved for histological and Western blot analyses. The passive shoulder abduction angles at the time of sacrifice were 138° ± 8° (Group A), 146° ± 5° (Group B), 95° ± 11° (Group C), 132° ± 8° (Group D), and 158° ± 2° (Control). The histological assessments and Western blots showed greater fibrosis and inflammation in the groups that did not receive the corticosteroid injection (Groups C and D) compared to the corticosteroid-injected groups (Groups A and B). These findings demonstrate the anti-inflammatory and disease-modifying effects of corticosteroid injections during the freezing phase of frozen shoulder in an animal model.

Insights into the Medial Pectoral Nerve Transfer for Shoulder Abduction in Brachial Plexus Injuries: A Retrospective Case Series Analysis

Treatment priority in C5, C6, and C7 brachial plexus root avulsion is the recovery of shoulder function through reinnervation of shoulder muscles. The medial pectoral nerve is a potential donor for axillary nerve transfer, but outcomes are sparsely reported. This study reports the results of medial pectoral nerve transfer to the axillary nerve. We conducted a retrospective analysis of 12 patients with traumatic brachial plexus injury (C5, C6, and C7 root avulsion) who underwent medial pectoral nerve transfer to the axillary nerve. Sociodemographic and clinical characteristics, including electromyography findings, were documented. We assessed postoperative shoulder abduction strength and range of motion. Statistical analyses compared presurgery and postsurgery outcomes and contrasted our results with those from a study using spinal accessory nerve transfer to the suprascapular nerve. Postsurgery, the mean shoulder abduction range of motion was 65.45°, with a median strength of M2. Significant improvement was noted compared to preoperative values. However, outcomes did not significantly surpass those from spinal accessory nerve transfer. Electromyography showed a low incidence of motor unit action potentials in the deltoid. Medial pectoral nerve transfer to the axillary nerve did not yield superior results in shoulder abduction and deltoid reinnervation in our group of patients. At present, different nerve donors may also need to be considered for deltoid muscle reinnervation in patients with C5, C6, and C7 root avulsion to achieve better shoulder abduction recovery.

Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy.

The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1cm, equivalent to 20-30% of the tendon width) and medium-sized (1-3cm, equivalent to 40-50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.

Effect of physical exercise on postoperative shoulder mobility and upper limb function in patients with breast cancer: a systematic review and meta-analysis.

The shoulder pain and reduced range of motion caused by breast cancer seriously affect the quality of life of women. Such persistent impairments can escalate into chronic pain, diminished muscle strength, lymphedema, and compromised cardiorespiratory health potentially culminating in permanent disability. This systematic review aims to evaluate how physical exercise impacts shoulder mobility and upper limb function in breast cancer patients post-surgery, examining various aspects of exercise such as type, intensity, duration, frequency, and intervention timing to determine the influence on outcomes. A comprehensive search was conducted across seven databases up to April 16, 2024. Two reviewers independently assessed randomized controlled trials (RCTs) focusing on the effects of physical exercise on postoperative outcomes in breast cancer patients. Quality was assessed using the Cochrane risk of bias tool, with meta-analyses and publication bias tests performed via RevMan5.4, and evidence quality evaluated using GRADEPro. Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty studies (25 RCTs involving 2,171 patients) were included for both the systematic review and the meta-analysis. Meta-analysis confirmed that physical exercise significantly enhanced shoulder flexion (SMD =0.59; 95% CI: 0.32, 0.86; P<0.001) and abduction (SMD =1.01; 95% CI: 0.43, 1.60; P<0.001) in postoperative patients, and improved upper limb function (SMD =0.87; 95% CI: 0.48, 1.26; P<0.001). Subgroup analyses indicated that comprehensive exercise, particularly when performed ≤3 times a week or over 8-12 weeks, was most effective for improving shoulder flexion, while shorter durations (<8 weeks) and similar frequencies were optimal for abduction. Resistance exercises, especially when started early (<2 weeks post-surgery), showed significant benefits for upper limb function. The included studies were of moderate to high quality, though some lacked detailed reporting on blinding or allocation concealment. Analysis suggests that the timing of intervention initiation, along with exercise type and frequency, may contribute to observed variations in outcomes. Evidence quality assessments did not reveal significant issues with indirectness or imprecision, and no significant publication bias was detected. Given the low heterogeneity and absence of significant downgrade factors, intermediate evidence quality was assigned for upper limb function and shoulder abduction, with high quality for shoulder flexion. Physical exercise is notably effective in enhancing both upper limb function and shoulder mobility in breast cancer patients, with the timing and frequency of exercise interventions influencing these improvements. This provides valuable evidence for clinical rehabilitation strategies.

Arthroscopic Bankart repair using a single anterior working portal technique: a systematic review and meta-analysis.

To evaluate the efficacy and outcomes of arthroscopic Bankart repair using a single anterior working portal and determine whether they are comparable to the standard two-portal technique. A search following PRISMA guidelines was performed in July 2024 in the PubMed, Embase, Scopus, and Cochrane Library databases. Studies evaluating outcomes of patients undergoing arthroscopic Bankart repair using a single anterior portal technique were included. A meta-analysis comparing outcomes was performed using a random-effects model. A P-value < 0.05 was considered statistically significant. Seven studies in patients undergoing Bankart repair with a single anterior portal were included (311 patients, 84.6% male, mean age 27.8 years, mean follow-up 37.4 months). Five of seven studies compared outcomes of a single anterior portal versus the standard two-portal technique. The duration of surgery was significantly shorter in the single anterior portal group (P < 0.00001). The postoperative Oxford Instability Score (P = 0.84), Rowe score (P = 0.26), American Shoulder and Elbow Surgeons score (P = 0.73), Constant-Murley score (P = 0.92), and Visual Analog Scale Pain score (P = 0.07) were similar between both groups. The postoperative degree of shoulder abduction (P = 0.84) and external rotation (P = 0.64) were similar between both groups. The risk of redislocation (P = 0.98) was similar between both groups. Patients undergoing arthroscopic Bankart repair with a single anterior portal had significantly lower operative times and comparable PROs, ROM, and risk of redislocation relative to patients undergoing repair with a standard two-portal technique.

Is the use of neuromonitoring necessary in Sprengel's deformity surgery?

This study aimed to emphasize the effectiveness of using intraoperative neuromonitoring (IONM) in preventing possible nerve damage in Sprengel's deformity surgery. Eighteen patients who underwent Woodward surgery accompanied by neuromonitoring due to Sprengel's deformity were included in the study. Demographic information of the patients and their clinical and cosmetic results before and after surgery were recorded. Complications that occurred during and after the surgery were recorded. Of the 18 patients who underwent surgery, 12 were female and 6 were male. The mean age of the patients was 4.4 (2-8). The mean shoulder abduction angle of the patients was 84.4 (65-105) degrees before the surgery and 151.1 (125-175) degrees in the first year after the surgery. The mean Cavendish score of the patients was 3.6 (3-4) before the surgery and 1.1 (1-2) in the first year after the surgery. In one patient, there was a decrease in IONM motor-evoked potency signals during the reduction of the intraoperative scapula. Considering some loss of correction in the deformity, the scapula was detected at the point where there was no loss of signals. No patients developed wound problems or infections. In this study, it was determined that the use of neuromonitoring was effective in preventing brachial plexus damage, even if this complication was minimal in patients operated on due to Sprengel's deformity.

The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis.

Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.

Defining the glenohumeral range of motion required for overhead shoulder mobility: an observational study.

Recovery of overhead mobility after shoulder surgery is time-consuming and important for patient satisfaction. Overhead stretching and mobilization of the scapulothoracic and glenohumeral (GH) joints are common treatment interventions. The isolated GH range of motion (ROM) of flexion, abduction, and external rotation required to move above 120° of global shoulder flexion in the clinical setting remains unclear. This study clarified the GH ROM needed for overhead mobility. The timely development of shoulder ROM in patients after shoulder surgery was analyzed. Passive global shoulder flexion, GH flexion, abduction, and external rotation ROM were measured using goniometry and visually at 2-week intervals starting 6-week postsurgery until the end of treatment. Receiver operating characteristic curves were used to identify the GH ROM cutoff values allowing overhead mobility. A total of 21 patients (mean age 49 years; 76% men) after rotator cuff repair (71%), Latarjet shoulder stabilization (19%), and arthroscopic biceps tenotomy (10%) were included. The ROM cutoff value that accurately allowed overhead mobility was 83° for GH flexion and abduction with the area under the curve (AUC) ranging from 0.90 to 0.93 (p < 0.001). The cutoff value for GH external rotation was 53% of the amount of movement on the opposite side (AUC 0.87, p < 0.001). Global shoulder flexion above 120° needs almost full GH flexion and abduction to be executable. External rotation ROM seems less important as long as it reaches over 53% of the opposite side.

Instant Pain Relief and ROM By Soft Glides

Effectiveness of Soft Tissue gliding in bringing about Instant spike of Mobility and Instantaneous relief in pain during Shoulder Abduction Movement: A Promising Case Study.

Validity and reliability of the Six-Minute Pegboard Ring Test for assessing functional capacity and upper limb function in persons with multiple sclerosis

BackgroundThe timed walk test is essential for assessing the functional capacity of persons with multiple sclerosis (MS). When a decline in ambulation ability and loss of function in the later stages of MS is observed, it is imperative to utilize alternative methods for measuring functional capacity. ObjectiveTo investigate the validity and reliability of the Six-Minute Pegboard Ring Test (6PBRT) in persons with MS. MethodsForty-three persons with MS were included in this study. Disease severity was quantified using the Expanded Disability Status Scale (EDSS). The 6PBRT was employed to assess upper extremity function during exercise stress, and vital signs were monitored pre- and post-test. Muscle strength was measured using a digital dynamometer for shoulder flexor, shoulder abductor, and grip strength, in addition to a hand dynamometer. Manual dexterity was evaluated through the 9-Hole Peg Test (9HPT), and walking endurance was assessed using the 2-Minute Walk Test (2MWT). Test-retest reliability was computed using the intraclass correlation coefficient (ICC). ResultsThe ICC value for the 6PBRT was 0.96 (95% CI 0.92–0.97), indicating excellent test-retest reliability. Significant differences in vital signs were observed before and after conducting the 6PBRT (p < 0.05). A strong negative correlation was found between the 6PBRT score and EDSS (r = -0.650, p < 0.001). The 9HPT of the dominant side demonstrated a moderate correlation with the 6PBRT score (r = -0.502, p = 0.001), whereas no significant correlation was shown between the non-dominant side 9HPT and the 6PBRT score (p > 0.05). Moreover, a positive moderate correlation was shown between the performance on the 2MWT and the 6PBRT score (r = 0.413, p = 0.006). However, no significant correlation was detected between the proximal muscle strength of the upper extremity, handgrip strength, and the 6PBRT score in individuals with multiple sclerosis (p > 0.05). ConclusionThe 6PBRT is a reliable and valid tool to evaluate upper extremity function and exercise capacity in persons with MS.

Effects of supplementing extracorporeal shockwave therapy (ESWT) to hyaluronic acid (HA) injection among patients with rotator cuff lesions without complete tear: A prospective double-blinded randomized study.

The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears. Eligible patients were randomized into three groups: 3 HA injections combined with 2 sham ESWT (HA), 3 HA injections combined with 1 ESWT and 1 sham ESWT (HA + 1 ESWT), or 3 HA injections combined with 2 ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant-Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed pre-intervention and at 1, 3, 6, and 12 months post-initial HA injection. Shoulder magnetic resonance imaging (MRI) was conducted before and twelve months after the intervention. All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP (P=0.011) and CMS (P=0.018) at 1 month, and in MP (P=0.014) and CMS (P=0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF (P=0.027), IR (P=0.019), and SROM (P=0.025) at 1 month, and in ABD (P=0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF (P=0.013), IR (P=0.019), and SROM (P=0.025) at 1 month, and in FF (P=0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans. ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.

Effects of Sling-Suspension-Based Active Shoulder Joint Exercise on Shoulder Joint Subluxation, Pain, Muscle Strength, and Upper Limb Function in Patients with Subacute Stroke.

Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl-Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group-time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p < 0.011 for the splenius and F(1, 26) = 9.623, p < 0.005 for the upper trapezius. A significant time-group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p < 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time-group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p < 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p < 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke.

Effect of low-intensity pulsed ultrasound on postoperative rehabilitation of rotator cuff tears: Protocol for a systematic review and meta-analysis.

Rotator cuff tears are a common shoulder injury that significantly impacts patients' daily lives and work abilities. Although surgical treatment methods for rotator cuff tears have been continuously improved with advances in medical technology, postoperative rehabilitation remains challenging. Therefore, finding effective rehabilitation treatments is crucial for improving patient prognosis and enhancing quality of life. This study will aim to systematically evaluate the impact of low-intensity pulsed ultrasound (LIPUS) on postoperative rehabilitation of rotator cuff tears, comprehensively assessing the efficacy and safety of LIPUS in postoperative recovery. This protocol will search multiple databases including PubMed/MEDLINE, Embase, Cochrane Library, CNKI, Scopus, and Web of Science to identify randomized controlled trials related to LIPUS for postoperative rehabilitation of rotator cuff tears. The search will encompass literature published from the inception of the databases up to April 2024. Methodological quality assessment and data extraction will be conducted using the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. Meta-analysis will be performed on appropriate studies using either random-effects or fixed-effects models, and subgroup analyses will be conducted to explore potential heterogeneity. Studies meeting the inclusion criteria will be included in the analysis. All analyses will be performed using Stata version 16.0. The incidence of rotator cuff tear rates will be assessed by imaging techniques such as MRI or ultrasound. Pain intensity will be scored using standardized pain assessment scales, such as the Visual Analog Scale (VAS). Improved range of motion (ROM) in shoulder flexion, abduction, and rotation. Functional outcomes will be evaluated using effective measures such as Constant-Murley scores (CMS) and shoulder joint scores by American Shoulder and Elbow Surgeons (ASES). Adverse events associated with LIPUS therapy, including skin irritation, increased pain, or any other complications. Subgroup analysis will also be carried out if possible. Following the meta-analysis, we will assess the overall effect of LIPUS on postoperative rehabilitation of rotator cuff tears, and further explore its impact on aspects such as pain relief, functional improvement, and postoperative complications. It is anticipated that this study will provide comprehensive evidence regarding the role of LIPUS in postoperative rehabilitation of rotator cuff tears, guiding clinical practice and future research. The resultant manuscript will be submitted for publication in a peer-reviewed journal. CRD42024530798.

Closing the Gaps: An Integrative Review of Yoga's Benefits for Lymphedema in Breast Cancer Survivors.

Dissection of the axillary lymph nodes during surgery for breast cancer with lymph node involvement is burdened by a complication: lymphedema. Approximately half of women undergoing axillary dissection suffer from it, with a notable impact in terms of perceived discomfort, presented quality of life, and alteration of body image. There is also no shortage of problems in the patient's social and professional life. The present review aims to select Randomized Controlled Trials (RCTs) present in the literature regarding the effects of yoga as an alternative therapy in patients with breast cancer-related lymphedema. A search of four databases was undertaken: Cochrane, Pubmed, Scopus, and Web of Science. The searches were conducted on 19 May 2024, and updated to 30 June 2024 without date limits. RCTs without language limitations, in any context, and with any yoga variant were considered. The postulated search strings highlighted a total of 69 potentially eligible studies. The study selection system consisted of two levels of screening, (1) abstract selection and (2) full-text selection, for a total of three studies included in the review. The three RCTs included involved mixed treatment sessions in an outpatient setting with a yoga teacher and at home using a DVD. In the various studies, the outcome measures concerned quality of life, ROM, spinal mobility, limb volume, and tissue induration. According to the analysis of the data obtained, yoga as an alternative therapy could be useful if combined with the usual care routine in women with lymphedema related to sensory cancer, in terms of improving physical, professional, and emotional quality of life and reducing symptoms such as fatigue, pain, and insomnia. Furthermore, yoga could bring about a reduction in tissue induration of the limb, greater spinal mobility evaluated in terms of improvement of the pelvic and kyphotic angle, and greater strength in shoulder abduction.

The Efficacy of Triple Shoulder Injection with Steroids and Ozone in the Treatment of Chronic Shoulder Pain and Range of Motion Limitation

Objective: This study aimed to evaluate and compare the therapeutic effects of fluoroscopy-guided triple shoulder injections with steroids and, a combination of steroids and ozone. Methods: Data were retrospectively collected from the files of 70 patients diagnosed with non-specific chronic shoulder pain and received triple shoulder injections. The patients were divided into two groups. One group included triple shoulder injections with steroids under fluoroscopic guidance, while the other group included combination of steroids and ozone. Pain intensity was evaluated with the Visual Analog Scale (VAS), the patient's quality of life and functionality were assessed using the Shoulder Pain and Disability Index (SPADI), and the active range of motion (ROM) of shoulder abduction, external rotation, and flexion were measured by goniometry. Beck Depression Inventory (BDI) was used to measure the severity of depression before the procedure. All measurements were recorded at baseline and 1, 3, and 6 months after the procedure. Results: Baseline characteristics were similar in both groups. There was no statistical difference in VAS scores between the two groups at baseline, 1st, and 3rd months. However, in the 6th months, the VAS scores of patients treated with steroids plus ozone were significantly lower than those of patients treated with steroids (P&lt;0.001). Both groups showed significant improvements in SPADI pain, disability, and total subscores compared to pre-treatment values (P &lt; 0.001). There was a significant improvement in the ROM of the shoulder joint in both groups (p&lt;0.001). However, patients who received ozone and steroid treatments showed a significantly greater increase in SPADI and ROM of shoulder joints in the 6th months (p&lt;0.001). There was a positive correlation between BDI score and pain duration, and the severity of depression had no statistically significant effect on VAS scores. Conclusion: Results of this study revealed that triple shoulder injection with steroids or a combination of steroids and ozone proved to be an effective therapeutic approach for patients suffering from shoulder pain and limited mobility. The combination of ozone with steroids may lead to better results than using steroids alone. Furthermore, a long duration of pain increases the risk of chronic depression in patients.

Association Between Acromiohumeral Distance, Shoulder Rotational Strength, And Range of Movements in University Basketball Players: A Cross-Sectional Study

Objective: Limited information exists regarding the sports-related adaptations at the shoulder complex in university basketball players. Therefore, this study aimed to evaluate the shoulder rotational muscle strength, range of movements (ROM), and acromiohumeral distance (AHD) values to interpret side-to-side differences regarding injury risk factors in throwing and non-throwing shoulders of university basketball players. Materials and Methods: Twenty university basketball players (10 males, 10 females; age=20.2±1.8 years; body mass index=21.1±2.22 kg/m2) were included. AHD values, isometric and concentric strengths of shoulder external (ER) and internal rotation (IR), and shoulder ER, IR, and total rotational ROM were measured bilaterally. Results: AHD was greater on the throwing side at 0° (p&amp;lt;0.001) and 60° of shoulder abduction positions (p&amp;lt;0.001). However, throwing shoulders demonstrated more AHD reduction from 0° to 60° of shoulder abduction (p=0.01). We found greater isometric ER strength (p=0.006), ER/IR ratio (p=0.001), concentric ER strength (p&amp;lt;0.001), concentric ER/IR ratio (p&amp;lt;0.001), and ER ROM (p&amp;lt;0.001) in the throwing shoulders. Besides, AHD was correlated with isometric ER strength on the throwing side (p=0.012, r=0.552) and non-throwing side (p=0.041, r=0.461), also, isometric ER/IR strength ratio on the throwing side (p=0.017, r=0.526) and the non-throwing side (p=0.013, r=0.545). Conclusion: University basketball players demonstrated stronger ER muscle strength, higher ER/IR strength, increased ER ROM, and wider AHD values on the throwing shoulders. Moreover, greater ER muscle strength and ER/IR strength ratio were associated with greater AHD.

Effects of Video-Based Exercises and Conventional Physiotherapy on Upper Extremity Functionality, Selective Motor Control, and Proprioception in Unilateral Cerebral Palsy: A Randomized Controlled Trial.

Objective: The present study was conducted to evaluate the effects of video-based exercises added to conventional physiotherapy (CPT) on upper extremity functionality, selective motor control, and proprioception in individuals with unilateral cerebral palsy (UCP). Materials and Methods: Thirty patients with UCP were randomized into two groups: the intervention group (15 individuals with a mean age of 9.2 ± 3.8 years) and the control group (15 individuals with a mean age of 8.3 ± 4.1 years). The intervention group received 8 weeks of video-based exercises, and the control group received 8 weeks of conventional physiotherapy. Upper extremity functional abilities, upper extremity selective motor control, proprioception, and entertainment levels were evaluated before and after the intervention for all groups. Results: While a significant change was observed in the mean scores of the ABILHAND-Kids, Selective Control of the Upper Extremity Scale right-left scores, shoulder flexion, shoulder abduction, and elbow flexion proprioception angles after the video-based exercises in the intervention group (P < 0.05), a significant change was observed only in the 60-degree flexion angle in the control group (P = 0.001). In the comparison between the groups, there were significant differences in post-intervention value only in shoulder flexion and abduction angles, whereas there was no difference between the groups in elbow flexion angles (P > 0.05). Conclusion: Incorporating video-based exercises into the upper extremity rehabilitation processes of individuals with UCP is beneficial in terms of upper extremity functionality, selective motor control, and proprioception.

Impact of tendon transfer on scapulothoracic and glenohumeral motion in children with brachial plexus birth injuries

BackgroundTendon transfers are often utilized to improve shoulder external rotation and abduction in children with brachial plexus birth injuries and are designed to improve glenohumeral (GH) joint motion. However, changes in scapulothoracic (ST) and glenohumeral (GH) joint function after tendon transfer are not well defined. The purpose of this study was to quantify changes in GH, ST, and humerothoracic (HT) joint function before and after tendon transfer, and we hypothesized that tendon transfers would reorient the arc of motion into more external rotation and abduction, but not increase GH motion. MethodsMotion analysis was performed in 15 children (ages 3-16) before and after transfer of teres major and/or latissimus dorsi. Scapulothoracic, GH, and HT joint angles were measured in a neutral, resting position and each of the modified Mallet positions. Joint angular displacements from the neutral position and the total arc of internal-external rotation for each joint were also calculated. Relevant joint angles, joint angular displacements, and internal-external rotation arcs were compared using multivariate analyses of variance with repeated measures and univariate post-hoc analyses. ResultsGlenohumeral and HT external rotation were significantly increased in all positions postoperatively. The arc of GH internal-external rotation was unchanged, but oriented in more external rotation after surgery. Only 6 patients gained active external rotation. Glenohumeral and HT internal rotation were significantly decreased after surgery, but ST internal rotation was significantly increased. Two patients had loss of midline function. In the abduction position, GH elevation joint angles were unchanged, but ST and HT elevation increased. DiscussionOnly four patients gained active GH external rotation and maintained their internal rotation. Each of those patients underwent isolated tendon transfer without concomitant joint release. Seven patients maintained their preoperative internal rotation, which was attributed to increased ST internal rotation. The other half of patients lost internal rotation and gained external rotation through reorientation of the arc of rotation. Nine patients gained HT elevation, with three attributed to increased ST upward rotation, five attributed to a combination of increased ST upward rotation and increased GH elevation, and one attributed to increased GH abduction contracture. These findings challenge the dogma that teres major/latissimus dorsi tendon transfers augment GH motion and highlight the importance of ST function for outcome determination.