Shoulder Abduction Research Articles

Repetitive peripheral magnetic stimulation for improving upper limb function in post-stroke hemiparesis

BackgroundStroke is one of the leading causes of disability worldwide, with hand and arm weakness, affecting the patients’ daily activities and quality of life. Recently, repetitive peripheral magnetic stimulation (rPMS) was found to enhance neuroplasticity and motor recovery post-stroke hemiparesis via its deep proprioceptive stimulation and simulation of lost voluntary movement.ObjectiveTo determine the therapeutic effect of rPMS on the functional improvement of upper limb in patients with hemiparesis following cerebrovascular insult and to compare the effect of therapy in subacute and chronic cases.ResultsPost-rehabilitation program both the Fugl-Meyer-Upper Extremity scale (FM-UE) and Functional Independence Measures (FIM) scale showed highly significant improvement in the active group, compared to controls. Regarding active range of motion (AROM) of the shoulder abductors, triceps, wrist extensors and supinators, significant differences were also found in the active group in comparison to controls. Modified Ashworth scale showed also significant change in the active group. When dividing our patients according to the duration post-stroke, into subacute group (6 weeks to 6 months post-stroke) and chronic group (more than 6-month post-stroke), the subacute group showed significant improvements in the FM-UE scale, and in the AROM of wrist extensors and supinators but not in the chronic group. Ultrasonographic measurements showed a significant decrease in cross sectional area of the control group.ConclusionrPMS is potentially effective in improving motor recovery post-stroke, especially in the subacute stage.

Shoulder brace has no detrimental effect on basic spatio-temporal gait parameters and functional mobility after arthroscopic rotator cuff repair

BackgroundThe risk of falls in patients undergoing orthopedic procedures is significant in terms of health and socioeconomic effects. Research questionIs there an influence of the shoulder abduction brace (SAB) on gait parameters in patients undergoing arthroscopic rotator cuff repair (ARCR)? MethodsThirty-five patients undergoing ARCR, who used a 15° SAB in the postoperative period, were included in a prospective study. Participants underwent gait analysis preoperatively (T0), 24 h after surgery (T1), 1 week (T2), and 4 weeks after surgery (1 week after SAB removal) (T3) by using a wearable inertial sensor (BTS G-Walk sensor). Gait Parameters (cadence, speed, right (R) and left (L) step length, gait and propulsion-R and L symmetry indices) and functional mobility (agility and balance) were assessed using the 10-meter test (10MWT) and the Timed Up and Go (TUG) test, respectively. ResultsThere were 22 men and 13 women with a median age of 56 (IQR 48.0–61.0) years. The right upper limb was involved in 83% of cases. Regarding the 10MWT, speed was significantly higher at T0 than at T1 (p < 0.01) and significantly lower at T1 than at T3 (p < 0.05). Cadence was significantly lower at T1 than at T3 (p < 0.05). Propulsion-R was significantly higher at T3 than at T1 (p < 0.01), whereas propulsion-L was significantly lower at T1 than at T0 (p < 0.05) and significantly higher at T2 and T3 than T1 (p < 0.01 for all). No significant differences were found for R and L step lengths as well as for symmetry index (p > 0.05). Regarding TUG test, the final turning phase was significantly higher at T2 than at T3 (p < 0.01). SignificanceThe results demonstrated that the use of the SAB affected gait speed and propulsion only 24 h after ARCR, but no effects were reported at long-term observations.

Analysis of in vivo humeral rotation of reverse total shoulder arthroplasty patients during shoulder abduction on the scapular plane with a load

BackgroundFew studies have investigated the kinematics after reverse total shoulder arthroplasty (RTSA). This study aimed to compare the shoulder kinematics in RTSA patients during shoulder abduction on the scapular plane with and without a load and yield information regarding the function of stabilizing the joints against gravity for the functional assessment of the shoulder after RTSA, which could lead to changes in postoperative rehabilitation treatment.MethodsTwenty RTSA patients (7 men, 13 women; mean age: 78.1 [64–90] years) were examined. First, active shoulder abduction in the scapular plane was captured using single-plane fluoroscopic X-ray images. Imaging was performed by stipulating that one shoulder abduction cycle should be completed in 6 s. Two trials were conducted: one under a load equivalent to 2% of body weight and one without a load. Next, a three-dimensional (3D) model of each humeral and scapular component was matched to the silhouette of the fluoroscopic image to estimate the 3D dynamics. By using the 3D dynamic model obtained, the kinematics of the glenosphere and humeral implant were calculated relative to the shoulder abduction angle on the scapular plane and were compared between groups with and without a load. A one-way analysis of variance and a post hoc paired t-test with a statistical significance level of 0.05 were performed.ResultsThe humeral internal rotation decreased with a load at shoulder abduction between 40° and 90° on the scapular plane (P < 0.01, effect size: 0.15). No significant differences in scapular upward rotation (P = 0.57, effect size: 0.022), external rotation (P = 0.83, effect size: 0.0083) and posterior tilting (P = 0.74, effect size: 0.013) were observed between groups with and without a load. The main effect was not observed with and without a load (P = 0.86, effect size: 0.0072). However, the scapulohumeral rhythm was significantly greater without a load during shoulder joint abduction between 40° and 60° on the scapular plane.ConclusionIn RTSA patients, the glenohumeral joint was less internally rotated, and the scapulohumeral rhythm decreased under loaded conditions. It was stabilized against the load through the mechanical advantage of the deltoid muscle and other muscles.

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

The relationships between upper extremity muscle strength and endurance with respiratory function, functional capacity and quality of life in children and adolescents with cystic fibrosis

Background/Aims The number of studies exploring isolated upper extremity muscle strength and endurance in paediatric patients with cystic fibrosis is limited. The aim of this study was to investigate the relationship between upper extremity muscle strength and endurance with respiratory functions, functional capacity and quality of life in children and adolescents with cystic fibrosis. Methods Children and adolescents with cystic fibrosis performed a flexed arm hang test to measure muscle endurance, movement against a dynamometer to measure muscle strength, a pulmonary function test and 6-minute walk test to measure functional capacity. The Cystic Fibrosis Questionnaire Revised was used to assess quality of life. Results A total of 29 children and adolescents with cystic fibrosis (15 girls, 14 boys) participated in the study. Biceps muscle strength moderately correlated with forced expiratory volume in 1 second predicted percentage, forced vital capacity predicted percentage and the ratio of forced expiratory volume in 1 second to forced vital capacity predicted percentage (r=0.306, P=0.035; r=0.405; P=0.029; r=0.367, P=0.048, respectively). Biceps muscle strength, shoulder abductors muscle strength, hand grip strength and flexed arm hang test correlated with the ratio of forced expiratory volume in 1 second to forced vital capacity predicted percentage. Biceps muscle strength, shoulder abductors muscle strength, hand grip strength and flexed arm hang test correlated with 6-minute walk test distance (r=0.678, p&lt;0.001; r=0.732, p&lt;0.001; r=0.512, P=0.005; r=0.375, P=0.045, respectively). Biceps muscle strength and shoulder abductors muscle strength moderately correlated with emotional functioning and eating disturbances in the Cystic Fibrosis Questionnaire Revised (r=0.451, P=0.014). Conclusions Specific assessment of upper extremity muscle strength and endurance in children and adolescents with cystic fibrosis may be helpful in informing physiotherapists of respiratory function, functional capacity and quality of life status.]

Kinematic and Kinetic Comparisons of Arm Slot Position Between High School and Professional Pitchers.

Throwing arm kinetics differ in pitchers at varying arm slot (AS) positions (frontal-plane arm position at ball release relative to the vertical axis). To determine how kinematic and kinetic values differ between professional and high school pitchers with varying AS positions, and whether these differences are similarly observed in both populations. High school (n = 130) and professional (n = 288) pitchers threw 8 to 12 fastballs under 3-dimensional motion capture technology. Pitchers in each cohort were subdivided based on mean AS position at ball release: AS1 (least degree of AS: most overhand throwing styles), AS2 (intermediate degree of AS: three-quarter throwing styles), or AS3 (greatest degree of AS: most sidearm throwing styles). Kinetic and kinematic parameters were compared between groups. Controlled laboratory study. High school pitchers had a more overhand AS at ball release (50° ± 11°) compared with professional pitchers (58° ± 14°) (P < .001). In both cohorts, AS1 pitchers had significantly greater shoulder abduction (high school, P <0.001; professional, P <0.0001) and lateral trunk flexion (high school, P < 0.001; professional, P <0.0001) at ball release compared with AS3 pitchers. Professional pitchers with an AS3 position had significantly delayed timing of maximum upper trunk angular velocity compared with AS1 pitchers (64% ± 7% vs 57% ± 7% of pitch time, respectively; P < .0001). A significant positive correlation between AS and elbow flexion torque was found in high school pitchers (P = .002; β = 0.28), and a significant negative correlation between AS and elbow varus torque (P < .001; β = -0.22) and shoulder internal rotation torque (P < .001; β = -0.20) was noted in professional pitchers. AS position was related to shoulder abduction and trunk lateral tilt. Professional and high school pitchers with varying AS positions did not experience similar changes in throwing arm kinetics. In professional pitchers, the earlier onset of maximum upper trunk angular velocity with overhand throwing style may reflect inappropriate pelvis-trunk timing separation, a parameter implicated in upper extremity injury, and the negative correlation between AS and elbow varus and shoulder internal rotation torque suggests that both excessive and minimal AS positions have negative implications.

Reliability and Concurrent Validity of a Markerless, Single Camera, Portable 3D Motion Capture System for Assessment of Glenohumeral Mobility.

Recent technological advancements have enabled medical, sport, and fitness professionals to utilize digital tools that assist with conducting movement examinations and screenings. One such advancement has been the implementation of a single camera, markerless, and portable 3D motion capture system designed to obtain ROM measurements for multiple body parts simultaneously. However, the reliability and validity of a markerless 3D motion capture system that uses a single camera has not been established. The purpose of this study was to investigate the reliability and concurrent validity of this 3D motion capture system compared to a goniometer in assessing ROM of the glenohumeral joint. Quasi-experimental reliability, convenience sampling. Forty healthy volunteers (mean ± SD, age 27.4 ± 12.4 years, height 173.4 ± 11.1 cm, weight 72.1 ± 16.2 kg) participated in this study. Intrarater reliability was analyzed by ICC(2,k) with a 95% CI using two repeated trials for each shoulder movement (flexion, abduction, external rotation, internal rotation) that were recorded simultaneously via two methods: a standard goniometer and a 3D motion capture system. Concurrent validity was analyzed using Pearson Correlation Coefficient (r). The intrarater reliability between the two instruments for glenohumeral motions yielded an overall ICC of 0.82 (95% CI: 0.74-0.88) indicating good reliability for both instruments.The 3D motion capture system demonstrated strong correlations with goniometry for shoulder flexion (r = 0.67), abduction (r = 0.63), and external rotation (r = 0.76), and very strong correlation for shoulder internal rotation (r = 0.84). Results from this study indicated that a markerless, single camera, portable 3D motion capture system can be a reliable and valid tool to assess glenohumeral joint ROM in comparison to a standard goniometer. 3.

Scapular dyskinesis after treatment of proximal humerus fracture, a 3-dimensional motion analysis and clinical outcomes.

The alteration of scapular kinematics can predispose patients to shoulder pathologies and dysfunction. Previous literature has associated various types of shoulder injuries with scapular dyskinesis, but there are limited studies regarding the effect that proximal humeral fractures (PHFs) have on scapular dyskinesis. This study aims to determine the change in scapulohumeral rhythm following treatment of a proximal humerus fracture as well as differences in shoulder motion and functional outcomes among patients who presented with or without scapular dyskinesis. We hypothesized that differences in scapular kinematics would be present following treatment of a proximal humerus fracture, and patients who presented with scapular dyskinesis would subsequently have inferior functional outcome scores. Patients treated for a proximal humerus fracture from May 2018 to March 2021 were recruited for this study. The scapulohumeral rhythm and global shoulder motion were determined using a 3-dimensional motion analysis (3DMA) and the scapular dyskinesis test. Functional outcomes were then compared among patients with or without scapular dyskinesis, including the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the visual analog scale (VAS) for pain, and the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L). Twenty patients were included in this study with a mean age of 62.9±11.8 years and follow-up time of 1.8±0.2 years. Surgical fixation was performed in 9 of the patients (45%). Scapular dyskinesis was present in 50% of patients (n=10). There was a significant increase in scapular protraction on the affected side of patients with scapular dyskinesis during abduction of the shoulder (P=.037). Additionally, patients with scapular dyskinesis demonstrated worse SICK scapula scores (2.4±0.5 vs. 1.0±0.4, P=.024) compared to those without scapular dyskinesis. The other functional outcome scores (ASES, VAS pain scores, and EQ-5D-5L) showed no significant differences among the 2 groups (P=.848, .713, and .268, respectively). Scapular dyskinesis affects a significant number of patients following treatment of their PHFs. Patients presenting with scapular dyskinesis exhibit inferior SICK scapula scores and have more scapular protraction during shoulder abduction compared to patients without scapular dyskinesis.

Contralateral cervical 7 as a potential donor in nerve transfer of adult brachial plexus injury especially in root avulsion case: A case report

Introduction: Contralateral cervical 7 (CC7) nerve transfer can be used in the absence of neurotizer in the BPI total root avulsion case. CC7 nerve transfer was introduced by Gu et al. in 1986, and aimed to restore motor and sensory function in the hand. The purpose of this paper is to report BPI patients with nearly total root avulsion using CC7 nerve transfer to the median nerve. Case Presentation: A man suffered a motorcycle accident in March 2010. There was a complete loss of motor and sensory in the right upper limb. From the examination, it was obtained that the cervical root avulsion of C5-6, C7 postganglionic rupture and cervical root avulsion of C8-T1. In April of 2010 has been done root neurotization C4 to C5, C3 root neurotization was to the suprascapular nerve, neurotization of the phrenic nerve to C6, neurotization C7 to C6 with graft, and neurotization CC7 to median nerve with vascularized pedicle ulnar graft. An evaluation was made at the donor and recipient sites. From the first admission he had total motoric loss to the last evaluation for 5 years post operation of motoric in the recipient site showed range of motion (ROM) of elbow flexion recovered to M4 with ROM 135o, shoulder abduction reached M3 30 o, finger flexion recovered to M2, and hand sensation came up to S1. There was no morbidity on the donor site from the first evaluation. Conclusion: Therefore, CC7 can be a potential donor in nerve transfer of adult BPI root avulsion cases without causing morbidity in the donor site.

Virtual embodiment for improving range of motion in patients with movement-related shoulder pain: an experimental study

BackgroundRecent evidence supports the use of immersive virtual reality (VR) as a means of delivering bodily illusions that may have therapeutic potential for the treatment of musculoskeletal conditions. We wanted to investigate whether a single session of an embodiment-based immersive VR training program influences pain-free range of motion in patients with shoulder pain.MethodsWe designed a rehabilitation program based on developing ownership over a virtual body and then “exercising” the upper limb in immersive VR, while the real arm remains static. We then carried out a single-arm pre-post experiment in which 21 patients with movement-related musculoskeletal shoulder pain were exposed to the 15-min VR program and measured their active pain-free range of motion immediately before and afterwards.ResultsWe found that shoulder abduction and hand-behind-back movements, but not shoulder flexion, were significantly and clinically improved post-intervention and that the level of improvement correlated with the level of embodiment. Following this one session, at 1-week follow-up the improvements were not maintained.ConclusionsVirtual embodiment may be a useful therapeutic tool to help improve range of motion in patients with movement-related shoulder pain in the short term, which in turn could expedite rehabilitation and recovery in these conditions.

Prospective study comparing outcomes of primary intraplexal repair versus distal nerve transfers in Narakas grade I birth brachial plexus palsy.

To compare the results of intraplexal repair and distal nerve transfer in babies with birth brachial plexus palsy (BBPP), children with Narakas group I obstetric palsy were assigned to two groups of 16 each. Children in group A were treated with classical intraplexal repair and those in group B were treated by distal nerve transfers. At 6 months, all the children in group B had achieved Modified Medical Research Council (MMRC) grade 3 elbow flexion along with 8 of the 16 children in group A, which was a statistically significant difference. At 6 months, all the children in group B achieved MMRC grade 3 or higher shoulder abduction and 8 of the 16 children in group A had done so, which was also statistically significant. At the final follow-up, the distal transfer surgical treatment group had a significantly higher Mallet score. Distal nerve transfers have a significant advantage in early recovery in elbow flexion and shoulder abduction, but the outcomes became similar after 9 months.Level of evidence: III.

Factors Associated with Medial Elbow Torque Measured Using a Wearable Sensor in Junior High School Baseball Pitchers

There are no reports investigating the relationship between shoulder range of motion (ROM) and pitching elbow torque in junior high school pitchers. Therefore, we aimed to evaluate the factors associated with medial elbow torque in this population. Sixty-three junior high school baseball pitchers were recruited for this study. The participants completed a questionnaire and passive ROM measurements of shoulder abduction and horizontal adduction. All pitchers pitched three fastballs at maximum effort while wearing a wireless sensor recording pitching mechanics and elbow valgus torque for each pitch. Age (r = 0.65, p &lt; 0.001), height (r = 0.83, p &lt; 0.001), body weight (r = 0.82, p &lt; 0.001), BMI (r = 0.60, p &lt; 0.001), and ball velocity (r = 0.80, p &lt; 0.001) were significantly positively correlated with elbow valgus torque. Participants were divided into two groups based on elbow valgus torque, &gt;30 (high torque [HT]) and &lt;30 N·m (low torque [LT]). Age, height, body weight, BMI, and ball velocity were significantly higher in the HT group than in the LT group. The difference between dominant and non-dominant shoulder horizontal adduction ROM was 5.3 ± 9.3° and 1.0 ± 6.4° in the HT and LT groups, respectively, which was also significantly different. Ball velocity, age, larger physique, and increased restriction of the dominant shoulder’s horizontal adduction ROM were associated with higher medial elbow torque in junior high school pitchers. This suggests that improving the dominant shoulder’s horizontal adduction ROM contributes to preventing elbow injuries.

Effect of upper extremity kinesio tape application on hand function, wrist joint position and grip strength in children with hemiparetic cerebral palsy

Abstract Although kinesio taping (KT) is frequently used in musculoskeletal disorders, there is not enough data on the effectiveness of holistic KT application on the upper extremity in spastic hemiparetic children. Our study aims to evaluate the effect of KT application on spasticity, range of motion, dexterity and hand grip strength in these patients. Twenty patients diagnosed with spastic hemiparetic cerebral palsy, aged 5-17 years, who were trained and treated in a private educational institution, were included in the study. Between November 2021 and January 2022, in addition to neurodevelopmental therapy for 12 weeks, KT was applied from the lateral epicondyle region to the end of the metacarpals, with 15-25% tension, to the dorsal face of the hand, with the taping direction facilitation technique (starting direction is the origin of the muscle). Spasticity, range of motion, dexterity and hand grip strength were evaluated as pre-test and post-test. It was determined that the mean score difference between the pre-test and post-test range of motion (ROM) shoulder abduction, ROM supination, ROM wrist flexion, ROM wrist extension and hand grip strength of the individuals was statistically significant (). It was determined that the individuals’ pre-test-post-test Jebsen hand function test (JHFT) Writing, JHFT card flipping, JHFT small objects, JHFT nutrition simulation, JHFT backgammon checkers stamps, JHFT large light objects, JHFT total score average difference was statistically significant (). These results indicate that KT application positively affects upper extremity functions in the rehabilitation of hemiparetic cerebral palsy. Longitudinal studies are recommended in patients with hemiparetic cerebral palsy.

Supine counterstrain technique for rhomboid tender point.

Because poor posture is a common instigating factor in back, shoulder, and neck pain, the rhomboid muscles should be considered in a complete physical evaluation. Previous techniques for treating a rhomboid tender point have addressed only one of the two main actions of the muscle, specifically retraction of the scapula utilizing shoulder abduction. This modified supine counterstrain technique forthe rhomboid tender point incorporates both scapular retraction as well as superior, medial rotation of the inferior border of the scapula without abduction, providing a comprehensive treatment to accommodate patients with shoulder movement restrictions. This article discusses indications, contraindications, treatment, and a list of problem-solving strategies for the rhomboid tender point.

The feasibility of an upper limb strength test protocol in children with Duchenne muscular dystrophy

Question This study aimed to develop and assess a protocol for evaluating upper limb strength and its association with functional abilities in children and adolescents diagnosed with Duchenne muscular dystrophy (DMD). Design A cross-sectional study. Participants Eleven male individuals diagnosed with DMD (aged 11 to 18 years). Intervention A systematic protocol for assessing the maximum voluntary isometric contraction (MVIC) of the upper limbs using grip and pull dynamometers was developed and conducted in conjunction with the Performance of Upper Limb (PUL) scale. Outcome measures Feasibility was evaluated by appraising the number of participants capable of successfully executing the strength test protocol. Correlations were conducted to examine the relationship between upper limb strength and PUL scores. Results The grip strength assessment was feasible for all participants, while the complete strength testing protocol was feasible for nine, excluding two individuals with non-ambulatory mobility. Significant correlations were found between overall upper limb strength and total PUL scores (rs = 0.742, p = 0.022), grip strength and distal PUL scores (rs=0.733, p = 0.010), shoulder abduction strength and PUL shoulder scores (rs=0.905, p = 0.005), and grip strength and overall PUL scores (rs=0.794, p = 0.004). The middle-level correlation was not statistically significant (rs=0.590, p = 0.094). Conclusion The established strength test protocol demonstrated feasibility among ambulatory participants. However, alternative approaches are essential for those with limited ambulation. The study identified a robust correlation between upper limb strength and functional abilities. Further extensive studies are required to validate these findings. Trial registration The present study is a part of a longitudinal intervention study registered at the ClinicalTrials.gov (NCT03963453).

Sex differences regarding the effects of arm swing on ground reaction force and trunk movements between track and field athletes

The purpose of this study was to clarify the sex difference in the effects of arm swing movements of track and field athletes on ground reaction force and trunk movement. Seven male and nine female athletes belonging to a university track and field team were asked to perform arm swings for 10 seconds each under three different conditions (longitudinal, lateral, and original) while in the standing position. Three-dimensional coordinate data for each experimental trial was collected using an automatic optical motion analyser, and ground reaction forces were measured using a force plate. Under the longitudinal condition, the mean acceleration force was greater for males than for females (p &lt; .05), and the operating range of trunk twist angle was significantly greater for females than for males (p &lt; .05). However, under the original condition, there were no significant differences between the sexes in mean acceleration force, but there were significant differences in maximum twist angle and minimum and maximum shoulder abduction angles (p &lt; .05). These results indicate that there are sex differences in trunk movement and ground reaction force depending on the direction of arm swing.

Influence of motor imagery training on hip abductor muscle strength and bilateral transfer effect.

Motor imagery training could be an important treatment of reduced muscle function in patients and injured athletes. In this study, we investigated the efficacy of imagery training on maximal force production in a larger muscle group (hip abductors) and potential bilateral transfer effects. Healthy participants (n = 77) took part in two experimental studies using two imagery protocols (∼30min/day, 5days/week for 2 weeks) compared either with no practice (study 1), or with isometric exercise training (study 2). Maximal hip abduction isometric torque, electromyography amplitudes (trained and untrained limbs), handgrip strength, right shoulder abduction (strength and electromyography), and imagery capability were measured before and after the intervention. Post intervention, motor imagery groups of both studies exhibited significant increase in hip abductors strength (∼8%, trained side) and improved imagery capability. Further results showed that imagery training induced bilateral transfer effects on muscle strength and electromyography amplitude of hip abductors. Motor imagery training was effective in creating functional improvements in limb muscles of trained and untrained sides.

Greater tuberosity medial malposition: does it affect shoulder abductor moment?

The detrimental effect of greater tuberosity malposition on functional scores is well known. Superior or posterior malpositions exceeding five mm lead to excessive loading on the deltoid strength. However, the significance of situations where greater tuberosity becomes medialized due to the compressive effect of the locking plate fixation, especially in fractures with metaphyseal dead space, has not been emphasized. It is hypothesized that this condition may cause shortening of the rotator cuff moment arm and consequently impact functional scores. Between 2012 and 2018, 52 patients, aged 65,28 (ranging 40-85) proximal humerus fractures treated with locking plate fixation were included in the study. Cephalodiaphyseal angle, greater tuberosity displacement , patients reported outcome and Constant-Murley scores were evaluated. The mean Constant Murley score was determined to be 78.76 (ranging from 38 to 100). According to the patients reported outcome 39 excellent , five good , two fair, six poor results were observed. Avascular necrosis with screw migration was detected in five cases, while one patient experienced implant insufficiency along with varus deformity. Greater tuberosity was found to be positioned between 6 mm posterior-superior and -13 mm medial. Significant medial malposition was observed in three patients, with -9, -12, and -13 mm of medialization, respectively. Cephalodiaphysial angle was determined as 139.30 degrees (ranging from 120 to 150 degrees) and showed weak correlation with the functional score. Greater tuberosity medialization also showed weak correlation with the Constant-Murley score. The values exhibiting deviation were associated with low patient-reported outcome results and functional scores. In the examination of greater tuberosity displacement values, it was observed that Neer type 3 and 4 fractures differed significantly from Neer type 2 fractures regarding to Kruskal-Wallis test. Medial impaction of greater tuberosity may be the reason of decreased functional scores, similar to superior or posterior malposition. The medialization of greater tuberosity should be considered as a potential factor leading to the shortening of the rotator cuff's abductor moment.

Validation of ergonomic running handgrip elements to improve arm posture of running novices

Abstract Running is one of the most popular sports worldwide motivating many non-athletic people to start new physical activities. But especially novice runners are at risk to develop injuries as they tend to run with prejudicial posture. Hence, there has been considerable research to identify factors improving running performance. One of these factors is the correct movement of arms as a swinging pendulum during running. Based on this knowledge ergonomically shaped handgrip elements were designed to improve the posture of the shoulder-arm complex during running. The main objective of this study was the validation of the actual effectiveness on shoulder-arm posture of these handgrips. In this sense 25 adult, healthy persons without running experience were examined by motion capture analysis during running on a treadmill with and without the use of the handgrips. The focus of movement analysis was on changes of hand supination, shoulder abduction and shoulder rotation. Flexion of elbows and shoulders were not expected to change and thus, were investigated as an internal control. Significant changes were found in sense of a reduction of forearm pronation, shoulder abduction, and internal rotation of the shoulder, resulting in improved posture during running. At the same time, no significant changes were found in elbow flexion and shoulder flexion. Future studies are needed to investigate the effects of the detected improvement of arm posture on other important running parameters, such as trunk stability, movement of lower limbs, running economy, and risk of injury. These studies should also compare effects in competitive athletes, recreational runners, and novice runners.

Validity and Reliability of the Kinvent Handheld Dynamometer in the Athletic Shoulder Test.

Long-lever shoulder strength tests may aid clinical decision-making regarding return to sport after a shoulder injury. The Athletic Shoulder Test (AST) was developed to measure force production in 3 positions of shoulder abduction (90°, 135°, and 180°) using force plates. However, handheld dynamometers (HHDs) are more portable, affordable, and may provide valid and reliable results which would increase the clinical utility of long-lever tests. HHDs vary in shape, design, and their capacity to report parameters such as rate of force production and require further investigation. The aim of this study was to examine the intrarater reliability of the Kinvent HHD and assess its validity against Kinvent force plates in the AST. Peak force (in kilograms), torque (in Newton meters), and normalized torque (in Newton meters per kilogram) were reported. Validity and reliability study. Twenty-seven participants with no history of upper limb injury performed the test in a randomized order using the Kinvent HHD and force plates. Each condition was assessed 3 times, and peak force was recorded. Arm length was measured to calculate peak torque. Normalized peak torque was calculated by dividing torque by bodyweight (in kilograms). The Kinvent HHD is reliable when measuring force (intraclass correlation coefficient [ICC] ≥ .80), torque (ICC ≥ .84), and normalized torque (ICC ≥ .64) during the AST. The Kinvent HHD is also valid when compared with the Kinvent force plates for force (ICC ≥ .79; r ≥ .82), torque (ICC ≥ .82; r ≥ .76), and normalized torque (ICC ≥ .71; r ≥ .61). There were no statistically significant differences across the 3 trials on analyses of variance (P > .05). The Kinvent HHD is a reliable tool when used to measure force, torque, and normalized torque in the AST. Furthermore, given the lack of significant difference between trials, clinicians can use one test to accurately report relative peak force/torque/normalized torque rather than average 3 separate trials. Finally, the Kinvent HHD is valid when compared with Kinvent force plates.