Shoulder Extension Research Articles

Effects of multimodal physical activity program in the cognive functions and functional fitness test in elderly with and without Alzheimer Disease

AbstractBackgroundAlzheimer’s Disease (AD) is the most prevalent disease among all dementias, and is characterized by progressive deficits in cognitive function and activities of daily living.The aim of this study was compare effects of multimodal physical activity program in functional capacity, memory, and attention in elderly with and without AD.MethodEighteen elderly with AD were ramdomized into the control (AD‐C) or multimodal physical activity program (AD‐T) groups. Also twenty without AD were divided in the control (NAD‐C) or physical activity program (NAD‐T) groups. All participants performed the international physical activity questionnaire, neuropsicological evaluation using Mini Mental State Examination, Syndrom Kurztest (SKT), clinical dementia rating. The functional fitness test was evaluated by the muscular resistance (30‐second chair stand and arm curl), aerobic capacity (2‐minute step in the place), lower and upper body flexbility (chair sit‐and‐reach, and back scratch tests) and agility/dynamic balance (8‐foot up and go). The shoulder and ankle amplitude were measured using a Fleximeter. The multimodal physical activity program included warm up, aerobic exercises, strength, flexibility, and cool down for 3 months, twice a week, with 75 min each session for NAD‐T and AD‐T groups.ResultThe physical activity program significantly increased the leisure‐time physical activity level, upper body muscular strength, aerobic capacity, upper and lower body flexibility, shoulder and ankle extension range in the NAD‐T and AD‐T (P<0.05). Also increased agility/dinamic balance compared to the AD‐C group (P<0.05). Concerning the cognition, the multimodal training improved SKT‐memory in both groups NAD‐T and AD‐T (P<0.05). SKT‐atention improved in the NAD‐T group (P<0.05).ConclusionThe multimodal physical activity program was effective in increasing the level of leisure‐time physical activity, aerobic capacity, muscle strength, lower limb flexibility, shoulder extension, and memory, independent of the AD. Additionaly, the program attenuated the decline in agility/dinamic balance compared to the AD‐C group. Attentional function improved in the NAD‐T group. These benefits may contribute to a better performance in activities of daily living, reduction of falls and attenuation of the decline of cognitive functions in elderly people with and without AD.

Effects of a High-Volume 7-Week Pectoralis Muscle Stretching Training on Muscle Function and Muscle Stiffness

BackgroundThere is evidence that high-volume static stretching training of the lower limbs can increase the range of motion (ROM) while decreasing muscles stiffness. However, to date, there is no evidence on the effects of upper limb stretching training or its effect mechanism. Therefore, this study aimed to investigate the effects of a comprehensive 7-week static stretching training program of the pectoralis major muscle (PMa) on glenohumeral joint ROM, muscle force, and muscle stiffness.MethodsThirty-eight healthy, physically active participants (23 male, 15 female) were randomly assigned to either the PMa-static stretching intervention (PMa-SS) group or the control group. The PMa-SS group performed a 7-week intervention comprising three sessions a week for 15 min per session, including three static stretching exercises of the PMa for 5 min each. Before and after the intervention period, shoulder extension ROM, muscle stiffness of the PMa (pars clavicularis), and maximal voluntary isometric contraction (MVIC) peak torque (evaluated at both long (MVIClong) and short (MVICshort) muscle lengths) were investigated on a custom-made testing device at 45° shoulder abduction.ResultsIn the PMa-SS group, the shoulder extension ROM (+ 6%; p < 0.01; d = 0.92) and the MVIClong (+ 11%; p = 0.01; d = 0.76) increased. However, there were no significant changes in MVICshort or in PMa muscle stiffness in the PMa-SS group. In the control group, no changes occurred in any parameter.ConclusionIn addition to the increase in ROM, we also observed an improved MVIC at longer but not shorter muscle lengths. This potentially indicates an increase in fascicle length, and hence a likely increase in sarcomeres in series.

The PAY test: a new approach for assessing functional performance in children and adolescents with asthma

ObjectiveTo develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth). Methodsparticipants without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET). Outcomes: PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST. Results8 healthy volunteers, aged 12 (7 - 15) years old were included in the development phase and 34 participants with asthma, aged 11 (7 -14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 [3.0 - 3.3] min vs. 2.3 [2.1 – 2.4 min]), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55–0.90, p < .001). ConclusionsThe PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.

Effects of Exercise Intervention (with and without Joint Mobilization) in Patients with Adhesive Capsulitis: A Systematic Review and Meta-Analysis.

This review aimed to investigate the effects of exercise and exercise with joint mobilization on shoulder range of motion (ROM) and subjective symptom recovery in patients with adhesive capsulitis (AC). Related Studies published from 2000 to 2021 that were peer-reviewed and for which pre-and post-values could be calculated were extracted from PubMed, CINAHL, SPORTDiscus, and Web of Science. Nine studies met our inclusion criteria. As a result of calculating the standard mean difference (SMD) and 95% confidence intervals (CI), both exercise and exercise with joint mobilization showed a large effect on shoulder ROM and subjective outcomes. The combination showed a more significant effect than exercise alone on shoulder flexion (SMD = -1.59 [-2.34, -0.65]), extension (SMD = -1.47 [-2.05, -0.89]), internal rotation (SMD = -1.77 [-2.17, -1.36], external rotation (SMD = -2.18 [-2.92, -1.44]), and abduction ROM (SMD = -1.99 [CI -3.86, -0.12]). Patients who performed exercise alone showed a higher effect of improvement in subjective function (SMD = 3.15 [2.06, 4.24]) and pain (SMD = 4.13 [1.86, 6.41]). Based on these results, an AC rehabilitation exercise program should be developed by adjusting the amount of exercise and joint mobilization by identifying the patient's needs, subjective symptoms, and ROM.

Quantifying the Effects of American Football Shoulder Pads on Reach Distance and Player Perception of Comfort and Fit

Background: The majority of sports equipment research to date has focused on their protective capabilities, and not on how they impact player performance and comfort while using them. Objective: The purpose of this study was to quantify the reach distances of players wearing different football shoulder pads and determine player perceptions of shoulder pad comfort and fit. Methods: Football players (n=10) underwent a standardized reach distance protocol comprised of three trials of repeated shoulder flexion, extension, abduction, horizontal flexion, and horizontal extension in each of the three shoulder pad conditions (no shoulder pad, standard shoulder pad, prototype shoulder pad). Player perceptions of shoulder pad comfort and fit, breathability, restrictiveness, and weight were also evaluated using a questionnaire. Reach distances were recorded using five GoPro Hero 9 cameras and analyzed using ProAnalyst®3D motion tracking software. Results: Reach distances were significantly affected during several movements, but especially in the vertical direction, for flexion and abduction, with mean differences between the prototype pad and standard pad of 10.3 cm and 23.1 cm, respectively (P = 0.007 and P = 0.003). Differences in reach distance were greater for the standard shoulder pad than the prototype shoulder pad on average. This indicates that the prototype shoulder pad was less restrictive, which aligned with what players reported. There was significantly more discomfort reported in the neck collar and armpit regions for the standard shoulder pad compared to the prototype pad. Participants also found the prototype shoulder pad to be lighter, and more breathable (P0.05). Conclusion: These results provide manufacturers with valuable insights from a design standpoint, and offer athletes who are looking for superior sport protective equipment key evidence regarding shoulder pad performance, fit, and comfort.

Do the Testing Posture and the Grip Modality Influence the Shoulder Maximal Voluntary Isometric Contraction?

Assessing and monitoring shoulder strength is extremely important during rehabilitation. A fixed dynamometer represents a valid and inexpensive assessment method. However, it has not been studied whether posture and grip modality influence shoulder muscle strength. The aim of this study was to compare shoulder strength values between sitting and standing positions and between the handle and cuff grip modalities. A total of 40 volunteers were divided into a posture (PG) and a handle-cuff group (HCG). Participants in the PG were asked to perform a maximum voluntary isometric contraction (MVIC) for shoulder flexion, extension, ab-adduction, and intra-extra rotation in standing and sitting positions. The HCG participants were tested in a standing position while holding a handle or with a cuff around their wrist. PG showed higher forces in the standing position for shoulder flexion (p = 0.009); internal rotation showed higher values in the sitting position (p = 0.003). ER/IR ratio was significantly higher in the standing position (p < 0.001). HCG showed higher significant forces during cuff modality in all positions and grip modalities, including the ER/IR ratio (p < 0.05). Different body positions and grip modalities influenced the assessment of shoulder strength as recorded by a fixed dynamometer; therefore, these factors should be carefully considered when carrying out a shoulder strength assessment, and we encourage the development of assessment guidelines to make future clinical trial results comparable.

The effect of tablet tilt angles and time on posture, muscle activity, and discomfort at the neck and shoulder in healthy young adults.

Although young adults regularly perform tablet writing, biomechanics during the tablet writing with different tilt angles has not been studied. The objective of this study was to compare posture, muscle activity, and discomfort at the neck and shoulder between tablet writing with 0° (horizontal) and 30° tablet tilt angles over 40 minutes in healthy young adults. Twenty participants wrote continuously for 40 minutes on a tablet with both tilt angles in a randomized order. Between conditions, there was a 5-minute activity break. Differences in neck and shoulder posture, muscle activity, and discomfort between both tablet tilt angles and changes in the outcomes every 10 minutes over 40 minutes were investigated. With the tilted tablet, there were lower neck flexion (Z = -4.637, P<0.001), lower shoulder extension (Z = -3.734, P<0.001), and lower neck Visual Analogue Scale (VAS) (left; Z = -4.699, P<0.001 and right; Z = -3.874, P<0.001) as compared to the no tilt condition. However, the right upper trapezius muscle activity was higher in the tilted condition as compared to the no tilt one. Over 40 minutes, the neck VAS (left; χ2(4) = 30.235, P<0.001 and right; χ2(4) = 32.560, P<0.001) and heart rate variability (χ2(4) = 12.906, P = 0.012) showed notable increases after 20 minutes compared to baseline. In conclusion, adjusting the tablet tilt to 30° and limiting time spent to 20 minutes are recommended for young adults during the tablet writing to prevent neck problems.

The Differences of Shoulder Range of Motion and Dynamic Stability in Upper Extremity Depending on Ages and Experiences of Shoulder Injuries among Volleyball Players

PURPOSE: This study aimed to verify the differences in shoulder range of motion (ROM) and dynamic stability in the upper extremities depending on the players’ ages and frequency of sports injuries in the shoulder joint.METHODS: A total of 519 volleyball players enrolled in the Korea Volleyball Association and Korean Volleyball Federation participated in this study. All participants answered questions about their experiences of sports-related shoulder injuries and were then categorized into shoulder-injured and non-injured groups. Shoulder ROM (flexion/extension and internal/external rotation) and upper quarter Y-balance (YBT-UQ) were tested by trained examiners. The YBT-UQ was normalized to the arm length (%AL) of the players.RESULTS: Among elementary and middle school players, the shoulder-injured group had lower internal rotation than the non-injured group. In addition, elementary school players with a history of shoulder injuries performed worse in the YBT-UQ test. Regardless of their history of shoulder injury, older patients tended to have decreased shoulder flexion and extension. In the injured group, younger players had lower internal rotation of the shoulder.CONCLUSIONS: These results showed that player age should be considered for rehabilitation to prevent shoulder sports-related injuries in volleyball players.

The Comparison of Physical Fitness Factors between Korea Water Polo National-team and Reserve-team Athletes

PURPOSE: The purpose of the study was to evaluate isokinetic muscle strength (IMS), anaerobic power, basic physical fitness, and body composition of Korean water polo athletes in the national team (NT) and reserve team (RT).METHODS: Twenty-nine male water polo athletes (aged 22.2±1.9 years) including 14 NT and 15 RT athletes participated in this study. The participants were evaluated for physiological parameters such as body composition, physical fitness, IMS, and anaerobic power. The IMS of the knees and shoulders (60°/s, 180°/s, and 240°/s, indicating maximal muscle strength, muscle power, and muscle endurance, respectively) and trunk (30°/s and 120°/s) were measured using a dynamometer (NORM, CSMI, USA). Anaerobic parameters were also measured using the 30-s maximal ergometer cycling Wingate test (Monark, Sweden).RESULTS: No significant differences in the IMS of the knee were found between two groups. Although the IMSs of shoulder flexion at 180º/s and 60°/s were not significantly different between the two groups, the IMSs of shoulder extension at 180º/sec and 60°/s in NT athletes were higher than those in RT athletes (&lt;i&gt;p&lt;/i&gt;&lt;.05, &lt;i&gt;p&lt;/i&gt;&lt;.01). There were no significant differences between the NT and RT (NS) groups in the left and right knee flexion/extension ratios (H/Q ratio, 60º/sec, 180º/sec). However, a significant difference was found in the right shoulder extension/flexion ratio (E/F ratio) between the two groups. Although height, muscle mass, fat mass, and Wingate anaerobic power were not significantly different between the two groups, the FEV1 and FVC of NT athletes were higher than those of RT athletes, respectively (&lt;i&gt;p&lt;/i&gt;&lt;.05, &lt;i&gt;p&lt;/i&gt;&lt;.01).CONCLUSIONS: These results suggest the athletic characteristics of water polo players who pass and shoot and make swimming movements. The difference in the shoulder extensor muscle strength was one of the determining factors for the performance of water polo athletes.

Effect of the lumbar stability exercise on the height difference between shoulders and range of motion in older adults.

[Purpose] The purpose of this study was to investigate the effect of the lumbar stability exercise on the range of motion (ROM) and height difference of the shoulder and to provide basic data to prevent musculoskeletal disorders for improvement of the quality of life of older adults. [Participants and Methods] Twenty older adults without musculoskeletal problems were divided into the lumbar stability exercise group and the passive upper arm exercise group and performed exercise for 30 minutes, 3 times a week for 5 weeks. The shoulder flexion, abduction, extension, and height difference between shoulders were measured. A paired t-test was applied for comparative analysis of data before and after exercise in both groups. [Results] In the lumbar stability exercise group, the shoulder flexion, abduction and height difference were significantly different. In the passive upper arm exercise group, the abduction was significantly different. [Conclusion] Since it was proved that the height difference and range of motion of shoulder are improved when the lumbar stability exercise is indirectly carried out without directly doing shoulder exercise, it is suggested that the lumbar stability exercise is strongly recommended for clinical uses to improve functions in older adults.

Biomechanical Parameters that Correlate with Peak Shoulder Extension Torque during Arm Support Phase of Kicking Pullovers

Biomechanical Parameters that Correlate with Peak Shoulder Extension Torque during Arm Support Phase of Kicking Pullovers

Kinetics of the front-arm technique in cricket fast bowling

The aim of this study was to investigate the kinetics of the front arm in cricket fast bowling. Eighteen male fast bowlers (mean age = 17.2 ± 1.6 years; mean height = 1.89 ± 0.05 m; mean mass = 85.0 ± 10.0 kg) were recruited from NSW grade club level and their bowling actions recorded by a Cortex 2.0 motion analysis system (200 Hz). The interaction between joint power and joint angular velocity data was observed simultaneously for the front shoulder and elbow joints. A joint actuation strategy (active or controlled) was assigned to shoulder flexion–extension, abduction–adduction, and elbow flexion–extension motion to understand whether the joint kinematics followed the time-history of the joint torque. The results only partially agreed with the commonly prescribed coaching maxim of “pulling down” the front arm for faster ball speeds. Active extension and adduction of the front shoulder joint were observed during the delivery phase of the action, whereas the acceleration phase was marked by periods of controlled shoulder extension and active shoulder flexion. At the elbow joint, active elbow flexion was observed at a time when it may reduce the moment of inertia about the thoracic and lumbar spine rotation axes. Overall, combinations of active and controlled joint powers were observed for the front shoulder and elbow joints, implying that this sample of bowlers did not adhere to the traditional notion of “pulling down” the front arm as fast as possible.

Baseline robot-measured kinematic metrics predict discharge rehabilitation outcomes in individuals with subacute stroke.

Background: The literature on upper limb robot-assisted therapy showed that robot-measured metrics can simultaneously predict registered clinical outcomes. However, only a limited number of studies correlated pre-treatment kinematics with discharge motor recovery. Given the importance of predicting rehabilitation outcomes for optimizing physical therapy, a predictive model for motor recovery that incorporates multidirectional indicators of a patient's upper limb abilities is needed. Objective: The aim of this study was to develop a predictive model for rehabilitation outcome at discharge (i.e., muscle strength assessed by the Motricity Index of the affected upper limb) based on multidirectional 2D robot-measured kinematics. Methods: Re-analysis of data from 66 subjects with subacute stroke who underwent upper limb robot-assisted therapy with an end-effector robot was performed. Two least squares error multiple linear regression models for outcome prediction were developed and differ in terms of validation procedure: the Split Sample Validation (SSV) model and the Leave-One-Out Cross-Validation (LOOCV) model. In both models, the outputs were the discharge Motricity Index of the affected upper limb and its sub-items assessing elbow flexion and shoulder abduction, while the inputs were the admission robot-measured metrics. Results: The extracted robot-measured features explained the 54% and 71% of the variance in clinical scores at discharge in the SSV and LOOCV validation procedures respectively. Normalized errors ranged from 22% to 35% in the SSV models and from 20% to 24% in the LOOCV models. In all models, the movement path error of the trajectories characterized by elbow flexion and shoulder extension was the significant predictor, and all correlations were significant. Conclusion: This study highlights that motor patterns assessed with multidirectional 2D robot-measured metrics are able to predict clinical evalutation of upper limb muscle strength and may be useful for clinicians to assess, manage, and program a more specific and appropriate rehabilitation in subacute stroke patients.

The Influence of Anticipation of Movement Starting Time on Feedforward Activation of Trunk Muscles during Rapid Shoulder Joint Movements.

This study aimed to clarify the differences in the onset of trunk muscle activity with and without anticipation of the movement starting time during rapid shoulder movements. Ten healthy men in a relaxed upright position performed rapid 135° flexion, 135° abduction, and 45° extension of the shoulder on the dominant hand side with and without anticipation of the movement starting time. They moved their shoulder joints following a 3-s countdown and a light stimulus in the anticipation and non-anticipation conditions, respectively. Electromyography of the anterior and posterior quadratus lumborum, transversus abdominis, internal oblique, external oblique, rectus abdominis, lumbar multifidus, lumbar erector spinae on the non-dominant hand side, and the middle deltoid on the dominant hand side were measured. The onset of activity of each trunk muscle relative to the onset of the middle deltoid was calculated. Two-way analysis of variance (eight trunk muscles × two anticipation conditions) was used to compare the onset of electromyographic activity of the trunk muscles in each direction of the shoulder movement. There were significant interactions between the muscles and anticipation conditions during shoulder abduction and extension. The onset of activity in the anterior and posterior quadratus lumborum, transversus abdominis, and internal oblique occurred earlier with anticipation of the movement starting time than without anticipation during shoulder abduction and extension. The anticipation of movement starting time may contribute to a reliable center of mass control within the support base and improve lumbar spine stability by hastening the onset of activity of the deep trunk muscles.

No association between dynamic trunk flexion strength and throwing velocity in elite women handball players

BACKGROUND: The relationship between strength and throwing velocity is much investigated in handball, but core strength is largely ignored. Only four studies have investigated the effect of core training on handball throwing velocity, reporting conflicting results in amateur players. However, lack of specificity and deficient technical execution of throwing in amateurs can obscure the results. OBJECTIVE: To examine the direct association between trunk flexion strength and throwing velocity in elite handball players, using women as a model. METHODS: Sixteen women players from an elite-level Norwegian handball team participated in the study. Strength in trunk flexion, shoulder extension, internal shoulder rotation, and forearm pronation was assessed using isokinetic dynamometer measurements (peak moment, total work, angular impulse). Throwing velocity in both the standing throw with run-up and the jump throw was determined from motion capture measurements. To account for arm strength, the association between trunk flexion strength and throwing velocity was examined using partial correlation analyses. RESULTS: No significant association was found between any measure of trunk flexion strength and throwing velocity for either throwing technique (explained variance ⩽ 13.7%). CONCLUSIONS: The results indicate that isolated, dynamic trunk flexion strength is not a differentiating factor for handball throwing velocity in elite women players.

Bench, Bar, and Ring Dips: Do Kinematics and Muscle Activity Differ?

The purpose of this study was to profile and compare the kinematics, using 3D motion capture, and muscle activation patterns, using surface electromyography (sEMG), of three common dip variations; the bench, bar, and ring dips. Thirteen experienced males performed four repetitions of each dip variation. For each participant, repetitions 2–4 were time-normalized and then averaged to produce a mean value for all kinematic and sEMG variables. The mean maximal joint angles and mean peak sEMG amplitudes were compared between each variation using a one-way ANOVA with repeated measures. Several significant differences (p < 0.05) between dip variations were observed in both kinematic and sEMG data. The bench dip predominantly targets the triceps brachii but requires greater shoulder extension range. The mean peak triceps brachii activation was 0.83 ± 0.34 mV on the bench, 1.04 ± 0.27 mV on the bar, and 1.05 ± 0.40 mV on the ring. The bar dip is an appropriate progression from the bench dip due to the higher peak muscle activations. The ring dip had similar peak activations to the bar dip, with three muscles increasing their activation intensities further. These findings have implications for practitioners prescribing the dip, particularly to exercisers with a history of shoulder pain and injury.

Predicting the Clean Movement Technique in Crossfit® Athletes Using an Optimal Upper-Limb Range of Motion: A Prospective Cohort Study.

Background: The aim of this study was to determine the optimal upper-limb range of motion (ROM) profile for the catch phase of the clean movement (CPCM) and to identify the key ROMs for performing the CPCM in CrossFit® athletes. Methods: A prospective cohort study of twenty CrossFit® athletes aged 20–36 years was conducted. Data were collected regarding age, anthropometrics, CrossFit® training experience and upper-limb ROM. The ROM was measured using the ROM-SPORT method. After 7 months, athletes performed a clean movement with a load of 80% one repetition maximum. A Bayesian Student’s t-analysis, binary logistic regression analysis and Receiver Operating Characteristic analysis were performed. Results: The optimal upper-limb ROM profile that predicted correct CPCM performance was 78° in shoulder extension, 173° in shoulder flexion, 107° in shoulder external rotation, 89° in shoulder internal rotation, 153° in elbow flexion, 99° in elbow pronation and 92° in wrist extension (area under the curve ≥ 651; positive predictive value ≥ 80%). Shoulder external rotation, elbow pronation and wrist extension were found to be the most important ROMs for the efficient and safe performance of CPCM (area under the curve ≥ 854; positive predictive value ≥ 85.7%). Conclusion: The upper-limb ROM profile is associated with proper clean performance. Further studies are warranted to determine whether improving flexibility on upper-limb ROM may improve proper clean movement performance.

VP.11 Shoulder subluxations and dislocations in non-ambulatory patients with Duchenne muscular dystrophy (DMD)

Patients with DMD are living into their 3rd decade of life, which raises a concern for upper extremity (UE) dysfunction. Many young men are now going to college and entering the work force, adding new contexts for which UE joint integrity and function need to be managed. Currently, there are no research studies on the evaluation and treatment of shoulder subluxations and dislocations in non-ambulatory individuals with DMD. The objective of this case series is to investigate the need for the evaluation, prevention, and treatment of shoulder subluxations and dislocations in non-ambulatory patients with DMD. A retrospective chart review of non-ambulatory patients with DMD took place in an interdisciplinary DMD dedicated clinic at UMass Memorial Medical Center. Herein we report the clinical profiles of 7 non-ambulatory patients aged 20-28 years old who were found to have shoulder subluxations and/or dislocations. Clinical evaluations included PROM, seated alignment assessment, manual muscle testing, and a PUL 2.0 outcome measure assessment. Common findings included: wheelchair-bound for 6-13 years with 6/7 patients on steroids, 5/7 patients without initial complaint of shoulder pain, 6/7 patients with atraumatic mechanism of injury, limited shoulder flexion, abduction and/or extension PROM with or without pain, shoulder complex depression, postural asymmetries, and Brooke score of 5 which corresponds to severe weakness, the inability to raise their hand to mouth, and elevate their shoulder against gravity. Patients responded to the treatments of UE support and wheelchair armrest modifications. In conclusion, patients presenting with limited PROM with or without pain, loss of antigravity shoulder function, and asymmetric shoulder alignment may need further evaluation of shoulder stability. X-rays can confirm the diagnosis and severity. Education on positioning and shoulder support may be helpful in the prevention and treatment of shoulder subluxation/ dislocation.

Segmental sequencing of the upper body segments in unconstrained maximum overarm throws: An implication for coaching.

Overarm throwing is an essential fundamental movement skill (FMS). Competency in throwing is critical to encourage physical activity throughout lifespan. However, the segmental sequencing characteristics of skilled throwing to achieve maximum ball release speed are unclear. Further, the standard instructions for segmental sequencing in coaching manuals are anecdotal and not based on scientific evidence. Therefore, the aim of this study was to establish the critical features of upper-body sequencing in skilled throwing for maximum speed. This would enable revised instructions for coaching throwing based on scientific evidence. The three-dimensional kinematics of 144 right-handed unconstrained maximum overarm throws were captured and analyzed. The quartiles of participants with the fastest and lowest ball release speed, normalized by height, were defined as the Skilled Group and Less Skilled Group, respectively. Paired t-tests were used to determine the differences in times of successive events within groups and independent t-tests for between-group differences in temporal space between events for all sequences. A characteristic segmental sequence of each group was defined as a sequence with significant within-group differences in two successive events (p < 0.001), while a critical segmental sequence was defined as a sequence with significant differences in temporal space both within groups and between groups (p < 0.001). The Skilled Group had six characteristic sequences, while two were found for the Less Skilled Group, summarized in the conceptual model. A single critical sequence of non-throwing arm elbow extension prior to shoulder extension was found. Five evidence-based instructions were recommended to add to the Australian FMS instruction manual.

Long-term outcome of dogs treated by surgical debridement of proximal humeral osteochondrosis.

To evaluate long-term clinical outcomes of dogs surgically treated for proximal humeral osteochondrosis (OC). Cross-sectional study. Twenty dogs (n=26 shoulders). Dogs treated with surgical debridement of proximal humeral OC lesions >12 months prior were enrolled. Orthopedic examination (including limb circumference and shoulder goniometry), kinetic gait analysis, shoulder radiographs, shoulder computed tomography (CT), and shoulder arthroscopy were performed. All owners completed a dog mobility questionnaire. Brachial circumference (P=.003) and maximum shoulder extension (P=.013) were decreased and maximum shoulder flexion (P=.008) was increased (ie less flexion) in the OC limb versus the contralateral limb in unilaterally affected dogs. There were no differences in peak vertical force and vertical impulse between affected and unaffected limbs. Dogs demonstrated a 4.4% decrease in load distributed to the operated limb. Osteoarthritis was present in all shoulders treated for OC lesions. The degree of osteoarthritis in OC-affected shoulders was increased compared to the contralateral limb as evaluated on CT (P=.005) and radiography (P=.0001) in unilaterally affected cases. Moderate-to-severe synovitis was seen in all OC-affected joints. Arthroscopically, all lesions were noted to have patchy, incomplete cartilaginous infilling. Median of aggregate Liverpool Osteoarthritis in Dogs (LOAD) scores was 6. All dogs exhibited ipsilateral muscle atrophy and progressive osteoarthritis, with most dogs exhibiting subtle lameness on the subjective gait examination. Despite this, owner-perceived mobility was satisfactory. Progression of joint disease over time should be expected; however, the abnormalities detected on examination appear to be of questionable clinical relevance.