Shoulder Extension Research Articles

SHOULDER ISOKINETIC PERFORMANCE IN HEALTHY PROFESSIONAL JUDO ATHLETES: NORMATIVE DATA.

ABSTRACTObjective:To evaluate normative data of shoulder isokinetic strength in healthy professional judo athletes.Methods:Cross-sectional study with 20 professional male and female athletes (10 female), evaluated with an isokinetic dynamometer. The strength assessment was carried out in external and internal rotation, flexion, extension, adduction and abduction. All data collected on muscle torque were normalized with body mass index.Results:Athletes demonstrated higher peak torque and joint work in shoulder adduction, abduction, flexion, and extension for the dominant limb compared to the non-dominant limb (p <0.05), with most of these deficits below 10%. Shoulder internal/external rotation ratios for male and female athletes had no significant differences between dominant and non-dominant sides, demonstrating values at 60°/s of 49.4 ± 7.2 on the dominant side of males and 49.1 ± 4.9 for females.Conclusion:The normative data are described to assist during treatment, return to sport and injury prevention. Level of evidence IV, cross-sectional study.

A Triple Application of Kinesio Taping Supports Rehabilitation Program for Rotator Cuff Tendinopathy: a Randomized Controlled Trial

Rotator cuff tendinopathy (RoCT) is a common pathology among adults. Kinesio-taping (KT) represents a possible rehabilitative treatment. The aim of the present study is to investigate the efficacy of a combination of three different applications of KT combined with a standardized protocol of rehabilitative exercises in reducing pain and in functional recovery in patients affected by RoCT. 21 patients were enrolled in a real group (RG) and 19 in a sham group (SG). RG received a real KT application and SG received a sham KT application. Both groups received the same rehabilitative protocol. A Numeric Rating Scale (NRS) for shoulder pain, Medical Research Council (MRC) Scales for shoulder strength assessment and Costant Murley Score (CMS) were administered before (T0) and at the end of treatment (T1). Within-group analysis for RG at T1 showed significant improvement in: NRS at-rest (p=0.002), during-movement (p&lt;0.001); CMS (p&lt;0.001); MRC shoulder flexion (p=0.003), extension (p=0.005), abduction (p=0.003), adduction (p=0.007), external rotation (p=0.011), internal rotation (p=0.002), elbow flexion (p=0.008) and extension strength (p=0.011). Within-group analysis for SG at T1 showed significant improvement in: during-movement NRS (p=0.010); CMS (p&lt;0.001). 1. KT application combined with conventional rehabilitative treatment can facilitate immediate pain reduction during rehabilitative treatment. 2. KT application combined with conventional rehabilitative treatment can increase function recovery. 3. KT application combined with conventional rehabilitative treatment can increase strength recovery. 4. Our findings however are not strong enough to recommend the application of KT during rehabilitative treatment for RoCT. 5. These results are the basis for future prospective, randomized controlled trials of larger samples of patients.

Shoulder extension strength: a potential risk factor for shoulder pain in young swimmers?

ObjectivesTo determine the relationship and predictive value of isometric shoulder strength in the development of shoulder pain in young swimmers. DesignProspective, cohort study. MethodsShoulder flexion, extension, external and internal rotation strength tests were performed in elevation on 85 swimmers (14–20 years; 48 females) without current shoulder pain using a hand-held dynamometer. Following testing, swimmers were emailed questionnaires to determine if significant shoulder pain developed within 24 months subsequent to testing. The differences between shoulders that did and did not develop pain and the predictive ability of shoulder strength and strength ratios were investigated using Mann Whitney U tests and receiver operating characteristic curves. ResultsThirty-seven swimmers (47%) returned questionnaires and 18 reported shoulder pain. A comparison of individual shoulders (27 with pain reported and 47 without) determined that shoulder extension strength was lower and flexion:extension strength ratio was higher for male swimmers (n=36 shoulders) who reported shoulder pain compared to those who did not (p=0.04). The predictive value of extension strength was fair (0.72; p=0.03) for males with a cut-off value for extension strength calculated at 13.5% body mass. There were no differences between the two groups in shoulder rotation strength, age, training hours or previous pain history. ConclusionsShoulder extension strength, a functional test for swimmers, was associated with and predictive of the development of shoulder pain in male swimmers. Low shoulder extension strength may be a risk factor for the development of shoulder pain in swimmers, proposing a direction for injury prevention and future investigation.

Effects of restrictive and non-restrictive harnesses on shoulder extension in dogs at walk and trot

The study aimed to compare the effect of restrictive and non-restrictive harnesses on shoulder extension of dogs at walk and trot. This was a prospective study of nine dogs. Dogs...

The influence of shoulder characteristics on the safety level of two-lane roads: A case-study

Constructing proper shoulders may improve road safety on two-lane roads. Previous research reported crash reductions following shoulder widening. This study aimed to examine the relationship between shoulder characteristics and crash occurrences on two-lane rural roads in Israel. The study database combined information on crash numbers, traffic volumes and road infrastructure characteristics of 3594 road sections. To examine a relationship between shoulder characteristics and crashes, given other road characteristics, two types of statistical models were developed: case-control and negative-binomial regression models, for several crash types. We found that the impacts of shoulder width and other road characteristics on crashes were generally consistent across various models and crash types, where a non-monotonous link between the shoulder width and crashes was typically observed. For various crash types, the models showed an increase in crash risk with an initial extension of the total shoulder, up to 2.2 m, and a consequent decrease in crashes with a further shoulder widening, over 2.2 m, by 2–6% and 1–4%, respectively, for each 0.1 m of shoulder extension. An increase in the width of unpaved shoulders, over 0.9 m, was associated with increased crash risk, in injury and total crashes, by 5% for each 0.1 m of shoulder extension. Lowest crash risks were found for total shoulder widths of about 3 m or more, but also for narrow total shoulders, below 1 m. Conversely, medium total shoulders, of 1.8–2.4 m in width, and unpaved shoulders of over 1 m, were associated with an increase in crash risk and, hence, are not recommended for use. The tools developed in the study may assist in decision-making during the design stages of a new road or upgrading existing road sections, on two-lane local roads.

The relationship of elbow alignment and kinematics on shoulder torque during the softball pitch: a biomechanical analysis of female softball pitchers

Female softball pitchers commonly throw more pitches per game and season than their baseball counterparts. The greatest stress to the shoulder during a softball windmill pitch is at ball release (BR). This study investigated shoulder torques at BR among female softball pitchers and identified relationships to the kinematics of the elbow and forearm and alignment of the elbow (carrying angle and elbow extension). High-speed 3-dimensional biomechanical analyses were performed in 33 pitchers (25 high school, 8 collegiate). Elbow and shoulder biomechanics at BR during fastball pitches and goniometric measures of carrying angle and elbow extension were collected and analyzed. Carrying angle correlated positively with shoulder extension torque at BR (rs = 0.371, P = .048) and forearm pronation at BR (rs = 0.370, P = .048). During the windmill pitch, the greater the elbow flexion, the greater shoulder adduction torque at BR (rs = -0.522, P = .007). Multiple regression analysis revealed that the carrying angle, passive elbow extension, and elbow flexion/extension angle at BR predicted shoulder flexion/extension torque at BR (F3,24 = 3.463, R2 = .302, P = .032.) CONCLUSIONS: Our findings demonstrate that shoulder torques during the softball fastpitch are influenced by the carrying angle and the kinematic elbow flexion angle at BR. Sports medicine clinicians and coaches should consider the role that the elbow carrying angle plays in creating shoulder stress when treating and training fastpitch softball players.

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients.

ObjectivesThe aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT‐A) in poststroke subacute hemiparetic patients.MethodsFourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT‐A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT‐A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores.ResultsComparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT‐A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0.ConclusionInjection of BoNT‐A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR‐related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex‐mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT‐A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons.

The Influence of Different Hind Shoes and Bare Feet on Horse Kinematics at a Walk and Trot on a Soft Surface

Although often discussed in practice, there is a paucity of scientific evidence as to the effect of different shoes on equine locomotion on soft ground, especially in hind limbs. Our objectives were to determine the effect of different shoeing conditions on the locomotion of sound horses on a soft surface. Two-dimensional kinematic video analysis was performed in six horses during walk and trot in hand on the same sand surface under seven different shoeing conditions: (1) front feet shod with aluminum shoes and hind feet with steel racehorse shoes, same front shoes in combination with (2) hind egg bar shoes (EGB), (3) hind reverse shoes (REV); and (4) hind covered toe shoe (COV); (5) all four feet unshod; (6) fore feet unshod and hind steel race shoes; and (7) front aluminum shoe and hind feet unshod (hind bare feet [HBF]). We showed that, in comparison to condition 1 which was used as the reference, HBF increased stifle, hip and fore fetlock extension, the fore shod conditions increased carpus and shoulder flexion, COV showed little effect, REV increased elbow and shoulder extension, and EGB increased stifle and hip extension. For main limitations, the results could be different in other speeds, gaits, and surfaces. In conclusion, on sand, shod conditions and hind shoes largely influence upper limb joint motion and have a relatively small influence on distal limb joint motion. This needs to be considered when horses are shod to improve kinematics for performance purposes or when addressing clinical problems.

The contribution of counter-rotation movements during fall recovery: A validation study

Three mechanisms of maintaining standing stability include M1 – moving the COP within the base of support, M2 – segment counter-rotation, and M3 – applying an external force. To date, the contributions of these mechanisms have not been quantified for the response to an external postural disturbance. The purpose of this study was to evaluate the construct validity of measures that quantify the M2 contribution to anteroposterior fall recovery. We evaluated the whole-body rotation contribution, as well as a measure specific to arm motion (MARMS). With segment counter-rotation as the main focus of this study, we examined standing feet-in-place responses to treadmill-induced falls. The treatment validity of our measures was assessed by comparing unconstrained responses to those with constrained arm motion. The convergent validity of our measures was assessed by correlating peak shoulder flexion and extension velocities with counter-rotation contributions. Eleven unimpaired participants responded to anteroposterior belt accelerations from a treadmill, and the M2 and MARMS contributions were quantified from three-dimensional segment motion. The treatment validity of these measures was partially supported. Constraining the arms reduced M2 for anterior, but not posterior falls. Conversely, MARMS was reduced for posterior, but not anterior falls. Convergent validity was supported for MARMS (r = 0.64–0.78), but not M2 (r = −0.40 to −0.15). These results support the use of MARMS over M2 when interested in the role of arm motion. Given that arm constraints did not change the contribution of MARMS during a forward fall, unimpaired participants may not necessarily rely on arm motion as part of their recovery strategy in this context.

Efficacy and safety of incobotulinumtoxinA in the treatment of shoulder spasticity due to cerebral causes

Botulinum neurotoxin is well established for treating upper limb spasticity. However, few studies have assessed efficacy in the shoulder. TOWER ( NCT01603459 ) previously evaluated the safety and efficacy of escalating incobotulinumtoxinA doses (400U– ≤ 800U) in adults with upper- and lower limb spasticity due to cerebral causes (Wissel. Neurology , 2017). This post-hoc analysis assessed the efficacy and safety of incobotulinumtoxinA for treating shoulder spasticity, as part of upper limb treatment. Patients received three injection cycles (IC) with escalating incobotulinumtoxinA doses on the same body side (400U, 600U and 600–800U; ≤ 600U per limb including optional shoulder dose, planned range 100–250U). Here, patients who had received shoulder treatment were compared with those who had upper limb treatment, without shoulder treatment. Ashworth Scale (AS) scores for shoulder adduction, extension and internal rotation were added to form the AS shoulder sum score (AS-SSS), to fully assess joint function. The incidence of adverse events (AEs) was assessed. The number of patients receiving shoulder treatment increased with escalating incobotulinumtoxinA dose at each IC, peaking in IC3 ( n = 84/140 [60.0%]; mean [SD] shoulder dose 118.4 [60.2] U). From baseline to 4 weeks post-injection in IC1, IC2 and IC3, respectively, the mean (SD) AS-SSS improved by −1.1 (1.9), −1.7 (1.8) and −1.7 (1.8) in patients treated in the shoulder and −0.5 (1.3), −0.8 (1.6) and −0.9 (1.4) in patients who were not. Multiple regression analysis adjusting for IC baseline showed significant improvement in AS-SSS with incobotulinumtoxinA shoulder dose in IC3 ( P = 0.0081). AEs occurred in 52.1% of patients treated in the shoulder and 61.0% in those who were not. No differences were observed in AE patterns and no unexpected safety concerns were reported with shoulder treatment or higher incobotulinumtoxinA dose. Results support the efficacy and safety of incobotulinumtoxinA for treatment of shoulder spasticity as part of upper limb treatment.

Characterizing the SEMG patterns with myofascial pain using a multi-scale wavelet model through machine learning approaches

In this paper, we introduce a newly developed multi-scale wavelet model for the interpretation of surface electromyography (SEMG) signals and validate the model’s capability to characterize changes in neuromuscular activation in cases with myofascial pain syndrome (MPS) via machine learning methods. The SEMG data collected from normal (N = 30; 27 women, 3 men) and MPS subjects (N = 26; 22 women, 4 men) were adopted for this retrospective analysis. SMEGs were measured from the taut-band loci on both sides of the trapezius muscle on the upper back while he/she conducted a cyclic bilateral backward shoulder extension movement within 1 min. Classification accuracy of the SEMG model to differentiate MPS patients from normal subjects was 77% using template matching and 60% using K-means clustering. Classification consistency between the two machine learning methods was 87% in the normal group and 93% in the MPS group. The 2D feature graphs derived from the proposed multi-scale model revealed distinct patterns between normal subjects and MPS patients. The classification consistency using template matching and K-means clustering suggests the potential of using the proposed model to characterize interference pattern changes induced by MPS.

500 Vibrotactile Stimulation and Pain Modulated Range of Motion Gains in Burn Scars

With an increase in survivability from burn injuries over the past couple of decades comes the challenge of managing post-burn scars. When scar tissue impairs joint function, range of motion (ROM) may be limited. Management of post-burn scar tissue offers many challenges for burn therapists including tolerance to ROM, particularly during the proliferative phase when the scar tissue is vascular, contracting, and the patient may be experiencing dysesthesia. When managing scars during this phase of healing, we investigated an alternative modality that may reduce pain and can be applied in conjunction with ROM to facilitate tissue elongation. We conducted trial runs of two outpatient post-burn survivors, both with right axilla involvement. Patient 1 had been discharged from the burn center for 94 days and patient 2 for 28 days. Both patients spent time at inpatient care facilities upon discharge. Patients were given protocol-based standardized treatments for ROM and measurements taken at conclusion of same, with patient reporting pain at maximal ROM attained. At that point, ROM was resumed with application of vibration for a dosage of 2–3 minutes per square inch of scar with use of skin lubricant. ROM was then measured and pain assessed at maximal ROM attained, and differences compared within each session. The handheld corded vibratory massager used during these trials produces 120 V / 60 Hz of power with adjustable intensity through a three pinpoint triad head. Intensity was adjusted to patient tolerance. The total contact area of the head was 2 cm2. Patient 1 was treated 3 times per week for 19 weeks and was 5 months post-burn at time of first session. Patient 2 was treated 3 times per week for 19 weeks and was 2 months post-burn at time of first session. At the completion of 4 weeks of treatment, patient 1 increased right shoulder flexion by 25 degrees (18.51%) and right shoulder abduction by 18 degrees (12.86%). Patient 2 increased right shoulder flexion by 18 degrees (12.86%), R shoulder abduction by 28 degrees (19.72%), and right shoulder extension by 17 degrees (34%). Both patients 1 and 2 reported less pain with use of vibration, with averages of 5/10 -> 0/10 and 4/10 -> 2/10, respectively. Preliminary data suggests that using a targeted vibratory stimulus during passive ROM may enhance analgesia and ROM gains in the outpatient setting. Reported pain during ROM was found to decrease for both patients. A prospective randomized trial is needed. This study could offer practitioners an alternate modality to use in conjunction with ROM to promote ROM gains while providing vibratory analgesia during the proliferative phase of healing. A prospective, randomized trial is needed.

Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue

BackgroundShoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion. ObjectiveTo determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion. DesignA randomized study with repeated measures observations. SettingThe study was performed at an institutional gait analysis laboratory. Participants18 able-bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P. MethodsShoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes. Main Outcome MeasuresThe primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre- and post-test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t-tests, and Kruskal-Wallis tests were used in analyzing data. ResultsAlthough not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre- and post-test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant. ConclusionsThese data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference. Level of EvidenceII

INTER-RATER AGREEMENT AND VALIDITY OF A TACKLING PERFORMANCE ASSESSMENT SCALE IN YOUTH AMERICAN FOOTBALL

Long term neurologic injury and concussion have been identified as risks from participation in American football. Altering tackling form has been recommended to reduce the risk of neurologic injury caused by head accelerations when tackling. The purpose of this research is to determine the inter-rater agreement and validity of the Qualitative Youth Tackling System (QYTS), a six-item feedback scale to correct tackling form, when utilized by novice and expert raters. Experienced raters will have higher levels of agreement with each other and with motion capture when compared to novice raters. Both novice and experienced raters viewed video of youth athletes (ages 9-13) tackling a dummy in a laboratory setting along. The raters identified successful performance according to a binary rating scale for each component. Analysis of both the raters' agreement with each other and with an objective motion capture measure were completed. Fliess' Kappa measures between all raters were found to be moderate for head placement (k=.48), fair for cervical extension (k=.38), trunk inclination (k=.37), shoulder extension (k=.27) and step length (k=.29), and there was no agreement for pelvic height (k=.-16). When compared to the dichotomized validation measures of each of the five components provided by the motion capture system the average Cohen's Kappa agreement was substantial for pelvic height (k=.63), fair for step length (k=.34), cervical extension (k=.40), trunk inclination (k=.35), and slight for shoulder extension (k=.16). The experienced raters outperformed the novice raters in all categories. The results of this study indicate that skilled raters are better able to identify the movement patterns included in the QYTS when compared to a validation measure as well have higher rates of inter-rater agreement than novice raters. 3b.

The effect of smartphone usage on the upper extremity performance among Saudi Youth, KSA

Abstract The current study aims to investigate the effect of smartphone usage on the upper extremity performance among Saudi youth. A goniometer to measure the Range of Motion (ROM), the Smartphone Addiction Scale (SAS), McGill Pain scale and Chattanooga stabilizer were used to perform the current study on a sample of 300 university students from Al-Imam Mohammed Bin Saud University. The results have shown that smartphone addiction is negatively correlated to the elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. Furthermore, the results have shown that McGill pain scores were positively correlated to elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. The study has concluded that smartphone usage among Saudi youth negatively affects the upper extremity and causes a significant increase in the pain intensity. The study has recommended that there is an urgent need for a significant awareness campaign to warn the community regarding the impact of using smartphones for long periods of time.

Childhood cardiorespiratory fitness, muscular fitness and adult measures of glucose homeostasis

ObjectivesTo assess whether childhood cardiorespiratory fitness (CRF) and muscular fitness phenotypes (strength, power, endurance) predict adult glucose homeostasis measures. DesignProspective longitudinal study. MethodsStudy examining participants who had physical fitness measured in childhood (aged 7–15 years) and who attended follow-up clinics approximately 20 years later and provided a fasting blood sample which was tested for glucose and insulin. Physical fitness measurements included muscular strength (right and left grip, shoulder flexion, shoulder and leg extension), power (standing long jump distance) and endurance (number of push-ups in 30s), and CRF (1.6km run duration). In adulthood, fasting glucose and insulin levels were used to derive glucose homeostasis measures of insulin resistance (HOMA2-IR) and beta cell function (HOMA2-β). ResultsA standard deviation increase in childhood CRF or muscular strength (males) was associated with fasting glucose (CRF: β=−0.06mmol/L), fasting insulin (CRF: β=−0.73mU/L; strength: β=−0.40mU/L), HOMA2-IR (CRF: β=−0.06; strength: β=−0.05) and HOMA2-β (CRF: β=−3.06%; strength: β=−2.62%) in adulthood, independent of the alternative fitness phenotype (all p<0.01). Adjustment for childhood waist circumference reduced the effect by 17–35% for CRF and 0–15% for muscular strength (males) and statistical significance remained for all associations expect between CRF, fasting glucose and HOMA2-β (p>0.06). ConclusionsCRF and muscular fitness in childhood were inversely associated with measures of fasting insulin, insulin resistance and beta cell function in adulthood. Childhood CRF and muscular fitness could both be potential independent targets for strategies to help reduce the development of adverse glucose homeostasis.

The Effects of Thai Yoga on Physical Fitness: A Meta-Analysis of Randomized Control Trials.

Thai yoga is a traditional Thai exercise used for improving health-related physical fitness. Many studies have evaluated these effects, but their results remain inconclusive. This meta-analysis aimed to examine the effectiveness of Thai yoga on physical fitness. PubMed, EMBASE, CINAHL, Cochrane library, Thai Library Integrated System (ThaiLis), Physiotherapy Evidence Database (PEDro), National Rehabilitation Information Center (Rehabdata), Scopus, Web of Science, Thai University library databases/journals, and Thai Physical Therapy database up to March 2016 were searched for randomized controlled trials (RCTs) examining the effect of Thai yoga exercise compared with normal daily activities as controls, in any language. The weighted mean difference (WMD) and 95% confidence intervals (95% CI) were performed using the random-effects model. Seven RCTs met the inclusion criteria. Thai yoga training significantly improved body flexibility by 3.9 cm after 4 weeks [95% CI = 3.9-4.0; p < 0.001: no heterogeneity χ2 = 0.66, d.f.2, p = 0.7; I2 0.00%] and 8.9 cm after 8 weeks [95% CI = 7.4-10.5; p < 0.001: no heterogeneity χ2 = 0.16, d.f.2, p = 0.9; I2 0.00%] compared to controls. It also significantly increased range of motion (ROM) of right shoulder extension by 1.5 degrees at week 8, compared to controls [95% CI = 0.12-2.81; p = 0.03; low heterogeneity χ2 = 1.61, d.f.1, p = 0.2; I2 37.9%]. Greater ROM for right shoulder abduction was observed after 12 weeks compared to controls [22.2 degrees (95% CI = 20-24; p < 0.001): no heterogeneity χ2 = 0.29, d.f.1, p = 0.6; I2 0.00%]. Thai yoga exercises appeared useful, in particular, on body and right shoulder joint flexibility. Regular stretching exercise of Thai yoga and/or in combination with exercises could promote health-related physical fitness.

Modified minimally invasive approach and intra-osseous portal for three-part proximal humeral fractures: a comparative study

BackgroundProximal humeral fracture is a common fracture. Different approaches have been utilized in the surgical intervention of three-part fractures. Our study is to evaluate the clinical outcomes and effectiveness of a modified anterolateral approach and intra-osseous portal in minimally invasive treatment for three-part proximal humeral fractures in comparison to the traditional deltopectoral approach.MethodsFrom March 2015 to September 2016, 13 patients with three-part proximal humeral fractures were treated with internal fixation through the modified anterolateral minimally invasive approach (MIPO). These cases were compared to 20 additional cases using the deltopectoral approach (DP). Clinical and radiographic evaluations were performed, including the constant score (CS) and range of motion in abduction, flexion/extension and external/internal rotation. Complications were recorded as well.ResultsAll patients were followed up for a mean time of 12.12 ± 4.01 months. At the latest follow-up, no significant differences (p < 0.05) were observed in terms of length of stay, range of motion for abduction, flexion or internal/external rotation of the shoulder, Constant score or visual analog scors (VAS) for pain. Elbow flexion (142.31 ± 8.32 vs. 123.00 ± 10.18), posterior shoulder extension (41.92 ± 5.22 vs. 35.50 ± 5.83) and postoperative VAS (4.38 ± 1.04 vs. 6.15 ± 0.99) were significantly better in the MIPO group than in the DP group (p < 0.05). No significant differences were detected in the radiographic evaluation, and complications including axillary nerve injury were not present.ConclusionThe use of the modified anterolateral approach and intra-osseous portal is safe and effective for minimally invasive reduction and plating treatment for three-part proximal humeral fractures.

EFFECT OF VISUAL AND AUDITORY FEEDBACK EXERCISES ON SHOULDER FUNCTION IN ROTATOR CUFF TENDONITIS PATIENTS

Background. There is a lot of information in literature about rotator cuff strengthening, stretching, and postural correction exercises, which are recommended as a complex for tendonitis rehabilitation (Dong et al., 2015). There is lack of information about visual and auditory feedback exercises for shoulder functions in rotator cuff tendonitis. Methods. The purpose of the study was to evaluate the effect of visual (VF) and auditory (AF) feedback exercises for shoulder functions in rotator cuff tendonitis patients. Thirty patients of Šiauliai rehabilitation centre were included in this study. Diagnostic tests, shoulder proprioception, posture, muscle strength (Lovett), functional muscle strength (Kendall), quality of life evaluations were performed before and after the study to evaluate the effect of VF and AF exercises. Results. VF exercise group had a greater increase (p &lt; .05) in shoulder flexion abduction, internal and external rotation range of motion, proprioception, muscle strength results, also increased physical functioning, and decreased role- physical and bodily pain in the quality of life evaluation. AF exercise group demonstrated a greater increase (p &lt; .05) in shoulder flexion abduction range of motion and muscle strength, bodily pain decreased in the quality of life evaluation. Conclusions. After comparing the results we concluded that shoulder extension, abduction, internal and external rotation range of motion and proprioception, muscle strength and the quality of life increased (p &lt; .05) more in VF exercise group than in AF group. All in all, visual feedback exercises had greater effect onr shoulder functions and the quality of life compared to auditory feedback group. We would recommend including this type of exercises in rotator cuff tendonitis rehabilitation program.

Complex Therapy Physical alone or Associated with Strengthening Exercises in Patients with Lymphedema after Breast Cancer Treatment: a Controlled Clinical Trial

Objective:To compare a complex physical therapy (CPT) protocol alone or combined with complex physical therapy muscle more strength training (CPT+ST) in patients with lymphedema after breast cancer treatment regarding strength and limb muscle volume.Methods:In this controlled clinical trial, consecutive patients treated from breast cancer from April 2014 to December 2015 were allocated in two groups, the CPT group 1 and the CPT+ST group 2, that performed CPT associated with muscle strengthening. Patients in the CPT group 1 received the routine protocol of care, consisting of manual lymphatic drainage (MLD), multilayer bandage compression therapy, skin care and regular exercises. Patients CPT+ST performed, 2 sets of 10 repetitions exercises at 40% of maximal voluntary contraction the first week, increasing to 3 sets with 10 repetitions during the second and third weeks, 3 sets with 15 repetitions, for 8 weeks, 50 minutes per session, twice per week. Strength and muscle volume were analyzed.Result:In the study period, 42 patients were enrolled, 22 in the CPT group 1 and 20 in the CPT+ST group 2. Only 36 completed treatment. Both groups showed similar increases in the range of movement in: shoulder flexion, extension, adduction, abduction and external rotation. Internal rotation showed less improvement in CPT+ST group 2 (p = 0,034). Strength improvement was similar between groups. The CPT+ST group 2 seemed to have a greater volume in the upper limb when compared to CPT group 1, but it was not possible to prove any significant difference (p = 0.555).Conclusion:There was no difference of muscular limb volume between the two interventions. This means that strengthening exercises can be performed by patients with lymphedema safely, without the risk of increasing upper limb volume with edema.