Shoulder External Rotation Research Articles

Impact of Timing of Primary Nerve Surgery on Shoulder, Forearm, and Elbow Recovery in Neonatal Brachial Plexus Palsy

BACKGROUND AND OBJECTIVES: Neonatal brachial plexus palsy (NBPP) almost universally affects movement at the shoulder, elbow, and forearm. Timing of nerve reconstruction surgery to optimize long-term outcomes remains unknown. This study aimed to determine if timing of nerve reconstruction affects long-term recovery of an active range of motion (AROM) at the shoulder, elbow, and forearm in NBPP. METHODS: We interrogated a prospectively collected database of all patients with NBPP who underwent primary nerve surgery at a single tertiary referral center between 2005 and 2020. The cohort was divided into those who underwent surgery at ≤6 or >6 months old and ≤9 or >9 months old. AROM for shoulder abduction, forward flexion, and external rotation, elbow flexion and extension, and forearm supination were collected at each visit. RESULTS: Ninety-nine children were included in the analysis; 28 underwent surgery at ≤6 months old, 71 at >6 months, 74 at ≤9 months, and 25 at >9 months. There was no difference in AROM at 5 years for any of the movements between the ≤6- and >6-month groups. The ≤9-month group had significantly better shoulder forward flexion and elbow extension AROM than the >9-month group at a 5-year follow-up and better forearm supination at up to a 15-year follow-up. Patients who presented earlier were more likely to have earlier operations. CONCLUSION: Surgery before 9 months may improve long-term upper extremity recovery in NBPP. Early referral should be encouraged to optimize timing of operative intervention.

Oncological and functional outcomes after resection of malignant tumours of the scapula.

The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification. The ten-year disease-specific survival was 76%. High tumour grade (hazard ratio (HR) 4.27; p = 0.016) and a total resection of the scapula (HR 3.84; p = 0.015) were associated with worse survival. The ten-year metastasis-free and local recurrence-free survivals were 82% and 86%, respectively. Total scapular resection (HR 6.29; p = 0.004) was associated with metastatic disease and positive margins were associated with local recurrence (HR 12.86; p = 0.001). At final follow-up, the mean shoulder forward elevation and external rotation were 79° (SD 62°) and 27° (SD 25°), respectively. The most recent functional outcomes evaluated included the mean Musculoskeletal Tumor Society Score (76% (SD 17%)), the American Shoulder and Elbow Score (73% (SD 20%)), and the Simple Shoulder Test (7 (SD 3)). Preservation of the glenoid (p = 0.001) and scapular spine (p < 0.001) improved clinical outcomes; interestingly, preservation of the scapular spine without the glenoid improved outcomes (p < 0.001) compared to preservation of the glenoid alone (p = 0.05). Resection of the scapula is a major undertaking with an oncological outcome related to tumour grade, and a functional outcome associated with the status of the scapular spine and glenoid. Positive resection margins are associated with local recurrence.

Biomechanical Evaluation of the 2 Different Levels of Coracoid Graft Positions in the Latarjet Procedure for Anterior Shoulder Instability.

In the Latarjet procedure, the ideal placement of the coracoid graft in the medial-lateral position is flush with the anterior glenoid rim. However, the ideal position of the graft in the superior-inferior position (sagittal plane) for restoring glenohumeral joint stability is still controversial. To compare coracoid graft clockface positions between the traditional 3 to 5 o'clock and a more inferior (for the right shoulder) 4 to 6 o'clock with regard to glenohumeral joint stability in the Latarjet procedure. Controlled laboratory study. A total of 10 fresh-frozen cadaveric shoulders were tested in a dynamic, custom-built robotic shoulder model. Each shoulder was loaded with a 50-N compressive load while an 80-N force was applied in the anteroinferior axes at 90° of abduction and 60° of shoulder external rotation. Four conditions were tested: (1) intact, (2) 6-mm glenoid bone loss (GBL), (3) Latarjet procedure fixed at 3- to 5-o'clock position, and (4) Latarjet procedure fixed at 4- to 6-o'clock position. The stability ratio (SR) and degree of lateral humeral displacement (LHD) were recorded. A 1-factor random-intercepts linear mixed-effects model and Tukey method were used for statistical analysis. Compared with the intact state (1.77 ± 0.11), the SR was significantly lower after creating a 6-mm GBL (1.14 ± 0.61, P = .009), with no significant difference in SR after Latarjet 3 to 5 o'clock (1.51 ± 0.70, P = .51) or 4 to 6 o'clock (1.55 ± 0.68, P = .52). Compared with the intact state (6.48 ± 2.24 mm), LHD decreased significantly after GBL (3.16 ± 1.56 mm, P < .001) and Latarjet 4 to 6 o'clock (5.48 ± 3.39 mm, P < .001). Displacement decreased significantly after Latarjet 3 to 5 o'clock (4.78 ± 2.50 mm, P = .04) compared with the intact state but not after Latarjet 4 to 6 o'clock (P = .71). The Latarjet procedure in both coracoid graft positions (3-5 and 4-6 o'clock) restored the SR to the values measured in the intact state. A more inferior graft position (fixed at 4-6 o'clock) may improve shoulder biomechanics, but additional work is needed to establish clinical relevance. An inferior coracoid graft fixation, the 4- to 6-o'clock position, may benefit in restoring normal shoulder biomechanics after the Latarjet procedure.

Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis

Background: Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. Objective: To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. Methods: A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. Results: Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (−0.6; 95% confidence interval, −1.1 to −0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0–6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (−1.2; −2.2 to −0.2; I2 = 61%; N = 100), and disability SMD of (−1.3; confidence interval −2.2 to −0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. Conclusion: Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.

Therapeutic Photobiomodulation Before Strenuous Exercise Attenuates Shoulder Muscle Fatigue.

Photobiomodulation therapy (PBMT) applied as a preconditioning treatment before exercise has been shown to attenuate fatigue and improve skeletal muscle contractile function during high-intensity resistance exercise. Practical implications for preconditioning muscles with PBMT before fatiguing exercise include a safe and noninvasive means to enhance performance and reduce the risk of musculoskeletal injury. To examine the muscle fatigue-attenuating effects of PBMT on performance of the shoulder external-rotator muscle group when applied as a preconditioning treatment before high-intensity, high-volume resistance exercise. Sham-controlled, crossover design. Laboratory. Twenty healthy men (n = 8) and women (n = 12) between the ages of 18 and 30 years. Photobiomodulation therapy was administered using a near-infrared laser (λ = 810/980 N·m, 1.8 W/cm2, treatment area = 80-120 cm2) to the shoulder external-rotator muscles at a radiant exposure of 10 J/cm2. Participants performed 12 sets of isokinetic shoulder exercise. Each set consisted of 21 concentric contractions of internal and external rotation at 60°/s. The sets were subdivided into 3 blocks of exercise (block 1: sets 1-4; block 2: sets 5-8; block 3: sets 9-12). Normalized peak torque (N·m/kg), average peak torque (N·m), total work (N·m), and average power (W). During the last block of exercise (sets 9-12), all performance measures for the active PBMT condition were 6.2% to 10% greater than the sham PBMT values (P < .02 to P < .001). Photobiomodulation therapy attenuated fatigue and improved muscular performance of the shoulder external rotators in the latter stages of strenuous resistance exercise.

Shoulder Tensiomyography and Isometric Strength in Swimmers Before and After a Fatiguing Protocol.

Shoulder muscles are active during front-crawl swimming to provide propulsion and stabilize the glenohumeral and scapulothoracic joints. Researchers have proposed that fatigue might contribute to altered activation of these muscles and represent a risk factor for injuries. Tensiomyography (TMG) might function as a noninvasive tool to detect changes in contractile measures of the skeletal muscles due to exercise-induced neuromuscular fatigue, though it has not yet been used in the shoulder muscles of swimmers. To assess the effects of a fatiguing swimming protocol on shoulder muscle TMG measures and isometric strength in competitive swimmers. Cross-sectional study. Swimming pool facility. A total of 14 young front-crawl competitive swimmers (11 males and 3 females; age = 21 ± 3 years [range, 17-26 years], height = 1.78 ± 0.06 m, mass = 73.1 ± 9.2 kg). Participants completed TMG and isometric strength assessments before and after 30-minute, high-intensity swim training. The TMG assessment was performed on 7 muscles of the shoulder according to front-crawl biomechanics and the applicability of the technique to obtain data, such as time to contraction and muscle-belly radial displacement. Isometric strength was assessed using a digital handheld dynamometer during shoulder flexion, extension, external rotation, and internal rotation. Fatigue induced a smaller radial displacement, mostly observable in latissimus dorsi (-1.0 mm; 95% CI = -1.7, -0.3 mm; P = .007) and pectoralis major muscles (-1.4 mm; 95% CI = -2.4, -0.4 mm; P = .007). Only shoulder extension showed an isometric strength reduction after the fatiguing protocol (-0.03 N/kg; 95% CI = -0.05, -0.01 N/kg; F1,13 = 4.936; P = .045; ηp2 = 0.275). This study provides preliminary evidence for the usefulness of TMG to detect fatigue-induced changes in contractile properties of the shoulder muscles in swimmers, in particular the latissimus dorsi and pectoralis major.

Two Cases of Spinal Accessory Neuropathy Due to Muscle Injection of Nandrolone For Bodybuilding

The accessory nerve is the eleventh cranial nerve that supplies the sternocleidomastoid and trapezius muscles. Injury to the spinal accessory nerve is most commonly caused by medical procedures that involve the head and neck, which causes wasting of the shoulder muscles, winging of the scapula, and weakness of shoulder abduction and external rotation. Here, two cases of spinal accessory neuropathy after injection of trapezius muscle for body building are reported.

Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study

Background: The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. Hypothesis: PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. Results: Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. Conclusion: Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.

Shoulder vibratory exercises improves shoulder external rotation muscle strength and shoulder function: Randomized comparison trial.

Based on electromyography measurements, shoulder vibratory exercises efficiently stimulate shoulder muscles activity. Yet very few studies have supported that shoulder vibratory exercises increased shoulder muscles strength and function, and the noninferiority compared with conventional elastic resistance exercises remains unknown. This study investigated the effect of vibratory exercises versus conventional elastic resistance exercises with elastic bands on shoulder external rotation muscles strength and functional performance in young adults. 26 young adults (7 males and 19 females, with age 23.89 ± 3.02) were recruited and randomly allocated to shoulder vibratory exercises with FLEXI-BAR (FLEXI-BAR group) or conventional resistance exercises with elastic band (TheraBand group) for 3 times/week, 4 weeks totally. Shoulder external rotator muscles strength test and Underkofler softball distance throw test (USDTT) were performed before and after the training period. After 4 weeks training, shoulder external rotator muscles strength increased 22.25 ± 15.06 N (P= 0.004, effect size = 1.48) within FLEXI-BAR group and 22.81 ± 14.94 N (P= 0.007, effect size = 1.53) within TheraBand group. There were no statistically significant differences between groups in the three muscle strength tests (P> 0.65). Regarding shoulder function, FLEXI-BAR exercises increased the throw distance 0.81 ± 0.92 meters in USDTT (P= 0.041, effect size = 0.88) while TheraBand exercise did not (P= 0.284), yet there was no statistically significant between group effects (P= 0.608). These findings suggest that shoulder vibratory exercises can improve shoulder muscles strength in young adults and can be a useful alternative to the conventional elastic resistance exercises to improve the shoulder muscles strength and function. This provides therapists with more options in terms of choosing training equipment for rehabilitation programs.

Treatment of Ideberg type Ⅱ scapular glenoid fracture with compression screw combined with Buttress plate through direct axillary approach

To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. A retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05). Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.

Effects of a dry-land strengthening exercise program with elastic bands following the Kabat D2 diagonal flexion pattern for the prevention of shoulder injuries in swimmers.

Background: During the repetitive execution of the swimming strokes, the muscles responsible for the internal rotations of the shoulders tend to become stronger compared to the muscles that oppose these movements. The aim of this study was to analyse the effect of a strengthening program for the shoulder rotator muscles using elastic band exercises in a diagonal Kabat pattern (D2 for flexion) in swimmers, to develop an effective, quick and easy-to-implement protocol for preventive training routines. Methods: A randomized controlled trial design was carried out. Internal and external rotation range of movement, isometric strength of the muscles responsible for internal and external rotation of the shoulder, scapular movements, was measured at the beginning of the study and after 8weeks post-intervention. A total of 22 male swimmers participated in the study and were randomly assigned to either an experimental group (n = 11) or a control group (n = 11). The experimental group underwent a 8-week shoulder-strength program using elastic bands, while the control group focused on aquatic training. Results: The strength-training program resulted in an improvement in the isometric strength of the muscles responsible for external rotation and a better balance between the shoulder rotator muscles in the experimental group. However, these improvements have not been significant (p > 0.05). Conclusion: The strengthening exercise program showed minimal improvement in shoulder rotation strength and range of motion. These findings suggest that the prescribed shoulder-strengthening exercise could be a quick-beneficial dry-land training option to improve external rotation shoulder strength or range of motion, but more studies with larger sample sizes and more weeks of treatment are needed to determine the efficacy of this protocol.

The Factors Influencing Shoulder Mobility Disorders in Patients after Radical Breast Cancer Surgery: A Cross-Sectional Study

Introduction: This study is a cross-sectional study that investigated the factors influencing shoulder mobility in terms of pain, grip strength, and supraspinatus muscle thickness in patients with impaired shoulder mobility during chemotherapy after radical breast cancer surgery. Methods: This study included 165 female patients with unilateral breast cancer who had shoulder joint mobility disorders during chemotherapy within 3 months after surgery. The clinical examination included the maximum active range of motion of the shoulder (flexion, extension, abduction, adduction, external rotation, and internal rotation), pain score (visual analog scale [VAS]), grip strength, and supraspinatus muscle thickness. Results: During shoulder abduction, supraspinatus muscle thickness was greatest at 90°, lowest at 0°, and higher at 60° than at 30° (p < 0.01). The factors influencing the active movement of shoulder flexion were the VAS score, body weight, grip strength, and supraspinatus contraction rate (R² = 0.295), while the factors influencing active shoulder abduction were the VAS score, body weight, grip strength, supraspinatus muscle thickness (drooping position), and supraspinatus contraction rate (R² = 0.295). Moreover, the factors influencing the active movement of shoulder external rotation were age, VAS score, body weight, grip strength, and supraspinatus muscle thickness (drooping position) (R² = 0.258). There were no significant results from multiple linear regressions for shoulder extension, adduction, or internal rotation. Conclusion: Pain, weight, grip strength, supraspinatus muscle thickness, and supraspinatus distensibility are the main factors affecting shoulder flexion, abduction, and external rotation. In addition, supraspinatus muscle thickness and contraction rate may be a new index for assessing shoulder dysfunction.

Upper limb biomechanical differences in volleyball spikes among young female players

The performance assessment of relevant biomechanical factors is essential for appropriate age-related training progression in volleyball spike (VS). This study aimed to investigate the differences in upper limbs’ (a) range of motion (ROM), (b) angular velocities, and (c) muscular activity during VS among under 16- (U-16), under 18- (U-18), and under 20- (U-20) year-old female volleyball players. The kinematic variables of the spike performances were recorded using six optoelectronic cameras (Vicon Motion system, UK). Additionally, the wireless Trigno system (Delsys, USA) was used to record the electromyographic signals. The one-way ANOVA (1d SPM analysis) exhibited a significantly greater wrist internal rotation ( p &lt; .001), wrist adduction velocity (p &lt; .001), and palmaris longus activity ( p &lt; .001) in the acceleration phase in U-20, compared to the U-16 group. Additionally, the U-20 and the U-18 players portrayed a significantly greater shoulder external rotation ( p &lt; .001) and internal angular velocity ( p = .035) relative to the U-16 group. A significantly greater pectoralis major (p &lt; .001), biceps brachii ( p &lt; .001), and anterior deltoid ( p &lt; .001) activity was observed in the U-20 group, compared to younger groups. This study suggests that older players employ more upper limb muscular activities during spike with the presence of blocks, which enables them to hit the ball with greater velocities and direct the ball in their desired direction through increased wrist ROMs.

The in vivo passive stretch response of the pectoralis major is region-specific

The pectoralis major (PM) is a broad muscle commonly divided into three regions, which contribute uniquely to shoulder stability and movement. The PM muscle regions likely respond differently to stretch, but this has never been shown in vivo. We used shear wave elastography to assess the stretch response of different PM muscle regions during shoulder abduction and external rotation in 20 healthy male participants. Participants’ shoulder was passively rotated through their range of motion in 5.7° increments and shear wave velocities (SWV) were obtained for each muscle region. A piece-wise model was fitted to the SWV-joint angle data, from which slack angle, slack stiffness and elasticity coefficient were determined. For shoulder abduction, we found that the sternocostal region had a significantly smaller slack angle (p = 0.049) and greater slack stiffness (p = 0.005) than the abdominal region, but there was no difference for elasticity coefficient (p = 0.074). For external rotation, only slack stiffness was greater for the sternocostal than the abdominal region (p < 0.001) with no differences found for slack angle (p = 0.18) and elasticity coefficient (p = 0.74). However, our data indicates that neither region was slack in this condition. These findings indicate that the sternocostal and abdominal regions respond differently to passive stretch, highlighting the PM’s functional differentiation. This differentiation should be considered during treatment interventions such as PM muscle harvesting or treatments for breast cancer.

Dry needling versus muscle energy technique on shoulder adhesive capsulitis post mastectomy

Objectives. To compare the effect of dry needling and muscle energy technique on adhesive capsulitis post mastectomy. Design. A single-blinded randomized clinical study. Setting. Outpatient setting. Subjects. Fifty female patients diagnosed with shoulder adhesive capsulitis post mastectomy, ranging in age from 30 to 60 years, were randomly assigned to two groups. Participants in Group A were administered dry needling treatment, plus a traditional physical therapy program in the form of shoulder joint mobilization, shoulder muscle stretching, and ROM exercise; Group B received muscle energy technique, plus a traditional physical therapy program in the form of shoulder joint mobilization, shoulder muscle stretching, and ROM exercise. Intervention. Two sessions per week over five weeks. Outcome measures. Shoulder range of motion, pressure pain threshold, and shoulder dysfunction were measured pre-treatment and post-treatment. Results. There was no statistically significant difference observed in the age distribution between the groups (p &gt; 0.05). Following the treatment, there was a notable rise in the pressure pain threshold and a considerable decline in shoulder dysfunction when compared to the pre-treatment condition (p &lt; 0.001). There was a notable rise in the ranges of shoulder flexion, abduction, and external rotation after the treatment when compared to before the treatment in both group A and B (p &gt; 0.001). The percentage of change in flexion, abduction, and external rotation in group A was 125.03%, 76.43%, and 58.72%, respectively. In contrast, group B exhibited percentage changes of 137.48%, 97.51%, and 68.78% in flexion, abduction, and external rotation, respectively. There was no statistically significant difference seen between the groups prior to treatment, as shown by a p-value greater than 0.05. The analysis of the data after treatment demonstrated a statistically significant rise in the pressure pain threshold for group A in comparison to group B (p &lt; 0.001). However, there was no significant disparity observed in shoulder dysfunction between the two groups (p &gt; 0.05). Following the treatment, there was a notable rise in the range of motion (ROM) for flexion, extension, and abduction in group B when compared to group A (p &lt; 0.001). Conclusion. Application of either dry needling or muscle energy technique results in a notable enhancement in the severity of symptoms in adhesive capsulitis post mastectomy, with superiority for dry needling.

Acute effect of upper body vibration on shoulder joint internal and external active position sense in healthy female university students

Background and Study Aim. Neuromuscular and joint deep sensation adaptations have been linked to functional alterations and skill acquisition after body vibration training via muscular recruitment, coordination of motor units, and enhanced neural activation. The aim of the current study is to explore the effect of upper body vibration on shoulder joint active position sense in healthy female university students. Material and Methods. Sixty healthy female university students were distributed into two equal groups; 30 subjects in the control group (mean age 21 ± 2.2) and 30 subjects in the experimental group (mean age 20.9 ± 2.3). The shoulder joint active position sense was evaluated using Biodex Isokinetic Dynamometer Multi-Joint System 4 pro. In addition, the Power Plate ® Whole Body Vibration device was used as an intervention method from the push-up position. Results. After three vibration exposures of 60 seconds for each, the MANOVA test showed statistically significant differences in the average error scores of active joint position senses of shoulder external rotation only in the pre-post-test of the experimental group (p= .000). Moreover, the statistically significant difference was detected in the average error scores of shoulders external rotation in post-treatment intervention between both groups (p= .000). Conclusions. These results suggested that short-term vibration training may reveal an improvement in shoulder joint active position sense, particularly the shoulder external rotation. The use of vibration training to improve shoulder awareness and reduce the risk of injury when the shoulder externally rotates during different functions may therefore be advocated to physiotherapists.

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy.

There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively. We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval. In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1-2 injury, shoulder abduction and forward flexion. We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1-2 injury, shoulder abduction and forward flexion.

Length-Tension Differences Between Concentric and Eccentric Shoulder Rotation Strength.

Giordano, KA, Cassidy, MM, and Oliver, GD. Length-tension differences between concentric and eccentric shoulder rotation strength. J Strength Cond Res 38(2): 253-258, 2024-Eccentric contractions generally produce more force than concentric contractions. However, if length-tension relationships affect both contractions equally remains unknown. Therefore, our purpose was to compare concentric versus eccentric shoulder external and internal rotation strength across a continuous 90° arc. Fifty-two physically active individuals performed isokinetic concentric and eccentric shoulder external rotation and internal rotation through a 90° arc (forearm horizontal to forearm vertical) with the shoulder elevated in both the frontal and scapular planes. Statistical parametric mapping analysis compared concentric and eccentric trials within subjects. Frontal plane eccentric external rotation torque was greater than concentric 30°-90° (p < 0.01) external rotation, and concentric external rotation torque was greater 5°-15° external rotation (p = 0.01). Frontal plane, eccentric internal rotation torque was greater than concentric 15°-55° external rotation (p < 0.01), and concentric torque was greater at forearm horizontal (p = 0.05) and 70°-90° external rotation (p < 0.01). Scapular plane eccentric external rotation torque was greater than concentric 30°-90° external rotation (p < 0.01) and concentric external rotation torque was greater 5°-20° external rotation (p < 0.01). Scapular plane eccentric internal rotation torque was greater than concentric 15°-60° external rotation (p < 0.01), and concentric torque was greater at forearm horizontal (p = 0.05) and 78°-90° external rotation (p = 0.02). Coaches, clinicians, and researchers should interpret data from studies reporting isokinetic data with the understanding that isokinetic peak strength values are not comparing the same muscle length and are not an appropriate measure for all muscle lengths. Furthermore, shoulder stability is affected through decreased eccentric force production at end ranges of shoulder rotation.

Blood Flow Restriction Training in Nonspecific Shoulder Pain: Study Protocol of a Crossover Randomised Controlled Trial.

"Nonspecific shoulder pain" encompasses various non-traumatic musculoskeletal shoulder disorders, diverging from diagnostic terminologies that refer to precise tissue-oriented clinical diagnosis. Blood flow restriction (BFR) training, involving partial arterial inflow and complete venous outflow restriction, has exhibited acute hypoalgesic effects primarily in healthy populations by increasing their pain thresholds. This study aims to examine whether a single BFR session with low-load exercises can alleviate pain perception among nonspecific shoulder pain patients. Conducted as a single-blind crossover randomised clinical trial, 48 adults (age range: 18 to 40) presenting with nonspecific shoulder pain will partake in two trial sessions. Random assignment will place participants into BFR or sham BFR groups and ask them to perform one exercise with BFR. Subsequently, participants will complete a shoulder girdle loading regimen comprising six exercises. The second session will involve participants switching treatment groups. Pain pressure thresholds (PPTs), shoulder pain and disability via the shoulder pain and disability index (SPADI), maximal voluntary isometric contraction (MVIC) of shoulder external rotators, pain during active abduction, and peak pain during shoulder external rotation will be evaluated using the numeric pain rating scale (NPRS). Immediate post-exercise assessments will include patient-perceived pain changes using the global rating of change scale (GROC) and participant-rated perceived exertion (RPE), employing a modified Borg's scale (Borg CR10) post-BFR or sham BFR exercise session. Each session will encompass three assessment periods, and a combination of mixed-effect models and descriptive statistics will underpin the analysis. This protocol was approved by Cyprus National Bioethics Committee (ΕΕΒΚ/2023/48), and was registered in ClinicalTrials.gov (Registration number: NCT05956288). Conclusion: The anticipated outcomes of this study illuminated the acute effects of BFR training on pain perception within the context of nonspecific shoulder pain, potentially advancing strategies for managing pain intensity using BFR techniques.

Shoulder and Scapular Muscle Activity During Low and High Plank Variations With Different Body-Weight-Bearing Statuses.

Can, EN, Harput, G, and Turgut, E. Shoulder and scapular muscle activity during low and high plank variations with different body-weight-bearing statuses. J Strength Cond Res 38(2): 245-252, 2024-This study investigated the activation levels and activation ratios of shoulder and scapular muscles during low plank (LP) and high plank (HP) variations, with varying levels of body-mass support, including 4-point, 3-pod, and 2-point body-weight-bearing (BWB) statuses. The study was conducted with 21 healthy men (mean ± SD , 26 ± 6.5 years of age and 24.4 ± 2.4 kg·m -2 BMI). Ten different plank exercises were performed in a mixed order by changing elbow joint positions (LP and HP) and BWB statuses (2-point, 3-pod, and 4-point). Activation levels of the lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), biceps brachii, triceps brachii, infraspinatus, and serratus anterior (SA) muscles were assessed with a surface electromyography device. Results of this study showed that elbow position changes resulted in higher LT ( p = 0.01) and TB ( p = 0.001) activation in HP exercises. In general, it was observed that an increase in BWB status was effective in increasing activation for the scapula and shoulder girdle muscles. The ratios of the UT muscle to the SA, LT, and MT muscles were less than 1 during side plank, bird dog, front reach, shoulder taps, and plank with shoulder external rotation exercises. High plank with toe touch exercise resulted in a marked increase in the UT activation. Therefore, it was concluded plank variations alter activation levels and activation ratios of shoulder and scapular muscles. Plank exercises may be used in shoulder rehabilitation and the progression in plank variations can be achieved by changing elbow position and BWB status based on individual requirements.