Shoulder Flexion Range Of Motion Research Articles

Effect of Shoulder Flexion Range of Motion and Trunk Muscle Activity on Lumbar Lordosis in the Streamlined Posture in Healthy Young Men

Effect of Shoulder Flexion Range of Motion and Trunk Muscle Activity on Lumbar Lordosis in the Streamlined Posture in Healthy Young Men

Comparison of mid-term effectiveness between diabetic secondary stiff shoulder and primary frozen shoulder after arthroscopic shoulder capsular release combined with acromiohumeral distance restoration

To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films. All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P<0.05), there was no significant difference in other indicators between the two groups ( P>0.05). Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.

Effectiveness of physiotherapy lymphedema management in limb circumference and shoulder mobility among women with breast cancer-related lymphedema

Introduction: This study aimed to evaluate the effectiveness of physiotherapy lymphedema management (LM) in upper limb circumference (LC) and shoulder mobility and determine whether baseline muscle strength (MS) was associated with LC and shoulder mobility in women with breast cancer-related lymphedema. Methods: This study analyzed 79 patients (mean age = 58.89 ± 10.22 years) who were categorized by age group (&lt;60 and ≥60 years) and lymphedema stage (stages 1-2 and 3-4) and completed 8 sessions of LM. Key outcomes evaluated included shoulder flexor strength, LC, and shoulder flexion range of motion (ROM). Data were analyzed using a paired t-test and Pearson’s correlation based on age group and stage of lymphedema. Results: There was a significant reduction in LC by 12.56%, 16.41%, 9.60%, 22.84%, and 7.76% for all patients, those aged &lt;60 years (n = 38), ≥60 years (n = 41), stage 1-2 (n = 41), and stage 3-4 (n = 38), respectively (all p &lt; 0.05). Shoulder flexion ROM improved by 3.99% (p &lt; 0.05), 3.06% (p &gt; 0.05), 5.06% (p &lt; 0.05), 2.95% (p &gt; 0.05), and 5.5% (p &lt; 0.05) for all patients, those &lt;60 years, ≥60 years, stage 1-2, and stage 3-4, respectively. Baseline MS was significantly correlated with LC at pre- and post-treatment for all groups (r = −0.53-−0.92) (p &lt; 0.05), except for the LC of those with stages 1-2 of lymphedema at post-treatment while baseline MS was significantly correlated with shoulder flexion ROM at pre- and post-treatment in all groups (r = 0.86-0.98), except for stages 1-2. Conclusion: An 8 sessions of LM may effectively reduce lymphedema and improve shoulder mobility. MS may be associated with LC and ROM; thus, the LM protocol should include regular assessment of MS and incorporate progressive strengthening exercises at an early stage.

Optimizing shoulder elevation assist rate in exoskeletal rehabilitation based on muscular activity indices: a clinical feasibility study

BackgroundRestoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index.MethodsTwelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4–5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl–Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test.ResultsAll 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients.ConclusionsThe study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase.

The Combined Effect of the Trapezius Muscle Strengthening and Pectoralis Minor Muscle Stretching on Correcting the Rounded Shoulder Posture and Shoulder Flexion Range of Motion among Young Saudi Females: A Randomized Comparative Study.

The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p < 0.05 for all respective statistical analyses. The within-group comparison revealed significant improvements (q > 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them.

Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial

BackgroundPost-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.AimTo investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.Study designRandomized controlled trial.MethodsA total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).ResultsA significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).ConclusionsThe application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.

Characteristics of Postoperative Patients with Breast Cancer Aged 65 Years and Older.

Objective: This study aimed to compare postoperative patients with breast cancer aged ≥65 years with those aged <65 years and clarify the characteristics of postoperative patients with breast cancer aged ≥65. Methods: In total, 376 patients in whom we were able to evaluate survey items one month after surgery were included in the study. Comorbidity, including diabetes mellitus and hypertension, shoulder range of motion (ROM), upper-limb function, and psychological problems, was evaluated. Results: Hypertension and diabetes mellitus were significantly higher in patients aged ≥65 years (the elderly group) than in those aged <65 years (the non-elderly group) (p < 0.05). Preoperative shoulder flexion ROM was significantly restricted in the elderly group compared with the non-elderly group (p < 0.05). Preoperative shoulder abduction ROM was significantly restricted in the elderly group compared with the non-elderly group (p < 0.05). At one month after surgery, upper-limb function was more impaired in the non-elderly group than in the elderly group (p < 0.05). In both groups, both ROM and upper-limb function were significantly impaired one month after surgery compared with before surgery (p < 0.05). Conclusions: Postoperative patients with breast cancer aged ≥65 years should be careful about risk management and intervention during rehabilitation. Preoperative evaluation of shoulder ROM should be performed because patients aged ≥65 years have limited ROM before surgery.

Effect of total arthroscopic rotator cuff repair on pain degree and complications of elderly patients with rotator cuff injury within 72 hours after operation

To analyze the clinical effect of rotator cuff repair and small incision rotator cuff repair under the total arthroscopy in elderly patients with rotator cuff injury. A total of 60 elderly patients with rotator cuff injury from January 2017 to November 2018 were selected as the research objects, including 37 males and 23 females;aged from 61 to 77 years old with an average of (63.45±12.34) years old;disease duration ranged from 6 to 12 months, with an average of (5.32±1.02 ) months;29 cases on the left side and 31 cases on the right side. Among them, 30 patients underwent total arthroscopic rotator cuff repair (observation group), 30 patients underwent small-incision rotator cuff repair(control group). The scores of University of California, Los Angeles(UCLA) shoulder rating scale, before and after surgery in the two groups were observed and recorded. The American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score, shoulder flexion range of motion, external rotation range of motion, abduction range of motion, visual analogue scale(VAS) within 72 hours after surgery, as well as the complcations were compared. The postoperative UCLA score, ASES score and Constant-Murley score between two groups were significantly higher than those before operation (P<0.05). There was no significant difference in postoperative UCLA, ASES and Constant-Murley score between two groups (P>0.05). The shoulder flexion range of motion, external rotation range of motion and abduction range of motion between two groups were significantly higher than those before operation (P<0.05). There was no significant difference between the two groups after operation (P>0.05). The VAS at 24, 48 and 72 h after operation in observation group were significantly lower than those in control group (P<0.05). The total incidence of complications in observation group(13.33%, 4/30) was sinificantly lower(P<0.05)than that in control group(33.33%, 10/30). Total arthroscopic rotator cuff repair and small incision rotator cuff repair can improve the shoulder function after rotator cuff injury in elderly, but the degree of pain and complications within 72 hours after total arthroscopic rotator cuff repair are significantly better than small incision rotator cuff repair, which can be selected according to the clinical situation and needs of patients.

A comparative analysis of titanium anatomic plate and titanium reconstructive plate for treatment of extra-articular fractures of the scapula (Miller types IIb, IIc, and IV).

Because of the irregular shape of the scapula and the different types of fractures, a standard internal fixation device is lacking in clinical practice, even though there are many options available. This study aimed to compare the therapeutic efficacy of titanium anatomic and reconstructive plates for extra-articular fractures of the scapula (Miller types IIb, IIc, and IV). A retrospective study of 41 patients who underwent treatment for extra-articular fractures of the scapula between March 2017 and March 2020 was conducted. Patients were divided into 2 groups based on the fixation device: titanium anatomic plate group (20 patients) and titanium reconstructive plate group (21 patients). After follow-up for 12-18 months, the general characteristics, perioperative characteristics, postoperative follow-up findings, and imaging data of the 2 groups were compared. The surgical procedures were uneventful in both groups. The anatomic plate group significantly outperformed the reconstructive plate group with respect to surgical duration and intraoperative blood loss (P<.001). At 3-month postoperative follow-up, the Constant-Murley score (P=.026), shoulder flexion range of motion, and shoulder abduction range of motion in the anatomic plate group were all significantly better than those in the reconstructive plate group (P<.001). The postoperative Western Ontario Shoulder Instability scores of the 2 groups were similar. Imaging showed functional recovery and stable and reliable fixation in both groups. Time to bone union was similar in both groups (9.10±1.25 weeks in anatomic plate group and 9.24±1.41 weeks in reconstructive plate group, P=.742). No complications occurred in any patient, such as fixation failure, instability, or bone nonunion. Surgeons should favorably consider titanium anatomic plates for the treatment of extra-articular scapular fractures owing to their clear efficacy associated with a shorter surgical time, less intraoperative blood loss, better fixation, and rapid short-term functional recovery.

Regaining motion among patients with shoulder pathology - are all exercises equal?

Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.

Comparison of the effectiveness of proprioceptive neuromuscular facilitation exercises and shoulder mobilization patients with Subacromial Impingement Syndrome: A randomized clinical trial

IntroductionThe aim of this study was to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) exercises and shoulder mobilization (SM) in addition to conventional physiotherapy on pain, range of motion (ROM), functionality, and muscle strength in patients with Subacromial Impingement Syndrome (SIS). MethodsForty-four patients were randomly allocated into three groups as conventional physiotherapy (control group; n = 14), conventional physiotherapy + PNF exercises (PNF group; n = 15), and conventional physiotherapy + SM techniques (SM group; n = 15). Pain, ROM, muscle strength, and functionality were evaluated by using VAS (Visual Analog Scale), goniometer, push-pull dynamometer, Constant-Murley score and DASH (Disabilities of the Arm, Shoulder and Hand) score. Patients were received 20 sessions (4 weeks) of treatment. Assessments were performed at baseline, and weeks two, four, and sixteen. ResultsAfter treatment, significant improvements in outcome measurements were observed in all groups (all p < 0.05). PNF or SM groups were not superior to each other in terms of improving pain and functionality. SM group was superior to PNF group for improving shoulder flexion ROM at week 4 (p = 0.009). The improvements in shoulder extension muscle strength were greater in PNF group at weeks 2 and 16 compared with other groups (p = 0.030, 0.035). ConclusionPNF or SM, in addition to conventional physiotherapy, might help to improve pain and functionality more in patients with SIS. It is recommended to add SM or PNF to conventional treatment to maintain the ROM increase gained with SIS treatment after treatment, and to apply this treatment for 4 weeks for muscle strength increase.

Factors associated with return to work of breast cancer patients following axillary lymph node dissection.

The identification of factors that are related to return to work after surgery for breast cancer could help healthcare professionals accurately identify patients at risk of return to work-related difficulties in order to provide them with appropriate support during breast cancer management. The aim of this study was to identify factors related to return to work in breast cancer patients three months after axillary lymph node dissection. Seventy-three women who were working before the surgery were evaluated. Age, body mass index, level of lymph node dissection, marital status, children, co-resident household members, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and work were evaluated. Patients who had returned to work constituted the return to work group, and those who had not returned to work constituted the no return to work group. Of the patients, 36 returned to work at three months. Logistic regression analysis including the five variables showed that shoulder flexion range of motion and DASH were significantly associated with return to work (p < 0.05). The observation that the symptoms and limitations of upper limb function and shoulder flexion range of motion affect return to work may indicate the importance of postoperative rehabilitation in breast cancer patients following axillary lymph node dissection.

Correlation between Shoulder Range of Motion, Upper Extremity Disability and Quality of Life in Female Breast Cancer Survivors Post Modified Radical Mastectomy: A Pilot Study

Background: Many complications may occur after modified radical mastectomy (MRM) such as restricted shoulder mobility, wound infection, seroma formation, pain and lymph edema. Purpose: To find the correlation between shoulder flexion and abduction range of motion (ROM) with upper extremity disability and quality of life in female post MRM. Methodology: A cross section observation study was conducted in a tertiary care hospital. A total of 20 breast cancer survivors who underwent MRM before 6 months or more were included. Their affected side shoulder flexion and abduction ROM was measured using universal goniometer, upper extremity disability was assessed using Upper Extremity Functional Index (UEFI) and Quality of Life was assessed using WHOQoL-BREF questionnaire. Results: Karl Pearson’s correlation coefficient was used to find the correlation. Strong positive correlation was found between shoulder flexion ROM and UEFI score, physical, psychological and environmental domains, whereas moderate positive correlation was found between shoulder flexion ROM and overall QoL, these were statistically significant (p&lt;0.001). But there was weak positive correlation found between shoulder flexion ROM and social domain of WHOQoL-BREF which was statistically not significant (p&gt;0.001). Further strong positive correlation was found between shoulder abduction ROM and UEFI score, overall Qol, physical and psychological domain and moderate positive correlation was found between shoulder abduction ROM and environmental domain whereas again weak positive correlation found with social domain which was statistically not significant (p&gt;0.001). Conclusion: Decreased shoulder ROM can increase upper extremity disability and affect overall QoL in breast cancer survivors post MRM. Keywords: Breast cancer survivors, Modified Radical Mastectomy, Quality of Life, Shoulder ROM, Upper extremity disability.

The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial.

This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.

Effects of Proprioceptive Neuromuscular Facilitation Stretching Combined with Aerobic Training on Pulmonary Function in COPD Patients: A Randomized Controlled Trial.

BackgroundThe proprioceptive neuromuscular facilitation (PNF) stretching could improve the contractile capacity of respiratory muscles, but the effect on pulmonary function, when it is combined with aerobic training, remains unknown.ObjectiveTo evaluate the effect of PNF combined with aerobic training on respiratory symptoms, pulmonary function and neck/shoulder mobility in patients with COPD.DesignRandomized controlled trial.ParticipantsFifty-five COPD patients were randomly divided into PNF group (n=28) and control group (n=27).InterventionOn the basis of conventional treatment, the control group performed 30 min aerobic training on a treadmill, while the PNF group added 10-minute PNF stretching 3 times every training day. Both groups did their training in 5 days per week for 6 weeks.MeasuresMeasures were taken before and after 6 weeks of training. COPD Assessment Test (CAT), dyspnea Visual Analog Scale (VAS), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), inspiratory capacity (IC), inspiratory reserve volume (IRV), 6-minute walk test (6MWT), the range of motion (ROM) of head protraction, shoulder flexion, and the non-dominant pectoralis minor muscle (PmM) length were measured.ResultsAll the indicators of both groups were significantly improved after 6 weeks of intervention except for FVC, FEV1 and PmM length. Compared to the control group, the PNF group showed significant improvement in the CAT score, dyspnea VAS score, IC, IRV, 6MWT, as well as head protraction ROM and shoulder flexion ROM. Furthermore, IC was positively correlated with the head protraction ROM and PmM length (r=0.415, 0.579, P=0.028, 0.001); IRV was positively correlated with the shoulder flexion ROM (r=0.405, P=0.032) in the PNF group.ConclusionPNF stretching combined with aerobic training reduces dyspnea and improves some pulmonary function measures, which is associated with neck/shoulder mobility, in COPD patients.

Effectiveness of aerobic exercise on upper limb function following breast cancer treatment: a systematic review and meta-analysis.

Aerobic exercise is currently considered to be an effective method of rehabilitation in breast cancer patients. Studies have shown that aerobic exercise after breast cancer surgery can improve upper limb function, cardiopulmonary function, and quality of life. Breast cancer rehabilitation guidelines encourage patients to actively participate in aerobic exercise to promote rehabilitation, the current study is to evaluate the effectiveness of aerobic exercise on upper limb muscle strength and range of motion (ROM) following breast cancer treatment. Electronic databases (Cochrane Library, PubMed, Web of Science, EBSCO and Embase) were searched for randomized controlled trials (RCTs) published before September 1, 2019, using the search terms "aerobic exercise", "exercise", "breast cancer", "muscle strength", "strength", "flexibility" and "function". Grip strength and shoulder joint ROM were used to evaluate upper limb strength and upper limb flexibility respectively. All statistical tests were performed using RevMan5.3 software. Nine RCTs (421 patients) were included for analysis, with JBI scores ranging from 19 to 23, and bias grade B for all studies among which, there were six studies reported change in grip strength, and five studies reported change in shoulder joint ROM. Meta-analysis showed a statistically significant difference in shoulder flexion ROM (MD =4.97, 95% CI: 0.47-9.46, P=0.03), shoulder abduction ROM (MD =8.95, 95% CI: 0.99-16.91, P=0.03), shoulder internal rotation ROM (MD =3.45, 95% CI: 1.80-5.09, P<0.0001), shoulder external rotation ROM (MD =7.69, 95% CI: 0.06-15.32, P=0.05) between the intervention and control groups following completion of the aerobic exercise intervention, while there were no significant improvement with respect to grip strength and shoulder extension ROM (P>0.05). Aerobic exercise could improve shoulder joint ROM in breast cancer survivors, but shows no obvious effect on the improvement of upper limb strength.

Prediction of Shoulder Pain in Youth Competitive Swimmers: The Development and Internal Validation of a Prognostic Prediction Model

Background: Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain. Purpose: To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism. Results: A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94). Conclusion: Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.

Relationships within and between lower and upper extremity dysfunction in people with diabetes

IntroductionDiabetes mellitus (DM) is associated with systemic musculoskeletal system impairments suggesting concurrent development of lower and upper extremity musculoskeletal problems. This study aims to examine relationships between lower and upper extremity function in people with DM. MethodsSixty people with type 2 DM and peripheral neuropathy [mean (standard deviation); 67(6) years old, DM duration 14(10) yrs] completed the following measures: 1) Self-reports of function: Foot and Ankle Ability Measure (FAAM; higher = better function) and Shoulder Pain and Disability Index (SPADI; lower = better function), 2) Range of motion (goniometry): ankle dorsiflexion and shoulder flexion, and 3) Strength: unilateral heel rise power (UHR, 3D kinetics) and hand grip dynamometry. Pearson correlations examined associations between lower and upper extremity measures, p < .05. ResultsForty of 60 (67%) reported pain/disability in both the foot/ankle and shoulder and 95% of study participants had some limitation in foot or shoulder function. Significant between extremity correlations: FAAM and SPADI (r = −0.39), ankle dorsiflexion and shoulder flexion range of motion (r = 0.35), and UHR and hand grip strength (r = 0.40). Significant within extremity correlations: FAAM and UHR (r = .47) and SPADI with shoulder flexion (r = −0.44). ConclusionUpper and lower extremity inter- and intra-relationships indicate systemic musculoskeletal impairments in people with DM. Healthcare practitioners should consider the potential for concurrent and disabling musculoskeletal problems in people with DM.

EFFECTS OF SWISS BALL EXERCISE AND STRETCHING EXERCISE IN CHEST WALL MOBILITY AND SHOULDER RANGE OF MOTION AMONG POST-OPERATIVE BREAST CANCER WOMEN

Objectives of the Study: The objectives of the study were to determine and compare the effects of Swiss ball exercises and stretching exercises in improving chest expansion, forced expiratory volume in one second (FEV1), and shoulder range of motion (ROM) among post-operative breast cancer women.&#x0D; Methods: The study included 20 females who underwent surgery for breast carcinoma. Each group consists of 10 participants who were assessed for chest expansion at three levels, FEV1, and shoulder ROM for flexion and abduction. Group A was treated with Swiss ball exercises and Group B was treated with stretching exercises for a period of 4 weeks, 5 days/week following which post-test was performed same as of pre-test.&#x0D; Results: Comparison between Swiss ball Group A and stretching Group B shows the chest expansion measurement at axillary level has a significant difference between the groups with p=0.0001, fourth intercostal level showed a difference in mean with p=0.004 and xiphisternal level p-value observed as (0.001), FEV1 between the group also shows significant changes in the post-test with a p=0.0481 and shoulder flexion ROM was increased in post-test when compared to pre-test scores with a p=0.0042 and abduction ROM also showed a significant difference with p=0.0463. Thereby, the post-test scores of Group A are higher than the Group B.&#x0D; Conclusion: Exercise training on Swiss ball is more effective than stretching in treating post-operative breast cancer patients.

Intrarater and Interrater Reliability of a Passive Shoulder Flexion Range of Motion Measurement for Latissimus Dorsi Flexibility in Young Competitive Swimmers.

The latissimus dorsi plays a major role in generating the propulsive force during swimming. In addition, stiffness of this muscle may result in altered stroke biomechanics and predispose swimmers to shoulder pain. Measuring the flexibility of the latissimus dorsi can be of interest to reduce injury. However, the reliability of such measurement has not yet been investigated in competitive swimmers. To assess the within-session intrarater and interrater reliability of a passive shoulder flexion range of motion measurement for latissimus dorsi flexibility in competitive swimmers. Within-session intrarater and interrater reliability. Competitive swimming clubs in Flanders, Belgium. Twenty-six competitive swimmers (15.46 [2.98]y; 16 men and 10 women). Each rater performed 2 alternating (eg,left-right-left-right) measurements of passive shoulder flexion range of motion twice, with a 30-second rest period in between. The intraclass correlation coefficients were calculated to assess intrarater and interrater reliability. Interrater intraclass correlation coefficient ranged from .54 (95% confidence interval [CI], -.16 to .81) to .57 (95% CI, -.24 to .85). Results for the intrarater reliability ranged from .91 (95% CI, .81 to .96) to .94 (95% CI, .87 to .97). Results of this study suggest that shoulder flexion range of motion in young competitive swimmers can be measured reliably by a single rater within the same session.