Shoulder Flexion Range Of Motion Research Articles

DRY NEEDLING AND PHYSICAL THERAPY VERSUS PHYSICAL THERAPY ALONE FOLLOWING SHOULDER STABILIZATION REPAIR: A RANDOMIZED CLINICAL TRIAL

Post-operative range of motion (ROM) loss and pain can limit quality of life, prolong functional return to activity, and may be sport/career threatening. Dry needling (DN) is intended assist in the treatment of these complaints. To determine if the addition of upper quarter DN to a rehabilitation protocol is more effective in improving ROM, pain, and functional outcome scores when compared to a rehabilitation protocol alone after shoulder stabilization surgery. Single-Blind Randomized Clinical Trial. Thirty-nine post-operative shoulder patients were randomly allocated into two groups: (1) standard of care rehabilitation (control group) (2) standard of care rehabilitation plus dry needling (experimental group). Patient's pain, ROM, and functional outcome scores were assessed at baseline (4 weeks post-operative), and at 8 weeks, 12 weeks, and 6 months post-operative. Of 39 enrolled patients, 20 were allocated to the control group and 19 to the experimental group. At six-month follow up, there was a statistically significant improvement in shoulder flexion ROM in the control group. Aside from this, there were no significant differences in outcomes between the two treatment groups. Both groups showed improvement over time. No adverse events were reported. Dry needling of the shoulder girdle in addition to standard of care rehabilitation after shoulder stabilization surgery did not significantly improve shoulder ROM, pain, or functional outcome scores when compared with standard of care rehabilitation alone. Both group's improvement was largely equal over time. The significant difference in flexion at the six-month follow up may be explained by additional time spent receiving passive range of motion (PROM) in the control group. These results provide preliminary evidence that dry needling in a post-surgical population is safe and without significant risk of iatrogenic infection or other adverse events. Therapy, Level 2.

The effectiveness of Ergon Instrument-Assisted Soft Tissue Mobilization, foam rolling, and athletic elastic taping in improving volleyball players' shoulder range of motion and throwing performance: a pilot study on elite athletes.

[Purpose] The purpose of this pilot study was to investigate the effectiveness of instrument-assisted soft tissue mobilization (IASTM), foam rolling, and athletic elastic taping on improving elite volleyball players’ shoulder range of motion (ROM) and throwing performance. [Participants and Methods] Fifteen elite male volleyball players (mean age: 24 ± 4.54 years; mean height: 177 ± 0.08 cm; mean weight: 81 ± 7.71 kg) received shoulder Ergon IASTM, foam rolling, and elastic taping treatment in random order on both upper extremities once a week for three weeks. Pre-and post-treatment assessments of their shoulders’ ROM and functional throwing performance were performed. [Results] Ergon IASTM technique resulted in significantly higher shoulder flexion ROM values than foam rolling and elastic taping. Foam rolling, in turn, showed better results than athletic elastic taping. Moreover, the Ergon IASTM technique resulted in significantly higher OSP values than athletic elastic taping. No significant differences were observed between the therapeutic interventions in terms of FTPI. [Conclusion] This pilot study on elite athletes provides evidence that both IASTM and foam rolling techniques may improve their passive shoulder ROM compared to elastic athletic taping while Ergon IASTM can also enhance their shoulder throwing performance.

Greater Lumbar Extension During Dolphin Kick and Psoas Major Tightness in Swimmers With Low Back Pain.

In competitive swimming, many swimmers experience low back pain (LBP). Lumbar hyperextension may cause LBP, and tight hip-flexor muscle may cause lumbar extension during swimming. The purpose of this study was to clarify the features of the elastic moduli of the muscles and the lumbar extension when swimmers with LBP perform a dolphin kick (DK). Cross-sectional study. Single center. Eleven male college swimmers were enrolled as the LBP group (who have LBP when swimming and during a lumbar extension), and 21 male college swimmers were recruited as the control group (no LBP). The elastic moduli of the psoas major, iliacus, teres major, latissimus dorsi, pectoralis major, and pectoralis minor were measured through ultrasonic shear wave elastography. The lumbar and hip extension angles during a DK were measured using a video camera. The passive hip extension and shoulder-flexion range of motion (ROM) were measured using a goniometer. Muscle elastic moduli and lumbar extension angles during DK. The characteristics, muscle elastic moduli, DK motion, and ROM were compared between the 2 groups. LBP group demonstrated significantly higher elastic modulus of the psoas major and lower modulus of pectoralis minor compared with the control group. Also, LBP group showed greater lumbar extension during a DK and less hip extension ROM than the control group. The higher elastic modulus of the psoas major and greater lumbar extension during a DK may be related to the LBP in swimmers.

Shoulder Pain Among Patients With Amyotrophic Lateral Sclerosis: A Case Series.

Evidence has demonstrated that shoulder pain constitutes a functional impairment for patients with amyotrophic lateral sclerosis (ALS). No studies have yet examined the efficacy of scapular mobilization of the painful shoulder among patients with ALS. Our retrospective case series evaluated the effects of scapular mobilization on pain and shoulder motion among patients with ALS. Retrospective case series over 2 yr. A multidisciplinary outpatient clinic at an academic medical institution. Twenty-eight patients with ALS who had shoulder pain and range of motion (ROM) limitations. Patients were excluded if information on visual analog scale (VAS) score for pain and shoulder ROM was not available. Scapular mobilization, ROM, and caregiver education. All patients also received standard occupational therapy treatment for this patient population. The primary outcome was VAS shoulder pain scores; the secondary outcome was shoulder flexion ROM. The median VAS pain score was 2 before treatment and 0 after treatment, with a significant median reduction of 2. Median shoulder flexion ROM was 100° before mobilization treatment and 130° after treatment, with a significant median increase of 25°. The results provide strong evidence that both VAS pain score and shoulder ROM noticeably improve after mobilization treatment. Occupational therapists can effectively promote shoulder care techniques such as scapular mobilization to both patients and care providers to reduce pain and improve quality of life for patients with ALS.

Strength and Motion in the Shoulder, Elbow, and Hip in Softball Windmill Pitchers.

Softball pitching is a ballistic, complex movement that requires an underhand windmill motion to create force and ball velocity. In addition to proper pitch biomechanics, upper and lower extremity strength and joint motion likely contribute to ball location accuracy and velocity. Yet, the number of studies reporting muscle strength and joint range of motion among softball pitchers is scarce. To assess differences between throwing and nonthrowing shoulder, elbow, and hip (lead and trail leg) strength and range of motion (ROM) in high school and collegiate level softball windmill pitchers. Cross-sectional study. Thirty-three female softball pitchers (24 high school, 9 collegiate) were recruited from local teams. Goniometric joint ROM and handheld dynamometer strength measurements of the bilateral shoulders, elbows, and hips were measured. Goniometric joint ROM of the bilateral elbows (flexion, extension), shoulders, and hips (flexion, extension, internal rotation [IR], external rotation [ER]). Handheld dynamometer strength measurements of the bilateral shoulders (flexion, extension, abduction, IR, ER), elbows (flexion, extension), and hips (flexion, extension, IR, ER, abduction). Across all pitchers, there was greater shoulder flexion ROM in the nonthrowing limb than in the throwing limb (P = .004). There was greater hip extension in the lead leg than trail leg. Among high school pitchers, there was greater shoulder ER (x = 105.792 ± 7.11) than collegiate pitchers (x = 100.1 ± 6.92), P = .05. There was no difference in total arc of shoulder rotational motion (ER+ IR) between throwing and nonthrowing limbs across all pitchers, nor between high school and collegiate pitchers. Strength measures demonstrated greater throwing limb shoulder abduction (P = .006) and IR strength (P = .001) than the nonthrowing shoulder across all pitchers. Elbow flexion strength was significantly greater than the nonthrowing side (P = .001). No difference was noted in hip strength between lead and trail lower extremities. Developing normative data for softball pitchers upper and lower extremity strength and range of motion may allow providers to assess players more comprehensively and identify athletes out of the expected value range. This information may help in guiding strength and conditioning programs for softball pitchers. III.

Assessment of impact of late postoperative physical functional disabilities on quality of life in breast cancer survivors.

Breast cancer is the second most common malignancy among women. Surgical and supplemental (or adjuvant) therapies to combat the disease may implicate physical functional consequences for the ipsilateral upper extremity. These dysfunctions may persist for many years and have repercussions on the performance of daily living activities. The aim of this study was to assess the impact of physical functional disabilities on quality of life in women after breast cancer surgery. Eighty-two women in the postoperative period of conservative surgery for breast cancer participated in the study. Axillary lymph node dissection was performed in all patients and mean time since surgery was 5.78 (± 4.60) years. The women responded to a questionnaire to assess quality of life (FACT-B) and to another to assess functional capacity (QuickDASH). They were then referred to physical therapy examination to measure shoulder range of motion (flexion, abduction and external rotation) and arm volume. Range of motion in the ipsilateral shoulder was limited: shoulder flexion range of motion reached a mean value of 155.44º (± 28.31), mean abduction was 149.05º (± 29.51), and mean external shoulder rotation was 58.44º (± 29.17). These limitations had a negative impact on functional capacity and global quality of life. Lymphedema was present in 28.04% of women assessed and did not impair quality of life or functional capacity. Physical functional disabilities were present in the late postoperative period of breast cancer survivors and limited shoulder range of motion negatively influenced their functional capacity and quality of life. The presence of lymphedema did not impair functional capacity or quality of life in the postoperative period.

Tele-rehabilitation service delivery journey from prototype to robust in-home use

Purpose: The purpose of this study is to present a retrospective study on clients with Acquired Brain Injury (ABI) enrolled in a tele-motion-rehabilitation service program for two or more months.Methods: Data from 82 clients (46 males; 74 with ABI), aged 22–85 years, are reported. The Kinect-based CogniMotion System (ReAbility Online, Gertner Institute, Tel Hashomer, Israel) provided services that included 30-min biweekly sessions. Participants were evaluated prior to and 2 months following the commencement of service with clinical assessments that measured movements and function of the weaker upper extremity and cognitive abilities.Results: Clients enrolled in the service had intact or mild cognitive impairment, mild-moderate motor impairment but little use of their weak upper extremity for daily activities. They were satisfied with the service and reported high levels of system usability. Post-intervention clinical assessments were performed on about half of the participants after 2 months; significant improvements in active movements of the weak upper extremity, shoulder flexion range of motion and in the Trail Making Test were found (p < 0.05).Conclusions: The service appears to be feasible for people with ABI and effective in important clinical outcomes related to improvements in upper extremity function.Implications for RehabilitationTele-rehabilitation provided with Microsoft Kinect 3D sensor virtual reality tracking system is feasible for people with Acquired Brain Injury.People with Acquired Brain Injury in the chronic stage were satisfied with the tele-rehabilitation service and perceived it as beneficial to improve their motor and cognitive abilitiesThe CogniMotion System service appears to be effective in important clinical outcomes related to improvements in upper extremity function.

The effects of a 6-month Tai Chi Qigong training program on temporomandibular, cervical, and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors.

Nasopharyngeal cancer (NPC) survivors often sustain head-neck-shoulder impairments from conventional treatments, which could disturb sleep. This novel study aimed to examine the efficacy of Tai Chi (TC) Qigong in optimizing temporomandibular joint (TMJ), cervical, and shoulder joint mobility and reducing sleep problems in NPC survivors. Fifty-two NPC survivors participated in the study. The experimental group (n = 25) received 6 months of TC Qigong training (1.5 h/session; 4 sessions/wk including self-practice) while the control group (n = 27) received no training. Cervical side flexion and rotation, shoulder flexion and horizontal flexion range of motion (ROM), mouth opening capacity (interincisor distance), and sleep problems (Medical Outcomes Study Sleep Scale) were assessed at baseline, mid-intervention (3 months), immediately after TC Qigong training, and at 6-month follow-up. Intention-to-treat analysis revealed improvement in cervical side flexion ROM only (P < .008) and unchanged shoulder and TMJ mobility (P > .008) after the TC Qigong training. Deterioration was observed in shoulder flexion ROM and mouth opening capacity in the no-training controls over time (P < .008). Sleep problems also decreased in the TC Qigong group (P < .008), and this effect was most profound during the follow-up period. In addition, improvement in cervical side flexion ROM was associated with a reduction in sleep problems in the experimental group after TC Qigong training (P < .05). The 6-month TC Qigong intervention improved neck mobility, maintained TMJ and shoulder joint mobility, and reduced sleep problems for NPC survivors. TC Qigong could be an effective nonpharmacological intervention for managing progressive trismus, chronic neck and shoulder hypomobility, and reducing sleep problems among NPC survivors.

The Effect of Prospective Monitoring and Early Physiotherapy Intervention on Arm Morbidity Following Surgery for Breast Cancer: A Pilot Study

Significant arm morbidity is reported following surgery for breast cancer, yet physiotherapy is not commonly part of usual care. This study compared the effect on arm morbidity after surgery for breast cancer of a clinical care pathway including preoperative education, prospective monitoring, and early physiotherapy (experimental group) to that of preoperative education alone (comparison group). A prospective quasi-experimental pretest-posttest, non-equivalent group design compared two clinical sites; Site A (n=41) received the experimental intervention, and Site B (n=31) received the comparison intervention. At baseline (preoperative) and 7 months postoperative, shoulder range of motion (ROM), upper-extremity (UE) strength, UE circumference, pain, UE function, and quality of life were assessed. The experimental group maintained shoulder flexion ROM at 7 months, whereas the comparison group saw a decrease (mean 1° [SD 9°] vs. -6° [SD 15°], p=0.03). A lower incidence of arm morbidity and better quality of life were observed in the experimental group, but these findings were not statistically significant. Baseline characteristics and surgical approaches differed between the two sites, which may have had an impact on the findings. Initial results are promising and support the feasibility of integrating a surveillance approach into follow-up care. This pilot study provides the foundation for a larger, more definitive trial.

Effects of latissimus dorsi length on shoulder flexion in canoeists, swimmers, rugby players, and controls

BackgroundShoulder flexion requires an optimal length of the latissimus dorsi muscle in order to allow full lateral rotation of the humerus and upward scapular rotation. If shoulder flexion (in an externally rotated position) is restricted, this may predispose the individual to shoulder pathology. Sports such as swimming and canoeing have increased shoulder injuries and require high levels of latissimus dorsi muscle activity, which may create muscle hypertrophy and increased stiffness, resulting in a loss of muscle length. The objective of this study was to investigate if differences are present in shoulder flexion in internally and externally rotated positions across different sports (swimming, canoeing, and rugby) and a non-sporting control group. MethodsOne hundred subjects (40 physically active controls, 25 professional Rugby Union players, 20 elite, national-level canoeists (slalom), and 15 elite, national-level swimmers) participated in this study. Shoulder flexion range of motion was measured using a standard goniometer, with the arm elevated in either full external or internal rotation. ResultsA significant difference in shoulder flexion range was observed between canoeists and swimmers, canoeists and controls, rugby players and canoeists, rugby players and swimmers, and controls and swimmers in the external rotation position (p < 0.017), but not between controls and rugby players (p = 0.12). For the internal rotation position, swimmers significantly differed from canoeists, rugby players, and controls (p < 0.017), but there were no significant differences between rugby players, canoeists, and controls (p > 0.07). ConclusionThis study found that the length of the latissimus dorsi differs between sports and controls in accordance with the specific physical demands of their sport.

Effect of Scapular Mobilization on Improvement of Shoulder Flexion Range in Erb’s Palsy Children

Objectives: The aim of this work was to show Effect of scapular mobilization on improvement of shoulder flexion in erbs palsy. Method: Thirty children were enrolled in this study and randomly assigned into two groups; group A (scapular mobilization plus traditional physiotherapy program), and group B (traditional physiotherapy program only). Standard goniometer was used to detect and follow shoulder flexion in addition to stand and reach test. This measurement was taken before initial treatment and after 12 weeks of treatment. The children parents in both groups B were instructed to complete 3 hours of home routine program. Results: Data analysis was available on the 30 Erb’s palsy children participated in the study. The mean value of shoulder flexion ROM test in both groups at baseline measurement (pre-treatment) was insignificant (p>0.05). By comparison of both groups there was significant improvement in shoulder flexion ROM post-treatment (p<0.05). The difference between pre and post treatment results was significant in both groups in favor of the study group (p=0.0079). Conclusion: According the results of this study it can be concluded that the combined effect of physiotherapy training program in addition to scapular mobilization can be recommended in improvement shoulder flexion range of motion in erbs palsy children.

Does Kinesio taping in addition to exercise therapy improve the outcomes in subacromial impingement syndrome? A randomized, double-blind,controlled clinical trial

The aim of this study was to determine the effectiveness of Kinesio taping (KT) application added to the exercise treatment of subacromial impingement syndrome (SIS). Thirty-eight (25 female, 13 male) patients with SIS were randomly divided into therapeutic KT (n=19) and sham KT (n=19) groups. All patients received the same exercise therapy in addition to therapeutic or sham KT at 3-day intervals for 12 days. The groups were compared according to pain, range of motion (ROM), muscle strength and DASH and Constant scores before treatment and at the 5th and 12th treatment days. Within group comparisons showed significant improvements in both groups at the 5th and 12th day evaluations (p<0.05). In comparisons between the groups, pain with movement and DASH scores in the therapeutic group were significantly lower at the 5th day (p<0.01). There were significant improvements in night pain, pain with movement, DASH score, shoulder external rotation muscle strength, and pain free shoulder abduction ROM in the therapeutic group at the 12th day (p<0.05). Passive shoulder flexion ROM increased more in the sham group at the 12th day (p<0.05). The addition of KT application to the exercise program appears to be more effective than the exercise program alone for the treatment of SIS.

Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment

The aim of the current study was to investigate the relationship between pressure pain thresholds, shoulder movement, mood state, pain perception, muscle endurance, quality of life and fatigue in breast cancer survivors (BCS). Fifty-nine BCS reporting fatigue were examined at 6 months post-treatment. Women completed the Piper Fatigue Scale, the Breast Cancer-Specific Quality of Life Questionnaire, the Profile of Mood State, and neck-shoulder visual analogue scale. Additionally, shoulder flexion range of motion, the McQuade test (trunk flexor endurance) and pressure pain thresholds over the C5-C6 joint, the deltoid muscle, the second metacarpal and tibialis anterior muscle were assessed. Fatigue was greater in those patients with higher depression (r= 0.45, P < 0.05), higher shoulder pain (r= 0.39, P < 0.05), higher neck pain (r= 0.46, P < 0.01), lower body image (r=-0.34, P < 0.05) and reduced shoulder movement (r=-0.32, P < 0.05). Regression analyses demonstrated that depression, cervical pain intensity, body image and shoulder mobility were associated with fatigue (r= 0.55, P < 0.001). A psychological state characterised with higher depression and reduced body image and a physical impairment with higher cervical pain intensity and reduced shoulder mobility confirm multidimensional character of fatigue in BCS.

The Relationship of Pain Intensity, Physical Impairment, and Pain-Related Fear to Function in Patients With Shoulder Pathology

Cross-sectional. This study examined the baseline relationship of pain intensity, physical impairment, and pain-related fear to shoulder function. There is no consensus regarding the influence psychological variable have on function and recovery in individuals with shoulder pathologies. While pain-related fear has been shown to predict disability for patients with low-back and cervical pain, this relationship has not been consistently reported for patients with shoulder pain. One hundred forty-two subjects (78 male, 64 female; mean age, 41.4 years) with nonoperative unilateral shoulder disorders were identified from a clinical database of impairment and outcome measures.Demographic information, duration of symptoms, mechanism of injury, pain intensity, pain-related fear, and range-of-motion (ROM) measures were collected. Self-report of function was measured with the Shoulder Pain and Disability Index (SPADI). Hierarchical regression analysis determined the proportions of explained variance in function. Demographic variables (duration of symptoms, sex, age, and mechanism of injury) collectively contributed approximately 9% (P=.003) of the variance in function scores. Average pain intensity and flexion ROM contributed an additional 22% (P<.001) of the variance, and Tampa Scale of Kinesiophobia (TSK-11) scores contributed an additional 3% (P<.001). In the final parsimonious model, presence of symptoms longer than 3 months (beta=.23, P=.003), pain intensity (beta=.25, P=.002), shoulder flexion ROM index (beta=-.35, P=.001), and kinesiophobia (beta=.17, P=.026) explained 33% of the variance in SPADI function score (P<.001). Presence of symptoms longer than 3 months, average pain intensity, flexion ROM index (strongest contributor in multivariate model), and fear-of-pain scores all contributed to baseline shoulder function. The immediate clinical relevance of these findings is unclear but they do provide direction for prospective studies.

Reproducibility and Minimal Detectable Change of Three-Dimensional Kinematic Analysis of Reaching Tasks in People With Hemiparesis After Stroke

Three-dimensional kinematic analysis of reaching has emerged as an evaluative measure of upper-extremity motor performance in people after stroke. However, the psychometric properties supporting the use of kinematic data for evaluating longitudinal change in motor performance have not been established. The objective of this study was to determine, in a test-retest reliability manner, the reproducibility and minimal detectable change for reaching kinematics in people after stroke. Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters. Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%. Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.

Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study

This pilot study examined the effects of a self-administered, home-based exercise (HBE) rehabilitation programme designed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection. Twenty-seven women who were scheduled for surgery were randomly assigned to either a post-surgical experimental HBE rehabilitation group (n = 16) or a usual care group (UC; n = 11). Women assigned to the HBE group followed an 11 day (days 3-14 post-surgery), home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape. The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society. As a result of the exercise programme intervention, there was a time x group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion (ROM) (p = 0.003) and abduction ROM (p = 0.036) when compared to the UC. There were no statistical differences in shoulder strength between groups over time. External rotation (p = 0.036) and grip strength (p = 0.001) significantly increased in both groups during the intervention period but there were no interaction effects. With respect to the forearm circumferences, there was a significant decrease over time (p < 0.001) but no interaction between groups. This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery.

The prevalence and characteristics of shoulder pain after traumatic brain injury

Objective: To determine the prevalence and characteristics of shoulder pain in people with traumatic brain injury participating in inpatient rehabilitation and to compare the clinical presentation with that of people with stroke. Design: A prospective comparative study. Setting: Six metropolitan rehabilitation units. Subjects: Eighty-seven people with traumatic brain injury and 52 people with stroke took part in the study. Main measures: Assessment of shoulder pain, range of motion, strength and function was conducted on admission and, for the subjects with traumatic brain injury, at discharge if rehabilitation exceeded two weeks. Results: The prevalence of shoulder pain in people with traumatic brain injury was 62%, which was comparable with the 69% of subjects with stroke that experienced shoulder pain (odds ratio 0.72, 95% confidence interval 0.34 -1.5). Fracture in the shoulder complex and passive shoulder external rotation range of motion were the best predictors for shoulder pain after traumatic brain injury. This was different from the subjects with stroke for which the best predictors were passive shoulder flexion range of motion and length of acute hospital stay. Conclusion: There is a relatively high prevalence of shoulder pain after traumatic brain injury. Trauma to the shoulder complex contributes to shoulder pain after traumatic brain injury, making clinical presentation different from people with stroke. The findings support the need for greater attention in the management of shoulder pain after traumatic brain injury.

Passive insufficiency of two-joint shoulder muscles

This preliminary study examined the effects of full elbow flexion and full elbow extension on the end-point of active range of motion of shoulder flexion and shoulder extension respectively. The end-points were measured from lateral photographs of the right upper limbs of 30 men after they flexed and extended their shoulders with their elbows held in full flexion and full extension. Angular measurements showed that full elbow flexion limited shoulder flexion range of motion and that full elbow extension limited shoulder extension range of motion. The results indicated that passive muscle insufficiency of active shoulder flexion and extension was probably brought about by lengthening the triceps brachii and the biceps brachii muscles respectively. Clinicians are encouraged to considerthis passive insufficiency when measuring range of motion of shoulderflexion and extension and when implementing therapeutic interventions.