Shoulder Girdle Research Articles

Motor alterations along the kinetic chain in amateur volleyball and handball athletes with shoulder pain: An observational comparative study

Overhead sports overload the shoulder complex due to movement repetition and the great amount of force created during the athletic motion, which may cause adaptations in the shoulder and lead to shoulder pain. However, overhead movements include the kinetic chain, and alterations in some of the structures throughout the kinetic chain may increase stress on the shoulder complex and be associated with shoulder pain. PurposeTo compare kinetic chain components in overhead athletes with and without shoulder pain. MethodsForty-one volleyball and handball athletes (21 with and 20 without shoulder pain) were included and assessed for hip internal (IR) and external rotation (ER) range of motion (ROM), hip and trunk isometric strength, trunk endurance and neuromuscular control of the lower and upper limbs (Y balance test). ResultsAthletes with shoulder pain showed smaller IR ROM in both hips, lower endurance time for trunk extensors and flexors, decreased reach distance in the anterior and posteromedial direction, as well as a smaller composite score in the Y balance test (p < 0.05). ConclusionVolleyball and handball athletes with shoulder pain showed changes in ROM throughout the kinetic chain in addition to lower core endurance, and decreased neuromuscular control of lower limbs.

Treatment options and outcomes for delayed scapular anatomical neck fractures: a case report and review of the literature

IntroductionScapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery.Case presentationA 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont–Evrard approach was used because of the patient’s extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79.ConclusionsThe most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient’s specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.

A comparison of tag retention and mortality from two tagging methods for internal tag placement in Channel Catfish

AbstractObjectiveDocumenting the movement of Channel Catfish Ictalurus punctatus through telemetry, where a transmitter tag is surgically implanted in the fish, can provide valuable insight into the species' spatial ecology and habitat use. However, since fish in the order Siluriformes can expel foreign objects such as tags from their body cavity, the utility of telemetry technology may be limited for Channel Catfish. This study aimed to determine (1) how quickly Channel Catfish reject tags that were surgically implanted into the body cavity, (2) if surgical implantation of transmitter tags causes mortality, and (3) what surgical method is best to minimize tag rejection and/or mortality.MethodsThree surgical trials were conducted on Channel Catfish (n = 24) using two tag implantation methods: a nontethered method, in which the tag was freely implanted into the body cavity, and a tethered method, where the tag was attached to the pectoral girdle. Fish were observed in the lab for 30 days for trials 1 and 2 and 225 days for trial 3 following tag implantation.ResultNo complete tag rejections occurred during any of the three experimental trials. However, all five tethered fish experienced mortality during trial 3 (58–221 days postsurgery). Necropsies indicated that the tethered tagging method led to septicaemia infections and internal lacerations from the tether, which were not observed in the nontethered fish. Tags in the nontethered fish were in the process of being absorbed into the intestinal tract, which over time might have led to tag rejection.ConclusionWhile rejection is possibly the end point of the nontethered tagging method, our results suggest it is nevertheless the better tagging method for Channel Catfish given higher survival.

Weeping blisters – Clinical presentation in an uncommon site

Lymphangioma Circumscriptum (LC), a microcystic hamartomatous lymphatic malformation is a rare benign condition characterized by the proliferation of dilated lymphatic vessels in the skin. Usually, it is congenital, but some may become clinically apparent later in life. They account for 4% of all vascular malformations. Usually seen in and around the shoulder and pelvic girdle. This case report discusses LC in a teenage girl with a 13-year-old history of painless, grouped fluid filled blisters on the right side of her chest, an uncommon site presenting after several years seeking intervention. The diagnosis was established through clinical examination and skin biopsy. With normal basic laboratory investigations, we initiated her with lesional cryotherapy as the primary efficacious intervention before planning for surgical excision. Cryotherapy is cheap, safe and easily available option.

3D Ultrasound Mosaic of the Whole Shoulder: A Feasibility Study

A protocol is proposed to acquire a tomographic ultrasound (US) scan of the musculoskeletal (MSK) anatomy in the rotator cuff region. Current clinical US imaging techniques are hindered by occlusions and a narrow field of view and require expert acquisition and interpretation. There is limited literature on 3D US image registration of the shoulder or volumetric reconstruction of the full shoulder complex. We believe that a clinically accurate US volume reconstruction of the entire shoulder can aid in pre-operative surgical planning and reduce the complexity of US interpretation. The protocol was used in generating data for deep learning model training to automatically register US mosaics in real-time. An in vivo 3D US tomographic reconstruction of the entire rotator cuff region was produced by registering 53 sequential 3D US volumes acquired by an MSK sonographer. Anatomical surface thicknesses and distances in the US mosaic were compared to their corresponding MRI measurements as the ground truth. The humeral head surface was marginally thicker in the reconstructed US mosaic than its original thickness observed in a single US volume by 0.65 mm. The humeral head diameter and acromiohumeral distance (ACHD) matched with their measured MRI distances with a reconstruction error of 0 mm and 1.2 mm, respectively. Furthermore, the demonstration of 20 relevant MSK structures was independently graded between 1 and 5 by two sonographers, with higher grades indicating poorer demonstration. The average demonstration grade for each anatomy was as follows: bones = 2, muscles = 3, tendons = 3, ligaments = 4–5 and labrum = 4–5. There was a substantial agreement between sonographers (Cohen’s Weighted kappa of 0.71) on the demonstration of the structures, and they both independently deemed the mosaic clinically acceptable for the visualisation of the bony anatomy. Ligaments and the labrum were poorly observed due to anatomy size, location and inaccessibility in a static scan, and artefact build-up from the registration and compounding approaches.

Growth of the brachial nerve plexus with reference to topographical relation of the medianus nerve ansa with the thoracic wall and shoulder: a histologic study using human embryos and fetuses.

There is currently no information on positional changes in the brachial nerve plexus during prenatal growth. The subclavian-axillary artery passing through the medianus nerve ansa is considered a good landmark for evaluating the height of the plexus. We used histologic sections from 9 embryos and 17 fetuses (approximately 6-15weeks of gestational age) to identify the height of the ansa by referring to the level of the rib and the glenohumeral joint. The nerve ansa was usually (23 plexuses) observed at the level of the first and/or second ribs. However, it was sometimes observed above the first rib, at a distance equal to or more than an intercostal width (7 plexuses). In the latter group, the ansa was usually located below the glenohumeral joint. Thus, the joint was located higher than the first rib, although the upper extremities were in the anatomic position for all specimens. The left-right difference in the height of the plexus corresponded to or was less than the width of the first intercostal space. Despite the synchronized growth between the thorax and shoulder girdle, the brachial plexus showed a considerable variation in comparative height; the range corresponded to twice of an intercostal width. Whether the nerve plexus is located high or low is determined at an early developmental stage and is maintained during the later growth stages. The high-positioned plexus might cause nerve injury at delivery, followed by a glenohumeral joint deformity because of the fragility without fixation in the thorax.

Scapula fractures: functional anatomy, clinical assessment and management.

Fractures of the scapula are rare injuries, accounting for 3-5% of all shoulder girdle fractures. They are frequently the result of high energy trauma and often present with concurrent and life-threatening injuries to adjacent structures, leading to significant morbidity and mortality. Patients presenting with scapula fractures must receive a thorough and systematic clinical assessment as directed by national trauma guidelines. Appropriate imaging is essential in delineating fracture morphology and should at the very least include anteroposterior, anteroposterior oblique (Grashey) and axillary or scapula 'Y' view of the shoulder. Computed tomography imaging with three-dimensional reconstruction allows better delineation of the fracture morphology and helps with surgical planning. A lack of randomised controlled trials comparing the efficacy of conservative and operative management of scapula fractures has resulted in limited consensus for surgical indications. Nevertheless, most extra-articular fractures can be managed conservatively while intra-articular fractures of the glenoid frequently require surgical fixation.

Peculiarities of Adolescent, Qualified Female Volleyball Players’ Shoulder Girdle

Peculiarities of Adolescent, Qualified Female Volleyball Players’ Shoulder Girdle

Children and adolescents with all forms of shoulder instability demonstrate differences in their movement and muscle activity patterns when compared to age- and sex-matched controls

BackgroundShoulder instability is a complex impairment and identifying biomarkers which differentiate subgroups is challenging. There is limited fundamental movement and muscle activity data for identifying different mechanisms for shoulder instability in children and adolescents which may inform subgrouping and treatment allocation. HypothesisChildren and adolescents with shoulder instability (irrespective of etiology) have differences in their movement and muscle activity profiles compared to age- and sex-matched controls (two-tailed). MethodsYoung people between eight to 18 years were recruited into two groups of shoulder instability (SI) or and age- and sex-matched controls (CG). All forms of SI were included and young people with co-existing neurological pathologies or deficits were excluded. Participants attended a single session and carried out four unweighted and three weighted tasks in which their movements and muscle activity was measured using 3D-movement analysis and surface electromyography. Statistical parametric mapping was used to identify between group differences. ResultsData was collected for 30 young people (15 SI (6M:9F) and 15 CG (8M:7F)). The mean (SD) age for all participants was 13.6 years (3.0). The SI group demonstrated consistently more protracted and elevated sternoclavicular joint positions during all movements. Normalized muscle activity in Latissimus dorsi was lower in the SI group and had the most statistically significant differences across all movements. Where differences were identified, the SI group also had increased normalized activity of their middle trapezius, posterior deltoid and biceps muscles whilst activity of their latissimus dorsi, triceps and anterior deltoid were decreased compared to the CG group. No statistically significant differences were found for pectoralis major across any movements. Weighted tasks produced fewer differences in muscle activity patterns compared to unweighted tasks. DiscussionYoung people with SI may adapt their movements to minimize glenohumeral joint instability. This was demonstrated by reduced variability in acromioclavicular and sternoclavicular joint angles, adoption of different movement strategies across the same joints and increased activity of the scapular stabilizing muscles, despite achieving similar arm positions to the CG. ConclusionYoung people with shoulder instability demonstrated consistent differences in their muscle activity and movement patterns. Consistently observed differences at the shoulder girdle included increased sternoclavicular protraction and elevation accompanied by increased normalized activity of the posterior scapula stabilizing muscles. Existing methods of measurement may be used to inform clinical decision making, however, further work is needed evaluate the prognostic and clinical utility of derived 3D and sEMG data for informing decision making within shoulder instability.

Transformation of the pectoral girdle in pennaraptorans: critical steps in the formation of the modern avian shoulder joint.

Important transformations of the pectoral girdle are related to the appearance of flight capabilities in the Dinosauria. Previous studies on this topic focused mainly on paravians yet recent data suggests flight evolved in dinosaurs several times, including at least once among non-avialan paravians. Thus, to fully explore the evolution of flight-related avian shoulder girdle characteristics, it is necessary to compare morphology more broadly. Here, we present information from pennaraptoran specimens preserving pectoral girdle elements, including all purportedly volant taxa, and extensively compare aspects of the shoulder joint. The results show that many pectoral girdle modifications appear during the evolution from basal pennaraptorans to paravians, including changes in the orientation of the coracoid body and the location of the articulation between the furcula and scapula. These modifications suggest a change in forelimb range of motion preceded the origin of flight in paravians. During the evolution of early avialans, additional flight adaptive transformations occur, such as the separation of the scapula and coracoid and reduction of the articular surface between these two bones, reduction in the angle between these two elements, and elongation of the coracoid. The diversity of coracoid morphologies and types of articulations joining the scapula-coracoid suggest that each early avialan lineage evolved these features in parallel as they independently evolved more refined flight capabilities. In early ornithothoracines, the orientation of the glenoid fossa and location of the acrocoracoid approaches the condition in extant birds, suggesting a greater range of motion in the flight stroke, which may represent the acquisition of improved powered flight capabilities, such as ground take-off. The formation of a new articulation between the coracoid and furcula in the Ornithuromorpha is the last step in the formation of an osseous triosseal canal, which may indicate the complete acquisition of the modern flight apparatus. These morphological transitions equipped birds with a greater range of motion, increased and more efficient muscular output and while at the same time transmitting the increased pressure being generated by ever more powerful flapping movements in such a way as to protect the organs. The driving factors and functional adaptations of many of these transitional morphologies are as yet unclear although ontogenetic transitions in forelimb function observed in extant birds provide an excellent framework through which we can explore the behavior of Mesozoic pennaraptorans.

Where to mount the IMU? Validation of joint angle kinematics and sensor selection for activities of daily living

We validate the OpenSense framework for IMU-based joint angle estimation and furthermore analyze the framework's ability for sensor selection and optimal positioning during activities of daily living (ADL). Personalized musculoskeletal models were created from anthropometric data of 19 participants. Quaternion coordinates were derived from measured IMU data and served as input to the simulation framework. Six ADLs, involving upper and lower limbs were measured and a total of 26 angles analyzed. We compared the joint kinematics of IMU-based simulations with those of optical marker-based simulations for most important angles per ADL. Additionally, we analyze the influence of sensor count on estimation performance and deviations between joint angles, and derive the best sensor combinations. We report differences in functional range of motion (fRoMD) estimation performance. Results for IMU-based simulations showed MAD, RMSE, and fRoMD of 4.8°, 6.6°, 7.2° for lower limbs and for lower limbs and 9.2°, 11.4°, 13.8° for upper limbs depending on the ADL. Overall, sagittal plane movements (flexion/extension) showed lower median MAD, RMSE, and fRoMD compared to transversal and frontal plane movements (rotations, adduction/abduction). Analysis of sensor selection showed that after three sensors for the lower limbs and four sensors for the complex shoulder joint, the estimation error decreased only marginally. Global optimum (lowest RMSE) was obtained for five to eight sensors depending on the joint angle across all ADLs. The sensor combinations with the minimum count were a subset of the most frequent sensor combinations within a narrowed search space of the 5% lowest error range across all ADLs and participants. Smallest errors were on average &amp;lt; 2° over all joint angles. Our results showed that the open-source OpenSense framework not only serves as a valid tool for realistic representation of joint kinematics and fRoM, but also yields valid results for IMU sensor selection for a comprehensive set of ADLs involving upper and lower limbs. The results can help researchers to determine appropriate sensor positions and sensor configurations without the need for detailed biomechanical knowledge.

Osteology and phylogenetic position of Plagiosaurus depressus (Temnospondyli: Plagiosauridae) from the Late Triassic of Germany and the repeated loss of dermal bones in plagiosaurids

Abstract The skull and postcranium of the Late Triassic plagiosaurid temnospondyl Plagiosaurus depressus from Halberstadt (Germany) are redescribed in detail. Plagiosaurus possesses two autapomorphies, the abbreviated tabular and the broad contact between the postorbital and parietal. A comprehensive phylogenetic analysis of Plagiosauridae finds a clade Plagiosaurinae consisting of Plagiosaurus and Gerrothorax. Among other characters, both taxa share the solid box-like sides of the low pectoral girdle, the short but robust humerus with small deltopectoral crest and well-developed supinator process, and an anterodorsally directed lateral line sulcus close to the mandibular symphysis. Compared with Gerrothorax, the skull of Plagiosaurus is deeper and more slender, and the postfrontal is absent, meaning that the parietal forms the posteromedial margin of the enlarged orbit. This new interpretation of the bone configuration shows that reduction of circumorbital bones associated with orbital enlargement occurred three times independently within Plagiosauridae, albeit probably in different functional contexts. Our phylogenetic analysis further reveals the Plagiosuchinae (Plagioscutum + Plagiosuchus) as the most basal plagiosaurid clade, which, in turn, forms the sister group to Plagiosaurinae and Plagiosterninae (Plagiorophus + (Plagiosternum + Megalophthalma)). The mentioned shared derived characters of Plagiosaurinae in the pectoral girdle, forelimbs, and mandibular lateral lines suggest a similar benthonic lifestyle.

Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions.

Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.

Dancers Show More Accurate Trunk-Pelvic Joint Angle Reproduction While Wearing a Jacket Augmented With Elastic Bands.

Purpose: The Backalast® compression jacket is intended to improve posture and proprioception of the trunk and shoulder girdle for dancers and dance students during dance training by way of elastic bands in the rear of the garment (which include bands enclosing the inferior thorax). This study was intended to investigate whether there is evidence to support those objectives. Materials and Methods: Fifteen dance students participated (4 male, mean age 19.9 ± 1.4 years old). The dependent variables of trunk-pelvis angle and proximity of trunk axis to global vertical for each participant were measured using optical motion capture before and after the completion of a series of trunk movements. The Helen Hayes model, which we used to represent the trunk, includes the shoulder girdles as part of the trunk. We compared the effect of the type of garment (Backalast® or control compression shirt) worn upon the 2 dependent variables, within-subject with paired t-tests. The order of whether Backalast® or control compression shirt was worn first was alternated between participants. Results: The pre/posttest difference in trunk proprioception as represented by the construct of ability to reproduce trunk-pelvis angle wearing the Backalast® was 0.8° ± 0.8°, but for the control shirt, the difference was 1.8° ± 1.4°, P = .03. The difference between garments in vertical trunk alignment, measured after the series of trunk movements, was not significant. Conclusion: Our findings suggest that the Backalast® can help enhance trunk proprioception when compared to the control compression shirt, although it did not change the angle at which the participants' held their trunks while standing erect (proximity to global vertical).

Clavicle fractures do not increase the occurrence of later subacromial pain syndrome. A registry-based case-control study with 15-25 years of follow-up of 131.838 persons from the Danish National Patient Register

BackgroundA clavicle fracture often changes the mechanical axes of the shoulder girdle due to displacement and shortening, potentially leading to scapular protraction and decreased subacromial space. If protraction of the scapula is a major risk factor for developing subacromial pain syndrome (SAPS), a previous clavicle fracture could increase the risk of later SAPS. The purpose of this study was to investigate if a previous clavicle fracture correlates with a higher occurrence or earlier diagnosis of SAPS. MethodsIn this retrospective case-control study with data from the Danish National Patient Register, all persons aged 18-60 years, with any hospital contact due to a clavicle fracture (DS420) between 1.1.1996 and 31.12.2005 were identified as cases. For each case, five controls, matched on age and sex, were identified. Primary outcome was the first hospital contact with a SAPS diagnosis (DM751-755) registered more than 180 days following fracture. Follow-up was until 01.11.2021. Results21.973 cases and 109.865 controls were included. The incidence of clavicle fractures was 76 fractures per 100.000 persons per years. 23% were female. 1.640 (7.46%) cases and 8.072 (7.35%) controls received a SAPS diagnosis within the following 15-25 years, demonstrating no significant difference in occurrence of SAPS (p=0.56).Mean time from fracture to SAPS diagnosis was shorter for cases compared to controls (4040 vs. 4442 days, p<0.001), and cases were slightly younger when receiving the diagnosis (51.3 vs 53.6 years, p<0.001).1614 cases underwent surgical fixation. This subgroup had a statistically significant higher occurrence of later SAPS diagnosis (205 cases, 13%, p<0.001). ConclusionPersons with a previous clavicle fracture did not have an increased occurrence of receiving a subacromial pain syndrome (SAPS) diagnosis compared to matched controls. However, the diagnosis was given 1-2 years earlier for people with a previous fracture. Based on these findings no strong argument for protraction of the scapula as a major risk-factor for the development of SAPS was found.

Extended Wrist Rotation Simplified.

Extended wrist rotation provides a simple clinical measure of rigidity in movement disorders. The supinator-pronator muscles of the forearm form an agonist-antagonist pair that can be isolated for diagnosis and monitoring. Patients rarely can isolate these muscles without extraordinary training and body awareness. Clinicians may find documenting the impact of the shoulder girdle, wrist, and hand movements overburdensome. A preliminary study shows that restricting the olecranon and keeping the wrist in line with the hand can provide a simple, reproducible measure of rigidity. We study a two-handed "handshake" examination and the use of a pulley-based goniometer. This preliminary analysis indicates that both offer the same observer and between-observer reliability. Two-way analysis of variance showed no statistical differences or outliers.

Reliability and validity of portable dynamometers in testing shoulder and shoulder girdle strength: A systematic review

Introduction&#x0D; The prevalence of shoulder pain is high in overhead athletes and in wheelchair users with a spinal cord injury (SCI). Especially in the latter, shoulder pain can have detrimental consequences for an individual's mobility, participation, and quality of life. Shoulder problems have been associated with high and/or repetitive loads induced by for example overhead activities, as well as manual wheelchair activities (Leong et al., 2019; Morrow et al., 2011). Modifiable risk factors for shoulder pain are related to the capacity of the shoulder musculature and include the relative strength or lack of force in certain shoulder muscles (Mulroy et al., 2015). Although isokinetic dynamometers are considered the gold standard in assessing muscle strength, they are typically not available in a therapy or training setting. Strength measurements with portable dynamometers offer a more feasible and financially affordable alternative. To assess changes in muscle strength over time, reliable and valid shoulder and shoulder girdle muscle strength tests are required. Therefore, the aim of this study was to identify validated and reliable portable dynamometer protocols to assess changes in shoulder strength in the general population and wheelchair users with SCI over time.&#x0D; Methods&#x0D; A literature search was performed with defined terms from the three main concepts “shoulder joint”, “strength testing” and “reproducibility of results”. The electronic search strategy was developed with the help of a librarian and adapted for the following databases: PubMed (Medline), Cochrane Library (Central register of controlled trials), Web of Science (Core Collection), CINAHL. The population of interest was the general population (≥ 18 years) with and without shoulder pain with a special focus on wheelchair users with SCI. Title and abstract screening, full-text screening, quality assessment and data extraction was performed using Covidence.org. For quality assessment selected boxes from the “COSMIN Risk of Bias tool” were used. Data extraction was performed by two independent authors. The main outcome measures extracted where test-retest reliability (intraclass correlation coefficient, standard error of measurement and minimum detectable difference) and concurrent validity (intraclass correlation coefficient).&#x0D; Results&#x0D; Trough systematic search 8,020 studies were identified for screening. Initially 2,267 were excluded as duplicates and 5,647 were excluded for not meeting the inclusion criteria. 106 full-texts have been screened. As data extraction is ongoing the results of reliability and validity of portable dynamometer in testing shoulder strength will be presented at the conference.&#x0D; Discussion/Conclusion&#x0D; As data extraction is ongoing the discussion and conclusion will be presented at the conference.&#x0D; References&#x0D; Leong, H. T., Fu, S. C., He, X., Oh, J. H., Yamamoto, N., &amp; Yung, S. H. P. (2019). Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 51(9), 627-637. https://doi.org/10.2340/16501977-2598&#x0D; Morrow, M. M. B., Kaufman, K. R., An, K.-N. (2011). Scapula kinematics and associated impingement risk in manual wheelchair users during propulsion and a weight relief lift. Clinical Biomechanics, 26(4), 352-357. https://doi.org/10.1016/j.clinbiomech.2010.12.001&#x0D; Mulroy, S. J., Hatchett, P., Eberly, V. J., Lighthall Haubert, L., Conners, S., &amp; Requejo, P. S. (2015). Shoulder strength and physical activity predictors of shoulder pain in people with paraplegia from spinal injury: Prospective cohort study. Physical Therapy, 95(7), 1027-1038. https://doi.org/10.2522/ptj.20130606

Effects of a Conventional Treatment Plus Scapular Exercises Program in Patients With Chronic Lateral Elbow Tendinopathy: A Pre-Post Single-Group Study.

Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. A total of 65 patients (72.3% females), with a mean age of 41.8years, were analyzed. At the end of 6weeks, the results showed clinically and statistically significant differences (P < .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P < .001); grip strength +33.6% (P < .001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5cm (P < .001); and Visual Analogue Scale at grip -2.3cm (P < .001). At the end of 6weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy.

Impact of Spencer Technique on Pain, Range of Motion, and Functional Disability in Patients With Frozen Shoulder: A Pilot Study.

Background and objective The shoulder is the most flexible ball- and socket-type joint in the human body. The pathological condition that can commonly affect this joint is the frozen shoulder. This condition is marked by pain and stiffness in the area surrounding the shoulder complex. This leads to difficulty in doing the daily activities of living. Exercise and physical therapy are mostly recommended to decrease pain and improve and maintain the range of motion (ROM). Mainly traditional techniques such as Mulligans, Maitland, and Kaltenborn are used, along with electrotherapy and exercises, for the treatment of this condition. The effect of the Spencer technique is seen in baseball players' shoulder function. Thus, the purpose of this study is to determine how the Spencer approach affects patients with frozen shoulders in terms of pain, ROM, and functional impairment. Methodology This study included 20 patients aged between 40 and 60 years with stage 2 and 3 diagnosed frozen shoulder. This is a single-group pilot study that received the Spencer technique along with a moist heat pack and Codman's exercises on the affected shoulder for three weeks. Outcome measures used for assessment before and after treatment were the visual analogscale (VAS), shoulder ROM, and shoulder pain and disability index (SPADI). After the second, third, and sixth months, a follow-up was conducted.Two patients were lost to follow-up; consequently, statistical analysis was performed on the data from 18 patients. Results The current study's results suggested that there was an improvement in the mean values of VAS, ROM, and SPADI at post-three weeks, anda sustained effect was observed at the second, third, and sixth months. A statistically significant difference (P< 0.05) was found. Conclusions The study's conclusions demonstrated improved pain, ROM, and SPADI scores post-intervention. Treatment effects persisted, as seen by follow-up at the two, three, and six-month marks. As a result, the Spencer technique utilized in this pilot study on frozen shoulder patients proved effective. Also, the outcome effects were sustained, which suggests its utility in frozen shoulder rehabilitation.

The ecological drivers of variation in pectoral girdle anatomy in frogs

The ecological drivers of variation in pectoral girdle anatomy in frogs