Shoulder Muscles Research Articles

A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players.

Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging. Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players. Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume. Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group. Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises.

Creatinine as a predictor of muscle mass deficiency in patients with severe cerebral palsy

Energy processes in muscles can be reflected by the creatine phosphokinase system of ATP resynthesis from ADP and creatine phosphate. The product of non-enzymatic degradation of creatine (creatine phosphate) is creatinine, which accumulates in the blood serum, and its concentration correlates with the volume of the patient’s muscle tissue, subject to the normal functioning of the kidneys. Purpose. To assess the perioperative serum creatinine level as a biological marker of muscle mass in patients with severe forms of cerebral palsy, IV–V level according to GMFCS, during orthopedic interventions on the hip joint. Material and methods. A prospective clinical observational study included 82 patients with severe forms of cerebral palsy, spastic dislocations (subluxations) of the hips, for which reconstructive or palliative interventions were performed on the hip joints. The trophological status of children was assessed before surgery, the level of serum creatinine was determined in the intraoperative period, on the first postoperative day, and on the fifth day after surgery. Results. The circumference of the middle third of the shoulder in 28 % of patients, as well as the thickness of the skin-fat fold over the triceps in 61 % of children were below the 10th centile, which was regarded as malnutrition. The calculated proportion of body fat equal to 10 [8; 20] % in combination with the circumference of the muscles of the middle third of the shoulder suggest a combination of protein-energy deficiency and muscle mass deficiency in 1/5 of the patients. Creatinine indicators at all stages of observation corresponded to the minimum age norm or were below these values, tended to decrease and had a random agreement (W = 0,129). Conclusion. The level of creatinine in the blood serum correlates with the «shoulder muscle circumference» parameter in children with severe forms of cerebral palsy, severe movement disorders of IV–V level according to GMFCS. Plasma creatinine can be used as a biological marker of skeletal muscle mass in patients with severe cerebral palsy.

Association between core strength and dynamic balance of throwing hand in professional healthy cricket fast bowlers: A cross sectional study

BackgroundThe core musculature gets activated by feed forward fashion during the movement of upper extremity, as in kinetic chain of throwing, shoulder muscle contributes larger dynamic balance and also in reversed manner. Aim of the current study was to associate the strength of core and the dynamic balance of throwing hand in cricket fast bowlers. Methods72 subjects were initially screened for eligibility, and ultimately, 55 male participants from various cricket coaching academies, aged 19.1 ± 2.6 on average, were included. The mean BMI of the participants was 20.9. The assessments included the Modified Upper Quarter Y Balance Test (mUQYBT)- Medial (M), Supero-Lateral reach (SL), Infero-Lateral reach(IL) along with Core measures- 600 Abdominal flexion test (600 AFT), right side plank test (RSP), Left side plank test (LSP), Beiring Sorenson test (BST), all of which were successfully completed. ResultsBased on our findings, we observed a mild positive correlation between the values of mUQYBT and core measures. We employed Pearson's coefficient to evaluate the association, and the R2 values were utilized to quantify the amount of variability. The resulting scores were RSP to SL (r = 0.38, R2 = 0.14), LSP to SL (r = 0.43, R2 = 0.19), LSP to RSP (r = 0.790, R2 = 0.62), BSP to Composite score (r = 0.29, R2 = 0.08), SL to 600 AFT* (r = 0.231, R2 = 0.05) and BMI to IL* (r = −0.107, R2 = 0.01). ConclusionIn conclusion, a positive correlation was exhibited between dynamic balance and core strength in healthy cricket fast bowlers. Educating bowlers on proper movement techniques and prescribing targeted exercises can enhance dynamic balance, reducing the risk of injuries.

Current Clinical Concepts: Nonoperative Management of Shoulder Instability.

Non-operative management following a shoulder dislocation or subluxation remains a challenging and complex task. Accurate diagnosis of the condition, and shared decision-making regarding operative and non-operative management, as well as timing of return to play is required. This clinical concept paper introduces a shoulder instability framework that addresses these fundamental clinical dilemmas. Valid clinical prognostic tools which can predict recurrent shoulder instability are reviewed. The process of shared decision-making within the realm of shoulder instability is also presented. Finally, a framework for progressive rehabilitation that addresses deficits in motor control, strength, and endurance in scapula and shoulder musculature is presented to guide patients from an initial instability event, through to return to play.

Differences in Glenohumeral Joint Contact Forces Between Recovery Hand Patterns During Wheelchair Propulsion With and Without Shoulder Muscle Weakness: A Simulation Study.

The majority of manual wheelchair users (MWCU) develop shoulder pain or injuries, which is often caused by impingement. Because propulsion mechanics are influenced by the recovery hand pattern used, the pattern may affect shoulder loading and susceptibility to injury. Shoulder muscle weakness is also correlated with shoulder pain, but how shoulder loading changes with specific muscle group weakness is unknown. Musculoskeletal modeling and simulation were used to compare glenohumeral joint contact forces (GJCFs) across hand patterns and determine how GJCFs vary when primary shoulder muscle groups are weakened. Experimental data were analyzed to classify individuals into four hand pattern groups. A representative musculoskeletal model was then developed for each group and simulations generated to portray baseline strength and six muscle weakness conditions. Three-dimensional GJCF peaks and impulses were compared across hand patterns and muscle weakness conditions. The semicircular pattern consistently had lower shear (anterior-posterior and superior-inferior) GJCFs compared to other patterns. The double-loop pattern had the highest superior GJCFs, while the single-loop pattern had the highest anterior and posterior GJCFs. These results suggest that using the semicircular pattern may be less susceptible to shoulder injuries such as subacromial impingement. Weakening the internal rotators and external rotators resulted in the greatest increases in shear GJCFs and decreases in compressive GJCF, likely due to decreased force from rotator cuff muscles. These findings suggest that strengthening specific muscle groups, especially the rotator cuff, is critical for decreasing the risk of shoulder overuse injuries.

Biomechanical Effects of Using a Passive Exoskeleton for the Upper Limb in Industrial Manufacturing Activities: A Pilot Study.

This study investigates the biomechanical impact of a passive Arm-Support Exoskeleton (ASE) on workers in wool textile processing. Eight workers, equipped with surface electrodes for electromyography (EMG) recording, performed three industrial tasks, with and without the exoskeleton. All tasks were performed in an upright stance involving repetitive upper limbs actions and overhead work, each presenting different physical demands in terms of cycle duration, load handling and percentage of cycle time with shoulder flexion over 80°. The use of ASE consistently lowered muscle activity in the anterior and medial deltoid compared to the free condition (reduction in signal Root Mean Square (RMS) -21.6% and -13.6%, respectively), while no difference was found for the Erector Spinae Longissimus (ESL) muscle. All workers reported complete satisfaction with the ASE effectiveness as rated on Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and 62% of the subjects rated the usability score as very high (>80 System Usability Scale (SUS)). The reduction in shoulder flexor muscle activity during the performance of industrial tasks is not correlated to the level of ergonomic risk involved. This preliminary study affirms the potential adoption of ASE as support for repetitive activities in wool textile processing, emphasizing its efficacy in reducing shoulder muscle activity. Positive worker acceptance and intention to use ASE supports its broader adoption as a preventive tool in the occupational sector.

Impact of Deltoid Computer Tomography Image Data on the Accuracy of Machine Learning Predictions of Clinical Outcomes after Anatomic and Reverse Total Shoulder Arthroplasty.

Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2-3 years, and 3-5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool.

To allow or avoid pain during shoulder rehabilitation exercises for patients with chronic rotator cuff tendinopathy-Study protocol for a randomized controlled trial (the PASE trial)

BackgroundRotator cuff (RC) tendinopathy is the most reported shoulder disorder in the general population with highest prevalence in overhead athletes and adult working-age population. A growing body of evidence support exercise therapy as an effective intervention, but to date there are no prospective randomized controlled trials addressing pain as an intervention variable.MethodsA single-site, prospective, pragmatic, assessor-blinded randomized controlled superiority trial. Eighty-four patients aged 18–55 years with chronic (symptom duration over 3 months) RC tendinopathy are randomized 1:1 to receive shoulder exercise during which pain is either allowed or avoided. The intervention period lasts 26 weeks. During that period, participants in both groups are offered 8 individual on-site sessions with an assigned sports physiotherapist. Participants perform home exercises and are provided with a pain and exercise logbook and asked to report completed home-based exercise sessions and reasons for not completing sessions (pain or other reasons). Patients are also asked to report load and the number of sets and repetitions per sets for each exercise session. The logbooks are collected continuously throughout the intervention period. The primary and secondary outcomes are obtained at baseline, 6 weeks, 26 weeks, and 1 year after baseline. The primary outcome is patient-reported pain and disability using the Shoulder PAin and Disability Index (SPADI). Secondary outcomes are patient-reported pain and disability using Disability Arm Shoulder and Hand short-form (Quick DASH), and shoulder pain using Numeric Pain Rating Scale. Objective outcomes are shoulder range of motion, isometric shoulder muscle strength, pain sensitivity, working ability, and structural changes in the supraspinatus tendon and muscle using ultrasound.DiscussionThe results of this study will contribute knowledge about the treatment strategies for patients with RC tendinopathy and help physiotherapists in clinical decision-making. This is the first randomized controlled trial comparing the effects of allowing pain versus avoiding pain during shoulder exercises in patients with chronic RC tendinopathy. If tolerating pain during and after exercise proves to be effective, it will potentially expand our understanding of “exercising into pain” for this patient group, as there is currently no consensus.Trial registrationClinicalTrials.gov NCT05124769. Registered on August 11, 2021.

Evolutionary anatomical and functional characteristics of the intrinsic shoulder and brachial muscles in the northern anteater (Tamandua mexicana).

Tamandua mexicana is an anteater species native from Mexico to Peru. This species is of great evolutionary interest because it belongs to one of the oldest clades of placental mammals in the American continent. This study aimed to describe the origin, insertion, and arterial supply of the intrinsic shoulder and brachial muscles of T. mexicana. We also compared the masses of the functional groups. Gross dissections were performed on both thoracic limbs of 13 cadavers. ANOVA followed by Tukey's test was used for statistical analyses. The subscapularis muscle presents a hiatus to the common tendon of the caput breve of the biceps brachii and coracobrachialis muscles. A variant accessory muscle, the m. articularis humeri lateralis, was found on the lateral surface of the shoulder joint. M. deltoideus pars acromialis has two bellies. The teres major muscle is perforated by the aponeurotic origin of the m. tensor fasciae antebrachii. The triceps brachii has two capita longi. The caput mediale is fused with the m. anconeus medialis. The caput laterale can have an accessory belly as an anatomical variant. Among the functional groups, a significant difference was found between the elbow extensors and flexors, with the latter having the lowest mass. In conclusion, the intrinsic muscles of T. mexicana presented unique features for the species, as well as arrangements in mass distribution that evidence a possible evolutionary convergence among species of the Superorder Xenarthra.

Effect of Adding Shoulder Stabilization Exercises to the Rehabilitation of Postoperative Hand Injuries in Young Adult Patients.

Hand injuries are common and could have an impact on all upper limb functions. Engaging shoulder muscle training during the rehabilitation protocol postoperatively could have a significant impact on regaining all upper limb function. The purpose of this study was to assess the effect of adding shoulder stabilization exercise to hand rehabilitation postoperatively. Forty patients were randomly assigned to 2 equal groups. Group A received a standard physical therapy program plus shoulder exercise protocol and group B received only a standard physical therapy protocol for hand rehabilitation. Outcome measures were pain intensity; grip strength; Arabic modified Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; and range of motion (ROM). All outcome measures were assessed before and after treatment. Statistical analysis revealed that both groups, the experimental and control, showed significant improvement in all outcome measures, but experimental group A showed significant improvement than the control group B posttreatment for hand grip strength, ROM, and QuickDASH questioners (P < .001). Adding shoulder stabilizer muscle training to the hand rehabilitation protocol postoperatively has a significant impact on hand function outcomes.

Clinical outcomes of arthroscopic superior capsule reconstruction in patients aged over 70 with irreparable rotator cuff tears

BackgroundArthroscopic superior capsule reconstruction (SCR) was developed to restore superior shoulder stability, muscle balance, and function after irreparable posterior–superior rotator cuff tears. The purpose of this study was to investigate whether favorable clinical outcomes after SCR for irreparable rotator cuff tears would be obtained in patients older than 70 years. MethodsA total of 173 consecutive shoulders in 162 patients who underwent arthroscopic SCR using autografts of fascia lata for irreparable rotator cuff tears were allocated to three groups according to patient age at the time of surgery: Group 1, <55 years old (11 shoulders); Group 2, 55 to 70 years old (85 shoulders); and Group 3, >70 years old (77 shoulders). American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, active shoulder range of motion (ROM), and visual analog scale (VAS) were evaluated before surgery and at the final follow-up. Postoperative complications, including graft tears in MRI and donor-site morbidity, were assessed. ResultsThe mean follow-up was 3 years and 9 months. Both ASES and JOA scores and active ROM (elevation, external rotation, and internal rotation) increased significantly after arthroscopic SCR in all three groups (P < .001), and VAS decreased significantly. All three groups had low graft tear (6%–10%) and donor site morbidity (0%–1%) rates, with no significant difference among the groups. ConclusionArthroscopic SCR can lead to functional improvement and pain relief with a low rate of complications regardless of patient age.

The effect of a rehabilitation program using some exercises and ultrasound on the posterior shoulder muscle tear in athletes

&#x0D; Excessive physical pressure causes injury. It may occur at a sudden moment and is usually the result of an error in the application or an unexpected accident, or it may arise as a result of repeated injury to the same place, which leads to serious injury if it continues to occur. Hence the need to use methods and techniques in Treatment and rehabilitation of sports injuries and rehabilitation of the injured faster and better, a research problem is whether rehabilitative exercises with the ultrasound device have a role in improving the strength and range of motion of the injured hidden shoulder muscle. The current research aims to prepare rehabilitative exercises with an ultrasound device to rehabilitate the rupture of the posterior shoulder muscle in some athletes and to identify the preference of the program through the pre and post tests. To achieve this goal, the researcher used the experimental approach in one group design (pre-post). As for the research community, the researcher identified his research community in the intentional way, which is represented by the players with rupture of the posterior shoulder muscle from the Muthanna Governorate clubs, who numbered (8) injured (handball, volleyball, gymnastics, and wrestling). The researchers used tests that measure the extent of injury improvement, by testing (Kinetic range of the shoulder joint) As for the rehabilitation program, it took (6) weeks to be implemented, at the rate of (3) units per week, bringing the total number of rehabilitation units to (18) units, as the first and second week included ultrasound sessions only. As for the rehabilitative exercises, they were applied from the third week to the sixth week, at a rate of four weeks, as the number of units reached (12) rehabilitative units.&#x0D; &#x0D;

Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery

Surgeons performing robotic-assisted laparoscopic surgery experience physical stress and overuse of shoulder muscles due to sub-optimal arm support during surgery. The objective is to present a novel design and prototype of a dynamic arm support for robotic laparoscopic surgery to evaluate its ergonomics and performance on the AdLap-VR simulation training device. The prototype was designed using the mechanical engineering design process: Technical requirements, concept creation, concept selection, 3D-design and built of the prototype. A crossover study was performed on a marble sorting task on the AdLap-VR. The first group performed four trials without the arm support, followed by four trials with the arm support, and the other group executed the sequence vice versa. The performance parameters used were time to complete (s), path length (mm), and the number of collisions. Afterward, the participants filled out a questionnaire on the ergonomic experience regarding both situations. 20 students executed 160 performed trials on the AdLap-VR Significant decreases in the subjective comfort parameters mental demand, physical demand, effort and frustration were observed as a result of introducing the novel arm support. Significant decreases in the objective performance parameters path length and the number of collisions were also observed during the tests. The newly developed dynamic arm support was found to improve comfort and enhance performance through increased stability on the robotic surgery skills simulator AdLap-VR.

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

Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder. Sixty eligible participants with frozen shoulder were included and the active group (n = 30, age 52.12 ± 5.2years) received a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with active ESWT (3.5 bar air pressure and 2000 pulses with an energy flux density (EFD) ¼ 0.16 mJ/mm2) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up. The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (-23.6) (CI 95% -27.47 to -19.72), (-18.10) (CI 95% -19.72 to -16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment. The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder. https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.

Effectiveness of Antenatal Exercises Program for the Management of Neck and Shoulder Pain

Background: Pregnancy is a significant period in a woman's life, often accompanied by various physical discomforts, including neck and shoulder pain. The management of these discomforts through non-pharmacological methods, particularly exercise, has gained attention due to its potential benefits for both maternal and fetal health. Objective: This study aimed to evaluate the effectiveness of a structured antenatal exercise program in reducing the severity of neck and shoulder pain, improving functional limitations, and enhancing the quality of life among pregnant women. Methods: A randomized control trial was conducted at the Jinnah College of Rehabilitation Sciences, Sohail University, Karachi, from June to December 2023. A total of 220 pregnant women between 14 to 30 weeks of gestation were recruited and randomly assigned to either an intervention group (n=110) or a control group (n=110). The intervention group participated in a structured antenatal exercise program designed by certified physiotherapists, which included stretching, strengthening, and relaxation exercises targeting the neck and shoulder muscles. The control group received standard prenatal care. Data on pain severity, functional limitations, and quality of life were collected at baseline, mid-intervention, and post-intervention. Statistical analysis was performed using SPSS version 25.0, with p-values less than 0.05 considered statistically significant. Results: The intervention group demonstrated a significant reduction in pain scores from a baseline of 6.0 to 3.0 post-intervention, compared to the control group, which saw a decrease from 6.0 to 5.0 (p&lt;0.01). Functional limitations were also significantly reduced in the intervention group, from 70% at baseline to 20% post-intervention, whereas the control group showed a reduction from 70% to 60% (p&lt;0.01). Positive feedback regarding pain relief, mobility, and empowerment was reported by participants in the intervention group. Conclusion: The structured antenatal exercise program was effective in significantly reducing neck and shoulder pain and improving functional limitations among pregnant women. These findings suggest that antenatal exercise programs can be a valuable component of prenatal care, enhancing the overall well-being of pregnant women.

Effect of Prathimarsa Nasya and Abhyanga on the Physical Fitness among Athletes in the Sports Hostel of Mar Basil Higher Secondary School Kothamangalam

Physical fitness has direct influence on athlete’s performance level. Sports medicine deals with the physical fitness and the treatment of injury related to sports and exercise by curative, rehabilitative and preventive modalities. Ayurveda the complete science of life can contribute in this field also. Abhyanga and Prathimarsa nasya are important Dinacharya procedures which play a key role in the maintenance of health and fitness of athletes. Regular Abhyanga controls Vata dosas and improves physical strength. Prathimarsa nasya improves the musculature of neck shoulder and chest. Ayurveda classics advice Abhyanga with Thila thailam and Prathimarsa Nasya with Anuthailam as a daily regimen for healthy individual. This study is being made to highlight the application of these Ayurveda Dinacharya procedures in promoting the physical fitness of sports persons. This study is a single group pre-post study. 47 subjects of age group 12–18 participating in athletic events were selected from the Sports Hostel of Mar Basil Higher Secondary School Kothamangalam as per the inclusion and exclusion criteria. After necessary investigations participants had been advised to follow the daily regimen Abhyanga with Thila Thaila after work out, half an hour before bath and Prathimarsa Nasyam with Anuthailam in morning, between 6am- 6.30am for 60 days continuously. Assessments were done on 31st day, 61st day and 91st day (follow up). Scores recorded for test items were converted into marks as per formula based on AAHPER fitness test chart and subjected to statistical analysis using repeated measure ANOVA test. Results showed that Pratimarsha nasya and Abhyanga have statistical significance in improving the physical fitness variables and overall performance level of athletes.

Automated recognition of the major muscle injury in athletes on X-ray CT images1.

In this research, imaging techniques such as CT and X-ray are used to locate important muscles in the shoulders and legs. Athletes who participate in sports that require running, jumping, or throwing are more likely to get injuries such as sprains, strains, tendinitis, fractures, and dislocations. One proposed automated technique has the overarching goal of enhancing recognition. This study aims to determine how to recognize the major muscles in the shoulder and leg utilizing X-ray CT images as its primary diagnostic tool. Using a shape model, discovering landmarks, and generating a form model are the steps necessary to identify injuries in key shoulder and leg muscles. The method also involves identifying injuries in significant abdominal muscles. The use of adversarial deep learning, and more specifically Deep-Injury Region Identification, can improve the ability to identify damaged muscle in X-ray and CT images. Applying the proposed diagnostic model to 150 sets of CT images, the study results show that Jaccard similarity coefficient (JSC) rate for the procedure is 0.724, the repeatability is 0.678, and the accuracy is 94.9% respectively. The study results demonstrate feasibility of using adversarial deep learning and deep-injury region identification to automatically detect severe muscle injuries in the shoulder and leg, which can enhance the identification and diagnosis of injuries in athletes, especially for those who compete in sports that include running, jumping, and throwing.

The Effect of Suspension Training on Some Factors Related to the Shoulder Injuries in Athletes with Scapular Dyskinesis

This study aimed to examine the effect of suspension training on some factors related to the shoulder injuries in athletes with scapular dyskinesis. The present study employed a semi-experimental pre-test and post-test design. Thirty male athletes with scapular dyskinesis were randomly allocated into either the training or control group, with 15 individuals in each. Identification of scapular dyskinesis was conducted through the utilization of a lateral scapular slide test. During the pre-test stage, the shoulder joint muscles strength, proprioception and functional stability, were assessed via manual dynamometer, upper body functional balance test, and imaging methods, respectively. Subsequently, the training group participated in an 8-week suspension training, with three sessions per week. Following the 8-week intervention period, all participants underwent the same measurements administered during the pre-test stage. Statistical analysis was conducted using a two-way analysis of variance at a significance level of P≤0.05 to analyze the research findings. The findings from the two-way analysis of variance indicated that, during the post-test stage, the experimental group showed significant enhancements in muscle strength, functional stability, and accuracy of shoulder joint proprioception in comparison to the control group. The study's results suggest that suspension training used in this study can be employed to enhance shoulder muscle strength, functional stability, and accuracy of shoulder joint proprioception, which may assist in ameliorating disorders resulting from scapular dyskinesis. Furthermore, the findings imply that incorporating these exercises into training regimens could help prevent shoulder joint injuries.

Electromyographic activity of periscapular muscles in symptomatic people: Does scapular dyskinesis have an impact on it?

BACKGROUND: Scapular dyskinesis (SD) is a modification of the positioning and movement of the scapula and is associated with shoulder pain. Exercises to strengthen the shoulder and scapular muscles have been proposed as a therapeutic strategy to reduce pain and improve function. OBJECTIVE: We aimed to investigate the electromyographic activity of the periscapular and trunk muscles in individuals with shoulder pain and SD in different multi-joint exercises. METHODS: Thirty-two subjects with subacromial pain, of both sexes, with the presence or absence of SD, participated in this study. Volunteers performed five repetitions in five exercises (Closed Row; Pronated Row; Push-up; Scapular Push-up; T-push-up). The activity of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, external oblique, and rectus abdominis muscles was recorded using electromyography. RESULTS: Our results showed a decrease in the electromyographic activity of the serratus anterior and external oblique during the T-push-up exercise in individuals with shoulder pain and SD. No differences were observed between groups for the trapezius and the rectus abdominis. CONCLUSIONS: Rehabilitation programs may initially prioritize rowing and push-up exercises to strengthen periscapular muscles. More complex exercises with greater mechanical demand on the kinetic chain, such as the T-push-up, may have to be implemented in later phases.