Shoulder Passive External Rotation Research Articles

ASSESSMENT OF HUMERAL TORSION BY PALPATION IN BASEBALL PITCHERS: A VALIDATION STUDY.

Greater humeral retroversion has been associated with shoulder and elbow injuries. Methods for measuring torsion include radiography, computed tomography (CT) and sonography (US) which may be costly or unavailable. A palpation method might be a reliable alternative to imaging techniques. The purpose of the current study was to examine the construct validity of the palpation technique for humeral torsion by (1) determining if a side-to-side difference in humeral torsion (HT) could be detected in a cohort of baseball pitchers using the palpation technique and (2) compare the side-to-side difference in HT obtained through the palpation method to the US method. Clinical assessment of HT by palpation is reliable and is as accurate as sonographic HT measurements among overhead athletes. Twenty collegiate and high school pitchers were assessed. Bilateral shoulder passive external rotation (ER) and internal rotation (IR) range of motion were measured. Humeral torsion was indirectly measured using sonographic and palpatory methods. Paired t-tests were used to determine HT side-to-side difference measured by US versus palpation. Pearson's correlation coefficient (r) was used to determine the relationship between HT side-to-side difference detected by palpation and US, and relationships among IR and ER of the shoulder and HT side to-side difference measurements. There was significantly greater HT in dominant versus nondominant arm assessed by both palpation (5°±5, p=0.0004) and ultrasound (9°±11, p=0.0007). There was a positive correlation between both methods of HT measurement (r = 0.522, p=0.018). Palpation significantly underestimated HT as compared to US measurements (difference 4°±9, p=0.048). Difference in IR between shoulders correlated with HT measured by palpation (r=-0.651, p=0.002) and US (r=0.569, p=0.009). Increased ER in the dominant versus nondominant arm correlated with the side-to-side difference in HT measured by both palpation (r = 0.509, p=0.02) and US (r = 0.602, p=0.005). Greater HT on the dominant versus nondominant shoulder via palpation indicated this method can be used to assess HT in pitchers. HT assessed by palpation correlated with HT assessed by US. However, the magnitude of side-to-side difference in HT was smaller with palpation compared to US, and the two techniques should not be used interchangeably. Nevertheless, assessment of HT via palpation is a reliable and practical method and its use should be encouraged. Level 3, measurement study.

Outcomes of Botulinum Toxin Injection for Shoulder Internal Rotation Contractures in Infants with Brachial Plexus Birth Injury

Shoulder internal rotation contractures (IRC) are common sequela of brachial plexus birth injuries (BPBI). Botulinum toxin A (BTX-A) injection into targeted muscles has been described to facilitate functional improvement at the shoulder joint and prevent glenohumeral dysplasia. The purpose of this study was to assess the outcomes of BTX-A injections on shoulder IRC in children with BPBI. We conducted a retrospective analysis of 47 children with shoulder IRC due to BPBI, who were treated with BTX-A. Shoulder passive external rotation in adduction and Active Movement Scale external rotation scores were recorded before and after BTX-A injection. We also recorded the number of children who underwent secondary surgical balancing procedures to improve shoulder motion after BTX-A injection. Mean age at the time of injection was 12 months (range, 5-23 months). Subjects demonstrated a significant increase in passive external rotation of 46° (range, 10° to 90) at 4 months; an average improvement of 18° (range, -30° to 80°) persisted at 11 months after injection. A total of 28 patients (60%) underwent subsequent external rotation tendon transfer. At 5-year follow-up, 7 patients (15%) had adequate functional shoulder range of motion and did not undergo external rotation tendon transfer. Botulinum toxin A injections result in improvement in IRC due to BPBI, which is sustained beyond the expected half-life of 3 months. As many as 15% of patients who have this treatment avoid external rotation tendon transfer. Diagnostic IV.

Joint hypermobility syndrome must be investigated in case of snapping scapula syndrome

The snapping scapula syndrome (SSS) is an uncommon clinical picture responsible for significant discomfort. Various diagnoses are known but this problem is often non-specific. The joint hypermobility syndrome (JHS) has never been described in association with SSS. We report three cases of idiopathic SSS associated with JHS. Case 1: Female 18 yo, SSS right, JHS with a Beighton score of 9/9. Maximal passive external rotation of the shoulder > 85°. CT, MRI, Ultrasound and EMG: normal. Treatment with extended rehabilitation. Evolution unchanged. Case 2: Male 32 yo, SSS left, JHS with a Beighton score of 8/9. Maximal passive external rotation of the shoulder > 85°. CT, MRI and EMG: normal. Treatment with rehabilitation. Partially favorable evolution. Case 3: Male 45 yo, SSS right. Previous history of shoulder dislocation with spontaneous reduction. HJS with a Beighton score of 9/9. Maximal passive external rotation of the shoulder > 90°. MRI normal. No further follow-up data. SSS first described by Boinet in 1867 is a rare cause of shoulder pain. A “mechanical conflict” between the rib cage and the scapula is proposed. The conflict may be favoured by the presence of congenital or acquired bone abnormalities (exostosis, scapula fractures), muscle abnormalities (atrophy, tumors) or others like bursitis. In about 30% of the cases SSS no specific cause is found. CT, MRI and EMG are often required in the diagnostic process. Our 3 cases with SSS were only associated with positive criterion of JHS and shoulder passive external rotation more than 85°. Shoulder passive external rotation > 85° is a criteria of shoulder hyperlaxity but not of JHS. Only one patient was known for glenohumeral dislocation. We believe that JHS could be a factor favouring development of non-specific SSS, although the exact mechanism of SSS remains unclear. Treatment is based on rehabilitation often with poor results. We recommend searching a JHS as well as shoulder hyperlaxity in case of SSS.

Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective, randomised study

BackgroundStress relaxation and static progressive stretch are techniques used for non-surgical restoration of shoulder range of motion for patients with adhesive capsulitis. ObjectivesTo compare a static progressive stretch device plus traditional therapy with traditional therapy alone for the treatment of adhesive capsulitis of the shoulder. DesignProspective, randomised controlled trial. ParticipantsSixty patients with adhesive capsulitis of the shoulder were assigned at random to an experimental group or a control group. InterventionsBoth groups received three traditional therapy sessions per week for 4 weeks. In addition, the experimental group used a static progressive stretch device for 4 weeks. Main outcome measuresThe primary outcome measure was shoulder range of motion (active and passive shoulder abduction, and passive shoulder external rotation). The secondary outcome measures were function [measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] and pain [measured using a visual analogue scale (VAS)]. ResultsAt baseline, there were no differences between the two groups. However, after the intervention, there were significant (P<0.05) differences between the groups for all outcome parameters: 0.3 for mean VAS scores [95% confidence interval (CI) −0.6 to 1.1], −10.1 for DASH scores (95% CI −21.0 to 0.9), 21.2° for shoulder passive external rotation (95% CI 16.8 to 25.7), 26.4° for shoulder passive abduction (95% CI 17.4 to 35.3), and 27.7° for shoulder active abduction (95% CI 20.3 to 35.0). At 12-month follow-up, the differences between the groups were maintained and even increased for mean shoulder range of motion, VAS scores and DASH scores, with significant differences (P<0.001) between the groups: −2.0 for VAS scores (95% CI −2.9 to −1.2), −53.8 for DASH scores (95% CI −64.7 to −42.9), 47.9° for shoulder passive external rotation (95% CI 43.5 to 52.3), 44.9° for shoulder passive abduction (95% CI 36.0 to 53.8), and 94.3° for shoulder active abduction (95% CI 87.0 to 101.7). ConclusionUse of a static progressive stretch device in combination with traditional therapy appears to have beneficial long-term effects on shoulder range of motion, pain and functional outcomes in patients with adhesive capsulitis of the shoulder. At 12-month follow-up, the experimental group had continued to improve, while the control group had relapsed.

Treatment Effects of Ultrasound-Guided Capsular Distension With Hyaluronic Acid in Adhesive Capsulitis of the Shoulder

ObjectiveTo investigate the efficacy of ultrasound-guided intra-articular (IA) hyaluronic acid injection with capsular distension compared with steroid injection alone in patients with adhesive capsulitis of the shoulder by assessing pain relief, functional improvements, and range of motion at 2 and 6 weeks after final injections. DesignProspective randomized controlled trial. SettingUniversity hospital. ParticipantsPatients (N=100) with adhesive capsulitis of shoulder. InterventionsSubjects were randomly assigned to 2 groups: 45 patients in group A were treated with 0.5% lidocaine plus triamcinolone 40mg IA injection and 45 patients in group B were treated with 0.5% lidocaine plus hyaluronic acid 20mg and capsular distension. All injections were performed every 2 weeks for a total of 3 times. Main Outcome MeasuresTreatment effects were assessed using the Shoulder Pain and Disability Index (SPADI), Verbal Numeric Scale (VNS), and passive range of motion (ROM) of the shoulder (flexion, abduction, external rotation) before injections and at 2 and 6 weeks after the last injections. ResultsSPADI, VNS, and passive ROM were improved at 2 and 6 weeks in both groups. The statistical differences were not observed in SPADI and VNS between groups (P<.05), and shoulder passive external rotation was more improved in group B than in group A (P<.05). ConclusionsCapsular distension with IA hyaluronic acid injection was shown to be a treatment method as effective as the steroid injection alone in pain relief and functional improvement; additionally, it was more effective in passive external rotation improvement than steroid injection alone.