Shoulder Passive Range Of Motion Research Articles

The influence of fascial manipulation on shoulder range of motion, pain, and function in individuals with chronic shoulder pain

BackgroundA prevalent musculoskeletal condition that has a substantial socioeconomic impact and causes considerable morbidity is chronic shoulder pain (CSP). CSP may result from a dysfunction of the upper quarter region's (UQR) myofascial continuum (MC), which is connected by deep fascia. Fascial Manipulation® (FM), proposed by Luigi Stecco, involves deep kneading performed at specific points on the deep fascia. FM is considered to reinstate the gliding of the fascial layers, thus may aid in the reduction of pain and improvement of shoulder function. ObjectiveThis study aims to determine the influence of FM on shoulder pain, passive range of motion (PROM), and function in participants with CSP. DesignSingle group, pretest-posttest design. MethodEighteen individuals with CSP aged 18–45 years were recruited. FM was applied to the painful and densified centre of coordination (CC) points on the MC of the UQR based on Stecco's FM method. The therapist performed the baseline, post-treatment, and numerical pain rating scale (NPRS) at rest and during activity, PROM, and pressure pain threshold (PPT). The follow-up measurements were done after seven days following the FM intervention. Also, the baseline and follow-up measurements of disability of arm, shoulder, and hand (DASH) score were performed. ResultsA considerable improvement in all shoulder PROM (p < 0.01), DASH score (p = 0.01), and pain reduction (p = 0.01) following FM were observed. However, the PPT showed no differences following FM (p > 0.05). ConclusionFM may be an effective treatment strategy in reducing pain and improving shoulder range of motion and function in patients with CSP.

Clinical Impairments and Rotator Cuff Tendon Pathology in Primary and Intrinsic Secondary Adhesive Capsulitis.

This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology.

Analysis of patients with adhesive capsulitis after COVID-19 vaccination: An observational study.

This study aimed to increase the awareness of clinicians about shoulder injury related to vaccine administration (SIRVA) by analyzing 21 patients with adhesive capsulitis that developed after COVID-19 (coronavirus disease 2019) vaccination. In this observational study, 21 patients (11 males, 10 females; mean age: 60.7±7.3 years; range, 45 to 70 years) with incipient shoulder pain and limitation diagnosed with adhesive capsulitis due to SIRVA were evaluated between June 2021 and December 2022. Demographic and clinical data of the patients were recorded. Pain was evaluated with the Visual Analog Scale (VAS). The passive range of motion (ROM) of the affected shoulder was measured by a goniometer. The applied treatment methods (medical treatment, physical therapy, intraarticular steroid injection, hydrodilatation, and suprascapular nerve block) were recorded. The patients were called in for control two months later. Visual Analog Scale scores and passive shoulder ROMs were reevaluated. Symptoms started after the second dose in nine (42.9%) patients. The mean time between vaccination and onset of complaints was 8.0±6.4 days. Sinovac vaccine was administered to eight patients, BioNTech vaccine was administered to five patients, and Sinovac+BioNTech vaccine was administered to eight patients. Baseline to control ROM angle changes were 128.8±30.4º to 155.0±20.6° for flexion, 117.1±37.8° to 147.1±26.4° for abduction, 45.9±17.8° to 61.9±12.6° for internal rotation, and 43.4±21.9° to 56.3±18.3° for external rotation, respectively. The mean VAS scores were 7.0±1.2 (5-9) at baseline and 2.7±1.0 (1-5) at the control. There was a statistically significant difference between the baseline and control (two months after treatment) in terms of VAS scores and ROM angles (p<0.001). Clinicians should be aware of adhesive capsulitis following vaccine administration since a significant improvement can be obtained by proper treatment for SIRVA.

The Relationship between Self-Perceived Health and Clinical Symptoms in Patients with Frozen Shoulders.

Current healthcare is centered on the perception of people's health. The purpose of this study was to investigate the relationship between self-perceived health (physical, psychological, social, and environmental dimensions) and two main clinical symptoms (shoulder pain and restricted shoulder motion) in patients with frozen shoulders. A total of 49 patients diagnosed with frozen shoulders were recruited and divided into high- and low-disability groups according to the severity of their frozen shoulders. Participants were measured for shoulder passive range of motion, pain intensity, and self-perceived health, using a brief version of the World Health Organization Quality of Life questionnaire. The results showed that the high-disability group had poorer self-perceived health (lower quality of life scores) than the low-disability group (p < 0.05). There was no significant correlation between the quality of life scores and the two clinical symptoms in either the high- or low-disability group. Our findings revealed that the multidimensional self-perceived health of frozen shoulder patients could not be inferred from the severity of shoulder pain and restricted shoulder motions. This study suggests that healthcare providers should pay more attention to patients' self-perceived health needs while addressing the clinical symptoms in patients with frozen shoulders.

Clinical shoulder measurements related to joint loads in collegiate pitchers

Pitchers are prone to upper extremity injury due to repetitive high joint loads. Clinical measures of shoulder strength and range of motion (ROM) have shown links to injury risk in pitchers, however, these factors have rarely been studied in relation to throwing joint loads. The purpose of this study was to identify which clinical ROM and isokinetic strength variables were related to peak shoulder and elbow joint torques in collegiate pitchers. Thirty-three healthy collegiate pitchers participated in this study. Fastball velocity, shoulder concentric and eccentric strength, and passive shoulder ROM variables were analyzed using a Lasso regression to determine what factors influenced shoulder internal rotation torque and elbow varus torque. Fastball velocity was selected by the Lasso as indicator of increased shoulder and elbow torque. Passive shoulder external rotation ROM was also selected as an important factor in joint loading with increased shoulder external rotation ROM being related to lower joint loads. The bilateral ratio of shoulder internal rotator concentric strength was related to peak shoulder and elbow torques with an increase in the bilateral ratio of shoulder strength leading to reduced joint torques. Increases in the eccentric external rotator to concentric internal rotator strength (functional ratio) of the dominant arm and increases in dominant arm eccentric internal rotator strength were both related to increases in each joint torque. Results from the study indicate that pitch speed, passive shoulder external rotation ROM, and the isokinetic shoulder strength profile including internal rotator strength and functional strength ratio of pitchers are related to joint loading during the pitch and may be important to monitor in relation to injury risk and/or during rehabilitation. These results provide insight into the role that both shoulder ROM and rotator cuff strength play in the dynamic stabilization of the elbow and shoulder during pitching.

Effects of preoperative personal education on shoulder function and lymphedema in patients with breast cancer: A consort.

Background:To compare the incidence and severity of ipsilateral shoulder dysfunction and lymphedema of 2 groups of patients needing to undergo unilateral breast cancer surgery, one of which had only received printed education materials and the other group which had received educational materials plus preoperative education.Methods:We selected 61 patients who had been diagnosed with unilateral breast cancer and planned to undergo surgery. Before surgery, patients were randomly assigned, either to a control group that only received printed education materials about exercise for shoulder pain relief and lymphatic edema prevention following breast cancer surgery, or to an experimental group that received the printed education material with personal education. Participants were evaluated at 1, 3, 6, and 12 months after the surgery. To evaluate the impairment of shoulder function, we measured the passive shoulder range of motion (ROM), the degree of pain as visual analog scale (VAS), the short version of the disability of arm, shoulder, and hand (short DASH) scores, and the shoulder pain and disability index (SPADI). We checked arm circumferences to evaluate lymphedema.Results:There was no significant difference in demographic or clinical variables between the control and experimental groups. The experimental group showed significantly less limitation in abduction (P = .042) and forward flexion (P = .039) in the 6 months following surgery. Change in the VAS, short DASH, and SPADI scores were 1.633 (P < .001), 2.167 (P < .001), and 4.1 (P = .003) at 1 month following surgery, respectively. These then decreased with time. These changes started before shoulder ROM and arm circumference changes had occurred, which had started 3 months following surgery.Conclusions:Preoperative education might be helpful for the prevention of a shoulder ROM limitation, and we need to focus on pain and disability in patients immediately following breast cancer surgery, and then on ROM and lymphedema.

Effect of Transfer Energy Capacitive and Resistive Therapy on Shoulder Pain, Disability, and Range of Motion in Patients With Adhesive Capsulitis: A Study Protocol for a Randomized Controlled Trial

ObjectiveWe describe a protocol to evaluate the effectiveness of transfer energy capacitive and resistive (TECAR) therapy on shoulder passive range of motion, shoulder pain, and disability index in patients with adhesive capsulitis. MethodsThis study will be a double-blinded randomized clinical trial with a 1-month follow-up. For the purpose of this research, 30 patients with a 3-month history of shoulder pain and disability diagnosed as adhesive capsulitis will be selected and then randomized into 2 groups, including conventional physiotherapy consisting of electrophysical modalities and therapeutic exercises, which will be given to the control group. In the intervention group, after conventional physiotherapy, 10 minutes of TECAR therapy in resistive mode will be applied on both the anterior and inferior aspects of the shoulder joint. Outcome measures will be related to shoulder passive range of abduction, flexion, and external rotation that will be measured using a digital inclinometer, as well as shoulder pain and disability index that will be assessed by the validated questionnaire. Assessment will be done at baseline, 1 day after the intervention, and by passing 1 month. ResultsThe statistical analysis will describe within-group and between-group comparisons; the findings will be illustrated in tables and charts. ConclusionGiven the reason that the effectiveness of TECAR therapy has not been widely evaluated in adhesive capsulitis, the findings of this pilot study would provide baseline information on the effectiveness and complications of this treatment method and possibly propose a more appropriate protocol for patients with adhesive capsulitis.

Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial

Background and objectivesFrozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder.Materials and methodsForty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients.ResultsThe primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05).ConclusionAs an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.

Passive mobilisation of the shoulder in subacute stroke patients with persistent arm paresis: A randomised multiple treatment trial.

BackgroundPerforming a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce.ObjectivesA randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM.MethodEleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period.ResultsUsing combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation (p = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation −7.27° ± 10.81°; angular mobilisation −5.45° ± 11.72°).ConclusionThese preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis.Clinical implicationsPerforming a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.

Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial.

The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. Level I, Therapeutic Study.

Short-term and long-term outcome of manipulation under anesthesia in primary frozen shoulder

Background: Painful restriction of active and passive shoulder range of motion which cannot be attributed to any internal shoulder pathology is termed as primary frozen shoulder. It has three stages – freezing stage, frozen stage, and thawing stage. Nonsteroidal anti-inflammatory drugs, physiotherapy, intra-articular corticosteroid injection, hydrodilatation, arthroscopic capsular release, and manipulation under anesthesia (MUA) are different modalities of treatment. Aims and Objectives: The main objective of our study was to assess the short-term and long-term outcome of MUA in frozen shoulder once it did not respond to 3 months course of physiotherapy. Materials and Methods: Fifty patients of primary frozen shoulder fulfilling inclusion criteria were manipulated under general anesthesia, and intra-articular Depo-Medrol and bupivacaine were administered. Functional status of the shoulder was assessed using the adjusted Constant-Murley (CM) score preoperatively and in subsequent follow-ups. Results: There was a significant improvement of mean adjusted CM score in short- and long-term follow-ups compared to pre-manipulation value. A significant negative correlation was found between the age of the patient and the final outcome. Conclusion: MUA is an effective modality of treatment in primary frozen shoulder with good short- and long-term outcomes.

Prognostic value of magnetic resonance imaging in the evaluation of physical therapy outcomes in patients with adhesive capsulitis.

Objectives This study aims to investigate whether the treatment outcomes of patients with a clinical diagnosis of adhesive capsulitis (AC) and magnetic resonance imaging (MRI) findings consistent with AC undergoing physical therapy (PT) differs to those with AC in the absence of these MRI findings. Patients and methods Between January 2012 and October 2012, a total of 30 patients (8 males, 22 females; mean age 55.6±12.1 years; range, 35 to 85 years) with a clinical diagnosis of AC underwent MRI of the index shoulder. The MRI scans were evaluated for findings associated with AC: intensity of the inferior glenohumeral ligament (IGHL) and rotator interval (RI). All patients received a total of 15 sessions of PT: hot pack, transcutaneous electrical nerve stimulation, ultrasound, and shoulder exercises. The patients were assessed for shoulder range of motion (ROM) using the Visual Analog Scale (VAS) for shoulder pain, Quick Disabilities of the Arm Shoulder and Hand (Q-DASH), and Health Assessment Questionnaire (HAQ) prior to and following completion of PT. Results Of the patients, 21 had no MRI findings consistent with AC (Group 1), nine patients had changes in the IGHL and/or RI characteristic of AC (Group 2). In both groups, there was a significant improvement in active and passive shoulder ROM and VAS scores for shoulder pain at rest (Group 1: p<0.001, Group 2: p=0.017) with movement (Group 1: p<0.001, Group 2: p=0.007) and at night (Group 1: p<0.001, Group 2: p=0.012) following PT. However, there was no significant inter-group difference in scores. Similar findings were recorded for Q-DASH and HAQ. Conclusion Based on these study findings, the presence of characteristic MRI findings of AC with a clinical diagnosis do not predict clinical response to physical therapy.

Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls.

Background:Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players.Purpose:To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests.Results:There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) (P < .001).Conclusion:In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

End-Range and Scapular Mobilization Technique Versus PassiveStretching Exercises in Treatment of Shoulder Adhesive Capsulitis

AbstractBackground: Idiopathic adhesive capsulitis of the shoulderis a condition characterized by gradual loss of active andpassive glenohumeral motion. The prevalence of adhesivecapsulitis is estimated to be two to five percent of the generalpopulation. Stretching the adhered shoulder capsule by meansof end range mobilization and passive stretching is the cor-nerstone of physical therapy interventions for treatment ofadhesive capsulitis. Scapular mobilization is also recommendedto correct the abnormal scapulohumeral rhythm accompaniedwith the limited motion at glenohumeral joint in patients withadhesive capsulitis.Aim of Study: To compare between the effect of end rangemobilization and scapular mobilization versus passive stretch-ing exercises on shoulder pain severity, functional disabilityand passive range of motion of shoulder flexion, abduction,internal rotation and external rotation in treatment of idiopathicshoulder adhesive capsulitis.Design of the Study: Randomized clinical trial, pretreat-ment posttreatment design was used.Methods: Forty male patients with idiopathic adhesivecapsulitis of the shoulder, whose age ranged between 40 to65 years with limited shoulder passive range of motion in atleast 2 of 4 directions and duration of illness ranged between 3 and 12 months participated in this study. They were randomly distributed into two equal experimental groups. The first group received end range mobilization technique and scapular mobilization technique and the second group received passive stretching exercises. In addition to that both groups received infrared radiation before each treatment session for warming up. All patients were treated twice weekly for six weeks.Results: Both groups had significant improvement in allmeasured variables. End range mobilization and scapularmobilization was significantly more effective than passivestretching exercises in improving shoulder pain severity,functional disability and range of motion of shoulder flexionand abduction. However, there was no significant differencebetween groups in improving range of motion of shoulderexternal rotation and internal rotation.

Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial.

ObjectiveWe evaluated the effect of ultrasound (US)-guided injection of platelet-rich plasma (PRP) into the shoulder joint in patients with adhesive capsulitis (AC) and compared its effect with that of conventional physiotherapy (CPT).MethodsSixty-four subjects with AC were included and randomly allocated into two groups, as follows: PRP (n=32; intra-articular [IA] PRP [4 mL] was injected); and CPT (n=32; short wave diathermy and exercise therapy were performed at three sessions/week for 6 weeks). Treatment outcomes evaluated therapeutic effectiveness before and at 1, 3, and 6 weeks after PRP injection and CPT initiation.ResultsSubjects in both groups showed a significant decrease in the visual analogue scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after IA PRP injection compared with that after CPT.ConclusionsIA PRP injection is a useful option for treating patients with AC, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.

DESCRIPTIVE PROFILE OF SHOULDER RANGE OF MOTION AND STRENGTH IN YOUTH ATHLETES PARTICIPATING IN OVERHEAD SPORTS.

The unilateral and repetitive nature of overhead sports, often result in a biomechanical overload of the upper extremity. Understanding the musculoskeletal shoulder range of motion (ROM) and strength patterns in the youth sports of baseball, softball, and tennis could assist injury prevention screening and further the development of conditioning and rehabilitation programs. To generate a descriptive profile of shoulder musculoskeletal characteristics and determine whether bilateral differences in shoulder ROM exist in youth baseball, softball, and tennis athletes. A secondary aim was to determine whether shoulder rotational adaptations are correlated with playing position, sport, or years of experience. Descriptive Laboratory. A total of 136 competitive youth overhead athletes (baseball: n = 51,12.8 ± 0.9yrs; softball: n = 63,12.3 ± 1.1yrs; and tennis: n = 22,12.5 ± 0.9yrs) participated. Bilateral shoulder internal (IR) and external (ER) passive ROM and external rotation strength were measured using an inclinometer and handheld dynamometer. Significant differences (p<.001) in bilateral shoulder ROM and ER strength were found between the athletes in the three sports. Post-hoc test revealed tennis athletes had greater bilateral shoulder ROM than both baseball and softball athletes, but baseball and softball athletes had greater bilateral ER strength than tennis athletes. There were no differences between baseball and softball athletes. Additionally, tennis athletes had greater bilateral internal rotation and total ROM but less ER strength than baseball pitchers, baseball positional athletes, softball pitchers, and softball positional athletes. There were no significant differences between positions and baseball and softball athletes. There were no significant correlations between playing position, sport, or years of experience. The results of this study showed differences in shoulder passive ROM and strength adaptations between youth tennis, baseball, and softball athletes. The descriptive nature of this study is impactful as it presents specific ROM adaptions seen in this population. Future research is needed to further evaluate if the "at risk" ROM identified in older populations holds true in the youth population. Diagnosis, Level 3b.

Efficacy of platelet-rich plasma in the treatment of hemiplegic shoulder pain.

The aim of this study was to examine the effects of platelet-rich plasma (PRP) on pain and functional outcomes in patients with hemiplegic shoulder pain. We compared the effects of PRP against saline solution by designing a double blind, randomized, prospective study. Forty-four patients with hemiplegia were included in this study. All patients received a total of 3 injections, 1week apart. The first group received PRP injections while the second group received placebo injections. After 3months of follow-up, 40 patients completed the trial. Primary outcome measure was movement-induced pain score (VAS), and secondary outcome measures were spontaneous pain score, shoulder passive range of motion (ROM), functional independence measure score, and the amount of paracetamol used. All subjects were evaluated at baseline, 1week, 1month, and 3months after the completion of the last injection. Both groups showed an improvement in spontaneous and movement-related pain scores and shoulder passive ROM values on 1st and 3rd month visits (p < 0.05). No significance difference was detected between groups (p > 0.05). Similarly, FIM scores improved significantly in both groups (p < 0.05) but no difference was found between groups. Paracetamol use did not differ significantly between groups. The PRP injections were found not to be superior to placebo. Improvements in both groups can be attributed to the use of rehabilitation techniques and exercises in all patients. There is still need for further research to show whether PRP is a treatment option in the course of hemiplegic shoulder pain. ClinicalTrials.gov Identifier: NCT03931824.

The management of hemiplegic shoulder pain in stroke subjects undergoing pulsed radiofrequency treatment of the suprascapular and axillary nerves: a pilot study.

Our trial aims to provide evidence for pain management and rehabilitation in patients with hemiplegic shoulder pain (HSP). HSP is one of the most common pains and disabilities occurring after a stroke. With accumulating evidence, the management of the suprascapular nerve (SSN) or axillary nerve (AN) might effectively relieve the pain and disability associated with HSP. However, no study has compared the effects of pulsed radiofrequency and nerve block of SSN and AN. Twenty patients with chronic stroke (over one year from onset) and HSP [visual analog scale (VAS) for pain ≥30 mm] randomly underwent ultrasound-guided SSN and AN pulsed radiofrequency or nerve block treatment. All patients were evaluated before treatment (T0) and at 4 (T1) and 16 (T2) weeks of follow-up. The primary outcome was the VAS score. Secondary outcomes were the Modified Ashworth Scale (MAS) score, passive shoulder range of motion (PROM), Disability Assessment Scale (DAS) score, and EuroQol-5 dimension questionnaire (EQ-5D). Significant improvements in the VAS score were observed in both groups at T1 and T2. However, a significant difference was not observed between the two groups (T1: P=0.43; T2: P=0.23). No statistically significant differences were observed in the MAS score between the two groups at T1 (P=0.06) and T2 (P=0.07). In the PROM of shoulder abduction and external rotation, statistically, significant differences were observed between the two groups at T1 (P=0.02*, & P=0.04*) and T2 (P=0.02*, & P=0.00*). Statistically significant differences in shoulder flexion and extension were not observed between the two groups at T1 (P=0.23, & P=0.35) and T2 (P=0.14, & P=0.14). Statistically significant differences in the DAS score were not observed between the 2 groups at T1 (P=0.51, & P=0.33, & P=0.36, & P=0.75) and T2 (P=0.12, & P=0.54, & P=0.41, & P=0.86). No statistically significant differences in the EQ-5D responses were observed between the two groups at T1 (P=0.42) and T2 (P=0.11). Pulsed radiofrequency of SSN and AN achieves similar therapeutic effects to the nerve block. Pulsed radiofrequency modulation is superior to nerve block in improving the PROM of shoulder abduction and external rotation.

Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage

Background: No study has reported clinical evidence for cartilage change in the glenohumeral joint or the cause of loss in range of motion (ROM) after arthroscopic Bankart repair with remplissage technique (BR). Purpose: To investigate the postoperative features of glenohumeral joint cartilage, ROM, and anchor placement for remplissage at a minimum of 2 years of follow-up after BR and to analyze the correlations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 21 patients who underwent BR received follow-up for a minimum of 2 years. At both preoperative assessment and final follow-up, passive shoulder ROM, Oxford Shoulder Instability Score, Simple Shoulder Test score, and Single Assessment Numerical Evaluation score were assessed. All patients underwent 3.0-T magnetic resonance imaging (MRI) examination at final follow-up. The clinical outcomes, glenohumeral cartilage or Hill-Sachs lesion–related MRI parameters, and their potential correlations were analyzed. Results: The mean follow-up was 55.0 months (range, 24-119 months). Compared with preoperative assessment, all functional scores significantly improved (P < .001). At the final follow-up, a significant ROM loss (>15°) of external rotation (ER) at the side (ER0) was found in 12 patients, among whom 8 patients had significant ROM loss of ER at 90° of abduction as well. Further, 12 patients with decreased ER had significantly higher signal intensity of cartilage on the anterior, middle, and posterior humeral head (anterior, P = .002; middle, P < .001; posterior, P < .001) than 9 patients with normal ER. The ratio of the width of the remplissage anchor to the diameter of the humeral head (w:d ratio) was significantly greater (P = .031) in the decreased ER group than in the normal ER group. Correlation analysis showed that signal intensity on the posterior humeral head and ER0 loss (ΔER0) had a significantly positive correlation (r = 0.516; P = .034), while the w:d ratio and ΔER0 had a significantly positive correlation (r = 0.519; P = .039). Conclusion: At a minimum of 2 years of follow-up, patients who underwent BR showed significant clinical improvement compared with preoperative assessment, except for limitations in ER. The glenohumeral cartilage degeneration (higher signal intensity) after BR had a significantly positive correlation with the postoperative ER loss, which was found to be associated with a relatively medial placement of the remplissage anchor.

Discrimination between pain and contracture in limited passive motion patients with rotator cuff tear: A STROBE-compliant cross-sectional study.

Either pain or contracture may limit shoulder passive range of motion (PROM) in patients with rotator cuff disease, and an appropriate treatment may be determined according to its cause. If there is no change in PROM under general anesthesia, contracture, rather than pain, may be the underlying condition. Our goal was to devise a physical examination that would help discriminate between pain and contracture in limited PROM patients with rotator cuff tear.This is a STROBE-compliant cross-sectional study. Patients with rotator cuff tears (N = 28) were scheduled for arthroscopic repair. The main outcome measure was PROM, including flexion, external rotation (ER), and abduction obtained by a blinded examiner before and after the induction of general anesthesia, and the abduction/ER ratio was calculated. In order to perform a subgroup analysis, patients were divided into 2 groups, one where abduction difference after the general anesthesia was 8°≤ (n = 22) and the other 8°> (n = 6).Patients’ average age (62.6 ± 7.2 years), symptom duration (13.0 ± 10.0 months), intensity of shoulder pain on a visual analog scale (4.8 ± 2.1), and Constant-Murley functional score (63.4 ± 8.9); the ratio of gender (male: female = 12:16); and the arthroscopic findings were recorded. According to the correlation analysis, the abduction/ER ratio before general anesthesia was correlated best with the change in PROM after general anesthesia (correlation coefficient –0.74, P < .001); the correlations for abduction and flexion were –0.69 and –0.57, respectively (P < .001 and .002, respectively). The age, gender, height, weight, duration of symptoms, trauma history, visual analog score for shoulder pain, Constant-Murley functional score, size of rotator cuff tear, and biceps pathology did not differ significantly between the 2 groups in the subgroup analysis (P > .05). The only significant difference between the 2 groups was in the synovitis status (P = .04).Patients with greater abduction/ER ratio before anesthesia exhibited fewer PROM changes after anesthesia. The abduction/ER ratio was strongly and inversely correlated with PROM changes, allowing physicians to choose an appropriate treatment for limited PROM in patients with rotator cuff tears.