Shoulder Rehabilitation Exercises Research Articles

Rotator cuff-related shoulder pain (RCRSP): semistructured patient interviews to explore the barriers and enablers to rehabilitation exercises

This study aimed to explore the barriers and enablers to physiotherapist-prescribed rehabilitation exercises for people with rotator cuff-related shoulder pain (RCRSP) and to guide the development of a theoretically informed...

Machine-learning models for shoulder rehabilitation exercises classification using a wearable system.

The objective of this study is to train and test machine-learning (ML) models to automatically classify shoulder rehabilitation exercises. The cohort included both healthy and patients with rotator-cuff (RC) tears. All participants performed six shoulder rehabilitation exercises, following guidelines developed by the American Society of Shoulder and Elbow Therapists. Each exercise was repeated six times, while wearing a wearable system equipped with three magneto-inertial sensors. Six supervised machine-learning models (k-Nearest Neighbours, Support Vector Machine, Decision Tree, Random Forest (RF), Logistic Regression and Adaptive Boosting) were trained for the classification. The algorithms' ability to accurately classify exercise activities was evaluated using the nested cross-validation method, with different combinations of outer and inner folds. A total of 19 healthy subjects and 17 patients with complete RC tears were enroled in the study. The highest classification performances were achieved by the RF classifier, with an accuracy of 89.91% and an F1-score of 89.89%. The results of this study highlight the feasibility and effectiveness of using wearable sensors and ML algorithms to accurately classify shoulder rehabilitation exercises. These findings suggest promising prospects for implementing the proposed wearable system in remote home-based monitoring scenarios. The ease of setup and modularity of the system reduce user burden enabling patient-driven sensor positioning. Level III.

Classification of Shoulder Rehabilitation Exercises by Using Wearable Systems and Machine Learning Algorithms

Classification of Shoulder Rehabilitation Exercises by Using Wearable Systems and Machine Learning Algorithms

Early Implementation of Exercise to Facilitate Recovery After Breast Cancer Surgery

Recovery of shoulder function following breast cancer surgery is crucial for physical functioning and quality of life. While early implementation of shoulder rehabilitation exercises may enhance recovery, the optimal timing and exercise program remain unclear. To investigate whether an early exercise intervention, initiated 1 day postsurgery and continued for 1 month through subsequent visits, could improve shoulder range of motion (ROM) and strength in patients with breast cancer. A parallel-group, 2-arm randomized clinical trial was conducted between June 2020 and October 2021 at the Breast Cancer Center in Seoul, South Korea. Fifty-six patients (of 119 screened) with early-stage breast cancer who were scheduled for partial or total mastectomy were randomized into a tailored resistance exercise group (n = 28) or a usual care group (n = 28). Data were analyzed from November 2021 to June 2022. The exercise intervention commenced 1 day postsurgery and consisted of 4 supervised exercise education sessions corresponding with surgeon visits and daily home-based exercises for the first postoperative month. Tailored programs, including stretching and strength exercises, were adjusted based on individual shoulder function recovery status. Primary end points were shoulder ROM and strength at 1 and 6 months postsurgery. Physical activity, body composition, and quality of life were assessed at 6 months. Of 56 patients randomized (mean [SD] age, 50.3 [6.6] years), 54 completed the trial (96%), with 100% and 97% compliance to supervised and home-based exercise sessions, respectively. At 1 month postsurgery, 19 (67.9%) in the exercise group had fully recovered shoulder strength compared to 1 (3.6%) in the usual care group (P < .001). At 6 months, 22 (78.6%) in the exercise group had fully recovered shoulder ROM and 24 (85.7%) had fully recovered strength compared to 6 (21.4%) and 5 (17.9%), respectively, in the usual care group (P < .001). The exercise group exhibited less loss in muscle mass and improved physical activity and quality of life compared to the usual care group. In this trial, 1-month tailored exercise program, initiated immediately after breast cancer surgery and supplemented with supervised sessions coinciding with surgeon visits, significantly improved shoulder function in patients with breast cancer. WHO International Clinical Trials Registry identifier: KCT0006997.

Electromyographic analysis of selected shoulder muscles during shoulder rehabilitation exercises in patients after reverse total shoulder arthroplasty

BackgroundReversed shoulder arthroplasty (RSA) aims to restore function in patients with rotator cuff failure and joint arthropathy. After surgery, patients are routinely referred to a rehabilitation specialist to regain range of motion, strength, and function. A key element in these programs is active exercises. The exercises are often selected based on assumed muscle activity, investigated by electromyography (EMG). In particular, in this patient population, activation of the deltoid and the scapular muscles is the focus of exercise therapy. Currently, most studies investigating muscle activity levels during exercises are performed on healthy individuals. To our knowledge, no study exists analyzing EMG activity during exercises in a population of shoulder arthroplasty patients. Therefore, the study aimed to analyze activity in the shoulder girdle muscles during 6 commonly used rehabilitation exercises 12 weeks after RSA surgery. MethodsForty-four patients (50 shoulders) participated in this cross-sectional study, 12 weeks postoperatively (mean 99.18±12.8 days), aged 68.9±7.75 years. Surface EMG activity was measured in 10 shoulder girdle muscles: the 3 trapezius parts, serratus anterior, the 3 deltoid parts, latissimus dorsi, and 2 pectoralis major parts during 6 exercises, 3 in a closed chain, and 3 open chain elevation exercises. ResultsGravity- minimized exercises (horizontal plane) show low activity for almost all muscles. Vertical closed kinetic chain exercises show an increased activity compared to horizontal plane exercises. Open kinetic chain exercises against gravity showed the greatest activity in Deltoid and Upper trapezius. For the other muscles no consistency in progression was found. ConclusionThis study offers a progression of exercises for patients after reversed shoulder arthroplasty based on increased muscle activity.

Deep learning model for classifying shoulder pain rehabilitation exercises using IMU sensor

BackgroundArtificial intelligence is being used for rehabilitation, including monitoring exercise compliance through sensor technology. AI classification of shoulder exercise wearing an IMU sensor has only been reported in normal (i.e. painless) subjects. To prove the feasibility of monitoring exercise compliance, we aimed to classify 11 types of shoulder rehabilitation exercises using an AI (artificial intelligence) algorithm in patients with shoulder pain. We had the patients wear an IMU-based sensor, collected data during exercise, and determined the accuracy of exercise classification.MethodsData were collected from 58 patients (27 males, 31 females, age range 37–82 years) diagnosed with shoulder diseases such as adhesive capsulitis and rotator cuff disease. 11 types of shoulder pain rehabilitation exercise programs were developed and repeated each exercise ten times per session while wearing an IMU sensor. The study applied the Rectified Linear Unit (ReLU) and the SoftMax as the activation function for hidden layers, the output layer.ResultsThe acquired data was used to train a DNN model using the multilayer perceptron algorithm. The trained model was used to classify 11 types of shoulder pain rehabilitation exercises. The training accuracy was 0.975 and the test accuracy was 0.925.ConclusionThe study demonstrates that IMU sensor data can effectively classify shoulder pain rehabilitation exercises, providing more appropriate feedback for patients. The model can be utilized to establish a system for remotely monitoring patients’ exercise performance. The use of deep learning in patient monitoring and rehabilitation has significant potential to bring innovative changes to healthcare service delivery.

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.

Effects of Shoulder Rehabilitation Exercise on Range of Motion, Muscle Activity, Muscle Tone and Manual Muscle Strength after Arthroscopic Bankart Repair in Elite Collegiate Rowing Athlete: Case Report

OBJECTIVES The purpose of this study was to evaluate the effects of shoulder rehabilitation exercise on range of motion (ROM), muscle activity, muscle tone and manual muscle strength after arthroscopic bankart repair in elite collegiate rowing athlete.METHODS A 22-year-old elite collegiate rowing athlete with nerve decompression surgery for scapular entrapment syndrome in 2019, and arthroscopic bankart repair in 2021 was enrolled in this case study. Shoulder rehabilitation exercise program was received weight bearing and elastic band exercises, and was performed for 50 min/day, and 3 day/week for 8 weeks. ROM (flexion, extension, abduction, internal rotation, external rotation), muscle activity, muscle tone and manual muscle strength (infraspinatus; IFP, teres minor; TM, biceps; BI, lateral deltoid; LD, supraspinatus; SSP, upper trapezius; UT) were measured before, after 4 and 8 weeks of shoulder rehabilitation exercise.RESULTS Shoulder ROM increased at flexion, extension, abduction, internal rotation, external rotation after shoulder rehabilitation exercise. Muscle tone increased at IFP, TM, LD, SSP, and UT, but BI decreased after shoulder rehabilitation exercise. Muscle activity and manual muscle strength increased at IFP, TM, BI, LD, SSP, UT after shoulder rehabilitation exercise.CONCLUSIONS The results of this case report confirmed that shoulder rehabilitation exercise had a positive effect on the muscular physiological indices after arthroscopic bankart repair in elite collegiate rowing athlete.

Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program.

The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. We describe various applications of the ISEO exercise program in terms of frequency and intensity. An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. DERR1-10.2196/35757.

Characterization of Functional Connectivity in Chronic Stroke Subjects after Augmented Reality Training

Augmented reality (AR) tools have been investigated with promising outcomes in rehabilitation. Recently, some studies have addressed the neuroplasticity effects induced by this type of therapy using functional connectivity obtained from resting-state functional magnetic resonance imaging (rs-fMRI). This work aims to perform an initial assessment of possible changes in brain functional connectivity associated with the use of NeuroR, an AR system for upper limb motor rehabilitation of poststroke participants. An experimental study with a case series is presented. Three chronic stroke participants with left hemiparesis were enrolled in the study. They received eight sessions with NeuroR to provide shoulder rehabilitation exercises. Measurements of range of motion (ROM) were obtained at the beginning and end of each session, and rs-fMRI data were acquired at baseline (pretest) and after the last training session (post-test). Functional connectivity analyses of the rs-fMRI data were performed using a seed placed at the noninjured motor cortex. ROM increased in two patients who presented spastic hemiparesis in the left upper limb, with a change in muscle tone, and stayed the same (at zero angles) in one of the patients, who had the highest degree of impairment, showing flaccid hemiplegia. All participants had higher mean connectivity values in the ipsilesional brain regions associated with motor function at post-test than at pretest. Our findings show the potential of the NeuroR system to promote neuroplasticity related to AR-based therapy for motor rehabilitation in stroke participants.

Effects of the Upper Trapezius Taping on Shoulder Pain, Muscle Activity, Strength, Scapular Elevation in Subjects with Latent Myofascial Trigger Points

Background Patients who have latent myofascial trigger points commonly over-compensate with the upper trapezius (UT) due to insufficient shoulder flexion strength. Previous studies have suggested that taping is an effective way to restrict unwanted joint movements along the direction of the tape. However, few studies have been conducted to investigate how taping affects shoulder compensation movements in individuals with MTPs. Objectives We investigated the effects of taping on pain, activation of the UT, anterior deltoid (AD), serratus anterior (SA), shoulder flexion strength, and the angle of scapular elevation in subjects with MTPs. Methods In total, 30 subjects with latent MTPs were recruited. The subjects were randomly assigned to two groups (inhibition taping group, n=15; sham taping group, n=15). Subjects were evaluated for pain, activation of the UT, AD, and SA, shoulder flexion strength, and scapular elevation angle during maximum isometric shoulder flexion pre and immediately post-the-taping intervention. Two-way repeated ANOVA was performed to analyze group (inhibitory vs. sham) and time (pre vs. post-taping values) main and interaction effects. Results Statistically significant main effect for time was found in UT (p < 0.001), AD (p < 0.001), shoulder flexion strength (p < 0,001), and scapular elevation angle (p < 0,001) after inhibition taping. Additionally, the inhibition taping group showed significantly greater changes in UT (p = 0.020), AD (p = 0.048) EMG activity, shoulder elevation angle (p = 0.005), and scapular elevation angle (p = 0.049). Conclusions These results suggest that when performing shoulder rehabilitation exercises in a clinical setting, restricting scapular elevation via taping is an effective way to correct compensatory scapular movement and alter the recruitment pattern of UT and AD activation in patients with MTPs.

Mathematical Analysis and Motion Capture System Utilization Method for Standardization Evaluation of Tracking Objectivity of 6-DOF Arm Structure for Rehabilitation Training Exercise Therapy Robot.

A treatment method for suppressing shoulder pain by reducing the secretion of neurotransmitters in the brain is being studied in compliance with domestic and international standards. A robot is being developed to assist physical therapists in shoulder rehabilitation exercise treatment. The robot used for rehabilitation therapy enables the training of patients to perform rehabilitation exercises repeatedly. However, the biomechanical movement (or motion) of the shoulder joint should be accurately designed to enhance efficiency using a shoulder rehabilitation robot. Furthermore, safely treating patients by accurately evaluating biomechanical movements in compliance with domestic and international standards is a major task. Therefore, an in-depth analysis of shoulder movement is essential for understanding the mechanism of shoulder rehabilitation using robots. This paper proposes a method for analyzing shoulder movements. The rotation angle and range of motion (ROM) of the shoulder joint are measured by attaching a marker to the body and analyzing the inverse kinematics. The first motion is abduction and adduction, and the second is external and internal rotation. The location information of the marker is transmitted to an application software through an infrared camera. For the analysis using an inverse kinematics solution, five males and five females participated in the motion capture experiment. The subjects did not have any disability, and abduction and adduction were repeated 10 times. As a result, ROM of the abduction and adduction were 148° with males and 138.7° in females. Moreover, ROM of the external and internal rotation were 111.2° with males and 106° in females. Because this study enables tracking of the center coordinates of the joint suitably through a motion capture system, inverse kinematics can be accurately calculated. Additionally, a mathematical inverse kinematics equation will utilize follow-up study for designing an upper rehabilitations robot. The proposed method is assessed to be able to contribute to the definition of domestic and international standardization of rehabilitation robots and motion capture for objective evaluation.

Scapulothoracic muscle activity during kinetic chain variations of a prone elevation exercise

BackgroundScapular rehabilitation exercises should target appropriate muscles. Recently, adding external rotation resistance to scapular exercises has gained interest. Moreover, clinical experts advise kinetic chain integration into shoulder rehabilitation exercises. ObjectiveTo investigate scapular muscle activity during kinetic chain variations of a prone elevation exercise. MethodsActivity of the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles was determined with surface electromyography (EMG) in 31 asymptomatic participants during six prone elevation exercise variations. Variation was created by adding external rotation resistance, adding trunk extension, or changing exercise position (prone on a Swiss ball with knees or feet supported, or prone on a physiotable). All data were normalized as a percentage of maximal voluntary isometric contraction (% MVIC). For each muscle, a Friedman's ANOVA was conducted to analyse statistical differences in EMG signal intensity between exercises. ResultsThe LT was moderately (42 - 48% MVIC) and MT highly (63 - 66% MVIC) activated during all exercise variations. No significant differences between exercises for these muscles could be detected. Adding external rotation to a prone elevation exercise decreased UT activity while adding trunk extension increased UT activity. Altering exercise position had no influence on scapular muscle activity except increased UT activity when lying prone on a physiotable with trunk extension. ConclusionProne elevation exercises are appropriate for facilitating LT and MT activity. Adding external rotation inhibits UT activity while UT facilitation could be achieved when adding trunk extension.

Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair.

BackgroundElectromyography (EMG) is frequently used as a guide for exercise rehabilitation progression following rotator cuff repair. Knowledge of EMG activity during passive and active-assisted exercises may help guide clinicians when considering exercise prescription in the early post-operative period.PurposeThe purpose of this study was to investigate EMG activity of the rotator cuff and deltoid musculature during passive and active-assisted shoulder range of motion (ROM) exercises commonly performed in post-operative rehabilitation.Study DesignDescriptive cohort laboratory study using healthy subjects.MethodsIn sixteen active healthy volunteers, surface and fine-wire EMG activity was measured in the supraspinatus, infraspinatus, subscapularis, and anterior, middle and posterior deltoid muscles during eight common ROM exercises. Mean %MVIC values and 95% confidence intervals were used to rank exercises from the least to the most amount of muscular activity generated during the exercises.ResultsStandard pendulum exercises generated low levels of EMG activity in the supraspinatus and infraspinatus (≤15% MVIC), while active-assisted table slides, and the upright wall slide generated low levels of EMG activity in only the supraspinatus. No exercises were found to generate low levels of muscular activation (≤15% MVIC) in the subscapularis.ConclusionThis study found no clear distinctions between the EMG activity of the supraspinatus or the infraspinatus occurring during common passive and active-assisted ROM exercises. Subdividing ROM exercises based on muscle activity, may not be necessary to guide progression of exercises prior to commencing active motion after rotator cuff repair.Level of EvidenceLevel 3b

Telehealth for consultation and shoulder rehabilitation: a preliminary study on the perspectives of 30 patients during the COVID-19 lockdown.

BackgroundThis study aimed to determine: the perspectives of the patient cohort that underwent telehealth consultation and shoulder rehabilitation during coronavirus disease 2019 (COVID-19) and the differences in the patients’ perspectives with the two different telehealth video applications (apps) used in the study.MethodsThis is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patients from the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom or WhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtual consultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained from the TUQ were the primary outcome measure.ResultsThe study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20–77 years). The patients who contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in the study. The average TUQ score was 13.6 (median, 14.5; range, 6–21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than the WhatsApp app (median, 8.5; average, 9.6) (p=0.004).ConclusionsPatients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth apps with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.

Functional outcome in surgically treated proximal humerus fractures with and without rotator cuff tear

Proximal humerus fractures are the second most common type of fractures in incidence among upper extremity fractures after distal radius fractures. With the relatively recent advent of locking plate technology and advances in surgical techniques, a greater proportion of the proximal humerus fractures are being treated surgically than in the past. Rotator cuff muscles are the main stabilizer of the shoulder joint and are torn in case of proximal humerus fractures. Their simultaneous repair along with the fixation of proximal humerus overcomes the need for multiple surgeries on later date. This study was a prospective observational study with an aim to find the incidence of rotator cuff injury and the functional outcome following repair in comparison to intact cuff in patients with proximal humerus fractures. The patients were subjected to MRI shoulder to know the rotator cuff status preoperatively and findings compared intra-operatively. The subjects were divided into 2 groups based on rotator cuff status. Cuff tears were repaired simultaneously while fracture fixation. The patients were asked to maintain arm pouch for a period of 6 weeks and followed by shoulder rehabilitation exercises. The functional outcome were then assessed at 12 weeks and 24 weeks post-surgery. The functional outcome was comparatively better in subjects who had intact rotator cuff, compared to torn rotator cuff in proximal humerus fractures at both 12 and 24 weeks follow-up. Complications like stiffness and pain was more common in patients with torn rotator cuff.

Effect of Unilateral and Bilateral Shoulder Rehabilitation Exercise Protocol in Patients Secondary to Radical Mastectomy

Background: Mastectomy is an operation which causes many changes in a woman’s body. Its consequence is, among other things, lymphatic edemas, limitation of movements and strength of the upper limb of the patient, experiences in the emotional sphere, difficulties related to the postoperative scar and the results of supplementing treatment such a radiotherapy or chemotherapy. Recent studies have shown the result of effective physiotherapy treatment postoperatively. There is a paucity of literature available showing the effect of bilateral approach rather than a unilateral one for the recovery Objective: Objective of the study was to find out the effect of effect of unilateral and bilateral shoulder rehabilitation exercise protocol in patients secondary to radical mastectomy Method: A total of 20 females who underwent mastectomy procedure along with chemotherapy were included in the study. Demographic data and consent form were taken from the patients. Group A was received treatment for the unilateral i.e. the affected side and group B received treatment bilaterally for five days per week for eight weeks and pre and post assessment was done with shoulder pain and disability index (SPADI), range of motion (ROM) and manual muscle testing (MMT) Results: Statistics results within the group values for Group A SPADI (p=0.6385) and mean difference (MD) was Conclusion: A proper knowledge regarding ergonomics is important to avoid the development of musculoskeletal disorders, taking stretch breaks in between long working hours can provide a healthier working environment for nursing staff and maximize human resource efficiency.

Shoulder Motion Analysis During Codman Pendulum Exercises

PurposeTo quantify shoulder motion during Codman pendulum exercises. MethodsShoulder kinematics were analyzed in 17 healthy volunteers using a validated biomechanical model coupling patient-specific imaging and motion capture. Participants were instructed to perform medio-lateral, antero-posterior and circular pendulum exercises. Glenohumeral (GH), scapulothoracic (ST), thoracohumeral (TH) ROM and overall exercise amplitude were calculated for each sequence. Linear regression analyses were carried out to determine association between different components of shoulder motion. ResultsMean overall exercise amplitude was 40.59±11.24° (range, 25.38 to 70.25°) for medio-lateral exercises, 46.5±22.02° (range, 20.68 to 100.24°) for antero-posterior exercises, and 20.28±7.13° (range, 10.9 to 35.49°) for circular exercises. Mean GH and ST involvement remained minimal, ranging from 6.74 to 13.81°, and 1.5° to 5.12°, respectively. There was no significant correlation between overall exercise amplitude and GH (R = 0.31, p = 0.01) or ST ROM (adjusted R2 = 0.57, p < 0.001), but a moderate correlation with TH ROM (R = 0.73, p < 0.001). ConclusionThis study demonstrates that Codman pendulum exercises depend mainly on truncal movement and produce very little movement in the GH and ST joints. Although they may be a safe way to promote early general stretching of the upper limb, they may be of limited further use in restoring passive shoulder ROM. Clinical RelevanceThis study quantifies motion during frequently administered shoulder rehabilitation exercises and shows that they do not produce significant movement in the shoulder. Their use in restoring passive range of motion is thus questionable.

The Relationship Between Surface Electromyographic Activity and Torque Production of the Infraspinatus Muscle in Shoulder Rehabilitation Exercises.

In current rehabilitation practice, exercise selection is commonly based on the amount of muscle recruitment demonstrated by electromyographic (EMG) analysis. A preponderance of evidence supports the concept that EMG of a muscle and torque output are positively correlated. This study was designed to investigate the relationship between surface EMG activity of the infraspinatus and torque production during exercises involving shoulder external rotation (ER). A total of 30 participants (average age = 24.6y) performed maximum voluntary isometric contraction of ER at 5 points within the range of motion of 3 shoulder exercise positions with concomitant surface EMG recording. As a maximal internally rotated position was approached, maximum ER torque and minimum or near-minimum EMG recruitment were demonstrated. Conversely, at maximally externally rotated positions, EMG activity was greatest and torque values were lowest. An inverse relationship between joint torque output and EMG activity was established in each of the 3 exercises. The inverse relationship between EMG activity and torque output during Shoulder ER suggests that there may be additional factors warranting consideration during exercise selection. Further research may be needed to determine the relative value of electrical activity versus torque output to optimize the selection of rehabilitative exercises.

Analysis of Scapular Kinematics and Muscle Activity by Use of Fine-Wire Electrodes During Shoulder Exercises

Background: During nonoperative or postoperative rehabilitation after sports injuries, exercise selection is often based on minimal load on the injured/repaired glenohumeral structures, while optimally activating scapulothoracic muscles. Previous research explored scapular muscle activity during rehabilitation exercises using surface electromyography (EMG). However, limited information exists about the deeper lying muscle activity, measured with fine-wire electrodes, even more in combination with 3-dimensional scapular kinematics. Purpose: To report scapular kinematics synchronously with surface and fine-wire EMG during specific shoulder exercises for early rehabilitation. Study Design: Descriptive laboratory study. Methods: A total of 23 healthy male patients were recruited. Three-dimensional scapular kinematics were measured combined with EMG recording of 8 muscles during 4 commonly used shoulder exercises (inferior glide, low row, lawnmower, and robbery). Upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior muscle activities were measured with bipolar surface electrodes. Intramuscular electrodes were placed in the levator scapulae (LS), rhomboid major (RM), pectoralis minor (Pm), and infraspinatus (IS) muscles. All data were normalized as a percentage of maximal voluntary isometric contraction (%MVIC). A linear mixed model with Bonferroni correction was applied for statistical analysis. Results: Scapular kinematics revealed an anterior tilt position during the inferior glide, low row, and robbery (P < .05). An upward rotation position between 20° and 30° was reached in all exercises except low row. Inferior glide (31°) and low row (42°) represented a significantly increased internal rotation position compared with lawnmower and robbery. Lawnmower and robbery showed significantly (P < .05) more MT (lawnmower, 36% MVIC; robbery, 39% MVIC) and RM (lawnmower, 59% MVIC; robbery, 66% MVIC) activation compared with inferior glide and low row. Lawnmower and robbery showed significantly (P < .05) less Pm activation (9.5%-12% MVIC). LS was significantly more active during robbery (58% MVIC) compared with inferior glide and low row (27%-36% MVIC) (P < .05). IS showed moderate activity (24%-37% MVIC) for all exercises, except low row (13% MVIC). Conclusion/Clinical Relevance: This study provides new insights about scapular positions and activation of the deeper layer muscles during 4 commonly used shoulder rehabilitation exercises. The lawnmower showed a favorable position of the scapula with less Pm activity in contrast to the low row. The inferior glide, lawnmower, and robbery should not be implemented in early phases of shoulder rehabilitation because of their moderate muscle activity.