External Rotation Strength Research Articles

"Surviving the dip" after subacromial balloon spacer implantation for massive rotator cuff tear treatment: a retrospective case series.

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. Between 12 and 26 weeks post-SBSI, gradual implant resorption may create a "balloon dip" that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and functional task impairment during the "balloon dip" period. Sixty-five consecutive patients (55.9 ± 7years of age, 42 men) with an irreparable RCT treated by the same fellowship-trained shoulder surgeon participated in this study. Outcome measurements pre-SBSI, during Phase I (early pain control ≤ 3weeks post-SBSI), Phase II (early rehabilitation > 3-11weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16weeks post-SBSI), Phase IV (early strength training > 16-24weeks post-SBSI), and Phase V (advanced strength training > 24weeks post-SBSI) included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility, and shoulder manual muscle strength testing (p ≤ 0.05). The mean final follow-up time was 40weeks (range = 24.1-89.7weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases V-III than pre-SBSI. Peak shoulder internal rotation to level 12 (thoracic spinous process #10) occurred during Phase V. Peak shoulder flexor, external rotator, and internal rotator strength occurred during Phase V. During Phase I, most subjects were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Tasks that were impaired during the "balloon dip" (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most subjects could perform each task with minimal or no difficulty. Surgical shoulder function improved and pain decreased, however, specific perceived functional task impairments remained. During the "balloon dip" phase, the perceived ability to lift 10 lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

Profiling Shoulder Strength in Youth Surfers: Implications for Injury Prevention and Performance Enhancement

The scapular region has the highest incidence of acute injuries in surfing. However, little is known about the shoulder strength profile in surfers. The aim of this research was to establish the profile of internal and external rotation strength in a group of youth surfing athletes. Methods: Isometric shoulder internal and external rotation strength was measured using a portable dynamometer in 41 (19 boys e 22 girls) youth surfing athletes (13.3 ± 2.1 years, 49.3 ± 9.8 kg, and 157.4 ± 9.5 cm). Regardless of gender, no significant differences were found between shoulder internal and external rotation strength. However, internal rotation strength was bilateral greater than external rotation strength. When comparing boys and girls, statistically significant differences were only found for the left-arm internal rotation strength when adjusted for body mass. Boys exhibited more strength than girls in all situations. No differences were observed based on the surfer's stance. The data from this research provides valuable information for coaches and trainers working with young surfers, allowing a deeper understanding of the specific shoulder strength profile, for a more effective development of training programs.

Enhancing Acromioclavicular Rehabilitation and Functional Capacity With Blood Flow Restriction Training: A Case Report

BACKGROUND: Type V Acromioclavicular joint (ACJ) separations often require surgical stabilization to restore functional capacity of the shoulder. However, the purpose of this case study is to demonstrate non-surgical management of this condition. CASE PRESENTATION: A 32-year-old female with a radiographic Type V ACJ separation underwent non-surgical management. This case used a novel criteria-based protocol which utilized 6 weeks of upper extremity blood flow restriction (BFR) to restore the functional capacity of a radiographic type V ACJ separation. OUTCOME AND FOLLOW UP: Following non-surgical management, there was a 2.47 fold increase in external rotation strength, 97% limb symmetry on upper quarter Y-Balance, a score of 91 on American Shoulder and Elbow Surgeons assessment, and 9 mm radiographic reduction of the coracoclavicular interval. DISCUSSION: The case illustrates how clinical findings did match the radiographical findings, but the non-surgical treatment using upper extremity BFR provided a desired functional outcome.

Hip Range of Motion and Strength in Young Pre-Professionals Ballet Dancers Versus Non-Dancers.

Introduction: Lower-extremity external rotation, commonly known as turnout, is a fundamental skill in dance. Limited data exist regarding joint range of motion and strength in pre-professional young dancers and non-dancers. This study aimed to evaluate the differences in hip range of motion and hip strength between pre-professional ballet dancers and non-dancers. Additionally, the study assessed the variations between the left and right sides within each group. Methods: This observational study assessed 60 pre-professional ballet dancers and 31 non-dancers with an average age of 11.91 ± 1.49. Evaluation included passive hip rotation, tibial torsion, total passive turnout measured with digital goniometers, and total active turnout (both static and dynamic) through standing on paper and rotational discs. Hip rotation strength was measured using a force sensor device. Statistical analyses encompassed student t-tests, Pearson's correlations, and ANCOVA with age and body weight as covariates, applying the Bonferroni correction for multiple comparisons. Results: Ballet dancers exhibited greater passive hip external rotation and lower passive hip internal rotation compared to non-dancers. They also demonstrated superior total active turnout (static and dynamic). After adjusting for age and weight, dancers demonstrated significantly higher hip external rotation strength than non-dancers. Hip internal rotation strength did not differ significantly between the groups. Ballet dancers displayed inherent asymmetry, with the left side showing greater tibial torsion and standing active turnout, while the right side exhibited greater hip external rotation during dynamic active turnout. Non-dancers did not show significant side differences. Conclusions: Young pre-professional ballet dancers exhibited significant hip rotation differences compared to non-dancers, including notable right-left asymmetry. These findings should be considered when planning training, aiming to optimize musculoskeletal attributes and promote balanced hip rotation. Recognizing these asymmetries and addressing muscular imbalances is vital for injury prevention and performance enhancement.

Which muscle is the external rotation compensator after superior capsular reconstruction?

BackgroundSuperior capsular reconstruction (SCR) is a surgical option for massive irreparable rotator cuff tears, particularly involving the supraspinatus and infraspinatus. In this procedure, the torn infraspinatus is not repaired or reconstructed. However, an improvement in postoperative external rotation (ER) angle and strength is observed. There is a lack of studies explaining how ER is restored after SCR. The aim of this study is to identify the ER compensator by assessing the muscle volume of the posterior deltoid and teres minor. MethodsSixty-eight patients with massive rotator cuff tears underwent SCR during 2016-2021. Of these patients, 28 who met the following inclusion criteria were retrospectively reviewed: (1) massive rotator cuff tears including the supraspinatus and infraspinatus; (2) severe muscle atrophy and fatty change; (3) intact or reparable subscapularis tendon; (4) Hamada of grade 3 or lower. Posterior deltoid and teres minor volume were measured by using an open-source medical image processing software preoperatively and 1-year postoperatively. The percentage of the posterior deltoid and teres minor muscle volume change was compared between patients with 1-year postoperative ER manual motor testing (MMT) of grade 5 and of grade < 5. The relationship between grade of fatty change, percentage of the muscle volume change, and ER angle and strength were evaluated. ResultsThere was a significant increase in the 1-year postoperative teres minor volume compared with the preoperative volume (24.6±10.3 cm³ versus 20.9±8.3 cm³, p<0.000), while the posterior deltoid volume remained unchanged (178.1±48.3 cm³ versus 178.8±47 cm³). Patients with ER MMT of grade 5 had a greater teres minor volume compared to those with an ER MMT grade of less than 5 (22.3% versus 9.4%), although this difference was not significant (p=0.074, 95% CI=-1.3–27.0). The posterior deltoid volume showed no significant change. The percentage of teres minor volume change had a weak positive correlation with ER strength (r=0.308, p=0.055, 95% CI=-0.02–1.0). There was a significant negative correlation between ER strength and the severity of both preoperative and postoperative fatty changes in the teres minor (r=-0.258, p=0.065, 95% CI=-1.0–-0.042 and r=-0.323, p=0.028, 95% CI=-1.0–-0.113, respectively). The pre- and postoperative fatty changes in the teres minor were negatively correlated with the percentage of teres minor volume change (r=-0.298, p=0.062, 95% CI=-1.0–0.031 and r=-0.413, p=0.015, 95% CI=-1.0–-0.1, respectively). ConclusionThe teres minor may serve as a potential compensator for ER in patients with massive rotator cuff tears following SCR.

Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study

Background: Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint. Purpose: To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS. Study Design: Cohort study; Level of evidence, 2. Methods: The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability–Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed. Results: A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s (P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST (P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities (r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s (r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s (r = 0.30-0.38; P < .05). Conclusion: Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.

Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.

A rotator cuff retear following arthroscopic rotator cuff repair (ARCR) is a concern in older patients. However, only a few of its risk factors are amenable to preoperative intervention. We aimed to elucidate the relationship between preoperative nutritional status and rotator cuff retears after ARCR. This single-center retrospective study included patients aged ≥65 years with rotator cuff tears who underwent ARCR. The Geriatric Nutritional Risk Index (GNRI) was used to assess preoperative nutritional status. Data collection encompassed patient demographics, clinical assessments, and surgical specifics. Patients were divided into healed and retear groups based on 2-year post-ARCR magnetic resonance imaging results. Logistic regression analysis was conducted to adjust for confounding factors and detect independent risk factors for retears. The GNRI cutoff value for retear prediction was determined by a stratum-specific likelihood ratio; clinical outcomes were compared based on the cutoff values obtained. Overall, 143 patients were included. The retear rate was 20.3%. The albumin level, GNRI, postoperative shoulder strength of abduction and external rotation, and postoperative Japanese Orthopaedic Association and Constant scores in the retear group were significantly lower than those in the healed group. The logistic regression analysis showed that low risk of morbidity and mortality (compared with no risk) based on the GNRI (odds ratio [OR], 3.39) and medial-lateral tear size per mm (OR = 1.10) were independent risk factors for a retear 2 years after ARCR. Stratum-specific likelihood ratio analysis identified data-driven strata as GNRI < 103, 103 ≤ GNRI < 109, and GNRI ≥ 109. Univariate analysis showed that patients with GNRI < 103 had a significantly higher retear risk than those with 103 ≤ GNRI < 109 and those with GNRI ≥ 109. Logistic regression analysis showed that GNRI < 103 compared with 103 ≤ GNRI < 109 (OR = 3.88) and GNRI < 103 compared with GNRI ≥ 109 (OR = 5.62), along with the medial-lateral tear size per mm (OR = 1.10), were independent risk factors for a retear at 2 years after ARCR. When assessing the risk of a retear after ARCR, GNRI ≥ 103 may indicate good preoperative nutritional status. However, more data are essential to ascertain the importance of this finding. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Greater hip internal rotation range of motion is associated with increased dynamic knee valgus during jump landing, both before and after fatigue.

The aim of this study was to analyse sex-specific differences contributing to dynamic valgus in competitive soccer players before and after a standardised fatiguing protocol. Thirty-nine healthy female and male competitive soccer players (19 females and 20 males) were recruited for the purpose of this study. Bilateral medial knee displacement (MKD) was assessed during drop jump landings using a three-dimensional motion capture system before and after a standardised fatiguing protocol. In addition, all soccer players underwent clinical examinations, including rotational hip range of motion (ROM), isokinetic strength testing and magnetic resonance imaging (MRI) of the hip and knee. Sex-specific and fatigue-dependent differences were reported, and the influence of demographic, clinical and radiographic factors on MKD was analysed via multiple linear regression models. Compared with male soccer players, female soccer players demonstrated a tendency towards increased MKD during drop jump landings before (p = 0.09) and after the fatiguing protocol (p = 0.04). Sex-specific differences included increased hip internal rotation (IR) ROM, decreased hip external rotation (ER) strength and increased femoral torsion in females (all p < 0.002). According to the multiple linear regression models (stepwise method), increased hip IR ROM (90° of flexion) and the non-dominant leg remained the sole independent predictors of increased MKD during drop jump landings before (p < 0.01 and p = 0.02, respectively) and after fatigue (p < 0.01 and p < 0.01, respectively). An increase in hip IR ROM in females was linearly related to MKD after fatigue (R2 = 0.25; p < 0.01). Female soccer players exhibited increased dynamic valgus before and after fatigue, which is likely attributed to joint mobility, as well as muscular and anatomical differences, such as increased hip IR ROM, reduced hip ER strength and increased femoral torsion. In particular, females with increased hip IR ROM were more susceptible to effects of fatigue on MKD, which may increase their risk for anterior cruciate ligament injury. Level III.

Effect of improving asymmetry through self-myofascial release in adolescent soccer player with hypomobility syndrome hip: A randomized controlled trial.

Hypomobility syndrome (HMS), or limited hip range of motion (ROM), is often reported in adolescents who train heavily. This study was aimed to investigate the impact of traditional static stretching (STR) and self-myofascial release (MFR) in adolescents with HMS hip. This study was a randomized controlled trial. Adolescent athletes with HMS hip were grouped as 23 STR and 23 MFR. Foam rolling was employed as the training method for MFR. Both interventions were performed twice a day for 20 minutes in 6 weeks. The training was filmed and distributed via the mobile video. Self-assessed Copenhagen Hip & Groin Outcome Score, ROM, strength, and hop tests were measured before and after the interventions. The healthy side without limitations was designated as non-HMS (nHMS) and taken as reference value. The study participants had limitations in flexion (FLX), abduction (ABD), internal rotation (IR), and external rotation (ER). The ROM of STR group was recovered to nHMS level. The FLX and ABD of MFR group was also recovered, however the IR and ER had lower angles compared to nHMS. MFR FLX, ABD, ER strength, and single hop test were restored like that of nHMS, however STR group was substantially lower than nHMS despite the improvements. Both groups depicted lower pre-intervention Copenhagen Hip & Groin Outcome Score subscale activities daily living, sport, and physical activity compared to nHMS. Activities daily living and physical activity were improved to healthy levels after the intervention, however sport was lower than that of nHMS. Both STR and MFR had impact on hip mobility and hip self-assessment score. Furthermore, MFR had strength improvements in FLX, ABD, and ER. However, the improvements in MFR group regarding triples, crossover hops, and self-assessed sports were limited. Therefore, STR and MFR are effective in improving not only ROM but also muscle function asymmetry in HMS hip.

Superior Capsular Reconstruction Using an Acellular Dermal Xenograft or Allograft Improves Shoulder Function but Is Associated with a High Graft Failure Rate.

Objectives: The purpose of the present study was to evaluate clinical and functional outcomes, graft integrity rate and progression of osteoarthritis after superior capsular reconstruction (SCR) at short-term follow-up. Methods: Consecutive patients that underwent SCR using an acellular dermal xeno- or allograft between May 2018 and June 2020 for the treatment of irreparable posterosuperior rotator cuff tears were included. Shoulder function (American Shoulder and Elbow Surgeons [ASES] score), pain (Visual Analog Scale [VAS] for pain) and active shoulder range of motion (ROM) were evaluated preoperatively and after a minimum of 24 months postoperatively. Isometric strength was measured at follow-up and compared to the contralateral side. Magnetic resonance imaging was performed to evaluate graft integrity and osteoarthritis progression (shoulder osteoarthritis severity [SOAS] score). Results: Twenty-two patients that underwent SCR using a xeno- (n = 9) or allograft (n = 13) were evaluated 33.1 ± 7.2 months postoperatively. Four patients in the xenograft group underwent revision surgery due to pain and range of motion limitations and were excluded from further analysis (revision rate: 18.2%). Shoulder function (ASES score: 41.6 ± 18.8 to 72.9 ± 18.6, p < 0.001), pain levels (VAS for pain: 5.8 ± 2.5 to 1.8 ± 2.0, p < 0.001) and active flexion (p < 0.001) as well as abduction ROM (p < 0.001) improved significantly from pre- to postoperatively. Active external rotation ROM did not improve significantly (p = 0.924). Isometric flexion (p < 0.001), abduction (p < 0.001) and external rotation strength (p = 0.015) were significantly lower in the operated shoulder compared to the non-operated shoulder. Ten shoulders demonstrated a graft tear at the glenoid (n = 8, 44.4%) or humerus (n = 2, 11.1%). Graft lysis was observed in seven shoulders (38.9%). The graft was intact in one shoulder (5.6%), which was an allograft. A significant progression of shoulder osteoarthritis was observed at follow-up (SOAS score: 42.4 ± 10.1 to 54.6 ± 8.4, p < 0.001). Conclusions: At short-term follow-up, SCR using an acellular dermal xeno- or allograft resulted in improved shoulder function and pain with limitations in active external rotation ROM and isometric strength. Graft failure rates were high and osteoarthritis progressed significantly. Level of Evidence: Retrospective cohort study, Level III.

Understanding musculoskeletal disorders in dancers: The role of lumbopelvic muscles and movement competency

ObjectiveTo investigate whether transversus abdominis activation (TrA), hip strength, and movement competency are associated with the incidence of musculoskeletal disorder episodes (MDEs) in dancers when controlling for confounding variables. The secondary objectives were to determine if there were differences between professional and preprofessional dancers for the aforementioned factors, as well as to determine if there were differences in TrA activation and hip strength between the dominant and non-dominant sides. DesignProspective cohort study. Methods118 dancers were recruited. The independent variables were collected at the beginning of the dance season: 1) TrA activation, 2) hip strength, and 3) movement competency. To assess the development of MDEs, a weekly electronic diary was used over a 38-week period. MDEs were compiled for each dancer's whole body and subdivided into total musculoskeletal disorder episodes (all body parts) and lower quadrant musculoskeletal disorder episodes (lower limb and lower back). ResultsLower TrA, as well as higher hip abductor and external rotator strength, were associated with a lower incidence of MDEs. TrA activation (β = 0.260, p = 0.023) and hip external rotator strength (β = −0.537, p = 0.002) could significantly explain 25.4% of the variance of total MDEs, as well as 20.9% of the variance of lower quadrant musculoskeletal disorder episodes (β = 0.272, p = 0.016; β = −0.459, p = 0.011). No significant associations were found between movement competency and MDEs. ConclusionsHigher hip strength could be a protective factor for MDEs among dancers. Further studies are needed to better understand the involvement of the transversus abdominis in MDEs.

Latissimus dorsi transfer or lower trapezius transfer: a treatment algorithm for irreparable posterosuperior rotator cuff tears muscles transfers in posterosuperior rotator cuff tears

IntroductionTendon transfers of the latissimus dorsi (LDT) or the lower trapezius (LTT) are treatment options for irreparable posterosuperior rotator cuff tears (PSIRCT). There is still no consensus on which type of tendon transfer is superior in the treatment of PSIRCT. Due to the differences in the anatomy and biomechanics, we hypothesize that there are different clinical situations in which either LDT or LTT should be preferred. The aim of this study was to evaluate the clinical and radiological outcomes of LDT and LTT in patients with PSIRCT to establish a clinical algorithm for the treatment decision. Materials and MethodsThis is a retrospective, single center observational study. Included were patients who underwent arthroscopically assisted LDT (aaLDT) or arthroscopically assisted LTT (aaLTT) for PSIRCT. In all patients, range of motion (ROM), external rotation strength, Visual Analogue Scale of Pain (VAS) and Subjective Shoulder Value (SSV) were determined pre- and postoperatively. Constant-Murley Score (CS) was evaluated at final follow-up. Complication rate, failure of the tendon transfer and revision rate were analyzed. ResultsIn total, 29 aaLDT (age 64 years, median follow-up time 45 months) and 8 aaLTT (age 54 years, median follow-up time 34 months) were included. Active ROM, VAS and SSV was significantly improved in both cohorts. At follow-up, the median CS was 73 (aaLDT) and 77 (aaLTT), respectively. Failure rate including revision surgery was 14% (aaLDT) and 13% (aaLTT), respectively. Low functional findings preoperatively were correlated to a lower functional outcome at follow-up in both groups. Painful loss of anterior elevation (PLEA) and loss of ER had no significant impact on functional outcomes in aaLDT. ConclusionFollowing the treatment algorithm based on the clinical examination, clinical outcome parameters, active ROM and pain could be significantly improved. Good preoperative function was associated with a good clinical outcome in both transfers. A low failure and revision rate supports the good decision-making of the algorithm presented.

Isometric Shoulder and Hip Strength Impact on Throwing Velocity and Reactive Strength.

The aim of the study is to examine relationships between shoulder extension-flexion and internal-external rotation strength of professional male handball players with throwing velocity, and the hip extension-flexion strength with horizontal and vertical reactive strength index. Fifteen professional male handball players participating in 1st League matches took part in the study. The results showed that isometric shoulder flexion and extension strength significantly predicted stable throwing velocity (r2=between 0.27-0.73) and dynamic throwing velocity (r2=between 0.30-0.62). In addition, isometric internal and external rotation strength significantly predicted stable throwing velocity (r2=between 0.32-0.54) and dynamic throwing velocity (r2=between 0.31-0.44). Moreover, isometric hip extension and flexion strength significantly predicted vertical reactive strength index (r2=between 0.31-0.45) and horizontal reactive strength index (r2=between 0.26-0.42). In conclusion, it was observed that shoulder strength has an enhancing effect on handball players' throwing velocity, while hip strength is a determining factor for the reactive strength index. In this context, it is assumed that shoulder weakness during throwing will affect the accuracy and velocity of throwing by disrupting the angular momentum, while weakness in the hip during the jump phase of the throwing motion will negatively affect the explosive power by limiting stabilization during landing.

Can acute mobilization and oscillation training profit on the joint position sense and strength of the rotator cuff muscles in young tennis players?

The rotator cuff is a group of muscles and tendons that act to stabilize the human shoulder and allow for its extensive range of motion. This study aimed to compare the immediate effect and durability of mobilization and oscillation dumbbell (OD) training on the Joint Position Sense (JPS) and strength of rotator cuff muscles in young tennis players. Twenty-six tennis players were divided into two experimental groups. G1 only performed mobilization techniques while G2 only performed OD training, before, after and after one week of the protocols, the strength and JPS of the shoulder joint were measured with an isokinetic dynamometer. Repeated analysis of variance (RMANOVA) and Bonferroni post hoc test were used to examine the differences between the groups. The analysis of covariance was used to examine the differences between the groups. In general, the results showed a significant effect of both mobilization techniques and OD training programs on the JPS and internal and external rotation strength of young tennis players, but only one difference was observed between the two in external rotation for the eccentric/concentric action at 120°/sec (p=0009; ƞ2p= 0.32). Moreover, the main findings showed that mobilization techniques and OD improved internal and external rotations after the protocol and after one week when compared with baseline for the concentric/concentric and eccentric/concentric at 60°/sec and 120°/sec (p &lt; 0.05) with only one exception for the internal rotation concentric/concentric at 120°/sec for both groups (p &gt; 0.05). Based on this, it seems that in healthy tennis players, both one-session mobilization techniques and OD training can be used to improve JPS and strength. Keywords: Shoulder, Isokinetic, Torque, Resistance, Rotator cuff.

Trunk and shoulder strength and mobility in young female volleyball and handball athletes

IntroductionVolleyball and handball have typical overhead throwing motion that can generate adaptations in the athlete's kinetic chain predisposing to injuries and pain. Considering the importance of the trunk and shoulder in overhead throwing motion and the particularities of these action in different sports, this study aimed to compare the trunk and shoulder muscle strength and mobility in young female volleyball and handball athletes. DesignCross-sectional study with 70 female volleyball and handball athletes between 13 and 18 years old. MethodsShoulder rotators, trunk extension and flexion with rotation strength was measured with a handheld dynamometer (MicroFET 2, Hoogan Health Industries, West Jordan, UT, USA). Shoulder and trunk range of motion was measured with a digital inclinometer (Acummar – model ACU001). Total range of motion deficit (TROM deficit), glenohumeral internal and external rotation of dominant (DOM) and non-dominant (NDOM) shoulder were also calculated. ResultsHandball athletes presented greater muscle strength of trunk flexors/rotators (DOM: 24.96%, effect size: 0.687; NDOM, 31.83%, effect size: 0.798) and dominant shoulder internal rotators (16.65%, effect size: 0.619). The groups showed no difference for trunk and shoulder range of motion and external rotators strength. A TROM (volleyball: 48%, handball: 35%) and a glenohumeral internal rotation deficit (volleyball: 28%, handball: 29%) was found in both groups. ConclusionsYoung female handball athletes have greater strength of trunk flexors/rotators and dominant shoulder internal rotators compared to volleyball athletes. These differences may be related to the different demands required in the movement of these sports.

Internal and External Rotators Muscle Strength Ratio and Acromio-Humeral Distance as Predictors of Shoulder Injuries in Volleyball Players

Abstract Purpose We aimed to investigate the ratio between strength of internal and external rotators of shoulder using handheld dynamometer and acromio-humeral distance actively and passively using musculoskeletal ultrasound to identify a relation between strength imbalance and shoulder joint injuries in Egyptian volleyball players. Methods A case control study, carried out on 60 volleyball players, subdivided into 2 subgroups, 30 with shoulder pain (injured group) and 30 apparently healthy players as a control group. The internal and external rotator muscles were measured with and held dynamometer, and acromio- humeral distance was measured using musculoskeletal ultrasound. Results injured group included 10 female players (33.3%) and 20 male players (66.7%), age ranged between 16-30 years old, while control group included 4 females (13.3%) and 26 males (86.7%). Internal and external rotation strength ratio was less than 0.9 in injured group in the dominant arm, in favor of the normal group with statistical difference between them (p &amp;lt; 0.004). Acromio-humeral distance actively in injured group ranged from 0.45 to 0.87cm with mean ±SD of (0.64±0.07), less than normal group which ranged from 0.7 to 1cm with a mean ±SD of (0.79±0.08) (p &amp;lt; 0.000) Conclusion Weakness of external rotators muscles strength will decrease ratio between external rotator/internal rotator muscles, reducing the acromio-humeral distance especially during abduction, leading to shoulder injuries among volleyball players.

Early Rehabilitation With Blood Flow Restriction Therapy Following Arthroscopic Rotator Cuff Repair: A Case Report

BACKGROUND AND PURPOSE: Rotator cuff tears are commonly addressed through arthroscopic surgical intervention and postoperative rehabilitation exercises. The addition of postoperative blood flow restriction therapy (BFRT) in patients with arthroscopic rotator cuff repair has not been described in the literature. The purpose of this case report was to describe the use of BFRT in the postoperative rehabilitation of a patient with arthroscopic rotator cuff repair. CASE PRESENTATION: A 54-year-old male with an arthroscopically treated full-thickness rotator cuff tear completed a 12-week postoperative rehabilitation that included low-intensity resistance exercises with BFRT. Assessment was performed at baseline, at 6 and 12 weeks of treatment, and at 6 months follow-up. At baseline, the patient presented with a reduction in shoulder muscle thickness, strength, and active range of motion and reported shoulder pain and limited physical function. OUTCOME AND FOLLOW-UP: At the 12th week of postoperative physical therapy discharge, the patient showed clinically significant improvements in biceps brachii muscle thickness, abduction and external rotation strength and range of motion of the shoulder, movement-evoked pain, and physical function. DISCUSSION: The addition of BFRT to postoperative rehabilitation exercises may be a valuable therapeutic strategy in arthroscopically treated rotator cuff tears. Randomized clinical trials are needed to evaluate the efficacy of BFRT in patients with arthroscopic rotator cuff repairs. JOSPT Cases 2024;4(3):104-111. Epub 2 July 2024. doi:10.2519/josptcases.2024.0052

Superior Capsular Reconstruction With the Mini-open Keyhole Technique Using Achilles Allograft Shows Favorable Outcomes for Patients With Preoperative Pseudoparalysis but Worse Outcomes and Strength With Longer Duration of Pseudoparalysis

PurposeThe purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes. MethodsBetween January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group. Results69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes. ConclusionsSuperior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.

Comparing Hip Muscle Imbalances of Professional Football Players and Ordinary People

Background and Aims Muscle strength is one of the main factors in athletic success, injury prevention, and optimal rehabilitation for injured athletes. Also, the symmetry of the muscle strength ratio is fundamental to maintaining force-producing torques. Therefore, the present study aimed to evaluate and compare hip muscle imbalances in football athletes and normal individuals. Methods The current research is causal-comparative. Fifteen football players and 15 normal healthy individuals volunteered for the study. Then, their flexor, extensor, abductor, adductor and internal and external rotator strengths were assessed using a hand-held strength test. Results The present study showed a significant difference in the ratios of extensor to flexor muscle strength, adductor to abductor, and internal to external rotator strength between the dominant and non-dominant thigh (P&lt;0.05). In addition, significant differences were observed in thigh muscle strength between football players and ordinary people (P&lt;0.05). Conclusion According to the results of the present study, the nature of football in greater use of the dominant leg can lead to an imbalance in the strength ratio of the agonist and antagonist muscles in the hip joint between the dominant and non-dominant limbs. Therefore, it is recommended that corrective exercises and movements be used for the antagonist part that caused an imbalance in muscle strength to reduce the possibility of injury in the future.

Solid organ transplant patients do well after shoulder arthroplasty: a propensity matched analysis

Solid organ transplant (SOT) recipients are commonly prescribed immunosuppressive therapies which may predispose patients to higher infection and complication rates following total shoulder arthroplasty. This article aims to analyze the effects SOT and subsequent immunosuppressive regimens have on the functional and patient-reported outcomes of total shoulder arthroplasties. A single institution, multisurgeon retrospective case-control study investigating the functional and patient-reported outcomes of shoulder arthroplasty after SOT was conducted between the years of 2010 and 2020. To be included in the study, patients must have undergone SOT prior to primary total shoulder arthroplasty. A 4:1 match-paired control group lacking SOT prior to arthroplasty was then constructed. Thirty-four SOT patients (18 males and 16 females) and 136 control patients (77 male and 59 female) were included in the study. Patients were analyzed who underwent SOT prior to shoulder arthroplasty, with outcomes compared to controls that only underwent arthroplasty. The primary outcomes include range of motion and strength in forward elevation, external rotation, and internal rotation, and patient reported outcomes. There was no significant difference in improvement for range of motion and strength between the 2 cohorts, but within each cohort, improvement was statistically significant. In the SOT patients, forward elevation improved by 56° ± 52°, external rotation increased by 13° ± 20°, and internal rotation increased by 2 vertebral levels. In the non-SOT patients, forward elevation improved by 45° ± 51°, external rotation increased by 16° ± 25°, and internal rotation increased by 3 vertebral levels. SOT patients had equivocal visual analog scale pain and Simple Shoulder Test scores but lower American Shoulder and Elbow Surgeons (59±13 vs. 79±2; P=.002) and SANE (61±30 vs. 84±17; P<.001) scores than non-SOT patients. Complication rates were not significantly higher in the SOT group (15% vs. 6%; P=.05), but incidence of surgical revisions was not significantly different (SOT=3%; non-SOT=5%; P=.59). Shoulder arthroplasty is a safe, effective surgical intervention for improving shoulder function in patients with a history of SOT. Despite being on chronic immunosuppressive regimens, our solid organ transplants had comparable clinical outcomes and revision rates, but higher complication rates.