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Alder KD, Baker CE, Robinson KE, Shaughnessy WJ, Shin AY. Lower Trapezius Tendon Transfer for Restoration of External Rotation in Brachial Plexus Birth Injury. World Neurosurg 2024:S1878-8750(24)01533-X. [PMID: 39243968 DOI: 10.1016/j.wneu.2024.08.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Patients with brachial plexus birth injuries (BPBIs) are at risk for limitations in shoulder external rotation. The role of lower trapezius tendon transfer to restore shoulder external rotation in this population has not been well characterized. This study aimed to evaluate the utility of lower trapezius tendon transfer for restoration of external rotation in a subset of pediatric patients. METHODS Seventeen pediatric patients with BPBI were treated with lower trapezius tendon transfer to restore external rotation of the shoulder. Mean age at surgery was 8 years, and 11 were female. Six patients had prior shoulder surgery to restore external rotation, while 1 had prior nerve surgery to restore shoulder function. Range of motion before lower trapezius transfer and at latest follow-up was obtained. Mean follow-up was 36 months. RESULTS Active forward flexion did not significantly change from preoperative to final follow-up (mean, 147° and 141°; P = 0.46). External rotation in adduction significantly changed from preoperative to final follow-up (mean, 4° and 26°; P < 0.001). External rotation in abduction significantly changed from preoperative to final follow-up (mean, 75° and 84°; P = 0.048). Six patients (35%) had subsequent surgeries at average 17 months from this procedure. Significant univariate associations with subsequent surgery included certain intraoperative concomitant procedures-coracoid osteotomy/excision (P = 0.02) and biceps tenodesis (P = 0.04)-while bony glenoid augmentation/reconstruction trended toward significant association (P = 0.05). CONCLUSIONS Lower trapezius tendon transfer for BPBI showed a statistically significant but unlikely clinically meaningful improvement in external rotation with a high rate of reoperation.
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Affiliation(s)
- Kareme D Alder
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney E Baker
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle E Robinson
- Alix School of Medicine, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Huang TS, Ou HL, Lin JJ. Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis. J Hand Ther 2020; 32:345-352. [PMID: 29196161 DOI: 10.1016/j.jht.2017.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Crossover repeated-measure design. INTRODUCTION Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment. PURPOSE OF THE STUDY The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis. METHODS Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application. RESULTS UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis. DISCUSSION The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated. CONCLUSION Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Effects of Femoral Rotational Taping on Dynamic Postural Stability in Female Patients With Patellofemoral Pain. Clin J Sport Med 2017; 27:438-443. [PMID: 28036322 DOI: 10.1097/jsm.0000000000000392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of femoral rotational taping on task performance, dynamic postural control, and pain during the Star Excursion Balance Test (SEBT) in patients with patellofemoral pain (PFP) compared to healthy controls. DESIGN Case-control study, pretest-posttest. SETTING Laboratory. PARTICIPANTS Twenty-four female participants (16 with PFP, 8 controls). INTERVENTIONS Participants in both the PFP and control groups performed SEBT with no taping, sham taping, and femoral rotational taping. MAIN OUTCOME MEASURES The maximum anterior excursion distance, 3-dimensional hip and knee kinematics of the stance leg, and pain score (VAS) during SEBT were recorded. The coefficients of variance (CV) of kinematic data gathered from electromagnetic sensors on pelvis and femur were calculated to represent segmental stability. RESULTS When performing the SEBT in the anterior direction, application of femoral rotational taping increased maximum excursion distance (65.57% vs 66.15% leg length, P = 0.027), decreased hip adduction excursion (47.6 vs 32.1 degrees, P = 0.010), and pain (3.34 vs 2.38, P = 0.040) in the PFP group. Femoral rotational taping also improved the medial-lateral (7.1 vs 4.6, P = 0.015) and proximal-distal stability (7.5 vs 4.5, P = 0.020) of the pelvis, and medial-lateral stability (7.2 vs 6.1, P = 0.009) of the femur. CONCLUSIONS The results support the use of femoral rotational taping for improving dynamic postural control and reducing pain during SEBT. CLINICAL RELEVANCE Femoral rotational taping could be used in the management of young female patients with PFP.
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Ou HL, Huang TS, Chen YT, Chen WY, Chang YL, Lu TW, Chen TH, Lin JJ. Alterations of scapular kinematics and associated muscle activation specific to symptomatic dyskinesis type after conscious control. ACTA ACUST UNITED AC 2016; 26:97-103. [PMID: 27525356 DOI: 10.1016/j.math.2016.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/04/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scapular orientation and movements can affect the function of the shoulder. However, evidence is limited on whether symptomatic subjects can actively maintain the scapula in a neutral position through conscious control. OBJECTIVE To investigate whether symptomatic subjects with scapular dyskinesis can achieve optimal scapular movements and associated muscle activities through conscious control. DESIGN A cross-sectional study. METHODS Sixty subjects with scapular dyskinesis (16 inferior angle pattern I, 16 medial border pattern II, and 28 mixed pattern) performed 3 selected exercises (arm elevation, side-lying elevation, and side-lying external rotation) with and without conscious control. Three-dimensional electromagnetic motion and electromyography were used to record the scapular kinematics and muscle activation during the exercises. RESULTS For scapular kinematics, significant increases in scapular external rotation (4.6 ± 3.2°, p < 0.0125) were found with conscious control during arm elevation and side-lying elevation in three groups. Significant increases in activation of the middle and lower trapezius (MT: 4.9 ± 2.4% MVIC; LT: 10.2 ± 6.8% MVIC, p < 0.0 25) were found with conscious control in 3 exercises among the 3 dyskinesis groups. Increased serratus anterior activation (SA: 11.2 ± 4.8% MVIC, p < 0.0 25) was found in the concentric phase of side-lying external rotation in the pattern I and I + II groups. CONCLUSION Conscious control of the scapula can alter scapular orientation and MT, LT, and SA activation during 3 selected exercises in subjects with symptomatic dyskinesis. Specifically, conscious control during side-lying external rotation can be applied to increase SA activity in pattern I and I + II dyskinesis.
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Affiliation(s)
- Hsiang-Ling Ou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Yu-Ting Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Wen-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taiwan, ROC
| | - Yu-Li Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan, ROC
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Ting-Han Chen
- Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC.
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Huang TS, Huang CY, Ou HL, Lin JJ. Scapular dyskinesis: Patterns, functional disability and associated factors in people with shoulder disorders. ACTA ACUST UNITED AC 2016; 26:165-171. [PMID: 27693966 DOI: 10.1016/j.math.2016.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/12/2016] [Accepted: 09/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patterns of scapular dyskinesis have unique scapular kinematics and associated muscular activation. The characteristics of unique dyskinesis patterns may be associated with functional disability. OBJECTIVES To investigate whether the shoulder function level and primary dysfunction items were different in unique dyskinesis pattern. The factors associated with shoulder dysfunction in different dyskinesis patterns were identified. DESIGN Cross-sectional study. METHODS Fifty-one participants with unilateral shoulder pain were classified as having a single dyskinesis pattern (inferior angle prominence, pattern I; medial border prominence, pattern II) or a mixed dyskinesis pattern (patterns I + II). Clinical measurements with the Flexilevel Scale of Shoulder Function (FLEX-SF), shoulder range of motion and pectoralis minor index were recorded. These clinical measurements, 3-D scapular kinematics (electromagnetic-based motion analysis), and associated muscular activation (electromyography on the upper/middle/lower trapezius and serratus anterior muscles) during arm elevation were analyzed for associations with functional disability. RESULTS We found FLEX-SF scores and primary dysfunction items were similar among the patterns of dyskinesis. In inferior angle prominence, increased shoulder function was associated with decreased upper trapezius activity (R2 = 0.155, p = 0.035), which accounted for approximately 16% of the variance of FLEX-SF scores. In medial border prominence, increased shoulder function was associated with increased lower trapezius activity (R2 = 0.131, p = 0.017), which accounted for approximately 13% of the variance of FLEX-SF scores. CONCLUSION Upper and lower trapezius activities are important to consider in the evaluation of patients with pattern I and II, respectively. No other factors were related to shoulder dysfunction due to insufficient challenge of arm elevation tasks.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ying Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Scapular kinematic is altered after electromyography biofeedback training. J Biomech 2016; 49:1881-1886. [DOI: 10.1016/j.jbiomech.2016.04.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
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Richardson RT, Nicholson KF, Rapp EA, Johnston TE, Richards JG. A comparison of acromion marker cluster calibration methods for estimating scapular kinematics during upper extremity ergometry. J Biomech 2016; 49:1255-1258. [DOI: 10.1016/j.jbiomech.2016.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 01/16/2023]
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Worobey LA, Lin YS, Koontz AM, Boninger ML. Dynamic Three-Dimensional Ultrasound to Evaluate Scapular Movement Among Manual Wheelchair Users and Healthy Controls. Top Spinal Cord Inj Rehabil 2015; 21:303-12. [PMID: 26689695 DOI: 10.1310/sci2104-303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A large percentage of individuals with spinal cord injury (SCI) report shoulder pain that can limit independence and quality of life. The pain is likely related to the demands placed on the shoulder by transfers and propulsion. Shoulder pathology has been linked to altered scapular mechanics; however, current methods to evaluate scapular movement are invasive, require ionizing radiation, are subject to skin-based motion artifacts, or require static postures. OBJECTIVE To investigate the feasibility of applying 3-dimensional ultrasound methods, previously used to look at scapular position in static postures, to evaluate dynamic scapular movement. METHODS This study evaluated the feasibility of the novel application of a method combining 2-dimensional ultrasound and a motion capture system to determine 3-dimensional scapular position during dynamic arm elevation in the scapular plane with and without loading. RESULTS Incremental increases in scapular rotations were noted for extracted angles of 30°, 45°, 60°, and 75° of humeral elevation. Group differences were evaluated between a group of 16 manual wheelchair users (MWUs) and a group of age- and gender-matched able-bodied controls. MWUs had greater scapular external rotation and baseline pathology on clinical exam. MWUs also had greater anterior tilting, with this difference further accentuated during loading. The relationship between demographics and scapular positioning was also investigated, revealing that increased age, pathology on clinical exam, years since injury, and body mass index were correlated with scapular rotations associated with impingement (internal rotation, downward rotation, and anterior tilting). CONCLUSIONS Individuals with SCI, as well as other populations who are susceptible to shoulder pathology, may benefit from the application of this imaging modality to quantitatively evaluate scapular positioning and effectively target therapeutic interventions.
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Affiliation(s)
- Lynn A Worobey
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yen-Sheng Lin
- Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Alicia M Koontz
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael L Boninger
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rettig O, Krautwurst B, Maier MW, Wolf SI. Definition of anatomical zero positions for assessing shoulder pose with 3D motion capture during bilateral abduction of the arms. BMC Musculoskelet Disord 2015; 16:383. [PMID: 26646907 PMCID: PMC4673792 DOI: 10.1186/s12891-015-0840-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background Surgical interventions at the shoulder may alter function of the shoulder complex. Clinically, the outcome can be assessed by universal goniometry. Marker-based motion capture may not resemble these results due to differing angle definitions. Methods The clinical inspection of bilateral arm abduction for assessing shoulder dysfunction is performed with a marker based 3D optical measurement method. An anatomical zero position of shoulder pose is proposed to determine absolute angles according to the Neutral-0-Method as used in orthopedic context. Static shoulder positions are documented simultaneously by 3D marker tracking and universal goniometry in 8 young and healthy volunteers. Repetitive bilateral arm abduction movements of at least 150° range of motion are monitored. Similarly a subject with gleno-humeral osteoarthritis is monitored for demonstrating the feasibility of the method and to illustrate possible shoulder dysfunction effects. Results With mean differences of less than 2°, the proposed anatomical zero position results in good agreement between shoulder elevation/depression angles determined by 3D marker tracking and by universal goniometry in static positions. Lesser agreement is found for shoulder pro-/retraction with systematic deviations of up to 6°. In the bilateral arm abduction movements the volunteers perform a common and specific pattern in clavicula-thoracic and gleno-humeral motion with maximum shoulder angles of 32° elevation, 5° depression and 45° protraction, respectively, whereas retraction is hardly reached. Further, they all show relevant out of (frontal) plane motion with anteversion angles of 30° in overhead position (maximum abduction). With increasing arm anteversion the shoulder is increasingly retroverted, with a maximum of 20° retroversion. The subject with gleno-humeral osteoarthritis shows overall less shoulder abduction range of motion but with increased out-of-plane movement during abduction. Conclusions The proposed anatomical zero definition for shoulder pose fills the missing link for determining absolute joint angles for shoulder elevation/depression and pro-/retraction. For elevation-/depression the accuracy suits clinical expectations very well with mean differences less than 2° and limits of agreement of 8.6° whereas for pro-/retraction the accuracy in individual cases may be inferior with limits of agreement of up to 24.6°. This has critically to be kept in mind when applying this concept to shoulder intervention studies.
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Affiliation(s)
- Oliver Rettig
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Britta Krautwurst
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
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Hannah DC, Scibek JS. Collecting shoulder kinematics with electromagnetic tracking systems and digital inclinometers: A review. World J Orthop 2015; 6:783-794. [PMID: 26601060 PMCID: PMC4644866 DOI: 10.5312/wjo.v6.i10.783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
The shoulder complex presents unique challenges for measuring motion as the scapula, unlike any other bony segment in the body, glides and rotates underneath layers of soft tissue and skin. The ability for clinicians and researchers to collect meaningful kinematic data is dependent on the reliability and validity of the instrumentation utilized. The aim of this study was to review the relevant literature pertaining to the reliability and validity of electromagnetic tracking systems (ETS) and digital inclinometers for assessing shoulder complex motion. Advances in technology have led to the development of biomechanical instrumentation, like ETS, that allow for the collection of three-dimensional kinematic data. The existing evidence has demonstrated that ETS are reliable and valid instruments for collecting static and dynamic kinematic data of the shoulder complex. Similarly, digital inclinometers have become increasingly popular among clinicians due to their cost effectiveness and practical use in the clinical setting. The existing evidence supports the use of digital inclinometers for the collection of shoulder complex kinematics as these instruments have been demonstrated to yield acceptable reliability and validity. While digital inclinometers pose a disadvantage to ETS regarding accuracy, precision, and are limited to two-dimensional and static measurements, this instrument provides clinically meaningful data that allow clinicians and researchers the ability to measure, monitor, and compare shoulder complex kinematics.
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Huang TS, Ou HL, Huang CY, Lin JJ. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elbow Surg 2015; 24:1227-34. [PMID: 25704212 DOI: 10.1016/j.jse.2014.12.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of the kinematics and associated muscular activity in individuals with scapular dyskinesis may provide insight into the injury mechanism and inform the planning of treatment strategies. We investigated scapular kinematics and associated muscular activation during arm movements in individuals with scapular dyskinesis. METHODS A visual-based palpation method was used to evaluate 82 participants with unilateral shoulder pain. Scapular movements during arm raising/lowering movements were classified as abnormal single pattern (inferior angle prominence, pattern I; medial border prominence, pattern II; excessive/inadequate scapular elevation or upward rotation, pattern III), abnormal mixed patterns, or normal pattern (pattern IV). Scapular kinematics and associated muscular activation were assessed with an electromagnetic motion-capturing system and surface electromyography. RESULTS More scapular internal rotation was found in pattern II subjects (4°, P = .009) and mixed pattern I and II subjects (4°, P = .023) than in control subjects during arm lowering. Scapular posterior tipping (3°, P = .028) was less in pattern I subjects during arm lowering. Higher upper trapezius activity (14%, P = .01) was found in pattern II subjects during arm lowering. In addition, lower trapezius (5%, P = .025) and serratus anterior activity (10%, P = .004) were less in mixed pattern I and II subjects during arm lowering. CONCLUSIONS Specific alterations of scapular muscular activation and kinematics were found in different patterns of scapular dyskinesis. The findings also validated the use of a comprehensive classification test to assess scapular dyskinesis, especially in the lowering phase of arm elevation.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ying Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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Khadilkar L, MacDermid JC, Sinden KE, Jenkyn TR, Birmingham TB, Athwal GS. An analysis of functional shoulder movements during task performance using Dartfish movement analysis software. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2014; 8:1-9. [PMID: 24926157 PMCID: PMC4049033 DOI: 10.4103/0973-6042.131847] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose: Video-based movement analysis software (Dartfish) has potential for clinical applications for understanding shoulder motion if functional measures can be reliably obtained. The primary purpose of this study was to describe the functional range of motion (ROM) of the shoulder used to perform a subset of functional tasks. A second purpose was to assess the reliability of functional ROM measurements obtained by different raters using Dartfish software. Materials and Methods: Ten healthy participants, mean age 29 ± 5 years, were videotaped while performing five tasks selected from the Disabilities of the Arm, Shoulder and Hand (DASH). Video cameras and markers were used to obtain video images suitable for analysis in Dartfish software. Three repetitions of each task were performed. Shoulder movements from all three repetitions were analyzed using Dartfish software. The tracking tool of the Dartfish software was used to obtain shoulder joint angles and arcs of motion. Test-retest and inter-rater reliability of the measurements were evaluated using intraclass correlation coefficients (ICC). Results: Maximum (coronal plane) abduction (118° ± 16°) and (sagittal plane) flexion (111° ± 15°) was observed during ‘washing one's hair;’ maximum extension (−68° ± 9°) was identified during ‘washing one's own back.’ Minimum shoulder ROM was observed during ‘opening a tight jar’ (33° ± 13° abduction and 13° ± 19° flexion). Test-retest reliability (ICC = 0.45 to 0.94) suggests high inter-individual task variability, and inter-rater reliability (ICC = 0.68 to 1.00) showed moderate to excellent agreement. Conclusion: Key findings include: 1) functional shoulder ROM identified in this study compared to similar studies; 2) healthy individuals require less than full ROM when performing five common ADL tasks 3) high participant variability was observed during performance of the five ADL tasks; and 4) Dartfish software provides a clinically relevant tool to analyze shoulder function.
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Affiliation(s)
- Leenesh Khadilkar
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Joy C MacDermid
- Co-Director, Clinical Research Lab, Hand and Upper Limb Centre, St Joseph's Health Centre, London ; Professor, School of Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn E Sinden
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thomas R Jenkyn
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada ; Co-Director, Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - Trevor B Birmingham
- Co-Director, Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada ; School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - George S Athwal
- Hand and Upper Limb Centre, St Joseph's Health Centre, London, Ontario, Canada
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Cutti AG, Parel I, Raggi M, Petracci E, Pellegrini A, Accardo AP, Sacchetti R, Porcellini G. Prediction bands and intervals for the scapulo-humeral coordination based on the Bootstrap and two Gaussian methods. J Biomech 2014; 47:1035-44. [PMID: 24485513 DOI: 10.1016/j.jbiomech.2013.12.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 11/26/2022]
Abstract
Quantitative motion analysis protocols have been developed to assess the coordination between scapula and humerus. However, the application of these protocols to test whether a subject's scapula resting position or pattern of coordination is "normal", is precluded by the unavailability of reference prediction intervals and bands, respectively. The aim of this study was to present such references for the "ISEO" protocol, by using the non-parametric Bootstrap approach and two parametric Gaussian methods (based on Student's T and Normal distributions). One hundred and eleven asymptomatic subjects were divided into three groups based on their age (18-30, 31-50, and 51-70). For each group, "monolateral" prediction bands and intervals were computed for the scapulo-humeral patterns and the scapula resting orientation, respectively. A fourth group included the 36 subjects (42 ± 13 year-old) for whom the scapulo-humeral coordination was measured bilaterally, and "differential" prediction bands and intervals were computed, which describe right-to-left side differences. Bootstrap and Gaussian methods were compared using cross-validation analyses, by evaluating the coverage probability in comparison to a 90% target. Results showed a mean coverage for Bootstrap from 86% to 90%, compared to 67-70% for parametric bands and 87-88% for parametric intervals. Bootstrap prediction bands showed a distinctive change in amplitude and mean pattern related to age, with an increase toward scapula retraction, lateral rotation and posterior tilt. In conclusion, Bootstrap ensures an optimal coverage and should be preferred over parametric methods. Moreover, the stratification of "monolateral" prediction bands and intervals by age appears relevant for the correct classification of patients.
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Affiliation(s)
- A G Cutti
- I.N.A.I.L. Centro Protesi - Vigorso di Budrio, Italy.
| | - I Parel
- I.N.A.I.L. Centro Protesi - Vigorso di Budrio, Italy; DI3, University of Trieste, Italy
| | - M Raggi
- I.N.A.I.L. Centro Protesi - Vigorso di Budrio, Italy
| | - E Petracci
- I.N.A.I.L. Centro Protesi - Vigorso di Budrio, Italy; Department of Statistics, University of Bologna, Italy
| | - A Pellegrini
- Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, Italy
| | | | - R Sacchetti
- I.N.A.I.L. Centro Protesi - Vigorso di Budrio, Italy
| | - G Porcellini
- Department of Statistics, University of Bologna, Italy
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Shoulder adaptations among pitchers and position players over the course of a competitive baseball season. Clin J Sport Med 2013; 23:184-9. [PMID: 22935558 DOI: 10.1097/jsm.0b013e31826ab928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if throwing arm shoulder range of motion (ROM) and scapular kinematic differences exist between baseball pitchers and position players over the course of a baseball season. DESIGN Prospective cohort. SETTING Professional baseball athletic training room. PARTICIPANTS Sixteen asymptomatic professional baseball pitchers and 16 position players. INDEPENDENT VARIABLES Preseason glenohumeral (GH) posterior tightness and scapular position. MAIN OUTCOME MEASURES Throwing arm GH horizontal adduction ROM and GH internal rotation bilateral asymmetry ROM, as well as bilateral differences in forward scapular posture and throwing arm scapular upward rotation at rest, 60, 90, and 120 degrees of humeral elevation were measured. These measurements were taken before and at the conclusion of a 140-game baseball season. RESULTS Analyses of covariances showed no significant differences in GH horizontal adduction or internal rotation asymmetry ROM between groups over the course of the season. However, the pitchers developed significantly less scapular upward rotation at 60 degrees (P = 0.007) and 90 degrees (P = 0.006) of humeral elevation compared with the position players during the season. Forward scapular posture (P = 0.23) and scapular upward rotation at 0 degrees (P = 0.93) and 120 degrees (P = 0.29) of humeral elevation were not significantly different between groups. CONCLUSIONS These results suggest that baseball position players develop more scapular upward rotation over the course of a competitive season than pitchers. This discrepancy may increase the pitchers' risk of injury and may partially explain their higher incidence of shoulder injury compared with position players. Therefore, pitchers may benefit from strengthening exercises and stretches aimed at increasing scapular upward rotation throughout the competitive baseball season.
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15
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The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy. J Orthop Sports Phys Ther 2012; 42:1005-16. [PMID: 22951537 DOI: 10.2519/jospt.2012.4142] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVES To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. BACKGROUND There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. METHODS Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. RESULTS TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean ± SD change, 2.6 ± 1.1), Neer (2.6 ± 1.3), and Hawkins-Kennedy (2.8 ± 1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean ± SD change, 2.0 ± 1.5; P<.001) and improved shoulder function (force production, 2.5 ± 1.4 kg; Penn Shoulder Score, 7.7 ± 9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4 ± 13.2) (all, P<.001). CONCLUSION Immediate improvements in shoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. LEVEL OF EVIDENCE Therapy, level 4.
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16
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Defining functional shoulder range of motion for activities of daily living. J Shoulder Elbow Surg 2012; 21:1177-83. [PMID: 22047785 DOI: 10.1016/j.jse.2011.07.032] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/12/2011] [Accepted: 07/24/2011] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). MATERIALS AND METHODS The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. RESULTS Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. CONCLUSION Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.
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17
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Seitz AL, Uhl TL. Reliability and minimal detectable change in scapulothoracic neuromuscular activity. J Electromyogr Kinesiol 2012; 22:968-74. [PMID: 22683057 DOI: 10.1016/j.jelekin.2012.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 05/13/2012] [Accepted: 05/13/2012] [Indexed: 11/26/2022] Open
Abstract
Alterations in scapular muscle activity, including excess activation of the upper trapezius (UT) and onset latencies of the lower trapezius (LT) and serratus anterior (SA) muscles, are associated with abnormal scapular motion and shoulder impingement. Limited information exists on the reliability of neuromuscular activity to demonstrate the efficacy of interventions. The purpose of this study was to characterize the reproducibility of scapular muscle activity (mean activity, relative onset timing) over time and establish the minimal detectable change (MDC). Surface electromyography (sEMG) of the UT, LT, SA and anterior deltoid (AD) muscles in 16 adults were captured during an overhead lifting task in two sessions, one-week apart. sEMG data were also normalized to maximum isometric contraction and the relative onset and mean muscle activity during concentric and eccentric phases of the scapular muscles were calculated. Additionally, reliability of the absolute sEMG data during the lifting task and MVIC was evaluated. Both intrasession and intersession reliability of normalized and absolute mean scapular muscle activity, assessed with intraclass correlation coefficients (ICC), ranged from 0.62 to 0.99; MDC values were between 1.3% and 11.7% MVIC and 24 to 135 mV absolute sEMG. Reliability of sEMG during MVIC was ICC = 0.82-0.99, with the exception of intersession upper trapezius reliability (ICC = 0.36). Within session reliability of muscle onset times was ICC = 0.88-0.97, but between session reliability was lower with ICC = 0.43-0.73; MDC were between 39 and 237 ms. Small changes in scapular neuromuscular mean activity (>11.7% MVIC) can be interpreted as meaningful change, while change in muscle onset timing in light of specific processing parameters used in this study is more variable.
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Affiliation(s)
- Amee L Seitz
- Department of Physical Therapy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
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18
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Lazarus NR, Harridge SDR. Examination of the relationship between age and clinical function: missing the trees for the wood. Aging Clin Exp Res 2011; 23:323-4. [PMID: 22067374 DOI: 10.1007/bf03324969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lin JJ, Hsieh SC, Cheng WC, Chen WC, Lai Y. Adaptive patterns of movement during arm elevation test in patients with shoulder impingement syndrome. J Orthop Res 2011; 29:653-7. [PMID: 21437944 DOI: 10.1002/jor.21300] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 10/18/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine if a distinctive characteristic exists in the pattern of movement (scapular elevation and upward rotation to reduce impingement) and associated muscular activities during arm elevation in subjects with shoulder impingement (SI) that is associated with the severity of the disease. Fourteen subjects (7 amateur athletes and 7 student athletes) with SI and 7 controls performed arm elevation in the scapular plane. Scapular kinematics (upward rotation, elevation, tipping, and scapulohumeral rhythm) and muscular activity [upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and deltoid] were measured by an electromagnetic motion tracking system and surface electromyography, respectively. Subjects with SI had greater elevation of the scapula (11.9 mm, p < 0.005) and less peak scapular posterior tipping (10.6°, p < 0.02) than controls. In more severe subjects (amateur athletes), the elevation and posterior tipping of the scapula were correlated with an increase in the UT (R = -0.818, p = 0.025) and a decrease in SA (R = 0.772, p = 0.040) activity, respectively. Our results identified a characteristic compensatory scapular elevation to reduce impingement during arm elevation in subjects with SI. Assessing scapular elevation during arm elevation may be a useful functional marker for evaluating impingement status and associated muscle function. Additionally, SA and LT muscle strengthening may improve SI.
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Affiliation(s)
- Jiu-jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University and Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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20
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Ludewig PM, Hassett DR, Laprade RF, Camargo PR, Braman JP. Comparison of scapular local coordinate systems. Clin Biomech (Bristol, Avon) 2010; 25:415-21. [PMID: 20185212 PMCID: PMC2862764 DOI: 10.1016/j.clinbiomech.2010.01.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our purposes were to compare between the original and current recommended standard methods of three-dimensional scapular rotation descriptions and to examine the prevalence of gimbal-lock for scapular motion during scapular plane abduction. Additionally we compared these standards to an alternative method and a glenoid based description. METHODS Eleven asymptomatic subjects were studied using electromagnetic sensors secured to bone-fixed pins in the scapula and humerus during two repetitions of scapular plane abduction. Anatomical landmarks defined scapular axes. Scapular angular data were analyzed at humerothoracic elevation angles from initial to maximum elevation. Repeated measures ANOVAs were performed for each variable with a significance level of P<0.05. An anatomical model was used to compare the standards to the alternative and glenoid methods. FINDINGS For scapular upward rotation and tilting, larger differences occurred between standards at higher angles of elevation. The current standard measured 12.4 degrees less upward rotation and 6.1 degrees greater posterior tilting at maximum elevation as compared to the original. The current standard measured 11.6 degrees less scapular internal rotation across all elevation angles. Using the original landmarks, six subjects attained a mean end-range humerothoracic elevation of 147.4 degrees (SD 12.1 degrees ), with a mean end-range scapular upward rotation of 54.4 degrees . The alternative method was more closely aligned to the glenoid method than the current standard. INTERPRETATION Significant differences were found between the two standards. The current standard interprets the same scapular motion with less internal rotation and upward rotation, and more posterior tilting than the original. No subjects reached upward rotation positions nearing gimbal-lock. Axis orientations also affect clinical interpretation. The alternative method appears worthy of further consideration as shoulder kinematic measurement further evolves.
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Affiliation(s)
- Paula M Ludewig
- Program in Physical Therapy, Department of Physical Medicine and Rehabilitation, The University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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21
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Alteration in shoulder kinematics and associated muscle activity in people with idiopathic scoliosis. Spine (Phila Pa 1976) 2010; 35:1151-7. [PMID: 20421854 DOI: 10.1097/brs.0b013e3181cd5923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional control-matched study in adolescents with idiopathic scoliosis (IS). OBJECTIVE To evaluate whether subjects with IS had shoulder dysfunction and associated impairment in shoulder kinematics and muscular activation. SUMMARY OF BACKGROUND DATA Evidence indicates that shoulder kinematics are related to shoulder pain and dysfunction. Despite the degree of morbidity associated with altered shoulder kinematics likely to occur in subjects with IS, no report has been published to address this hypothesis. METHODS In this investigation, shoulder kinematics (scapular tipping, scapular upward rotation, and scapulohumeral rhythm) and associated muscular activities [upper trapezius (UT), lower trapezius (LT), serrantus anterior (SA), and middle deltoid (MD)] were evaluated with a 3-dimensional electromagnetic tracking device and electromyography during arm elevations in 13 female subjects with IS and 13 age-gender-dominant hand-matched controls. Additionally, self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) was evaluated between the 2 groups. RESULTS Subjects with IS demonstrated lower FLEX-SF scores than the controls (P = 0.01). For the convex side, more anterior tilt of the scapula in resting position was identified (P = 0.006). For the concave side, more scapular upward rotation in resting position was identified (P = 0.01). For the EMG amplitude, higher LT contraction activity on the convex side and lower LT and SA contraction activity on the concave side were established (P = 0.007 and less than 0.01, respectively). A moderate positive association was found between scapular posterior tipping during movement and FLEX-SF functional score (R = 0.51). A moderate negative association was found between LT muscular activity and FLEX-SF functional score (R = -0.54). CONCLUSION Given the progressive nature of IS and kinematic linkage among the thoracic spine, scapula, and arm, inadequate posterior tipping movement and high LT muscular activity on the convex side of IS are important to consider in rehabilitation programs for subjects with IS.
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Yang JL, Lu TW, Chou FC, Chang CW, Lin JJ. Secondary motions of the shoulder during arm elevation in patients with shoulder tightness. J Electromyogr Kinesiol 2009; 19:1035-42. [DOI: 10.1016/j.jelekin.2008.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 08/25/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022] Open
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Abstract
STUDY DESIGN Controlled laboratory study using a single-group, repeated-measures design. OBJECTIVES To investigate scapular kinematics during both constrained and functional shoulder movements. BACKGROUND Abnormal scapulothoracic joint motion has been associated with pathologies such as shoulder impingement. Constrained protocols are commonly used in the measurement of shoulder kinematics; however, few studies have measured motion during functional tasks. METHODS Twenty-five healthy subjects participated in this study. Three-dimensional kinematic data from the scapula and humerus with respect to the thorax were collected with a magnetic tracking system. Functional testing consisted of 6 different tasks representing common activities of daily living. Constrained testing consisted of at least 42 arm elevations in various planes. Two-way analyses of variance with repeated measures were used to compare scapular rotations between constrained and functional movements at the same humeral elevation and plane of elevation angles. Intersubject variability was compared between the overhead tasks and the constrained humeral elevation in the scapular plane by using the coefficient of multiple correlations. RESULTS Significant differences between constrained trials and functional tasks were found for all scapular rotations. A similar pattern was observed for scapular rotations variability between overhead tasks and constrained arm elevation in the scapular plane. CONCLUSION Care needs to be taken when comparing and generalizing scapular kinematic data from constrained humeral movements and applying it to functional humeral movements.
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Abstract
OBJECTIVE The purpose of this study was to establish if, in elite junior tennis players, there is a difference between the dominant and nondominant shoulders in the internal and external range of motion (ROM) of the shoulder and to examine the effect of taping the dominant shoulder on glenohumeral internal and external rotation ROM. DESIGN Measurement of glenohumeral rotational ROM was performed on the dominant and nondominant shoulders in supine with the humerus abducted to 90 degrees. SETTING Training room at the New South Wales Institute of Sport tennis center, Homebush, New South Wales, Australia. PARTICIPANTS Eleven asymptomatic male subjects and 10 asymptomatic female subjects from an elite junior training squad participated in the study. INTERVENTION Humeral head repositioning with tape. MAIN OUTCOME MEASURE Glenohumeral ROM. RESULTS A statistically significant decrease in internal rotation for both the male and female groups between the dominant and nondominant shoulders, but only the female group had a significant increase in external rotation in the dominant compared with the nondominant shoulder. There was also a statistically significant increase in range between the tape and no tape conditions for each rotation condition. CONCLUSIONS The specific application of tape to the glenohumeral joint can immediately increase rotational ROM in the dominant arm of tennis players.
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25
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Yang JL, Chen SY, Chang CW, Lin JJ. Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders. ACTA ACUST UNITED AC 2009; 14:81-7. [DOI: 10.1016/j.math.2007.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 10/17/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
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Laudner KG, Stanek JM, Meister K. Differences in scapular upward rotation between baseball pitchers and position players. Am J Sports Med 2007; 35:2091-5. [PMID: 17687122 DOI: 10.1177/0363546507305098] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Baseball pitchers have been reported to have an increased prevalence of shoulder injury compared with position players such as infielders and outfielders. Furthermore, insufficient scapular upward rotation has been empirically linked with several of these shoulder disorders. However, the difference in scapular upward rotation between pitchers and position players is not known. HYPOTHESIS Pitchers will have decreased scapular upward rotation of their dominant shoulders compared with position players. STUDY DESIGN Descriptive laboratory study. METHODS Dominant shoulder scapular upward rotation was measured with the arm at rest and at 60 degrees , 90 degrees , and 120 degrees of humeral elevation among 15 professional baseball pitchers and 15 position players with no recent history of upper extremity injury. RESULTS Independent t tests showed pitchers have significantly less scapular upward rotation at 60 degrees (3.9 degrees , P = .011) and 90 degrees (4.4 degrees , P = .009) of humeral elevation compared with position players. CONCLUSION Baseball pitchers have less scapular upward rotation than do position players, specifically at humeral elevation angles of 60 degrees and 90 degrees . CLINICAL RELEVANCE This decrease in scapular upward rotation may compromise the integrity of the glenohumeral joint and place pitchers at an increased risk of developing shoulder injuries compared with position players. As such, pitchers may benefit from periscapular stretching and strengthening exercises to assist with increasing scapular upward rotation.
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Affiliation(s)
- Kevin G Laudner
- Biomechanics Laboratory, School of Kinesiology and Recreation, Illinois State University, Normal, Illinois 61790, USA.
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27
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Yang JL, Chang CW, Chen SY, Wang SF, Lin JJ. Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Phys Ther 2007; 87:1307-15. [PMID: 17684085 DOI: 10.2522/ptj.20060295] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to compare the use of 3 mobilization techniques--end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)--in the management of subjects with frozen shoulder syndrome (FSS). SUBJECTS Twenty-eight subjects with FSS were recruited. METHODS A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics. RESULTS Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did. DISCUSSION AND CONCLUSION In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.
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Affiliation(s)
- Jing-lan Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Lin JJ, Lim HK, Soto-quijano DA, Hanten WP, Olson SL, Roddey TS, Sherwood AM. Altered patterns of muscle activation during performance of four functional tasks in patients with shoulder disorders: Interpretation from voluntary response index. J Electromyogr Kinesiol 2006; 16:458-68. [PMID: 16324850 DOI: 10.1016/j.jelekin.2005.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 08/19/2005] [Accepted: 09/19/2005] [Indexed: 11/23/2022] Open
Abstract
Altered motor control of the shoulder muscles during performance of a specific motor task in patients with shoulder disorders (SDs) has been an interesting subject to researchers. This study compared shoulder muscle activation patterns by surface electromyography (sEMG), including the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) muscles, during four functional tasks in 25 patients with SDs and controls. A voluntary response index (VRI) was calculated, including magnitude and similarity index (SI), to quantify sEMG patterns during four functional tasks. Responsiveness and clinically meaningful levels of discrimination between patients and control for EMG magnitude and SI were determined. An altered pattern of motor control during four functional tasks was evident in the patients, in which greater EMG amplitude and abnormal EMG patterns were found. For SI among four functional tasks, normal subjects ranged from 0.80 to 1.00 while patients ranged from 0.70 to 0.99. High probabilities (97%) of discrimination between patients and normal subjects were found by SI method during an overhead height task (patients: 0.85-0.96, normal subjects: 0.95-1.00). Our results also suggest that an individual can be estimated to be abnormal when lower SI values are observed during the four functional tasks.
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Affiliation(s)
- Jiu-jenq Lin
- School of Physical Therapy and National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan
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Lin JJ, Lim HK, Yang JL. Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders. J Orthop Res 2006; 24:1044-51. [PMID: 16602114 DOI: 10.1002/jor.20126] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Shoulder tightness may cause altered kinematics and lead to development of subacromial impingement, tendinitis, and degenerative changes. In this investigation, the humeral head translations, scapular kinematics, and scapulohumeral rhythm were determined with a three-dimensional electromagnetic tracking device during arm elevations in six subjects with anterior shoulder tightness and in six subjects with posterior shoulder tightness to study the effects of anterior/posterior tightness on shoulder kinematics. Subjects with anterior tightness showed lower slopes in curves of glenohumeral elevation plotted against scapular upward rotation (scapulohumeral rhythm, 0.11 to 0.32; p = 0.021) and less posterior scapular tilt (2.9 to 7.5 degrees; p = 0.002) during arm elevations when compared to the group with posterior tightness. The humeral head was positioned less posteriorly (2.2 to 3.4 mm; p = 0.004) and more superiorly (3.8 to 7.0 mm; p < 0.0005) during arm elevation in subjects with posterior tightness. The alternations in shoulder kinematics between subjects with anterior and posterior shoulder tightness may be relevant to the development of subacromial impingement, tendinitis, and degenerative changes as seen in subjects with stiff shoulders.
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Affiliation(s)
- Jiu-Jenq Lin
- School of Physical Therapy and National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chun-Shan S Rd, Taipei, Taiwan, Republic of China
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