scholarly journals Effects of Repetitive Shoulder Activity on the Subacromial Space in Manual Wheelchair Users

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Yen-Sheng Lin ◽  
Michael Boninger ◽  
Lynn Worobey ◽  
Shawn Farrokhi ◽  
Alicia Koontz
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Shoulder Function ◽  
Subacromial Space ◽  
Wheelchair Users ◽  
Manual Wheelchair ◽  
Before And After ◽  
Acromiohumeral Distance ◽  
The Relationship ◽  
Subject Characteristics

This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Pairedt-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P<0.01) occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P=0.008). Increased shoulder pain was associated with AHD percentage narrowing after ER (P≤0.007). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.

scholarly journals Assessment of Subacromial Space and Its Relationship With Scapular Upward Rotation in College Baseball Players

2013 ◽  
Vol 22 (3) ◽  
pp. 216-223 ◽  
Author(s):  
Stephen John Thomas ◽  
Charles Buz Swanik ◽  
Thomas W. Kaminski ◽  
Jill S. Higginson ◽  
Kathleen A. Swanik ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Laboratory Setting ◽  
Subacromial Space ◽  
Baseball Players ◽  
Type Design ◽  
Dependent Variables ◽  
Injured Population ◽  
College Baseball ◽  
Acromiohumeral Distance ◽  
The Relationship

Context:Subacromial impingement is a common injury in baseball players and has been linked to a reduction in the subacromial space. In addition, it has been suggested that decreases in scapular upward rotation will lead to decreases in the subacromial space and ultimately impingement syndrome.Objective:The objective of this study was to evaluate the relationship between acromiohumeral distance and scapular upward rotation in healthy college baseball players.Design:Posttest-only study design.Setting:Controlled laboratory setting.Participants:24 healthy college baseball players.Intervention:Participants were measured for all dependent variables at preseason.Main Outcome Measures:Acromiohumeral distance at rest and 90° of abduction was measured with a diagnostic ultrasound unit. Scapular upward rotation at rest and 90° of abduction was measured with a digital inclinometer.Results:Dominant-arm acromiohumeral distance at rest and 90° of abduction (P = .694, P = .840) was not significantly different than in the nondominant arm. In addition, there was not a significant correlation between acromiohumeral distance and scapular upward rotation at rest and 90° of abduction for either the dominant or the nondominant arm.Conclusions:These results indicate that the acromiohumeral distance is not adapting in the dominant arm in healthy throwing athletes. In addition, a relationship was not identified between acromiohumeral distance and scapular upward rotation, which was previously suggested. These results may suggest that changes that are typically seen in an injured population may be occurring due to the injury and are not preexisting. In addition, scapular upward rotation may not be the only contributing factor to acromiohumeral distance.

Performing Clinical Exams at Specific Joint Positions May Help Identify Injured Regions of the Glenohumeral Capsule Following Anterior Dislocation

2012 ◽  
Author(s):  
Carrie A. Rainis ◽  
Daniel P. Browe ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Tissue Damage ◽  
External Rotation ◽  
Anterior Dislocation ◽  
Joint Position ◽  
Anterior Instability ◽  
Glenohumeral Ligament ◽  
Before And After ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
The Relationship

The anteroinferior glenohumeral capsule (anterior band of the inferior glenohumeral ligament (AB-IGHL), axillary pouch) limits anterior translation, particularly in positions of external rotation. [1, 2] Permanent tissue deformation that occurs as a result of dislocation contributes to anterior instability, but, the extent and effects of this injury are difficult to evaluate as the deformation cannot be seen using diagnostic imaging. Clinical exams are used to identify the appropriate location of tissue damage and current arthroscopic procedures allow for selective tightening of localized capsule regions; however, identifying the specific location for optimal treatment of each patient is challenging. Although the reliability of clinical exams has been shown to change with joint position [3] a standardized procedure has yet to be established. This lack of standardization is particularly problematic since capsule function is highly dependent upon joint position [4–7], and could be responsible for failed repairs attributed to plication of the wrong capsular region [8]. Understanding the relationship between the location of tissue damage and changes in capsule function following anterior dislocation could aid clinicians in diagnosing and treating anterior instability. Therefore, the objective of this work was to compare strain distributions in the anteroinferior capsule before and after anterior dislocation in order to identify joint positions at which clinical exams would be capable of detecting damage (nonrecoverable strain) in specific locations.

EFFECT OF MULLIGAN’S POSTEROLATERAL GLIDE ON SHOULDER ROTATOR STRENGTH, SCAPULAR UPWARD ROTATION IN SHOULDER PAIN SUBJECTS – A RANDOMIZED CONTROLLED TRIAL

2016 ◽  
Vol 19 (03) ◽  
pp. 1650014 ◽  
Author(s):  
Y. V. Raghava Neelapala ◽  
Y Ravi Shankar Reddy ◽  
Roopa Danait
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Controlled Trial ◽  
Acute Effect ◽  
Exercise Group ◽  
Before And After ◽  
Strength Formula ◽  
Improved Function ◽  
Rotation Strength ◽  
External Rotator

Background and objectives: Joints may have an effect on the function of the surrounding muscles through nociceptors and mechanoreceptors. Pain reduction in the shoulder might lead to improved function of the muscles surrounding the shoulder in individuals with shoulder pain. The aim of our work was to determine the acute effect of Mulligan’s posterolateral glide on shoulder rotator strength, scapular motor control, and pain in painful shoulders. Methodology: Individuals with shoulder pain were randomly assigned to a control active exercise group and an experimental Mulligan’s posterolateral glide group. VAS, scapular upward rotation and shoulder rotator strength were the outcomes measured before and after three sessions of intervention. Multivariate analysis of variance (MANOVA) was used to analyze the differences between the groups after the intervention. Results: A total of 31 subjects with shoulder pain participated in the study. After the intervention, VAS scores ([Formula: see text] (1, 29) [Formula: see text] 27, [Formula: see text]) and Shoulder external rotator strength ([Formula: see text] (1, 29) [Formula: see text] 4.6, [Formula: see text]) were statistically significantly different between both the groups as revealed by one-way MANOVA. There were no significant differences found between the groups in scapular upward rotation ([Formula: see text] (1, 29) [Formula: see text] 0.09, [Formula: see text]) and internal rotator strength ([Formula: see text] (1, 29) [Formula: see text] 0.03, [Formula: see text]) post treatment. Pain scores were lesser and the external rotation strength was higher after Mulligans’ mobilization when compared to active exercise. Conclusion: Mulligan’s mobilization with posterolateral glide was effective in reducing pain and improving external rotator strength in individuals with painful shoulders when compare to active exercise. There were no significant differences noted in shoulder internal rotator strength and scapular upward rotation.

Evaluation of the relationship of tibiofemoral kinematics before and after total knee replacement in an in vitro model of cranial cruciate deficiency in the dog

2016 ◽  
Vol 29 (06) ◽  
pp. 484-490 ◽  
Author(s):  
Rebecca Howie ◽  
Timothy Foutz ◽  
Curtis Cathcart ◽  
Jeff Burmeister ◽  
Steve Budsberg
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee ◽  
Tibiofemoral Kinematics ◽  
The Relationship

SummaryObjective: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro.Animals: Eight canine hemipelves.Methods: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage. Joint angles and translations of the femur relative to the tibia, including flexion-extension versus adduction-abduction, flexion-extension versus internal-external rotation, as well as flexion-extension versus each translation (cranial-caudal and lateral-medial) were calculated.Results: Significant differences were identified in kinematic data from limbs following TKR implantation as compared to the unaltered stifle. The TKR resulted in significant decreases in external rotation of the stifle during flexion-extension compared to the limb prior to any intervention, as well as increasing the abduction. The TKR significantly increased the caudal translation of the femur relative to the tibia compared to the unaltered limb. When compared with the cranial cruciate ligament-transection stage, TKR significantly decreased the ratio of the external rotation to flexion.Discussion: All three test periods showed significant differences from the unaltered stifle. The TKR did not completely restore the normal kinematics of the stifle.

scholarly journals Arthroscopic Superior Capsule Reconstruction Eliminates Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011 ◽  
Author(s):  
Teruhisa Mihata ◽  
Thay Q. Lee ◽  
AKIHIKO HASEGAWA ◽  
Takeshi Kawakami ◽  
Kunimoto Fukunishi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Healing Rate ◽  
External Rotation ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Shoulder Stiffness ◽  
Graft Healing ◽  
Acromiohumeral Distance ◽  
Tear Size ◽  
Shoulder Elevation

Objectives: We have developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function—particularly deltoid muscle function—and relieving pain. In this study, we evaluated whether arthroscopic SCR reversed preoperative pseudoparalysis in patients with irreparable rotator cuff tears. Methods: A series of 100 consecutive patients with irreparable rotator cuff tears that had failed conservative treatment underwent arthroscopic SCR using fascia lata autografts; 7 patients with deltoid weakness due to cervical or axillary nerve palsy and 3 patients with severe shoulder stiffness (passive shoulder elevation, less than 90°) before surgery were excluded from the study population. The remaining 90 patients were allocated into 3 groups according to their preoperative active shoulder elevation: (1) no pseudoparalysis: more than 90° of active shoulder elevation (48 patients; mean age, 66.3 years; mean tear size in anterioposterior direction, 3.5 cm); (2) moderate pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients maintained more than 90° elevation once the shoulder was elevated passively (27 patients; mean age, 68.1 years, mean tear size, 3.5 cm); and (3) severe pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients had a positive drop-arm sign (15 patients; mean age, 62.3 years, mean tear size, 4.9 cm). Physical examination, radiography, and magnetic resonance imaging were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. The American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, acromiohumeral distance, and healing rate were compared between patients with and without pseudoparalysis as well as between before surgery and at the final follow-up (mean, 48 months; range, 24 to 88 months) by using the t and chi-square tests. A significant difference was defined as P < 0.05. Results: ASES score, active elevation, active external rotation, and acromiohumeral distance increased significantly after arthroscopic SCR in patients with no pseudoparalysis, moderate pseudoparalysis, or severe pseudoparalysis. The graft healing rate was 96% (43 of 45) in patients with no pseudoparalysis, 96% (26 of 27) in those with moderate pseudoparalysis, and 87% (13 of 15) in the severe pseudoparalysis group. Postoperative ASES score, active elevation, active external rotation, acromiohumeral distance, and healing rate did not differ among the 3 patient groups. Pseudoparalysis was reversed in 96% (26 of 27) of patients with moderate pseudoparalysis and in 93% (14 of 15) patients with severe pseudoparalysis. Patients with residual moderate or severe pseudoparalysis had graft tears postoperatively. Conclusion: Arthroscopic SCR improved shoulder function and achieved superior stability in patients with previously irreparable rotator cuff tears both with and without pseudoparalysis. Providing that the graft did not tear postoperatively, arthroscopic SCR reversed preoperative pseudoparalysis. The graft healing rate after arthroscopic SCR did not differ between patients with and without pseudoparalysis.

Relationship between Shoulder Pain and Selected Variables in Patients with Hemiplegia

1988 ◽  
Vol 2 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Richard W Bohannon
Keyword(s):  
Body Weight ◽  
Shoulder Pain ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Independent Variables ◽  
Extensor Muscles ◽  
Shoulder External Rotation ◽  
Muscle Groups ◽  
The Relationship ◽  
External Rotator

This investigation was performed to clarify the relationship between six independent variable categories and shoulder pain (SP) in hemiplegia. In this study, 30 hemiplegic patients served as subjects. The Ritchie articular index was used to measure SP. The independent variables were age, body weight, time since onset of stroke, shoulder subluxation, range of shoulder external rotation, and plegic shoulder muscle group strength. Subluxation was judged by palpation. Range of shoulder external rotation was measured goniometrically. Strength of the shoulder internal and external rotator, abductor and extensor muscles was measured with a hand-held dynamometer and normalized against body weight. A strength balance ratio of the shoulder was also determined (external rotators + abductors/internal rotators + extensors). Variables were measured on admission and prior to discharge. Spearman correlations or chi-squares were determined between the initial and final measurements of the independent variables and SP. More than 80% of the patients had SP. Correlated significantly with SP at both assessments and across time were range of shoulder external rotation (−.574 to −.797), and strength of the shoulder external rotator (−.523 to −.583) and abductor (−.375 to −.519) muscles. Correlated significantly at one or more of the assessments were body weight, time since onset and the strength of the other muscle groups (including the strength ratio). Shoulder subluxation was not correlated with SP. Patients with greater weakness may be more prone to the development of pain because their muscles lack adequate strength to move the joint enough to prevent the development of adhesive capsulitis.

Bi-Articulate Approach to Addressing Shoulder Pain Issues in Manual Wheelchair Users

2008 ◽  
Author(s):  
Sarah R. Dubowsky ◽  
Sue Ann Sisto ◽  
Noshir A. Langrana
Keyword(s):  
Shoulder Pain ◽  
Shoulder Joint ◽  
Health It ◽  
Wheelchair Users ◽  
Manual Wheelchair ◽  
Joint Forces ◽  
Primary Means

Pain throughout wheelchair (WC) propulsion is a very real fact of life for individuals who use a manual WC as their primary means of locomotion. A number of studies have reported the prevalence of shoulder pain in manual wheelchair users (MWU’s) ranging between 30–73% [1, 2]. Questions exist as to what may cause the extent of such shoulder pain. It is possible that a lack of education on proper propulsion techniques leads to poor propulsion habits that can be detrimental to overall shoulder health. It is also possible that such acquired techniques translate into shoulder joint forces whose repetition and magnitude may be so high that they are injurious to the user.

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