Electromyographic analysis of selected shoulder muscles during shoulder rehabilitation exercises in patients after reversed shoulder arthroplasty.

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

Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain.

BACKGROUND: Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood. PURPOSE: This study aimed to investigate the relationship between shoulder pain and proprioception. STUDY DESIGN: This was a cross-sectional comparative study. METHODS: Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations. RESULTS: Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = -0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = -0.31 [-0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]). CONCLUSIONS: Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.

Humeral Torsion in Relation to Shoulder Range of Motion in Elite Field Hockey Players.

CONTEXT: Sport-specific adaptations in shoulder rotation range of motion (ROM) and the relationship with humeral torsion have been described in overhead-throwing sports. However, information is lacking for other shoulder-loading sports such as field hockey. Therefore, this study's purpose was to evaluate humeral torsion in elite, male field hockey players and explore its association with shoulder ROM. DESIGN: Cross-sectional study. METHODS: Twenty-five male, elite field hockey players were included. Humeral torsion and shoulder external and internal rotation ROM were evaluated bilaterally by ultrasound and an inclinometer smartphone application, respectively. RESULTS: Field hockey players showed a significantly increased humeral retroversion on the dominant compared with the nondominant side (P < .001; Cohen d = 1.75), along with a significantly increased external (P = .004; Cohen d = -0.64) and decreased internal rotation ROM (P = .003; Cohen d = 0.65). This finding illustrates a shift in total shoulder rotational ROM arc. Correlation analysis showed a significant moderate association between the increased humeral retroversion and decreased internal rotation ROM on the dominant side (r = .523). CONCLUSIONS: Elite male field hockey athletes show sport-specific adaptations regarding humeral torsion and shoulder rotation ROM, similar to throwing athletes. These findings increase our insight into the field hockey athlete's shoulder, which is essential to optimize performance and assist in correctly interpreting shoulder rotational ROM measurements.

Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain.

BACKGROUND: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts. METHODS: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus. RESULTS: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain; 17 items, in the "rationale and clinical reasoning" domain; 11 items, in the "subjective examination" domain; 44 items, in the "physical examination" domain; and 27 items, in the "treatment" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively). CONCLUSION: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.

The Effects of a Compensatory Training Program Adding an Isoinertial Device in the Shoulder Function on Young Tennis Players.

ABSTRACT: Fernandez-Fernandez, J, Moreno-Perez, V, Cools, A, Nakamura, FY, Teixeira, AS, Ellenbecker, T, Johansson, F, and Sanz-Rivas, D. The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players. J Strength Cond Res 37(5): 1096-1103, 2023-The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR ( p < 0.001, effect size [ES] = 1.83) and ER ( p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side ( p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM ( p < 0.001, ES = 3.32) and total ROM (TROM) ( p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM ( p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances.

Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes.

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Does the Activity in Scapular Muscles During Plyometric Exercises Change When the Kinetic Chain Is Challenged?-An EMG Study.

ABSTRACT: Werin, MB, Maenhout, AG, Icket, J, Jacxsens, N, Kempkes, E, and Cools, AM. Does the activity in scapular muscles during plyometric exercises change when the kinetic chain is challenged?-An EMG study. J Strength Cond Res 36(7): 1793-1800, 2022-Plyometric exercises for the shoulder are used in rehabilitation and in workout regime when the sport demands high speed power training. The aim of this clinical laboratory electromyography (EMG) study was to determine whether scapular muscle performance differs during plyometric shoulder exercises when changing the demand on the kinetic chain. Thirty healthy overhead athletes, with a mean age of 22.7 years (±2.2), performed 6 exercises, with both a low and a high demand on the kinetic chain, in prone, side and standing in positions. The EMG activity of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) on the tested side and bilateral of gluteus maximus (GM) and abdominal oblique externus (OE) was registered with wireless surface EMG. Intermuscular muscle ratios UT/SA, UT/MT, and UT/LT were also calculated. The level of significance set for the study was alpha = 0.05. The muscle ratio UT/SA was significantly lower (p < 0.05) when high demand on the kinetic chain compared with low. SA muscle activity showed significantly (<0.001) higher values in the prone position with high demand on the kinetic chain compared with low. All 3 trapezius muscle parts had significantly higher values (p < 0.001) in the prone compared with side and standing positions. The GM and OE showed significantly higher (p ≤ 0.01) activity in positions more demanding for the kinetic chain. When composing a strengthening or a rehabilitation program for athletes, the knowledge of how scapular and trunk muscles interact can be used to amplify the strengthening effect.

Angle-Specific Isokinetic Shoulder Rotational Strength Can be Reliably Assessed in Collision and Contact Athletes.

An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the test-retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured collision and contact athletes; (2) develop a normal descriptive profile of angle-specific rotational torque measurements in the same cohort; and (3) examine the effects of direction and joint angle on shoulder rotational strength interlimb asymmetries. Twenty-three collision and contact athletes were recruited for the interday reliability substudy and 47 athletes were recruited for the remaining substudies. We used intraclass correlation coefficients with 95% confidence intervals to quantify interday reliability of all variables. We used a 2-way repeated-measures analysis of variance to analyze differences in absolute interlimb asymmetries. Interday reliability for the isokinetic strength variables was good to excellent (0.78-0.90) on the dominant side and moderate to good (0.63-0.86) on the nondominant side. Maximum angle-specific torque (as well as peak torque) can be measured reliably in internally and externally rotated positions. A normal profile of clinically relevant, angle-specific shoulder rotational torque measurements for collision and contact athletes has been established which provides a reference when assessing shoulder strength in this population.

Association Between Lower Trapezius Isometric Strength and Y-Balance Test Upper Quarter Performance in College Volleyball Players.

CONTEXT: Knowing the possible association between the isometric strength of the shoulder rotators, scapular muscles, and the Y-balance test upper quarter (YBT-UQ) performance could help identify which indicators of shoulder stability should be considered in this field test. This study aimed to determine whether the isometric strength of the shoulder rotators and scapular muscles is associated with the YBT-UQ performance of the dominant upper limb in amateur volleyball players. DESIGN: Cross-sectional study. METHODS: A convenience sample of 22 male and 18 female volleyball players (≥12 h of training/week) between 18 and 26 years of age. The isometric strength of the middle trapezius, lower trapezius, serratus anterior, internal, and external rotator muscles was assessed with a handheld dynamometer. Participants performed the YBT-UQ in the superolateral, medial, and inferolateral directions. The absolute isometric peak force (in Newtons) was normalized to body weight (in Newtons per kilogram) for each muscle test. For each YBT-UQ direction, the distance (in centimeters) was normalized for upper limb length (in percentage). A backward multiple linear regression analysis was used to determine the associations between variables. RESULTS: The analysis revealed that the isometric strength of the lower trapezius (ß = 26.82; 95% confidence interval, 21.24-32.40) is associated with inferolateral YBT-UQ performance (adjusted R2 = .706; P < .001). This factor explains 70% of the variability of the YBT-UQ in the inferolateral direction. CONCLUSIONS: Lower trapezius isometric strength is associated with inferolateral YBT-UQ performance of the dominant upper limb in amateur volleyball players. These findings could help in the development of more specific training programs and rehabilitation goals according to the performance of the athletes in the test.

Shoulder Strength and Upper Body Field Performance Tests in Young Female Handball and Volleyball Athletes: Are There Differences Between Sports?

CONTEXT: Volleyball and handball players have usually been studied collectively as "overhead athletes," since throwing present similarities in the proximal to distal movement sequencing and upper limb joints ranges of motion. However, each sport presents specificities in the objectives when accelerating the ball and a variety of possible throwing techniques. Therefore, it is expected there may be differences in the shoulder and upper body physical performance between sports. OBJECTIVE: The aim of this study was to determine if there are differences in shoulder muscle strength and upper body field performance tests between volleyball and handball athletes. DESIGN: Cross-sectional. METHODS: Ninety-nine volleyball and handball female athletes aged between 13 and 20 years were evaluated for isometric shoulder abductor and rotator strength (handheld dynamometer) and upper body field performance tests: Y Balance Test-Upper Quarter, modified Closed Kinetic Chain Upper-Extremity Stability Test, and unilateral and bilateral Seated Medicine Ball Throw. RESULTS: Handball athletes presented greater shoulder internal rotation strength (between-group difference: 2.84; effect size 0.70), higher medial (between-group difference: 9.54; effect size 0.90), superolateral (between-group differences: 8.9; effect size 0.68), and composite scores (between-group difference 5.7; effect size 0.75) of the Y Balance Test-Upper Quarter and higher unilateral (between-group difference: 41.92; effect size 0.91) and bilateral (between-group difference: 46.11; effect size 0.83) Seated Medicine Ball Throw performance. Groups were not different for Closed Kinetic Chain Upper-Extremity Stability Test, external rotation, and abduction isometric strength. CONCLUSION: Our findings suggest that young female handball athletes present greater internal rotator strength and better performance in Y Balance Test-Upper Quarter and Seated Medicine Ball Throw compared to volleyball players. These differences may be related to the different demands required in the throwing movements performed in each sport and should be considered when assessing these populations.

Biomechanical upper-extremity performance tests and isokinetic shoulder strength in collision and contact athletes.

The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/contact athletes and (3) to establish a normal descriptive profile of the vertical ground reaction forces from the performance tests, in a cohort of contact/collision athletes. The study was split into two sub-sections; the inter-day reliability of three upper-extremity performance tests (n = 21) and a descriptive, correlation study investigating the relationship between isokinetic dynamometry and performance tests metrics (n = 39). We used intraclass correlation coefficients (absolute agreement, 2-way mixed-effects model) with 95% confidence intervals to quantify inter-day reliability of all variables. We used Pearson correlation coefficients to investigate associations between isokinetic strength and vertical ground reaction force asymmetry variables. Inter-day reliability was moderate-to-excellent for the upper-extremity performance tests (ICC 0.67-0.97). There was no statistically significant correlation between external and internal rotational peak torque and the variables of CPMU, PJ and BDL (r range = .02-.24).These upper-extremity tests are reliable for use with male contact/collision athletes.

Does an effective shoulder injury prevention program affect risk factors in handball? A randomized controlled study.

BACKGROUND: Shoulder problems are common in handball, but injury risk reduction is possible by implementing a prevention program. However, player compliance to the program remains a challenge, with feedback from players that the program is too time consuming. AIM: To develop a more efficient program, we aimed to assess the effect of the Oslo Sports Trauma Research Center shoulder injury prevention program on external rotation (ER) strength and internal rotation (IR) range of motion (ROM), considered to represent key risk factors for injury. METHODS: Four youth handball teams (three females, one males, 57 players, mean age 17.1 years) were randomized to an intervention or control group. The intervention program was conducted three times per week as a part of handball warm-up for 18 weeks, supervised by physical therapists. The main outcome variables were the between-group differences in ER strength and IR ROM change from baseline to postintervention. Isometric ER strength was measured with a handheld dynamometer and IR ROM with a digital goniometer. RESULTS: Mean dominant shoulder isometric ER strength increased both in the intervention (10%) and the control group (6%) during the intervention, but there was no significant group by time interaction (group difference: 0.06 N/kg (95% CI: -0.04 to 0.17). IR ROM did not change in either group during the intervention. CONCLUSION: The Oslo Sports Trauma Research Center shoulder injury prevention program did not affect the risk factors ER strength and IR ROM. The preventive effect of the program must therefore be due to other factors.

Changes in supraspinatus and biceps tendon thickness: influence of fatiguing propulsion in wheelchair users with spinal cord injury.

STUDY DESIGN: A quasi-experimental, pretest-posttest design. OBJECTIVES: To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI). SETTING: Biomechanical laboratory Swiss Paraplegic Research. METHODS: A population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured by using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast, and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels, and body weight. RESULTS: A reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (-1.39 mm; 95% CI: -2.28; -0.51) was identified after controlling for all potential confounders. Females who fatigued (n = 4) displayed a greater reduction in supraspinatus tendon thickness as compared with those who did not fatigue (n = 7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness. CONCLUSIONS: Acute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.

Subacromial space outlet in female patients with multidirectional instability based on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder measured by ultrasound.

OBJECTIVE: The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups. METHODS: Twenty-nine female patients with hEDS/HSD (aged 34 ± 12.9 years) and 20 healthy controls (aged 33 ± 10.8 years) participated in the study. The supraspinatus tendon (SST) thickness and AHD were measured using ultrasound. The interplay between the SST and the AHD was expressed as the occupation ratio (OcAHD), calculated as the SST thickness as a percentage of AHD. The measures were performed in the resting position and in subsequently 45° and 60° of active arm elevation in the scapular plane. RESULTS: The main finding is that patients with hEDS/HSD have a larger subacromial space outlet compared with the controls when measured by ultrasound. Furthermore, in both groups, we found an increased OcAHD during active arm elevation compared with the resting position, which indicates that similar mechanisms occur for patients with hEDS/HSD and healthy controls. CONCLUSION: Patients with hEDS/HSD have a larger available subacromial space outlet compared with healthy individuals. OcAHD increased during active arm elevation compared with the resting position in both groups. This knowledge is important when designing rehabilitation exercise programs for shoulder instability patients with abnormal glenohumeral biomechanics.

Electromyographic analysis of selected shoulder muscles during a series of exercises commonly used in patients with symptomatic degenerative rotator cuff tears.

BACKGROUND: In the nonoperative treatment of degenerative rotator cuff (RC) tears, exercise therapy is advocated. Exercises focusing on strengthening the anterior deltoid (AD) and the scapular muscles are proposed to compensate for RC dysfunction. However, the amount of electromyographic (EMG) activity in these muscles during these exercises remains unclear. Moreover, it is unknown whether muscle activity levels during these exercises alter with increasing age. Therefore, the purpose of this study was to evaluate EMG activity in the deltoid and scapular muscles during 2 series of commonly used shoulder rehabilitation exercises and assess possible age-related changes in muscle activity. METHODS: Fifty-five healthy participants (aged 18-60 years) participated in this study. Surface EMG activity was measured in 8 shoulder girdle muscles during a progression of a closed chain elevation program (bench and wall slides) and during a progression of previously published AD exercises. In addition, muscle activity was compared between 3 age categories (18-32 years, 33-46 years, and 47-60 years). RESULTS: The proposed progressions exhibited increasing activity from <10% of maximal voluntary isometric contraction to >20% of maximal voluntary isometric contraction for the AD for both exercise programs and for the middle deltoid, upper trapezius, and middle trapezius during the closed chain elevation exercises. Activity levels in the other muscles remained <20% throughout the progression. Age-related analysis revealed increased activity in the AD, infraspinatus, and middle trapezius and decreased lower trapezius activity during the bench and wall slides. No age-related changes were noted for the AD exercises. CONCLUSION: These findings may assist the clinician in prescribing appropriate progressive exercise programs for patients with symptomatic RC tears.

Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review.

STUDY DESIGN: This is a systematic review. INTRODUCTION: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. PURPOSE OF THE STUDY: The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics. METHOD: MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment. RESULTS: Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles. DISCUSSION: Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial. CONCLUSION: The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.

Proprioception: How is it affected by shoulder pain? A systematic review.

INTRODUCTION: Proprioception encompasses the submodalities of joint position sense (JPS), kinesthesia, sense of force, and velocity. Owing to the vast mobility of the shoulder, it heavily relies on an intact sense of proprioception. Moreover, shoulder injuries are associated with a decreased sense of proprioception. What remains unclear is how shoulder proprioception is affected by pain and competing nociceptive senses. PURPOSE OF THE STUDY: To summarize the literature evaluating the relationship between pain and shoulder proprioception. METHODS: A literature review was conducted from inception until 22 October 2018, using electronic databases (PubMed, Web of Science, Scopus, EBSCO, CINAHL, and Embase). Retrieved citations were screened for eligibility, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Eleven studies were included (n = 447 participants with shoulder pain, n = 20 with experimentally induced pain [EIP]/n = 600 painful shoulders and n = 20 [EIP]). The mean methodological quality of the studies was good (76%). Five studies investigated active JPS, four investigated passive JPS, six investigated kinesthesia, sense of force was measured in one study, and no study investigated sense of velocity. There is moderate evidence for impaired kinesthesia and low evidence for reduced sense of force among painful shoulders. Conflicting evidence is seen for the other proprioceptive submodalities. CONCLUSION: The overall impact of pain on shoulder JPS remains unclear, while moderate evidence for an affected sense of kinesthesia is possible. There is low evidence for an impaired sense of force among painful shoulders. Standardization between studies is lacking, limiting the range of our conclusions. Further investigation is required into well-controlled and pain-induced studies to better understand the influence of pain on shoulder proprioception.

A demographic study of acute injuries in basketball players.

Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. The purpose is to present an overview of the incidence of injuries and injury patterns in Flanders and to correlate them to possible intrinsic and extrinsic risk factors. All acute injuries that occurred in Flanders during 2009-2013, collected by the insurance, were analysed. The incidence and parameters such as date of birth, date of occurrence of the injury, gender and diagnosis were evaluated. Injury incidence varied from 7.40% up to 8.45%. Females and players at age 16-17, 14-15 and older than 30 are at higher risk. The ankle/foot region is most frequently injured. There is a higher risk of injury after season-and Christmas break. Age, gender and chronometry are risk factors to get injured. Sprains are the most frequent, while the nkle/foot region is the most susceptible to injury. Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. Female players and players at age 16-17, 14-15 and older than 30 are at higher risk to basketball injuries. The ankle/foot region is most frequently injured followed by lower arm and hand. There is a higher risk of injury after season-and Christmas break.

Can a Conservative Rehabilitation Strategy Improve Shoulder Proprioception? A Systematic Review.

CONTEXT: Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception. OBJECTIVES: To summarize the available evidence of conservative rehabilitation (ie, nonsurgical) on proprioception among individuals with shoulder disorders. EVIDENCE ACQUISITION: PubMed, Web of Science, and EBSCO were systematically searched, from inception until November 24, 2019. Selected articles were systematically assessed, and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were utilized for this review. The conservative treatments were categorized as follows: (1) conventional therapy, (2) proprioceptive training, (3) elastic kinesiology tape, and (4) other passive therapies. EVIDENCE SYNTHESIS: Twelve articles were included, yielding 58 healthy control shoulders and 362 shoulders affected by impingement syndrome, glenohumeral dislocations, nonspecific shoulder pain, rotator cuff dysfunction, or subluxation poststroke. The level of agreement between the evaluators was excellent (84.9%), and the studies were evaluated to be of fair to excellent quality (risk of bias: 28.5%-100%). This review suggests, with moderate evidence, that proprioceptive training (upper-body wobble board or flexible foil training) can improve proprioception in the midterm. No decisive evidence exists to suggest that conventional therapy is of added value to enhance shoulder proprioception. Conflicting evidence was found for the improvement of proprioception with the application of elastic kinesiology tape, while moderate evidence suggests that passive modalities, such as microcurrent electrical stimulation and bracing, are not effective for proprioceptive rehabilitation of the shoulder. CONCLUSIONS: Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic kinesiology tape does not appear to affect the sense of shoulder proprioception. This review suggests a possible specificity of training effect with shoulder proprioception.

Elite male field hockey players have symmetric isokinetic glenohumeral strength profiles, but show asymmetry in scapular muscle strength.

Shoulders of elite field hockey players are loaded continuously during play. However, shoulder girdle muscle performance in this population has never been examined yet. This study aimed to compare isokinetic shoulder girdle performance in elite male field hockey players to matched controls, with respect to strength, endurance and muscle balance. The complete male national field hockey team of Belgium (n = 25) was included and matched to a gender- and age-matched control group of healthy participants (n = 25). A Biodex system-4 dynamometer was used to measure glenohumeral and scapular muscle strength at 2 velocities in a concentric/concentric mode. With the main outcome measures being isokinetic strength values, peak force (protraction-retraction), peak torque (rotations), fatigue index and agonist/antagonist ratio's. Measurement results showed that elite male field hockey players were stronger than their matched controls, for both the rotational and the protraction-retraction movement. Concerning rotational strength, symmetrical findings were established, contrary to scapular strength, where side differences were noted. At low velocity, retraction peak force was higher on the dominant side. Protraction peak force was higher on the non-dominant side when measured at high velocity. In conclusion, elite field hockey players have a symmetrical rotational strength profile, in contrast to their scapular strength profile.