Does range of motion measurement and reference values differ?: a multi-centered study

This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p < 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p < 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p > 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3's range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.

Análise eletromiográfica de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica / Análisis electromiográfico de los músculos del complejo del hombro durante ejercicios de rotación externa con banda elástica / Electromyographic analysis of muscles of the shoulder complex during external rotation exercises with elastic band

RESUMO Na artrocinemática do ombro, o manguito rotador atua estabilizando a cabeça umeral em contato com a cavidade glenoidal, enquanto realiza a translação inferior para contrabalancear a força rotacional promovida principalmente pelo deltoide. Exercícios de rotação externa (RE) vêm sendo utilizados na reabilitação de pacientes com disfunções no complexo do ombro buscando restaurar a artrocinemática. Porém, poucos estudos abordam a utilização da faixa elástica e a avaliação dos músculos da cintura escapular, determinantes para uma cinemática adequada. O objetivo deste estudo é comparar a atividade eletromiográfica (EMG) de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. Participaram 11 sujeitos do sexo masculino que foram avaliados durante os movimentos de (1) RE em ortostase; (2) RE com abdução de ombro; (3) RE em decúbito lateral (DL). Os músculos avaliados pela EMG foram: (1) trapézio superior (TS); (2) deltoide médio (DM); (3) deltoide posterior (DP); e (4) infraespinal (IN). A resistência foi determinada por uma faixa elástica cinza calibrada com carga de 5% do peso corporal. A análise dos dados foi realizada no software Biomec-SAS e as estatísticas foram calculadas por meio da Anova de medidas repetidas no software SPSS v20.0. Pôde-se constatar que os músculos TS e DM obtiveram maior atividade EMG durante o exercício de RE com abdução de ombro, o músculo DP durante a RE com abdução de ombro e RE em decúbito lateral, enquanto o IN a obteve durante a RE em ortostase e RE em decúbito lateral.

RESUMEN En la artrocinemática del hombro, el manguito rotador actúa estabilizando la cabeza umeral en contacto a la cavidad glenoidal, mientras realiza la traslación inferior para contrarrestar la fuerza rotacional promovida principalmente por el deltoides. Los ejercicios de rotación externa (RE) se han utilizado en la rehabilitación de pacientes con disfunciones en el complejo del hombro buscando restaurar la artrocinemática. Pocos estudios abordan la utilización de la banda elástica y la evaluación de los músculos de la cintura escapular, determinantes para una cinemática adecuada. El objetivo de este estudio es comparar la actividad electromiográfica (EMG) de los músculos del complejo del hombro durante ejercicios de rotación externa con banda elástica. Participaron 11 sujetos, varones, que fueron evaluados durante el movimiento de (1) RE en ortostasis; (2) RE con abducción de hombro; y (3) RE en decúbito lateral (DL). Los músculos evaluados por la EMG fueron: (a) trapecio superior (TS); (b) deltoides central (DC); (c) deltoides posterior (DP) e (d) infraespinoso (IN). La resistencia se determinó mediante una banda elástica gris calibrada con carga del 5% del peso corporal. El análisis de los datos se realizó con la utilización del software BIOMEC-SAS, y las estadísticas por medio de la Anova de medidas repetidas en el software SPSS v20.0. Se pudo constatar que los músculos TS y DC obtuvieron mayor actividad EMG durante el ejercicio de RE con abducción de hombro, el músculo DP durante la RE con abducción de hombro y RE en decúbito lateral, mientras que el IN durante la RE en ortostasis y en decúbito lateral.

ABSTRACT In shoulder arthrokinematics, the rotator cuff acts on a lower base to counterbalance a glenoid cavity, while performing a lower translation to counterbalance a rotational force mostly provided by the deltoid. External rotation (ER) exercises have been used in the rehabilitation of patients with shoulder joint dysfunction, with the aim of restoring arthrokinematics. Few studies approached the use of the elastic band and the evaluation of the shoulder girdle muscles, essential for suitable kinematics. The objective of this study was to compare the electromyographic activity (EMG) of the muscles from the shoulder complex during external rotation exercises with elastic band. A total of 11 male subjects were evaluated during (1) ER in orthostasis; (2) ER with shoulder abduction; (3) ER with lateral decubitus. The muscles assessed by the EMG were: (a) upper trapezius (UT); (b) middle deltoid (MD); (c) posterior deltoid (PD) and (d) infraspinatus (IS). Resistance was made with a gray elastic band calibrated with a load of 5% body weight. Data analysis was performed using the application software BIOMEC-SAS and statistics for the repeated measures using ANOVA in SPSS version 20.0. The UT and MD muscles were found to have increased EMG activity during ER exercise with shoulder abduction, as well as the PD muscle during ER with shoulder abduction and ER in lateral decubitus, whereas IS had increased EMG activity during an ER in orthostasis and ER in lateral decubitus.

Development of Patient Transfer Techniques based on Postural-stability Principles for the Care Helpers in Nursing Homes and Evaluation of Effectiveness

PURPOSE: This study was done to develop a postural-stability patient transfer technique for care helpers in nursing homes and to evaluate its effectiveness. METHODS: Four types of patient transfer techniques (Lifting towards the head board of the bed, turning to the lateral position, sitting upright on the bed, transferring from wheel chair to bed) were practiced in accordance with the following three methods; Care helpers habitually used transfer methods (Method 1), patient transfer methods according to care helper standard textbooks (Method 2), and a method developed by the author ensuring postural-stability (Method 3). The care helpers' muscle activity and four joint angles were measured. The collected data were analyzed using the program SPSS Statistic 21.0. To differentiate the muscle activity and joint angle, the Friedman test was executed and the post-hoc analysis was conducted using the Wilcoxon Signed Rank test. RESULTS: Muscle activity was significantly lower during Method 3 compared to Methods 1 and 2. In addition, the joint angle was significantly lower for the knee and shoulder joint angle while performing Method 3 compared to Methods 1 and 2. DISCUSSION: Findings indicate that using postural-stability patient transfer techniques can contribute to the prevention of musculoskeletal disease which care helpers suffer from due to physically demanding patient care in nursing homes.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

BACKGROUND: There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. METHODS: Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. RESULTS: There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). CONCLUSIONS: The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Biomechanical Comparison of the Latarjet Procedure with and without Capsular Repair

BACKGROUND: The purpose of this study was to determine if capsular repair used in conjunction with the Latarjet procedure results in significant alterations in glenohumeral rotational range of motion and translation. METHODS: Glenohumeral rotational range of motion and translation were measured in eight cadaveric shoulders in 90degrees of abduction in both the scapular and coronal planes under the following four conditions: intact glenoid, 20% bony Bankart lesion, modified Latarjet without capsular repair, and modified Latarjet with capsular repair. RESULTS: Creation of a 20% bony Bankart lesion led to significant increases in anterior and inferior glenohumeral translation and rotational range of motion (p < 0.005). The Latarjet procedure restored anterior and inferior stability compared to the bony Bankart condition. It also led to significant increases in glenohumeral internal and external rotational range of motion relative to both the intact and bony Bankart conditions (p < 0.05). The capsular repair from the coracoacromial ligament stump to the native capsule did not significantly affect translations relative to the Latarjet condition; however it did cause a significant decrease in external rotation in both the scapular and coronal planes (p < 0.005). CONCLUSIONS: The Latarjet procedure is effective in restoring anteroinferior glenohumeral stability. The addition of a capsular repair does not result in significant added stability; however, it does appear to have the effect of restricting glenohumeral external rotational range of motion relative to the Latarjet procedure performed without capsular repair.

Prevention of shoulder injuries in overhead athletes: a science-based approach

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.

Arthroscopic treatment of refractory adhesive capsulitis of the shoulder / Tratamento artroscópico da capsulite adesiva refratária do ombro

OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66), predominantly female (90%), six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40%) and six secondary (60%). RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001). By the Constant Score (range of motion), there was an increase of 13.8 (average pre) to 32 points (average post). CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years. .

OBJETIVO: avaliar os resultados do tratamento artroscópico da capsulite adesiva refratária do ombro, relacionados à melhora da amplitude de movimentos, após seguimento mínimo de seis anos. MÉTODOS: do período de agosto de 2002 a dezembro de 2004, dez pacientes com capsulite adesiva do ombro resistentes ao tratamento conservador foram submetidos à cirurgia artroscópica. Foi colocado um cateter interescalênico para analgesia pós-operatória, antes do procedimento. Todos se encontravam na Fase II, com seguimento mínimo de dois anos. A média de idade foi 52,9 anos (39 a 66), com predominância do sexo feminino (90%), sendo seis ombros do lado esquerdo. O tempo entre o aparecimento dos sintomas e o tratamento operatório variou de seis a 20 meses. Foram encontradas quatro capsulites adesivas na forma primária (40%) e seis secundárias (60%). RESULTADOS: a média ativa pré-operatória da elevação anterior foi 92°, da rotação externa 10,5° da rotação interna nível L5 e a média ativa pós-operatória foi 149°, 40° e nível T12, respectivamente. Portanto, os ganhos médios foram de 57° na elevação anterior, 29,5° na rotação externa e seis processos espinhosos. Houve diferença significativa nos ganhos de movimentos entre o pré e o pós-operatório (p<0,001). Pela pontuação de Constant (amplitude de movimentos), houve um aumento de 13,8 (média pré) para 32 pontos (média pós). CONCLUSÃO: o tratamento artroscópico mostrou-se eficaz na capsulite adesiva refratária do ombro, resistente ao tratamento conservador, melhorando a amplitude dos movimentos articulares de pacientes avaliados após seguimento mínimo de seis anos. .

Shoulder isokinetic profile of male handball players of the Brazilian National Team

BACKGROUND: Data obtained on an isokinetic dynamometer are useful to characterize muscle status and have been reported in muscle imbalance studies in different types of sport. However, few studies have assessed elite handball players to establish reference values. OBJECTIVE: The purpose of this study was to compare, for the dominant (D) and non-dominant (ND) side, the isokinetic profile of shoulder rotator muscle strength between male handball players (H) and asymptomatic non-athletes (NA). METHOD: Isokinetic concentric and eccentric strength tests for D upper limbs were performed by the H group (n=20) and the NA group (n=12). Internal and external rotator muscle peak torque in concentric action was assessed at 60°/s and 300°/s and in eccentric action at 300°/s. We also calculated conventional balance (the ratio of external rotator peak torque to internal rotator peak torque in concentric action) and functional balance (the ratio of external rotator peak torque in eccentric action to internal rotator peak torque in concentric action). RESULTS: In the H group, dominant limbs were stronger in concentric action for external rotation at 60 and 300°/s. The conventional balance ratio for the D side was significantly lower at 60 and 300°/s for H compared to NA. The functional ratio for the D side was significantly lower at 300º/s for H compared to NA. CONCLUSIONS: Compared to asymptomatic non-athletes, handball players presented significant muscular imbalance resulting from daily sports practice, a known risk factor for shoulder injuries. .

Análise da variação dos valores da rotação medial conforme a posição da diáfise do úmero / Analysis on the variation of medial rotation values according to the position of the humeral diaphysis

OBJETIVO: Analisar a validade da medida de rotação medial (RM) do ombro pelos níveis vertebrais conforme a variação da posição da diáfise do úmero, testando o bigoniômetro como novo instrumental de aferição. MÉTODOS: Foram avaliados, prospectivamente, 140 ombros (70 pacientes) que tinham limitação da RM do ombro unilateral. Avaliou-se, por meio da escala visual, o nível vertebral e correlacionou-se com o ângulo obtido conforme a posição da diáfise do úmero utilizando o bigoniômetro desenvolvido com a Engenharia Mecânica do Mackenzie. RESULTADOS: O nível vertebral máximo alcançado na RM do lado não acometido variou de T3 a T12, e para o lado acometido variou de T6 a trocânter. Já quando o membro acometido foi reposicionado em RM de acordo com os valores angulares do lado normal, 57,13% dos pacientes alcançaram níveis mais baixos entre sacro, glúteo e trocânter. Analisando o nível vertebral máximo alcançado e a variação entre o ângulo x (plano frontal: abdução e RM do ombro) acometido e o ângulo x não acometido em RM, verificamos que quanto maior a angulação do eixo da diáfise menor a variação do nível vertebral alcançado. Avaliando a correlação linear entre as variáveis diferença do nível vertebral máximo alcançado e a variação do ângulo y (extensão e adução do ombro) acometido e ângulo y não acometido em RM, verificamos que não há uma relação linear bem estabelecida entre estas variáveis. CONCLUSÃO: A medida da RM pelos níveis vertebrais não corresponde aos valores reais, pois varia conforme o posicionamento da diáfise do úmero.

OBJECTIVE: To analyze the validity of measurements of shoulder medial rotation (MR) of the shoulder, using vertebral levels, according to the variation in the position of the humeral diaphysis, and to test the bi-goniometer as a new measuring instrument. METHODS: 140 shoulders (70 patients) were prospectively evaluated in cases presenting unilateral shoulder MR limitation. The vertebral level was evaluated by means of a visual scale and was correlated with the angle obtained according to the position of the humeral diaphysis, using the bi-goniometer developed with the Department of Mechanical Engineering of Mackenzie University. RESULTS: The maximum vertebral level reached through MR on the unaffected side ranged from T3 to T12, and on the affected side, from T6 to the trochanter. Repositioning of the affected limb in MR according to the angular values on the normal side showed that 57.13% of the patients reached lower levels, between the sacrum, gluteus and trochanter. From analysis on the maximum vertebral level attained and the variation between the affected angle x (frontal plane: abduction and MR of the shoulder) and the unaffected angle x in MR, we observed that the greater the angle of the diaphyseal axis was, the lower the variation in the vertebral level attained was. From evaluating the linear correlation between the variables of difference in maximum vertebral level reached and variation in the affected angle y (extension and abduction of the shoulder) and the unaffected angle y in MR, we observed that there was no well-established linear relationship between these variables. CONCLUSION: Measurement of MR using vertebral levels does not correspond to the real values, since it varies according to the positioning of the humeral diaphysis.

Effects of Passive Upper Arm Exercise on Range of Motion, Muscle Strength, and Muscle Spasticity in Hemiplegic Patients with Cerebral Vascular Disease

PURPOSE: The purpose of this study was to investigate the effects of passive upper arm exercise on range of motion, muscle strength, and muscle spasticity in hemiplegic patients with cerebral vascular disease. METHODS: A quasi-experimental design with nonequivalent control group was utilized. According to inclusion criteria, 25 patients were assigned to the control group with routine care, followed by 25 to the intervention group with passive exercise for 30 minutes per session, twice a day for 2 weeks. Eighteen patients in the intervention group and 17 in the control group completed the posttest measurement, including range of motion for upper arm joints, manual muscle test, and Modified Ashworth Scale for muscle spasticity. RESULTS: The intervention group had a significantly improved range of motion in the shoulder and wrist joints. No interaction effect was found for the elbow joint. No significant differences were found in muscle strength or muscle spasticity between the groups. CONCLUSION: Results of the study indicate that passive exercise safely applied for two weeks improves range of motion in joints of the upper arm in these patients. Further study with long-term follow-up is needed to verify the role of passive exercise in preventing muscle spasticity in this population.

Upper extremity joint stresses during walkerassisted ambulation in post-surgical patients / Estresse articular no membro superior durante marcha assistida por andador em pacientes pós-cirúrgicos

BACKGROUND: A walker is a common device prescribed for ambulatory assistance for individuals with balance difficulties or to reduce lower extremity demands following injury or surgery. The long-term use of a walker imposes significant demands on the patient's upper extremities that may lead to increased risk for development of secondary conditions such as wrist, elbow or shoulder pain. OBJECTIVE: To describe the joint kinematics, forces and moments of the wrist, elbow and shoulder in a sample of twenty patients that were using a walker as a result of total joint surgery of the hips and knees. METHODS: Three-dimensional upper extremity kinematics were recorded using a motion capture system synchronized with forces and torques transmitted through a walker instrumented with force transducers in the handles. RESULTS: Compressive forces were found to be nearly 20 percent of the body weight at each of the upper extremity joints, both surgical and non-surgical sides, being the greatest force at the wrist and decreasing proximally. Compression forces were greater in the non-surgical side limb at the wrist and at the elbow. CONCLUSION: Our findings indicated that loads on upper extremity joints associated with the use of a walker for assisted ambulation are high and further studies are needed to address the cause-effect relationship between the actual joint loading and the development of secondary musculoskeletal upper extremity complaints in more frail patients.

CONTEXTUALIZAÇÃO: Um andador é um dispositivo frequentemente prescrito para auxiliar a marcha de indivíduos com dificuldades de equilíbrio ou para reduzir demandas à extremidade inferior após cirurgia ou lesão. O uso prolongado de um andador impõe significante demanda para a extremidade superior do paciente, o que pode levar a um risco aumentado de desenvolver condições secundárias, como dor no punho, cotovelo e ombro. OBJETIVO: Descrever a cinemática articular, forças e momentos do punho, cotovelo e ombro de uma amostra de 20 pacientes que faziam uso de um andador após cirurgia de substituição articular do joelho ou quadril. MÉTODOS: A cinemática tridimensional foi registrada usando um sistema de captura de movimento sincronizado com o registro de transdutores de força, que mediam a força transmitida através do andador. RESULTADOS: Este estudo revelou forças de até 20 por cento do peso corporal nos transdutores, com forças compressivas maiores do lado do membro inferior não operado, no punho e no cotovelo. CONCLUSÃO: Os achados indicam que demandas no membro superior associadas ao uso de andador como dispositivo auxiliar da marcha são grandes, e mais estudos são necessários para averiguar relações de causa-efeito entre as reais sobrecargas articulares e o desenvolvimento de queixas musculoesqueléticas no membro de pacientes em condições de debilidade.

Características biomecânicas da articulação escapulotorácica no retorno da elevação dos membros superiores: uma revisão da literatura / Biomechanical characteristics of the scapulothoracic joint while lowering the arms: a literature review

Observações clínicas indicam que os indivíduos com disfunções no complexo articular do ombro descrevem o movimento de retorno da elevação dos membros superiores (MMSS) como mais doloroso que a elevação. O objetivo deste estudo foi realizar uma revisão da literatura sobre as características biomecânicas da articulação escapulotorácica no retorno da elevação dos MMSS em indivíduos saudáveis e com disfunções no complexo articular do ombro. Para isso, foram realizadaspesquisas nas bases de dados MedLine (PubMed), LILACS, Scielo e PEDRo seguida de busca manual e, após análise de um total de 232 estudos encontrados, 14 foram selecionados por atenderam aos critérios de inclusão previamente estabelecidos. Desses, oito investigaramcaracterísticas cinemáticas, seis características eletromiográficas, sendoque dois estudos investigaram as duas características associadas e apenasdois apresentaram resultados relacionados a indivíduos com disfunçõesno complexo articular do ombro. Os resultados desses estudosdemonstraram que, durante o retorno, os movimentos tridimensionais da articulação escapulotorácica envolvem a combinação de rotação inferior (eixo perpendicular ao plano da escápula), inclinação anterior (eixo medial-lateral) e rotação interna (eixo vertical) seja o retorno realizado no plano frontal (retorno da abdução), sagital (retorno da flexão) ou no plano escapular. Dessa forma, o retorno da elevação dos MMSSresulta em reversão dos movimentos escapulotorácicos que ocorremdurante a elevação, mas apresenta diferenças significativas nas posiçõesangulares da articulação escapulotorácica em relação à elevação,principalmente para os movimentos de rotação interna e inclinação anterior. A escassez de estudos que avaliaram as características biomecânicas da articulação escapulototácica em indivíduos com disfunções no complexo articular do ombro limita a compreensão da cinemática e atividade muscular nessa população específica.

Clinical observations have shown that subjects with disorders of the shoulderjoint complex describe the lowering of the arms to be more painful than their elevation. The relevance of the scapulothoracic joint is important inunderstanding the kinematics and muscle activity in the shoulder joint complex, as well as the specific features of the arm-lowering movement. Therefore, the aim of this study was to conduct a critical review of the biomechanicalcharacteristics of the scapulothoracic joint during the loweringof the arms in healthy subjects and in subjects with shoulder disorders. Acomputerized search was performed in MEDLINE, SCIELO, LILACS and PEDrodatabases. Manual searching was then done and, after analyzing the 232 studies that were found, 14 remained eligible to be included according to the inclusion criteria previously established. Of these, eight investigated kinematic characteristics and six, electromyographical characteristics. Twostudies analyzed both characteristics, and only two gave results relatedto individuals with shoulder disorders. The results of these studies showedthat during the lowering of the arms, the three-dimensional movements of the scapulothoracic joint involved a combined movement of downwardrotation (axis perpendicular to the scapular plane), anterior tilt (mediallateral axis), and internal rotation (vertical axis) in the frontal (lowering of arm abduction), sagittal (lowering of arm flexion), and scapular planes. Thus, the lowering of the arms is considered to be a reverse movement ofthe scapulothoracic movements during arm elevation. However, there aresignificant differences in angular positions of the scapulothoracic jointwhen compared to arm elevation, especially in the downward rotation andtilt movements. The isolated muscular activity and the co-activation of thescapulothoracic muscles gradually lessen during the lowering of the arms and show lower magnitude than during the elevation phase. The scarcity of...

Força do manguito rotador em indivíduos com síndrome do impacto comparado ao lado assintomático / Rotator cuff strength in subjects with shoulder impingement syndrome compared with the asymptomatic side

OBJETIVO: Avaliar a força muscular de rotação interna, externa e elevação dos ombros sintomáticos comparado aos assintomáticos, associando a força muscular à função da articulação. MÉTODOS: Quarenta e oito indivíduos com diagnóstico de SIO unilateral foram avaliados quanto a força muscular isométrica do ombro sintomático e assintomático (utilizando um dinamômetro isométrico manual), além de serem avaliados quanto a função utilizando a escala de Constant-Murley. Os indivíduos foram distribuídos em 2 grupos: grupo 1 = 35 a 49 anos; grupo 2 = 50 a 65 anos. RESULTADOS: Foi encontrada redução da força de rotação interna, externa e elevação no ombro sintomático, comparado ao lado assintomáticos (p< 0,0001), mas não foi observada redução da força de rotação medial nos sujeitos do grupo 1. Também observamos que a força muscular é diretamente proporcional a função do ombro, onde indivíduos com pouca força do manguito rotador apresentam menor função. CONCLUSÃO: A SIO causa diminuição da força muscular de rotação interna, externa e elevação comparado ao lado assintomático, além de causar diminuição da função do ombro. A redução da função é proporcional a diminuição da força muscular do manguito rotador. Nível de Evidência III, Estudo analítico.

OBJECTIVE: To evaluate the strength of internal rotation, external rotation and elevation of the shoulders of symptomatic compared with asymptomatic patients, associating muscle strength with joint function. METHODS: Forty-eight individuals diagnosed with unilateral SIS were evaluated in relation to isomeric muscle strength of symptomatic and asymptomatic shoulders (using a hand-held isometric dynamometer), in addition to evaluating function using the Constant-Murley scale. The subjects were divided into 2 groups: group 1 = 35 to 49 years, group 2 = 50 to 65 years. RESULTS: A reduction in strength of internal rotation, external rotation and elevation of the symptomatic shoulder were found, compared with the asymptomatic side (p <0.0001), but there was no reduction in the strength of medial rotation in the subjects of group 1. It was observed that muscle strength is directly proportional to shoulder function, with individuals with little strength of the rotator cuff having less function. CONCLUSION: SIS causes decreased muscle strength of internal rotation, external rotation and elevation compared with the asymptomatic side. It also causes decreased shoulder function. The reduced function is proportional to the decrease in muscle strength of the rotator cuff. Level of evidence: level III, analytical study.

Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20 percent) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60 percent and 57.80 percent and non-surgical, 62.06 percent and 54.06 percent, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27 percent; non-surgical, 98.61 percent). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

Effectiveness of Subacromial Anti-Adhesive Agent Injection after Arthroscopic Rotator Cuff Repair: Prospective Randomized Comparison Study

BACKGROUND: Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. METHODS: Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. RESULTS: The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. CONCLUSIONS: A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.

Avaliação muscular isocinética da articulação do ombro em atletas da Seleção Brasileira de voleibol sub-19 e sub-21 masculino / Isokinetic muscular assessment of the shoulder joint in athletes from the male under-19 and under-21 Brazilian volleyball teams

INTRODUÇÃO E OBJETIVO: A musculatura do complexo do ombro possui um papel importante na produção de força e potência articular no voleibol, permitindo a realização do gesto esportivo de maneira coordenada. A documentação objetiva produzida pela avaliação isocinética auxilia no diagnóstico e na prevenção de lesões do complexo do ombro, além de ser uma ferramenta útil no prognóstico do retorno rápido e seguro para a prática esportiva do atleta lesionado. O objetivo deste estudo foi avaliar o desempenho muscular isocinético dos músculos rotadores laterais e mediais da articulação glenoumeral em atletas de voleibol da Seleção Brasileira Masculina sub-19 e sub-21. MÉTODOS: O protocolo realizado durante o teste foi de cinco repetições máximas de rotação lateral e medial de ombro no modo concêntrico-concêntrico na velocidade de 60º/s e 30 repetições na velocidade de 360º/s. Análise de variância (ANOVA) mista foi utilizada para avaliar as variáveis dependentes: trabalho máximo e torque máximo normalizados pela massa corporal dos músculos rotadores laterais e mediais do ombro, razão agonista/antagonista nas duas velocidades e índice de fadiga muscular. RESULTADOS: A análise dos dados demonstrou haver um desequilíbrio entre os rotadores laterais e mediais (razão agonista/antagonista) da articulação do ombro em atletas brasileiros de voleibol da categoria sub-21, revelando menor força relativa dos rotadores laterais. CONCLUSÃO: Foi possível identificar alterações em atletas de voleibol que, associadas a demandas específicas do esporte, podem levar à sintomatologia no complexo do ombro e/ou queda da performance.

INTRODUCTION AND PURPOSE: The shoulder complex muscles play an important role in force, power and endurance production in volleyball, allowing the accomplishment of movement in a coordinated manner. The objective written account produced by isokinetic evaluations assists in the diagnosis and prevention of shoulder complex injuries. In addition, it is a useful tool in promoting safe and fast return of the injured athlete to sports practice. The purpose of this study was to analyze the isokinetic muscle performance of the lateral and medial rotators of the glenohumeral joint in Brazilian male volleyball teams (under-19 and under-21). METHODS: The protocol used during the test included five maximum repetitions of shoulder lateral and medial rotation in concentric-concentric mode at 60º/s and 30 repetitions at 360º/s. Analysis of variance was used to evaluate the dependent variables: maximum work and maximum torque of shoulder lateral and medial rotators normalized by body mass, antagonist/agonist ratio at the two speeds and muscular fatigue index. RESULTS: Data analysis demonstrated an imbalance between the shoulder lateral and medial rotators (antagonist/agonist ratio) in the under-21 category of the Brazilian volleyball athletes, demonstrating relative weakness of the lateral rotators. CONCLUSION: It was possible to identify changes in volleyball players, which added to specific demands of the sport, can lead to symptoms in the shoulder complex and / or decrease of performance.

Associação entre discinesia escapular e dor no ombro de praticantes de natação / Association between scapular dyskinesia and shoulder pain in swimmers

A escápula possui funções essenciais no ombro do atleta de arremesso. Qualquer desequilíbrio presente entre as estruturas responsáveis pela sua estabilidade originará uma condição denominada discinesia escapular, a qual é comumente acompanhada de dor no ombro. Este estudo tem o objetivo de verificar se há associação entre a discinesia escapular e a dor no ombro de praticantes de natação. Foi realizado um estudo analítico observacional de corte transversal, incluindo 36 praticantes de natação do sexo masculino, com idade de 18 a 36 anos. Como métodos diagnósticos sugestivos de discinesia escapular foram utilizados o Slide Lateral Scapular Test e a filmagem proposta por Kibler. A existência de proporções significativas entre as variáveis nominais foi comprovada pelo teste do qui-quadrado ou pelo teste exato de Fisher. Para identificar associações entre as variáveis contínuas e os grupos de estudo foi utilizado o teste t de Student. Um p < 0,05 foi considerado estatisticamente significante. O grau de concordância interexaminador (Kappa; p < 0,0001) foi considerado substancial, correspondendo a 86,1 por cento (0,7656) no ombro direito e 83,3 por cento (0,6412) no esquerdo. Constatou-se que a grande maioria (80 por cento) dos indivíduos que apresentaram positividade no Slide Lateral Scapular Test relatou dor no ombro. Dentre os nadadores que apresentaram discinesia escapular durante a filmagem, em 70,8 por cento também foi constatada a presença dessa condição no teste estático. Este é um estudo original no que diz respeito à abordagem da discinesia escapular em nadadores e em relacioná-la com a presença de dor no ombro. Porém, a hipótese inicial de que haveria uma associação significante não foi correspondida.

The scapula plays an essential role in the throwing motion performed by athletes. Scapular dyskinesia is a condition characterized by imbalance in the structures responsible for the joint stability, which is often accompanied by shoulder pain. The main objective of this study is to assess the relationship between scapular dyskinesia and shoulder pain in swimmers. A total of 36 male swimmers aged between 18 and 36 years were diagnosed for scapular dyskinesia utilizing two different methods: the Lateral Slide Scapular Test and the video recording method suggested by Kibler. Statistical analysis was performed using the Chi-square test or Fisher's exact test. Comparisons between groups were performed using the t-test. The degree of p< 0.05 was considered statistically significant. Significance was set at á=0.05. There was a high inter-rate reliability concerning the video analysis (Kappa; p<0.0001), corresponding to 86.1 percent (0.7656) on the right shoulder and 83.3 percent (0.6412) on the left shoulder. The majority of the individuals that had positive diagnosis assessed by the Lateral Slide Scapular Test (80 percent) reported pain on the shoulder. Furthermore, 70.8 percent of the subjects who had positive diagnosis by the video recording also had positive diagnosis in the static test. Although a significant association between scapular dyskinesia and shoulder pain was not found, this is an important study to approach these conditions in swimmers.

[Normalized electromyography of shoulder muscles during selected functional tasks of upper limb in patients with shoulder impingement syndrome]

Precise muscle activity pattern is required to maintain normal shoulder function and any alteration in muscle activity can result in movement impairment. The purpose of this study was to assess normalized electromyography [EMG] of shoulder muscles during selected functional tasks of upper limb in patients with shoulder impingement syndrome. Test group consisted of 15 subjects with shoulder impingement syndrome selected by nonprobability convenient sampling and control group consisted of 15 matched healthy subjects. In each group selected exercises including open kinetic chain with and without external load and closed kinetic chain with axial load were done and during each exercise surface EMG from selected muscle was recorded. There was significant difference between the two groups in the activities of upper trapezius, infraspinatus and three regions of deltoid muscle [P<0.05].changes in normalized EMG were task dependent. Among all selected exercises, D2E showed minimum changes and tripod showed maximum changes in muscle activity domain. Decrease in activity domain of infraspinatus and trapezius muscles in patients with shoulder impingement syndrome causes impairment of shoulder function. D2E with causing minimum changes and Tripod with causing maximum changes in muscles activity domain are suggested respectively as the first and the last activity patterns in the treatment of these patients

Avaliação ultra-sonográfica da articulação do ombro em nadadores de nível competitivo / Sonographic evaluation of the shoulder joint in competitive swimmers

OBJETIVO: Avaliar o ombro de nadadores em nível competitivo, sintomáticos ou não, e quantificar a incidência de lesões do manguito rotador nesses atletas. MATERIAIS E MÉTODOS: Foram estudados, por meio de exame ultra-sonográfico, ambos os ombros de 11 nadadores de nível competitivo (categoria master), sendo oito homens e três mulheres, com idade variando de 28 a 52 anos, tanto sintomáticos quanto assintomáticos, para determinação de alterações e correlação com quadro clínico. Os exames foram realizados avaliando-se os tendões que compõem o manguito rotador em pelo menos dois planos ortogonais distintos, assim como as estruturas não-tendíneas que fazem parte da articulação do ombro. As alterações tendíneas foram classificadas como tendinose, prováveis roturas intra-substanciais e roturas parciais. As lesões não-tendíneas foram classificadas como presentes ou ausentes. Além do exame, foram consideradas, na análise dos resultados, a presença ou ausência de sintomas e a idade dos pacientes. RESULTADOS: A prevalência geral de indivíduos sintomáticos foi de 63,6 por cento (sete atletas). Neste grupo encontravam-se 75 por cento das bursites e 100 por cento das roturas tendíneas parciais. Entre as alterações tendíneas isoladas, o tendão mais freqüentemente acometido foi o supra-espinal, tendo alteração de seu padrão ecográfico em 36,36 por cento. A tendinose foi o achado mais prevalente, estando presente em pelo menos um dos tendões em 50 por cento dos ombros estudados. A incidência de roturas parciais foi semelhante à observada na população geral, sendo de 13 por cento, estando estas, sempre que presentes, na faixa etária acima de 40 anos. CONCLUSÃO: Nadadores não parecem ter maior incidência de roturas ou degenerações tendíneas quando comparados com indivíduos da população geral. A idade dos indivíduos, sendo estes praticantes ou não de atividades que exijam sobrecarga desta articulação, é o fator com maior determinância em relação às lesões...

OBJECTIVE: To evaluate the shoulders of symptomatic or asymptomatic competitive swimmers, quantifying the incidence of rotator cuff lesions in these athletes MATERIALS AND METHODS: Eleven (eight male and three female) symptomatic and asymptomatic, competitive swimmers (master category) in the age range between 28 and 52 years, had both shoulders prospectively evaluated by ultrasonography for determining the prevalence of injuries in correlation with clinical findings. The studies included at least two orthogonal planes of rotator cuff tendons, as well as non-tendinous components of the shoulder joint. Tendinous findings were classified into tendinosis, probable full-thickness tears and partial-thickness tears. Non-tendinous findings were classified into present or absent. Additionally to the sonographic studies results, the analysis has taken the presence or absence of symptoms and the patients' age into consideration. RESULTS: Overall, the prevalence of symptomatic patients was higher (63.6 percent; seven athletes), with 75 percent of patients with bursitis, and 100 percent of those with partial-thickness tendon tears. Among isolated tendinous findings, the supraspinatus tendon was the most frequently involved, showing echographic pattern alteration in 36.36 percent of cases. Tendinosis was the most prevalent finding, present in at least one tendon in 50 percent of the studied shoulders. The incidence of partial-thickness tendon tears was similar to the incidence reported for non-athlete individuals (13 percent), always present in individuals above 40 years of age. CONCLUSION: Swimmers do not seem to present a higher incidence of tendon tears or degeneration when compared with the general population. Individuals' age is the most relevant determining factor, as far as rotator cuff lesions are concerned, no matter these individuals practice or not activities involving an overload of the shoulder joint.