Postoperative Rehabilitation of Anterior Glenohumeral Joint Instability Surgery: A Systematic Review.

Anterior glenohumeral instability is the most common form of shoulder instability. The systematic review summarizes the latest research on rehabilitation after Bankart repair. Inclusion criteria included postoperative rehabilitation and published in English between 2000 and 2019. Studies were excluded if they were addresses, comments, or editorials, or included other shoulder injuries or cadaver models. Two rounds of review using Rayyan QCRI software were performed for screening and full text search, and the articles were graded for levels of evidence. Of the 1982 articles, 14 articles were included with levels of evidence 1 through 4. Both arthroscopic and open Bankart repair have demonstrated improving functional outcomes and reducing recurrence rates of anterior shoulder instability. Accelerated postoperative rehabilitation may be comparable to a conventional protocol for arthroscopic repair, and the subscapularis musculature involvement during open repair can impact the timeframe. Strong evidence supports 4 phases of rehabilitation and future clinical trials are needed to compare different programs.

Postoperative Rehabilitation of Multidirectional Instability Surgery: A Systematic Review.

Multidirectional instability (MDI) of the shoulder is managed with surgery when conservative rehabilitation fails. The optimal postsurgical management of MDI is not well understood. The purpose of this study is to create a systematic review evaluating postsurgical rehabilitation protocols treating MDI. Articles were included if a postsurgical rehabilitation protocol was described following surgical treatment for MDI. Identified articles underwent 2 phases of screening by blinded team members. Remaining articles had their level of evidence determined by a predefined grading system, ranging from levels I to V. Articles with evidence levels I to IV were included in analysis. Of the 163 articles identified in the literature, 9 were included in this study. Surgical techniques examined in these articles include capsular plication, rotator interval closure, and capsular shift. Rehabilitation protocols were evaluated for duration of treatment and physical therapy modalities. Article results were evaluated for subjective and objective measures of protocol success. Overall, there is a lack of evidence to indicate the optimal rehabilitation protocol post-MDI surgery. Further research is needed to compare rehabilitation protocols following specific surgical procedures to determine their effect on postsurgical patient outcomes.

No Added Benefit of 8 Weeks of Shoulder External Rotation Strength Training for Youth Handball Players Over Usual Handball Training Alone: A Randomized Controlled Trial.

OBJECTIVE: To assess the effectiveness of a short (5-10 minutes) shoulder external rotation (ER) strength program, using elastic bands, in adolescent handball players. DESIGN: Randomized controlled trial. METHODS: The sample included 6 adolescent handball teams (3 female, 3 male) with a total of 92 players and a mean age of 16.6 years. Players were randomized within teams to an intervention group, which completed a shoulder ER strengthening program of 2 exercises performed 3 times per week after handball training for 8 weeks, or a control group of no treatment. The primary outcome was the between-group difference in shoulder ER strength change, measured as isometric strength using a handheld dynamometer from preintervention to postintervention (8 weeks). Secondary outcomes were between-group differences in internal rotation (IR) strength and the ER/IR strength ratio from preintervention to postintervention. RESULTS: The estimated between-group difference in dominant-shoulder ER strength was 0.06 N/kg (95% confidence interval [CI]: -0.01, 0.14) in favor of the intervention group. The estimated between-group differences in the ER/IR ratio and IR strength were 0.03 (95% CI: -0.02, 0.08) and 0.02 (95% CI: -0.08, 0.13), respectively. CONCLUSION: The ER strength program improved neither the ER strength nor the ER:IR ratio. J Orthop Sports Phys Ther 2021;51(4):174-187. doi:10.2519/jospt.2021.9957.

The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play.

Shoulder injuries and sports-related shoulder pain are substantial burdens for athletes performing a shoulder loading sport. The burden of shoulder problems in the athletic population highlights the need for prevention strategies, effective rehabilitation programs, and a individually based return-to-play (RTP) decision. The purpose of this clinical commentary is to discuss each of these 3 challenges in the sporting shoulder, to assist the professional in: (1) preventing injury; (2) providing evidence-based practice rehabilitation and; (3) to guide the athlete toward RTP. The challenges for injury prevention may be found in the search for (the interaction between) relevant risk factors, develop valid screening tests, and implement feasible injury prevention programmes with maximal adherence from the athletes. Combined analytical and functional testing seems mandatory screening an athlete's performance. Many questions arise when rehabilitating the overhead athlete, from exercise selection, over the value of stretching, toward kinetic chain implementation and progression to high performance training. Evidence-based practice should be driven by the available research, clinical expertise and the patient's expectations. Deciding when to return to sport after a shoulder injury is complex and multifactorial. The main concern in the RTP decision is to minimize the risk of re-injury. In the absence of a "gold standard", clinicians may rely on general guidelines, based on expert opinion, regarding cutoff values for normal range of motion, strength and function, with attention to risk tolerance and load management.

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study.

BACKGROUND: After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation. OBJECTIVES: The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha. METHODS: A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire "Shoulder Pain and Disability Index" (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy. RESULTS: Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months. CONCLUSION: The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants.

Incorporation of the Kinetic Chain Into Shoulder-Elevation Exercises: Does It Affect Scapular Muscle Activity?

CONTEXT: Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. OBJECTIVE: To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. DESIGN: Cross-sectional study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty-one asymptomatic participants (15 men, 16 women). MAIN OUTCOME MEASURE(S): The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). RESULTS: A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference = 3.44% MVIC) and LT (mean difference = 7.76% MVIC) activity. Incorporating the lower limb (exercises 3-5) increased UT activity when compared with exercise 1 (mean differences = 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT : MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). CONCLUSIONS: Incorporating the kinetic chain during shoulder-elevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity.

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.

Umbral de dolor a la presión del hombro revisado: influencia de la metodología y del sitio de medición, y asociación con el sexo, la habilidad manual y la composición corporal / Shoulder pressure pain thresholds revisited: The influence of assessment methodology and site, and association with gender, dexterity and body composition

Antecedentes y objetivos: Existe escasa información acerca de valores de referencia para el umbral de dolor a la presión (UDP) en el hombro. Nuestros objetivos fueron evaluar el UDP normal en cinco sitios de relevancia clínica del hombro y analizar la influencia de factores como el método de cálculo, el sexo, la composición corporal y la habilidad manual. Materiales y métodos: Este estudio transversal incluyó 58 individuos asintomáticos de ambos sexos de entre 18 a 65años. El UDP fue evaluado a nivel del músculo infraespinoso (IE), del músculo deltoides medio (DM), de la inserción del músculo pectoral menor (IPM), de la articulación acromioclavicular (AAC) y del músculo trapecio superior (TS). En cada sitio se tomaron 3 mediciones, eliminando la primera para el cálculo del valor promedio. Se utilizó el test t de Student para comparar las diferencias entre grupos (nivel de significación del 95%). Resultados: El punto más sensible fue el TS (4,31±2,09kg/cm2), seguido por la IPM (4,63±1,85kg/cm2), el DM (5,60±2,28kg/cm2), el IE (6,33±2,25kg/cm2) y la AAC (6,70±2,26kg/cm2). Solo el DM demostró una diferencia significativa entre ambos lados. Los hombres tuvieron valores de UDP superiores, excepto en el TS. Los sujetos con sobrepeso tuvieron valores superiores de UDP a nivel del DM y la IPM. Conclusiones: No se encontraron diferencias significativas con los valores de referencia reportados previamente. Las discrepancias entre diferentes estudios podrían ser independientes de la metodología utilizada para el cálculo del UDP. Se encontró una correlación estadística entre el UDP del músculo DM y el dominio manual, aunque dicha asociación puede no ser clínicamente relevante. Finalmente, este estudio demostró que el UDP a nivel del DM y la IPM es dependiente del índice de masa corporal (IMC)

Background and aims: There is little evidence regarding reference values for shoulder pressure pain threshold (PPT). Our aims were to assess the normal PPT around the shoulder, and to analyse the influence of the calculation method, gender, body composition and manual dexterity. Methods: In this cross-sectional study, 58 asymptomatic individuals of both genders, aged between 18 and 65years, were recruited. The PPT was assessed in the infraspinatus muscle (IS), middle deltoid muscle (MD), pectoralis brevis muscle insertion (PBI), acromioclavicular joint (ACJ) and upper trapezius muscle (UT). Three measurements were taken at each site, and the first was eliminated to calculate the mean value. The independent t-test was used to determine differences between groups (level of significance of 95%). Results: The most sensitive point was the TS (4.31±2.09kg/cm2), followed by the PBI (4.63±1.85kg/cm2), MD (5.60±2.28kg/cm2), IS (6.33±2.25kg/cm2) and ACJ (6.70±2.26kg/cm2). Only the MD showed a significant difference between sides. Men had higher PPT values, except for the TS. Overweight subjects had higher PPT values in the MD and the PBI. Conclusions: No significant differences with previous reference values were found. Discrepancies between different studies might not depend on the method used to obtain the final value. A statistical correlation was found between PPT at the MD and hand dexterity, although this association may not be clinically relevant. Finally, this study showed that the PPT of the MD and the PBI is BMI-dependent

[Ipsilateral Fractures of the Coracoid and Acromion Process of the Scapula Combined with the Distal Clavicle End Fracture, Treatment Options]. / Ipsilaterální zlomenina processus coracoideus a akromionu lopatky v kombinaci se zlomeninou laterální cásti klavikuly, terapeutická moznost resení.

Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.

Clinical application of the Turkish Get-Up to an acute shoulder injury in a competitive Brazilian Jiu-Jitsu athlete.

INTRODUCTION: The rationale for this case report was to identify the strengths and weaknesses associated with prescribing the Turkish Get-Up as an isometric shoulder and neck exercise. The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. DISCUSSION: The Turkish Get-Up was selectively applied as a therapeutic corrective intervention to a patient suffering a mild to moderate cervical, acromio-clavicular and sterno-clavicular joint sprain with associated facet syndrome and muscle spasm. There were concerns that initially gave a guarded prognosis with the realization that further imaging may be warranted after an initial trial. CONCLUSION: The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. This exercise allowed the injured patient to integrate full body movement and conditioning with an emphasis on pain free isometric shoulder and cervical spine contractions to re-establish strength and motor control. The patient now has the ability to add to his training and rehabilitation an exercise that can be endlessly progressed to build continuous strength, endurance and motor control.

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.

[Shoulder pain rehabilitation in young athletes]. / Rehabilitacion del hombro doloroso en el atleta joven.

Early specialisation in sports continues to increase and is a risk factor for the incidence of injuries in young athletes. In overhead athletes, the shoulder is the most affected joint, related to a combination of impingement and glenohumeral instability, as well as musculoskeletal immaturity. Identification of risk factors and rehabilitation is usually an effective recovery option for these athletes.

Shoulder Rehabilitation Protocol and Equipment Fit Recommendations for the Wheelchair Sport Athlete With Shoulder Pain.

Shoulder injuries in wheelchair sport athletes is the most commonly reported injury site and can directly impact not only sport performance, but everyday function and mobility. There is abundant research on shoulder rehabilitation for able bodied athletes, but minimal specifically related to wheelchair sport athletes. The purpose of this paper is to outline an exercise protocol and wheelchair sport equipment fit guidelines based off current research and expert opinion. Further research is needed on the effectiveness of a wheelchair athlete specific shoulder rehabilitation protocol, and biomechanical analysis of ideal wheelchair sport equipment fit to reduce shoulder injury and optimize performance.

Determining the minimal clinically important difference of the hand function sort questionnaire in vocational rehabilitation.

OBJECTIVE: To estimate the Minimal Clinically Important Difference (MCID) of the French version of the Hand Function Sort questionnaire (HFS-F). As a comparison, the MCID of the Disabilities of the Arm, Shoulder, and Hand (DASH) was also estimated. MATERIALS AND METHODS: We included French-speaking patients hospitalized in a multidisciplinary rehabilitation program for chronic pain of the upper limb after an accident. HFS-F and DASH scores were collected at admission and discharge; the Patient Global Impression of Change measure (PGIC; 7 levels) was collected at discharge. The MCID was estimated by 2 methods: the anchor-based method (receiver operating characteristic [ROC], delta (Δ) mean of scores) and the objective method based on the distribution of scores (standard error of measurement, SEM). RESULT: We included 225 patients. By the anchor-based method, the MCID for the HFS-F and DASH was +26 (SD 35) (P<10-4) and -13 (SD 13) (P<10-4), respectively, and by the ROC curve, it was +10 to +12 for the Δ-HFS-F and -7.5 to -5 for the Δ-DASH. The area under the ROC curve (AUC) was 0.726 [0.638-0.781] for Δ-HFS-F and 0.768 [0.701-0.83] for Δ-DASH. The correlations between the anchor and delta scores were>0.38 (P<10-4). The SEM was 16.2 for the HFS-F and -4.3 for the DASH. CONCLUSIONS: Values below the SEM must be rejected. Our anchor was significantly correlated with the outcome. Therefore, we propose an MCID for the HFS-F of 26, corresponding to approximately 10% progression of the score.

Pain Perception in Clarinetists with Playing-Related Pain After Implementing a Specific Exercise Program.

BACKGROUND: Wind musicians suffer injuries resulting from muscle overuse and poor postural habits, often due to the lack of required physical fitness. For this reason, it is important to study and analyze the characteristics of their activity in order to select appropriate preventive exercises. METHODS: 10 clarinetists, who were experiencing joint pain due to instrumental practice, followed a specific program of physical activity, 3 times a week for 2 months. To assess postural changes after its implementation, the Langlade test and muscle pain scale were used at the beginning and the end of the program. RESULTS: The results show a significant decrease in perceived pain (p<0.001) and changes in the dorsal spine (p=0.001). Given the relationship between the improvement in the Langlade item, which refers to the correct position of the shoulder blades, and muscle pain, with a correlation level of 0.582, it can be said that a change in the shoulder girdle position leads to a decrease of pain in that area. CONCLUSIONS: In this pilot study of 10 clarinetists, a regular program of physical activity for 9 weeks led to an observable change in posture and a reduction in pain using self-report measures.

The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature.

Introduction: Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. Source of data: A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. Areas of agreement: Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. Areas of controversy: No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. Growing points: The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. Areas timely for developing research: There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.

The Overhead Athletes Shoulder.

The overhead athlete places tremendous forces across the shoulder which result in necessary adaptive, but also potentially pathologic structural change. In this chapter we aim to review the biomechanics of throwing, the mechanisms of injury with overhead sports, the detailed history, and physical examination in this population, and concluding with specific diagnoses and the various treatment options.

A Telerehabilitation System for the Selection, Evaluation and Remote Management of Therapies.

Telerehabilitation systems that support physical therapy sessions anywhere can help save healthcare costs while also improving the quality of life of the users that need rehabilitation. The main contribution of this paper is to present, as a whole, all the features supported by the innovative Kinect-based Telerehabilitation System (KiReS). In addition to the functionalities provided by current systems, it handles two new ones that could be incorporated into them, in order to give a step forward towards a new generation of telerehabilitation systems. The knowledge extraction functionality handles knowledge about the physical therapy record of patients and treatment protocols described in an ontology, named TrhOnt, to select the adequate exercises for the rehabilitation of patients. The teleimmersion functionality provides a convenient, effective and user-friendly experience when performing the telerehabilitation, through a two-way real-time multimedia communication. The ontology contains about 2300 classes and 100 properties, and the system allows a reliable transmission of Kinect video depth, audio and skeleton data, being able to adapt to various network conditions. Moreover, the system has been tested with patients who suffered from shoulder disorders or total hip replacement.