Greater trochanteric pain syndrome in the UK National Health Service: A multicentre service evaluation.

PURPOSE: Greater trochanteric pain syndrome (GTPS) is a debilitating condition causing lateral hip pain. A recent randomized controlled trial (LEAP) demonstrated that exercise interventions for GTPS provided superior outcomes, compared with corticosteroid injection and wait-and-see approaches. However, participants were not patients seeking care and therefore may not have represented the typical patient seen within the National Health Service (NHS). The present service evaluation aimed to provide data on the characteristics of patients with GTPS presenting to NHS physiotherapy services, to enable consideration of the applicability of the findings of the LEAP trial to patients seeking care within the NHS. METHODS: Four NHS sites provided anonymized data on patients presenting to their service with a primary complaint of GTPS. RESULTS: The data from 162 patients suggested that the typical patients presenting to the NHS with GTPS are female (73%), overweight (body mass index 28.5) and experiencing a 12-month or longer history of lateral hip pain (56.8%). Patients reported high levels of pain (visual analogue score 6.5), low health-related quality of life (EuroQol five-dimensions - 5-level score 0.6), coexisting medical conditions (79.0%) and high medication use (82.7%). CONCLUSIONS: Patients presenting to the NHS with GTPS appear to have multifactorial issues, with high levels of pain and disability, and are often medicated for multiple coexisting conditions. These characteristics differentiate them from patients recruited to the LEAP trial. Hence, it is unclear whether the findings of the LEAP trial are applicable to patients with GTPS who consult physiotherapy services in the NHS. Further research is warranted to evaluate this.

Shoulder kinematics is not influenced by external load during elevation in the scapular plane.

The current study aimed to compare the shoulder kinematics (3D scapular orientation, scapular angular displacement and scapulohumeral rhythm) of asymptomatic participants under unloaded and loaded conditions during unilateral shoulder elevation in the scapular plane. We used a repeated-measures design with a convenience sample. Eleven male participants with an age range of 21-28 years with no recent history of shoulder injury participated in the study. The participants performed isometric shoulder elevation from a neutral position to approximately 150 degrees of elevation in the scapular plane in intervals of approximately 30 degrees during unloaded and loaded conditions. Shoulder kinematic data were obtained with videogrammetry. During shoulder elevation, the scapula rotated upwardly and externally, and tilted posteriorly. The addition of an external load did not affect 3D scapular orientation, scapular angular displacement, or scapulohumeral rhythm throughout shoulder elevation (P > .05). In clinical practice, clinicians should expect to observe upward and external rotation and posterior tilt of the scapula during their assessments of shoulder elevation. Such behavior was not influenced by an external load normalized to 5% of body weight when performed in an asymptomatic population.

Comparison of shoulder resultant net moment between three different exercises and load conditions.

Different exercises are prescribed by physiotherapists and despite the popular use of elastic resistance, few studies have investigated the effect of such rehabilitation tools on shoulder resultant net moment (RNM). The aim of the present study was to compare shoulder RNM peak values and the respective angle of occurrence during three shoulder rehabilitation exercises: 1) elevation in the scapular plane; 2) flexion; and 3) abduction when performed in three different load situations: 1) without external load; 2) with dumbbells (DB); and 3) with elastic resistance. Twenty-one healthy subjects participated in the study. Kinematic data were obtained by means of an inverse dynamic model. A two-way ANOVA was used for data analysis (α < 0.05). The highest RNM peak for abductor and external rotator muscles was during shoulder abduction exercise and for flexor muscles was during flexion and elevation in the scapular plane. The DB load condition was associated with highest RNM peak values for all muscle groups. This study presents differences among three exercises and load situations for RNM peak values and angle of occurrence. Furthermore, it also presents theoretical rationale for load progress and selection of exercises for shoulder rehabilitation management. Clinicians should consider it, when prescribing strengthening exercises for shoulder rehabilitation.

Estimated force and moment of shoulder external rotation muscles: differences between transverse and sagittal planes.

The aim of this study was to compare shoulder muscle force and moment production during external rotation performed in the transverse and sagittal planes. An optimization model was used for estimating shoulder muscle force production of infraspinatus, teres minor, supraspinatus, anterior deltoid, middle deltoid and posterior deltoid muscles. The model uses as input data the external rotation moment, muscle moment arm magnitude, muscle physiologic cross-sectional area and muscle specific tension. The external rotation moment data were gathered from eight subjects in transverse and six subjects in sagittal plane using an isokinetic dynamometer. In the sagittal plane, all studied muscles presented larger estimated force in comparison with the transverse plane. The infraspinatus, teres minor, supraspinatus and posterior deltoid muscles presented larger moment in sagittal when compared with transverse plane. When prescribing shoulder rehabilitation exercises, therapists should bear in mind the described changes in muscle force production.

Scapular kinematics and scapulohumeral rhythm during resisted shoulder abduction--implications for clinical practice.

OBJECTIVE: To offer a three-dimensional description of the scapular kinematics and scapulohumeral rhythm (SHR) in healthy subjects during quasi-static shoulder abduction. To analyze and compare the influence of loaded and unloaded conditions on scapula kinematics and SHR. DESIGN: Eleven subjects were analyzed using videogrammetry and the application of mathematical modelling during quasi-static shoulder abduction positions (intervals of approximately 30 degrees). MAIN OUTCOME MEASUREMENTS: Scapular kinematic data under unloaded and loaded conditions. RESULTS: The scapula presented external rotation, upward rotation and posterior tilting during the studied movement. Analyzing the scapulohumeral rhythm, different behaviours were observed in the scapular movement planes. Loading condition increased scapular upward rotation and posterior tilt at 60 degrees and 90 degrees of abduction (p>0.01). CONCLUSIONS: Analyzed scapular kinematics and scapulohumeral rhythm showed differences between adopted loading conditions. The clinical applications of these findings are discussed.