Morphological analysis and lipid composition of the stable fly Stomoxys calcitrans salivary glands reinforce important features of feeding behaviour.

Stomoxys calcitrans L. (Diptera: Muscidae), the stable fly, is a hematophagous insect of great veterinary importance, because it is a mechanical vector of diverse pathogens in livestock. The saliva of blood-feeding insects presents important pharmacologically active molecules that impair blood clotting, promote vasodilation and modulate the host immune system response, crucial processes for successful feeding. These properties also enable pathogens' transmission. In the present work, we describe an efficient protocol to dissect S. calcitrans salivary glands, their morphological characteristics and lipid profile. The mean length of the tubular gland is 3.23 mm with a bulbous posterior end and a narrow anterior end. Histological analysis revealed a monolayer of large polygonal epithelial cells with voluminous nuclei and high lipid content in their cytoplasm. Ultrastructural analysis showed that the epithelium is rich in mitochondria, free ribosomes, Golgi complex cisternae, presenting a great extension of rough endoplasmic reticulum that contains an electron-dense material. Lipid analysis by thin-layer chromatography showed that neutral fatty acids and phosphatidylcholine are predominant in the fly salivary glands. Lysophosphatidylcholine, an important signalling biomolecule involved in different metabolic processes, including host's immunomodulation and pathogens proliferation and differentiation, is also present.

Stomoxys calcitrans L. (Diptera: Muscidae), a mosca­dos­estábulos, é um inseto hematófago de grande importância veterinária, uma vez que é vetor mecânico de diversos patógenos que infectam animais da pecuária. A saliva de insetos que se alimentam de sangue apresenta importantes moléculas farmacologicamente ativas que impedem coagulação sanguínea, promovem vasodilatação e modulam o sistema imune do hospedeiro, processos cruciais para uma alimentação bem sucedida. Tais propriedades também permitem a transmissão de patógenos. No presente trabalho, nós descrevemos um protocolo eficiente para dissecar as glândulas salivares de S. calcitrans, suas características morfológicas e perfil lipídico. O comprimento médio da glândula tubular é 3.23 mm com uma porção posterior bulbosa e porção anterior estreita. Análises histológicas revelaram uma monocamada de células epiteliais largas e poligonais com núcleos volumosos e alto conteúdo lipídico em seus citoplasmas. Análises ultraestruturais mostraram um epitélio rico em mitocôndria, ribossomos livres, cisternas do complexo de Golgi, apresentando uma grande extensão de retículo endoplasmático que contém um material eletrodenso. A análise lipídica mostrou que ácidos graxos neutros e fosfatidilcolina predominam nas glândulas salivares da mosca. Lisofosfatidilcolina, uma importante biomolécula sinalizadora envolvida em diferentes processos metabólicos, incluindo imunomodulação do hospedeiro e proliferação e diferenciação de patógenos, também se encontra presente.

Psychometric Properties of Patient-reported Outcome Measures to Assess Resilience in Individuals with Musculoskeletal Pain or Rheumatic Conditions: A COSMIN-based Systematic Review.

OBJECTIVES: The objective of this systematic review was to provide a comprehensive overview of the measurement properties of patient-reported outcome measures (PROMs) used to assess resilience in individuals with musculoskeletal and rheumatic conditions. METHODS: Four electronic databases (MEDLINE, CINAHL, PsycINFO, and Web of Science) were searched. Studies assessing any measurement property in the target populations were included. Two reviewers independently screened all studies and assessed the risk of bias using the COSMIN checklist. Thereafter, each measurement property of each PROM was classified as sufficient, insufficient, or inconsistent based on the COSMIN criteria for good measurement properties. RESULTS: Four families of PROMs [Brief Resilient Coping Scale (BRCS); Resilience Scale (RS-18); Connor-Davidson Resilience Scale (CD-RISC-10 and CD-RISC-2); and Pain Resilience Scale (PRS-14 and PRS-12)] were identified from the 9 included studies. Even if no PROM showed sufficient evidence for all measurement properties, the PRS and CD-RISC had the most properties evaluated and showed the best measurement properties, although responsiveness still needs to be assessed for both PROMs. Both PROMs showed good levels of reliability (intraclass coefficient correlation 0.61 to 0.8) and good internal consistency (Cronbach's alpha ≥0.70). Minimal detectable change values were 24.5% for PRS and between 4.7% and 29.8% for CD-RISC. DISCUSSION: Although BRCS, RS-18, CD-RISC, and PRS have been used to evaluate resilience in individuals with musculoskeletal and rheumatic conditions, the current evidence only supports the use of PRS and CD-RISC in this population. Further methodological studies are therefore needed and should prioritize the assessment of reliability and responsiveness.

Gender inequalities in violence victimization and depression in Brazil: results from the 2019 national health survey.

BACKGROUND: Violence is a worldwide public health challenge and has been linked to depression in many settings. Depression is higher in women and differential exposure to violence is a potential risk factor - especially in countries with high-levels of violence. This paper provides a comprehensive characterization of the association between violence victimization and depression in Brazil, focusing on sex/gender inequalities. METHODS: We used data from the 2019 wave of the National Health Survey (PNS) in Brazil to assess whether respondents had depression (using PHQ-9) and if they were victims of violence, differentiating by the type of violence, the frequency of victimization, and the primary aggressor. We used logit models to assess the association between victimization and the likelihood of having depression. We predicted probabilities of being depressed, considering the interaction between violence victimization and sex/gender, to analyze the differences between men and women. RESULTS: Rates of violence victimization and depression were higher among women than among men. The odds of being depressed were 3.8 (95%CI: 3.5-4.2) times higher among victims of violence than among non-victims, and 2.3 (95%CI: 2.1-2.6) times higher among women than among men, adjusting for socioeconomic factors. For any given income level, racial/ethnic or age group, victims of violence who were women had the highest predicted probabilities of being depressed - e.g., 29.4% (95%CI: 26.1-32.8) for lower-income women, 28.9% (95%CI: 24.4-33.2) for black women, and 30.4% (95%CI: 25.4-35.4) for younger women that suffered violence. Over one in three women that suffered multiple types of violence, experienced violence more frequently, or where the aggressor was an intimate partner or another family member were predicted to have depression. CONCLUSIONS: Being a victim of violence was strongly associated with higher risk of depression in Brazil, with women more likely to be both victims of violence and develop depression. Frequent, sexual, physical or psychological violence, and intimate partners or family member perpetrators were major risk factors for depression and should be a public health priority.

Is the angular onset of pain during arm elevation associated to functioning in individuals with rotator cuff related shoulder pain?

BACKGROUND: Rotator cuff related shoulder pain (RCRSP) is the main diagnosis for shoulder pain. A painful arc during active arm elevation is a common finding in RCRSP. The angular onset of pain during arm elevation may play an important role on functioning of the upper extremities. OBJECTIVE: This study aimed to: 1) determine and characterize the association between the angular onset of pain during arm elevation and upper-limb self-reported functioning, 2) verify whether demographic and clinical characteristics contribute to this association, and 3) investigate whether these characteristics differ considering distinct ranges of angular onset of pain in individuals with RCRSP. METHODS: 252 individuals with RCRSP were divided in 3 groups based on the angular onset of pain during arm elevation in the sagittal plane: <60°, 60°-120°, and >120°. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess functioning of the upper limbs. Demographic and clinical characteristics were selected for the multivariable analysis. RESULTS: Individuals with an angular onset of pain above 120° of arm elevation presented lower DASH score (lesser disability) than individuals with an angular onset of pain between 60°- 120°. Male sex, age, dominance of the side affected, duration of symptoms, and the angular onset of pain during arm elevation explained 31% of the DASH score variance. CONCLUSION: Individuals with RCRSP and angular onset of pain above 120° of arm elevation present better functioning than individuals with onset of pain between 60°-120°, and similar functioning as those with pain below 60°. Male sex, lower age, non-dominant side being affected and longer duration of symptoms are also associated to better functioning as assessed by the DASH questionnaire.

Ratio between 3D glenohumeral and scapulothoracic motions in individuals without shoulder pain.

This study determined the ratio between glenohumeral and three-dimensional scapular motion during arm elevation and lowering in 91 individuals without shoulder pain. Scapular kinematics were assessed using an electromagnetic tracking device. Individuals performed 3 repetitions of elevation and lowering of the arm in the sagittal plane. Two-way ANOVAs (interval: 30-60°, 60-90°, 90-120° x phase: elevation and lowering) and paired t-tests were used for data analysis. For scapular internal/external rotation, lesser scapular internal rotation contribution was found during the 60-90° interval as compared to the 90-60° interval. Lesser scapular external rotation was identified in the 60-30° interval of arm lowering. The ratio was greater during arm elevation (1.89) compared to lowering (1.74) across the entire motion arc. For scapular upward rotation, greater upward rotation contribution was observed during arm elevation at the 30-60° interval, and less scapular downward rotation contribution in the final range of arm lowering. For scapular tilt, lesser scapular posterior tilt contribution during arm elevation was observed compared to arm lowering. The ratios between glenohumeral elevation/lowering and each individual scapulothoracic motion showed either differences between intervals and/or between elevation and lowering during specific intervals in healthy individuals.

Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial.

BACKGROUND: Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. OBJECTIVE: To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. METHODS: In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. RESULTS: Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment. CONCLUSION: The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.

Antileishmanial activity of the essential oils of Myrcia ovata Cambess. and Eremanthus erythropappus (DC) McLeisch leads to parasite mitochondrial damage.

Leishmania amazonensis is a species causative of cutaneous and anergic diffuse cutaneous leishmaniasis, treatment-resistant form, in the New World. Plants essential oils exhibit great potential as microbicide agents. We described the composition of the essential oils of two plants native from Brazil, Myrcia ovata, with geranial and neral as major constituents, and Eremanthus erythropappus, with α-bisabolol. In vitro effects of these essential oils on L. amazonensis promastigotes growth and ultrastructure were analysed as well as their cytotoxicity to murine macrophages. Both oils were highly active with IC50/96 h of 8.69 and 9.53 µg/mL for M. ovata and E. erythropappus against promastigotes and caused ultrastructural alterations including mitochondrial enlargement. Cytotoxicity for murine macrophages varied with the oil concentrations. The IC50 low values of both M. ovata and E. erythropappus oils against L. amazonensis and their relative low cytotoxicity to mammal host cells support their potential use against cutaneous leishmaniasis.

Establishment and quantitative measure of Stomoxys calcitrans (Linnaeus, 1758) colony production in Rio de Janeiro, Brazil.

Functional insect vector colonies are essential for the study of their biology, evolution, behavior as well as control strategies of these organisms that transmit pathogens of medical and veterinary importance. In addition to the establishment, improvement and adaptation of pre-established protocols in the maintenance of a colony is important, as it may result in higher production of insects. Stomoxys calcitrans or stable fly causes important economic losses in production of beef and milk, besides mechanically transmitting a great variety of pathogens to cattle. In order to generate flies under laboratory conditions, a colony of S. calcitrans was established at our laboratory considering local environment geographical characteristics. Adults collected in UFRRJ campus were kept in the laboratory and maintained with daily feeding on anticoagulant-containing bovine blood offered in disposable sanitary napkins. Immature forms were maintained on diets rich in organic matter. The colony temperature and relative humidity were daily monitored as well as the development of insects. The monthly measured biological parameters included the development of eggs into pupae, of pupae into F1 adults and the comparison of the number of flies collected in the field with the number of F1 flies emerged in the laboratory. The data presented here was obtained from March to November 2019. In that period, the average per month of flies collected in the field was 604.2, of generated eggs was 2694.3, of generated pupae was 349.5 and of generated F1 flies in the laboratory was 205.9. Fluctuations of abiotic and biological factors contributed to an uneven production of flies in the colony throughout the months. This is the first report with numerical quantification of S. calcitrans flies production in a laboratory in Brazil. Some methodologies used in the colony shall be reevaluated and modified with the goal of obtaining higher numbers of flies generated in the laboratory over time.

The effect of the biflavonoid 2″,3″-dihydroochnaflavone on Trypanosoma cruzi Y strain.

Trypanosoma cruzi is the causative agent of Chagas disease which affects 8 million people in Latin America. The parasite possesses high capacity to evade host immune system and the available drugs to treat Chagas disease present low efficacy combined to serious side effects to patients. Therefore, the identification of alternative therapeutics is essential. Brazilian flora exhibits an immense diversity of metabolites with great potential to be developed into new drugs. We investigated the action of 2″,3″-dihydroochnaflavone a biflavonoid extracted from Luxemburgia nobilis Eichler ex Engl. (Ochnaceae) against T. cruzi (Y strain). Our experiments showed that this compound is effective against parasite epimastigote forms, presenting IC50 value of (2.5 ± 0.1) µM after 96 h of treatment. Ultrastructure alterations were also detected in treated epimastigotes especially mitochondrial enlargement at the kinetoplast region. At the concentration of 30 µM, the compound killed (61.6 ± 3.37)% of the parasite in its amastigote form. In addition, at the same concentration, the compound killed all trypamastigotes growing within murine macrophages after 7-9 days of infection. Nonetheless, the biflavonoid concentrations were harmless to murine enriched population of lymphocytes and peritoneal macrophages. These results indicate that 2″,3″- dihydroochnaflavone presents activity against T. cruzi.

Description of Referrals for Colposcopy in a Hospital in Brazil.

OBJECTIVE: To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses. METHODS: A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy. RESULTS: Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral. CONCLUSION: Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.

OBJETIVO: Descrever os encaminhamentos para colposcopia em um hospital no Brasil e a frequência relativa dos pacientes que foram beneficiados, considerando as indicações corretas para o exame e seus diagnósticos finais. MéTODOS: Foi realizado um estudo retrospectivo no banco de dados do serviço de colposcopia do Hospital Universitário de Taubaté, Taubaté, SP, Brasil. A frequência validou em análise de prontuários de mulheres encaminhadas por indicação clínica ou alteração citológica, atendidas no período de março de 2015 a março de 2017. A população selecionada e analisada incluiu 256 resultados que estavam correlacionadas aos dados citológicos, clínicos e com o resultado da colposcopia. RESULTADOS: Das mulheres encaminhadas, 45% apresentaram-se fora da idade de rastreamento conforme as diretrizes de rastreio de câncer de colo uterino, sendo que 8,6% eram adolescentes e adultas jovens < 25 anos de idade e 36,4% das pacientes tinham idade ≥ 65 anos. Um total de 50% das pacientes não possuía indicação de colposcopia, ou seja, citologias normais, de alterações benignas, ectopia, cervicite, células escamosas atípicas de significado indeterminado (ASC-US) e lesão intraepitelial escamosa de baixo grau (LSIL) sem persistência e aspecto clínico normal. Um total de 39,84% das pacientes que realizaram a colposcopia tiveram resultados de lesão de alto grau ou câncer e, dessa forma, se beneficiaram com o encaminhamento adequado. CONCLUSãO: A maioria (60,16%) das pacientes encaminhadas para o serviço de colposcopia não se beneficiou com o encaminhamento, por resultados sem alterações como colposcopias negativas, histologias com ausência de neoplasia intraepitelial cervical (NIC) ou apenas NIC 1, ou estavam fora da idade de rastreamento. Esses achados demonstram, portanto, significativo número de encaminhamentos desnecessários e inadequados.

Description of referrals for colposcopy in a hospital in Brazil / Descrição dos encaminhamentos para colposcopia em um hospital no Brasil

Abstract Objective To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses. Methods A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy. Results Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral. Conclusion Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.

Resumo Objetivo Descrever os encaminhamentos para colposcopia em um hospital no Brasil e a frequência relativa dos pacientes que foram beneficiados, considerando as indicações corretas para o exame e seus diagnósticos finais. Métodos Foi realizado um estudo retrospectivo no banco de dados do serviço de colposcopia do Hospital Universitário de Taubaté, Taubaté, SP, Brasil. A frequência validou em análise de prontuários de mulheres encaminhadas por indicação clínica ou alteração citológica, atendidas no período de março de 2015 a março de 2017. A população selecionada e analisada incluiu 256 resultados que estavam correlacionadas aos dados citológicos, clínicos e com o resultado da colposcopia. Resultados Das mulheres encaminhadas, 45% apresentaram-se fora da idade de rastreamento conforme as diretrizes de rastreio de câncer de colo uterino, sendo que 8,6% eram adolescentes e adultas jovens < 25 anos de idade e 36,4% das pacientes tinham idade ≥ 65 anos. Um total de 50% das pacientes não possuía indicação de colposcopia, ou seja, citologias normais, de alterações benignas, ectopia, cervicite, células escamosas atípicas de significado indeterminado (ASC-US) e lesão intraepitelial escamosa de baixo grau (LSIL) sem persistência e aspecto clínico normal. Um total de 39,84% das pacientes que realizaram a colposcopia tiveram resultados de lesão de alto grau ou câncer e, dessa forma, se beneficiaram com o encaminhamento adequado. Conclusão A maioria (60,16%) das pacientes encaminhadas para o serviço de colposcopia não se beneficiou com o encaminhamento, por resultados sem alterações como colposcopias negativas, histologias com ausência de neoplasia intraepitelial cervical (NIC) ou apenas NIC 1, ou estavam fora da idade de rastreamento. Esses achados demonstram, portanto, significativo número de encaminhamentos desnecessários e inadequados.

Impacto de una intervención educativa en el conocimiento del cáncer de mama en mujeres colombianas / Impact of an educational intervention on the knowledge of breast cancer in Colombian women

Introducción: La educación permite el desarrollo de capacidades y facilita el conocimiento, esto la hace parte de las estrategias fundamentales que ayudan a fortalecer los procesos de promoción de la salud que contribuyen con la formación de hábitos de autocuidado. Objetivos: Evaluar el impacto de una intervención educativa en el conocimiento del cáncer de mama en un grupo de mujeres adultas de Santa Marta. Métodos: Estudio con diseño cuasi-experimental, muestra no probabilística; que evaluó el conocimiento sobre prevención y control de cáncer de mama, antes y después de una intervención educativa, utilizando como instrumento de recolección de información la encuesta diseñada y validada por Santos y Mata en el 2011. El análisis estadístico se hizo utilizando el software Past v.3.14, mediante comparación de medias y prueba de Wilcoxon para muestras no paramétricas; se tuvo en cuenta un valor de p con un nivel de confianza del 95 por ciento y un margen de error del 5 por ciento. Se respetaron los criterios éticos nacionales e internacionales. Resultados: Los resultados de la intervención educativa fueron estadísticamente significativos, mostraron un valor p < 0,05 en 7 de los 8 grupos de preguntas, con lo que se favorece la hipótesis alterna (H1); datos corroborados mediante el análisis de la desviación interna que resultó ser menor en el grupo post intervención. Conclusiones: Se confirmó que, una vez que se desarrolló la intervención educativa se incrementó el conocimiento sobre prevención y control del cáncer de mama en el grupo de mujeres que participaron en el estudio(AU)

Introduction: Education allows the development of abilities and eases knowledge; it is also part of the fundamental strategies that help strengthen the processes of health promotion, since they contribute to the construction of self-care habits. Objectives: To assess the impact of an educational intervention on the knowledge of breast cancer in a group of adult women of Santa Marta. Methods: Quasi-experimental design study, and non-probabilistic sample which assessed the knowledge about prevention and control of breast cancer, before and after an educational intervention, using as an instrument of information collection the survey designed and validated by Santos and Mata in 2011. Statistical analysis was done using Past software version 3.14, and the comparison of means and the Wilcoxon test for non-parametric samples. It was taken into account the value of p with a confidence level of 95 percent and an error margin of 5 percent. National and international ethical criteria were respected. Results: The results of the educational intervention were statistically significant, showing a value of p < 0.05 in 7 of the 8 groups of questions, favoring the alternative hypothesis (H1); data was corroborated through the analysis of the internal deviation that turned out to be lower in the post intervention group. Conclusions: It was confirmed that once the educational intervention was developed, knowledge about breast cancer was increased in the group of women who participated in the study(AU)

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study.

BACKGROUND: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. PURPOSE: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. STUDY DESIGN: Controlled laboratory study. METHODS: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. RESULTS: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. CONCLUSION: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. CLINICAL RELEVANCE: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics.

BACKGROUND: Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. OBJECTIVE: The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. DESIGN: The design was a cross-sectional group comparison. METHODS: Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. RESULTS: The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41-55.63). LIMITATIONS: These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. CONCLUSIONS: Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.

Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain.

Background: There is evidence that pectoralis minor (PM) length influences scapula position and that scapula position relates to glenohumeral joint (GHJ) external rotation (ER) range of motion (ROM). Objectives: To explore the association between PM resting length and GHJ ER ROM in individuals with and without shoulder pain. The influence of GHJ ER ROM measurement position on this association was also evaluated. Design: Cross-Sectional. Methods: Fifty individuals (25 asymptomatic and 25 with shoulder pain) participated. PM resting length was measured using a tape measure with subjects standing, while GHJ ER ROM was quantified using a digital inclinometer with participants in both supine and seated positions. The same blinded investigator took all measurements. Results/Findings: A significant negative correlation between PM resting length and GHJ ER ROM in the seated position was noted in the asymptomatic group (r = -0.41; p = 0.04), but not in the symptomatic group (r = -0.33; p = 0.11). A nonsignificant negative correlation was also demonstrated in the supine position for both groups (r ranged from -0.35 to -0.17; p > 0.05). There was a significant group x position interaction (F = 4.06; p = 0.04) with more GHJ ER ROM (6.80°) for asymptomatic group in the seated position. Conclusions: PM length is not strongly correlated with GHJ ER ROM in individuals with or without shoulder pain. However, the position in which GHJ ER ROM is measured influenced the motion in asymptomatic individuals.

The influence of posterior glenohumeral joint capsule tightness and humeral retroversion on clinical measurements.

OBJECTIVES: To assess the influence of posterior capsule tightness and humeral retroversion on shoulder motion measurements. DESIGN: Cross-Sectional study. SETTING: Controlled university laboratory. PARTICIPANTS: 75 asymptomatic individuals were assigned to one of 4 groups: control (n = 28); posterior capsule tightness only (n = 17); humeral retroversion only (n = 15); and combined posterior capsule tightness and retroversion (n = 15). MAIN OUTCOME MEASURES: Six clinical measurements were compared across groups: bicipital forearm angle, low flexion, glenohumeral internal and external rotation, horizontal adduction and extension with internal rotation. RESULTS: The group with both adaptations had decreased internal rotation compared to the control and retroversion only groups, as well as increased external rotation compared to the control and posterior capsule only groups. There were no between group differences for the horizontal adduction or extension with internal rotation measurements. The retroversion only and combined groups showed decreased bicipital forearm angle compared with the control and posterior tightness groups. The posterior capsule tightness and combined groups demonstrated decreased low flexion compared to the other groups. CONCLUSION: The combination of osseous and soft tissue adaptions alter shoulder motion measures more than a single adaption, making a comprehensive clinical assessment vital when managing individuals with shoulder pain.

Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain.

STUDY DESIGN: Parallel-group intervention with repeated measures. INTRODUCTION: Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. PURPOSE OF THE STUDY: To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. METHODS: A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. RESULTS: Disabilities of the Arm, Shoulder, and Hand scores decreased (P < .05) in the patient group at post-intervention. No differences (P > .05) were found for PM length in both groups. Scapular anterior tilt increased (P < .05) at 90° of flexion in the healthy group. DISCUSSION: This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. CONCLUSION: The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the upper limbs improved in patients with shoulder pain. LEVEL OF EVIDENCE: 2b.

Sex-Related Differences in Scapular Kinematics During Elevation of the Arm in Asymptomatic Children and Adults.

Recently, it has been suggested that sex may influence scapular kinematics. A more comprehensive analysis of the scapular kinematics in children and adults, including sex as a factor, will help to understand if differences between sexes are present since childhood. The purpose of this study was to compare scapular kinematics between sex in children and adults during elevation of the arm. One-hundred and sixteen asymptomatic adults (58 men and 58 women) and 53 children (28 boys and 25 girls) participated in the study. Three-dimensional scapular kinematics during elevation of the arm were obtained using an electromagnetic tracking device. Women had a more upwardly rotated scapula in the nondominant side (P < .05), with large effects and a more anteriorly tilted position at 60°, 90°, and 120° of arm elevation in the dominant side, and at 90° and 120° in the nondominant side (P < .05) with moderate effects when compared with men. Differences between sexes were not found in the children (P > .05). In conclusion, sex seems to influence scapular kinematics in adulthood, but not in childhood.

Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement

Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.