Investigating the effects of neuromobilization in lateral epicondylitis.

STUDY DESIGN: Randomized controlled study. INTRODUCTION: Lateral epicondylitis (LE) causes pain and loss of function in the affected limb. Different exercises have been used for the treatment of LE. In recent years, the technique of neuromobilization has been frequently used to treat tendinopathy. However, there is no study that demonstrates the effects of neuromobilization techniques on patients with LE. PURPOSE OF THE STUDY: The aim of the present study was to determine the effects of neuromobilization techniques on pain, grip strength, and functional status in LE patients and to compare them with conservative rehabilitation treatment. METHODS: A total of 40 patients (26 females and 14 males; age: 42.80 ± 8.91 years) with a history of LE participated in the study. The patients were randomly assigned to two groups: the neuromobilization group and the control group. The neuromobilization group completed a 6-week conservative rehabilitation and radial nerve mobilization program, whereas the control group received conservative rehabilitation therapy only. Both groups underwent a 7-day weekly conservative home rehabilitation program. Pain severity, grip strength, pinch strength, joint motions, and upper extremity functional level were assessed before treatment, at the third week after treatment, and at the sixth week after treatment. RESULTS: There was a significant decrease in all pain scores in favor of the neuromobilization group at week 6 after treatment (at rest: P = .001, effect size (ES) = 0.84; at night: P = .001, ES = 0.91 and during activity: P = .004, ES = 1.06). No significant differences were found for grip strength, pinch strength, joint motions, and functional level in the neuromobilization group, although trends toward better improvement were observed. CONCLUSIONS: Radial nerve mobilization techniques are more effective on pain than conservative rehabilitation therapy in LE patients, and this effect continues after treatment.

Alterations in forearm muscle activation patterns after scapholunate interosseous ligament injury: A dynamic electromyography study.

STUDY DESIGN: Case control. PURPOSE OF THE STUDY: This study aimed to investigate the alterations seen in the activation patterns of the forearm muscles and to demonstrate the associated functional outcomes, in patients with scapholunate interosseous ligament (SLIL) injury. METHODS: The study involved 15 patients with SLIL injury (instability group) and 11 healthy participants (control group). Both groups were evaluated with regard to their pain, grip strength, and upper extremity functional level (disabilities of the arm, shoulder and hand and patient-rated wrist evaluation questionnaires), and they also underwent a dynamic electromyography analysis of their forearm muscle activity. The activation patterns of the extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), flexor carpi ulnaris, and flexor carpi radialis muscles during wrist extension and flexion were recorded by means of surface electromyography. RESULTS: In the instability group, the pain severity was higher and the functional level was worse than in the control group (P < .05). Furthermore, during wrist extension, the ECR activity was lower and the ECU activity was higher in the instability group than in the control group (P < .05). CONCLUSION: Dynamic stabilization of the wrist, flexor carpi ulnaris, and flexor carpi radialis muscles have been shown to play an active role with ECU and ECR. Increased ECU and decreased ECR activation may pose a potential risk in terms of enhancing the scapholunate gap. We, therefore, propose that appropriate preventive neuromuscular exercise strategies implemented as part of a physiotherapy program for patients with SLIL lesions might increase the contribution of the dynamic stability effect of the relevant muscles.

Evaluation of upper extremity function and its relation to curve pattern in female adolescents with idiopathic scoliosis: a pilot study.

STUDY DESIGN: Cross-sectional and clinical measurement. OBJECTIVE: To evaluate upper extremity function and its relation to the curve pattern in idiopathic scoliosis. Postural alterations and trunk distortions-caused by three-dimensional deformity itself in idiopathic scoliosis-may lead to functional changes in the upper extremity of subjects. METHODS: Handgrip, pulp and lateral pinch strengths, hand dexterity, hand reaction time, coordination of upper extremity, upper extremity performance, throwing accuracy, and self-reported upper extremity disability were evaluated in 96 subjects. These subjects were divided into 3 groups: 47 with main thoracic curve pattern scoliosis (Lenke type 1), 31 with thoracolumbar/lumbar curve pattern scoliosis (Lenke type 5), and 18 unaffected (healthy control). Comparisons were performed between these three groups. RESULTS: The thoracic scoliosis group showed a significant decrease in concave lateral pinch strength, concave hand dexterity of turning, coordination of the upper extremities, and concave hand reaction time than the thoracolumbar/lumbar scoliosis group (p < 0.05). Bilateral handgrip strengths decreased in thoracic scoliosis group when compared to healthy controls. Healthy individuals demonstrated greater throwing accuracy than individuals with scoliosis. CONCLUSIONS: Upper extremity function was found to be affected based on the curve pattern. Individuals with main thoracic curves are likely to have deteriorated upper extremity function, especially for hand-specific motor skills, on the concave side, when compared to lumbar curves and healthy controls. LEVEL OF EVIDENCE: Level III.

Effectiveness of basic body awareness therapy in adolescents with idiopathic scoliosis: A randomized controlled study1.

BACKGROUND: In scoliosis, curve progresses due to muscle imbalance and poor posture. Basic body awareness therapy (BBAT) aims to improve posture, coordination, and balance by increasing body awareness, which may help decrease deformities. OBJECTIVE: This study aimed to investigate effects of Basic body awareness therapy (BBAT) on curve magnitude, trunk asymmetry, cosmetic deformity, and quality of life in adolescent idiopathic scoliosis (AIS) patients. METHODS: Twenty female AIS patients were randomly assigned to BBAT and traditional exercises (TEs) groups. The BBAT group received BBAT and traditional exercises (TEs), while the TEs group received only TEs. The following assessments were included: Cobb angles using X-ray, angle of trunk rotation (ATR) using scoliometer, trunk asymmetry using the Posterior Trunk Symmetry Index (POTSI), cosmetic deformity using the Walter Reed Visual Assessment Scale (WRVAS), and quality of life using the SRS-22 test. Measurements were conducted at baseline examination and ten weeks later. Patients were instructed to wear their brace 23 h daily. Results were analyzed using the Wilcoxon rank-sum test to compare repeated measurements and Mann-Whitney U test to compare the groups. RESULTS: The BBAT group had greater improvement in the thoracic Cobb angle than the TEs group. Cosmetic deformity improved in both groups, whereas body asymmetry improved in only the BBAT group. SRS-22 scores were unchanged in both groups. CONCLUSIONS: BBAT as an additive to bracing and TEs improve curve magnitude, body symmetry and trunk deformity.

Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists.

Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.

Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial.

STUDY DESIGN: Single-blinded randomized controlled trial. INTRODUCTION: Pain management is essential in the early stages of the rehabilitation of distal radius fractures (DRFx). Pain intensity at the acute stage is considered important for determining the individual recovery process, given that higher pain intensity and persistent pain duration negatively affect the function and cortical activity of pain response. Graded motor imagery (GMI) and its components are recent pain management strategies, established on a neuroscience basis. PURPOSE OF THE STUDY: To investigate the effectiveness of GMI in hand function in patients with DRFx. METHODS: Thirty-six participants were randomly allocated to either GMI (n = 17; 52.59 [9.8] years) or control (n = 19; 47.16 [10.5] years) groups. The GMI group received imagery treatment in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 8 weeks. The assessments included pain at rest and during activity using the visual analog scale, wrist and forearm active range of motion (ROM) with universal goniometer, grip strength with the hydraulic dynamometer (Jamar; Bolingbrook, IL), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire, and the Michigan Hand Questionnaire. Assessments were performed twice at baseline and at the end of the eighth week. RESULTS: The GMI group showed greater improvement in pain intensity (during rest, 2.24; activity, 6.18 points), wrist ROM (flexion, -40.59; extension, -45.59; radial deviation, -25.59; and ulnar deviation, -26.77 points) and forearm ROM (supination, -43.82 points), and functional status (Disability of the Arm, Shoulder and Hand Questionnaire, 38.00; Michigan Hand Questionnaire, -32.53 points) when compared with the control group (for all, P < .05). CONCLUSION: The cortical model of pathological pain suggests new strategies established on a neuroscience basis. These strategies aim to normalize the cortical proprioceptive representation and reduce pain. One of these recent strategies, GMI appears to provide beneficial effects to control pain, improve grip strength, and increase upper extremity functions in patients with DRFx.

Repositioning the scapula with taping following distal radius fracture: Kinematic analysis using 3-dimensional motion system.

STUDY DESIGN: Cross-sectional and controlled laboratory study using pretest-posttest design. INTRODUCTION: Patients with distal radius fracture (DRfx) report proximal segment problems. Taping is commonly recommended because it provides improved posture and function. PURPOSE OF THE STUDY: This study aimed to investigate the 3-dimensional scapular kinematics and the effect of taping on the kinematics in participants with DRfx. METHODS: Twenty participants with a unilateral history of DRfx and 20 healthy controls participated. Scapular kinematics was assessed using an electromagnetic system. Three separate strips of elastic taping were applied for participants with DRfx over the arm, scapula, and middle and lower trapezius muscles through the paravertebral muscles. Afterward, the scapular kinematics was reassessed in taped condition. RESULTS: When participants with DRfx and healthy controls compared, the scapula was more downwardly rotated at 120° of humerothoracic elevation (mean difference [MD], 9.06°) and at 120° (MD, 9.04°), 90° (MD, 5.6°) of humerothoracic lowering, more upwardly rotated at 30° of humerothoracic lowering (MD, 5.1°). Taping showed a significant effect on kinematics; specifically, the scapula was more externally rotated (38.9° untaped vs 31.1° taped) and posteriorly tilted (-9.2° untaped vs -4.8° taped) during humerothoracic elevation and lowering for participants with DRfx. DISCUSSION: Participants with DRfx showed different scapular kinematics and taping resulted in changes on tested kinematic parameters during humeral movements. Differences in scapular motion during elevation with taping showed a specific pattern. CONCLUSIONS: Overall, taping maintained a position likely to produce optimal rotator cuff function during early rehabilitation of patients with DRfx. LEVEL OF EVIDENCE: N/A.

Scapular kinematics in adolescent idiopathic scoliosis: A three-dimensional motion analysis during multiplanar humeral elevation.

The scapula plays a critical role in supporting shoulder function. Considering the closed anatomical relationship between the scapula and the thoracic cage, the presence of postural disturbances could be linked to alterations in the scapular position and orientation in adolescent idiopathic scoliosis (AIS). However, currently there is a lack of descriptive research and detailed assessment of scapular kinematics in AIS. The aim of this study was to investigate the three-dimensional scapular kinematics in AIS. Nineteen AIS patients and fourteen healthy controls participated in this study. Bilateral shoulder kinematics were measured with an electromagnetic tracking device during shoulder elevation in the sagittal, scapular, and frontal planes. Data for the scapular orientation were analyzed in the resting position and at 30°, 60°, 90°, and 120° of humerothoracic elevation. Scapular behavior was different in participants with AIS, compared to healthy controls, with different patterns observed on convex and concave sides. While examining all three planes of elevation, the scapula was more internally and anteriorly tilted on the convex side, while the scapula was more externally, downwardly rotated, and posteriorly tilted on the concave side in participants with AIS. Furthermore, there was a decreased peak humerothoracic elevation and altered scapular posterior tilt in participants with AIS in the resting position. These findings increase our knowledge and understanding of scapular alterations and the reported scapular alterations can be considered as adaptive compensation strategies in AIS.

Acute effects of spinal bracing on scapular kinematics in adolescent idiopathic scoliosis.

BACKGROUND: Bracing is the most common nonsurgical treatment for adolescent idiopathic scoliosis. Spinal braces affect glenohumeral and scapulothoracic motion because they restrict trunk movements. However, the potential spinal-bracing effects on scapular kinematics are unknown. The present study aimed to investigate the acute effects of spinal bracing on scapular kinematics in adolescent idiopathic scoliosis. METHODS: Scapular kinematics, including scapular internal/external rotation, posterior/anterior tilting, and downward/upward rotation during scapular plane elevation, were evaluated in 27 in-brace and out-of-brace adolescent idiopathic scoliosis patients with a three-dimensional electromagnetic tracking system. Data on the position and orientation of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation were used for statistical comparisons. The paired t-test was used to assess the differences between the mean values of in-brace and out-of-brace conditions. FINDINGS: The in-brace condition showed significantly increased (P<0.05) scapular anterior tilting and decreased internal rotation in the resting position on the convex and concave sides; increased scapular downward rotation at 120° humerothoracic elevation on the convex side and at 30°, 60°, 90°, and 120° humerothoracic elevation on the concave side; increased scapular anterior tilt at 30°, 60°, 90°, and 120° humerothoracic elevation on the convex and concave sides; and decreased (P<0.05) maximal humerothoracic elevation of the arm. INTERPRETATION: Spinal bracing affects scapular kinematics. Observed changes in scapular kinematics with brace may also affect upper extremity function for adolescents with idiopathic scoliosis. Therefore, clinicians should include assessments of the glenohumeral and scapulothoracic joints when designing rehabilitation protocols for patients with adolescent idiopathic scoliosis.

The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial.

BACKGROUND: Core stabilization training is used to improve postural balance in musculoskeletal problems. OBJECTIVES: The purpose of this study was to investigate the effectiveness of stabilization training in adolescent idiopathic scoliosis. STUDY DESIGN: A randomized controlled trial, pretest-posttest design. METHODS: In total, 25 subjects with adolescent idiopathic scoliosis were randomly divided into two groups: stabilization group ( n = 12) and control group ( n = 13). The stabilization group received core stabilization in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 10 weeks. Assessment included Cobb's angle on radiograph, apical vertebral rotation in Adam's test, trunk asymmetry (Posterior Trunk Symmetry Index), cosmetic trunk deformity (Trunk Appearance Perception Scale), and quality of life (Scoliosis Research Society-22 questionnaire). RESULTS: Inter-group comparisons showed significantly greater improvements in the mean change in lumbar apical vertebral rotation degree and the pain domain of Scoliosis Research Society-22 in the stabilization group than those in the control group ( p < 0.05). No significant differences were observed for other measurements between the groups; however, trends toward greater improvement were observed in the stabilization group. CONCLUSION: Core stabilization training in addition to traditional exercises was more effective than traditional exercises alone in the correction of vertebral rotation and reduction of pain in adolescent idiopathic scoliosis. Clinical relevance Stabilization exercises are more effective in reducing rotation deformity and pain than traditional exercises in the conservative rehabilitation of adolescent idiopathic scoliosis. These improvements suggest that stabilization training should be added to rehabilitation programs in adolescent idiopathic scoliosis.

Functional contributors to poor movement and balance control in patients with low back pain: A descriptive analysis.

BACKGROUND: Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE: To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS: Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS: The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS: LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

BACKGROUND: Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. METHODS: Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. FINDINGS: Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (P<0.001) on the affected side during frontal plane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). INTERPRETATION: Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies.

Effect of a spinal brace on postural control in different sensory conditions in adolescent idiopathic scoliosis: a preliminary analysis.

BACKGROUND: Despite the positive effects of spinal braces on postural stability, they may constrain movement, resulting in poor balance control in patients with adolescent idiopathic scoliosis (AIS). Therefore, assessment of postural dynamics may aid in designing new less-constraining braces. OBJECTIVES: The effects of a spinal brace on postural stability and Cobb angle were investigated in this study. METHODS: Thirteen pediatric patients (10 females, three males) with AIS were recruited to participate in the study. Cobb angle was assessed by X-ray analyses, and postural stability was tested by computerized dynamic posturography in braced and unbraced conditions. A polyethylene underarm corrective spinal brace was fabricated for the subjects. RESULTS: Thoracic and lumbar curvature decreased to 18.88 ± 11.73° and 17.70 ± 10.58°, respectively, after bracing (p < 0.05). Lower equilibrium scores were observed in the "eyes closed" condition and higher scores in the "eyes closed with a swaying support" condition; higher composite equilibrium scores were also observed for the sensory organization test (p < 0.05) in the braced condition. Lower scores were observed for the "toes-up adaptation test" in the braced condition (p < 0.05). In the braced condition, the reaction time was slower in the right-backward direction and movement velocity was higher in the right-front direction on the limits of stability test (p < 0.05). Furthermore, lower on-axis velocity during forward/backward dynamic balance control was observed in the braced condition (p < 0.05). CONCLUSIONS: Wearing a spinal brace improved postural stability in terms of increased proprioception, equilibrium performance, and rhythmic movement ability in patients with AIS.

Core stabilisation reduces compensatory movement patterns in patients with injury to the arm: a randomized controlled trial.

OBJECTIVE: To investigate the effects of adding core stabilisation exercises to traditional rehabilitation in patients with arm injuries. DESIGN: Randomized controlled trial. SETTING: Outpatient clinic. SUBJECTS: Twenty-seven patients with elbow and wrist injuries were randomized to a stabilisation or control group. INTERVENTIONS: The stabilisation group received core stabilisation training and traditional arm rehabilitation and the control group received traditional arm rehabilitation alone for three days/week for six weeks. MAIN MEASURES: Pre- and post-treatment assessments comprising an analysis of compensatory movement patterns and trunk muscle strength as well as functional measurements of the arm, including pain, range of motion, disabilities of arm, shoulder and hand questionnaire and endurance and fatigue severity were performed. RESULTS: Inter-group comparison revealed significantly greater improvements in the degree of mean change (SD) in total compensation (in degrees) of the head (-14.47 (21.65)) and trunk (-5.56 (5.71)) as well as total compensation (-50.02 (48.62)) for the stabilisation group than for the control group (p < 0.05). Increase in trunk muscle strength (2.43 (3.46)) was statistically significant in the stabilisation group compared with the control group. No significant differences were found for functional measures, including pain, range of motion, disabilities of arm, shoulder and hand or endurance and fatigue severity between the groups, although trends towards greater improvement were observed in the stabilisation group. CONCLUSIONS: Adding core stabilisation exercises to traditional arm rehabilitation for patients with traumatic arm injury reduces compensatory movement patterns. Trends towards better functional outcomes in the stabilisation group are worth testing in a large-scale trial.

Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases.

OBJECTIVE: The aim of this case series is to describe the effect of nerve mobilization techniques in the standard conservative management of cubital tunnel syndrome (CTS). METHODS: Seven patients with CTS participated in this study. Inclusion criteria were having grade 1 and grade 2 entrapment neuropathy according to the McGowan grading system and no other neuropathies. In the evaluation, gripping with grip dynamometer; palmar gripping with a pinchmeter; pain level and Tinel sign with visual analog scale; sensibility with Semmes-Weinstein monofilaments; and functional status of the patients with the Turkish version of the Disability of Arm, Shoulder, and Hand Index were performed before starting a rehabilitation program, at the end of the 8-week rehabilitation program, and at 12-month follow-up. The physiotherapy program consisted of cold application, pulsed ultrasound, nerve mobilization techniques, strengthening exercises, postural adaptations, patient education, and ergonomic modifications. RESULTS: Pain; Tinel sign; and Disability of Arm, Shoulder, and Hand Index scores were decreased, whereas grip and pinch strength increased in the observation period for these 7 patients. CONCLUSION: This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study.

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 - 100 degrees abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.