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Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Abnormal posture is known to affect the efficacy of exercise therapy for musculoskeletal diseases. However, no studies to date have examined the effect of exercise programs should take into account the posture of the upper body in patients with rotator cuff disease. This study aimed to assess how rotator cuff and corrective exercises impact shoulder function and muscle strength post-arthroscopic rotator cuff repair surgery, providing tailored rehabilitation programs for patients with forward posture. Methods: Ninety male patients who underwent arthroscopic rotator cuff repair participated in this study. The patients were randomly divided into three groups corrective exercise group (CEG, n = 29), rotator cuff exercise group (REG, n = 27), and control group (CG, n = 28). Each group was instructed to apply different exercise programs to correct posture and enhance rotator cuff strength. All patients were checked by the American Shoulder and Elbow Surgeons (ASES) score, Constant score and muscle strength, and range of motion preoperatively and postoperatively at 6 months and 1 year. Results: ASES shoulder function scores showed significant difference between the three groups (p = 0.002, F = 7.03), indicating that the corrective exercise program was more beneficial than rotator cuff exercises (p = 0.009, F = 3.78). A significant intergroup difference in mean Constant score was also noted (p = 0.025, F = 3.86), while a statistically significant interaction between time and group was observed (p = 0.032, F = 2.96). Conclusions: These results suggested that a corrective exercise program can improve shoulder muscle strength and function after rotator cuff repair in male patients with a forward shoulder posture. [ABSTRACT FROM AUTHOR]

This study investigates the impact of a five-week functional exercise intervention designed to enhance the muscular endurance of the posterior shoulder musculature, aiming to mitigate shoulder fatigue and overuse injury. Twelve Division I collegiate butterfly swimmers were recruited and evenly randomized into exercise (EX) and control (CTRL) groups. Weekly 100-yard butterfly sprints were performed, with Muscle Oxygen Saturation (SmO2) continuously monitored using a wearable near-infrared spectroscopy (NIRS) device. This study is among the first to utilize wearable NIRS devices to monitor SmO2 underwater during swimming, demonstrating that a targeted 5-week exercise program significantly improves posterior shoulder endurance, as evidenced by increased Posterior Shoulder Endurance Test (PSET) scores and distinctive SmO2 adaptations in the EX-group compared to the CTRL group. These findings suggest that targeted dryland exercises can enhance posterior shoulder endurance with long-term implications for potentially reducing injury risk and improving performance. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed kinematic analysis protocol can play a role in detecting electromyographic and kinematic alterations of the shoulder for the pre-clinical detection of the risk factors for overuse pathologies. Moreover, the proposed exercise prevention protocol has shown valuable results in optimizing shoulder movement and can be proposed to overhead athletes as a part of their athletic preparation. Scapular dyskinesia, glenohumeral internal rotation deficit, upper posterior labral anterior tears, and rotator cuff injuries are common in athletes who play "overhead" sports due to their repetitive excessive movements. The aims of this study are to propose a new protocol with kinematic analysis coupled with sEMG and to objectively analyze the effect of a specific prevention exercise protocol. Thirty-two subjects (age: 22 ± 4 years, height: 183 ± 3.2 cm, BMI: 23 ± 0.96 kg/m2), including sixteen healthy subjects (Group A) and sixteen male water polo athletes (Group B), underwent a three-dimensional motion analysis based on optoelectronic and sEMG systems. A functional evaluation was performed on Group A and Group B to assess the reliability of the operator-dependent tasks and collect a series of normative data, before starting the prevention protocol (T0) and after 8 weeks (T1). The athletes performed a specific exercise protocol to prevent shoulder injuries. In Group B, the movements of abduction (T0: 111° ± 24°; T1: 140° ± 13°) and extension (T0: 72°± 10°; T1: 84° ± 2.8°) of the glenohumeral joint and the scapulothoracic joint (T0: 33° ± 8.36°; T1: 40.5° ± 10.6°) significantly improved. A significant reduction (in %) in the maximum voluntary contraction (MCV) at T1 of the upper trapezius, teres minor, and pectoralis major was observed. This protocol provides objective data in a simple and reliable way for the functional assessment of the shoulder in water polo players during the sport season. [ABSTRACT FROM AUTHOR]

Background: Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy. Methods: The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient. Discussion: The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial. [ABSTRACT FROM AUTHOR]

To assess the effects of the eFisioTrack monitoring system on clinical variables in patients with prescribed physiotherapy for shoulder injuries, twenty-four adult patients with shoulder orthopaedic injuries who underwent physical therapy treatment in a hospital setting participated in the study (twelve in the experimental group and twelve as controls). Clinical outcome measures were shoulder function and pain (Constant–Murley Score and Disabilities of the Arm, Shoulder, and Hand or DASH score). Each variable was measured by a blinded physiotherapist at baseline and at one month follow-up. Patients performed the prescribed exercises either supervised by the physiotherapist (control group) or in a separate room without therapist supervision (experimental group). There were no statistically significant differences between groups before treatment or at follow-up for any outcomes (p ≥ 0.05). There was a statistically significant decrease (p ≤ 0.05) of at least 10 points in both groups for the DASH score at follow-up. Differences in the total score and subjective components of the Constant–Murley were also evidenced within groups. The use of the eFisioTrack system showed similar results in clinical measures compared to those performed under the direct supervision of the physiotherapist. This approach might be suitable for providing an effective shoulder exercise program at home. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to compare and analyze the representative opening and closing movement of Tai Chi elastic band exercise with the reverse fly movement of elastic band resistance training. The aim was to explore the biomechanical differences between the two exercises and provide theoretical support for the application of Tai Chi elastic band exercise in health intervention. Methods: A total of 26 male participants were recruited and randomly divided into two groups in a 1:1 ratio. There were 13 participants in each Tai Chi elastic band exercise group and elastic band resistance training group. Both groups of participants used an elastic band to perform movement in the experiment. Experimental data were collected using the Vicon infrared motion capture system and Delsys surface EMG system. The AnyBody software was utilized to simulate the creation of a musculoskeletal model for both exercises. Result: The study found that the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angle and flexion angle of the shoulder joint, as well as normalized RMS of the anterior deltoid and triceps brachii, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited greater elbow flexion angle, elbow flexion torque, and muscle strength of the infraspinatus, coracobrachialis, biceps brachii, brachialis and brachioradialis, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angular velocity of the shoulder joint and a lower normalized RMS of the posterior deltoid, compared to the elastic band resistance training group (P < 0.05). Conclusion: (1) The opening and closing movement of Tai Chi elastic band exercise is characterized by a large elbow flexion angle, a small shoulder joint horizontal angle and flexion angle, and a slow and uniform speed of movement. The reverse fly movement of elastic band resistance training is characterized by a large horizontal abduction angle of the shoulder joint, a large flexion angle of the shoulder joint, a small flexion angle of the elbow joint, and a fast and uneven speed. (2) The opening and closing movement exerts a greater torque on the elbow flexion, while the reverse fly movement exerts a greater torque on the shoulder joint horizontal abduction and external rotation. (3) The opening and closing movement provide greater stimulation to the infraspinatus, coracobrachialis, and elbow flexor, while the reverse fly movement provides greater stimulation to the posterior deltoid, anterior deltoid, subscapularis, and elbow extensor. In summary, the variation in joint angle, joint angular velocity, and hand position could be the factor contributing to the differences in joint torque and muscle activity between the opening and closing movement of Tai Chi elastic band exercise and the reverse fly movement of elastic band resistance training. [ABSTRACT FROM AUTHOR]

Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl–Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group–time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p < 0.011 for the splenius and F(1, 26) = 9.623, p < 0.005 for the upper trapezius. A significant time–group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p < 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time–group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p < 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p < 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. [ABSTRACT FROM AUTHOR]

Background: The age-related loss of skeletal muscle mass is an important characteristic of sarcopenia, an increasingly recognized condition with systemic implications. However, its association with shoulder function in elderly patients with rotator cuff tears (RCT) remains unknown. This study aimed to investigate the relationship between low skeletal muscle mass and shoulder function in elderly RCT patients. Methods: A retrospective analysis was conducted on RCT patients who underwent chest computed tomography (CT) scans for clinical evaluation. Preoperative CT scan images of the chest were used to calculate the cross-sectional area (CSA) of thoracic muscle at the T4 level. The medical records were reviewed. Shoulder function was assessed using the ASES score and CMS score both preoperatively and at the final follow-up. Data on the preoperative range of motion (ROM) for the affected shoulder, were collected for analysis. Subgroup analyses by sex were also performed. Results: A total of 283 RCT patients, consisting of 95 males and 188 females, with a mean age of 66.22 ± 4.89(range, 60–95 years) years were included in this retrospective study. The low muscle mass group showed significantly higher level of c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to the normal group(3.75 ± 6.64 mg/L vs. 2.17 ± 2.30 mg/L, p = 0.021; 19.08 ± 12.86 mm/H vs.15.95 ± 10.76 mm/H, p = 0.038; respectively). In the normal group, pre-operative passive ROM, including forward elevation, abduction, lateral rotation, and abductive external rotation, was significantly better than that in the low muscle mass group (127.18 ± 34.87° vs. 89.76 ± 50.61°; 119.83 ± 45.76° vs. 87.16 ± 53.32°; 37.96 ± 28.33° vs. 25.82 ± 27.82°; 47.71 ± 23.56° vs. 30.87 ± 27.76°, all p < 0.01, respectively). Similar results were found in the active ROM of the shoulder. The female low muscle mass group exhibited significantly poorer passive and active ROM (p < 0.05). The post-operative ASES scores and CMS scores of the female low muscle mass group were also statistically worse than those of the female normal group (p < 0.05). Conclusions: The results of present study revealed that the low skeletal muscle mass is associated with inferior ROM of the shoulder and per- and post-operative shoulder function, especially for elderly female patients. [ABSTRACT FROM AUTHOR]

Introduction: Tasks performed at or above head height in industrial workplaces pose a significant challenge due to their association with musculoskeletal disorders. Upper-body exoskeletons have been identified as a potential solution for mitigating musculoskeletal loads and fighting against excessive muscular fatigue. However, the influence of such support on fine motor control, as well as on cognitive-motor interference, has received limited attention thus far. Therefore, this crossover randomized study aimed to investigate the impact of the use of a passive upper-body exoskeleton in the presence of muscular fatigue or not. Additionally, focusing on differences between single (ST) and dual (DT) industrial tasks consisting of overhead speed and accuracy exercises. Methods: In both scenarios, N = 10 participants (5 male/5 female) engaged in an overhead precision task using a nail gun to precisely target specific areas on three differently sized regions, based on Fitts' law paradigm (speed-accuracy trade-off task). This was done with and without the passive upper-body exoskeleton, before and immediately after a fatiguing exercise of shoulder and leg muscles. In addition, a second task (dual-task, DT) was carried out in which the occurrence of an auditory signal had to be counted. The main outcomes were muscular activation of the shoulder girdle as well as the time to perform speed-accuracy tasks of different difficulty indexes (calculated by means of Fitts' law). Results and discussion: In the absence of fatigue, the exoskeleton did not affect the speed-accuracy trade-off management of participants in the single task, but it did in the dual-task conditions. However, after muscle fatigue, the speedaccuracy trade-off was differently affected when comparing its execution with or without the exoskeleton. In general, the dual task resulted in longer times to perform the different tasks, whether it was with or without the exoskeleton. Furthermore, the use of the exoskeleton decreased muscle activity, which is associated with less physical effort, but only significantly for the M. deltoideus and M. trapezius when compared by tasks. Overall, these study findings highlight the potential supportive effects of using an upper-body exoskeleton for industrial overhead tasks. [ABSTRACT FROM AUTHOR]

Although various treatment options are available for spinoglenoid cyst, including conservative and surgical methods, there is no standard guideline for its surgical decompression. Thus, the purpose of the study was to correlate the size of the spinoglenoid notch ganglion cyst (GC) as revealed by magnetic resonance imaging (MRI) with electrophysiological alterations, muscle power, and pain severity, and to estimate a cut-off value of cyst size to perform a decompression. Between January 2010 and January 2018, the patients with a GC at the spinoglenoid notch diagnosed on MRI, and who had a minimum follow-up of 2 years after the decompression were included. Maximum cyst diameter as measured on MRI was used for comparison. Electromyography (EMG) and nerve conduction velocity (NCV) studies were performed before the surgery. Peak torque deficit (PTD) percentage compared to opposite shoulder was calculated preoperatively and at 1 year after surgery. Pain severity was estimated using visual analogue scale (VAS) preoperatively. Ten (50%) of 20 patients with GC > 2.2 cm and 1 (5.9%) of 17 patients with GC < 2.2 cm showed EMG/NCV abnormalities (p = 0.019). There was a correlation between the cyst size and the positive EMG/NCV findings (Correlation coefficient (CC) = 0.535, p < 0.001). The preoperative peak torque deficit on the external rotation was correlated with the positive EMG/NCV findings (CC = 0.373, p = 0.021). The PTD was improved significantly at 1 year postoperatively in patients with a GC size >2.2 cm (p = 0.029). The cyst size was not related to the preoperative pain VAS and muscle power. The spinoglenoid cyst size >2.2 cm, but not pain severity or muscle power, correlates with the positive finding of EMG for compressive suprascapular neuropathy. The GC size >2.2 cm can be a reference to decide the need of decompression surgery. IV, case series. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. Methods: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. Results: The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). Conclusions: Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears. [ABSTRACT FROM AUTHOR]

To examine the effect of induced posterior pelvic tilt (changes in pelvic kinematics) on serratus anterior, lower trapezius, and upper trapezius electromyographic activity, and thoracic posture during arm elevation in individuals with rounded shoulder. Materials and methods Thirty healthy volunteers (26 male and 4 female participants) with rounded shoulder, their mean age 22.80±3.2, BMI 23.51± 3.9 were evaluated for both thoracic and pelvic posture using a 9-camera, 3-dimensional motion capture system (Vicon Nexus version 2, Oxford, UK), serratus anterior, lower trapezius, and upper trapezius electromyographic activity. The measurements were recorded in different six experimental conditions while inducing posterior pelvic tilt during arm elevation. For the six experimental conditions involving arm elevation, repeated measures analysis of variance within-subjects was used to examine the changes in electromyographic activities of lower trapezius, upper trapezius, and serratus anterior due to pelvic kinematics' changes whereas paired t-tests were used to examine the changes in the thoracic posture in response to pelvic kinematics' changes and to compare the pelvic tilt angle between the habitual relaxed position and the induced posterior tilt position. Results Upper trapezius, serratus anterior, and lower trapezius electromyographic activity significantly increased in response (changes in pelvic kinematics) induced posterior pelvic tilt (35:40%) of the maximal posterior pelvic tilt, although there were no apparent alterations in thoracic posture. (p>0.05). Conclusion Induced posterior pelvic tilt, (35:40%) of the maximum, resulted in an increase in the electromyographic activity of serratus anterior, lower trapezius, upper trapezius, which reflects that changes in pelvic kinematic could alter scapular muscles activity, so comprehensive examination of pelvic posture is required in both preventive and treatment programs of shoulder complex injuries. Meanwhile, no significant effect was reported on thoracic posture. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether scapular morphology could predict isolated supraspinatus tendon tear propagation after exercise therapy. We hypothesised that a larger critical shoulder angle (CSA) and type III acromial morphology predict a positive change in tear size. Methods: Fifty‐nine individuals aged 40–70 years with isolated symptomatic high‐grade partial or full‐thickness supraspinatus tendon tears were included. Individuals participated in a structured, individualised 12‐week exercise therapy programme and underwent ultrasound to measure tear size at baseline and 12 months following therapy. Computed tomography images were segmented to create three‐dimensional subject‐specific bone models and reviewed by three trained clinicians to measure CSA and to determine acromion morphology based on the Bigliani classification. A binary logistic regression was performed to determine the predictive value of CSA and acromion morphology on tear propagation. Results: The CSA was 30.0 ± 5.4°. Thirty‐one individuals (52.5%) had type II acromial morphology, followed by type III and type I morphologies (25.4% and 22.0%, respectively); 81.4% experienced no change in tear size, four (6.8%) individuals experienced tear propagation and seven (11.9%) individuals had a negative change in tear size. No significant difference in tear propagation rates based on CSA or acromion morphology (not significant [NS]) was observed. The model predicted tear size status in 81.4% of cases but only predicted tear propagation 8.3% of the time. Overall, CSA and acromion morphology only predicted 24.3% (R2 = 0.243) of variance in tear propagation (NS). Conclusions: CSA and acromion morphology were NS predictors of tear propagation of the supraspinatus tendon 12 months following an individualised exercise therapy programme. Level of Evidence: II. [ABSTRACT FROM AUTHOR]

Aim: Clinical diagnosis and surgical treatment of chondrosarcoma (CS) are continuously improving. The purpose of our study is to evaluate the effectiveness of microwave ablation (MWA) assisted degradation therapy in the surgical treatment of intramedullary chondrosarcoma of the extremities, to provide a new reference and research basis for the surgical treatment of CS. Methods: We recruited 36 patients with intramedullary CS who underwent MWA assisted extended curettage. Preoperative patient demographics and clinical data were recorded. Surgery was independently assisted by a medical team. Patients were followed up strictly and evaluated for oncological prognosis, radiological results, limb joint function, pain, and complications. Results: We included 15 men and 21 women (mean age: 43.5 ± 10.1). The average length of the lesion was 8.1 ± 2.5 cm. Based on preoperative radiographic, clinical manifestations, and pathological results of puncture biopsy, 28 patients were preliminarily diagnosed with CS-grade I and eight patients with CS-grade II. No recurrence or metastasis occurred in the postoperative follow-up. The average Musculoskeletal Tumor Society score was 28.8 ± 1.0, significantly better than presurgery. Secondary shoulder periarthritis and abduction dysfunction occurred in early postoperative stage CS of the proximal humerus in some, but returned to normal after rehabilitation exercise. Secondary bursitis occurred at the knee joint in some due to the internal fixation device used in treatment; however, secondary osteoarthritis and avascular necrosis of the femoral head were not observed. Overall, oncological and functional prognoses were satisfactory. Conclusions: The application of MWA assisted degradation therapy in intramedullary CS can achieve satisfactory oncology and functional prognosis, providing a new option for the limited treatment of CS. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the most common tumours and one of the leading causes of death among women in all parts of the world. The aim of this study is to investigate the influence of Nordic walking on the functional capacity of women who have undergone surgery for breast cancer. Methods: The study involved a cohort of women who exercised through Nordic walking for 10 weeks (from March to May 2022). The subjects trained with a licenced instructor (INWA method), with two training sessions per week of 70–80 min each. We collected information on pain, arm mobility, hand grip strength, shoulder joint range of motion bilaterally, circumference of both arms, body mass index, physical activity, aerobic capacity, and endurance. Results: There were 14 women, median age 63. BMI was significantly lower (28.9/28.1; p = 0.013) after training and a difference in shoulder range of motion was better (anteflexion right (142.5/170, p = 0.002), retroflexion right (40/60, p = 0.005), abduction right (135/180, p = 0.005), abduction left (135/180, p = 0.005)). There was no difference in right hand strength, while there was a significant difference in left hand strength (19/20, p = 0.007). A correlation was found between BMI and the six-minute walk test (r = −0.70; p = 0.005). Conclusions: Considering the multidimensionality of the disease itself and the results of this study, we believe that Nordic walking is a favourable and good choice of physical activity for breast cancer patients. [ABSTRACT FROM AUTHOR]

The demand for automated systems monitoring and supporting patients in their home-based recovery programs is substantial. While emerging technologies have been proposed as potential solutions to enhance at-home patient care, limited systems are in place due to their challenges in offering real-time monitoring and corrective feedback. Most proposed methodologies provide an overall measure or score for the executed movement. The proposed work involves the adaptation of an existing published dataset to cater to the needs of a system capable of remotely assisting patients, effectively acting as a virtual physical therapist able to provide corrective feedback. A dataset containing a set of three simple exercises for shoulder rehabilitation was processed. Each movement was meticulously annotated for temporal and categorical motion domains to monitor exercise execution in terms of the range of motion completeness and to evaluate compensatory movement patterns. This work carries substantial significance by offering a standardized and easily accessible model for human movement data, thus fostering the advancement of digital assistive systems designed to support home-based rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: Surgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears. Methods: In this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either 'BMC treatment', consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system. Results: Fifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study's two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment. Conclusions: Patients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears. Trial registration: This protocol was registered with www.clinicaltrials.gov (NCT01788683; 11/02/2013). [ABSTRACT FROM AUTHOR]

Background: Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous neurological recovery. Humerus derotation osteotomy has been suggested as a possible treatment option to improve arm positioning. However, consensus as to whether humerus derotation osteotomy can successfully restore limb function is missing. Methods: In the present controlled cohort study, we aimed at analyzing global upper extremity kinematics with a 3D-video analysis system in children with shoulder internal rotation contractures secondary to OBPP before, and one year after, humerus derotation osteotomy. Patients under 18 years of age that presented to our center with conservatively treated internal rotation contractures of the shoulder and subsequently underwent humerus derotation osteotomy were included. The unimpaired arm served as a respective control. Results: Pre-operatively, all patients showed severe internal rotation contractures of the shoulder of almost 60° at rest. At the follow-up, the position of the shoulder at rest was greatly shifted to 9° of internal rotation. The patients showed statistically significant improvement in maximum external rotation and abduction of the shoulder, as well as in maximum flexion of the elbow, and the range of motion of pro/supination. The maximum internal rotation of the shoulder, however, was diminished after the osteotomy. Conclusions: Our data indicated that derotational osteotomy is a promising procedure which can be used to correct for internal rotation contractures secondary to OBPP. Moreover, 3D-video analysis proved to be a useful tool that supplies the surgeon with both precise information about the degree of distortion pre-operatively, thus helping to decide on the amount of correction, and secondly, a measurement of the post-operative gain in upper extremity function. [ABSTRACT FROM AUTHOR]

Background and objective: Reduction manipulation using self-reduction procedures such as Stimson, Milch, and Boss-Holtzach should be easy and effective and also require less force, pain medication, and outside assistance. This technique should not cause damage to arteries, nerves, or shoulder joint components. Self-reduction is straightforward and can be done in clinics, making it ideal for people who suffer from shoulder joint dislocation frequently. The goal of this study is to compare the effectiveness of supervised self-reduction procedures vs. physician-assisted treatments in the treatment of anterior shoulder dislocations. Method: We conducted a comprehensive search on PubMed, Scopus, Web of Science, and Cochrane up to March 22, 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant articles were reviewed, with a focus on studies comparing supervised self-reduction techniques to physician-assisted techniques in cases of anterior shoulder dislocation. Results: Four papers in all were included in the meta-analysis. One prospective trial, one case-control study, one randomized clinical trial, and one retrospective trial made up these studies. The studies involved 283 patients in the physician-assisted group and 180 patients in the supervised self-reduction group. They were carried out in four European countries: Italy, Germany, Portugal, and Spain. The success rate of supervised self-reduction techniques was significantly higher, with an odds ratio of 2.71 (95% CI 1.25–5.58, p-value = 0.01). Based on the Visual Analog Scale (VAS) score, the physician-assisted group reported significantly higher maximum pain, with a mean difference of 1.98 (95% CI 1.24–2.72, p-value < 0.01). The self-reduction approaches exhibit shorter reduction time in comparison to physician-assisted groups. In addition, the self-reduction groups do not document any complications. Based on the GRADE system, the level of assurance in the evidence was high. Conclusion: Supervised self-reduction techniques outperform in terms of success rate and reduction-related maximum pain. These techniques could be used as an effective first-line treatment for anterior shoulder dislocation, potentially reducing the need for analgesics and emergency room visits. [ABSTRACT FROM AUTHOR]

Background: Restoring shoulder function is critical for upper-extremity rehabilitation following a stroke. The complex musculoskeletal anatomy of the shoulder presents a challenge for safely assisting elevation movements through robotic interventions. The level of shoulder elevation assistance in rehabilitation is often based on clinical judgment. There is no standardized method for deriving an optimal level of assistance, underscoring the importance of addressing abnormal movements during shoulder elevation, such as abnormal synergies and compensatory actions. This study aimed to investigate the effectiveness and safety of a newly developed shoulder elevation exoskeleton robot by applying a novel optimization technique derived from the muscle synergy index. Methods: Twelve chronic stroke participants underwent an intervention consisting of 100 robot-assisted shoulder elevation exercises (10 × 10 times, approximately 40 min) for 10 days (4–5 times/week). The optimal robot assist rate was derived by detecting the change points using the co-contraction index, calculated from electromyogram (EMG) data obtained from the anterior deltoid and biceps brachii muscles during shoulder elevation at the initial evaluation. The primary outcomes were the Fugl–Meyer assessment-upper extremity (FMA-UE) shoulder/elbow/forearm score, kinematic outcomes (maximum angle of voluntary shoulder flexion and elbow flexion ratio during shoulder elevation), and shoulder pain outcomes (pain-free passive shoulder flexion range of motion [ROM] and visual analogue scale for pain severity during shoulder flexion). The effectiveness and safety of robotic therapy were examined using the Wilcoxon signed-rank sum test. Results: All 12 patients completed the procedure without any adverse events. Two participants were excluded from the analysis because the EMG of the biceps brachii was not obtained. Ten participants (five men and five women; mean age: 57.0 [5.5] years; mean FMA-UE total score: 18.7 [10.5] points) showed significant improvement in the FMA-UE shoulder/elbow/forearm score, kinematic outcomes, and pain-free passive shoulder flexion ROM (P < 0.05). The shoulder pain outcomes remained unchanged or improved in all patients. Conclusions: The study presents a method for deriving the optimal robotic assist rate. Rehabilitation using a shoulder robot based on this derived optimal assist rate showed the possibility of safely improving the upper-extremity function in patients with severe stroke in the chronic phase. [ABSTRACT FROM AUTHOR]

Background and study aim. Shoulder injuries are common in women volleyball players, often resulting from repetitive overhead movements. Effective strength training methods can help prevent these injuries. This study aimed to investigate the efficacy of an eight-week resistance band training program on shoulder muscle strength enhancement and injury prevention in women volleyball athletes. Material and Methods. Forty collegiate women volleyball players, aged 18-25, were randomly assigned to either an intervention group (n=20) or a control group (n=20). The intervention group underwent a structured resistance band training program targeting shoulder strength, which included exercises like shoulder presses, lateral raises, internal and external rotations, and scapular retractions. Isokinetic dynamometry was used to assess shoulder muscle strength before and after the intervention, measuring peak torque of the shoulder flexors, extensors, internal rotators, and external rotators. Injury rates were monitored throughout the volleyball season, documenting the number and severity of shoulder injuries. Results. Significant improvements in shoulder muscle strength were observed in the intervention group across all measured parameters (p < 0.001), while the control group showed minimal changes (p > 0.05). Moreover, the intervention group exhibited a significant reduction in shoulder injury rates post-intervention (p = 0.041), whereas the control group's injury rates remained stable (p = 0.768). Conclusions. The findings suggest that resistance band training effectively enhances shoulder muscle strength and reduces injury rates in women volleyball athletes. Integrating targeted strength training, such as resistance band exercises, into regular training routines may help enhance athlete performance and mitigate injury risk in sports characterized by repetitive overhead movements. Further research is needed to explore the long-term effects and optimal implementation strategies of resistance band training in athletic contexts. [ABSTRACT FROM AUTHOR]

Background: In subacromial pain syndrome (SPS), it is unknown whether posterior shoulder stretching exercises (PSSE) with rapid eccentric contraction, a muscle energy technique, improve clinical and ultrasonographic outcomes more than no stretching or static PSSE. Hypothesis: PSSE with rapid eccentric contraction is superior to no stretching and static PSSE in improving clinical and ultrasonographic outcomes in SPS. Study Design: Randomized controlled trial. Level of Evidence: Level 1. Methods: Seventy patients with SPS and glenohumeral internal rotation deficit were randomized into the modified cross-body stretching with rapid eccentric contraction group (EMCBS; n = 24), static MCBS group (SMCBS; n = 23), or control group (CG; n = 23). In addition to 4-week physical therapy, EMCBS received PSSE with rapid eccentric contraction, SMCBS static PSSE, and CG no PSSE. The primary outcome was internal rotation range of motion (ROM). Secondary outcomes were posterior shoulder tightness, external rotation ROM (ERROM), pain, modified Constant-Murley score, short form of the disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), rotator cuff strength, acromiohumeral distance (AHD), supraspinatus tendon thickness, and supraspinatus tendon occupation ratio (STOR). Results: Shoulder mobility, pain, function and disability, strength, AHD, and STOR improved in all groups (P < 0.05). Conclusion: In patients with SPS, PSSE with rapid eccentric contraction and static PSSE were superior to no stretching in improving clinical and ultrasonographic outcomes. Stretching with rapid eccentric contraction was not superior to static stretching, but improved ERROM compared with no stretching. Clinical Relevance: In SPS, both PSSE with rapid eccentric contraction and static PSSE included in physical therapy program are beneficial to improve posterior shoulder mobility and other clinical and ultrasonographic outcomes. In the case of ERROM deficiency, rapid eccentric contraction might be preferred. [ABSTRACT FROM AUTHOR]

Background: Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. Methods and findings: Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to—1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). Conclusion(s): Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low. [ABSTRACT FROM AUTHOR]

Background: Adapted physical activity programs have shown promising results in reducing the physical, social and psychological side effects associated with breast cancer, but the extent to which they can be effectively adopted, implemented and maintained is unclear. The aim of this study is to use the framework to guide the planning and evaluation of programs according to the 5 following keys: Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate a fencing program under the French acronym RIPOSTE (Reconstruction, Image de soi, Posture, Oncologie, Santé, Thé rapie, Escrime) literally in English (Reconstruction, Self-Image, Posture, Oncology, Health, Therapy, Fencing). This program is an innovative intervention focused on improving the quality of life (QoL) of breast cancer surgery patients through fencing. Methods: A convergent mixed methods pilot study was conducted to preliminary evaluate the different RE-AIM dimension of the pilot program. Twenty-four participants who have just undergone surgery for invasive breast cancer were randomly allocated in two groups: one group started immediately after their inclusion (Early RIPOSTE group) and the other started 3 months following their inclusion (Delayed RIPOSTE group). Participants answered a questionnaire at inclusion and at the end of the program on QoL, shoulder functional capacity, fatigue, anxiety-depression and physical activity. Results: RIPOSTE program was able to reach mainly young and dynamic participants, attracted by the originality of fencing and keen to improve their physical condition. Regarding effectiveness, our results suggest a trend to the improvement of QoL, shoulder functional capacity, fatigue and anxietydepression state, even without any significant differences between the Early RIPOSTE group and the Delayed RIPOSTE group. Discussions: The cooperation, exchanges and cohesion within the group greatly facilitated the adoption of the program, whereas interruptions during school vacations were the main barriers. The intervention was moderately well implemented and adherence to the protocol was suitable. Conclusion: RIPOSTE is an acceptable and effective program for involving breast cancer survivors in physical activity, that needs to be tested at a larger scale to investigate its effectiveness, but has the potential to be transferred and scaled up worldwide. [ABSTRACT FROM AUTHOR]

Background: Shoulder pain is one of the most common symptoms after laparoscopic surgery, which seriously affects people's health and quality of life. Many clinical studies have shown that noninvasive physiotherapy is the most beneficial treatment for patients, but the best approach for various noninvasive physiotherapy is unclear. The purpose of this study protocol is to compare the effectiveness of different noninvasive physiotherapy in relieving postlaparoscopic shoulder pain (PLSP). Methods: We will search ten electronic databases including PubMed, Web of Science, Medline, Scopus, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, WanFang Data and VIP databases from their inception to November 2023. We will select randomized controlled trials (RCTs) to evaluate the effectiveness of noninvasive physiotherapy on PLSP. Our primary outcome will be to measure the intensity of shoulder pain at 24 and 48 hours after the end of the noninvasive intervention in the included study. Secondary outcomes include incidence of shoulder pain at 24 and 48 hours, postoperative nausea / vomiting and incidence of other complications after noninvasive intervention. Then, standard network meta-analysis will be conducted using Review Manager 5.4 and STATA 18. Results: Our systematic review and network meta-analysis will identify the best noninvasive physiotherapy for PLSP patients. Conclusion: This systematic review will address the existing knowledge gap regarding best practice for relieving PLSP with noninvasive physiotherapy. The results of this network meta-analysis will help medical staff and patients choose the best method to relieve the PLSP. Furthermore, we hope that the results of this study will provide evidence-based for the improvement of guidelines and facilitate the decision sharing process. Systematic review registration: PROSPERO CRD42023481829. [ABSTRACT FROM AUTHOR]

Background: Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty. Methods: A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18–40 years, group II = 41–60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed. Results: Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%). Conclusions: Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence is being used for rehabilitation, including monitoring exercise compliance through sensor technology. AI classification of shoulder exercise wearing an IMU sensor has only been reported in normal (i.e. painless) subjects. To prove the feasibility of monitoring exercise compliance, we aimed to classify 11 types of shoulder rehabilitation exercises using an AI (artificial intelligence) algorithm in patients with shoulder pain. We had the patients wear an IMU-based sensor, collected data during exercise, and determined the accuracy of exercise classification. Methods: Data were collected from 58 patients (27 males, 31 females, age range 37–82 years) diagnosed with shoulder diseases such as adhesive capsulitis and rotator cuff disease. 11 types of shoulder pain rehabilitation exercise programs were developed and repeated each exercise ten times per session while wearing an IMU sensor. The study applied the Rectified Linear Unit (ReLU) and the SoftMax as the activation function for hidden layers, the output layer. Results: The acquired data was used to train a DNN model using the multilayer perceptron algorithm. The trained model was used to classify 11 types of shoulder pain rehabilitation exercises. The training accuracy was 0.975 and the test accuracy was 0.925. Conclusion: The study demonstrates that IMU sensor data can effectively classify shoulder pain rehabilitation exercises, providing more appropriate feedback for patients. The model can be utilized to establish a system for remotely monitoring patients' exercise performance. The use of deep learning in patient monitoring and rehabilitation has significant potential to bring innovative changes to healthcare service delivery. [ABSTRACT FROM AUTHOR]

This study proposes an image-based three-dimensional (3D) vector reconstruction of industrial parts that can generate non-uniform rational B-splines (NURBS) surfaces with high fidelity and flexibility. The contributions of this study include three parts: first, a dataset of two-dimensional images is constructed for typical industrial parts, including hexagonal head bolts, cylindrical gears, shoulder rings, hexagonal nuts, and cylindrical roller bearings; second, a deep learning algorithm is developed for parameter extraction of 3D industrial parts, which can determine the final 3D parameters and pose information of the reconstructed model using two new nets, CAD-ClassNet and CAD-ReconNet; and finally, a 3D vector shape reconstruction of mechanical parts is presented to generate NURBS from the obtained shape parameters. The final reconstructed models show that the proposed approach is highly accurate, efficient, and practical. [ABSTRACT FROM AUTHOR]

Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging. Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players. Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume. Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group. Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises. [ABSTRACT FROM AUTHOR]

Background: Forward head posture and rounded shoulder posture are common postural variants found in upper crossed syndrome, which can lead to limited neck mobility, respiratory problems, and other issues. The purpose of this study was to investigate the effects of telerehabilitation, combining diaphragmatic breathing re-education and shoulder stabilization exercises, on young men with upper crossed syndrome during the COVID-19 pandemic over 4 weeks. Methods: The study included 37 participants aged in their 20s and 30s who were randomly divided into two groups. The experimental group received diaphragmatic breathing re-education and shoulder stabilization exercises, while the control group only underwent shoulder stabilization exercises. Both groups were trained three times a week for four weeks using telerehabilitation. The comparison of within-group pre–post differences in the experimental and control groups was conducted using a paired t-test, while the effects of treatment were assessed using repeated-measures analysis of variance. Results: After 4 weeks, both groups showed significant improvements in the pain pressure threshold of the upper trapezius, craniovertebral angle, round shoulder posture, shoulder tilt degree, neck disability index, and closed kinetic chain upper extremity stability test (all p < 0.05). The results showed a significant difference between the Time effect (p adj < 0.05/4) for both sides of PPT, CVA, and STD and both sides of RSP, NDI, and CKCUEST, and an interaction between the Time × Group effects (p adj < 0.05/4) for the Rt. PPT, CVA, and STD. Conclusions: These findings suggest that the telerehabilitation training group, which included diaphragmatic breathing re-education and shoulder stabilization exercises, was more effective in improving Rt. PPT, CVA, and STD in males with UCS. [ABSTRACT FROM AUTHOR]

Objective: Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device. Methods: We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow‐up. The operation‐related complications were also evaluated. The Student's t test and the Mann–Whitney U‐test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi‐squared test or Fisher's exact test. Results: Forty‐two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow‐up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation‐related complications in either group. Conclusions: The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation. [ABSTRACT FROM AUTHOR]

Background: Tele-rehabilitation, also known as tele-rehab, uses communication technologies to provide rehabilitation services from a distance. The COVID-19 pandemic has highlighted the importance of tele-rehab, where the in-person visits declined and the demand for remote healthcare rises. Tele-rehab offers enhanced accessibility, convenience, cost-effectiveness, flexibility, care quality, continuity, and communication. However, the current systems are often not able to perform a comprehensive movement analysis. To address this, we propose and validate a novel approach using depth technology and skeleton tracking algorithms. Methods: Our data involved 14 participants (8 females, 6 males) performing shoulder abduction exercises. We collected depth videos from an LiDAR camera and motion data from a Motion Capture (Mocap) system as our ground truth. The data were collected at distances of 2 m, 2.5 m, and 3.5 m from the LiDAR sensor for both arms. Our innovative approach integrates LiDAR with the Cubemos and Mediapipe skeleton tracking frameworks, enabling the assessment of 3D joint angles. We validated the system by comparing the estimated joint angles versus Mocap outputs. Personalized calibration was applied using various regression models to enhance the accuracy of the joint angle calculations. Results: The Cubemos skeleton tracking system outperformed Mediapipe in joint angle estimation with higher accuracy and fewer errors. The proposed system showed a strong correlation with Mocap results, although some deviations were present due to noise. Precision decreased as the distance from the camera increased. Calibration significantly improved performance. Linear regression models consistently outperformed nonlinear models, especially at shorter distances. Conclusion: This study showcases the potential of a marker-less system, to proficiently track body joints and upper-limb angles. Signals from the proposed system and the Mocap system exhibited robust correlation, with Mean Absolute Errors (MAEs) consistently below 10 ∘ . LiDAR's depth feature enabled accurate computation of in-depth angles beyond the reach of traditional RGB cameras. Altogether, this emphasizes the depth-based system's potential for precise joint tracking and angle calculation in tele-rehab applications. [ABSTRACT FROM AUTHOR]

Background & Objectives: There is conflicting evidence regarding the effects of exercise on shoulder impingement syndrome. Exercise therapy is one of the methods used to reduce pain and increase muscle strength in patients with shoulder impingement syndrome. There are several exercise therapy programs available in this area. The purpose of this study is to evaluate the effect of exercise therapy on pain and disability in patients with shoulder impingement syndrome. Materials & Methods: This randomized clinical trial was conducted in 25 patients with impingement syndrome from the Dastgheib Yasaei Pain Clinic in Fasa. Patients were randomized to receive medication (n=13) or medication plus exercise therapy (n=12). The Oswestry Disability Index (ODI) and the Verbal Numeric Rating Scale were used to measure disability and pain intensity before and after the intervention. Patient satisfaction was measured using the Likert scale. Independent and paired t-test, Mann-Whitney U test, and chi-squared were performed at a significant level of P=0.05. Analyses were performed with SPSS software (version 25.0). Results: There were no differences between groups in pre-intervention demographics (P>0.05), pain intensity (P=0.16), and ODI scores (0.93). Post-intervention pain and ODI scores were significantly higher in the medication group than in the medication-exercise group (P=0.06, P=0.03, respectively). There was a significant difference in pain and ODI scores at post-intervention compared to pre-intervention in both groups (P<0.001). The difference in pain intensity between pre- and post-intervention in both groups was also statistically significant (P=0.006). There was a significant difference in patient satisfaction between groups (P=0.03). Conclusion: These results suggest that a regular exercise program, along with medication, may be effective in reducing pain and disability in patients with shoulder impingement syndrome. [ABSTRACT FROM AUTHOR]

Background/aim: The shoulder is the most mobile joint in the body, and is frequently exposed to injuries. The applied surgical treatments, protection of the shoulder after surgery, care in the use of the shoulder in activities of daily living (ADLs) and gradual exercise programs are all vital to the recovery process. The present study investigates the effect of video-assisted training (VAT) on upper extremity complications and functions after rotator cuff repair (RCR). Materials and method: Included in this prospective, parallel two-armed, randomized controlled study were an experimental group (n: 24) that received VAT detailing early postoperative care for RCR and instructions on performing ADLs, and that had access to a 90-day gradual exercise program, and a control group (n: 24) that received routine care. The primary outcomes were upper extremity problems and functions, as assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) and modified Constant-Murley scores (MCM), while secondary outcomes were complications that had developed within the past three months. The outcomes were measured at baseline, after six weeks and at three months. Results: After 3 months, a statistically significant difference was noted in the DASH-Work (p = 0.001) and MCM ADLs scores (p = 0.003) of the two groups, and significant changes in which the scale scores of both groups when compared to the initial measurement. Only one patient in the VAT group developed complications after RCR at one month; there were no significant differences in the complications of the two groups (p = 0.235). Conclusion: VAT can increase function in RCR patients. Healthcare professionals, especially nurses, can use the VAT method to improve shoulder function in patients after RCR. [ABSTRACT FROM AUTHOR]

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps. [ABSTRACT FROM AUTHOR]

Background: Anesthesia with deep neuromuscular block for laparoscopic surgery may result in less postoperative pain with lower intra-abdominal pressure. However, the results in the existing literature are controversial. This study aimed to evaluate the effect of deep versus moderate neuromuscular block (NMB) on the postoperative recovery characteristics after laparoscopic sleeve gastrectomy (LSG) for weight loss surgery. Methods: This is parallel-group, randomized clinical trial. The study was conducted at a tertiary care center. Patients undergoing LSG were included. Patients were randomly assigned to either deep (post-tetanic count 1-2) or moderate (train-of-four 1-2) NMB group. The primary outcomes were numeric rating scale scores of the postoperative pain at rest and postoperative shoulder pain. The secondary outcomes were the length of hospital stay (LOS) and postoperative complications. The statistics were performed using StatsDirect statistical software (Version 2.7.9). Results: Two groups were identified: Group D (deep NMB), 29 patients, and Group M (moderate NMB), 28 patients. The BMI mean values for groups D and M were 44 and 45 kg/m2 respectively (P > 0.05). The mean durations of surgery for were 46.7 min and 44.1 min for groups M and D, respectively (P > 0.05). The mean train-of-four (TOF) counts were 0.3 and 0 for groups M and D, respectively (P < 0.05). The mean times from giving reversal agent to tracheal extubation (minutes) were 6.5 and 6.58 min for groups M and D, respectively (P > 0.05). In the recovery room, the means of pain scores were 3 and 4 for groups M and D, respectively (P > 0.05). Upon admission to the surgical ward, the median values of the pain score were non-significant (P > 0.05) (95% CI: 0.4-0.7). The opioid consumption in the recovery room was non-significant between both groups (P > 0.05) (95% CI: 0.3-0.6). Postoperative shoulder pain was non-significant between both groups (P > 0.05) (95% CI: 0.4-0.7). The median values of surgeon opinion of both groups were non-significant (P > 0.05). Regarding the LOS, the mean values of groups D and M were 1.20 and 1.21 days, respectively (P > 0.05). Conclusions: There was no significant difference between moderate and deep NMB techniques in terms of duration of the surgical procedure, postoperative pain, shoulder pain, and length of hospital stay. Further studies on a larger sample size are required to investigate the long-term recovery characteristics of patients with obesity undergoing LSG. [ABSTRACT FROM AUTHOR]

Background and Aims Previous studies have shown that core stability exercises reduce the applied force on the upper limbs in swimmers. However, the effect of these exercises on the range of motion (ROM), muscle strength, and pain in the shoulder of swimmers is unclear. Therefore, this study aims to investigate the effect of a core stability exercise program on shoulder pain, muscle strength, and ROM in female swimmers with shoulder impingement syndrome (SIS). Methods The study population consists of all female swimmers with SIS in Tabriz, Iran. Twenty eligible swimmers were selected and randomly divided into two exercise (n=10) and control (n=10) groups. The shoulder pain, ROM, and muscle strength were measured by the shoulder pain and disability index, a goniometer, and the bench press (One repetition maximum), respectively. The exercise group participated in a specific core stability exercise program. The data were analyzed in SPSS software, version 24 using repeated measures analysis of variance, independent t-test, and paired t-test for withingroup and between-group comparisons. The significance level was set at 0.05. Results After exercise, the amount of shoulder pain in the experimental group was significantly reduced compared to the control group (P=0.0001). It also had a significant effect on the ROM of the shoulder in this group. In addition, there was a significant difference in shoulder muscle strength in the experimental group before and after exercise (P=0.0001), but this difference was not significant in the control group (P=0.138). Moreover, there was a significant interaction effect of time and group in the shoulder girdle muscle strength (P=0.001). Conclusion The core stability exercises can reduce shoulder pain and improve shoulder ROM and muscle strength in female swimmers with SIS. Performing core stability exercises is recommended to reduce pain and improve shoulder girdle function in these swimmers. [ABSTRACT FROM AUTHOR]

Background and Aims Volleyball is one of the most popular sports in Iran and every year more teenagers and adults are attracted to this sport. However, there is no systematic injury prevention program for Iranian volleyball players in accordance with the cultural, economic and social conditions of the country. Therefore, the purpose of this study is to design an intervention program to prevent volleyball sports injuries in a systematic manner using the intervention mapping protocol. Methods The IM method was used to design the program which has 6 steps: (1) Needs assessment, (2) Determining intervention outcomes and objectives, (3) designing the intervention by selecting theory and their practical applications, (4) producing the intervention program, (5) Developing an implementation plan, and (6) Developing an evaluation plan. To design the intervention, we used the steps 1 to 4. Results The designed program included a warm-up program with more than 45 movements (with different types and levels for players with different abilities) that should be performed at least two sessions a week before training or competition. The program consisted of three 3-week phases and provided to the trainers every week to observe the gradual improvement in intensity, repetition, complexity, and time of training. The duration of each weekly session was 15 minutes, including 4-5 minutes of cardiorespiratory exercises (to increase body temperature and cardiorespiratory preparation) and 9-10 minutes of exercises to prevent shoulder, knee and ankle injuries. Conclusion Despite being time consuming, the IM is a suitable method for designing an intervention to prevent injuries in volleyball. The designed injury prevention intervention is a 15-minute warm-up program that includes more than 45 exercises for amateur volleyball players. The feasibility of this program is under investigation and the study of its effect will be conducted in the upcoming months. [ABSTRACT FROM AUTHOR]

Background: Moderate to severe slipped capital femoral epiphysis is a condition that benefits from treatment with modified Dunn realignment osteotomy and fixation1,2. The results are acceptable when the procedure is performed by experienced surgeons3,4. Description: The patient is placed in the lateral decubitus position. Surgical hip dislocation is performed after a digastric trochanteric osteotomy. An extended retinacular flap is carefully prepared, and the epiphysis separated from the metaphysis, exposing the entirety of the femoral neck. Following this, an open reduction is performed by excising the posteromedial callus and trimming the femoral neck in order to allow capital realignment while avoiding tension on the retinacular vessels. Finally, the reduced slip is fixed with 6.5 or 7-mm cancellous screws and Kirschner wires. The femoral head is then repositioned in the acetabulum, and the trochanter is fixed distal to its original position with use of 3.5-mm self-tapping cortical screws. Closure is performed in layers after achieving adequate hemostasis. Alternatives: Operative alternatives to this technique include cuneiform osteotomy, compensatory osteotomy of the base of the neck or intertrochanteric osteotomy and controlled repositioning, and osteoplasty5-7. Osteotomies performed distally and away from the deformity can still lead to cam impingement, thereby failing to reduce the risk of future joint degeneration. In situ pinning has also been described for use in moderate to severe cases of slipped capital epiphysis, but the residual deformity leads to substantial femoroacetabular impingement and thus affects the prognosis of such a hip8. Rationale: This technique accounts for the complex anatomy of the hip joint, especially in terms of its precarious blood supply. Long-term studies have shown that corrective osteotomy performed near the physis can correct the alignment at the head-neck junction, thereby avoiding future femoroacetabular impingement. In the hands of experienced surgeons, results have been shown to be favorable3,4. Expected Outcomes: In a series of 30 consecutive hips, including 20 moderate and 10 severe slips, the slip angle improved significantly following the modified Dunn procedure (by 43.63° ± 8.42°; p < 0.001). Osteonecrosis was observed in 2 hips (6.7%), and 1 hip had postoperative subluxation that required intervention9. In their series of 23 patients, Slongo et al. encountered 2 cases (9%) of osteoarthritis and osteonecrosis10. In their series of 40 patients from 2 different institutions, Ziebarth et al. reported no cases of chondrolysis or osteonecrosis11. Important Tips: The steps described need to be followed sequentially and meticulously in order to safely dislocate the hip while preserving the blood supply. The availability of an anterior pouch in draping, to deliver the leg during dislocation, will reduce the dependence on an assistant and maintain sterility The trochanteric osteotomy should be started with the help of a saw, completed with an osteotomy and must be about 1 to 1.5 cm thick in order to achieve good, stable fixation following relocation of the femoral head and to achieve good abductor function post-relocation. The use of curved, stout, thick scissors ("episiotomy scissors") can help to ease the step of cutting the ligamentum teres during dislocation. The retinacular flap should be widely exposed along with removal of the posterior callus so that no tension remains on the blood supply. Acronyms and Abbreviations: SCFE = slipped capital femoral epiphysis FAI = femoroacetabular impingement MDP = modified Dunn procedure AVN = avascular necrosis THR = total hip replacement FAER = flexion, abduction and internal rotation CT = computed tomography MRI = magnetic resonance imaging AP = anteroposterior [ABSTRACT FROM AUTHOR]

Aim: To study on surgical management of ipsilateral clavicle and scapular fractures (floating shoulder injury). Methodology: The study protocol was approved by an Ethical Committee for research studies of NRI Medical College. Patients of floating shoulder injury with gross displacement at fracture site of both clavicle and scapula attending the emergency department of NRI Medical College, Mangalagiri. Results: In our present study, we included patients in age range between 20-60 years with a mean age of 38.7 years with majority of the patients in range of 31-40 years (35%) In our present study males were predominant (75%) than females (25%) In our study Right sided injuries were more (60%) compared to left (40%). In our study majority of the injuries were due to high energy RTA (85%) followed by fall from height (15%). In our study ipsilateral side multiple rib fractures (40%) were the most common associated injury followed by head injury (15%) and C-spine fractures (5%). Among the 20 cases, Type C3 (Scapular neck displaced & unstable) was more common (60%) followed by C2 (Scapular neck undisplaced & unstable) (25%) and B3 (Scapular neck displaced & stable) (15%). The average duration for fixation of both clavicle and scapula in our study was 131.17 mins while for fixation of clavicle alone was 66.67 mins In our present study 17 cases (85%) were operated for both clavicle and scapula with LCP & RECON plates and 3 cases (15%) were operated for only clavicle with LCP. In our present study, the average blood loss in those patients who got operated for both clavicle and sc apula is around 90ml while those operated for clavicle alone it was around 35ml. In our present study the mean time period (in weeks) for the union was 12.6 weeks for both clavicle and scapula when operated with clavicle fixation alone and 14.7 weeks respectively for both clavicle & scapula when operated with fixation of both clavicle & scapula. In our study the functional outcome of all patients was analyzed using HERSCOVICI SCORE. The mean HERSCOVICI SCORE in our study was 13.3 (EXCELLENT) in clavicle fixation alone group and 11.35 (EXCELLENT) in both scapula & clavicle fixation group. Conclusion: We concluded that successful indirect reduction of the displaced fracture of the glenoid neck can be achieved with surgical fixation of the clavicle alone using LCP. However, open reduction and internal fixation of the scapula with RECON plating must be performed if significant displacement of scapula is present which ultimately resulted in good functional outcome. [ABSTRACT FROM AUTHOR]

The purpose of this study was to design and develop a passive assistive shoulder device for vulnerable older adults with an interest in exercising their shoulders with partial weight support and to test the device by measuring muscle activity. The healthy male subjects (N = 14) repeatedly transferred a lightweight ball from a lower basket (knuckles height) to a higher basket (shoulder height) based on individual anthropometry, completing 50 cycles both with and without the prototype device while electromyography recorded the three different shoulder muscle activities. The preliminary evaluation results show that the prototype reduced the electromyography of muscle activity by an average of 39% (from 11.20 ± 2.02 to 6.81 ± 1.50): anterior deltoid by 40% (from 12.40 ± 2.89 to 7.47 ± 1.48), middle deltoid by 43% (from 12.71 ± 1.66 to 7.30 ± 1.45), and pectoralis major by 33% (from 8.50 ± 1.75 to 5.71 ± 1.87). These results show that this device is suitable for shoulder training, which will be useful for vulnerable older adults. [ABSTRACT FROM AUTHOR]

Out-of-hospital reduction of shoulder dislocations using the Campell method is recommended by the International Commission for Alpine Rescue and applied in the Bavarian Mountain Rescue Service (Bergwacht Bayern, BWB) protocols. This prospective observational study includes patients out-of-hospital with suspected shoulder dislocation and treated and evacuated by the BWB. Data were systematically collected using three questionnaires: one completed on-site by the rescuer, the second in hospital by the physician and the third within 28 (8–143) days after the accident by the patient. The suspected diagnosis of shoulder dislocation was confirmed in hospital in 37 (84%) of 44 cases. Concomitant injuries in other body regions were found in eight (16%) of 49 cases and were associated with incorrect diagnosis (p = 0.002). Younger age (p = 0.043) and first shoulder dislocation event (p = 0.038) were associated with a higher success rate for reduction attempts. Out-of-hospital reduction of shoulder dislocations leads to significant pain relief and no poorer long-term outcome. Signs that are associated with successful out-of-hospital reduction (younger age and first event), but also those that are associated with incorrect diagnosis (concomitant injuries) should be considered before trying to reduce shoulder dislocation on site. The considerable rate of incorrect first diagnosis on site should give rise to an intensive discussion around teaching and training for this intervention. Trial registration: This study is registered with the German Registry for Clinical Trials (DRKS00023377). [ABSTRACT FROM AUTHOR]

Neuromuscular re-education through therapeutic exercise has a determinant role in chronic shoulder pain rehabilitation. Smartphones are an interesting strategy to extend the rehabilitation to a home-based scenario as it can increase the attraction and involvement of users by providing feedback. Objective: To analyze the concurrent validity of a smartphone's application based on 2D video analysis against the gold-standard 3D optoelectronic system for assessing movement quality during upper limb therapeutic exercises. Methods: Fifteen young adults were evaluated while executing two different shoulder exercises with a smartphone's 2D video and a 3D optoelectronic system simultaneously in two conditions: (1) with the supervision and instructions of a physiotherapist (guided exercise), and (2) without the feedback of the physiotherapist (non-guided exercise). The data obtained during the guided and non-guided exercises were compared to calculate the movement quality index based on the approximation of the non-guided exercise to the guided exercise for the head, trunk, and shoulder's range of movement. The agreement of the movement quality index assessed with the smartphone application and the optoelectronic system was carried out through Bland–Altman analysis. Results: The Bland–Altman analysis indicates the range of agreement and bias tendency. This tendency demonstrates that the percentage of difference between the two methods increases as the movement quality index decreases. Conclusions: There is agreement between the movement quality evaluated by a gold-standard method and the developed application, although the proposed method appears to have less sensitivity for evaluating movements with lower quality index. [ABSTRACT FROM AUTHOR]

Introduction: Rotator cuff tendinopathy is a common shoulder disorder in which the primary treatment is resistance exercises. Isometric exercises are being studied for lower limb tendinopathies but not for rotator cuff tendinopathy. This protocol for a randomized clinical trial aims to compare the effects of two types of exercise (isometric and isotonic) on shoulder pain, functioning, muscle strength, and electromyographic activity in individuals with rotator cuff tendinopathy. Methods: Forty-six individuals (18 to 60 years old) with shoulder pain for more than three months and unilateral supraspinatus and/or infraspinatus tendinopathy will participate in this trial. Individuals will be randomized into two exercise groups: isometric or isotonic. The following outcomes will be evaluated before and after the first session and after six weeks of intervention: shoulder pain and functioning; isometric strength of shoulder elevation and lateral and medial rotation; and electromyographic activity of medial deltoid, infraspinatus, serratus anterior, and lower trapezius. Groups will perform stretching and strengthening of periscapular muscles. The isometric group will perform three sets of 32 s, at 70% of maximal isometric strength. The isotonic group will perform concentric and eccentric exercises (2 s for each phase) in three sets of eight repetitions at a load of eight repetition maximum. The total time under tension of 96 s will be equal for both groups, and load will be adjusted in weeks three and five of the protocol. Treatment effect between groups will be analyzed using linear mixed model. Trial registration: Trial registration number: Universal Trial Number (UTN) code U1111-1284-7528 and Brazilian Clinical Trials Registry platform–RBR-3pvdvfk. [ABSTRACT FROM AUTHOR]

Background: Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. Hypotheses: Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. Results: Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. Conclusion: Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. Clinical Relevance: Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim. Methods: IRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed. Results: One hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p <.001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME (p <.05). Accuracy for predicting QFME was high with an AUC of.89 (95% CI.82–.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance. With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p =.021). Conclusion: Hip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion. Critical relevance statement: FABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making. Key points: • FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter. • Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema. • Foveal excursion was more frequent in hips with quadratus femoris muscle edema. [ABSTRACT FROM AUTHOR]