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Background Interventions using vibration stimulation have been recognized for their potential for increasing range of motion (ROM) without compromising muscle strength. Handheld vibration massagers can efficiently deliver vibration therapy to the shoulder joint and may be a potential treatment. Purpose To evaluate the effects of vibration massage using a handheld device on the soft tissues of the posterior shoulder joint, particularly on internal rotation (IR) passive ROM and external rotation (ER) muscle strength. Study Design Crossover study design. Methods A crossover study with a 5-min vibration massage and passive control condition was conducted in healthy male volunteers (mean age 20.5 ± 1.7 years). Vibration massage was applied to the posterior shoulder soft tissues of the dominant arm, with no intervention under control conditions. IR-ROM (vertebral level and in abduction) and strength of the external rotators (isometric and isokinetic) were measured before and immediately after the intervention. Vertebral levels were calculated as a ratio of lengths (ratio decreases with increased mobility). IR-ROM in abduction, the angle was measured. Statistical analysis was performed with two-way repeated measures ANOVA and paired t-test (Bonferroni correction). Results Vibration application decreased (improved) vertebral level IR ROM by -4.1% (p < 0.01, d = 0.445) and increased abduction position IR ROM by 11.4° (p < 0.01, d = 0.694). These changes exceeded the 95% confidence interval for the minimum detectable change. By contrast, the control condition produced no changes. IR-ROM (vertebral level and abduction) immediately after the intervention showed significant differences between the control and vibration conditions (p = 0.036, d = 0.273; p = 0.048, d = 0.483, respectively). Muscle strength did not show any interaction, time, or between-condition effects. Conclusions A massage using a handheld vibration massager applied to the posterior shoulder soft tissues increased IR-ROM without negatively affecting muscle strength, suggesting its potential use as a means of warming up. Level of Evidence Level 3 [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

Lateralizing the center of rotation in reverse shoulder arthroplasty (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture. Eighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications. After virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (P <.001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed. In a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture. [ABSTRACT FROM AUTHOR]

To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20–70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC. The Kaltenborn, Maitland, and Mulligan concepts are the most commonly used manual therapy approaches for adhesive capsulitis. The End-range mobilisation techniques seem to improve pain intensity, shoulder range of motion, and physical function at short- and medium-term of follow-up. The certainty of evidence was rated as very low for all the outcome measures. Despite the low certainty of evidence, it is recommended to continue using manual therapy for adhesive capsulitis due to the improvements demonstrated until further studies either confirm or refute its definitive efficacy. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present systematic review is to synthesize existing evidence (qualitative and quantitative) regarding age- and sex-specific differences with glenohumeral osteoarthritis. Design: The electronic databases PubMed, MEDLINE, and Web of Science were searched up to March 15, 2023. Articles reporting on the association of risk factors (age and sex) with glenohumeral osteoarthritis were considered. We used Newcastle-Ottawa Scale to assess study quality. Meta-analysis was conducted to quantitatively summarize the association of age and sex with glenohumeral osteoarthritis. Results: A total of 24 articles were retrieved for full-text review. Of 24 articles, 8 reporting age-specific and 5 articles reporting sex-specific associations with glenohumeral osteoarthritis were included. The odds ratio for the age (odds ratio = 3.18; 95% confidence interval = 1.10–15.92) and female sex (odds ratio = 1.78; 95% confidence interval = 0.95–3.42) were increased and observed statistically significant. Conclusions: The present systematic review and meta-analysis suggests the role of increasing age as one of the significant contributors to glenohumeral osteoarthritis. However, association of female sex with glenohumeral osteoarthritis is least convincing. Future studies are required to understand the molecular mechanisms behind the contributory role of increasing age and female sex in the establishment of glenohumeral osteoarthritis. [ABSTRACT FROM AUTHOR]

Background/purpose Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM. Design Randomized Sequential Intervention Laboratory Study Methods Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically. Results There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points. Discussion Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM. [ABSTRACT FROM AUTHOR]

Context: Overhead athletes place tremendous demands on the shoulder complex, which result in adaptive kinematics but potential susceptibility to injury. This study aimed to compare shoulder glenohumeral range of motion (ROM) and rotator muscles strength in bilateral and unilateral overhead sports. Design: Cross-sectional study; secondary care. Methods: Forty-two elite athletes (17.7 [4.5] y; 42.9% female), including 18 swimmers and 24 badminton players, were included. Preseason glenohumeral rotation ROM and isokinetic shoulder internal and external rotator muscles strength was tested (60°·s-1). Bilateral (nondominant:dominant) and agonist:antagonist (external rotator:internal rotator) conventional and functional deceleration ratios (eccentric to concentric) were calculated. The impact of sport and number of competitive years on shoulder ROM and strength was tested. Results: Badminton players had greater glenohumeral internal rotation deficit, total ROM deficit, and lower bilateral strength ratio than swimmers (P < .050). Rotational strength was positively associated with the competitive years, but greater in swimmers (P < .050) and on the internal rotator (P < .001). The functional deceleration ratio was negatively associated with the competitive years on the dominant side in swimmers and for both sides in badminton. Conclusions: Unilateral overhead athletes had greater ROM and rotational strength asymmetries than bilateral athletes. Interestingly, the functional deceleration ratio was lower over time on the dominant shoulder for both sports, but, surprisingly, also on the nondominant shoulder in badminton, potentially creating a greater risk for shoulder injuries. [ABSTRACT FROM AUTHOR]

Background: This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). Methods: LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. Results: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15–58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). Conclusions: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss. [ABSTRACT FROM AUTHOR]

Background: Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures. Purpose: To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft. Results: Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction (P =.042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction (P <.037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles (P <.039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition (P <.014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction (P =.019 and P =.048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles (P <.023), whereas LTT did not increase the contact area. Conclusion: SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT. Clinical Relevance: These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis, an idiopathic condition that can cause severe disability, is characterized by fibrosis, a reduced glenoid capsule volume, and increasing pain with loss of range of motion (ROM) in the shoulder joint. In this study the efficiency of scapular Proprioceptive Neuromuscular Facilitation (PNF) with Maitland glenohumeral mobilization in adhesive capsulitis patients. Purpose: This study was to evaluate the effectiveness of scapular Proprioceptive Neuromuscular Facilitation (PNF) mobilization with Maitland glenohumeral mobilization and) in subjects with adhesive capsulitis. Methodology: Subjects were selected from out patient department of Saveetha Medical College and Hospital among 15 subjects following inclusion and exclusion criteria. Quasi-experimental study design, Convenient sampling is the sampling method. Range of motion and the numerical pain rating scale (NPRS) two outcome measures. Both the universal goniometer for ROM and the numerical pain rating scale (NPRS), which were used as outcome measures for adhesive capsulitis, were measured before and after the 16th therapy session. For four weeks, the treatment consisted of four-week sessions. Conclusion: As a result of the findings, it was concluded that Scapular Proprioceptive Neuromuscular Facilitation with Maitland Glenohumeral Mobilization was effective in improving the Range of motion and reducing pain in Adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Context: Fatigue of the scapular stabilizing muscles resulting from repeated arm motion has been reported to alter scapular kinematics, which could result in shoulder pathology, especially impingement. Objective: This study aimed to examine the effects of fatigue of the serratus anterior muscle on scapular kinematics, specifically, decrease scapular posterior tilt and upward scapular rotation during arm elevation. Design: Repeated measures. Setting: Laboratory. Participants: Thirty participants were included in the investigation. Interventions: Scapular kinematics and shoulder strength were measured before and immediately following a serratus anterior fatigue protocol. Main Outcome: Scapular 3-dimensional position during arm elevation. Results: No difference in upward rotation of the scapula between prefatigue and postfatigue conditions (ascending: P =.188; descending: P =.798). Scapular posterior tilt decreased during arm elevation following the fatigue protocol between 60° and 90° and 90° and 120° of arm elevation during the ascent (P =.004) and the descent (P =.013). Fatigue by arm elevation angle interaction was found for clavicular elevation during the ascent (P =.050) between 90° and 120° of arm elevation. Scapular internal rotation increased during the ascent (P =.027). There was no difference in clavicular protraction between the prefatigue and postfatigue conditions (ascending: P ≤.001; descending: P ≤.001). Conclusion: Fatigue of the serratus anterior decreases posterior scapular tilt and greater clavicular elevation and scapular internal rotation at higher arm elevation angles. These findings are consistent with the scapular kinematic patterns associated with shoulder pain. Improving serratus anterior endurance might delay the changes in scapular kinematics associated with repeated arm motion and shoulder injury mechanisms. [ABSTRACT FROM AUTHOR]

Background: Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. Purpose: To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. Study Design: Cohort study; Level of evidence, 3. Methods: This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. Results: A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P =.3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P <.001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P =.0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P =.0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P <.0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P =.6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P =.9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P =.9421, P =.9400, and P =.6045, respectively). Conclusion: The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years. [ABSTRACT FROM AUTHOR]

Objective: Softball players commonly suffer overuse injuries due to the demands of repetitive throwing. The biceps tendon plays an important role in stabilizing the shoulder during the windmill pitch. The purpose of this study was to evaluate the measures used to identify and study biceps tendon pathology in softball players. Design: This was a systematic review. Setting: PubMed MEDLINE, Ovid MEDLINE, and EMBASE were searched. Participants: Studies that investigated biceps tendon injuries in softball players. Interventions: None. Main Outcome Measures: Range of motion (ROM), strength, and visual analog scale data were collected. Results: Of 152 search results, 18 were included. A total of 536 of 705 athletes (76%) were softball players (average age 14-25 years). Five of 18 articles (27.7%) studied changes in external rotation with the shoulder at 90 degrees of abduction, and 4 of 18 (22.2%) studied internal rotation. Two of 18 studies (11.1%) examined ROM or strength changes in forward flexion. Conclusions: While researchers agree that the windmill pitch places significant stress on the biceps tendon, our study finds that the metrics used to evaluate shoulder pathology in these players primarily evaluate the rotator cuff without isolating the biceps tendon. Future studies should include clinical tests and biomechanical metrics more specific to identifying biceps and labral pathology (eg, strength, fatigue, and ROM in glenohumeral forward flexion, elbow flexion, and forearm supination) and attempt to clarify differences in pathology between pitchers and position players to better characterize the frequency and severity of biceps tendon pathology in softball players. [ABSTRACT FROM AUTHOR]

Background: Synovitis of the glenohumeral (GH) joint and the subacromial (SA) space is commonly observed during arthroscopic rotator cuff surgery. Purpose: To investigate the distribution, severity, and clinical implications of synovitis in the GH joint and SA space in patients with a full-thickness rotator cuff tear (RCT). Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively collected from 207 patients with a full-thickness RCT who underwent arthroscopic repair. Preoperative parameters used in the clinical assessment included pain, range of motion (ROM), muscle strength, and functional scores. Macroscopic assessment of synovitis was performed intraoperatively in the 3 regions of interest (ROIs) of the GH joint and 4 ROIS of the SA space using an evaluation system. The distribution and severity of synovitis and the association between synovitis and clinical assessment were evaluated. Results: Synovitis was more severe in the GH joint than in the SA space (P <.001). Synovitis in the posterior GH joint and the lateral SA space, where most of the rotator cuff was located, was the most severe area among the ROIs of the GH joint and the SA space, respectively (P <.05). All types of pain, except for pain at rest, were associated with synovitis in the posterior GH joint (P <.05). All ROM measures were associated with synovitis in the posterior and inferior GH joint (| r | > 0.20; P <.05 for both). The strength of the supraspinatus and the infraspinatus was associated with synovitis in the posterior GH joint (P <.05). Shoulder function was associated with synovitis in the posterior and inferior GH joint and more in the posterior GH joint (P <.05 for both). Synovitis in the SA space was not associated with any of the clinical parameters. Conclusion: Synovitis in the posterior GH joint was the most severe form of synovitis in the GH joint in patients with a full-thickness RCT. Synovitis in the posterior GH joint was closely associated with increased pain and decreased ROM, muscle strength, and functional score. Synovitis in the SA space was milder and not associated with any clinical parameters. [ABSTRACT FROM AUTHOR]

Background: Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. Purpose: To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non–missed time injuries) among athletes in the National Football League (NFL). Study Design: Descriptive epidemiology study. Methods: The NFL's electronic medical record was retrospectively reviewed to identify non–missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated. Results: Of the 546 shoulder instability injuries documented during the study period, 162 were non–missed time injuries. The majority of non–missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non–missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusion: The majority of non–missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation. [ABSTRACT FROM AUTHOR]

Context: Range of motion (ROM) in the glenohumeral joint decreases with age in healthy subjects; however, the underlying mechanism remains unclear. The process of aging of the joint capsule, including the coracohumeral ligament (CHL), could affect ROM limitation. Objective: This study investigated correlations between elasticity of the CHL, evaluated by means of shear-wave elastography, and age, side dominance, and ROM in healthy individuals. Design: Experimental study. Setting: Laboratory. Subjects: Eighty-four healthy volunteers (39 men and 45 women, mean age: 42.6 y) were included. Main outcome measures: Subjects were divided into 3 age groups: younger (20-39 y), middle (40-59 y), and older (≥60 y) age groups. With participants in the supine position, CHL elasticity in both shoulders was evaluated in both neutral and 30° external rotation, with arms at the sides. ROM, including forward flexion, lateral elevation, external rotation, 90° abduction with external rotation, and hand behind the back were measured with participants in the standing position. Results: The CHL elastic modulus was higher in the older group than in the younger group in the neutral (78.4 kPa [SD: 37.1] and 56.6 kPa [SD: 31.7], respectively) and 30° external rotation positions (135.5 kPa [SD: 63.5] and 71.4 kPa [SD: 32.2], respectively). Negative correlations were found between the CHL elastic modulus and ROM in terms of 30° external rotation and both external rotation (R = -.59, P = .02) and 90° abduction with external rotation (R = -.71, P = .003) in the older group, with correlation coefficients increasing with age. Conclusions: Significant correlations were identified between CHL elasticity and ROM in both external rotation and 90° abduction with external rotation with increasing age. Decreased CHL elasticity was strongly associated with decreased shoulder ROM in middle-aged and older individuals. [ABSTRACT FROM AUTHOR]

Context: Several studies report static-stretch-induced deficits and dynamic-stretch performance improvement after intervention. Purpose: To investigate the muscle activation of the forehand and backhand in table tennis players after experiencing static- and dynamic-stretching protocols. Methods: A total of 24 elite male table tennis players (age 22.7 [3.46] y, height 1.78 [0.03] m) were tested before and 0, 10, 20, and 30 min after the 3 conditions (dynamic stretch, static stretch, and no stretch). The MEGA ME6000 (Mega Electronics, Kuopio, Finland) was used to capture the surface EMG data of the anterior deltoid, middle deltoid, posterior deltoid, biceps, and triceps muscles. Muscle activation data of the pretest were compared with posttest 0, 10, 20, and 30 min. These data were also compared between 3 different conditions (dynamic stretch, static stretch, and no stretch). Results: A 2-way repeated-measures analysis of variance indicated significant differences in the forehand and backhand, and Bonferroni test as a post hoc comparison revealed significant differences between the pretest and posttests in several muscles (P <.05). Furthermore, there were significant differences in the posttest between the 3 conditions (P <.05). Conclusions: In general, there was a short-term effect of static- and dynamic-stretching protocols on glenohumeral-joint muscle activation in elite table tennis players. The static and dynamic stretching presented a decrease and increase, respectively, in muscle activation up to 30 min after stretching. In conclusion, the additive and subtractive effects of dynamic- and static-stretching protocols on muscle activation seem to persist after 30 min. [ABSTRACT FROM AUTHOR]

Most upper-extremity musculoskeletal models represent the glenohumeral joint with an inherently stable ball-and-socket, but the physiological joint requires active muscle coordination for stability. The authors evaluated sensitivity of common predicted outcomes (instability, net glenohumeral reaction force, and rotator cuff activations) to different implementations of active stabilizing mechanisms (constraining net joint reaction direction and incorporating normalized surface electromyography [EMG]). Both EMG and reaction force constraints successfully reduced joint instability. For flexion, incorporating any normalized surface EMG data reduced predicted instability by 54.8%, whereas incorporating any force constraint reduced predicted instability by 43.1%. Other outcomes were sensitive to EMG constraints, but not to force constraints. For flexion, incorporating normalized surface EMG data increased predicted magnitudes of joint reaction force and rotator cuff activations by 28.7% and 88.4%, respectively. Force constraints had no influence on these predicted outcomes for all tasks evaluated. More restrictive EMG constraints also tended to overconstrain the model, making it challenging to accurately track input kinematics. Therefore, force constraints may be a more robust choice when representing stability. [ABSTRACT FROM AUTHOR]

Context: Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. Objective: To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. Design: Randomized controlled trial. Setting: Orthopedic rehabilitation clinic. Participants: A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. Main Outcome Measures: Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P <.05). Results: Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. Conclusions: The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor. [ABSTRACT FROM AUTHOR]

Context: The pectoralis minor (PM) is an important postural muscle that may benefit from myofascial techniques, such as Graston Technique® (GT) and self-myofascial release (SMR). Objective: To examine the effects of GT and SMR on PM length, glenohumeral total arc of motion (TAM), and skin temperature. Design: Cohort. Setting: Laboratory. Participants: Twenty-six healthy participants (19 females and 7 males; age = 20.9 [2.24] y, height = 170.52 [8.66] cm, and weight = 72.45 [12.32] kg) with PM length restriction participated. Interventions: Participants were randomized to the intervention groups (GT = 12 and SMR = 14). GT and SMR interventions were both applied for a total of 5 minutes during each of the 3 treatment sessions. Main Outcome Measures: PM length, TAM, and skin temperature were collected before and after each intervention session (Pre1, Post1, Pre2, Post2, Pre3, and Post3) and at 1-week follow-up (follow-up). Separate intervention by time analyses of variance examined differences for each outcomes measure. Bonferroni post hoc analyses were completed when indicated. Significance was set a priori at P ≤.05. Results: No significant intervention by time interactions were identified for PM length, TAM, or temperature (P >.05). No significant intervention main effects were identified for PM length (P >.05), TAM (P >.05), or temperature (P >.05) between the GT or SMR technique groups. Overall, time main effects were found for PM length (P =.02) and temperature (P <.001). Post hoc analysis showed a significant increase in PM length for both intervention groups at follow-up (P =.03) compared with Post2. Furthermore, there were significant increases in temperature at Post1 (P <.001), Post2 (P =.01), and Post3 (P <.001) compared with Pre1; Post2 was increased compared with Pre2 (P =.003), Pre3 (P <.001), and follow-up (P =.01); Post3 increased compared with Pre3 (P =.01) and follow-up (P =.01). Conclusion: Serial application of GT and SMR to the PM did not result in increases in PM length or TAM. Regardless of intervention, skin temperature increased following each intervention. [ABSTRACT FROM AUTHOR]

The study aimed to explore the influence of a sports‐specific intermittent sprint protocol (ISP) on wheelchair sprint performance and the kinetics and kinematics of sprinting in elite wheelchair rugby (WR) players with and without spinal cord injury (SCI). Fifteen international WR players (age 30.3 ± 5.5 years) performed two 10‐s sprints on a dual roller wheelchair ergometer before and immediately after an ISP consisting of four 16‐min quarters. Physiological measurements (heart rate, blood lactate concentration, and rating of perceived exertion) were collected. Three‐dimensional thorax and bilateral glenohumeral kinematics were quantified. Following the ISP, all physiological parameters significantly increased (p ≤ 0.027), but neither sprinting peak velocity nor distance traveled changed. Players propelled with significantly reduced thorax flexion and peak glenohumeral abduction during both the acceleration (both −5°) and maximal velocity phases (−6° and 8°, respectively) of sprinting post‐ISP. Moreover, players exhibited significantly larger mean contact angles (+24°), contact angle asymmetries (+4%), and glenohumeral flexion asymmetries (+10%) during the acceleration phase of sprinting post‐ISP. Players displayed greater glenohumeral abduction range of motion (+17°) and asymmetries (+20%) during the maximal velocity phase of sprinting post‐ISP. Players with SCI (SCI, n = 7) significantly increased asymmetries in peak power (+6%) and glenohumeral abduction (+15%) during the acceleration phase post‐ISP. Our data indicates that despite inducing physiological fatigue resulting from WR match play, players can maintain sprint performance by modifying how they propel their wheelchair. Increased asymmetry post‐ISP was notable, which may be specific to impairment type and warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Glenohumeral joint contact loading before and after glenoid bone grafting for recurrent anterior instability remains poorly understood. Purpose: To develop a computational model to evaluate the influence of glenoid bone loss and graft positioning on graft and cartilage contact pressures after the Latarjet procedure. Study Design: Controlled laboratory study. Methods: A finite element model of the shoulder was developed using kinematics, muscle and glenohumeral joint loading of 6 male participants. Muscle and joint forces at 90° of abduction and external rotation were calculated and employed in simulations of the native shoulder, as well as the shoulder with a Bankart lesion, 10% and 25% glenoid bone loss, and after the Latarjet procedure. Results: A Bankart lesion as well as glenoid bone loss of 10% and 25% significantly increased glenoid and humeral cartilage contact pressures compared with the native shoulder (P <.05). The Latarjet procedure did not significantly increase glenoid cartilage contact pressure. With 25% glenoid bone loss, the Latarjet procedure with a graft flush with the glenoid and the humerus positioned at the glenoid half-width resulted in significantly increased humeral cartilage contact pressure compared with that preoperatively (P =.023). Under the same condition, medializing the graft by 1 mm resulted in humeral cartilage contact pressure comparable with that preoperatively (P =.097). Graft lateralization by 1 mm resulted in significantly increased humeral cartilage contact pressure in both glenoid bone loss conditions (P <.05). Conclusion: This modeling study showed that labral damage and greater glenoid bone loss significantly increased glenoid and humeral cartilage contact pressures in the shoulder. The Latarjet procedure may mitigate this to an extent, although glenoid and humeral contact loading was sensitive to graft placement. Clinical Relevance: The Latarjet procedure with a correctly positioned graft should not lead to increased glenohumeral joint contact loading. The present study suggests that lateral graft overhang should be avoided, and in the situation of large glenoid bone defects, slight medialization (ie, 1 mm) of the graft may help to mitigate glenohumeral joint contact overloading. [ABSTRACT FROM AUTHOR]

Background: The amount of glenoid width that must be restored with a Latarjet procedure in order to reestablish glenohumeral stability has not been determined. Purpose/Hypothesis: The purpose of this article was to determine the percentage of glenoid width restoration necessary for glenohumeral stability after Latarjet by measuring anterior humeral head translation and force distribution on the coracoid graft. The hypothesis was that at least 100% of glenoid width restoration with Latarjet would be required to maintain glenohumeral stability. Study Design: Controlled laboratory study. Methods: Nine cadaveric shoulders were prepared and mounted on an established shoulder simulator. A lesser tuberosity osteotomy (LTO) was performed to allow accurate removal of glenoid bone. Coracoid osteotomy was performed, and the coracoid graft was sized to a depth of 10 mm. Glenoid bone was sequentially removed, and Latarjet was performed using 2 screws to reestablish 110%, 100%, 90%, and 80% of native glenoid width. The graft was passed through a subscapularis muscle split, and the LTO was repaired. A motion tracking system recorded glenohumeral translations, and force distribution was recorded using a TekScan pressure sensor secured to the glenoid face and coracoid graft. Testing conditions included native; LTO; Bankart tear; and 110%, 100%, 90%, and 80% of glenoid width restoration with Latarjet. Glenohumeral translations were recorded while applying an anteroinferior load of 44 N at 90° of humerothoracic abduction and 0° or 45° of glenohumeral external rotation. Force distribution was recorded without an anteroinferior load. Results: Anterior humeral head translation progressively increased as the proportion of glenoid width restored decreased. A marked increase in anterior humeral head translation was found with 90% versus 100% glenoid width restoration (10.8 ± 3.0 vs 4.1 ± 2.6 mm, respectively; P <.001). Greater glenoid bone loss also led to increased force on the coracoid graft relative to the native glenoid bone after Latarjet. A pronounced increase in force on the coracoid graft was seen with 90% versus 100% glenoid width restoration (P <.001). Conclusion: Anterior humeral head translation and force distribution on the coracoid graft dramatically increased when <100% of the native glenoid width was restored with a Latarjet procedure. Clinical Relevance: If a Latarjet is unable to fully restore the native glenoid width, surgeons should consider alternative graft sources to minimize the risk of recurrent instability or coracoid overload. [ABSTRACT FROM AUTHOR]

Background: Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. Methods: Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. Results: The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. Conclusions: Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition. [ABSTRACT FROM AUTHOR]

The reverse total shoulder arthroplasty is a popular surgical treatment for a degenerative shoulder with a nonfunctional rotator cuff. Currently, more than 36 different brands with small different features are available. This creates choice stress among many surgeons, who no longer know which parameters and surgical factors are important to optimize the placement of the implant. The first purpose of this pilot study was to compare the passive range of motion (ROM) of 6 different implant designs implanted following the manufacturer's guidelines. The second goal was to identify the impingements after implantation which determines the maximal ROM. The last goal of the study was to link the different parameters of an implant with the ROM. Six implant systems were implanted on identical sawbones. The procedure was repeated 3 times on a different sawbone to objectify the surgical repeatability of the procedures. A Stäubli TX-90 robot was used to perform and control the humerus' kinematic movement. An optical tracking system was used to perform the system's calibrations, track the humerus and scapula in space, and compute the center of rotation. There was a wide ROM in the scapular plane (44.8°-105.5°) while the minimal elevation (adduction) varied between −4.8° and 35.6°. The rotational movements were limited by contact of the superior humeral polyethylene inlay and the inferior scapular neck. The adduction in the coronal and scapular plane was limited by inferior scapular impingement, whereas the maximal abduction was limited either by bony contact between the humerus and acromion or by contact between the humeral polyethylene inlay and the superior glenoid cavity. A bigger radius of the glenosphere resulted in a larger passive humeroscapular ROM (P <.001). A larger Neck-Shaft-Angle results in a better abduction (P <.001) but compromised adduction (P <.001). The localization of the center of rotation has a significant impact on the ROM. The medialized designs have larger abduction and rotational angles (P <.001). There is a wide variation in the measured glenohumeral ROM between the 6 frequently implanted prostheses. The most important factor to optimize the impingement-free ROM in all types of prostheses is the creation of the prosthetic overhang of the glenosphere to the bone. Too much lateralization of the center of the glenosphere with or without lateralization of the humeral stem can create a subacromial and/or subcoracoidal impingement. [ABSTRACT FROM AUTHOR]

Background: There is evidence that high-volume static stretching training of the lower limbs can increase the range of motion (ROM) while decreasing muscles stiffness. However, to date, there is no evidence on the effects of upper limb stretching training or its effect mechanism. Therefore, this study aimed to investigate the effects of a comprehensive 7-week static stretching training program of the pectoralis major muscle (PMa) on glenohumeral joint ROM, muscle force, and muscle stiffness. Methods: Thirty-eight healthy, physically active participants (23 male, 15 female) were randomly assigned to either the PMa-static stretching intervention (PMa-SS) group or the control group. The PMa-SS group performed a 7-week intervention comprising three sessions a week for 15 min per session, including three static stretching exercises of the PMa for 5 min each. Before and after the intervention period, shoulder extension ROM, muscle stiffness of the PMa (pars clavicularis), and maximal voluntary isometric contraction (MVIC) peak torque (evaluated at both long (MVIClong) and short (MVICshort) muscle lengths) were investigated on a custom-made testing device at 45° shoulder abduction. Results: In the PMa-SS group, the shoulder extension ROM (+ 6%; p < 0.01; d = 0.92) and the MVIClong (+ 11%; p = 0.01; d = 0.76) increased. However, there were no significant changes in MVICshort or in PMa muscle stiffness in the PMa-SS group. In the control group, no changes occurred in any parameter. Conclusion: In addition to the increase in ROM, we also observed an improved MVIC at longer but not shorter muscle lengths. This potentially indicates an increase in fascicle length, and hence a likely increase in sarcomeres in series. [ABSTRACT FROM AUTHOR]

Background: Recurrent anterior glenohumeral instability is a disabling pathology that can be successfully treated by arthroscopic Bankart repair or open Latarjet. However, there is a paucity of studies comparing the postoperative recovery. The purpose of this study is to evaluate the postoperative pain and functional recovery following arthroscopic Bankart versus open Latarjet. Methods: This is a retrospective analysis of a multicenter prospective outcomes registry database. Postoperative recovery outcomes of either a primary or revision arthroscopic Bankart and open Latarjet procedures were compared. A minimum of 1-year follow-up was required. Outcomes measures included pain visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) function score, ASES index score, and single assessment numeric evaluation (SANE) score. Overall, 787 patients underwent primary arthroscopic Bankart, 36 underwent revision arthroscopic Bankart and 75 underwent an open Latarjet procedure. Results: When compared to primary arthroscopic Bankart, open Latarjet demonstrated significantly lower VAS scores at 6 weeks (p = 0.03), 3 months (p = 0.01), and 2 years (p < 0.05). Medium-term outcomes for ASES scores and SANE score, at 1 and 2 years showed no difference. Latarjet demonstrated significantly lower (p < 0.05) preoperative early postoperative VAS pain scores with no difference at 1 year or 2 years when compared to primary Bankart. There was no difference in ASES function or index between Bankart and Latarjet. Revision Bankart provided inferior outcomes for VAS, ASES function, and ASES index when compared to primary Bankart and Latarjet at 1 year and 2 years. Conclusions: Primary arthroscopic Bankart repair and open Latarjet provided nearly equivalent improvements in pain (VAS) and functional outcomes (ASES, SANE, VR-12) during the early recovery phase (2 years). This study supports the use of either procedure in the primary treatment of anterior glenohumeral instability. Revision arthroscopic Bankart repair demonstrated deteriorating outcomes at 1 and 2 years postoperatively. [ABSTRACT FROM AUTHOR]

Background: Repetitive pitching is thought to restrict the physiological derotation process of the humeral head. Some studies have reported that side-to-side differences in the humeral retrotorsion angle (ΔHRA) occur between the ages of 9 and 11 years in baseball players. However, it remains unclear whether the ΔHRA in Asian baseball players depends on pitching skill or competitive level. Purpose: To evaluate the ΔHRA in Asian collegiate and professional baseball players and to determine the effects of pitching activity on the physiological derotation process of the humeral head. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We evaluated 128 shoulders in 64 Asian baseball players who were stratified into 4 groups as follows: 13 professional pitchers; 9 professional fielders; 8 collegiate pitchers; and 34 collegiate fielders. The throwing and nonthrowing side HRA was assessed using an ultrasound-assisted technique, and the ΔHRA was compared among the 4 groups. In addition, Pearson correlation analysis was used to assess the relationship between ΔHRA and glenohumeral range of motion, baseball starting age, and fastball velocity in pitchers. Results: The HRA was significantly greater in the throwing arm than in the nonthrowing arm in each group, with no significant differences among the groups. There was no correlation between ΔHRA and range of motion or fastball velocity. There was a significant negative correlation between baseball starting age and ΔHRA in professional fielders (r = –0.633; P =.036). Conclusion: The findings of the present study provide evidence that in Asian baseball players, the HRA was significantly greater in the throwing arm than in the nonthrowing arm. There were no clear associations between HRA and pitching ability or competitive level. [ABSTRACT FROM AUTHOR]

Introduction: The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. Methods: A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6–10 weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10 weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. Results: About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8 years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. Conclusion: In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. Level of evidence IV: Therapeutic Study (Surgical technique and Retrospective cohort). [ABSTRACT FROM AUTHOR]

Background: Swimmers have a significant potential for shoulder injuries due to the unique nature of the different styles involved in swimming, as well as the high volume of repetitions required during training, which arise through repetitive strain and microtrauma. Injuries are the most frequent due to the repetitive use of the upper limb in overhead movements and factors related to Range of Motion (ROM) and strength. Objective: To analyze the performance of the shoulder of swimming athletes and to verify if there is a difference between athletes with and without a history of injury, as well as to verify the transmission between the performance of this joint with ROM and strength values. Methods: 24 competitive swimmers were evaluated, with an average age of 20 years (± 7.9). The glenohumeral internal rotation deficit (GIRD) and internal and external rotation ROM of the shoulder were evaluated using goniometry. Shoulder functionality was assessed using the closed kinetic chain test for upper limbs (CKCUEST). Handgrip strength was also evaluated with a dynamometer. SPSS software, version 21.0, was used and data were analyzed using Pearson's collaboration test and Student's t test for independent samples. Results: Athletes with a history of injuries had a higher weekly training load, although they did not differ in terms of the number of years practicing the sport. The performance in the CKCUEST was higher in the group without a history of injury (p=0.04) and there was no difference between the groups regarding the variables of total ROM and GIRD, as well as for grip strength. There was change only between the CKCUEST power values with the grip strength (p<0.05, r=0.677). Conclusion: The functional performance of the shoulder is greater in athletes without a history of injury. [ABSTRACT FROM AUTHOR]

Objectives: For anterior shoulder instability, anteroinferior labral repair (Bankart repair) is a reliable surgery to prevent shoulder dislocation. However, in biomechanical and clinical studies, maximum shoulder external rotation angle is reported to be decreased by about 10 degrees due to shortening of the anterior band of the inferior glenohumeral ligament (AIGHL) length after Bankart repair. For overhead throwing athletes, the 10 degrees reduction in shoulder external rotation makes it difficult to return to the previous performance level, although it does not affect daily activity. To prevent shortening of the AIGHL length, an AIGHL reconstruction was developed using fascia lata graft. Preliminary clinical results in overhead throwing athletes showed that a throwing program could start with complete restoration of maximum shoulder external rotation angle 3 months after AIGHL reconstruction. In this study the effect of AIGHL reconstruction on shoulder external rotation and anterior stability for simulated Bankart lesion in a cadaveric model of a thrower's shoulder was evaluated (Fig. 1). Methods: Eight cadaveric shoulders were tested at 60° of glenohumeral abduction (90° of shoulder abduction) to simulate throwing motion. Glenohumeral translations at 60° and 90° of external rotation, maximum humeral rotational range of motion, and humeral head shift were measured using goniometer and MicroScribe 3D-digitizer. Each specimen was subjected to five experimental stages: (1) intact condition; (2) simulation of thrower's shoulder by anterior capsular stretching based on previously reported method; (3) creation of Bankart lesion (AIGHL and the labrum were detached at glenoid side); (4) Bankart repair using three suture anchors; and (5) AIGHL reconstruction using allograft of fascia lata. In the AIGHL reconstruction, allograft was patched between the detached AIGHL and glenoid at maximum shoulder external rotation position to restore the original AIGHL length (Fig. 2). For statistical analysis, linear mixed-effects model and Tukey's post-hoc analysis were used. Results: After 20% stretching, shoulder external rotation and anterior translation were significantly increased (intact 128.3° and 2.8mm, thrower's shoulder 141.9° and 7.3mm, p<0.001). Creation of Bankart lesion significantly increased anterior translation (8.3mm) compared with intact condition (p=0.021). Bankart repair completely restored anterior translation (3.0mm) to intact level; however, maximum shoulder external rotation angle after Bankart repair (134.8°) was significantly less than that in thrower's shoulder (p=0.009). AIGHL reconstruction completely restored anterior translation (6.5mm) to thrower's shoulder without decreasing maximum shoulder external rotation angle (144.4°) compared with thrower's shoulder (Fig. 3 & 4). At maximum humeral external rotation, the humeral head was significantly shifted superiorly after creation of Bankart lesion compared with intact condition(p=0.005). After Bankart repair, the humeral head was significantly shifted inferiorly from the Bankart lesion (p=0.003) and was significantly inferior relative to the position after AIGHL reconstruction (p=0.007). Conclusions: While Bankart repair completely restored anterior translation to the intact level (tighter than thrower's shoulder), AIGHL reconstruction completely restored to the thrower's level. Furthermore, maximum shoulder external rotation angle was maintained after AIGHL reconstruction although Bankart repair decreased external rotation significantly. Therefore, AIGHL reconstruction can be a useful surgical option for Bankart lesion in overhead throwing athletes to restore anterior stability while maintaining maximum shoulder external rotation angle after surgery. [ABSTRACT FROM AUTHOR]

Symptomatic spondylolysis/spondylolisthesis is thought to be caused by repetitive lumbar extension. About 8.9% of baseball pitchers that experience back pain will be diagnosed with spondylolysis. Therefore, this study aims to identify and quantify lumbar extension experienced during baseball pitching. It was hypothesized that young pitchers would exhibit less lumbar extension than older pitchers. A total of 187 healthy pitchers were divided into 3 age groups: youth, adolescent, and college. Kinematic data were collected at 250 Hz using a 3-D motion capture system. Lumbar motion was calculated as the difference between upper thoracic motion and pelvic motion over the pitching cycle. Lumbar "hyperextension" was defined as ≥20° past neutral. College pitchers had significantly greater lumbar extension compared with youth and adolescent pitchers at the point of maximum external rotation of the glenohumeral joint during the pitch cycle (−25° [13°], P =.04). For all age groups, lumbar hyperextension was present during the first 66% of the pitch cycle. Most pitchers spent 45% of pitch cycle in ≥30° of lumbar extension. Understanding that lumbar extension and hyperextension are components of the complex, multiplanar motions of the spine associated with baseball pitching can potentially help in both the prevention and management of symptomatic spondylolysis/spondylolisthesis. [ABSTRACT FROM AUTHOR]

Context: Tennis induces a decreased internal rotation range of motion at the dominant glenohumeral joint. The effects of self-myofascial release have not yet been investigated to restore glenohumeral range of motion. Objective: This study aimed at investigating the effects of self-myofascial release on shoulder function and perception in adolescent tennis players. Design: Test–retest design. Setting: Tennis training sport facilities. Participants: Eleven male players participated in this study (age: 15 [3] y; height: 173.1 [11.1] cm; mass: 56.0 [15.1] kg; International Tennis Number: 3). Intervention: During 5 weeks, the players performed their regular tennis training. During 5 additional weeks, self-myofascial release of the infraspinatus and pectoralis muscles was implemented 3 times per week after the warm-up of the regular training session. Main Outcome Measures: The primary outcome was glenohumeral internal rotation range of motion. The secondary outcomes were perceived shoulder instability and tennis serve accuracy and velocity. Results: Adding self-myofascial release allowed an increase of 11° (2°) of internal rotation range of motion at the dominant glenohumeral joint (P <.001) and a decreased perception of shoulder instability (P =.03), while maintaining tennis serve velocity and accuracy. Conclusions: Implementing self-myofascial release on infraspinatus and pectoralis muscles 3 times per week during 5 weeks improved dominant glenohumeral internal rotation range of motion in tennis players. It can be used as a strategy to preserve the mobility of this joint. [ABSTRACT FROM AUTHOR]

Overuse injuries in the shoulders and lower back are hypothesized to be common in cross-country sit-skiing. Athletes with reduced trunk muscle control mainly sit with the knees higher than the hips (KH). To reduce spinal flexion, a position with the knees below the hips (KL) was enabled for these athletes using a frontal trunk support. The aim of the study was to compare the shoulder joint (glenohumeral joint) and L4-L5 joint reactions of the KL and KH sitting positions. Five able-bodied female athletes performed submaximal and maximal exercise tests in the sitting positions KL and KH on a ski ergometer. Measured pole forces and 3-dimensional kinematics served as input for inverse-dynamics simulations to compute the muscle forces and joint reactions in the shoulder and L4-L5 joint. This was the first musculoskeletal simulation study of seated double poling. The results showed that the KH position was favorable for higher performance and decreased values of the shoulder joint reactions for female able-bodied athletes with full trunk control. The KL position was favorable for lower L4-L5 joint reactions and might therefore reduce the risk of lower back injuries. These results indicate that it is hard to optimize both performance and safety in the same sit-ski. [ABSTRACT FROM AUTHOR]

Context: Tennis playing generates specific adaptations, particularly at the dominant shoulder. It remains to be established whether shoulder-strength balance can be restored by sling-based training for adolescent recreational tennis players. Objective: To investigate the effects of a sling-based exercise for shoulder external rotators on external rotator muscle strength, internal rotator muscle strength, glenohumeral range of motion, and tennis serve performance. Design: Test-retest design. Setting: Tennis training sports facilities. Participants: Twelve adolescent male players volunteered to participate in this study (age: 13.3 ±0.5 y; height: 1.64 ± 0.07 m, mass: 51.7 ± 5.8 kg, International Tennis Number: 8). Intervention: The procedure spanned 10 wk. For the first 5 wk, players performed their regular training (RT) twice a week. For the last 5 wk, a sling-based exercise (SE) for strengthening the shoulder external rotator muscles was added to their RT. Main Outcome Measures: Maximal isometric strength of shoulder external and internal rotator muscles and glenohumeral range of motion in external and internal rotation were assessed in both shoulders. Serve performance was also evaluated by accuracy and postimpact ball velocity using a radar gun. Results: No change was found in any measurement after the RT period. Significant increases in external (~+5%; P < .001) and internal (~+2%; P < .05) rotator muscle strength and in external/internal strength ratio (~+4%; P < .001) were observed after the SE period. Serve velocity and accuracy were significantly improved after SE (~+2% and ~+24%, respectively; P < .05 for both), while no clinically meaningful alterations in range of motion were observed. Conclusions: Prophylactic intervention through SE for strengthening shoulder external rotator muscles appears effective in restoring strength balance at the dominant shoulder and may prevent adolescent tennis players from sustaining degenerative shoulder problems, which could later impair their performance of daily and work-related tasks. [ABSTRACT FROM AUTHOR]

Background: The glenoid track concept has been widely used to assess the risk of instability due to bipolar bone loss. The glenoid track width was commonly used as 83% of the glenoid width to determine if a lesion was on-track or off-track. However, the value was obtained under static conditions, and it may not be able to reflect the actual mechanism of traumatic dislocation during motion. Purpose: To compare the glenoid track width under dynamic and static conditions using a dual-fluoroscopic imaging system. Study Design: Controlled laboratory study. Methods: In total, 40 shoulders of 20 healthy volunteers were examined for both dynamic and static tests within a dual-fluoroscopic imaging system at 5 different arm positions: 30°, 60°, 90°, 120°, and 150° of abduction, keeping the shoulder at 90° of external rotation. The participants performed a fast horizontal arm backswing for dynamic tests while keeping their arm in maximum horizontal extension for static tests. Computed tomography scans were used to create 3-dimensional models of the humerus and scapula for 2-dimensional to 3-dimensional image registration. Magnetic resonance imaging scans were obtained to delineate the medial margin of the rotator cuff insertion. The glenoid track width was measured as the distance from the anterior rim of the glenoid to the medial margin of the rotator cuff insertion and compared between static and dynamic conditions. Results: The mean glenoid track widths at 30°, 60°, 90°, 120°, and 150° of abduction were significantly smaller under dynamic conditions (88%, 81%, 72%, 69%, and 68% of the glenoid width) than those under static conditions (101%, 92%, 84%, 78%, and 77% of the glenoid width) (all P <.001). The glenoid track width significantly decreased with the increasing abduction angles in the range of 30° to 120° under static conditions (all P <.003) and 30° to 90° under dynamic conditions (all P <.001). Conclusion: A smaller dynamic-based value should be considered for the glenoid track width when distinguishing on-track/off-track lesions. Clinical evidence is needed to establish the superiority of the dynamic-based value over the static-based value as an indicator for augmentation procedures. Clinical Relevance: Some off-track lesions might be misclassified as on-track lesions when the original commonly used static-based value of 83% is used as the glenoid track width. [ABSTRACT FROM AUTHOR]

BACKGROUND: Shoulder external rotation in the throwing motion involves movement of the scapulothoracic and glenohumeral joints, thoracic spine, and the thorax. Restriction of thoracic expansion may decrease scapulothoracic joint motion and compensate by excessive glenohumeral joint motion. However, it is unclear how restricting the expansion of the thorax alters shoulder motion. OBJECTIVE: To elucidate changes in scapulothoracic and glenohumeral joint movements caused by restricted thoracic expansion. METHODS: Kinematic data were obtained using an electromagnetic tracking device (Liberty; Polhemus), from 18 male participants, during shoulder external rotation in the sitting position with and without restriction of thoracic expansion. The displacements from the start position to the maximum external rotation position were compared, and Pearson's correlation coefficient was calculated. RESULTS: A significant difference was observed in the scapulothoracic posterior tilt angle (P < 0.01) and glenohumeral external rotation angle (P < 0.01). A significant positive correlation existed between scapulothoracic posterior tilt and glenohumeral external rotation (P < 0.05) with and without restriction. CONCLUSIONS: Restriction of thoracic expansion decreased scapulothoracic motion and increased glenohumeral motion. Thus, a decrease in thoracic expansion may change scapulothoracic and glenohumeral movements, which may be a risk factor for throwing injuries. [ABSTRACT FROM AUTHOR]

OBJECTIVE Ice hockey is a fast and aggressive sport. Due to deliberate collisions and Mighting, a hard playing surface, and sharp skates, ice hockey players are at high and distinctive risk to injury. The way in which ice hockey players collide with, or check, one another, makes the shoulder vulnerable. About 8.6- 21.9% of injuries sustained in ice hockey involve the shoulder. Acromioclavicular joint sprains and anterior glenohumeral dislocations are most common. This case presents a 25-year-old male collegiate ice hockey player who sustained a recurrent right-sided glenohumeral dislocation after being checked from behind with his arm abducted and extended. Following reduction and referral, x-ray and CT scans detected a scapular spine fracture. The objectives for this case include recognizing the mechanism for scapular fractures, signs and symptoms versus common dislocations and identifying factors in strong interprofessional relationships. MEDICAL.HISTORY The athlete previously had two to three glenohumeral dislocations on the right side, fractured his right clavicle in 2014 and has a right-sided grade three acromioclavicular separation that was not repaired. He also has intermittent, long-term corticosteroid use to treat an auto-immune condition though he reports not taking the medication at least three months prior to this injury. DIFFERENTIAL.DIAGNOSIS Differential diagnoses included an anterior glenohumeral dislocation, potential labral damage, or a fracture to the shoulder girdle. RELATED.LITERATURE Scapular fractures are extremely rare injuries comprising 1 - 2.2% of all fractures. They make up 3-5% of fractures to the shoulder girdle and 0.5% of sports related fractures. Their rarity can be attributed to the scapula being a well-protected and well- located bone. The most common landmarks to fracture, consisting of 62-98% of scapular fractures, are the body and glenoid neck. These sites are followed by the glenoid, acromion, and spine respectively. Scapular spine fractures are 6% of all scapular fractures.High energy, direct trauma is the mechanism for 90% of scapular fractures. They are a common complication in those who have had a total shoulder arthropathy and 50% of them occur in motor vehicle accidents (MVA). Since scapular fractures are infrequent in sports, research on scapular fractures in sports medicine literature is extremely limited. There are surgical and conservative treatment options for scapular fractures, but the best course is debated and remains case dependent. There is no evidence-based gold standard treatment available for the management of scapular fractures. TREATMENT Initial treatment included reduction of the glenohumeral joint on the second attempt, sling immobilization, ice, 500mg of Tylenol, and physician referral. A conservative course of treatment, including immobilization and physical rehabilitation was chosen. Rehabilitation focused on restoring shoulder range of motion (ROM) and strengthening the rotator cuff. After one month, the athlete had normal ROM, full strength, and was permitted to skate and stickhandle with no contact. The athlete released for full participation 2.5 months post-injury and returned to competition within three months. DEVIATION FROM EXPECTED/UNIQUENESS Scapular spine fractures make up 0.6-0.12% of all fractures. This patient population is made up of geriatric patients, those who have had total shoulder arthropathy, or those who have been in an MVA. Scapular spine fractures are scarce in young, healthy, collegiate athletes making this case unique. CONCLUSION Due diligence in vetting potential differential diagnoses is imperative when performing evaluations and athletic trainers are obligated to consider each possibility, common and rare, when faced with recurrent injuries. This case highlights how interprofessional collaboration helped an athlete recover from a rare injury despite lack of evidence to support a standard treatment. Working collaboratively with other health care professionals provides patient Mirst, high quality care. [ABSTRACT FROM AUTHOR]

It is not clear if glenoid and scapulohumeral characteristics influence preoperative range of motion (ROM) and patient-determined outcomes. It is important to understand these interactions when planning and performing total shoulder arthroplasty in efforts of improving patient satisfaction and implant longevity. A retrospective review of patients that had three-dimensional computed tomography imaging for total shoulder arthroplasty was performed. Patients were separated into 2 groups determined by the presence (rotator cuff tear arthropathy [RCTA]) or absence (osteoarthritis [OA]) of an irreparable rotator cuff tear. Using the computed tomography measurements, shoulders were stratified by glenoid version (anteverted, normal, and retroverted), glenoid inclination (inferior, normal, and superior), and scapulohumeral subluxation (anterior, centered, and posterior) based on criteria determined from a review of the orthopedic literature. The Western Ontario Osteoarthritis Scale and the American Shoulder and Elbow Surgeons scores and ROM were determined preoperatively. In OA patients (n = 154), version was associated with scapulohumeral subluxation (P <.0001). Retroverted glenoids had less flexion (96° vs. 108°; P =.049) and external rotation (15° vs. 21°; P =.04) compared with normal version. Inferiorly inclined glenoids had greater posterior subluxation (77%) than those with normal (67%; P =.001) and superior inclination (68%; P =.01). There were no relationships between excessive inclination or subluxation on ROM. In RCTA patients (n = 115), retroverted glenoids had greater superior inclination compared with normal glenoids (12.1° vs. 8.4°; P =.049). Version was associated with scapulohumeral subluxation (anteverted = mean 34% subluxation; normal version = 56.4% subluxation; retroverted = 71.2% subluxation; P <.0001). Retroverted glenoids had less flexion compared with normal version (70° vs. 90°; P =.048), less abduction (62°) than normal glenoids (88°; P =.03) and anteverted glenoids (115°; P =.03), and less abduction/internal rotation (7°) than normal (22°; P =.03) and anteverted glenoids (36°; P =.04). Superiorly inclined glenoids have more posterior subluxation than normally inclined glenoids (64% vs. 56.6%; P =.02). There was no relationship between inclination and ROM. Patients with posterior subluxation had less external rotation compared with those with a centered humeral head (10° vs. 22°; P =.009) and less abduction/internal rotation compared with anterior subluxation (12° vs. 35°; P =.02). There was no relationship between version, inclination, or subluxation with preoperative Western Ontario Osteoarthritis Scale or American Shoulder and Elbow Surgeons in patients with OA (P >.17) or RCTA (P >.31). An interaction between version, inclination, and scapulohumeral subluxation in patients with OA and RCTA was found. Retroverted glenoids had decreased ROM measurements. RCTA shoulders with posterior scapulohumeral subluxation had decreased ROM. There was no relationship between glenoid and scapulohumeral morphology and patient-determined outcome scores. Level III; Retrospective Case-Control Prognosis Study [ABSTRACT FROM AUTHOR]

Background: We created patient-based 3D finite-element (FE) models that simulate the congruent-arc Latarjet (CAL) and traditional Latarjet (TL) procedures and then compared their stress distribution patterns with different arm positions and glenoid defects. Methods: The computed tomography data of 10 adult patients (9 men and 1 woman, ages: 18–50 years) were used to develop the 3D FE glenohumeral joint models. Twenty-five and 35% bony defects were created on the anterior glenoid rim, and the coracoid process was transferred flush with the glenoid by the traditional and congruent-arc techniques using two half-threaded screws. A load was applied to the greater tuberosity toward the center of the glenoid, and a tensile force (20 N) was applied to the coracoid tip along the direction of the conjoint tendon. The distribution patterns of the von Mises stress in the traditional and congruent-arc Latarjet techniques were compared. Results: The mean von Mises on the graft was significantly greater for the TL technique than for the CAL. While the von Mises stress was greater in the distal medial part of the graft in the TL models, a higher stress concentration was observed in the distal lateral edge of the coracoid graft in the CAL models. The proximal medial part of the graft exhibited significantly lower von Mises stress than the distal medial part when compared according to technique, defect size, and arm position. Increasing the glenoid defect from 25 to 35% resulted in a significant increase in stress on the lateral side of the graft in both models. Conclusion: The stress distribution patterns and stress magnitude of the coracoid grafts differed according to the procedure. Due to placing less stress on the proximal–medial part of the graft, the CAL technique may lead to insufficient stimulation for bone formation at the graft–glenoid interface, resulting in a higher incidence of graft osteolysis. Clinical relevance The CAL technique may lead to a higher incidence of graft osteolysis. Level of evidence: Basic Science Study; Computer Modeling. [ABSTRACT FROM AUTHOR]

Background Previous research has demonstrated the benefits of both stabilization and non-stabilization of the scapula during stretching in individuals with posterior shoulder tightness, but limited evidence exists in patients with shoulder pain. Hypothesis/Purpose The aim of this study was to determine the effect of stabilized scapular stretching on patients with shoulder pain. The primary hypothesis of this study is that stabilized scapular stretching will improve glenohumeral motion and pain compared to non-stabilized stretch program. A secondary hypothesis of this study is that stabilized scapular stretching will produce greater improvement in function compared to the non-stabilized stretching program. Study Design Randomized Clinical Trial Methods Sixteen patients with sub-acromial pain associated with tendinopathy and associated pathologies presenting to physical therapy were randomized into two groups (stabilized or non-stabilized scapular stretching). Baseline pain and range of motion were measured prior to and following each treatment session for three visits that occurred over the course five to seventeen days depending on the patients availability. The dependent measurements were stabilized horizontal adduction, stabilized internal rotation, stabilized shoulder flexion, non-stabilized shoulder flexion, and current pain level. Results Patients in the scapular stabilization stretching group increased horizontal adduction 40° (CI95 31, 48°) compared to the non-stabilization stretching group increase of 8° (CI95 0, 17°) over the course of the three treatments (p<0.001). Similarly, the stabilized stretching group increased internal rotation 48° (CI95 26, 69°) compared to the non-stabilized stretching group increase of 26° (CI95 4, 48°) (p=0.001). Pain decreased in the stabilized stretching group by 1.4 points (CI95 -0.4, 3.2) but increased slightly in non-stabilized group by -0.5 points (CI95 -2.3, 1.3) which was not a clinically meaningful change. (p=0.03) Conclusion Stabilized scapular stretching was more effective than non-stabilized stretching at gaining shoulder mobility in patients with shoulder pain. Benefits were immediate and sustained between treatment sessions. Stretching interventions improved range of motion but had limited effect on shoulder pain. Level of Evidence 2 [ABSTRACT FROM AUTHOR]

Background: Research has shown that repetitive stress from playing an overhead (OH) sport can cause musculoskeletal and osseous adaptations to occur on the dominant side. Additionally, there are limited data about the residual effects of these adaptations after the cessation of sports participation. Purpose: To investigate the effects of prior participation in an OH sport versus not participating in an OH sport on glenohumeral range of motion (ROM), isometric strength, and humeral retroversion (HR). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty-eight college-aged individuals participated. Participants were split into 2 groups: (1) individuals who previously participated in an OH sport (n = 20; age, 20.3 ± 1.1 years; height, 166.3 ± 15.27 cm; weight, 72.2 ± 13.5 kg) and (2) individuals who previously did not play an OH sport (n = 28; age, 20.6 ± 0.9 years; height, 168.8 ± 6.3 cm; weight, 68.1 ± 15.1 kg). After completing a health history questionnaire, the following were measured: side-to-side shoulder internal rotation (IR) and external rotation (ER) ROM via an inclinometer, isometric shoulder strength via a handheld dynamometer, and HR using an ultrasound imaging machine. A Mann-Whitney U test was used to determine group differences, and a Wilcoxon t test was used to analyze side-to-side differences within each group. Results: The Mann-Whitney U test revealed a statistically significant group difference for dominant shoulder ER ROM (U = 162.00, P =.014). Specifically, the prior OH group had significantly more ER than the control group. Within the prior OH group, testing revealed that athletes had significantly more HR (Z =–2.782, P =.005), ER ROM (Z =–1.979, P =.048), and ER isometric strength (Z =–2.763, P =.006) on their dominant than nondominant shoulder and significantly less IR ROM (Z =–3.099, P =.002) on their dominant than nondominant shoulder. Conclusion: Prior OH sports participation may have residual osseous and musculoskeletal effects that remain after cessation of the sport. [ABSTRACT FROM AUTHOR]

In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff repair is a common orthopaedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions. Purpose: To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon's insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests. Results: At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P =.01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P <.01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion. Conclusion: Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function. [ABSTRACT FROM AUTHOR]

Baseball players commonly show altered glenohumeral range of motion during internal rotation, external rotation, total rotation, and horizontal adduction. These altered ranges of motion appear to be associated with throwing shoulder injuries, which frequently involve the supraspinatus tendons; thus, we aimed to examine the relationship between altered glenohumeral range of motion and supraspinatus tendon changes in collegiate baseball players. To investigate this association using the Pearson correlation coefficient, we measured glenohumeral internal rotation, external rotation, total rotation, and horizontal adduction ranges of motion and supraspinatus tendon thickness in 22 college baseball players. Consequently, there was a significant relationship between increase in supraspinatus tendon thickness and greater deficit of internal rotation (r =–0.520, P =0.013). Increased supraspinatus tendon thickness tended to be associated with greater external rotation gain (r =0.394, P =0.073). No other range of motion had any relationship with supraspinatus tendon changes. These results might indicate that restricted glenohumeral internal rotation and excessive gain in external rotation increase the risk of supraspinatus tendon abnormalities in baseball players. [ABSTRACT FROM AUTHOR]

Shoulder and elbow injuries in overhead athletes, especially baseball pitchers, have become more common and result in limited participation. Upper extremity injuries in baseball can occur secondary to high velocity repetitive loading at extreme ranges of motion causing microtrauma to the musculoskeletal structures. With the vast number of youth and young adult baseball players in the United States and the increasing number of throwing related injuries, it is crucial that clinicians can perform a movement system evaluation of the throwing motion. An adequate evaluation of the movement system as it relates to the throwing motion can provide insight into abnormal throwing mechanics and provide rationale for selecting appropriate interventions to address identified impairments that may lead to injury. The purpose of this clinical commentary is to present a recommended movement system evaluation that can be utilized during both pre-season and in-season to assess for modifiable injury risk factors in youth and young adult baseball players. [ABSTRACT FROM AUTHOR]

Context: Plyometric training is credited with providing benefits in performance and dynamic restraint. However, limited prospective data exist quantifying kinematic adaptations such as amortization time, glenohumeral rotation, and scapulothoracic position, which may underlie the efficacy of plyometric training for upper-extremity rehabilitation or performance enhancement. Objective: To measure upper-extremity kinematics and plyometric phase times before and after an 8-wk upper-extremity strength- and plyometric-training program. Design: Randomized pretest-posttest design. Setting: Research laboratory. Participants: 40 recreationally active men (plyometric group, age 20.43 ± 1.40 y, height 180.00 ± 8.80 cm, weight 73.07 ± 7.21 kg; strength group, age 21.95 ± 3.40 y, height 173.98 ± 11.91 cm, weight 74.79 ± 13.55 kg). Intervention: Participants were randomly assigned to either a strength-training group or a strength- and plyometric-training group. Each participant performed the assigned training for 8 wk. Main Outcome Measures: Dynamic and static glenohumeral and scapular-rotation measurements were taken before and after the training programs. Dynamic measurement of scapular rotation and time spent in each plyometric phase (concentric, eccentric, and amortization) during a ball-toss exercise were recorded while the subjects were fitted with an electromagnetic tracking system. Static measures included scapular upward rotation at 3 different glenohumeral-abduction angles, glenohumeral internal rotation, and glenohumeral external rotation. Results: Posttesting showed that both groups significantly decreased the time spent in the amortization, concentric, and eccentric phases of a ball-toss exercise (P < .01). Both groups also exhibited significantly decreased static external rotation and increased dynamic scapular upward rotation after the training period (P < .01). The only difference between the training protocols was that the plyometric-training group exhibited an increase in internal rotation that was not present in the strength-training group (P < .01). Conclusion: These findings support the use of both upper-extremity plyometrics and strength training for reducing commonly identified upper-extremity-injury risk factors and improving upper-extremity performance. [ABSTRACT FROM AUTHOR]

Scapular bracing can correct scapular kinematics and restore normal scapular-muscle activity. However, there is little evidence to support the beneficial effects of a figure-8 strap, a type of scapular bracing, on muscle length, scapular alignment, and muscle activity during arm-lifting exercise. Objective: To investigate the immediate effect of a figure-8 strap on pectoralis minor length, scapular alignment, and scapular upward-rotator-muscle activity. Design: Cross-sectional study. Setting: Research laboratory. Participants: Fifteen male participants (age 22.1 ± 1.9 y, weight 68.2 ± 5.7 kg, height 176.2 ± 3.3 cm) with forward shoulder posture (FSP) were examined for pectoralis minor length and scapular alignment with and without the application of a figure-8 strap. Main Outcome Measures: Pectoralis minor length was measured using the Pectoralis Minor Index (PMI), scapular alignment was measured with FSP, and upper trapezius, lower trapezius, and serratus anterior muscle activity were measured using surface electromyography while participants performed an arm-lifting exercise. Data collected with and without applying a figure-8 strap were compared using a paired t-test. Results: Applying a figure-8 strap significantly decreased the PMI (P = .005) and scapular anterior tilting (P = .000). There were no differences in the muscle activity of the upper trapezius (P = .784), lower trapezius (P = .241), and serratus anterior muscles (P = .639). Conclusions: A figure-8 strap resulted in positive changes in pectoralis minor length and scapular alignment. The results support its use as a treatment aid in managing pectoralis minor length and scapular alignment during arm-lifting exercises. [ABSTRACT FROM AUTHOR]

Context: Clinicians use various stretching techniques to prevent the onset of and treat glenohumeral internal-rotation deficit (GIRD). It is unknown which stretching technique is the most effective. Objective: To investigate the acute effects of hold--relax proprioceptive neuromuscular facilitation (PNF) with and without vibration therapy on internal rotation in individuals with GIRD. Design: 2-within (stretch x time) comparison with repeated measures. Setting: Controlled laboratory. Participants: 11 male current and former overhead athletes (19.8 ± 1.4 y, 184.5 ± 4.5 cm, 91.8 ± 11.6 kg) who presented with GIRD. Interventions: At 3 separate sessions, participants performed 1 of 3 randomly assigned stretches: hold--relax PNF (PNF), hold--relax PNF in combination with a whole-body-vibration unit set at 30 Hz (PNF-V), and static stretch (SS). Pretest and posttest maximum passive glenohumeral internal-rotation measurements were taken with a digital protractor. Main Outcome Measures: The dependent variables were the mean glenohumeral internal-rotation measurements taken at the pretest and posttest. The influence of stretch (PNF, PNF-V, and SS) and time (pretest and posttest) on mean glenohumeral internal rotation was compared using a 3 x 2 factorial ANOVA with repeated measures on both variables (P ≤ .05). Results: There was a stretch-by-time interaction (F2,20 = 34.697, P < .001). Post hoc testing revealed that the PNF posttest (73.0° ± 10.4°) was greater than the PNF pretest (60.0° ± 11.8°), the PNF-V posttest (74.7° ± 10.0°) was greater than the PNF-V pretest (57.4° ± 10.4°), and the SS posttest (67.0° ± 10.7°) was greater than the SS pretest (60.1° ± 9.4°). When comparing the posttest values, the PNF-V posttest was greater than the SS posttest. Conclusions: All 3 stretches (PNF, PNF-V, and SS) resulted in acute increases in glenohumeral internal rotation in individuals presenting with GIRD. The PNF-V stretch resulted in the greatest increase and would be the most clinically beneficial for patients with GIRD. [ABSTRACT FROM AUTHOR]