RESUMEN

PURPOSE: The aim of this study was to compare the functional outcomes, recurrence rate, range of motion (ROM) and return to sports activities between arthroscopic Bankart repair (ABR) versus arthroscopic Bankart/SLAP repair (ABR/S) in limited contact-athletes with a type V SLAP lesion in the scenario of recurrent anterior shoulder instability (RASI). Our hypothesis was that there is no difference between the two treatments. METHODS: Two groups of 45 limited-contact athletes with type V SLAP lesion were created. Group 1 underwent an arthroscopic Bankart repair, while group 2 had an arthroscopic Bankart/SLAP repair. The minimum follow-up period was 2 years. The WOSI and ASES scores were used to assess primary functional outcomes. Recurrence rate, ROM and return to sport were also evaluated. RESULTS: Significant differences were reported in the WOSI and ASES scores pre- and post-operatively in each group. There were no significant differences between the two groups (P = 0.78 and 0.43). We reported 4 recurrences (8.8 %) in group 1 and 5 (11.1 %) in group 2, with no difference between them (P = 0.62). There were no significant differences between the range of motion of each of the groups as well as between them. More than 90% of the athletes in both groups returned to their previous sporting activities. CONCLUSIONS: Limited-contact athletes with RASI who have a type V SLAP lesion as their primary diagnosis can be treated using either ABR or ABR/S with equal efficacy. Both treatment alternatives preserve athlete's function, stability, ROM and return to sport.

Asunto(s)

Artroscopía , Inestabilidad de la Articulación , Rango del Movimiento Articular , Recurrencia , Volver al Deporte , Humanos , Artroscopía/métodos , Masculino , Volver al Deporte/estadística & datos numéricos , Estudios Prospectivos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Femenino , Adulto , Adulto Joven , Lesiones del Hombro/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/fisiopatología , Resultado del Tratamiento , Adolescente , Luxación del Hombro/cirugía , Luxación del Hombro/fisiopatología , Lesiones de Bankart/cirugía , Recuperación de la Función

RESUMEN

INTRODUCTION: Open Bankart repair plus inferior capsular shift has not yet been tested under the concept of glenoid track as a predictor of failure. The aim of this study was to compare the subjective and objective outcomes in collision athletes with subcritical glenoid bone loss and on-track Hill Sachs lesions versus those with off-track Hill Sachs lesions, all treated with open Bankart repair. METHODS: Two study groups were created: 50 patients had on-track Hill Sachs lesions, while 38 had off-track lesions. The subcritical glenoid bone loss was ≤ 10%. A minimum follow-up period of 3 years was established. Preoperative and postoperative evaluation of each group and between them was performed. The Western Ontario Shoulder Instability Index score and the American Shoulder and Elbow Surgeons scale were used to assess subjective outcomes. Recurrence rate, range of motion and return to sport were evaluated as objective outcomes. RESULTS: Significant differences were reported in the WOSI and ASES scores between preoperative and postoperative values in each group. There were no significant differences between the two groups (p-value = 0.36 and 0.71). Three dislocations (6%) in the on-track group and 3 (7.8%) in the off-track group were recorded, showing no differences between the two groups (p-value = 0.83). There were no differences in ROM between pre- and post-operatively in each group or when comparing the two groups. CONCLUSIONS: We found no differences between the outcomes of the two groups. According to the surgeon's preference, we recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with SGBL ≤ 10% independently of the type of Hill Sachs lesion.

Asunto(s)

Lesiones de Bankart , Humanos , Masculino , Lesiones de Bankart/cirugía , Femenino , Adulto , Adolescente , Adulto Joven , Traumatismos en Atletas/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Resultado del Tratamiento , Volver al Deporte , Luxación del Hombro/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos

RESUMEN

We tested if the movement slowness of individuals with Parkinson's disease is related to their decreased ability to generate adequate net torques and linearly coordinate them between joints. This cross-sectional study included ten individuals with Parkinson's disease and ten healthy individuals. They performed planar movements with a reversal over three target distances. We calculated joint kinematics of the elbow and shoulder using spatial orientation. The muscle, interaction, and net torques were integrated into the acceleration/deceleration phases of the fingertip speed. We calculated the linear correlations of those torques between joints. Both groups modulated the elbow and shoulder net torques with target distances. They linearly coupled the production of torques. Both groups did not modulate the interaction torques. The movement slowness in Parkinson's disease was related to the difficulty in generating the appropriate muscle and net torques in the task. The interaction torques do not seem to play any role in movement control.

Asunto(s)

Articulación del Codo , Actividad Motora , Enfermedad de Parkinson , Articulación del Hombro , Fenómenos Biomecánicos , Enfermedad de Parkinson/fisiopatología , Articulación del Codo/fisiopatología , Articulación del Hombro/fisiopatología , Músculo Esquelético/fisiopatología , Torque , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano

RESUMEN

SUMMARY: This study aimed to determine the benefits of a combined technique of muscle energy with and myofascial release more effective than using each in isolation in glenohumeral internal rotator deficits. An interventional study was designed for this study. Thirty-eight patients were diagnosed with painful shoulder syndrome. Patients were randomly allocated into 4 groups where Group A was treated with combined muscle energy and myofascial release; Group B with muscle energy technique; Group C with myofascial release and Group D used as control. The evaluation of the passive joint range of the glenohumeral internal rotation and sociodemographic data for each of the groups were measured, before and after interventions. Despite the use of myofascial release and muscle energy techniques being significantly beneficial in their respective groups, when both were combined; it outcomes were highly successful. A combination therapy treatment applied with the Muscle Energy and Myofascial Release Techniques in patients with painful shoulder syndrome will be more effective in increasing the range of motion of the glenohumeral internal rotation joint than any of the techniques applied individually.

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Este estudio tuvo como objetivo determinar los beneficios de una técnica combinada de energía muscular con liberación miofascial más efectiva que usar cada una de manera aislada en los déficits de los músculos rotadores internos glenohumerales. Para este estudio se diseñó un protocolo de intervención. En 38 pacientes se diagnosticó síndrome de hombro doloroso. Los pacientes fueron asignados aleatoriamente a 4 grupos; el grupo A fue tratado con energía muscular combinada y liberación miofascial; Grupo B con técnica de energía muscular; Grupo C con liberación miofascial y Grupo D utilizado como control. Se midió la evaluación del rango articular pasivo de la rotación interna de la articulación glenohumeral y datos sociodemográficos de cada uno de los grupos, antes y después de las intervenciones. A pesar de que el uso de técnicas de liberación miofascial y energía muscular resultó significativamente beneficioso en sus respectivos grupos, cuando ambas se combinaron; Sus resultados fueron muy exitosos. Un tratamiento de terapia combinada aplicado con las Técnicas de Energía Muscular y Liberación Miofascial en pacientes con síndrome de hombro doloroso será más efectivo para aumentar el rango de movimiento de la articulación de rotación interna glenohumeral que cualquiera de las técnicas aplicadas individualmente.

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Articulación del Hombro/fisiopatología , Rango del Movimiento Articular , Modalidades de Fisioterapia , Terapia Combinada , Terapia de Liberación Miofascial

RESUMEN

INTRODUCTION: The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively. METHODS: In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark. RESULTS: Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2-15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups. CONCLUSION: The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

Asunto(s)

Artroscopía , Rango del Movimiento Articular , Lesiones del Manguito de los Rotadores , Humanos , Masculino , Femenino , Persona de Mediana Edad , Artroscopía/efectos adversos , Factores de Riesgo , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/epidemiología , Incidencia , Estudios Prospectivos , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Manguito de los Rotadores/cirugía , Adulto

RESUMEN

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

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OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Articulación del Hombro/fisiopatología , Rango del Movimiento Articular , Terapia de Liberación Miofascial , Artropatías/rehabilitación , Rotación , Resultado del Tratamiento

RESUMEN

Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

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Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Articulación del Hombro/fisiopatología , Rango del Movimiento Articular/fisiología , Articulación de la Cadera/fisiopatología , Anquilosis/epidemiología , Osteoartritis/complicaciones , Calidad de Vida , Ejercicio Físico , Factores Sexuales , Prevalencia , Estudios Transversales , Factores de Riesgo , Factores de Edad , Complicaciones de la Diabetes/epidemiología , Depresión/complicaciones , Ecuador , Conducta Sedentaria

RESUMEN

BACKGROUND: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. PURPOSE: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. RESULTS: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation (P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points (P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up (P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points (P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). CONCLUSION: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

Asunto(s)

Trasplante Óseo/métodos , Inestabilidad de la Articulación , Músculo Esquelético/trasplante , Procedimientos Ortopédicos/métodos , Luxación del Hombro , Articulación del Hombro , Adolescente , Adulto , Atletas , Humanos , Inestabilidad de la Articulación/cirugía , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Hombro/fisiopatología , Hombro/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Adulto Joven

RESUMEN

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

Asunto(s)

Húmero/patología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Antebrazo , Humanos , Cápsula Articular , Masculino , Examen Físico , Rotación

RESUMEN

OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of instability and tears of the proximal long head of biceps tendon (LHBT). To assess intraobserver and interobserver agreement. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data of 100 consecutive shoulders who underwent non-contrast 1.5-T MRI prior to arthroscopic surgery due to rotator cuff injury. Images were independently analyzed by two musculoskeletal radiologists. LHBT was evaluated for presence of tearing (intact, longitudinal split, partial-thickness, or full-thickness) and position (normal, subluxated, and dislocated). Anterosuperior rotator cuff tears were also assessed. The reference standard was arthroscopic surgery. The ramp test was performed in order to evaluate LHBT stability. Diagnostic performance measures were determined and Kappa coefficients assessed agreement. RESULTS: Concerning the detection of overall tears, sensitivity ranged from 71 to 73% and specificity was 73%. The specificity for full-thickness tears ranged from 75 to 96%. Overall displacement showed sensitivity ranging from 51 to 58% and specificity ranging from 70 to 86%. The specificity of overall displacement combined with anterosuperior rotator cuff tears ranged from 73 to 91%. Interobserver Kappa values were between 0.59 and 0.69. Intraobserver Kappa values were between 0.74 and 0.82. CONCLUSIONS: MRI has moderate accuracy and good agreement for detection of LHBT tears and instability. There is a tendency for increased specificity for full-thickness tears and for instability in the coexistence of anterosuperior rotator cuff tears.

Asunto(s)

Artroscopía , Inestabilidad de la Articulación/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Lesiones del Hombro , Articulación del Hombro/diagnóstico por imagen , Traumatismos de los Tendones/diagnóstico por imagen , Anciano , Estudios Cruzados , Femenino , Humanos , Inestabilidad de la Articulación/fisiopatología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Articulación del Hombro/fisiopatología , Traumatismos de los Tendones/fisiopatología , Tendones/diagnóstico por imagen , Tendones/fisiopatología

RESUMEN

OBJECTIVES: To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN: Reliability study. SETTING: Clinical measurement. PARTICIPANTS: Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES: Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS: Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS: The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.

Asunto(s)

Articulación del Codo/fisiopatología , Aplicaciones Móviles , Examen Físico/métodos , Propiocepción/fisiología , Articulación del Hombro/fisiopatología , Dolor de Hombro/fisiopatología , Adulto , Femenino , Humanos , Masculino , Rango del Movimiento Articular/fisiología , Reproducibilidad de los Resultados

RESUMEN

BACKGROUND: Shoulder pain is reported to be one of the major challenges faced in the functional recovery of patients in rehabilitation following a stroke. In such cases, transcranial direct current stimulation (tDCS) has been used as an additional therapeutic tool for improvements in central and peripheral pain. The aim of the proposed study is to evaluate the effect of tDCS when combined with upper limb physical therapy on pain intensity and functional improvement in stroke survivors with shoulder pain in the hemiplegic limb. METHODS: A randomized, placebo-controlled, double-blind, clinical trial is proposed. The volunteers will be randomly allocated to receive passive movement on the upper limb, which will be performed by the therapist for 20 min followed by either active tDCS or sham tDCS (current stimulation for 30 s) during simultaneous physical activity of the upper limb ("mini-bike") for 20 min, totaling 40 min of intervention performed in 10 consecutive sessions. The anode electrode will be positioned over the primary motor cortex with a current of 2 mA and the cathode electrode will be positioned in the supraorbital region contralateral to the anode. The primary outcome will be shoulder pain intensity, which will be measured using the visual analog scale (VAS) on three occasions: 1) pre-intervention; 2) after 10 interventions (5 weekly sessions, for 2 weeks); and 3) 30 days after the end of the interventions. The secondary outcomes will be motor performance, upper limb function, and quality of life. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, RBR-8F5MNY . Registered on June 2, 2017.

Asunto(s)

Articulación del Hombro/fisiopatología , Dolor de Hombro/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Estimulación Transcraneal de Corriente Directa , Fenómenos Biomecánicos , Brasil , Método Doble Ciego , Humanos , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Recuperación de la Función , Dolor de Hombro/diagnóstico , Dolor de Hombro/etiología , Dolor de Hombro/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

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

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Cápsula Articular/fisiopatología , Síndrome de Abducción Dolorosa del Hombro/fisiopatología , Articulación del Hombro/fisiopatología , Adulto , Fenómenos Biomecánicos , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Fuerza Muscular , Dimensión del Dolor , Rango del Movimiento Articular , Rotación

RESUMEN

OBJECTIVE: To correlate the range of movement and functional performance of the shoulder with pain measures in inactive individuals with and without neck pain. In addition, comparisons were made between the groups. METHODS: The sample comprised two groups of inactive adults, aged 18-45 years: chronic neck pain (n = 30) and healthy subjects (n = 30). All participants had no clinical dysfunction in the shoulder joint. Aspects related to neck pain were evaluated with the Numerical Rating Scale, Neck Disability Index, and the Catastrophic Thoughts about Pain Scale. Range of motion and shoulder functionality was evaluated by means of goniometry and the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test, respectively. RESULTS: Individuals with neck pain presented reduction in CKCUES test (absolute score, mean difference [MD] = -1.50, 95% confidence interval [CI] [-2.87, -0.12]) and in abduction (MD = -7.36°, 95% CI [-13.84, -0.89]) and lateral rotation (MD = -8.61°, CI [-15.94, -1.28]) range of motion. Moreover, weak, significant, and negative association (p < 0.05, r = -0.262 to -0.384) was observed between the CKCUES test and pain intensity at rest and during active cervical movements, as well as catastrophizing. A weak, significant, and negative association (p < 0.05, r = -0.256 to -0.389) was also observed between the lateral rotation range of motion and catastrophizing, as well as pain intensity both at rest and during active movements. CONCLUSION: The greater the neck pain intensity and catastrophizing, the lower the functional performance and lateral rotation range of motion of the shoulder.

Asunto(s)

Dolor de Cuello/fisiopatología , Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Artrometría Articular , Estudios de Casos y Controles , Catastrofización , Estudios Transversales , Femenino , Humanos , Masculino , Rotación , Conducta Sedentaria , Adulto Joven

RESUMEN

OBJECTIVE: To investigate possible alterations on scapular muscle strength in subjects with traumatic anterior glenohumeral instability. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PARTICIPANTS: Fifty-two subjects of both sexes: 26 healthy and 26 with traumatic anterior glenohumeral instability. MAIN OUTCOME MEASURES: Subjects performed maximal isometric and concentric isokinetic contractions of shoulder protraction and retraction in scapular and sagittal planes, at slow (12.2 cm/s) and fast (36.6 cm/s) speeds. RESULTS: Subjects with glenohumeral instability presented lower peak force of protraction and retraction during isometric and fast speed tests in the scapular plane; and of isometric protraction in the sagittal plane. CONCLUSIONS: People with traumatic anterior glenohumeral instability present muscle weakness of scapular protractors and retractors. Considering the importance of the scapulothoracic muscles for the dynamic stability of the glenohumeral joint, strengthening of these muscles is recommended for rehabilitation of traumatic anterior glenohumeral instability.

Asunto(s)

Inestabilidad de la Articulación/fisiopatología , Fuerza Muscular , Músculo Esquelético/fisiopatología , Escápula , Lesiones del Hombro , Articulación del Hombro/fisiopatología , Adolescente , Adulto , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Contracción Isométrica , Masculino , Adulto Joven

RESUMEN

Table tennis requires rapid and extreme movements that may result in shoulder adaptations, such as glenohumeral internal rotation deficit, which is a risk factor for several injuries. This study compared range of motion of internal and external rotation and total rotation motion of glenohumeral joint between dominant and non-dominant shoulders of table tennis players. This is a cross-sectional observational study. Twenty healthy male table tennis players that were enrolled in an official table tennis league took part in this study (mean age: 22.9 ± 12.9 years, time of sports practice: 6.2 ± 7.12 years). Measurements of passive glenohumeral external rotation and internal rotation were taken with the individuals in the supine and sidelying positions. Total rotation motion was calculated by summing external and internal rotations. The dominant side showed decreased internal rotation when compared to non-dominant side in both supine (mean difference: 14.9°, p = 0.02) and sidelying positions (mean difference: 16.3°, p = 0.01). No significant difference (p > 0.05) was found for external rotation and total rotation motion between dominant and non-dominant shoulders. The findings indicate that table tennis players exhibit glenohumeral internal rotation deficit of dominant shoulder.

Asunto(s)

Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Tenis , Adolescente , Adulto , Atletas , Estudios Transversales , Humanos , Masculino , Rotación , Adulto Joven

RESUMEN

PURPOSE: To identify the rate of and predictive variables for functionally limited shoulder internal rotation in postoperative patients with brachial plexus birth palsy. METHODS: Records of patients with brachial plexus birth palsy who had surgery on the affected upper extremity during a 10-year period were retrospectively reviewed. Patient demographics, physical examinations, and all upper extremity procedures were recorded. Loss of midline function (LOM) was defined as a Modified Mallet Scale or Active Movement Scale (AMS) internal rotation score <3. Exclusion criteria were <1-year follow-up after the most recent procedure, insufficient documentation, or preexisting LOM. Multivariable logistic regression was performed on 3 different scenarios of candidate variables to identify those associated with LOM. All scenarios included each procedure as a candidate variable. Scenario A additionally analyzed preprocedural AMS scores. Scenario B additionally analyzed preprocedural Modified Mallet Scale scores. Scenario C isolated the surgical pathway without preprocedural examination scores. RESULTS: Among 172 included patients, 34 (19.8%) developed LOM. Predictive variables associated with LOM included severity of initial palsy (C5-7, odds ratio 3.6; C5-T1, odds ratio 4.9), poor recovery of upper trunk motor function before the patient's first surgery (specifically Modified Mallet Scale abduction < 4, AMS elbow flexion < 3, and AMS wrist extension < 3), and patients who ultimately required surgical glenohumeral reduction (odds ratio 3.6). Age, number of procedures, closed shoulder reduction with casting, shoulder tendon transfers, and external rotation humeral osteotomies were not predictive of LOM. CONCLUSIONS: Approximately 1 in every 5 patients with brachial plexus birth palsy will develop LOM after entering a surgical algorithm designed to improve shoulder external rotation. Patients with a more severe initial palsy (C5-7 or global), poor spontaneous recovery of upper trunk motor function (elbow flexion or wrist extension) before their first procedure, and those who ultimately require surgical glenohumeral joint reduction should be counseled as having a higher odds of LOM development. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Asunto(s)

Neuropatías del Plexo Braquial/fisiopatología , Neuropatías del Plexo Braquial/cirugía , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular/fisiología , Rotación , Articulación del Hombro/fisiopatología , Algoritmos , Traumatismos del Nacimiento/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Articulación de la Muñeca/fisiopatología

RESUMEN

Brachial plexus birth palsy resolves spontaneously in a majority of patients, however, others may have serious permanent dysfunction. Although nerve transfers or grafts are early options for treatment, many children have residual deficits or present too late for such procedures. In these patients, rotational osteotomy of the humerus may restore improved function and motion. Unfortunately, traditional humeral osteotomies only provide correction in a single plane, therefore appropriate correction of the typical residual deformity is incomplete. Here, we describe a novel technique for obtaining a calculated correction in 3 planes using a single osteotomy of the humerus on the basis of a mathematical equation. Nine patients are described here with an average of 35.4 months follow-up. Corrections were obtained in adduction, extension, and either internal or external rotation depending on the initial deformity and Modified Mallet scores were collected for each patient. There was 1 case of transient radial nerve palsy with no long-term complications overall.

Asunto(s)

Neuropatías del Plexo Braquial/complicaciones , Neuropatías del Plexo Braquial/cirugía , Húmero/cirugía , Osteotomía/métodos , Rango del Movimiento Articular/fisiología , Articulación del Hombro/cirugía , Traumatismos del Nacimiento/complicaciones , Traumatismos del Nacimiento/cirugía , Niño , Terapia por Ejercicio/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteotomía/rehabilitación , Cuidados Posoperatorios/métodos , Recuperación de la Función/fisiología , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Articulación del Hombro/fisiopatología , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Elastic tape has been widely used in clinical practice in order to improve upper limb (UL) sensibility. However, there is little evidence that supports this type of intervention in stroke patients. OBJECTIVE: To verify the effect of elastic tape, applied to the paretic shoulder, on joint position sense (JPS) during abduction and flexion in subjects with chronic hemiparesis compared to sham tape (non-elastic tape). Furthermore, to verify if this potential effect is correlated to shoulder subluxation measurements and sensorimotor impairment. METHODS: A crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper. RESULTS: Thirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p = 0.805; p = 0.951), and 60° (p = 0.509; p = 0.799), or flexion at 30° (p = 0.872; p = 0.897) and 60° (p = 0.853; p = 0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p = 0.001, r = -0.92) and 60° (p = 0.020, r = -0.75). CONCLUSION: Elastic tape improved shoulder JPS of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment. However, this improvement was influenced by the subluxation degree at abduction.

Asunto(s)

Paresia/terapia , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Hombro/fisiopatología , Cinta Quirúrgica , Adulto , Anciano , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Propiocepción/fisiología , Accidente Cerebrovascular/fisiopatología

RESUMEN

PURPOSE: The rotator cuff transverse force couple (RCTFC) is fundamental in the shoulder biomechanics, as the balance of its muscle components (the subscapularis relative to the infraspinatus and teres minor) provides stability to the joint. The chronic progression of rotator cuff tears usually present alterations in muscle volume, along with atrophy and compensatory hypertrophy, which can be determined using imaging techniques. The aim of this study was to quantify RCTFC muscle volume in a large sample taking into account the age and gender of the participants involved. METHODS: An observational, retrospective, cross-sectional, descriptive and comparative study was conducted, evaluating thoracic computed tomography scans from 152 patients (304 shoulders) of indistinct gender, with ages ranging between 18 and 85 years. The RCTFC muscle volume was quantified with an oblique/multiplanar segmentation technique. Measuring time was also documented. RESULTS: We observed that muscle volume decreases among the different age (p < 0.04) and gender (p < 0.001) groups. However, the RCTFC volume ratio remained constant at 1.02 ± 0.18 without significant differences throughout all age and gender groups evaluated (p > 0.298). CONCLUSION: The decrease in the RCTFC muscle volume is proportional during the different stages of life, maintaining a constant ratio between its components (physiological RCTFC muscle atrophy). The time-saving segmentation method and volume ratio formula proposed in this study contribute to the management and understanding of rotator cuff tear/pathology.

Asunto(s)

Atrofia Muscular/fisiopatología , Lesiones del Manguito de los Rotadores/fisiopatología , Manguito de los Rotadores/anatomía & histología , Articulación del Hombro/anatomía & histología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Factores Sexuales , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Tomografía Computarizada por Rayos X , Adulto Joven