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Yildiz TI, Turhan E, Ocguder DA, Yaman F, Huri G, Duzgun I. Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery. Sports Health 2023; 15:878-885. [PMID: 36539969 PMCID: PMC10606971 DOI: 10.1177/19417381221141075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. HYPOTHESES Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. RESULTS Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. CONCLUSION Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. CLINICAL RELEVANCE Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Firat Yaman
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Irem Duzgun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
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Ernstbrunner L, Waltenspül M, Suter C, El-Nashar R, Scherr J, Wieser K. Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up. Am J Sports Med 2022; 50:1495-1502. [PMID: 35315286 PMCID: PMC9069664 DOI: 10.1177/03635465221079858] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are concerns that the Latarjet procedure results in loss of glenohumeral rotation and strength and in subscapularis dysfunction. The long-term effects of this procedure on subscapularis quality, glenohumeral rotation, and strength are unknown. PURPOSE/HYPOTHESIS To analyze the long-term effect of the primary open Latarjet procedure using a muscle-splitting approach on internal and external rotation and strength, as well as subscapularis muscle quality as compared with the healthy contralateral side. We hypothesized that the primary open Latarjet procedure is associated with a reduction of long-term shoulder strength and function and decreased subscapularis quality. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 42 patients who underwent a primary open Latarjet procedure for recurrent anterior shoulder instability at a mean age of 26 years (range, 18-36) were reviewed after a mean follow-up of 8.4 years (range, 5-12). The subscapularis muscle volume and fat fraction of both shoulders were assessed. Bilateral active internal rotation (IR) and external rotation (ER), as well as IR and ER strength, were assessed by isokinetic testing (concentric, eccentric, and fatigability). RESULTS Active IR (0.6-point difference, P < .001) and ER (4° difference, P = .010) were significantly greater in healthy contralateral shoulders. The IR strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric and eccentric testing (range of deficit, 4%-6%; P < .05). Also, the ER strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric testing (11% deficit, P < .05). Subscapularis muscle volume was significantly greater in the operated shoulder (4% difference, P = .022), and there was no significant difference in fat fraction (P = .114). CONCLUSIONS The primary open Latarjet procedure was associated with significantly decreased active IR and ER and strength when compared with the healthy contralateral shoulder. The clinical influence of these findings is yet to be defined. There was no increased subscapularis muscle fatty degeneration but a minimal hypertrophy on the operated side at long-term follow-up.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia,Department of Biomedical Engineering, University of Melbourne, Parkville, Australia,Melbourne Orthopaedic Group, Windsor, Australia,Lukas Ernstbrunner, MD, PhD, Department of Orthopaedic Surgery, Royal Melbourne Hospital, Forchstrasse 340, Zurich, 8008, Switzerland ()
| | - Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Cyrill Suter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rany El-Nashar
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete’s decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete’s psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete’s return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
- Correspondence: Luciano Andrés Rossi, Peron 4190 (C1199ABB), Buenos Aires, Argentina, Email
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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Jeon YD, Kim HS, Rhee SM, Jeong MG, Oh JH. Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery. Orthop J Sports Med 2021; 9:23259671211059814. [PMID: 34938820 PMCID: PMC8685727 DOI: 10.1177/23259671211059814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.
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Affiliation(s)
- Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyong Suk Kim
- Department of Orthopaedic Surgery, Seoul Nalgae Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Myeong Gon Jeong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Aurich M, Hofmann GO, Best N. Clinical outcome and return to sports activity after surgical treatment for recurrent shoulder instability with a modified Latarjet procedure. Orthop Traumatol Surg Res 2021; 107:102977. [PMID: 34091084 DOI: 10.1016/j.otsr.2021.102977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/10/2020] [Accepted: 10/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Latarjet procedure is an attractive surgical option for the management of chronic anterior shoulder instability. The original surgical approach involves the vertical tenotomy of the subscapularis tendon. Alternatively, the subscapularis muscle is split longitudinally and the tendon left attached at the lesser tuberosity. HYPOTHESIS The hypothesis is that the longitudinal split is of functional advantage and may lead to better functional results and earlier return to sports activities compared to the vertical tenotomy. MATERIAL AND METHODS Thirty-two patients were included in this retrospective cohort study. In 14 patients, the subscapularis tendon was vertically incised (group A), whereas in 18 patients, the subscapularis muscle was split longitudinally (group B). Patients were evaluated at 1 year (FU1) and 2 years (FU2) after the Latarjet procedure. Results at follow-up were correlated with patient-specific data and compared with the preoperative status. Primary outcomes were the functional assessment based on Western Ontario Shoulder Instability (WOSI) index and Constant Score (CS) and the assessment of the return to sports activity. Patients' demographics, duration of surgery, and the rate of recurrent dislocations were recorded as secondary variables. RESULTS All patients started their sports activities with a mean±SD of 12.41±1.24 weeks. Interestingly, the time from surgery to full recovery of sports activities was significantly longer for group A (mean±SD of 30.17±10.36 weeks) compared to group B (mean±SD of 20.71±3.67 weeks). There is a statistically significant decrease of the WOSI score from the preoperative level compared to FU1 and FU2, indicating a decrease in instability related symptoms during the entire follow up period with no statistically significant difference between group A and B. There is an increase in shoulder function during the entire follow up period based on the CS. Most interestingly, there is a statistically significant difference between group A and B at FU1, indicating a significantly better shoulder function for group B at the early follow up timepoint (FU1). At the later follow up timepoint (FU2), no difference exists in the individual items. However, a significantly better total CS remains in group B, indicating an overall improved function compared to group A. DISCUSSION/CONCLUSION The longitudinal split of subscapularis muscle is a safe approach which leads to quicker functional recovery and return to sports activity compared to the vertical tenotomy, which is a benefit especially for active individuals. It is therefore recommended as the standard surgical approach. LEVEL OF EVIDENCE III; Retrospective cohort study.
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Affiliation(s)
- Matthias Aurich
- Section of Trauma- and Reconstructive Surgery, Department of Orthopaedics, Trauma- and Reconstructive Surgery, University Hospital Halle, Ernst-Grube-Str, 40, 06120 Halle Saale, Germany; Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str,. 165, 06112 Halle Saale, Germany.
| | - Gunther O Hofmann
- Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str,. 165, 06112 Halle Saale, Germany; Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Norman Best
- Department of Physiotherapy, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Daley P, Pomares G, Menu P, Gadbled G, Dauty M, Fouasson-Chailloux A. Shoulder Isokinetic Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091529. [PMID: 34573871 PMCID: PMC8465876 DOI: 10.3390/diagnostics11091529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Neurogenic thoracic outlet syndrome (NTOS) is an impairing painful condition. Patients usually report upper-limb pain, weakness and paresthesia. Shoulder weakness is frequently reported but has never been described with objective strength evaluation. We aimed to compare isokinetic shoulder strength between patients with NTOS and healthy controls. Patients and controls were prospectively evaluated with an isokinetic strength test at 60 and 180°/s, and an endurance test (30 repetitions at 180°/s) of the shoulder rotators. Patients were functionally assessed with QuickDASH questionnaires. One hundred patients and one hundred healthy subjects were included. Seventy-one percent of patients with NTOS were females with a mean age of 39.4 ± 9.6. They were compared to controls, 73% females and the mean age of 38.8 ± 9.8. Patients' mean QuickDASH was 58.3 ± 13.9. Concerning the peak of strength at 60°/s, the symptomatic limbs of patients with NTOS had significantly 21% and 29% less strength than the control limbs for medial and lateral rotators, respectively (p ≤ 0.001). At 180°/s, the symptomatic limbs had significantly 23% and 20% less strength than the controls for medial and lateral rotators, respectively (p ≤ 0.001). The symptomatic limbs had significantly 45% and 30% less endurance than the controls for medial and lateral rotators, respectively (p ≤ 0.001). These deficits were correlated to the QuickDASH. Patients with NTOS presented a significant deficit of strength and endurance of the shoulder rotators correlated to disability. This highlights the interest in upper-limb strength evaluation in the diagnostic process and the follow-up of NTOS.
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Affiliation(s)
- Pauline Daley
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
| | - Germain Pomares
- Institut Européen de la Main, 2540 Luxembourg, Luxembourg;
- Medical Training Center, Hopital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Guillaume Gadbled
- CHU Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, 44093 Nantes, France;
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, 44093 Nantes, France; (P.D.); (P.M.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, 44042 Nantes, France
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Correspondence: ; Tel.: +33-240-846-211
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Ribeiro LM, Lara PHS, Pochini ADC, Andreoli CV, Belangero PS, Ejnisman B. Avaliação isocinética do ombro após procedimento cirúrgico de Bristow/Latarjet em atletas. Rev Bras Ortop 2021; 57:128-135. [PMID: 35198120 PMCID: PMC8856852 DOI: 10.1055/s-0041-1726059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives
To evaluate the muscular strength of the internal (IR) and external (ER) rotators of the shoulder after Bristow/Latarjet surgery.
Methods
Cross-sectional study with 18 patients (36 shoulders). The isokinetic evaluation was performed using the Biodex 3 System Pro dynamometer (Biodex Medical System, Inc., Shirley, NY, USA). The athletic shoulder outcome rating scale (ASORS) and the visual analogue scale (VAS) were applied.
Results
The values of peak torque and maximum work in concentric and eccentric mode on the non-operated shoulder were higher than on the operated side for both the IR and ER (
p
< 0.01). The conventional and functional balance between the ER and IR showed no differences between the operated and the non-operated side. When comparing patients with postoperative time < 1 year or 1 year, no differences were observed in peak torque values at 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the IR to the operated shoulder. However, the peak torque values of 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the ER were higher in subjects with postoperative time ≥ 1 year in all variables (
p
< 0.05).
Conclusions
There was a decrease in the strength of the IR and ER in the operated shoulder compared with the healthy shoulder. However, the conventional and functional balance was maintained.
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Affiliation(s)
- Leandro Masini Ribeiro
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Henrique Schmidt Lara
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Alberto de Castro Pochini
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Carlos Vicente Andreoli
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Benno Ejnisman
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Rhee SM, Nashikkar PS, Park JH, Jeon YD, Oh JH. Changes in Shoulder Rotator Strength After Arthroscopic Capsulolabral Reconstruction in Patients With Anterior Shoulder Instability. Orthop J Sports Med 2021; 9:2325967120972052. [PMID: 33786332 PMCID: PMC7960904 DOI: 10.1177/2325967120972052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The correlation between isokinetic internal and external rotation (IR and ER) strength and functional outcomes in patients with anterior shoulder instability treated by arthroscopic capsulolabral reconstruction (ACR) has not been studied. Purpose: To analyze isokinetic IR and ER strength and their correlation with clinical outcomes in patients with anterior shoulder instability treated by ACR. Study Design: Case series; Level of evidence, 4. Methods: Between January 2004 and June 2015, a total of 104 patients who underwent ACR for anterior shoulder instability were analyzed. The mean peak torque (PT) in IR (IRPT) and ER (ERPT), PT deficit (PTD; %) relative to the opposite healthy shoulder, and PT ratio (PTR; ERPT/IRPT) were calculated before and 1 year after surgery. Functional scores were evaluated before surgery and at every follow-up visit. Recurrence and postoperative apprehension during ER at 90° of arm abduction were evaluated at 1 year and the final follow-up (76.6 ± 64.4 months). Results: IR and ER strength were measured for 68 of 104 patients at 1 year after surgery. ERPT and IRPT were less on the involved side than on the uninvolved side before surgery (0.29 ± 0.10 vs 0.33 ± 0.10 N·m/kg, respectively, for ERPT [P = .002]; 0.36 ± 0.14 vs 0.41 ± 0.16 N·m/kg, respectively; for IRPT [P = .01]). At 1 year after surgery, IRPT on the involved side recovered (0.40 ± 0.20 N·m/kg), whereas ERPT remained weak (0.30 ± 0.13 N·m/kg) relative to the baseline value. PTD in IR (PTDIR) improved to 2.2% ± 24.4% (P = .012), whereas PTD in ER (PTDER) showed no improvement (13.5% ± 13.8%; P = .569). PTR on the involved side improved from 1.07 ± 1.71 to 0.86 ± 0.23 at 1 year (P < .001). All functional scores improved significantly at the final follow-up. At 1 year, 9 of 68 (13.2%) patients showed positive apprehension. PTDIR and PTDER on the involved side were worse in patients with positive apprehension than in those with negative apprehension (P = .039 and .014, respectively). PTDER was worse than PTDIR in patients with positive apprehension at 1 year (P = .022). Conclusion: For those with anterior shoulder instability, preoperative IR and ER strength of the involved shoulder were lower than those of the uninvolved shoulder. IRPT recovered, whereas ERPT remained weak after ACR. To prevent positive apprehension after surgery, IR and ER strengthening exercises are important, with more emphasis on exercises for ER.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Piyush Suresh Nashikkar
- Department of Orthopaedic Surgery, Max Institute of Musculoskeletal Sciences, Max Smart Super Speciality Hospital, New Delhi, India
| | - Joo Hyun Park
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Young Dae Jeon
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Malavolta EA, Cruz DG, Gracitelli MEC, Assunção JH, Andrade-Silva FB, Andrusaitis FR, Ferreira Neto AA. Isokinetic evaluation of the shoulder and elbow after Latarjet procedure. Orthop Traumatol Surg Res 2020; 106:1079-1082. [PMID: 32739217 DOI: 10.1016/j.otsr.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND/HYPOTHESIS The Latarjet procedure changes the anatomy of the shoulder, moving the coracoid process distally through an incision in the subscapularis muscle. Some authors have studied the effect of this surgery on shoulder rotator strength. Our hypothesis is that the Latarjet procedure decreases elbow supination and flexion strength. METHODS A retrospective case series, evaluating patients submitted to the Latarjet procedure between May 2013 and June 2017. Movements of the elbow (supination, pronation, flexion and extension) and shoulder (internal and external rotation) were evaluated bilaterally using a Biodex System 3 isokinetic dynamometer (Biodex Medical Systems, New York) in concentric/concentric mode. RESULTS We evaluated 20 patients with an average follow-up of 36 months. In the elbow, we observed a 9.1% decrease in supination strength at a speed of 60°/s (p=0.044), without statistical difference at 120°/s (p=0.570). In the shoulder, there was a 13.5% decrease in external rotation strength at 60°/s and 4.5% at 180°/s (p=0.009 and p=0.040, respectively). The other movements did not demonstrate any statistically significant differences. CONCLUSION After the Latarjet procedure, the supination strength at 60°/s was decreased, as was the external rotation strength of the shoulder at 60°/s and 180°/s. We did not observe any reduction in strength for shoulder flexion or internal shoulder rotation. LEVEL OF EVIDENCE IV, case series.
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Lee JH, Park JS, Hwang HJ, Jeong WK. Time to peak torque and acceleration time are altered in male patients following traumatic shoulder instability. J Shoulder Elbow Surg 2018; 27:1505-1511. [PMID: 29678396 DOI: 10.1016/j.jse.2018.02.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous authors have evaluated the strength of the rotator cuff muscles in patients with shoulder instability. However, only limited data are available with regard to neuromuscular control in patients with traumatic anterior shoulder instability, in particular at 90° of abduction. This study was designed to assess muscle strength and neuromuscular control ability using time to peak torque and acceleration time in nonathletic patients with traumatic anterior shoulder instability. METHODS Isokinetic muscle performance testing was performed in 20 male nonathletic anterior shoulder instability patients compared with 20 side-matched asymptomatic volunteers. Isokinetic muscle performance testing was performed at an angular velocity of 180°/s with 90° of shoulder abduction. Muscle strength and neuromuscular control (time to peak torque and acceleration time) of the internal rotators (IRs) and external rotators (ERs) were measured. RESULTS There were no significant differences in muscle strength of the IRs and ERs between the 2 groups. The injured shoulder showed delayed neuromuscular control in both the IRs and ERs in the instability patients compared with the normal control subjects (time to peak torque, P = .023 for IRs and P = .020 for ERs; acceleration time, P = .035 for IRs and P = .021 for ERs). CONCLUSION The neuromuscular control of both the IRs and ERs was decreased in male nonathletic patients with traumatic anterior shoulder instability even though muscle strength was not altered. Therefore, clinicians and therapists should implement exercises that aim to restore neuromuscular control in the rehabilitation of nonathletic patients with anterior shoulder instability.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Ji Soon Park
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea; Sheikh Khalifa Specialty Hospital, North Ras Al Khaimah, United Arab Emirates
| | - Hyun Jung Hwang
- Department of Orthopaedic Surgery, Burteam Hospital, Seoul, Republic of Korea
| | - Woong Kyo Jeong
- Department of Sports Medical Center, Korea University, Anam Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
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Cousin J, Crenn V, Fouasson-Chailloux A, Dauty M, Fradin P, Gouin F, Venet G. Isolated Rupture of the Teres Major Muscle When Water Skiing: A Case Report and Literature Review. Case Rep Orthop 2018; 2018:3806534. [PMID: 29808143 DOI: 10.1155/2018/3806534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/07/2018] [Indexed: 11/17/2022] Open
Abstract
Isolated lesions to the teres major muscle are rare. They generally occur in patients participating in sports such as baseball, tennis, or boxing. We report the case of a sports patient who suffered an isolated injury to the teres major while water skiing. The clinical presentation was confirmed by MRI. Conservative treatment was chosen and consisted of brief analgesic immobilization, followed by rehabilitative treatment. The rapid recovery of this patient with normal isokinetic strength evaluation at 6 months was interesting for objectifying full muscle recovery. Our results and the data from the literature suggest that functional rather than surgical treatment is preferable in isolated lesions to the teres major muscle.
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Caubère A, Lami D, Boileau P, Parratte S, Ollivier M, Argenson JN. Is the subscapularis normal after the open Latarjet procedure? An isokinetic and magnetic resonance imaging evaluation. J Shoulder Elbow Surg 2017; 26:1775-81. [PMID: 28601489 DOI: 10.1016/j.jse.2017.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is considered to be a violation of the subscapularis muscle. This study evaluated the postoperative status of the subscapularis through isokinetic and magnetic resonance imaging analysis after splitting. We hypothesized that compared with a healthy contralateral shoulder, there would be satisfactory recovery of subscapularis strength at the cost of some fatigability and some mild fatty infiltration. MATERIALS AND METHODS This was a case-control retrospective study of patients who underwent a Latarjet procedure between January 2013 and January 2015. A total of 20 patients were reviewed at 1 year postoperatively. With the patient seated, strength testing of both shoulders was done (concentric, eccentric, and fatigability) with a dynamometer. Trophicity and fatty infiltration were analyzed by magnetic resonance imaging. RESULTS Strength of the internal rotators (IRs) and external rotators (ERs) of the injured shoulder was significantly lower compared with the healthy shoulder in concentric testing at 180°/s and 60°/s (13% for IR and 20% for E, P < .05) and in eccentric testing at 60°/s (19% for IR and 16% for ER, P < .05). A peak torque ratio (ER/IR) of the operated-on shoulder was maintained. The difference in muscular endurance was significant (P < .001). There was no muscle atrophy and minimal or no fatty infiltration of the subscapularis in any patient. CONCLUSION At 1 year after the open Latarjet procedure, isokinetic testing showed a combined strength deficit in both internal and external rotation with a conserved muscle balance. Although no significant subscapularis fatty infiltration or atrophy was noted, there was a significant deficit in endurance compared with the healthy shoulder.
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Guillemot P, Jan J, Rochcongar P. Analyse de la vitesse d’exécution de 101 tests isocinétiques réalisés sur des épaules pathologiques. Sci Sports 2016; 31:145-51. [DOI: 10.1016/j.scispo.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tahta M, Akmeşe R, Özberk ZN, Coşkun OO, Işik Ç, Korkusuz F, Bozkurt M. Muscle strength and function of shoulders with Bankart lesion after successful arthroscopic treatment: interlimb comparison 24 months after surgery. Arch Orthop Trauma Surg 2013; 133:1711-8. [PMID: 24100767 DOI: 10.1007/s00402-013-1859-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to examine outcomes following arthroscopic Bankart repair with the focus on strength after the repair. METHODS 56 shoulders with Bankart lesion were operated on arthroscopically. Gender, mechanism of the first dislocation, number of dislocations, dominant side, operated side and the number of anchors used for surgery were recorded. DASH and Oxford instability scoring systems were applied preoperatively and compared to scores at the 24-month follow-up. The scoring systems were also applied to contralateral shoulders at the 24th month of follow-up. Range of motion was measured with a goniometer. Muscle strength was analyzed with a dynamometer simultaneously with the muscle activity of four perishoulder muscles. The data were recorded with surface EMG. Range of motion, muscle strength and activity were evaluated according to the contralateral shoulder at the 24th month of follow-up. RESULTS Male/female ratio was 42/14 with a mean age of 32 years. The mean number of dislocations was 3 ± 1 and all were traumatic dislocations. The number of mean anchors used was 3.1 and the mean follow-up period was 24 months. In clinical evaluation, the preoperative and postoperative results of the DASH and Oxford instability scores of the unstable shoulders were significantly different. In the comparison between the operated and contralateral shoulders, there was no significant difference in DASH and Oxford instability scores at the 24th month of follow-up. There was no significant loss of range of motion. Only internal rotation strength was significantly reduced and there was no significant change in the EMG patterns. CONCLUSIONS Although good clinical results can be achieved, internal rotation strength is reduced after arthroscopic surgery, but daily activities are not affected. There is no guarantee for patients of excellent recovery. LEVEL OF EVIDENCE Level III cohort study.
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Affiliation(s)
- Mesut Tahta
- Orthopaedics and Traumatology Department, Iğdır State Hospital, Kışla District, Iğdır, Turkey,
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Lee DK, Kim TK, Lee JH, Lee DH, Jung WK. Comparison of Rotational Strength in Shoulders with Anterior Instability and Normal Shoulders Using Isokinetic Testing. Clin Shoulder Elb 2012. [DOI: 10.5397/cise.2012.15.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hadzic V, Ursej E, Kalc M, Dervisevic E. Reproducibility of shoulder short range of motion in isokinetic and isometric strength testing. J Exerc Sci Fit 2012. [DOI: 10.1016/j.jesf.2012.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Edouard P, Bankolé C, Calmels P, Beguin L, Degache F. Isokinetic rotator muscles fatigue in glenohumeral joint instability before and after Latarjet surgery A pilot prospective study. Scand J Med Sci Sports 2012; 23:e74-80. [DOI: 10.1111/sms.12011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | - L. Beguin
- Department of Orthopedics Surgery; Mutualiste Clinic; Saint-Etienne; France
| | - F. Degache
- Department of Physiology; Faculty of Biology and Medicine; Institute of Sport Sciences; University of Lausanne; Lausanne; Switzerland
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Edouard P, Ribinik P, Calmels P, Dauty M, Genty M, Yelnik AP. Care pathways in physical and rehabilitation medicine (PRM): the patient after shoulder stabilization surgery. Ann Phys Rehabil Med 2012; 55:565-75. [PMID: 23021941 DOI: 10.1016/j.rehab.2012.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 11/16/2022]
Abstract
This document is part of the "Care pathways in physical and rehabilitation medicine" series developed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Physical and Rehabilitation Medicine Federation (FEDMER). For a given patient profile, each concise document describes the patient's needs, the care objectives in physical and rehabilitation medicine, the required human and material resources, the time course and the expected outcomes. The document is intended to enable physicians, decision-makers, administrators and legal and financial specialists to rapidly understand patient needs and the available care facilities, with a view to organizing and pricing these activities appropriately. Here, patients with shoulder instability requiring surgical stabilization are classified into five care sequences and two clinical categories, each of which are treated according to the same six parameters and by taking account of personal and environmental factors (according to the WHO's International Classification of Functioning, Disability and Health) that may influence patient needs.
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Affiliation(s)
- P Edouard
- EA 4338, laboratoire de physiologie de l'exercice (LPE), service de MPR, hôpital Bellevue, 42055 Saint-Étienne cedex 02, France.
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Alta TDW, Veeger HEJ, Janssen TWJ, Willems WJ. Are shoulders with a reverse shoulder prosthesis strong enough? A pilot study. Clin Orthop Relat Res 2012; 470:2185-92. [PMID: 22328239 PMCID: PMC3392387 DOI: 10.1007/s11999-012-2277-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 01/30/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that limited active ROM of reverse shoulder prostheses relates to lack of strength. However, the postoperative strength has not been quantified. QUESTIONS/PURPOSES We therefore measured joint torques in patients with reverse shoulder prostheses and correlated torques with functional scores. METHODS We recruited 33 patients (age, 72 ± 8 years) with a reverse prosthesis (37 shoulders, 21 primary and 16 revisions). We obtained Constant-Murley, DASH, and Simple Shoulder Test ([D]SST) scores, and performed two isokinetic protocols (abduction/adduction and external/internal rotation) at 60° per second. Minimum followup was 4 months (average, 23 months; range, 4-63 months). RESULTS Twenty-three patients (24 shoulders; 13 primaries, 11 revisions) were able to perform at least one of the defined tasks. Mean abduction and adduction torques were 15 Nm ± 7 Nm and 16 Nm ± 10 Nm (19%-78% of normal shoulders). External and internal rotation tasks could be performed by only 13 patients (14 shoulders; nine primary, five revisions) generating 9 Nm ± 4 Nm and 8 Nm ± 3 Nm, respectively (13%-71% of normal shoulders). We found moderate correlations between Constant-Murley, DASH and (D)SST (D = Dutch translation) scores and abduction and external rotation. CONCLUSIONS Patients with a reverse prosthesis had reduced strength when compared with normal values reported in the literature (only 65% of patients could perform the protocol). This effect was greatest for external rotation and might explain clinical outcomes with which a moderately strong relationship was observed. Our observations suggest limited strength is a major factor in reduced ROM.
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Affiliation(s)
- Tjarco D W Alta
- Department of Orthopaedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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Olds M, McNair P, Nordez A, Cornu C. Active stiffness and strength in people with unilateral anterior shoulder instability: a bilateral comparison. J Athl Train 2011; 46:642-7. [PMID: 22488190 DOI: 10.4085/1062-6050-46.6.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Active muscle stiffness might protect the unstable shoulder from recurrent dislocation. OBJECTIVE To compare strength and active stiffness in participants with unilateral anterior shoulder instability and to examine the relationship between active stiffness and functional ability. DESIGN Cross-sectional study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants included 16 males (age range, 16-40 years; height = 179.4 ± 6.1 cm; mass = 79.1 ± 6.8 kg) with 2 or more episodes of unilateral traumatic anterior shoulder instability. MAIN OUTCOME MEASURE(S) Active stiffness and maximal voluntary strength were measured bilaterally in participants. In addition, quality of life, function, and perceived instability were measured using the Western Ontario Stability Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, and Single Alpha Numeric Evaluation, respectively. RESULTS We found less horizontal adduction strength (t(15) = -4.092, P = .001) and less stiffness at 30% (t(14) = -3.796, P = .002) and 50% (t(12) = -2.341, P = .04) maximal voluntary strength in the unstable than stable shoulder. Active stiffness was not correlated with quality of life, function, or perceived instability (r range, 0.0-0.25; P > .05). CONCLUSIONS The observed reduction in stiffness in the unstable shoulder warrants inclusion of exercises in the rehabilitation program to protect the joint from perturbations that might lead to dislocation. The lack of association between active stiffness and quality of life, function, or perceived instability might indicate that stiffness plays a less direct role in shoulder stability.
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Affiliation(s)
- Margie Olds
- Health and Rehabilitation Research Centre, Auckland University of Technology, New Zealand.
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Edouard P, Beguin L, Fayolle-Minon I, Degache F, Farizon F, Calmels P. Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique. Ann Phys Rehabil Med 2010; 53:499-510. [DOI: 10.1016/j.rehab.2010.07.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 07/16/2010] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
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