Effects of joint position on the distraction distance during grade III glenohumeral joint distraction in healthy individuals

Effect of Scapular Fixation on Lateral Movement and Scapular Rotation during Glenohumeral Lateral Distraction Mobilisation

BACKGROUND

Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation.

METHODS

Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation.

RESULTS

The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application.

CONCLUSIONS

Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.

Quantification of joint space width with different grades of manual traction in patients with adhesive capsulitis-A fluoroscopic study

Adhesive capsulitis causes adaptive shortening of the non-contractile structures around the shoulder joint which may affect the distraction distance or joint space width (JSW) between the glenoid and humeral head. Joint traction is a commonly used manual therapy technique to reduce pain and gain range of motion in patients with adhesive capsulitis. However, changes in JSW with manual traction are not objectively assessed. This study aimed to find differences in shoulder JSW with different grades of traction and made comparisons between the affected and the unaffected side using 2D fluoroscopy. Forty-one subjects (24 males, 17 females; age 53.9±7.9 years) diagnosed with adhesive capsulitis with low to moderate joint irritability were included. Their mean duration of symptoms was 5.25±1.7 months. True anteroposterior view images of the shoulder were taken with the patient in a supine position with their arms held at 75° of abduction. Images of the affected and unaffected side were taken while no traction, grade 2 and grade 3 manual traction were applied. The JSW was determined as the linear distance between the articular surfaces. Repeated measures ANOVA with post hoc testing was used for analysing differences across the sides (affected and unaffected side) and conditions (No, grade 2 and grade 3 traction). There was no significant interaction between conditions and sides (P=0.99). Averaged across sides, the JSW with grade 2 or 3 traction was 0.18 and 0.23 mm more than the no traction condition (P=0.013 and P=0.001, respectively). There were no differences in the JSW with grade 2 or 3 traction. Averaged across the conditions, the JSW on the unaffected side was 0.21 mm more than the affected side (P=0.03). The study demonstrates that adhesive capsulitis causes a reduction in JSW at 75° abducted position and grade 2 or 3 manual traction can significantly increase this JSW.

Clinical Trial Registry India: CTRI/2018/12/016657.

The Effect of Scapular Fixation on Scapular and Humeral Head Movements during Glenohumeral Axial Distraction Mobilization

Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05−0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force.

In vivo measurements of glenohumeral distraction technique performed in three different joint positions

Introduction: Distraction techniques are an important part of the manual approach in the glenohumeral joint; however, there is controversy regarding the initial joint position to maximize separation of joint surfaces.Objective: To identify, through an in vivo exploration, the behavior of the coracohumeral distance (CHD) during the application of a short lever arm grade III distraction technique on the humeral head, executed in three different glenohumeral positions (zero position (P0), rest position (RP) and 90º abduction position with maximum external rotation (ABD+ER)).Methods: 15 participants were selected. A physical therapist executed grade III distraction techniques in described joint positions. Ultrasound was used to visualize the differences in CHD. Statistical analysis included interclass correlation coefficients (ICC) and repeated measurements of ANOVA.Results: The range of ICC values was 0.740 and 0.948. The differences in CHD were 5.74 ± 0.51 mm, 3.97 ± 0.24 mm, and 0.64 ± 0.02 mm, for P0, RP and ABD+ER during application of distraction technique, respectively. There were differences between P0 and RP with ABD+ER (P < 0.001), and no differences between P0 and RP.Conclusion: Initial joint position of application influences the separation of the articular surfaces, being wider in the zero and rest positions.