DESCRIPTIVE PROFILE OF SHOULDER RANGE OF MOTION AND STRENGTH IN YOUTH ATHLETES PARTICIPATING IN OVERHEAD SPORTS

Shoulder pain occurrence in asymptomatic overhead athletes: a prospective cohort study with a 6-month follow-up

PURPOSE

To identify interactions among variables of the upper limbs, trunk, and hip joint associated with shoulder pain occurrence in asymptomatic overhead athletes.

DESIGN

prospective cohort study.

SETTING

Sports club facilities.

PARTICIPANTS

Ninety-five adult asymptomatic overhead athletes from national first division teams, both sexes.

MAIN OUTCOMES MEASURES

Isometric strength of the shoulder ER muscles, serratus anterior, lower trapezius and hip abductors, HipSIT, shoulder internal rotation (IR) range of motion (ROM), low flexion test, closed kinetic chain upper extremity stability test (CKCUEST), seat medicine ball test (SMB-T), upper seat shot put test (USSP-T), upper quarter Y balance test [UQYBT] and leg lateral reach test (LLRT). Shoulder pain occurrence was registered during a 6-month follow-up.

RESULTS

The model correctly classified 77.4 % of the athletes who did not develop shoulder pain and 100.0 % of those who developed shoulder pain. The accuracy was 89 % (95 %CI:83 %,96 %). Athletes with UQYBT score under 88.5 %, and isometric strength of the shoulder ER muscles above 0.780 N/kg did not develop shoulder pain (RR:0.02, 95 %CI:0.001,0.44). Athletes with UQYBT score above 88.5 % and USSP-T performance above 3.175m developed shoulder pain (RR:14.09, 95 %CI: 3.27,60.56).

CONCLUSION

Shoulder pain occurrence in overhead athletes was associated with interactions among UQYBT, isometric strength of the shoulder ER muscles, and USSP-T.

Investigating the validity and reliability of the functional movement screening tool in tennis

BACKGROUND

Recently, researchers use functional movement tests and especially the functional movement screen (FMS) as a screening tool to prevent injuries in sports. However, limited studies are available to strongly support the validity and reliability of the FMS in different sports populations. Therefore, the FMS does not seem to be a comprehensive FMS tool in order to investigate asymmetry and limitations in all sports. Therefore, the aim of the present study was to design and evaluate the validity and reliability of the screening tool for functional movements in tennis.

METHODS

To determine validity and reliability, the results obtained from semi-structured and in-depth interviews with 18 tennis experts were used, which led to the selection of 27 tests out of 108 initial tests. Face validity was evaluated by 10 tennis players, content validity by 10 experts in this field, and construct validity of the questionnaire by 234 tennis players. The reliability of tool was estimated by test-retest method at a time interval of 2 weeks on samples consisting of 20 tennis players using the intraclass correlation coefficient (ICC).

RESULTS

Based on the results obtained from the calculation of the content validity ratio, 21 out of 27 tests had a content validity ratio higher than 0.62 and the rest of the tests were excluded. Exploratory factor analysis (EFA) extracted two latent factors that explained 54.05% of the total variance. Confirmatory factor analysis (CFA) confirmed the final construct model. The reliability of the tool was estimated: 95% CI: 0.53-0.92, p = 0.001, ICC = 0.91.

CONCLUSION

The FMS tool designed for tennis had acceptable validity and reliability with the aim of investigating asymmetry and limitations in this sport. Factor analysis showed that considering the correct features of psychometrics, this tool can be used as a predictor of injury in tennis.

Effects of Asymmetric and Symmetric Sport Load on Upper and Lower Extremity Strength and Balance: A Comparison Between the Dominant and Non-Dominant Side in Adolescent Female Athletes

The aim of this research was to investigate the effects of primarily asymmetrical (soccer and volleyball) and symmetrical sport load (sprint and swimming) in the upper and lower limbs on dynamic balance and muscle strength and to compare these values in the dominant and non-dominant limbs. This study employed a cross-sectional design, included 45 adolescent female athletes from four sports, divided into asymmetric (ASYM, n = 25) and symmetric (SYM, n = 20) groups. They were assessed for maximal voluntary isometric muscle contraction (MVIC) relative muscular strength using a handheld dynamometer (HHD) for shoulder external rotation (ER) and internal rotation (IR), as well as hamstring and quadricep strength. Upper and lower limb balance were also assessed using the Upper (YBT-UQ) and Lower Quarter Y Balance Test (YBT-LQ) tests. The results showed significantly greater balance in the upper extremities of swimmers and in the lower extremities of the sprinters in both the dominant (DS) and non-dominant (NDS) sides than in other groups (p < 0.0001). However, no significant difference in internal and external shoulder rotator muscles strength between the groups (p > 0.05). Although significant differences were found in hamstring strength on the dominant side and quadricep strength on both sides (p < 0.05), a notable finding was that sprint athletes consistently demonstrated stronger quadriceps muscles as compared to other groups in both the dominant and non-dominant sides. According to the current findings, there are significant differences in upper and lower body balance, hamstring, and quadricep muscle strength among sports. This suggests that athletes of asymmetrical sports may need to improve non-dominant side knee strength and balance symmetry to prevent the risk of injury.

Psychometric Properties of the Athletic Shoulder Test in Adolescent Tennis Players

Background/Objectives: The Athletic Shoulder Test (ASH) has been described as one of the most promising upper-extremity tests to assess performance in overhead athletes. Its high reliability rates, short testing period, and applicability in any environment with portable and cheap equipment have been highlighted as some of the advantages of the test. However, it has yet to be evaluated in a non-adult athletic population. Therefore, the aim of this study was to investigate the ASH test's psychometric properties in a sample of young tennis players. Methods: A total of 33 adolescent tennis players were evaluated among two sessions with a week interval. Intra-rater, inter-rater, and test-retest reliability were investigated. Additionally, possible correlations with measures of rotational shoulder strength and upper-extremity performance were examined. Two novice physiotherapists performed all the measurements following appropriate training. Results: The relative reliability scores, as calculated by intraclass correlation coefficient (ICC) indices, were found to be excellent (ICC = 0.924-0.988). Standard error of measurement and minimal detectable change scores have been estimated per position (SEM = 2.74-7.06 N, MDC = 7.55-19.42N). Test-retest reliability provided slightly higher SEM and MDC scores on average (SEM = 3.33-6.47, MDC = 9.32-18.04) than intra-rater and inter-rater reliability. Associations between ASH and the two tests were found to be moderate to strong (r = 0.584-0.856), with the dominant arm providing higher correlation scores (r = 0.605-0.856) than the non-dominant one (r = 0.584-0.823). Absolute values were collected and are provided for all three upper-limb tests; normalized values were calculated for ASH and rotational strength and peak torque only for the ASH measurements. Conclusions: The excellent reliability rates establish the ASH test as a highly recommended testing protocol for adolescent tennis players.

Upper Extremity Musculoskeletal Profiles in Tennis Players: A Systematic Review

CONTEXT

Tennis-specific musculoskeletal (MSK) screening can assess range of motion (ROM) and muscular imbalances. Identifying normative values before implementing a MSK screen is essential in contributing to athlete performance and injury risk profiles.

OBJECTIVE

To review upper extremity MSK data in healthy tennis players across age, sex, and level of play.

DATA SOURCE

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. A search was conducted in MEDLINE, SPORTDiscus, Embase, and CINAHL.

STUDY SELECTION

This review included shoulder, elbow, and wrist ROM, isometric strength, or isokinetic strength in a tennis population. Each article was critically appraised to help identify the internal and external validity of each study.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

A total of 41 studies met the search criteria. Each contributor organized the data elements of interest into data tables, with a second contributor assigned for review. Data elements of interest included player and study characteristics: ROM, isometric dynamometry, and isokinetic strength.

RESULTS

A total of 3174 players were included in the final studies. Most of the players included were competitive adolescents and young adults; 15 studies included ROM data. Male tennis players consistently had more external rotation (ER) gain (range, 1.8º to 8.8º) and internal rotation (IR) loss (range, -15.3º to -3.0º) when compared with their female counterparts (ER range, -2.5º to 5.8º; IR range, -10.4º to -3º). Shoulder IR and ER strength were measured in the majority of all the strength studies, with the external rotators generating at least two-thirds the strength of the internal rotators.

CONCLUSION

Overall MSK data of tennis players indicate that shoulder strength values are often larger than nontennis players, but equal to or slightly lower than comparable athletes in other overhead sports. Adaptive changes of the glenohumeral joint and subsequent rotational motion are similar to those of other overhead athletes.

Trunk and shoulder strength and mobility in young female volleyball and handball athletes

INTRODUCTION

Volleyball and handball have typical overhead throwing motion that can generate adaptations in the athlete's kinetic chain predisposing to injuries and pain. Considering the importance of the trunk and shoulder in overhead throwing motion and the particularities of these action in different sports, this study aimed to compare the trunk and shoulder muscle strength and mobility in young female volleyball and handball athletes.

DESIGN

Cross-sectional study with 70 female volleyball and handball athletes between 13 and 18 years old.

METHODS

Shoulder rotators, trunk extension and flexion with rotation strength was measured with a handheld dynamometer (MicroFET 2, Hoogan Health Industries, West Jordan, UT, USA). Shoulder and trunk range of motion was measured with a digital inclinometer (Acummar - model ACU001). Total range of motion deficit (TROM deficit), glenohumeral internal and external rotation of dominant (DOM) and non-dominant (NDOM) shoulder were also calculated.

RESULTS

Handball athletes presented greater muscle strength of trunk flexors/rotators (DOM: 24.96%, effect size: 0.687; NDOM, 31.83%, effect size: 0.798) and dominant shoulder internal rotators (16.65%, effect size: 0.619). The groups showed no difference for trunk and shoulder range of motion and external rotators strength. A TROM (volleyball: 48%, handball: 35%) and a glenohumeral internal rotation deficit (volleyball: 28%, handball: 29%) was found in both groups.

CONCLUSIONS

Young female handball athletes have greater strength of trunk flexors/rotators and dominant shoulder internal rotators compared to volleyball athletes. These differences may be related to the different demands required in the movement of these sports.

Shoulder range of motion in competitive tennis players: systematic review and meta-analysis

Background

To compare shoulder range of motion (ROM) in dominant vs. nondominant shoulder of competitive tennis players, and to determine whether shoulder ROM is different between younger and older players, or males and females.

Methods

A search was performed on PubMed, Embase, and Epistemonikos on December 18, 2023. This study conforms to the principles of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Clinical studies or case reports on shoulder ROM including external rotation (ER; shoulder at 90° of abduction) and internal rotation (IR) in competitive, elite, or professional tennis players.

Results

We found 25 eligible studies that reported on a total of 18,534 tennis players, of which 20 studies reported the ROM for the dominant and nondominant side. Comparing dominant vs. nondominant shoulders revealed that dominant shoulders had significantly smaller IR (53.0° vs. 62.6°; P < .001). Comparing adults vs. children revealed that adults have significantly smaller IR (44.5° vs. 57.1°; P < .001) and ER (95.3° vs. 110.3°; P < .001). Comparing females vs. males revealed no significant differences in ER (113.4° vs. 104.9°; P = .360) or IR (54.3° vs. 56.4°; P = .710).

Conclusion

IR in shoulders of tennis players is significantly smaller in dominant vs. nondominant sides (53.0° vs. 62.6°, P < .001), and significantly smaller in adults vs. children (44.5° vs. 57.1°, P < .001). These findings could be relevant in the context of physical preparation and training of tennis players, to monitor evolution of IR as a result of their sport and/or as they transition from childhood to adulthood.

Preliminary Insights into the Diagnostic Accuracy of the Modified Arm Care Screen Test for Overhead Athletes: An On-Field Tool for Injury Prevention

BACKGROUND

The Arm Care Screen was developed to detect musculoskeletal limitations that could affect performance or even increase the risk for shoulder injuries in overhead athletes. This study aimed to assess the discriminant validity of the modified Arm Care Screen in overhead athletes.

METHODS

Sixty-two overhead athletes (mean age: 24.5 ± 4.2 years) were recruited. The athletes underwent a comprehensive Arm Care Screen evaluation, including reciprocal shoulder mobility, total body rotation, lower body diagonal reach, and rotary stability assessments. Ten different musculoskeletal measurements were independently measured by two physical therapists.

RESULTS

The modified Arm Care Screen showed moderate to strong associations (phi values ranged from 0.273 to 0.905) with the respective musculoskeletal range of motion and balance measurements. Sensitivity ranged from 81.25% to 88.57%, indicating a high true positive rate, and specificity ranged from 43.75% to 94.44%, indicating a moderate to strong positive rate. Positive and negative likelihood ratios ranged from 1.48 to 15.92 and 0.12 to 0.38, respectively. The positive and negative predictive value ranged from 58.14% to 92% and from 73.68% to 93.18%, respectively. The accuracy of the modified ACS ranged from 62.90% to 91.94%.

CONCLUSION

The modified Arm Care Screen demonstrated promising diagnostic accuracy in identifying significant movement restrictions.

Functional and morphological changes in shoulder girdle muscles after repeated climbing exercise

This study aimed to investigate the acute effect of repeated climbing actions on functional and morphological measures of the shoulder girdle. Fifteen male indoor climbers participated in this study. All the climbers declared route level 6a+, as the best climbing grade (French climbing grade scale). Functional (range of motion - ROM and muscle strength), and morphological measurements (muscle/tendon stiffness and thickness) after a repeated climbing exercise protocol were analysed. The ROM and muscle strength showed significant decreases from baseline to Immediate-Post (IA) as well as significant increases from IA to 1 h-Post for all movements (p ≤ .001 for all). Muscle stiffness showed significant increases from baseline to IA after as well as significant decreases from IA to 1 h-Post for all muscles (p ≤ .001 for all). However, the thickness showed significant increases from baseline to IA for supraspinatus tendon and muscle thickness and occupation ratio (p ≤ .001 for all), while a significant decrease was observed in acromiohumeral distance (p ≤ .001). Significant decreases from IA to 1 h-Post were found for muscles/tendons and occupation ratio (p ≤ .001 for all), while a significant increase for AHD (p ≤ .001). Our data demonstrated acute alterations in tendon thickness due to acute signs of implement symptom in climbers.

Caregiver Awareness of Safe Pitching Recommendations in Youth Fastpitch Softball Pitchers

Background

Although fastpitch softball participation continues to rise, there is a lack of established pitch count guidelines, potentially putting young female athletes at risk of overuse injuries. In addition to coaches, caregivers' ability to recognize and employ safe pitching guidelines plays an important role in athlete safety.

Purpose/Hypothesis

The purpose of this study was to assess caregivers' knowledge of their child's pitching practices and their familiarity with softball pitching recommendations. We hypothesized that caregivers would be unaware of safe pitching recommendations in youth fastpitch softball.

Study Design

Cross-sectional study.

Methods

A 30-question survey was distributed to caregivers of youth fastpitch softball pitchers in age groups 10U (ie, ≤10 years), 12U, 14U, 16U, and 18U. The survey included questions on the demographic characteristics of caregivers and athletes, caregivers' knowledge of safe pitching recommendations, and athletes' pitching background and throwing habits. Comparisons of responses between the age groups were conducted using the chi-square test, Fisher exact test, or 1-way analysis of variance, as appropriate.

Results

A total of 115 caregivers completed the survey. Of the respondents, 84% were between 31 and 50 years, and 81.7% had a degree beyond high school. Only 28.1% of caregivers reported participating in youth sports. When asked to estimate the number of pitches they considered a safe amount during a single outing, 28.7% of caregivers (n = 33) did not provide a limit, 4.3% (n = 5) stated no limit was needed, 32.2% (n = 37) suggested 25 to 80 pitches, 21.7% (n = 25) suggested 81 to 100 pitches, 12.2% (n = 14) suggested 100 to 150 pitches, and 0.9% (n = 1) suggested that >150 pitches were acceptable. These data emphasized that only 14.8% of the caregivers were aware of any pitching guidelines. However, 93% of caregivers acknowledged that they would adhere to recommendations if guidelines were made available.

Conclusion

The study findings demonstrated that a majority of caregivers are unaware of current youth fastpitch softball pitching recommendations.

Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome

PURPOSE

To analyze the shoulder alterations of professional tennis players during the competition season and to compare the differences between their dominant vs. non-dominant shoulders, as well as gender and age differences.

METHODS

Two-hundred and seventy shoulders of (78 men and 57 women) professional active tennis players were assessed during 3 ATP and WTA tournaments.

MAIN VARIABLES STUDIED

long head of biceps (LHB) tenderness and synovitis; glenohumeral internal rotation deficit (GIRD), total range of motion (TRM), external rotation (ER) and scapular dyskinesis (DK). Secondary variables: shoulder dominance, gender, age, training hours, ranking, type of backhand. LHB tenderness and synovitis were assessed by clinical and ultrasound examination, TRM with goniometer and DK by dynamic observation.

RESULTS

LHB tenderness of the dominant shoulder was present in 35% of all players, being more prevalent in women (47.4%) than men (26.9%) p = 0.023. LHB synovitis of the dominant shoulder was present in 20.2% of all players without difference between genders (n.s). High prevalence of GIRD was found in both dominant (87.4%) and non-dominant (56.3%) shoulders, being more prevalent in the dominant shoulder p = 0.00005. TRM was decreased in both dominant (144.5° ± 20.2°) and non-dominant shoulders (161.2° ± 18.9°) p = 0.00005. ER was normal in dominant (93.8° + /9.3°) and non-dominant shoulders (93.4° + /8.4°) (n.s). DK was present in 57.7% of dominant and 45.9% of non-dominant shoulders (n.s). The combination of LHB alterations, GIRD and DK in the dominant shoulder was present in 13.3% of the participants. There were no significant differences between younger (< 22 years) vs older players (≥ 22 years).

CONCLUSION

Professional tennis players actively playing suffer a high prevalence of LHB inflammation, GIRD, scapular dyskinesis and decreased TRM in their dominant and non-dominant shoulders. The LHB is a significant cause for anterior shoulder pain in this population. Women suffer more LHB tenderness than men. Young players are as affected as older players.

LEVEL OF EVIDENCE

Level IV.

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

Flexibility, Position, and Strength of the Shoulder Complex in Pediatric and Adult Amateur Tennis Athletes

CONTEXT

Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes "at risk" according to cutoff values for shoulder range of motion (ROM) were also analyzed.

DESIGN

Cross-sectional study.

METHODS

36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides.

RESULTS

Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P < .01) and decreased PMI (P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were "at risk" of shoulder problems.

CONCLUSION

Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.