Translation, cross-cultural adaptation, and validation of the Turkish version of the shoulder instability-return to sport (SI-RSI) after injury scale

To translate and culturally adapt the shoulder instability-return to sport after injury (SI-RSI) scale into Turkish (SI-RSI-Tr) and examine the psychometric properties of the Turkish version of athletes following a traumatic shoulder instability. The SI-RSI was translated into Turkish using Beaton guidelines. Sixty-nine patients with shoulder instability completed the translated SI-RSI, Western Ontario Shoulder Instability Index (WOSI), the Tampa Scale of Kinesiophobia (TSK), and the Walch-Duplay Scores. We analysed the internal consistency, agreement, reliability, and validity of the SI-RSI-Tr. The SI-RSI-Tr demonstrated excellent internal consistency (Cronbach's alpha = 0.92), test-retest reliability (ICC = 0.95), and feasibility with no ceiling or floor effect. SI-RSI-Tr correlated with WOSI total score (r = -0.824, p < 0.001), its subscales: WOSI-physical (r = -0.683, p < 0.001), WOSI-sports (r = -0.832, p < 0.001), WOSI-lifestyle (r = -0.739, p < 0.001), and WOSI-emotions (r = -0.734, p < 0.001) respectively), Walch-Duplay (r = 0.840, p < 0.001) and TSK (r = -0.828, p < 0.001) scores. The Turkish SI-RSI is a reliable, internally consistent, and valid tool for athletes with shoulder instability. Researchers and clinicians could safely use the SIRSI-Tr to evaluate the shoulder-specific psychological factors on return to sports following an episode of shoulder instability.

Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial

HYPOTHESIS

This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery.

METHODS

Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses.

RESULTS

At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery.

CONCLUSIONS

CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.

Blood Flow Restriction Training in Patients With Rotator Cuff Tendinopathy: A Randomized, Assessor-Blinded, Controlled Trial

OBJECTIVES

To investigate the effects of low-load blood flow restriction (BFR) training on shoulder muscle thickness, rotator cuff (RC) strength, and shoulder symptoms in patients with RC tendinopathy.

DESIGN

A randomized, assessor-blinded, controlled trial.

SETTINGS

Physiotherapy clinic at a university.

PARTICIPANTS

Twenty-eight patients were randomized into an 8-week (2 times/week) shoulder rehabilitation, that is, BFR or non-BFR group.

INTERVENTIONS

BFR training.

MAIN OUTCOME MEASURES

(1) RC, deltoid, scapula retractor, and biceps muscle thicknesses and shoulder internal rotation (IR) and external rotation (ER) strengths. (2) Shoulder pain/function.

RESULTS

The BFR group had a greater increase in biceps muscle thickness ( P = 0.002) and shoulder IR strength at 60 degrees/s ( P = 0.040) than the non-BFR group. No differences between the 2 groups were observed in other measurements. Significant improvements in supraspinatus, infraspinatus, and scapula retractor muscle thicknesses and in shoulder ER and IR strengths were observed over time in both the groups (all P < 0 .05). Also, shoulder pain decreased and shoulder function increased over time in both the groups (all P < 0 .05).

CONCLUSIONS

Low-load BFR training resulted in a greater increase in biceps thickness and shoulder IR strength compared with the non-BFR group in patients with RC tendinopathy. However, there was no superiority of either exercise training regarding the RC, scapula retractor, deltoid muscle thicknesses, or improvements in shoulder ER strength and shoulder pain/function.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

The study was registered in ClinicalTrials.gov named Blood Flow Restriction Training in Patients with Shoulder Pain and the registration number is NCT04333784.

Utilizing Scapula Retraction Exercises With or Without Glenohumeral Rotational Exercises With a Gradual Progression for Subacromial Pain Syndrome

BACKGROUND

Although exercise interventions are recommended in the management of subacromial pain syndrome (SPS), there is a lack of data regarding the exercises focusing on the principal biomechanical deficiencies that cause symptoms.

HYPOTHESIS

Utilizing progressive scapula retraction exercises (SRE) and glenohumeral rotation exercises (GRE) in the scapula stabilization program may lead to more reduction in symptoms and greater acromiohumeral distance (AHD) values.

STUDY DESIGN

A double-blind, randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 33 patients were assigned randomly to either SRE or SRE+GRE. Both groups received a 12-week supervised rehabilitation program, including manual therapy and exercises (stretching and progressive scapula stabilization exercises). In addition, the SRE+GRE group performed GRE exercises at gradual elevation angles. From 12 to 24 weeks, patients performed exercise programs less frequently (3 times per week). Disability (shoulder pain and disability index [SPADI]), AHD (at 5 active abduction angles), pain intensity (visual analogue scale [VAS]), and patient satisfaction were recorded at baseline, 12 weeks, and 24 weeks. A total of 16 healthy individuals were recruited as a control group to compare AHD values. Data were analyzed using mixed model analyses of variance.

RESULTS

A statistically significant group-by-time interaction was found for AHD values (F4,92 = 6.38; P = 0.001), a significant group-by-time interaction for SPADI-disability (F1,33 = 5.148; P = 0.01), SPADI-total (F1,32 = 4.172; P = 0.03), and for pain during activity (F2,62 = 3.204; P = 0.05). However, no significant group-by-time interaction for SPADI-pain (F1,33 = 0.533; P = 0.48), for pain at rest (F1,31 < 0.001; P = 0.99), and at night (F1,32 = 2.166; P = 0.15). Yet, a significant time effect was observed.

CONCLUSION

Progressive SRE and GRE in the scapula stabilization program lessens symptoms and improves AHD values in patients with SPS. Moreover, this program could preserve outcomes and further increase AHD when applied less frequently.

CLINICAL RELEVANCE

Utilizing SRE and GRE in the scapula stabilization program at gradual shoulder abduction angles provides better rehabilitation outcomes.

Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery

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.

Positioning efficacy and comfort profile of shoulder support braces: A randomized repeated-measures study using three-dimensional kinematic analysis

BACKGROUND

Shoulder bracing is very common in musculoskeletal rehabilitation.

OBJECTIVE

In this study, the positioning efficacy of shoulder support braces was investigated by analyzing their three-dimensional kinematic properties, as well as their perceived comfort was investigated with user ratings.

STUDY DESIGN

A randomized repeated-measures study.

METHODS

Seventeen asymptomatic participants were included. Scapular, humeral, and thoracic kinematics for all participants were measured using an electromagnetic tracking device in 6 experiments in randomized order: no brace, neutral brace, abduction brace, internal rotation brace, 15-degree external rotation brace (ER15-B), and 30-degree external rotation brace (ER30-B). Also, comfort ratings were obtained during each session.

RESULTS

Internal rotation brace achieved a mean of 29.34° of humerothoracic internal rotation while providing increased scapular internal rotation and upward rotation ( p < 0.05). Abduction brace achieved a mean of 45.39° of humerothoracic and 39.58° of glenohumeral elevation coupled with increased scapular upward rotation, posterior tilt, and humeral internal rotation ( p < 0.05). 30-Degree external rotation brace achieved a mean of 33.25° of glenohumeral external rotation and resulted in increased scapular external rotation, upward rotation, posterior tilt, and humeral external rotation ( p < 0.05). Abduction brace, internal rotation brace, ER15-B, and ER30-B moved the thoracic spine into a more axial rotation in the contralateral direction. Internal rotation brace, ER15-B, and ER30-B were rated more uncomfortable when compared with the no brace condition, with no significant differences observed among the braces.

CONCLUSIONS

The positioning efficacy was enhanced when an abduction pillow and external rotation wedge were applied. Selection of commercially available shoulder support braces should involve consideration of whether it can achieve the desired position and orientation as well as its comfort profile.

Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Recovery of the shoulder kinematics after reverse shoulder arthroplasty

BACKGROUND

There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure.

METHODS

Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months.

FINDINGS

Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05).

INTERPRETATION

Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.

Shoulder-Abduction Angle and Trapezius Muscle Activity During Scapular-Retraction Exercise

CONTEXT

Scapular-retraction exercises are often prescribed to enhance scapular stabilization.

OBJECTIVE

To investigate upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) activities and UT/MT and UT/LT ratios during scapular-retraction exercises with elastic resistance at different shoulder-abduction angles.

DESIGN

Descriptive laboratory study.

SETTING

Biomechanical analysis laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-five asymptomatic individuals.

MAIN OUTCOME MEASURE(S)

Surface electromyography was used to evaluate UT, MT, and LT activities during the scapular-retraction exercise at 0°, 45°, 90°, and 120° of shoulder abduction.

RESULTS

The mean muscle activity ranged from 15.8% to 54.7% maximal voluntary isometric contraction (MVIC) for UT, 30.5% to 51.6% MVIC for MT, and 21.4% to 25.5% MVIC for LT. A significant muscle × angle interaction was found (P < .001). Post hoc analysis revealed that the MT was more activated than the UT and LT during both retraction at 0° (P < .001 and P = .01, respectively) and 120° (P = .03 and P = .002, respectively). During retraction at 45° and 90°, the LT generated less activity than the UT (P = .02 and P = .03, respectively) and MT (P < .001 and P = .002, respectively). Further, UT/MT and UT/LT ratios during retraction at 0° were lower than at 45° (P = .03 and P = .001, respectively) and 90° (P < .001 and P < .001, respectively). Retraction at 90° resulted in a higher UT/LT ratio than at 45° (P = .004) and 120° (P = .004).

CONCLUSIONS

Due to less UT relative to MT activity, retraction at 0°, 45°, and 120° can be preferable in early shoulder training or rehabilitation. Additionally, retraction at 90° was the most effective exercise in activating all parts of the trapezius muscle.

Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review

STUDY DESIGN

This is a systematic review.

INTRODUCTION

Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear.

PURPOSE OF THE STUDY

The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics.

METHOD

MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment.

RESULTS

Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles.

DISCUSSION

Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial.

CONCLUSION

The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.

The Dynamic Innovative Balance System Improves Balance Ability: A Single Blind, Randomized Controlled Study

BACKGROUND

Functional balance training is crucial for both rehabilitation and prevention. A Dynamic Innovative Balance System (DIBA) is readily available for utilization in both functional and postural control training in a wide variety of dynamic conditions.

PURPOSE

The purpose of this study was to compare the effectiveness of the DIBA and standard balance training tools on dynamic and static balance.

STUDY DESIGN

Randomized controlled trial.

METHODS

Thirty-six healthy males (18 to 32 years) were randomly assigned to group DIBA (n=18) or to the control group (n=18) who performed balance training using a balance board, a wobble board, the BOSU, or a soft cushion block for eight weeks. Each participant was assessed before training, at the end of the fourth and eighth week by using the Flamingo balance test (FBT) for assessing static balance ability and using Y-Balance Test (YBT) for dynamic balance ability.

RESULTS

No significant differences were found in FBT and YBT between the DIBA and control groups at the end of fourth week (p>0.05). However, at the end of the eighth week, the DIBA group demonstrated statistically significantly better balance ability on the anterior component of YBT (p=0.001) and FBT (p=0.024) than controls.

CONCLUSION

The results of this study suggest that the DIBA was effective in both static and dynamic balance training and it may be used alongside other balance tools in a clinical setting. Further studies should include in lower extremity problems to confirm that DIBA training adaptations are transferred to clinical improvements in performance and balance qualities.

LEVEL OF EVIDENCE

2d.

The repeatability of 3-dimensional scapular kinematic analysis during bilateral upper extremity movements

Although three-dimensional electromagnetic systems are widely used to evaluate the 3-dimensional scapular kinematics their reliability when testing bilateral upper extremity tasks is unknown. The purpose of this study was to investigate the repeatability of the scapular kinematic analyses using the Flock of Birds (FOB) system during bilateral upper extremity movements. Twenty-one volunteers without shoulder problems were included (aged 24.8 years; body mass index averaged 21.2 kg/m²) to the study. Scapular internal-external rotation, upward-downward rotation, and anterior-posterior tilt was recorded during bilateral arm elevation on sagittal, scapular and frontal planes. Measurements were repeated at 5-7 days intervals. Intra-session and inter-session repeatability were determined using intraclass correlation coefficients (ICC) scores and standard errors of measurements (SEM). The ICC scores were found to be 0.81 to 0.99 for intra-session measurements and 0.60 to 0.83 for inter-session measurements. The SEM scores were 0.8°-3.4° and 2°-7.2° for the intra and inter-session measurements respectively. The repeatability of the FOB system was excellent for the intra-session measurements, but it was weaker for the inter-session measurements. These results support the use of the FOB system for assessing scapular orientation but the analyses should be conducted more carefully when it is applied to the longitudinal measurements.

Effect of Plyometric Training on Sport Performance in Adolescent Overhead Athletes: A Systematic Review

CONTEXT

Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited.

OBJECTIVE

To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance.

DATA SOURCES

Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies.

STUDY SELECTION

A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria.

RESULTS

A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance.

CONCLUSION

The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.

Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain

BACKGROUND

Although it is thought that there is a relationship between neck pain and scapular dysfunction, there are controversial results and no clear information in the literature regarding this issue. This study aimed to investigate the alterations in the 3-Dimensional scapular orientation on patients with non-specific neck pain.

METHOD

Thirty-four patients with chronic non-specific neck pain [age, 29.1 (5) years; height, 165.3 (6.1) centimeters; weight, 62.1 (9.6) kilogram] and 29 healthy controls [age, 28.2 (3.3) years; height, 166.8 (8.1) centimeters; weight, 60.9 (8.5) kilogram] were included in the study. 3-Dimensional scapular kinematics were obtained during arm elevation and lowering trials in the sagittal, scapular, and frontal planes.

FINDINGS

Compared to healthy controls, the patients with neck pain demonstrated significantly reduced upward scapular rotation on both the dominant and non-dominant sides in all three planes. Patients with neck pain had increased internal rotation in the sagittal and frontal planes on the dominant side and increased external rotation in the frontal plane on the non-dominant side. No difference was observed between groups considering posterior scapular tilt.

INTERPRETATION

There are alterations in the 3-Dimensional scapular orientations in patients with chronic non-specific neck pain compared to healthy controls. Therefore, the scapular control may also be examined in patients with neck pain and it can be included in the rehabilitation program if needed.

Trapezius muscle activation levels and ratios during scapular retraction exercises: A comparative study between patients with subacromial impingement syndrome and healthy controls

BACKGROUND

Little is known about trapezius muscle activities during scapular retraction exercises in patients with subacromial impingement syndrome. The aim of this study was to compare upper trapezius, middle trapezius and lower trapezius muscle activity and upper/middle and upper/lower trapezius ratios between patients with subacromial impingement syndrome and healthy individuals during six scapular retraction exercises.

METHODS

Twenty-two patients with subacromial impingement syndrome and 22 healthy individuals participated. Upper, middle, and lower trapezius activities were measured by surface electromyography, while the participants performed six scapular retraction exercises at different shoulder abduction angles in a standing position. Upper/middle and upper/lower trapezius ratios were also calculated. Repeated-measures analyses of variance were performed to determine whether muscle activation levels and ratios differed between groups during exercises.

FINDINGS

There was no significant exercise × group interactions for upper, middle, and lower trapezius activation levels and upper/middle and upper/lower trapezius ratios (P > .05). A main effect for the exercise was observed for the upper/middle and upper/lower trapezius ratios (P < .05).

INTERPRETATION

Compared to healthy individuals, patients with subacromial impingement syndrome did not exhibit different upper, middle, and lower trapezius activity and had similar upper/middle and upper/lower trapezius ratios during the various scapular retraction exercises. Therefore, scapular retraction exercises with various shoulder abduction could be safely offered for the patients with subacromial impingement syndrome since it does not lead to abnormal compensatory trapezius muscle activity. If the goal is to minimize upper/middle and upper/lower trapezius ratios, the scapular retraction exercises at 0° shoulder abduction may be used in early stage of shoulder rehabilitation.

A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping

BACKGROUND

The aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping.

METHODS

Twenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models.

RESULTS

The scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition.

CONCLUSIONS

Operated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.

Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?

OBJECTIVES

This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements.

METHODS

This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization.

RESULTS

Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05).

CONCLUSIONS

Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.

Low back pain prevalence in healthcare professionals and identification of factors affecting low back pain

BACKGROUND

Work-related musculoskeletal system diseases are commonly observed among nurses, physiotherapists, dentists, and dieticians.

OBJECTIVE

To assess working postures of nurses, physiotherapists, dentists and dieticians, to identify whether low back pain (LBP) is present, and to put forth the correlation between LBP, working posture, and other factors.

METHODS

Twenty seven physiotherapists, 34 nurses, 30 dentists, and 16 dieticians were included. Impairment ratings of cases with LBP were analysed with Quebec Back Pain Disability Scale (Quebec). Working postures were analysed with Owako Working Posture Analysis System.

RESULTS

LBP was observed in 70.09% of healthcare professionals. Of the individuals suffering from LBP, 57.2% were working with a risky posture. 40.63% of individuals without LBP were using risky working postures. Trunk and head posture distribution of individuals with and without LBP was found as different from each other (p < 0.05). LBP prevalence of dentists and nurses were higher compared to other groups (p < 0.05). Quebec scores of professionals with LBP were not different among occupations (p > 0.05). Quebec scores were observed as correlated with various factors in various occupation groups.

CONCLUSIONS

Considering that head-neck and trunk postures are changeable factors that are among the factors affecting LBP, correcting the working posture gains importance.

Shoulder kinematics and mobility adaptations in water-polo players

BACKGROUND

There is limited research to demonstrate how scapular kinematics and shoulder-related physical characteristics are affected in water-polo players, who undertake swimming and repetitive throwing activity. The aim of this study was to investigate possible adaptations in the three-dimensional scapular kinematics and in glenohumeral internal rotation, external rotation range of motion and shoulder posterior-capsule tightness in water-polo players.

METHODS

Fourteen water-polo players and 14 asymptomatic volunteers participated in the study. The scapular kinematics were recorded using an electromagnetic tracking device during the scapular plane shoulder elevation. Additionally, shoulder range of motion and posterior-capsule tightness were evaluated. Analysis of variance models were used to make comparisons between groups.

RESULTS

Although there was a trend toward increased scapular internal rotation and downward rotation in the throwing shoulders of water-polo players, comparisons revealed there was no significant differences in kinematics, shoulder internal-external range of motion and posterior-capsule tightness between the throwing shoulders of the players and dominant shoulders of the control participants.

CONCLUSIONS

The throwing shoulders of water-polo players did not demonstrate alterations in shoulder kinematics and mobility parameters.

The presence and influence of posterior capsule tightness on different shoulder problems

BACKGROUND

In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies.

OBJECTIVE

This study set about to compare the role of posterior capsule tightness in different shoulder problems.

METHODS

One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb.

RESULTS

It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05).

CONCLUSIONS

This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.

Scapular asymmetry in participants with and without shoulder impingement syndrome; a three-dimensional motion analysis

BACKGROUND

This study analyzed the dynamic three-dimensional scapular kinematics and scapular asymmetry in participants with and without shoulder impingement syndrome.

METHODS

Twenty-nine participants with shoulder impingement syndrome, have been suffering from unilateral shoulder pain at the dominant arm lasting more than six weeks and thirty-seven healthy controls participated in the study. Scapular kinematics was measured with an electromagnetic tracking device during shoulder elevation in the sagittal plane. Data for bilateral scapular orientation were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. The symmetry angle was calculated to quantify scapular asymmetry throughout shoulder elevation.

FINDINGS

Statistical comparisons indicated that the scapula was more downwardly rotated (p<0.001) and anteriorly tilted (p=0.005) in participants with shoulder impingement syndrome compared to healthy controls. Side-to-side comparisons revealed that the scapula was more anteriorly tilted on the involved side of participants with shoulder impingement syndrome (p=0.01), and the scapula was rotated more internally (p=0.02) and downwardly (p=0.01) on the dominant side of healthy controls. Although there were side-to-side differences in both groups, symmetry angle calculation revealed that the scapular movement was more asymmetrical for scapular internal and upward rotation in individuals with shoulder impingement syndrome when compared with healthy controls (p<0.05).

INTERPRETATION

The findings of the study increase our knowledge and understanding of scapular alterations in symptomatic and asymptomatic populations, which creates biomechanical considerations for shoulder assessment and rehabilitation.

Effect of trapezius muscle strength on three-dimensional scapular kinematics

[Purpose] This study aimed to investigate the effect of trapezius muscle isometric strength on three-dimensional scapular kinematics in asymptomatic shoulders. [Subjects and Methods] Thirty asymptomatic subjects were included to the study. Isometric strengths of the upper, middle, and lower trapezius muscle were measured using a handheld dynamometer. Three-dimensional scapular kinematics was recorded by an electromagnetic tracking device during frontal and sagittal plane elevation. For each muscle, the cut-off value for muscle strength was determined with the upper bound of the 95% confidence interval, and Student's t-test was used to compare the scapular kinematics between subjects with relatively weaker or stronger trapezius muscles. [Results] Shoulders with stronger upper trapezius muscles showed greater upward scapular rotation at 30°, 60°, 90°, and 120° of elevation in the frontal plane. Shoulders with stronger middle trapezius had greater scapular upward rotation at 90° of elevation in the frontal plane. Shoulders with stronger lower trapezius showed greater scapular posterior tilt at 90° of elevation in the sagittal plane. [Conclusion] This study's findings showed that isometric strength of the trapezius muscle affects upward scapular rotation and posterior tilt in asymptomatic shoulders. Therefore, trapezius muscle strength should be assessed and potential weakness should be addressed in shoulder rehabilitation programs.

Three-dimensional scapular kinematics during open and closed kinetic chain movements in asymptomatic and symptomatic subjects

The combination of open kinetic chain (OKC) and closed kinetic chain (CKC) exercises is commonly recommended in shoulder rehabilitation, aiming at improving strength and sport-specific performance. This study aimed to investigate the three-dimensional (3-D) scapular kinematics and bilateral symmetry of scapular motion during dynamic OKC and CKC movements in asymptomatic and symptomatic shoulders. Fifty subjects with unilateral shoulder pain (symptomatic subjects diagnosed with subacromial impingement syndrome, n=20) or without shoulder pain during active shoulder elevation (asymptomatic subjects, n=30) participated in the study. Furthermore, 3-D scapular kinematics were recorded using an electromagnetic tracking device in the sagittal plane of shoulder elevation for both the OKC and CKC conditions performed with slings. Data for scapular kinematics and symmetry angle (SA) were analyzed at 30°, 45°, 60°, 90°, and 120° of humerothoracic elevation. Analysis of variance models and Student׳s t-test were used to make comparisons between conditions. In general, the scapula was more externally rotated, upwardly rotated and anteriorly tilted for asymptomatic shoulders, and more upwardly rotated for symptomatic shoulders during CKC shoulder elevation. Further, comparisons of SA obtained during OKC and CKC movements revealed that during CKC, scapular motion was more symmetrical for upward-downward rotation and anterior-posterior tilt in asymptomatic shoulders and for anterior-posterior tilt in symptomatic shoulders, especially above 90° humerothoracic elevation. Differences in scapular motion during the CKC condition were in a specific pattern and enhanced symmetry, which would be considered to be a position less likely to produce compression of the rotator cuff tendons for both training in asymptomatic populations and for treatment in early rehabilitation of patients, such as those who have shoulder impingement syndrome.

Differences in strength, flexibility and stability in freestyle and Greco-Roman wrestlers

BACKGROUND AND OBJECTIVES

Wrestling includes a variety of functional properties: muscular strength, flexibility, neuromuscular coordination, and static and dynamic balance. The aim of the study was to identify differences in the strength, flexibility, postural stability and core stabilization of young national and international wrestlers in different weight groups.

MATERIAL AND METHOD

Eighty-one male wrestlers (17-21 years old) were divided into 6 groups according to their body mass (light, middle and heavy) and wrestling style. The lumbosacral flexion, extension and lateral flexion range of motion, hamstring extensibility, back and leg muscle strength, postural stability, and core stabilization were assessed.

RESULTS

Greco-Roman wrestlers had a higher lean body mass (6-12%) compared with freestyle wrestlers. However, the trunk lateral flexion flexibility was better in the Greco-Roman wrestlers (6-7%) than in the freestyle wrestlers, and the absolute back strength (BS) and leg strength (LS) were similar for both styles of wrestling. The BS/LBM and LS/LBM in the freestyle wrestlers were greater than in the Greco-Roman wrestlers, and the Light weight Greco-Roman wrestlers had the highest BS/LBM. The heavy weight Greco-Roman wrestlers and the light weight freestyle wrestlers had the greatest LS/LBM values. The postural control was similar for the two styles of wrestlers; however, the heavy weight Greco-Roman wrestlers had greater postural control in all directions compared with the light and middle weight Greco-Roman wrestlers. The core stabilization did not differ for the Greco-Roman and freestyle wrestlers except in the lateral bridge.

CONCLUSION

The style of wrestling demonstrates different strength, flexibility and stability demands on the body. The differences between Greco-Roman and freestyle wrestlers may be due to the wrestling style differences in training and to competition-related demands.

LEVEL OF EVIDENCE

Comparative study, level lV (case series).

Turkish version of the Rotator Cuff Quality of Life questionnaire in rotator cuff-impaired patients

PURPOSE

To date, the "Rotator Cuff Quality of Life" (RC-QOL) measure has not been translated into Turkish. The aim of this study was to perform a cross-cultural adaptation of the questionnaire and determine the reliability and reproducibility of the "Turkish version of the RC-QOL" (Tur-RC-QOL) questionnaire on Turkish-speaking patients.

METHODS

The translation followed an established forward-and-backward translation procedure. Thirty Turkish-speaking, rotator cuff-impaired patients were enrolled in the study. The validity of the Tur-RC-QOL was assessed and compared with the "Shoulder Pain and Disability Index" (SPADI) and the "Western Ontario Rotator Cuff Index" (WORC) using Pearson's correlation coefficients. A test-retest interval of 2 days was used to assess the reliability. Internal consistency was tested by Cronbach's alpha, relative reliability with "intraclass correlation coefficient" (ICC), and absolute reliability using the formula for the "standard error of measurement" (SEM).

RESULTS

The Cronbach's alpha scores were high for the total scores and subheadings of the Tur-RC-QOL, in the range of 0.83-0.98. Excellent test-retest reliability scores were found for the total score and for all parts of the Tur-RC-QOL, with the exception of "Part E". The ICC score for Part E was relatively lower than other parts (ICC = 0.71), and the SEM score was relatively higher (17.92 %). The Pearson correlation coefficients for the Tur-RC-QOL were high for SPADI (r = 0.90, p < 0.001) and WORC (r = 0.85, p < 0.001).

CONCLUSIONS

This study demonstrates that the Tur-RC-QOL is a reliable and valid instrument to assess the quality of life of rotator cuff-impaired patients.

LEVEL OF EVIDENCE

III.

Malpractice leading to secondary lymphedema after radical mastectomy: case report

BACKGROUND

With this case report we want to demonstrate the results of chemotherapy application to the mastectomized side in a patient who had undergone radical mastectomy.

CASE REPORT

A patient who was accidentally given chemotherapy on the mastectomized side (PCMS) and a control patient who received chemotherapy on the non-affected side (PCNS) were included in this study. Edema, pain, muscle strength, and shoulder mobility were evaluated. The results of the 2 patients were compared. After chemotherapy, PCMS experienced edema and pain in the affected arm compared to PCNS. Increased circumference measurement, and decreased shoulder mobility and muscle strength were observed in PCMS.

CONCLUSION

It was suggested that chemotherapy application on the mastectomized side triggered lymphedema. Our findings on the subject revealed that education of health care professionals and patients alike is very important.

Is There any Difference in Health Related Quality of Life, Self Care and Social Function in Children with Different Disabilities Living in Turkey?

OBJECTIVE

The aim of this study was to examine the differences in the health related quality of life and the self care and social function in daily life of children with different disabilities.

METHODS

One hundred and two children with physical, emotional and cognitive disabilities (cerebral palsy, mental retardation, and hearing loss) and 28 children age matched as a control group were included in this study for the comparison. The Pediatric Evaluation of Disability Inventory (PEDI) was used to evaluate the independence and participation of children in daily life activities. The Turkish version of the Child Health Questionnaire-Parent form (CHQ - PF50) was used to evaluate the health related quality of life.

FINDINGS

All 3 groups were different from the control group in terms of self-care and the social domains according to the PEDI results (P<0.05). Children with cerebral palsy (CP) were more dependent in the areas of self-care and mobility activities (P<0.05). The main difference was found in global general health (GGH), physical functioning (PF), the emotional impact on the parent (PE) subsections of the CHQ-PF50 between the CP and the hearing loss groups; the role of the physical (RP) and emotional behavior (BE) subsections between the mental retardation (MR) and the CP groups, and the BE and mental health (MH) subsections between the MR and the hearing loss (HL) groups (P<0.05).

CONCLUSION

All the children with disabilities were different from the control group in their quality of life, self care and social function. However the status of the children with MR and HL were parallel between each other in their health related quality of life, self care and social function. On the other hand, the most affected and dependent group was children with CP. The results will provide guidelines for healthcare professionals in implementing effective rehabilitation programs, especially to those with cerebral palsy, to reduce the level of strain and increase the health related quality of life, self care and social function of children with different disabilities.

Sensory integration and activities of daily living in children with developmental coordination disorder

Objective

The aim of our study was to evaluate sensory integration and activities of daily living in children with developmental coordination disorder

Subjects and methods

37 cases with developmental coordination disorder and 35 healthy age-matched peers were included in this study. Ayres Southern California Sensory Integration Test was used for evaluating the sensory integration and Functional Independence Measure for Children (WeeFIM) was used for evaluating the activities of daily living.

Results

Significant differences were found in the visual shape perception, position in space, and design copying (p < 0.05). According to the results of somatosensory perception tests, significant differences were found in kinesthesia, manual form perception, finger identification, figure-ground perception, localization of tactile stimuli, double tactile stimuli perception (p < 0.05). Control group was better in motor planning (p < 0.05). Comprehension, expression, social communication, problem solving, and memory skills were significant in favor of the control group (p < 0.05). Graphestesia and self-care domain was found to be correlated (r = 0,491, p = 0.002) between the groups.

Discussion

Special education and rehabilitation programs including sensory integration therapy and motor performance will increase independence in the activities of daily living in children with developmental coordination disorder.

Effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis

BACKGROUND

Cystic fibrosis is a multisystem disease where the main problems are existing in the respiratory system. Aerobic exercise programs are effective in increasing physical fitness and muscle endurance in addition to chest physiotherapy.

OBJECTIVE

The aim of this study was to evaluate the effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis.

METHODS

Sixteen patients with cystic fibrosis, between the ages 5-13 years, were included in this study. All children were assessed at the beginning and at the end of 6 week of the training. Modified Bruce protocol was used for assessing the cardiovascular endurance. The sit-up test was used to evaluate the dynamic endurance of abdominal muscles, standing long jump was used to test power, sit and reach, trunk lateral flexion, trunk hyperextension, trunk rotation and forward bending tests were used to assess flexibility, 20 m shuttle run test and 10-step stair climbing tests were used to assess power and agility. All patients received chest physiotherapy and aerobic training, three days a week for six weeks. Active cycle of breathing technique and aerobic exercise training program on a treadmill were applied.

RESULTS

By evaluating the results of the training, positive progressions in all parameters except 20 m shuttle run and 10 stairs climbing tests were observed (p < 0.05). Active cycle of breathing techniques were used together with exercise training in clinically stable cystic fibrosis patients increases thoracic mobility (p < 0.05) and the physical fitness parameters such as muscle endurance, strength and speed (p < 0.05). Comparison of the results in sit and reach and forward bending tests were not significant (p > 0.05).

CONCLUSION

It is thought that in addition to medical approaches to the systems affected, the active cycle of breathing techniques along with aerobic training helps to enhance the aerobic performance, thoracic mobility and improves physical fitness in children with cystic fibrosis.

The effects of rope or weighted rope jump training on strength, coordination and proprioception in adolescent female volleyball players

AIM

The aim was to assess the effects of a 12-week "rope jumping" and "weighted rope jumping" training programs on functional parameters including multi-joint coordination and proprioception, strength, endurance in adolescent female volleyball players.

METHODS

Pretest posttest experimental design.

INTERVENTION

Weighted Rope Training group (N.=9; 15±1 years), Rope Training group (N.=9; 14.1±1.3 years) and Controls (N.=7; 14.4±1.3 years).

MAIN OUTCOME MEASURES

Motor coordination, proprioception, strength and endurance of the lower extremities with concentric and eccentric performances in closed kinetic chain on multi joint system assessed by the Monitorized Squat system. Absolute average error (cm) and the standard deviation for coordination and proprioception, Peak Force (N), Total Work (Nm), Average Power (Nm/s), Maximal Speed for strength and endurance tests were calculated. Kruskal-Wallis and Mann Whitney U test were utilized.

RESULTS

Weighted rope jump group had significant decrease for the deviation results of coordination on the concentric and eccentric phases for both legs (P<0.05). Rope jump and weighted rope jump groups had significantly lower results on non visible second movement deviation (P<0.05). In strength tests, the difference was found for total work that there was difference on the post assessment within groups in favour of Weighted Rope Training group in comparison to controls (P<0.05). Weighted Rope Training and control groups improved in concentric maximal speed (P<0.05). Most significant changes occured on eccentric phaese of the endurance tests that peak force increased in Weighted Rope Training group (P<0.05).

CONCLUSIONS

Adding rope jump to training programs improves joint repositioning and coordination. Weighted Rope Training group got greater gains for coordination and eccentric endurance parameters for lower extremities in a closed kinetic chain.

Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain and functional activity

OBJECTIVES

In this study, we sought to compare the effects of the slow and accelerated protocols on pain and functional activity level after arthroscopic rotator cuff repair.

METHODS

The study included 29 patients (3 men, 26 women) who underwent arthroscopic repair of stage 2 and 3 rotator cuff tears. Patients were randomized in two groups: the accelerated protocol group (n=13) and slow protocol group (n=16). Patients in the accelerated protocol group participated in a preoperative rehabilitation program for 4-6 weeks. Patients were evaluated preoperatively and for 24 weeks postoperatively. Pain was assessed by visual analog scale, and functional activity level was assessed by The Disabilities of The Arm Shoulder and Hand (DASH) questionnaire. The active range of motion was initiated at week 3 after surgery for the accelerated rehabilitation protocol and at week 6 for the slow protocol. The rehabilitation program was completed by the 8th week with the accelerated protocol and by the 22nd week with the slow protocol.

RESULTS

There was no significant difference between the slow and accelerated protocols with regard to pain at rest (p>0.05). However, the accelerated protocol was associated with less pain during activity at weeks 5 and 16, and with less pain at night during week 5 (p<0.05). The accelerated protocol was superior to the slow protocol in terms of functional activity level, as determined by DASH at weeks 8, 12, and 16 after surgery (p<0.05).

CONCLUSION

The accelerated protocol is recommended to physical therapists during rehabilitation after arthroscopic rotator cuff repair to prevent the negative effects of immobilization and to support rapid reintegration to daily living activities.

Effect of Tanner stage on proprioception accuracy

The aim of this study was to compare the proprioceptive accuracy in the dominant and nondominant lower extremities between early and late stages of adolescence in boys. Participants displaying sexual development consistent with Tanner stages I or II were included in the early adolescent group, and those displaying development consistent with Tanner Stages IV or V were included in the late adolescent group. Proprioception was evaluated using the following 4 tests: one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test. There were statistically significant differences between the early and late stages of adolescence in nondominant ankles with regard to this single-limb-standing test. There were no statistically significant differences between the early and late adolescent stages, and between dominant and nondominant extremities with regard to the single-limb-hopping test. There were no statistically significant differences between early and late adolescent stages with regard to passive and active ankle plantar- and dorsiflexion position reproduction. Based on these findings, we concluded that sexual maturation categorized by Tanner stage does not affect proprioceptive ability in adolescent individuals.

CLINICAL RELEVANCE

This method, as a clinical assessment of detecting deficits in neuromuscular control examined by foot and ankle surgeons and a rehabilitation technique to treat functional instability of the ankle used by physical therapists, might be applied to adolescents. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in adolescents.