David Ebaugh

Defining functional shoulder range of motion for activities of daily living

INTRODUCTION The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). MATERIALS AND METHODS The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. RESULTS Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. CONCLUSION Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.

Scapulothoracic motion and muscle activity during the raising and lowering phases of an overhead reaching task.

Scapulothoracic muscle activity is essential for normal scapulothoracic motion. While previous research has furthered the understanding of scapulothoracic motion and muscle activity during the raising phase of motion, a gap exists with respect to the lowering phase. The purpose of this study was to compare scapulothoracic motion and scapulothoracic muscle activity between the raising and lowering phases of an overhead reaching task. Twenty healthy subjects volunteered to participate in the study. Three-dimensional scapulothoracic motion was collected using an electromagnetic device. Surface electromyography (EMG) was used to assess muscle activity from the upper trapezius, lower trapezius, and serratus anterior muscles. Overall scapulothoracic motion was similar for the raising and lowering phases of the overhead reaching task. However, significantly lower EMG amplitude values existed during the lowering phase across all muscles. Less muscle activity during the lowering phase may reflect differing neuromuscular control strategies between arm raising and lowering. These findings suggest that scapulothoracic muscle activation levels during eccentric contractions may be closer to an activation threshold below which their ability to control scapulothoracic motion may be compromised subsequently leading to altered scapulothoracic motion (scapular dyskinesis). This provides a possible explanation for why scapular dyskinesis is more notable during the lowering phase of motion.

Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors

Over 2.6 million breast cancer survivors currently reside in the United States. While improvements in the medical management of women diagnosed with breast cancer have resulted in a 5-year survival rate of 89%, curative treatments are associated with a high prevalence of shoulder and arm morbidity, which, in turn, can negatively impact a womans quality of life. Breast cancer survivors frequently experience shoulder and arm pain, decreased range of motion, muscle weakness, and lymphedema. These symptoms can lead to difficulties with daily activities ranging from overhead reaching and carrying objects to caring for family and returning to work. Despite health care professionals awareness of these problems, a significant number of breast cancer survivors are confronted with long-term, restricted use of their affected shoulder and upper extremity. This problem may partially be explained by: (1) an incomplete understanding of relevant impairments and diagnoses associated with shoulder/arm pain and limited upper extremity use, and (2) the limited effectiveness of current rehabilitation interventions for managing shoulder pain and decreased upper extremity function in breast cancer survivors. Because breast cancer treatment directly involves the neuromusculoskeletal tissues of the shoulder girdle, it is understandable why breast cancer survivors are likely to develop shoulder girdle muscle weakness and fatigue, decreased shoulder motion, altered shoulder girdle alignment, and lymphedema. These impairments can be associated with diagnoses such as post-mastectomy syndrome, adhesive capsulitis, myofascial dysfunction, and brachial plexopathy, all of which have been reported among breast cancer survivors. It is our belief that these impairments also put women at risk for developing symptomatic rotator cuff disease. In this paper we set forth the rationale for our belief that breast cancer treatments and subsequent impairments of shoulder girdle neuromusculoskeletal tissues place breast cancer survivors at risk for developing symptomatic rotator cuff disease. Additionally, we identify knowledge gaps related to the current understanding of relevant shoulder girdle impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Ultimately, information from studies designed to meet these gaps will provide a scientific basis for the development of new, or refinement of existing, examination, intervention, and prevention techniques, which should lead to improved clinical outcomes in this population.

Critical review of the impact of core stability on upper extremity athletic injury and performance

BACKGROUND: Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. OBJECTIVES: 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. DISCUSSION: Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. CONCLUSIONS: A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.

Reliability and validity of active and passive pectoralis minor muscle length measures

Highlights • This manuscript presents the measurement properties of a novel technique for lengthening the pectoralis minor muscle.• Active and passive lengthening procedures resulted in greater changes in pectoralis minor muscle length when compared to previously reported pectoralis minor muscle stretches.• This investigation provides the first evidence to support measurement of the extensibility of the pectoralis minor muscle.

Exercise Protocol for the Treatment of Rotator Cuff Impingement Syndrome

Abstract Reference/Citation: Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 200...

Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use

OBJECTIVE To assess the relation of pectoralis minor muscle (PMm) length and extensibility to shoulder pain, shoulder girdle motion, and duration of manual wheelchair (MWC) use, and to compare differences in muscle length, muscle extensibility, peak humeral elevation, and pain among groups based on duration of wheelchair use. DESIGN Cross-sectional cohort study. SETTING Laboratory setting. PARTICIPANTS Individuals with spinal cord injury (SCI) who used an MWC for daily community and home mobility (N=22; 18 men; mean age, 41.7y; duration wheelchair use, 14.6y). Participants were stratified into groups based on duration of wheelchair use: <5 years (n=6), 5 to 15 years (n=8), and >15 years (n=8). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical measures of PMm length and extensibility, shoulder girdle motion, and shoulder pain (Wheelchair Users Shoulder Pain Index). RESULTS Significant high correlations were found among duration of wheelchair use, passive PMm length, passive PMm extensibility, and peak humerothoracic elevation. Moderate correlation of peak humerothoracic elevation to pain was found. Individuals with >15 years wheelchair use had reduced PMm extensibility and reduced peak humerothoracic elevation than those with <5 years duration of use. CONCLUSIONS To our knowledge, this is the first investigation to identify the association of reduced PMm extensibility with reduced shoulder girdle mobility, pain, and duration of wheelchair use in individuals with SCI.

Breast cancer EDGE task force outcomes: Clinical measures of health related quality of life

Background: Health related quality of life (HRQOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life and has been extensively studied in the breast cancer population. The purpose of this review was to identify evidence‐based HRQOL assessment tools found in breast cancer research using the methodology of the Oncology Section Cancer EDGE Task Force. Methods: The authors systematically reviewed the literature for outcome measures used to assess HRQOL in published research involving women diagnosed with breast cancer. The goal was to examine the psychometric properties of commonly used HRQOL measures in order to determine their clinical utility. Results: European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) ‐ Breast 23, BREAST‐Q, Functional Assessment of Cancer Therapy (FACT) ‐ Breast, FACT‐B+4, EORTC QLQ ‐ Cancer 30, FACT‐General, Functional Living Index‐Cancer, Ferrans and Powers Quality of Life Index‐Cancer Version, Psychological Adjustment to Illness Scale, World Health Organization Quality of Life, and SF‐Health Surveys, were highly recommended by the Task Force. Conclusions: A variety of outcome measures have been reported in the literature to assess HRQOL in women diagnosed with breast cancer. Eleven measures were found to have satisfactory psychometric properties and are recommended for clinical use by the researchers on this Task Force.

Pectoralis minor muscle elongation and scapulothoracic motion do not differ in individuals with short versus typical resting pectoralis minor muscle length: a cross-sectional study

BACKGROUND Individuals with short resting pectoralis minor muscle length have been shown to have aberrant scapulothoracic motion when compared to individuals with long resting pectoralis minor muscle length. However, the degree to which the pectoralis minor muscle can be lengthened and whether or not scapulothoracic motion differs between individuals with short and typical resting pectoralis minor muscle length is unknown. OBJECTIVES To determine if: (1) pectoralis minor muscle elongation (percent pectoralis minor muscle can be actively and passively lengthened beyond resting length), (2) pectoralis minor muscle percent length change during overhead reaching, and (3) scapulothoracic motion during overhead reaching differ between individuals with short and typical resting pectoralis minor muscle length. DESIGN Two group comparison. METHODS Thirty healthy individuals were placed into a short or typical resting pectoralis minor muscle length group. A caliper was used to measure resting pectoralis minor muscle length and pectoralis minor muscle length during active and passive muscle lengthening. An electromagnetic tracking system was used to measure pectoralis minor muscle length change as well as scapular, humeral, and trunk motion during several arm elevation tasks. Pectoralis minor muscle elongation and length change during arm elevation tasks were compared between groups using independent t-tests. Two-factor mixed-model analyses of variance were used to compare scapulothoracic motion at arm elevation angles of 30°, 60°, 90°, and 120°. RESULTS Pectoralis minor muscle elongation and pectoralis minor muscle length change during arm elevation did not differ between groups. Scapulothoracic motion did not differ between groups across arm elevation tasks. CONCLUSIONS Although resting pectoralis minor muscle length differed between groups, pectoralis minor muscle lengthening and scapulothoracic motion were similar between participants with short and typical resting pectoralis minor muscle length. Additional studies are needed to better understand the role of pectoralis minor muscle elongation on scapulothoracic motion.

Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer related Lymphedema of the Upper Extremity (CLUE)

OBJECTIVE The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer-related lymphedema, for use in the context of outcome evaluation in clinical trials. DESIGN Blinded repeated measures observational study. SETTING Outpatient research laboratory. PARTICIPANTS Breast cancer survivors with and without lymphedema (N=71). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer-Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool. RESULTS Intrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score. CONCLUSIONS The CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy.