Irem Duzgun

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.

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.

Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial

OBJECTIVE To investigate the effects of 2 different exercise programs on 3-dimensional scapular kinematics, disability, and pain in participants with subacromial impingement syndrome (SIS). DESIGN Randomized controlled trial. SETTING Outpatient clinic and research laboratory. PARTICIPANTS Participants who were diagnosed with SIS and who also exhibited scapular dyskinesis (N=30). INTERVENTIONS The participants were randomized in 2 different exercise groups: (1) shoulder girdle stretching and strengthening with additional scapular stabilization exercises based on a kinetic chain approach (intervention group), and (2) shoulder girdle stretching and strengthening exercises only (control group). MAIN OUTCOME MEASURES Three-dimensional scapular kinematics, self-reported shoulder pain, and disability were evaluated at baseline, after 6 weeks of training, and after 12 weeks of training. RESULTS Significant differences were observed between the control and intervention groups in external rotation and posterior tilt after 6 weeks of training and in external rotation, posterior tilt, and upward rotation after 12 weeks of training. All groups showed improvement in self-reported pain and disability scores; however, there were no significant differences between the groups. CONCLUSIONS Progressive exercise training independent from specific scapular stabilization exercises provides decreased disability and pain severity in impingement syndrome.

Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair

OBJECTIVE The aim of the study was to investigate the effects of the early initiation of passive and active range of motion exercises following arthroscopic rotator cuff repair. METHODS The study included 40 patients who underwent arthroscopic rotator cuff repair. Patients were quasi-randomly assigned into accelerated (ACCEL) protocol (n=19) and slow (SLOW) protocol (n=21) groups. Patients in both groups were treated with the same protocol. Active range of motion was begun at the 3rd week in the ACCEL group and the 6th week in the SLOW group. Range of motion was recorded at postoperative weeks 3, 5, 8, 12, and 24. RESULTS While active range of motion for all measurements improved across weeks, there were no differences between groups, with the exception of active total elevation which was greater at all time point measurements in the ACCEL group (p<0.05). CONCLUSION The early initiation of passive and gentle controlled active motion exercise following rotator cuff repairs does not appear to affect range of motion in the first 6 postoperative months.

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.

Proprioception After Shoulder Injury, Surgery, and Rehabilitation

The glenohumeral joint is a complex joint for which both the mobility and the stability are significant. It has a broad range of motion; moreover the stabilization has to be provided to be able to create steady motion at distal joints in this range of motion. Neuromuscular control is of great importance to maintain dynamic stabilization. The glenohumeral joint is a mechanoreceptor-rich joint. The sensitivity of these receptors decreases because of the injury and this causes a deficit in the proprioceptive sense. The loss in the proprioceptive sense increases the risk of reinjury. It is critical to provide the proper mechanic for improving this sense. The proper mechanic can be provided with surgical procedures and physiotherapy and rehabilitation practices. Exercise is particularly important in physiotherapy and rehabilitation practices. In this section the receptors in the glenohumeral joint, their locations and functions, the effect of injury on the proprioceptive sense, and restoration of the sense are examined.

Active Scapular Retraction and Acromiohumeral Distance at Various Degrees of Shoulder Abduction

CONTEXT   Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking. OBJECTIVE   To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-time ultrasound. DESIGN   Cross-sectional study. SETTING   University laboratory. PATIENTS OR OTHER PARTICIPANTS   Twenty asymptomatic individuals (10 men, 10 women; age = 22.9 ± 2.8 years, height = 169.3 ± 9.5 cm, mass = 65.5 ± 12.9 kg) were recruited. MAIN OUTCOME MEASURE(S)   Real-time ultrasound images of AHD were obtained during nonretracted and retracted scapular conditions at 0°, 45°, 60°, and 90° of shoulder abduction. A 2-factor analysis of variance with repeated measures was used to evaluate the influence of shoulder retraction on AHD across shoulder-abduction angles. RESULTS   A scapular-retraction condition × shoulder-abduction-angle interaction for AHD was found ( F3,57 = 4.56, P = .006). The AHD was smaller at 0° (10.5 versus 11.2 mm, respectively; t19 = 2.22, P = .04) but larger at 90° (9.4 versus 8.7 mm, respectively; t19 = -2.30, P = .04) of shoulder abduction during the retracted than the nonretracted condition. No differences in AHD were observed between conditions at 45° ( t19 = 1.45, P = .16) and 60° ( t19 = 1.17, P = .86) of abduction. CONCLUSIONS   The observed differences in AHD at 0° and 90° of shoulder abduction were small and did not exceed the established minimal detectable change for either angle. Our findings suggest that active scapular retraction during shoulder abduction has a minimal influence on AHD at 0° and 90° in healthy individuals. Further investigations are needed to determine whether scapular retraction influences AHD in individuals with subacromial impingement.

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 capsules susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.

THU0618-HPR Immediate Effects of Mulligan's Concept Mobilization with Movement on Knee Pain and Functions in Patients with Knee Osteoarthritis

Background Knee osteoarthritis (KOA) is a frequent cause of knee pain which can be successfully managed by physiotherapy. Joint mobilization has been shown to be a useful modality to reduce knee pain. Mulligans concept of mobilization with movement (MWM) is a contemporary form of joint mobilization, consisting of a therapist-applied pain-free accessory gliding force combined with active movement. There are reports of immediate pain relief and improved function in response to these techniques in several musculoskeletal disorders. Objectives To investigate the immediate effect of Mulligans concept of MWM and Mulligan taping technique on function and pain in patients with KOA. Methods Sixty patients (with the mean age of 59±7,21) with the grade of 2 or 3 KOA according to the Kellegren and Lawrence included into the study. Patients randomly divided into 3 groups. Therapist applied MWM and Mulligan taping technique for group 1, MWM and placebo taping for group 2, just placebo taping for group 3. Demographics, pain severity in the rest, pain severity during the performance of the tests and tests scores before and after the applications (MWM and tapings) of the therapist were recorded for all groups. Functional status assessed with a group of functional tests including lift test (LT), pick-up test (PT), repeated sit-to-stand test (RST), Sock Test, Stair Ascending and Descending Test (SAD), Straight line walking test (SLW), Timed Up & Go Test (TUG). Pain severity was assessed with visual analog scale (VAS). Results In all groups there is a significant difference between pain levels and functional test scores before and after the applications (p<0,05). After the applications there is a significant difference between group 1 and 3 in the comparison of the all groups functional tests scores and pain levels during the tests (p<0,05). Additionally after the application of MWM and tapings there is a significant difference between group 1 and 2 just for RST, SAD and SLW scores (p<0,05). Conclusions This randomized clinical trial revealed that Mulligans Concept is an important method in recovery of knee function and reduction of pain in OA patients. Application of MWM with Mulligan taping is more effected on immediate reduction in pain during the function than only application of MWM. Disclosure of Interest None declared

AB1232-HPR The Relationship Between Kinesiophobia and Quality of Life, Functional Status, Disease Activity and Depression in Patients with Ankylosing Spondylitis

Background Ankylosing spondylitis (AS) is a chronic, inflammatory disorder characterized by pain and stiffness especially on back and sacroiliac joint. Pain, reduced spine mobility, and decreased physical functioning are the major manifestations of AS. In the literature, the role of kinesiophobia in musculoskeletal pain disorders has been examined in studies of acute and chronic back pain, osteoarthritis and fibromyalgia. The results of these studies tend to support the important contribution of fear of movement in the evaluation of pain, disability, function and QoL and treatment of musculoskeletal disorders. Objectives To investigate the effects of kinesiophobia on quality of life (QoL), functional ftatus, disease activity and depression of AS patients. Methods 163 participants (18 men, 18 women) who were under a regular follow-up protocol in Gazi University Rheumatology Clinic and Rheumatologic Rehabilitation Unit with the diagnosis of AS. Primary outcome measure was kinesiophobia. Evaluation was done using the The Tampa Scale of Kinesiophobia (TSK). Exploratory measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), BECK Depression Inventory (BDI) and AS quality of life questionnaire (ASQOL). Pearsons correlation test was used to verify correlations. Results Kinesiophobia was found to be very common in AS affecting 66.6% of patients. There were correlation found between TSK and BASDAI pain, BASFI, ASQOL, BDI scores (Respectively, r=.259, r=.294, r=.392, r=.398; p<.05). There were no correlations found between TSK and BASDAI total and BASMI scores (Respectively, r=.142, r=.198; p>.05). Conclusions Our study is the first clinical study designed to investigate the relationship of kinesiophobia with the other clinical measurements in AS patients. Their pain levels and psychological states have an impact on fear of movement. In relation, functional status and quality of life of them affected negatively. References Burwinkle T, Robinson JP, Turk DC. Fear of Movement:FactorStructure of the Tampa Scale of Kinesiophobia in Patients With Fibromyalgia Syndrome. The Journal of Pain, Vol 6, No 6 (June), 2005: pp 384-391. Vlaeyen JW, Kole-Snijders AM, Boeren RG, et al. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995; 62: 363-372. Dagfinrud H, Kvien TK, Hagen KB, Nghien FT, Donohue JT. Physiotherapy interventions for ankylosing spondylitis. Dochrana Databased System Reviews. 2008; 23(1): CD002822. Disclosure of Interest None declared