Jing-lan Yang

Mobilization Techniques in Subjects With Frozen Shoulder Syndrome: Randomized Multiple-Treatment Trial

Background and Purpose: The purpose of this study was to compare the use of 3 mobilization techniques—end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)—in the management of subjects with frozen shoulder syndrome (FSS). Subjects: Twenty-eight subjects with FSS were recruited. Methods: A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics. Results: Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did. Discussion and Conclusion: In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.

Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: A randomized control trial

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference=0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference=22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.

Proprioception assessment in subjects with idiopathic loss of shoulder range of motion: joint position sense and a novel proprioceptive feedback index.

We examined the effects of elevation range and plane on shoulder joint proprioception in subjects with idiopathic loss of shoulder range of motion (ROM). Joint position sense (JPS) and a novel proprioceptive feedback index (PFI), including difference magnitude and the similarity index, were used to assess proprioception. Twelve subjects (eight male, four female) with involved stiff shoulders and normal opposite shoulders were recruited from a university hospital. Subjects attempted to repeat six target positions. Target positions consisted of arm elevation in three planes (frontal, scapular, and sagittal planes) and two ranges (end/mid range). Six trials of each target position were used to determine acceptable trials for stabilization of the data, less than 5% of the cumulative mean values for at least three successive trials. The data stabilized at the sixth repetition. Compared to control shoulders, involved shoulders had enhanced proprioception during end range movements (p < 0.05). The magnitude of the repositioning error and difference magnitude decreased (1.6°–3.5° for repositioning error and 22.2°–62.1° for difference magnitude), whereas similarity index improved at end range movements compared to mid range movements (p < 0.05) in involved stiff shoulders. Results of JPS and PFI suggest that both capsuloligamentous and musculotendinous mechanoreceptors play an important role in proprioception feedback during active movements in subjects with idiopathic loss of shoulder ROM.

The development of ultra-low-carbon bainitic steels

Abstract This paper presents an introduction to ultra-low-carbon bainitic steels and illustrates their typical microstructural details. The aim of improving bainites hardenability and increasing its toughness is emphasized. The paper also deals with the effects of alloying additions and processing parameters on microstructures and mechanical properties for this type of steel.

Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders.

Measurement of anterior/posterior shoulder tightness, humeral external/internal rotation range of motion (ROM), scapular upward rotation/tipping ROM, and functional limitations were made in 46 patients with unilateral stiff shoulders (SSs) using a clinical measurement (shoulder tightness), a three-dimensional electromagnetic tracking device (shoulder ROM), and self-reports of function. Patients with SSs in their dominant shoulder demonstrated statistically greater posterior shoulder tightness compared to nondominant shoulder. Control dominant shoulders demonstrated decreased internal ROM as compared with control nondominant shoulders (p=0.021). In SSs, significant relationships were found between humeral internal rotation ROM and posterior shoulder tightness (R=0.49, p<0.0005), humeral external rotation ROM and anterior shoulder tightness (R=0.59, p=0.0002), scapular tipping and anterior shoulder tightness (R=0.57, p=0.004). Specifically, in patients with dominant SSs, posterior shoulder tightness and functional limitation were related (R=0.56, p=0.002). In patients with dominant involved shoulders, emphasise on posterior tightness stretch may improve functional ability directly. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the rehabilitation of patients with SSs.

Secondary motions of the shoulder during arm elevation in patients with shoulder tightness

An analysis of secondary shoulder motions (humeral rotation, humeral head anterior/posterior translation, scapular tipping, and scapular upward/downward rotation) in subjects with anterior/posterior shoulder tightness provides the opportunity to examine the role of tightness as a means of affecting shoulder motions. Subjects with shoulder tightness (anterior, n=12; posterior, n=12) elevated their arms in the scapular plane. Three replicated movements were performed to the maximum motions. Kinematics data were collected by FASTRAK 3D electromagnetic system. To determine if a significant difference of the secondary motions existed between anterior/posterior shoulder tightness, two-factor mixed ANOVA models with the repeated factor of elevation angle (five elevation angles) and the independent factor of group were calculated. The relationships between the self-reported functional scores (Flexilevel Scale of Shoulder Function, FLEX-SF) and abnormal shoulder kinematics were assessed. For humeral head anterior/posterior translation, the subjects with posterior tightness demonstrated anterior humeral head translation (10mm, p=0.019) compared to subjects with anterior tightness. The subjects with anterior tightness demonstrated less posterior tipping (2.2 degrees , p=0.045) compared to subjects with posterior tightness. The humeral anterior translation had moderate relationships with FLEX-SF scores (r=-0.535) in subjects with posterior tightness. The scapular tipping had moderate relationships with FLEX-SF scores (r=0.432) in subjects with anterior tightness. In conclusion, the secondary motions were different between subjects with anterior and posterior shoulder tightness. During arm elevation, less scapular posterior tipping and less posterior humeral head translation in subjects with anterior and posterior shoulder tightness, respectively, are significantly related to self-reported functional disability in these subjects.

Inter-session reliability of the measurement of the deep and superficial layer of lumbar multifidus in young asymptomatic people and patients with low back pain using ultrasonography

STUDY DESIGN Reliability study. OBJECTIVE To investigate the inter-session reliability of measuring the thickness of deep (dMF) and superficial layer of lumbar multifidus (sMF) using ultrasonography for participants with and without low back pain (LBP). BACKGROUND The lumbar multifidus is an important muscle in maintaining spinal stability. The dMF is considered important in maintaining tonic contraction and joint stability. Motor control impairment is also discovered in patients with LBP. However, no study to date has investigated the method of observing both the sMF and dMF through ultrasound imaging (USI). METHODS Twenty subjects aged 18-35 years old with LBP (N=10) and without LBP (N=10) were recruited. Every subject extended the upper trunk in prone lying with maximal isometric contraction. Simultaneously, the examiner measured the thickness of the dMF and the sMF using ultrasonography after ensuring the muscle belly was located. The participants performed three trials of isometric trunk extension in each session, with 30 min between each session. The reliability of measuring the change of thickness is represented by the intra-class correlation coefficient (ICC). RESULTS Through averaging three trials of measurement, the reliability of measuring the thickness of the dMF or the sMF in static or in the contracted condition, and the change of the thickness during contraction, is reliable (ICC=0.84-1.00). CONCLUSIONS The intra-rater inter-session reliability of measurement of the dMF and the sMF with USI has been established. This method could be applied to the qualification of the activation level of the dMF and the sMF with specific tasks.

Reliability and Validity of Transversus Abdominis Measurement at the Posterior Muscle-Fascia Junction with Ultrasonography in Asymptomatic Participants.

OBJECTIVE The purposes of this study were (1) to establish the intrarater sliding and change in thickness of the transversus abdominis (TrA) measurement at the posterior muscle-fascia junction and (2) to examine the relationship between the muscle thickness and sliding of the TrA at the anterior and posterior sites. METHODS Asymptomatic participants (n = 20) were placed into the hook-lying position to perform the abdominal drawing-in maneuver viewed in B-mode with a 5- to 12-MHz linear ultrasound transducer. The outcome variables included the resting thickness, the thickness during contraction, the change of thickness, and the change of sliding length. Both intraclass correlation coefficient and Pearson correlation were used for analysis. RESULTS Measuring the thickness and sliding of the TrA at the posterior muscle-fascia junction showed good reliability (intraclass correlation coefficient (3,3), 0.89-0.98). The correlations between the sliding measurements of the TrA at the anterior and posterior sites were moderate to good (r = 0.41-0.74). CONCLUSION This study found that measuring the musculofascial corset from the posterior site using ultrasonography is reliable, allowing for ultrasound measurements at both the anterior and posterior sites of the TrA to provide a comprehensive evaluation of the TrA fascia.

Shoulder physical activity, functional disability and task difficulties in patients with stiff shoulders: Interpretation from RT3 accelerator

We determined whether the degree of symptom-related functional disability was related to daily physical activity of the shoulder in subjects with stiff shoulders (SSs). Responsiveness and a clinically meaningful level of discrimination between improvement and non-improvement for shoulder physical activity (SPA) were determined. Twenty-six subjects with SSs participated. Shoulder physical activity was assessed by RT3 accelerometers fixed on the humerus during daily 14-h data collection periods twice a week for 2 weeks. A moderate correlation coefficient was found between SPA and functional disability (β = .47). Based on our cohort design and sample, we suggest that SPA (higher than 101.8 counts, hard-moderate or hard tasks) during daily activity are associated with (with at least 83% probability) non-improvement in an individual with SS. Compared to the non-improvement group, the improvement group had less duration of sedentary activity, less frequency and duration of hard tasks, and more frequency and duration of easy tasks (p < 0.01). Appropriate guidance on shoulder physical activities for subjects with SS is important to consider in rehabilitation strategies for these subjects. In our sample, a hard level of shoulder physical activity and sedentary activity should be cautious for these subjects. Further study is needed to validate therapeutic effect of physical activity on the course of patient improvement in subjects with SSs.

Progressive conscious control of scapular orientation with video feedback has improvement in muscle balance ratio in patients with scapular dyskinesis: a randomized controlled trial

BACKGROUND Video feedback (VF) can guide patients to consciously control scapular orientation without inappropriate substitution. This study investigated whether progressive conscious control with VF improves scapular muscle activation and movements during arm elevation in patients with subacromial impingement and scapular dyskinesis. METHODS The study recruited 38 amateur overhead athletes with subacromial impingement and scapular medial border prominence who were randomly assigned to the VF or control group. The participants in both groups controlled the scapular position and progressively practiced from 0° to 45° and from 0° to 90° of arm elevation. Participants in the VF group also controlled the scapular position with a video presentation of the scapula on a screen. We investigated the scapular kinematics, muscle activation, and balance ratio for outcome collection in the preintervention and postintervention conditions with and without VF conditions. RESULTS Decreased upper trapezius (UT) activation (3%-13%, P < .0083), increased lower trapezius (LT) activation (3%-17%, P < .0083), restored UT/LT ratios (0.67-3.13, P < .0083), and decreased scapular internal rotation (1.8°-6.1°, P < .003) relative to the preintervention condition were demonstrated in the 2 postintervention conditions in both groups. The VF group also demonstrated decreased UT/serratus anterior ratios (0.21-0.30, P < .0083) in 2 postintervention conditions relative to the preintervention condition. CONCLUSIONS The progressive control of scapular orientation with or without VF can be used to reduce the UT/LT ratio and improve scapular internal rotation during arm elevation. Control training with VF can further decrease the UT/serratus anterior ratio.