Leszek Romanowski

Measurement of active shoulder proprioception: dedicated system and device

Proprioception is an essential part of shoulder stability and neuromuscular control. The purpose of the study was the development of a precise system of shoulder proprioception assessment in the active mode (Propriometr). For that purpose, devices such as the electronic goniometer and computer software had been designed. A pilot study was carried out on a control group of 27 healthy subjects, the average age being 23.8 (22–29) in order to test the system. The result of the assessment was the finding of the error of active reproduction of the joint position (EARJP). EARJP was assessed for flexion, abduction, external and internal rotation. For every motion, reference positions were used at three different angles. The results showed EARJP to range in 3–6.1°. The proprioception evaluation system (propriometr) allows a precise measurement of active joint position sense. The designed system can be used to assess proprioception in both shoulder injuries and treatment. In addition, all achieved results of normal shoulders may serve as reference to be compared with the results of forthcoming studies.

Elbow joint position sense after total elbow arthroplasty

BACKGROUND Multiple human experiments have shown that articular lesions can have a negative effect on proprioception. The influence of total elbow arthroplasty on joint position sense has not been reported so far. The purpose of the study was to evaluate proprioception, defined as a joint position sense, after total elbow arthroplasty. METHODS The study included 16 patients with unilateral semiconstrained linked total elbow arthroplasty and 21 healthy volunteers. The evaluation included measurement of active and passive reproduction of joint position sense of both elbows after surgery and the control groups. Reference angles included extension to 50° and 70° and flexion to 110°. We also assessed function of the elbow in arthroplasty group using the Mayo Elbow Performance Score, the Disability of the Arm, Shoulder and Hand score, and a visual analog scale for pain level. RESULTS The average value of error of passive reproduction of joint position for elbows after arthroplasty was significantly inferior for all evaluated positions compared with the contralateral elbow and with the control group, respectively, at 110° flexion: 4.3°, 2.7°, and 3.2°; at 70° extension: 4.9°, 2.9°, and 2.7°; and at 50° extension: 6.3°, 3.8°, and 3.8°. The average value of error of active reproduction of joint position for the arthroplasty group was also significantly inferior, respectively, at 110° flexion: 3.5°, 1.9° and 2°; and at 50° extension: 4.4°, 3.3°, and 3°. CONCLUSION Proprioception in elbows that undergo total arthroplasty is significantly inferior compared with the contralateral site of the patient and in the healthy control group.

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

PurposeGlenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes.MethodsEighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement.ResultsGlenohumeral rotational deficits (>20–25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97–41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87–15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87–14%).ConclusionsShoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players’ shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology.Level of evidenceCross-Sectional study with control group, Level II.

Polish Adaptation of Wrist Evaluation Questionnaires.

BACKGROUND Questionnaires evaluating hand and wrist function are a very useful tool allowing for objective and systematic recording of symptoms reported by the patients. Most questionnaires generally accepted in clinical practice are available in English and need to be appropriately adapted in translation and undergo subsequent validation before they can be used in another culture and language. MATERIAL AND METHODS The process of translation of the questionnaires was based on the generally accepted guidelines of the International Quality of Life Assessment Project (IQOLA). First, the questionnaires were translated from English into Polish by two independent translators. Then, a joint version of the translation was prepared collectively and translated back into English. Each stage was followed by a written report. The translated questionnaires were then evaluated by a group of patients. We selected 31 patients with wrist problems and asked them to complete the PRWE, Mayo, Michigan and DASH questionnaires twice at intervals of 3-10 days. The results were submitted for statistical analysis. RESULTS We found a statistically significant (p<0.05) correlation for the two completions of the questionnaires. A comparison of the PRWE and Mayo questionnaires with the DASH questionnaire also showed a statistically significant correlation (p<0.05). CONCLUSION Our results indicate that the cultural adaptation of the translated questionnaires was successful and that the questionnaires may be used in clinical practice.

Directional asymmetry of upper limbs in a medieval population from Poland: A combination of linear and geometric morphometrics.

Degrees of upper‐limb bilateral asymmetry reflect habitual behavior and activity levels throughout life in human populations. The shoulder joint facilitates a wide range of combined motions due to the simultaneous motion of all three bones: clavicle, scapula, and humerus. Accordingly, we used three‐dimensional geometric morphometrics to analyze shape differences in the glenoid cavity and linear morphometrics to obtain the degree of directional asymmetry in a medieval population.

ABSOLUTE AND RELATIVE OUTCOMES OF SHOULDER INJURY PREVENTION PROGRAMS IN NON-INJURED OVERHEAD ATHLETES – A SYSTEMATIC LITERATURE REVIEW

Background The incidence of shoulder injuries in overhead sports is high. Despite this high rate, insufficient evidence is available on the efficacy of preventive training programs. Objective To analyze the absolute and relative outcomes of shoulder injury prevention programs in non-injured overhead athletes. Design Systematic literature review. Setting Amateur and professional. Participants Athletes of different throwing sports. Interventions We analyzed different prevention approaches in injury prevention programs, based on neuromuscular components, proprioceptive training, strength, plyometric exercises or other specific prophylaxis exercises. The following electronic databases were searched: MEDLINE, PubMed, PEDro. This systematic review was registered in PROSPERO data (PROSPERO 2013: CRD42013005769). Detailed search strategy is available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005769. Articles quality was assessed according to the 11-item Physiotherapy Evidence-Based Database (PEDro) Scale. Main outcome measurements Primary: absolute parameters of the effectiveness of injury prevention programs, such as the reduction of shoulder injury rate during the analyzed period of time. Secondary: relative outcomes such as improvement in biomechanical factors (e.g. throwing velocity, isokinetic strength) as a result of the applied injury prevention and/or performance enhancement programs. Results Our searches identified 827 potentially relevant articles. By reviewing titles and abstracts, we identified 26 articles examining the efficacy of shoulder injury prevention programs in overhead athletes. There were no paper reporting absolute outcomes. As the relative outcomes authors most frequently used: shoulder strength, power, throwing velocity, range of motion. Conclusions Conflicting evidence has been found. Not all of the PEDro criteria could be satisfied, as the experimental crossover design implemented by the majority of studies resulted in subject and therapist blinding not being possible. High-quality studies investigating the shoulder injury prevention are needed to reduce the incidence of injuries in non-injured overhead athletes.

Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture

BACKGROUND The purpose of this study was to evaluate the efficacy of arthroscopic elbow release for both traumatic and degenerative contractures from intraoperative recording through the recovery time until final follow-up. METHODS The study is based on 54 consecutive patients with extrinsic elbow contracture (traumatic in 31 and degenerative in 23) treated with arthroscopic arthrolysis by a single surgeon in 2011-2015. Range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) were recorded preoperatively; intraoperatively; following release; and in the 1st, 3rd, 8th, 12th, and 26th weeks and at 2 years postoperatively. RESULTS Significant improvements were noted in extension, flexion, and range of motion, measured both intraoperatively and at all follow-up visits. The greatest improvement in the range of motion was achieved at the time of surgery (from 89° ± 28° to 131° ± 14°, P < .001); it then decreased at 1 week to 103° ± 22° (P < .001) and slowly recovered to reach 124° ± 22° after 2 years. This was better than the preoperative value (P < .001) but worse than the intraoperative value (P = .002). A similar pattern was observed in both traumatic and degenerative contractures. The MEPS improved from 73 ± 12 preoperatively to 93 ± 14 at the final evaluation (P < .001). The ROM and MEPS results at every follow-up were comparable for both traumatic and degenerative contractures. ROM improved regardless of the severity of contracture. CONCLUSIONS Arthroscopic elbow arthrolysis was similarly efficient in ROM restoration in both traumatic and degenerative contractures and regardless of the severity of contracture. After early deterioration, the achieved gain slowly recovers over a period of 6 months but may not recover to the ranges achieved during arthroscopy.

Microcirculation and Hypothermia Model

Ischemia time is still one of the most limiting factors in microsurgery. It influences the success rate and survival of transferred or replanted tissue. Animal model of microcirculation in hypothermal conditions is one of the possibilities to analyze potential of decreased temperature and its influence on blood cells and perfusion. We describe the model including necessary technique and devices. Additionally, explanatory experiment is presented, providing wide range of data and remarks on model usability.

THROWING SPORT IMPROVES SHOULDER PROPRIOCEPTION

Background Proprioception is a specialized variation of the sensory modality of touch that includes the sensation of joint motion and joint position. It is an essential part of shoulder stability and neuromuscular control. It is controversial whether throwing sports and sports training effects shoulder proprioception. Objective To analyse the shoulder proprioceptive abilities of professional handball players. Design Prospective study with control group and descriptive analysis. Setting Elite division handball players. Participants 70 professional handball players from top national league and 25 healthy volunteers as control. Interventions Shoulder proprioception was evaluated by measuring error of active reproduction of joint position (EARJP). Own construction electronic goniometer (Propriometer) with accuracy of 0,1o was used for measurements. Both dominant and non-dominant shoulders were evaluated. EARJP was measured in 4 directions and 3 positions for each direction: flexion and abduction (60o, 90o, 120o), external and internal rotation (30o, 45o, 60o). Three repetitions for each position were performed to obtain an average EARJP for every subject and position. Results Based on statistical analysis there was significantly better proprioceptive control (lower EARJP) in throwing versus non throwing and throwing versus control group shoulder. No difference in proprioception when comparing dominant and non-dominant shoulders in control group. Higher reference angles correlated with better proprioception. Increased external rotation correlated with better shoulder control in mid range of external rotation. Conclusions Throwing sport affects neuromuscular shoulder control. Handball players show significantly better proprioceptive abilities when compared to control normal population. Throwing shoulder has better neuromuscular control then the opposite one.

ISOKINETIC MUSCLE PERFORMANCE IN MALE PROFESSIONAL HANDBALL PLAYERS

Background Muscle strength and endurance of the shoulder rotators is important for overhead throwing performance and dynamic glenohumeral stability. Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance. Objective To evaluate the external (ER) and internal rotator (IR) muscles isokinetic peak torque, total work and strength ratios in handball players. Design Prospective study with control group and descriptive analysis. Setting Elite division handball players. Participants The pilot studies included 48 professional handball players of average age 24.0 (±4.5 years), height 187.1 (±5.9) and weight 9.0 (±11.6). Interventions Isokinetic tests were performed concentrically at 180 and 270 deg/s using Biodex System 3 PRO in standard sitting position. Main outcome measurements Isokinetic peak torque, total work and strength ratios. Results: The differences between the athletes and controls regarding the peak torque at 180 deg/s and total work at 270 deg/s of the ER and IR muscles for dominant and non dominant shoulder were statistically significant. The control group presented higher ratios (D 85.8±26.9; ND 82.8±23.4) than handball players (D 65.4±13.3; ND 63.0±16.0)–differences were statistically significant. There were statistical differences between dominant and non dominant shoulder in both group for total work of the ER muscles. There were no statistical differences between dominant and non dominant shoulder in both group for peak torque of the ER and IR muscles. Conclusions Handball players present higher isokinetic parameters comparing to normal population. The study establishes additional normative data on ER and IR muscle torque and total work on high-level male handball players.