Marcelo Peduzzi de Castro

Scapular kinematics and scapulohumeral rhythm during resisted shoulder abduction – Implications for clinical practice

OBJECTIVEnTo offer a three-dimensional description of the scapular kinematics and scapulohumeral rhythm (SHR) in healthy subjects during quasi-static shoulder abduction. To analyze and compare the influence of loaded and unloaded conditions on scapula kinematics and SHR.nnnDESIGNnEleven subjects were analyzed using videogrammetry and the application of mathematical modelling during quasi-static shoulder abduction positions (intervals of approximately 30 degrees).nnnMAIN OUTCOME MEASUREMENTSnScapular kinematic data under unloaded and loaded conditions.nnnRESULTSnThe scapula presented external rotation, upward rotation and posterior tilting during the studied movement. Analyzing the scapulohumeral rhythm, different behaviours were observed in the scapular movement planes. Loading condition increased scapular upward rotation and posterior tilt at 60 degrees and 90 degrees of abduction (p>0.01).nnnCONCLUSIONSnAnalyzed scapular kinematics and scapulohumeral rhythm showed differences between adopted loading conditions. The clinical applications of these findings are discussed.

Construct validity of clinical spinal mobility tests in ankylosing spondylitis: a systematic review and meta-analysis

The study aimed to determine, using systematic review and meta-analysis, the level of evidence supporting the construct validity of spinal mobility tests for assessing patients with ankylosing spondylitis. Following the guidelines proposed in the Preferred Reporting Items for Systematic reviews and Meta-Analyses, three sets of keywords were used for data searching: (i) ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; (ii) accuracy, association, construct, correlation, Outcome Measures in Rheumatoid Arthritis Clinical Trials, OMERACT, truth, validity; (iii) mobility, Bath Ankylosing Spondylitis Metrology Index—BASMI, radiography, spinal measures, cervical rotation, Schober (a further 19 keywords were used). Initially, 2558 records were identified, and from these, 21 studies were retained. Fourteen of these studies were considered high level of evidence. Compound indexes of spinal mobility showed mostly substantial to excellent levels of agreement with global structural damage. Individual mobility tests for the cervico-thoracic spine showed only moderate agreements with cervical structural damage, and considering structural damage at the lumbar spine, the original Schober was the only test that presented consistently substantial levels of agreement. Three studies assessed the construct validity of mobility measures for inflammation and low to fair levels of agreement were observed. Two meta-analyses were conducted, with assessment of agreement between BASMI and two radiological indexes of global structural damage. The spinal mobility indexes and the original Schober test show acceptable construct validity for inferring the extent of structural damage when assessing patients with ankylosing spondylitis. Spinal mobility measures do not reflect levels of inflammation at either the sacroiliac joints and/or the spine.

The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: A repeated measures study on asymptomatic shoulders.

BACKGROUNDnManual therapy enhances pain-free range of motion and reduces pain levels, but its effect on shoulder muscle activity is unclear. This study aimed to assess the effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity.nnnMETHODSnThirty asymptomatic individuals participated in a repeated measures study of the electromyographic activity of the supraspinatus, infraspinatus, posterior deltoid, and middle deltoid. Participants performed four sets of 10 repetitions of shoulder scaption and abduction with and without a glide of the glenohumeral joint. Repeated-measures multivariate analysis of variance (MANOVA) was used to assess the effects of movement direction (scaption and abduction), and condition (with and without glide) (within-subject factors) on activity level of each muscle (dependent variables). Significant MANOVAs were followed-up with repeated-measures one-way analysis of variance.nnnRESULTSnDuring shoulder scaption with glide, the supraspinatus showed a reduction of 4.1% maximal isometric voluntary contraction (MVIC) (95% CI 2.4, 5.8); and infraspinatus 1.3% MVIC (95% CI 0.5, 2.1). During shoulder abduction with a glide, supraspinatus presented a reduction of 2.5% MVIC (95% CI 1.1, 4.0), infraspinatus 2.1% MVIC (95% CI 1.0, 3.2), middle deltoid 2.2% MVIC (95% CIxa0=xa00.4, 4.1), posterior deltoid 2.1% MVIC (95% CI 1.3, 2.8).nnnCONCLUSIONSnIn asymptomatic individuals, sustained glide reduced shoulder muscle activity compared to control conditions. This might be useful in enhancing shoulder movement in clinical populations. Reductions in muscle activity might result from altered joint mechanics, including simply helping to lift the arm, and/or through changing afferent sensory input about the shoulder.

Criterion-concurrent Validity of Spinal Mobility Tests in Ankylosing Spondylitis: A Systematic Review of the Literature

Objective. To examine the level of evidence for criterion-concurrent validity of spinal mobility assessments in patients with ankylosing spondylitis (AS). Methods. Guidelines proposed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to undertake a search strategy involving 3 sets of keywords: accura*, truth, valid*; ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; mobility, spinal measure*, (a further 16 keywords with similar meaning were used). Seven databases were searched from their inception to February 2014: AMED, Embase, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies (with modifications) was used to assess the quality of articles reviewed. An article was considered high quality when it received “yes” in at least 9 of the 13 items. Results. From the 741 records initially identified, 10 articles were retained for our systematic review. Only 1 article was classified as high quality, and this article suggests that 3 variants of the Schober test (original, modified, and modified-modified) poorly reflect lumbar range of motion where radiographs were used as the reference standard. Conclusion. The level of evidence considering criterion-concurrent validity of clinical tests used to assess spinal mobility in patients with AS is low. Clinicians should be aware that current practice when measuring spinal mobility in AS may not accurately reflect true spinal mobility.

Role of Physical Evaluation in the Early Identification of Axial Spondyloarthritis: A Research Proposal.

The aim of this study was to present a rationale to explore the use of clinical tests for the sacroiliac joints to detect early axial spondyloarthritis (SpA) and to suggest a protocol to validate these clinical tests. Based on the European Guidelines for Diagnosis and Treatments of Pelvic Girdle Pain, we propose a set of six clinical tests to identify the likely presence of inflammation in the sacroiliac joints associated with early axial SpA. As magnetic resonance imaging (MRI) is the current gold standard used to identify inflammation in the sacroiliac joints, the results of the proposed set of clinical tests are compared with those from the MRI examinations. We hypothesize that specific clinical tests, which combine pain provocation and functional tests, for assessing the sacroiliac joints will help to identify early active inflammation at the sacroiliac joints in axial SpA. If such tests prove to be sensitive and specific, they could add further value to the diagnostic classification criteria for axial SpA.