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Davis, Kelly A. "Shoulder Impingement in Water Polo Players." Scholarship @ Claremont, 2014. http://scholarship.claremont.edu/scripps_theses/324.
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Water polo is a highly dynamic and physically demanding sport that has heretofore not inspired nearly as much research as other overhead sports such as baseball or swimming. As in almost all overhead sports, water polo puts its players at high risks for shoulder injuries since the motions required to perform the sport at an optimum level push the limits of normal shoulder function.
Human shoulders are inherently unstable as a tradeoff to their flexibility. Because of this instability, many structures are required to work concurrently to keep the shoulder in place. These structures include muscles, ligaments and cartilages. It is important to recognize that the shoulder is not a singular joint in itself but rather a highly mobile complex that can perform many nuanced motions.
Shoulder instability can cause a variety of injuries such as impingement, which occurs often among overhead athletes. This malady refers to a pathologic limitation of normal subacromial space that causes structures to be in abnormal contact with each other, which causes abrasive and pinching forces. These forces can result in a range of shoulder maladies including bursitis, tendinitis, and tearing of muscles and ligaments.
Impingement is very apparent in both swimmers and water polo players due to the repetitive stresses present in each sport. In swimmers, impingement has been relatively well researched; the freestyle stroke utilized in water polo, however, is fundamentally different in that water polo players keep their heads and chests erect out of the water with a stroke known as head-up freestyle. Hitherto unknown are the biomechanics of this stroke and the extent to which impingement in water polo players is caused and/or worsened by this form of freestyle.
The proposed research is a two-part study to investigate the biomechanics of water polo head-up freestyle as a first step to understanding its role in impingement in water polo players. First, experienced water polo players with healthy shoulders approved by the IRB committee of Scripps College will be recruited in this study, and their head-up freestyle kinematic sequences and muscle activities will be recorded by synchronized high-speed cinematography and fine-wire electromyography. These data will be compared to those of head-down freestyle in the literature to understand the biomechanical differences between head-up in and head-down.
Part II of the study will recruit experienced water polo players with existing shoulder impingement in addition to those with healthy shoulders in Part I, and their head-up freestyle will be recorded in the same manner. These data will be compared to those in Part I to understand how the head-up stroke differs between impinged and healthy shoulders. This research will provide a basis for the understanding of impingement in head-up freestyle to ultimately increase the safety of the players. Further studies should be conducted to compare the patterns of biomechanical differences between healthy and impinged shoulders in head-up vs. head-down, analyze impingement in each phase of the head-up swim stroke, and investigate how the rate of impingement is altered by fatigue and poor technique.
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Hyvönen, P. (Pekka). "On the pathogenesis of shoulder impingement syndrome." Doctoral thesis, University of Oulu, 2003. http://urn.fi/urn:isbn:9514270258.
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Abstract
The pathomechanism of the shoulder impingement syndrome has been under debat. Two main theories of the pathogenesis of the disease exists; mechanical (extrinsic) and degenerative (intrinsic) theory.
The purpose of this work was to evaluate the pathogenesis of impingement syndrome with five studies that consentrate to aspects related to ethiopathology as outcome and recovery after surgery, radiological diagnosis, immunohisto- and histopathology of subacromial bursa, and subacromial mechanical pressures.
The good results of 14 shoulders of 96 operated with an open acromioplasty turned painful after an average of 5 (2 - 10) years postoperatively and had developed 6 full-thickness and 4 partial rotator cuff tears. Initially good result is not permanent in all cases, suggesting that a degenerative process is involved in the pathogenesis of impingement syndrome.
Shoulder muscle strengths of 48 patients, who had undergone an open acromioplasty, restored to near normal within one year after open acromioplasty, suggesting that mechanical compression plays a role in the pathogenesis of impingement syndrome.
Variation in the shape of the acromion, evaluated in 111 patients and their matched controls by a routine supraspinatus outlet view, is associated with impingement syndrome, but this association is weak. Validity of this radiograph in the diagnosis of impingement syndrome is therefore a minor adjunct to the other diagnostic methods.
The role of subacromial bursa in impingement syndrome was studied in 62 patients (33 tendinitis, 11 partial and 18 full-thickness RC tear) suffering from a unilateral impingement syndrome and 24 controls. Tenascin-C proved to be a more general indicator of bursal reaction compared to the conventional histological markers, being especially pronounced at the more advanced stages of impingement.
The local subacromial contact pressures measured in 14 patients and 8 controls with a piezoelectric probe were elevated in the impingement syndrome, supporting the mechanical theory.
On the basis of this study, both mechanical and degenerative factors are involved in the pathogenesis of impingement syndrome.
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Harvey, Daniel. "The diagnosis of subacromial impingement syndrome and associated pathology in the primary care setting." Click here to access this resource online, 2009. http://hdl.handle.net/10292/768.
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Diagnosing shoulder pain conditions is a challenging area of musculoskeletal practice. Subacromial impingement syndrome (SIS) is a clinical syndrome that indicates pain and pathology involving the subacromial bursa and rotator cuff tendons within the subacromial space. The three stages of SIS are subacromial bursitis, partial thickness and full thickness rotator cuff tears. The cause of SIS is believed to be multi-factorial with both extrinsic and intrinsic factors involved in its pathogenesis. Clinicians have traditionally diagnosed SIS using a clinical examination including a subjective history followed by confirmatory clinical tests. A review of the evidence for diagnostic accuracy of clinical tests highlights that individual tests have poor diagnostic accuracy. A combination of clinical tests or a clinical examination per se may be useful at ruling out rotator cuff tears, but is less accurate at detecting rotator cuff tears when it is present. There is consensus in the literature that particular combinations of signs and clinical features may be useful in diagnosing rotator cuff tears but not for diagnosing SIS. The vast majority of research to date examining the clinical diagnosis of SIS has been focused on individual clinical tests carried out by medical practitioners in specialist and tertiary care settings. This review has established that the majority of diagnostic accuracy studies for SIS and rotator cuff tears have had poor methodological design. This exploratory study was conducted with subjects undergoing a standardized clinical examination (index test) by a physiotherapist. The decision as to which specific tests were chosen for this research was based on supporting research within the literature and the test’s actual use within the New Zealand clinical setting. This included subjective history questions, active and passive shoulder movement tests and eleven SIS tests. Subjects were referred for a diagnostic ultrasound scan immediately following the clinical examination and results from the scan stood as the criterion reference standard. Thirty eight individuals (males n=23, females n=15) with new onset shoulder pain, who met the inclusion criteria, were assessed by a participating physiotherapist. Sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and respective 95% confidence intervals were calculated for all variables of the examination. Individual variables from the clinical examination were tested for their association with the diagnostic ultrasound scan reference criterion using Pearson Chi-Squared Exact test. Potential predictor variables were retained as potential predictors for use in the logistic regression analysis to determine the most accurate set of clinical examination variables for diagnosing SIS and the individual pathological stages of SIS. The results indicate that no historical, subjective or objective features from the clinical examination are accurate in diagnosing SIS or rotator cuff tears. The presence of night pain demonstrated a significant correlation (P<0.02) with the criterion reference standard for the presence of subacromial bursa fluid/bunching. Night pain and pain with overhead activity has a high sensitivity for subacromial bursa fluid/bunching being present. The absence of night pain and the absence of pain with overhead activity are two subjective phenomena from a clinical examination that are useful in ruling out subacromial bursa fluid/bunching being present. Night pain was also found to be the best predictor of subacromial bursa fluid/bunching being present (P<0.012). Male gender (P<0.034) was the best predictor of partial thickness rotator cuff tears while being 60 years of age or older (P<0.01) significantly correlated with full thickness rotator cuff tears. The Drop Arm Sign (P<0.01) and External Rotation Lag Sign (P<0.01) were significantly correlated with SIS and full thickness rotator cuff tears. Clinical tests for all three pathological stages of SIS and subacromial bursa fluid/bunching being present, had equivalent or if not greater diagnostic accuracy than previous report studies in the literature. The Hawkins-Kennedy Test and Neer Sign can be used in the primary care setting to rule out the presence of subacromial bursa fluid/bunching or SIS if the tests are negative. For mid to end stage SIS (rotator cuff tears) the Empty Can Test and Drop Arm Sign with their high sensitivity can be used to rule out rotator cuff tears especially to the supraspinatus tendon when the tests are negative. Despite the small sample size and other limitations of this study, the findings are an important addition to the current literature surrounding the diagnostic accuracy of clinical tests for SIS and rotator cuff tears. This is the first study to use physiotherapists as examiners and to be set in a primary care setting. The study is also the first to examine the diagnostic accuracy of a range of historical and subjective features from the clinical examination. The results found in the current study could be used by future studies as a starting point in the development of a clinical decision or prediction rule to assist clinicians in the diagnosis of SIS and rotator cuff tears.
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Peneda, Maria Inês Fortuna de Oliveira Silva. "Os efeitos da técnica de MWM na dor, amplitude de movimento e funcionalidade em pacientes com síndrome do impingement no ombro: uma revisão bibliográfica." Bachelor's thesis, [s.n.], 2020. http://hdl.handle.net/10284/9573.
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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia<br>Introdução: a técnica de mobilization with movement (MWM) é considerada uma abordagem
terapêutica manual realizada em articulações periféricas, envolvendo a combinação entre movimentos
fisiológicos e acessórios, com o objetivo de melhorar a funcionalidade e a qualidade de vida, sendo
aplicada em pacientes que apresentam síndrome de impingement (SI) no ombro. Objetivo: analisar
os efeitos de MWM na dor, amplitude de movimento e funcionalidade em pacientes com SI no
ombro. Metodologia: foi realizada uma pesquisa nas bases de dados PubMed, Web of Science
e PEDro, e em outras fontes, com o objetivo de explorar artigos randomizados controlados que
incluam a análise da técnica MWM em pacientes com SI no ombro. Resultados: da pesquisa
efetuada, 5 artigos randomizados controlados cumpriram os critérios de seleção pré estabelecidos, sendo, posteriormente, avaliados de acordo com a escala de PEDro, obtendo
como valor médio 6,2/10. Conclusão: a aplicação de MWM em pacientes com SI no ombro
parece ter um efeito benéfico imediato na redução da dor, ganho de amplitude de flexão,
abdução e rotação externa quando usada isoladamente a técnica e a melhoria da funcionalidade
não é consensual entre autores.<br>Introduction: mobilization with movement (MWM) technique is considered a manual
therapeutic approach performed in peripheral joints, involving the combination of physiological
movements and accessories, with the aim of improving functionality and quality of life, which
can be applied on patients with shoulder impingement syndrome (SIS). Objective: to analyse
the effects of MWM on pain, range of motion and functionality in patients with SIS.
Methodology: a research on PubMed, Web of Science and PEDro databases was carried out in
order to explore randomized controlled articles that include analysis of MWM technique in
patients with SIS. Results: from the research, 5 randomised controlled articles met the pre established selection criteria and were subsequently evaluated according to the PEDro scale,
obtaining as mean value 6,2/10. Conclusion: the application of MWM in patients with SIS
seems to have an immediate beneficial effect on pain reduction, flexion amplitude gain,
abduction and external rotation when used alone and improvement of functionality is not
consensual among authors.<br>N/A
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Bytautienė, Jūratė. "Tikslingai organizuotų ir savarankiškų kineziterapinių procedūrų efektyvumas esant peties sąnario ankštumo sindromui." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2006. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2006~D_20060510_114752-44195.
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Objective: To compare the effectiveness of complex physical therapy and exercise program which have been completed at home (control group) in shoulder impingement syndrome treatment. Discussion: The use of home exercise program in shoulder impingement physical therapy may have a positive impact, but not that much what we can get from complex physical therapy. By comparison all measures showed statistically significant difference. Conclusion: The shoulder impingement syndrome has to be individualized process and the treatment should be multimodal and include several physical therapy methods. The more methods we would use- the better results we could achieve.
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Muth, Stephanie. "The Effects of Thoracic Spine Manipulation in Subjects with Signs of Shoulder Impingement." Diss., Temple University Libraries, 2011. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/205769.
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Physical Therapy<br>Ph.D.<br>Shoulder impingement is the most common cause of shoulder pain. It is often described as mechanical irritation of the tendons of the rotator cuff or long head of the biceps due to compression against either the structures of the subacromial arch or the glenoid and glenoid labrum. Various treatment options exist to address impingement, and recent studies suggest thoracic spine manipulation may be a useful option. The purpose of this study was to assess changes in range of motion (ROM), pain and shoulder function both immediately post- and 7 to 10 days after receiving thoracic spine manipulations. We also attempted to identify changes in scapular kinematics and shoulder muscle activity associated with thoracic spine manipulation in subjects with shoulder impingement. Thirty subjects between the ages of 18 and 45 with signs of shoulder impingement participated in this repeated measures study. All subjects received both a mid-thoracic spine and a cervicothoracic junction manipulation. Changes in pain were assessed using an 11 point numeric pain rating scale. Subjects reported pain with performance of provocative testing (Jobes Empty Can, Hawkins-Kennedy and Neer's tests for impingement) as well as with performance of cervical rotation, thoracic spine flexion and extension and weighted humeral elevation. Shoulder elevation force production pre- and post- manipulation was assessed using hand-held dynamometry. Additionally, subjects completed the Penn Shoulder Score (PSS) and the Sports and Performing Arts Module of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire to assess shoulder pain and function 7 to 10 days post thoracic spine manipulation. Electromagnetic sensors tracked three-dimensional scapular and clavicular kinematics as well as cervical, thoracic and humerothoracic ROM. Surface electromyography data were collected from the infraspinatus, serratus anterior, and the upper, middle and lower trapezius muscles with loaded humerothoracic elevation. A repeated measures analysis of variance (ANOVA) was used to compare scapular orientation and muscle activity at 30, 60, 90 ad 120 degrees of humerothoracic elevation before and after spinal manipulation. Paired t - tests revealed significant decreases in pain [(Jobes 2.6 ± 1.1, Neer's 2.6 ± 1.3, Hawkins-Kennedy 2.8 ± 1.3; p<0.001 for all three tests) (weighted shoulder elevation 2.0 ± 1.5, p<0.001; cervical rotation 0.4 ± .9, p=0.039)] as well as improvements in shoulder function (Force production 5.5±3.1, PSS 7.7 ± 9.4 and DASH 16.4 ± 13.2; p<0.001 for each). No significant changes in any of the ROM assessments were observed. No changes in scapular or clavicular kinematics were observed, with the exception of small decrease in scapular upward rotation (p = .04). A small but significant increase in middle trapezius activity (p = .03) was detected; however, no other significant differences in muscle activity were observed following manipulation. Moreover, paired t-tests revealed no significant differences in muscle onset times after manipulation. The findings of this study indicate that thoracic spine manipulation may be an effective intervention to treat pain associated with shoulder impingement; however, the improvements associated with thoracic spine manipulation are not likely explained by changes in scapular kinematics or shoulder muscle activity. Thoracic spine manipulation did not substantially alter scapular kinematics or motor control at the shoulder.<br>Temple University--Theses
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Willians, Razana. "Knowledge and understanding of radiographers regarding supraspinatus outlet projection for shoulder impingement syndrome." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/4456.
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The shoulder is a complex anatomical structure and imaging plays an important role in the diagnosis and management of shoulder conditions. The complexity of the shoulder’s anatomy has led to the development of multiple radiographic projections and techniques within plain film imaging with each projection intended to demonstrate specific aspects of the anatomy of the shoulder. However, reproducing the required projections can be difficult especially if radiographers are not familiar with the projections and their evaluation criteria. Literature has revealed the importance of a comprehensive knowledge and understanding of anatomy, patient positioning, beam direction and centring point, and evaluation criteria to ensure a quality projection for accurate diagnoses. The aim of the study was to determine the knowledge and understanding of radiographers with regard to the supraspinatus outlet projection (SOP) for shoulder impingement syndrome (SIS) and its evaluation criteria. The inferences derived from the research findings were used to develop guidelines for a structured in-service training programme for practising radiographers to optimise their knowledge and understanding of the supraspinatus outlet projection in shoulder impingement syndrome. The proposed study followed a quantitative approach. Furthermore, a descriptive, exploratory, contextual design was employed. The research population consisted of practising radiographers working in the public and private hospitals of the Nelson Mandela Bay Municipality. The data were collected by means of a structured self-administered questionnaire. The questionnaire comprised of three sections. The first section requested demographic information from the participants. The second section assessed their knowledge and understanding regarding the scapular ‘Y’ and the supraspinatus outlet projections and shoulder impingement syndrome. The third section assessed their knowledge and understanding of anatomy and image evaluation/critiquing. The reliability and validity of the data collection instrument was ensured by conducting a pilot study and comparing the results with those of the main study. In addition, the expertise and guidance of a radiographer experienced in the clinical training of radiographers, the supervisor (who has twenty years’ experience in the teaching of radiographers) and a statistician was obtained. Descriptive and inferential statistical analyses were performed by means of a statistical programme and with the guidance of a statistician. The researcher ensured that the study was conducted in an ethical manner by adhering to the ethical principles of beneficence, justice and respect for persons.
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Ryan, Kelly. "The effects of manual therapy on scapular motion in a patient with shoulder impingement a dissertation [thesis] submitted in partial fulfilment for the degree of Master of Health Science, Auckland University of Technology, November 2003." Full thesis. Abstract, 2003. http://puka2.aut.ac.nz/ait/theses/RyanK.pdf.
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Johansson, Kajsa. "Patients with subacromial pain : Diagnosis, treatment and outcome in primary care." Doctoral thesis, Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med834s.pdf.
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Ogbeivor, Collins A. O. "Lateral versus posterior approach to shoulder injection in patients with subacromial impingement syndrome : a mixed methods study." Thesis, University of Essex, 2017. http://repository.essex.ac.uk/19673/.
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Objectives: To determine the effectiveness of lateral approach to subacromial injection compared to posterior approach for the treatment of subacromial impingement syndrome (SAIS); and to establish the experiences of SAIS patients receiving these injections associated with better clinical outcomes. Design: This study used a mixed methods approach that combines a pragmatic randomised control trial to investigate which injection approach is better and a semi-structured qualitative interview to investigate the experiences of SAIS patients receiving these injections. Settings: Out-patients community musculoskeletal service Sample: 80 patients with SAIS for the randomised control study and 20 participants for the semi-structured qualitative interview. Interventions: The Intervention group received a single subacromial injection with a 21-gauge Green needle with a 40 mg/ml of Kenalog and a 4 ml 1% of Lidocaine through a lateral approach. The Control group received an identical treatment except that the location was by a posterior approach. Outcome measures: Difference in improvements in the overall patient reported outcome measures (PROMs) and shoulder pain and disability index score (SPADI) at 8 and 12 weeks follow-up between the two groups. Results: A moderate but statistically and clinically significant difference in improvement in day-time pain (mean change score) occurred in favour of the lateral group (mean = 3.7) compared with the posterior group (mean = 2.3) between week 0 to 8 (1.4 points [95% CI 0.3 to 2.6, p = 0.018]). However, there were no statistically significant differences between the groups in night-time pain, shoulder function and SPADI scores. There was a statistically and clinically significant difference (p = 0.001) within the groups for all clinical outcomes between week 0 to 8 and between week 0 and 12. This was confirmed by participants from the semi-structured interviews which were conducted 12 weeks after the injection. Conclusion: There were no real significant differences in the treatments; however, both forms of treatment were associated with significant improvement in shoulder pain, function and disability. This was confirmed by participants from the semi-structured interviews, who felt that they improved not only because of the effect of the cortisone injection, but also because of other factors such as education about their treatment, exercise information, the experience and skills of the injecting clinicians, access to treatment as well as good customer service.
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Treutiger, Victoria. "Behandling av myofasciella triggerpunkter med ”dry needling” hos personer med impingement i axelleden : En prospektiv randomiserad interventionsstudie." Thesis, Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:gih:diva-3782.
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Abstract Aim: The aim of this study was to investigate if treatment with “dry needling” in myofascial triggerpoints (MTrPs) in the rotatorcuff muscles may affect impingement symptoms such as pain during provocative tests, shoulder mobility, and function. The research questions were: Does the value of pain change on the Visual Analog Pain Scale (VAS) between before and after treatment? Do the positive provocative tests for impingement change between before and after treatment? Does the active shoulder mobility change between before and after treatment? Does the self-rated function change between before and after treatment? Method: The study was a prospective randomized intervention study and 19 persons with impingement symptoms (mean ± standard deviation; 58 ± 18 years, and shoulder pain duration 3.9 ± 1.6 months) were randomized into two groups. The groups were tested before, directly after and 3 weeks after treatment. The intervention group was treated twice, with a week in between, with “dry needling” in MTrPs. The control group was also treated on two occasions but was instead given a superficial needle in the infraspinatus muscle. All subjects were treated by the same physiotherapist. Pain was evaluated on the VAS when subjects performed active shoulder flexion before and after treatment. Provocative tests for shoulder impingement (Neer sign, Hawkins-Kennedy test and Jobe test) as well as range of motion tests were performed before, after and three weeks after treatment. The frequencies of positive/negative provocative tests were presented. Shoulder function was evaluated with the QuickDASH questionnaire. Significance level p≤0.05 was used in the study and a tendency was identified between 0.05 ≤ p < 0.1. Results: There was a tendency (p=0.086) with decreased pain (VAS) in the intervention group after the treatment. Among the impingement tests only significant improved results was observed for Neer sign test three weeks after the treatment (p=0.025) No significant difference could be seen on the active shoulder mobility between before and after the treatment. The perceived function in the intervention group, measured with the Quick DASH questionnaire, showed a tendency (p=0.086) towards a better function. Conclusions: The study showed a tendency towards that”dry needling” in MTrPs may affect impingement symptoms such as pain and function. The provocative tests for shoulder impingement, Neer sign, showed a significant decrease in pain after treatment. More studies with larger population is needed to make a statement about the effect of “dry needling” in MTrPs as a treatment for shoulder impingement symptoms.<br>Sammanfattning Syfte och frågeställningar: Syftet med studien var att undersöka om behandling med ”dry needling” (intramuskulär nålstimulering) i myofasciella triggerpunkter (MTrPs) i rotatorcuffmuskulaturen kan påverka impingementsymptom såsom smärta vid provokationstester, axelledsrörlighet och funktion. Frågeställningarna var: Förändras smärtskattning på visuell analog skala(VAS) vid aktiv axelflexion efter jämfört med före behandling? Förändras de positiva provokationstesterna för impingement efter jämfört med före behandling? Förändras den aktiva axelledsrörligheten efter jämfört med före behandling? Förändras den självskattade funktionen efter jämfört med före behandling? Metod: Studien var en prospektiv randomiserad interventionsstudie, 19 forskningspersoner (fp) med impingementsymptom, (medelålder 58 ± 18 år, besvärsdurationens medeltid 3.9 ± 1.6 mån), randomiserades till två grupper. Grupperna undersöktes före, direkt efter och tre veckor efter avslutad behandling. Interventionsgruppen behandlades vid två tillfällen, med en veckas mellanrum, med ”dry needling” i MTrPs medan kontrollgruppen vid två tillfällen istället fick en ytlig akupunkturnål i m infraspinatus. Behandlingen av alla fp utfördes av en och samma fysioterapeut. Smärta utvärderades med (VAS) vid aktiv axelflexion direkt före och efter behandling. Provokationstester (Neer sign, Hawkins-Kennedy test och Jobe test) samt rörlighetsmätning utfördes före, efter och tre veckor efter avslutad behandling. Frekvensen positiva/negativa provokationstesttest summerades. Funktionen utvärderades med frågeformuläret QuickDASH. Signifikansnivå p< 0.05 används i studien och en tendens identifierades mellan 0.05 ≤ p < 0.1. Resultat: Det fanns en tendens (p=0.086) till minskad smärta (VAS) i interventionsgruppen efter jämfört med före behandling. Bland impingementtesterna sågs enbart ett signifikant förbättrat resultat för Neers sign tre veckor efter avslutad behandling jämfört med före behandling (p=0.025). Ingen signifikant skillnad kunde ses gällande rörligheten före och efter behandling. Den upplevda funktionsförmågan mätt med frågeformuläret QuickDASH visade en tendens (p=0.086) mot bättre funktion i interventionsgruppen. Slutsats: Studien har visat tendenser på att ”dry needling” i MTrPs kan påverka impingementsymptom såsom minskad smärta och bättre självskattad funktion efter behandling jämfört med före. Impingementtestet Neer sign visade en signifikant minskad smärta efter behandling. Fler studier med större grupper, större ålderspann och längre behandlingstid behövs för att kunna uttala sig om effekten av ”dry needling” i MTrPs som behandlingsmetod vid impingementsymptom i axeln.<br><p>Fristående kurs i Idrottsvetenskap inriktning idrottsmedicin 2013-2015</p>
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San, Juan Bernardo G. 1977. "Measuring humeral head translation after suprascapular nerve block." Thesis, University of Oregon, 2009. http://hdl.handle.net/1794/10325.
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xiii, 79 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.<br>Subacromial impingement syndrome is the most common disorder of the shoulder. Abnormal superior translation of the humeral head is believed to be one of the major causes of this pathology. The overall purpose of this study was to better understand glenohumeral kinematics in normal healthy individuals using fluoroscopy to help comprehend the mechanism of shoulder impingement. This research was divided into three sections: a validation study to measure humeral head translation, a comparison between dynamic and static arm elevation and lastly, humeral head translation after a suprascapular nerve block.
In the first study, fluoroscopy was used to take images of human cadaver shoulders. Scapular orientation was manipulated in different positions while the humerus was at 90 degrees of elevation. Humeral head translation was measured using two methods and was compared to the known translation. Additionally, the accuracy of the contour registration method to measure 2-D scapular rotations was assessed.
For the second study, subjects elevated their dominant arm while fluoroscopic images were taken. An edge detection software was utilized to digitize points on both the humeral head and glenoid. Humeral head translation and scapular upward rotation were measured using a contour registration method with respect to the glenoid during arm elevation. Five different arm elevation angles were investigated to measure differences in humeral head translation between trials. There was no difference found between humeral head translation and scapular upward rotation between static and dynamic shoulder elevation.
For the third study, humeral head translation was measured before and after a suprascapular never block. The humeral head was superiorly located and the scapula was more upwardly rotated after the block. The differences were observed during mid range of motion. This result showed that there was a compensatory increase in both humeral head translation and scapular upward rotation due to the nerve block. These results suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscle could prevent any increased superior humeral head translation. This may be beneficial in preventing shoulder impingement or rotator cuff tear over time. This dissertation includes unpublished co-authored materials.<br>Committee in charge: Andrew Karduna, Chairperson, Human Physiology;
Li-Shan Chou, Member, Human Physiology;
Louis Osternig, Member, Human Physiology;
Stephen Frost, Outside Member, Anthropology
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Haik, Melina Nevoeiro. "Shoulder Impingement : Short-term effects of a thoracic spine manipulation and a systematic review of physical therapy strategies." Universidade Federal de São Carlos, 2015. https://repositorio.ufscar.br/handle/ufscar/7725.
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Previous issue date: 2015-11-18<br>Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)<br>Background: Shoulder impingement syndrome (SIS) is a common cause of shoulder pain
complains and numerous treatment strategies are available in the clinic. Questions remain
regarding the effects of Thoracic Spinal Manipulation (TSM) on SIS and concerning the efficacy
of available techniques on the treatment of this population.
Objectives: In a clinical trial, the objective was to evaluate short-term effects of a TSM on pain,
function, scapular kinematics and scapular muscle activity in individuals with SIS. In a
systematic review, the objective was to summarize current evidence regarding effectiveness of
physical therapy to improve pain, function and range of motion in this population.
Methods: In the clinical trial, participants were randomly allocated to TSM group (n=30) or
sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Shoulder
pain, shoulder function (DASH and WORC questionnaires), scapular kinematics and scapular
muscle activity were measured. A blinded assessor evaluated the outcomes at day 1, day 2-pre,
day 2-post and day 3. In the review, Pubmed, Web of Science, CINAHL Cochrane, Embase,
Lilacs, Ibecs and Scielo databases were searched up to April 2015. Randomized controlled trials
investigating different modalities of physical therapy in the treatment of patients with SIS on
pain, function/disability or range of motion were included.
Results: In the clinical trial, TSM group improved pain (1.1 points) and tended to improve
function (5.0 points on WORC) over the sham-TSM group after 2 intervention sessions. Scapular
upward rotation increased 4.0°, 5.3° and 3.3° at day 2-pre, day 2-post and day 3, respectively, in
the TSM group during lowering of the arm. Changes in scapular internal rotation and tilt were
not different between groups. Upper and lower trapezius activity decreased in the TSM group
and both groups, respectively, during elevation and lowering of the arm. Serratus anterior
activity increased in the sham-TSM group. In the review, sixty-two RCTs were included. The
majority had a low to moderate risk of bias. Exercise therapy provided high evidence of
improvements to the treatment in the short, mid or long-term. Dynamic humeral centering,
proprioceptive exercises and manual therapy associated with conventional exercises enhance the
improvements in the short-term. Low-level laser, ultrasound, pulsed electromagnetic field and
kinesio taping provided moderate and high evidence level towards no benefits to the treatment of
SIS. Microwave diathermy, transcutaneous electrical nerve stimulation and isolated manual
therapy or acupuncture provided limited evidence of benefits.
Conclusion: TSM may be worthy to achieve short-term reduction of shoulder pain, increase of
scapular upward rotation and decrease of upper trapezius activity facilitating the application of
other movement-based interventions in individuals with SIS. Exercise therapy should be used as
the first choice to improve pain, function and range of motion, and the association of manual
therapy should be the best choice to accelerate symptoms decrease and progress exercise therapy
quickly. Low-level laser therapy, ultrasound, pulsed electromagnetic field and kinesio taping do
not provide significant effects to the therapy and therefore could be avoided. More studies are
necessary to improve evidence concerning effects of diacutaneous fibrolysis, microwave
diathermy, transcutaneous electrical stimulation, acupuncture and isolated manual therapy
techniques in the treatment of SIS.<br>Introdução: A Síndrome do Impacto (SI) é uma causa comum de dor no ombro e inúmeras
estratégias de tratamento estão disponíveis na clínica. Os efeitos da manipulação torácica e a
eficácia de muitas técnicas de tratamento da SI ainda não estão claros na literatura.
Objetivos: Em um ensaio clínico, os objetivos foram avaliar os efeitos a curto-prazo de uma
manipulação torácica na dor, função, cinematica scapular e atividade muscular em indivíduos
portadores de SI. Em uma revisão sistemática, o objetivo foi sintetizar a atual evidência a
respeito da efetividade da fisioterapia para melhorar a dor, função e amplitude de movimento
nessa mesma população.
Métodos: No ensaio clínico, os participantes foram distribuídos aleatoriamente ao grupo
manipulação (n=30) ou grupo sham (n=31) e receberam 2 sessões de intervenção durante 1
semana. Foram medidos dor e função do ombro (questionários DASH e WORC), cinematica e
atividade muscular da escápula. Um avaliador cego coletou as variáveis no dia 1, dia 2-pré
intervenção, dia 2 pós-intervenção e no dia 3. Na revisão sistemática, as buscas foram realizadas
nas bases de dados Pubmed, Web of Science, CINAHL Cochrane, Embase, Lilacs, Ibecs e Scielo
até abril de 2015. Foram incluídos ensaios clínicos randomizados controlados que investigaram o
efeito de diferentes modalidades fisioterapêuticas no tratamento de pacientes com SI na dor,
função e amplitude de movimento.
Resultados: No ensaio clínico, o grupo manipulação apresentou diminuição da dor (1.1 pontos) e
uma tendência de melhora na função (5.0 pontos no WORC) comparado ao grupo sham após 2
intervenções. A rotação superior da scapula aumentou 4.0°, 5.3° e 3.3° no dia 2 pré-intervenção,
dia 2 pós-intervenção e no dia 3, respectivamente durante a descida do braço. As mudanças na
rotação interna e na inclinação da scapula não foram diferentes entre os grupos. Atividade do
trapézio superior e trapézio inferior diminuiu no grupo manipulação e em ambos grupos,
respectivamente. A atividade do serrátil anterior aumentou no grupo sham. Na revisão
sistemática, 62 estudos controlados randomizados foram incluídos. A maioria dos estudos
apresentou baixo risco de vies. Os exercícios terapêuticos apresentaram alta evidência de
melhora no tratamento a curto, médio e longo prazo. Os exercícios proprioceptivos e a terapia
manual associada com exercícios convencionais aumentam as melhoras a curto prazo. O laser de
baixa intensidade, ultrassom, campo pulsado eletromagnético e o tape proporcionaram evidência
moderada e alta de nenhum benefício ao tratamento. As terapias com ondas curtas, estimulação
transcutânea eletromagnética, a terapia manual aplicada de forma isolada e a acupuntura
apresentaram evidência limitada de benefícios.
Conclusão: A manipulação torácica parece proporcionar a curto prazo redução da dor no ombro,
aumento da rotação superior da scapula e diminuição da atividade do trapézio superior
facilitando a aplicação de outras terapias focadas no restabelecimento do movimento em
pacientes com SI. Os exercícios terapêuticos devem ser utilizados como primeira opção para
melhorar a dor, a função e a amplitude de movimento, e a associação dos exercícios com a
terapia manual deve ser a melhor opção para acelerar a melhora dos sintomas. O laser de baixa
intensidade, ultrassom, campo eletromagnético pulsado e o tape não proporcionam efeitos
significativos à terapia, portanto, devem ser evitados. Mais estudos são necessaries para
aperfeiçoar a evidência a respeito da terapia com ondas curtas, miofibrólise, estimulação elétrica
transcutânea, acupuntura e terapia manual aplicada isoladamente no tratamento da SI.
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Costa, Susana Valentim. "Prevalência lesiva em atletas de voleibol: efeitos da implementação do protocolo “FIFA 11+ S” na funcionalidade do complexo articular do ombro." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/6263.
Full textAbstract:
Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia<br>Introdução: O ombro dos atletas de voleibol é submetido a forças repetitivas que podem proporcionar alterações biomecânicas e originar uma alta incidência de lesões nesta articulação. Objetivo: Este estudo tem como propósito analisar a prevalência de lesões em voleibolistas, e demostrar se o protocolo do “FIFA 11+S” promove alterações funcionais no complexo articular do ombro. Metodologia: Quinze atletas da federação portuguesa de voleibol (FPV) do sexo masculino, do escalão júnior, divididos em dois grupos foram submetidos a uma avaliação da força muscular dos rotadores do ombro no isocinético, e da funcionalidade do complexo articular do ombro através do “shoulder mobility test”. Durante 3 semanas foi aplicado o protocolo “FIFA 11+S” ao grupo experimental (GE), com uma periocidade de quatro vezes por semana, e com a duração de 30 minutos. Resultados: Após aplicação do protocolo constatou-se que os atletas do GE não apresentaram alterações significativas no “mobility shoulder test”, no peak torque, défices, nem a nível de rácios dos músculos rotadores do ombro. Conclusão: O protocolo “FIFA 11+S” não alterou de um modo significativo a funcionalidade do complexo articular do ombro.<br>Introduction: The shoulder of volleyball athletes is subjected to repetitive forces that can provide biomechanical alterations and lead to a high incidence of lesions in this joint. Objective: This study aims to analyze the prevalence of lesions in volleyball players, and demonstrate whether the protocol of "FIFA 11 + S" promotes functional alterations in the joint shoulder complex. Methodology: Fifteen athletes from Portuguese volleyball Federation (FPV) male junior echelon divided in two groups, were subjected to an evaluation of the rotator of the shoulder muscle strength in isokinetic and mobility of the shoulder joint complex through the "shoulder mobility test". During 3 weeks the Protocol "FIFA 11 + S" has been applied to the experimental group (GE) with a periodicity of four times a week, and with the duration of 30 minutes. Results: After application of the Protocol was found that GE athletes did not show significant changes in the "mobility shoulder test", in peak torque, deficits, or the level of ratios of the rotator shoulder. Conclusion: The Protocol "FIFA 11 + S" did not alter significantly the functionality of shoulder joint complex.<br>N/A
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Tillander, Bo. "The Supraspinatus Tendon : Clinical and histopathological aspects." Doctoral thesis, Linköping : Univ, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5224.
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Rufino, Filipa Alexandra Silva Cunha. "Comparação entre diferentes tipos de exercícios terapêuticos no conflito subacromial: uma revisão bibliográfica." Bachelor's thesis, [s.n.], 2020. http://hdl.handle.net/10284/9151.
Full textAbstract:
Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia<br>Objetivo: Este estudo teve como objetivo determinar o efeito da utilização de exercícios terapêuticos durante o tratamento fisioterapêutico da patologia em estudo, com o intuito de diminuir a sintomatologia dolorosa e aumentar a funcionalidade da articulação afetada. Metodologia: Pesquisa nas bases de dados Pubmed, EBSCOhost e PEDro para identificar estudos randomizados controlados que avaliassem várias intervenções de tratamentos com exercícios no conflito subacromial. Resultados: Nesta revisão foram incluídos 10 estudos envolvendo 613 pacientes, com classificação metodológica de média aritmética 6,1 na escala de PEDro. Relativamente aos artigos incluídos, 4 comparam diferentes tipos de exercícios, 3 compararam os exercícios com diferentes métodos de eletroterapia, 1 compara as correntes interferenciais com os exercícios e a terapia manual, 1 comprara a terapia convencional com a terapia de “Gaming” e 1 artigo que compara o efeito da mobilização e exercícios de fortalecimento. Conclusão: Os resultados nesta revisão bibliográfica sugerem que os exercícios parecem ter benefícios a longo prazo.<br>Objective: This study aimed to determine the effect of using therapeutic exercises during the physiotherapeutic treatment of the pathology under study, in order to decrease the painful symptoms and increase the functionality of the affected joint. Methodology: Searches the Pubmed, EBSCOhost and PEDro databases to identify randomized controlled studies that evaluate various treatment interventions with exercises in subacromial conflict. Results: This review included 10 studies involving 613 patients, with an arithmetic mean methodological classification of 6.1 on the PEDro scale. Regarding the articles included, 4 compared different types of exercises, 3 compared the exercises with different methods of electrotherapy, 1 compared them with interferences with the exercises and the therapy manual, 1 included a conventional therapy with “Gaming” therapy and 1 article that compares the effect of mobilization and strengthening exercises. Conclusion: The results in this literature review suggest that exercise appears to have long-term benefits.<br>N/A
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Jay, Gregoire Baptiste Joaquim. "Efeitos do tape rígido em pacientes com síndrome de Impingement subacromial." Bachelor's thesis, [s.n.], 2017. http://hdl.handle.net/10284/5873.
Full textAbstract:
Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia<br>Objetivo: Compreender a efetividade da aplicação do tape rígido durante um tratamento de
fisioterapia, ou como uma técnica fisioterapêutica isolada, em pacientes com síndrome de
impingement subacromial. Metodologia: Pesquisa computadorizada nas bases de dados
Pubmed/Medline e PEDro para identificar estudos que avaliassem a eficácia e os efeitos do
tape rígido em pacientes com síndrome de impingement subacromial. Resultados: Nesta
revisão foram incluídos 6 artigos envolvendo 366 indivíduos, com classificação metodológica
de 6,25 para os estudos randomizado e de 7,5 para os estudos de coorte na escala Critical
Appraisal Skills Programme (CASP). Dos estudos selecionados, três analisaram o efeito do
tape rígido na escápula durante um tratamento de fisioterapia, um estudo avaliou o efeito do
tape rígido de um modo isolado, um outro comparando o membro com SIS com o membro
contralateral e um último com uma população sem patologia. Conclusão: O tape rígido
desempenha um papel importante na correção postural, na facilitação dos movimentos, na
redução da dor e na atividade muscular. Nesta revisão, com os estudos analisados, vimos que
aplicação de tape rígido parece ter efeitos e eficácia apenas durante um curto prazo.<br>Objective: To understand the effectiveness of rigid tape application during a physiotherapy
treatment, or as an isolated physiotherapeutic technique, in patients with subacromial
impingement syndrome. Methodology: Research in computerized data bases
Pubmed/Medline e PEDro to identify studies evaluating the efficacy and effects of rigid tape
during a physiotherapy treatment or as an isolated physiotherapeutic technique in patients
with subacromial impingement syndrome. Results: This review included 6 articles involving
366 individuals with methodological classification of 6,25 for randomized controlled trials
and of 7,5 for cohort studies in the Critical Appraisal Skills Programme (CASP) scale. From
the analyzed studies it was found that three analyzed the effect of rigid tape in the scapula
during a physiotherapy treatment, one study evaluated the effect of solo rigid tape application,
another compared the involved limb with SIS with the uninvolved limb and the last compared
using a healthy population. Conclusion: The rigid tape plays an important role in postural
correction, facilitating movements, reducing pain and muscle activity. In this review, with the
studies analyzed, we have seen that rigid tape application seems to have effects and efficacy
only for a short time.<br>N/A
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Grimes, Jason Keith. "Immediate Effects of a Seated versus Supine Upper Thoracic Spine Thrust Manipulation Compared to Sham Manipulation in Individuals with Subacromial Pain Syndrome – A Randomized Clinical Trial." Diss., NSUWorks, 2017. https://nsuworks.nova.edu/hpd_pt_stuetd/58.
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Background: Individuals with Subacromial Pain Syndrome (SPS) often present with a variety of contributing factors. It is possible that a subgroup exists within SPS that has primary impairments of scapular mobility and/or muscle strength. In an attempt to better identify scapular contributions in SPS, the Scapular Assistance Test (SAT) and Scapula Reposition Test (SRT) have been described. Additionally, thoracic spine thrust manipulation has been shown to be effective for shoulder pain. Problem Statement: It is currently unknown whether or not there are impairments in scapulothoracic muscle force generation or scapular mobility in individuals with SPS who have positive results on the SAT and SRT. It also remains unknown whether individuals with SPS respond differently in the immediate effects on scapular motion, scapulothoracic muscle force generation, pain, or function following different manipulation techniques. Methodology: Sixty subjects with shoulder pain were enrolled in the study. Baseline measures were obtained for scapular upward rotation and posterior tilt, scapulothoracic muscle force generation, pectoralis minor muscle length, pain, and function. Participants were randomized to receive a seated thrust manipulation, supine thrust manipulation, or sham manipulation. Measures were reassessed immediately after treatment and the Penn Shoulder Score (PSS) was reassessed at 48 hours. Results: The results indicated no significant differences in scapular upward rotation or posterior tilt, or muscle force generation based on the results of the SAT or SRT. There was a small but significant difference in pectoralis minor muscle length based on the result of the SAT. There were no significant between-group differences in scapular motion, muscle force generation, or pectoralis minor muscle length based on the treatment received. There were no significant differences in 48-hour improvement in pain, function, satisfaction, and total PSS scores. Small but significant within group changes existed on several measures. Discussion: The SAT and SRT may be ineffective in differentiating scapular movement associated impairments. Thoracic spine thrust manipulation resulted in no greater immediate improvements in scapular motion, strength, pectoralis minor muscle length, pain, or function compared to a sham treatment. The improvements in pain and function are likely not biomechanical in nature and are likely not derived from the manipulative thrust.
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Ribeiro, Ivana Leão. "Mapa topográfico de sensibilidade dolorosa à pressão no ombro em indivíduos com síndrome do impacto do ombro." Universidade Federal de São Carlos, 2014. https://repositorio.ufscar.br/handle/ufscar/5329.
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Previous issue date: 2014-02-27<br>Universidade Federal de Minas Gerais<br>Background: Shoulder pain is one of the most common and disabling complaints, and shoulder impingement syndrome (SI) is one of the most common causes of this symptom. Recently, several records of pressure pain threshold become useful tools as topographical pressure pain sensitivity maps to assess the state of awareness on various musculoskeletal conditions. However, there are no studies that have proposed topographic maps to assess shoulder sensitivity. Objective: To develop topographical pressure pain sensitivity maps of the shoulder in subjects with SI as compared with healthy subjects, and to analyze the intra-rater reliability of the topographic maps of the shoulder in healthy and asymptomatic subjects. Methods: Initially, 29 predetermined points and 4 points in fixed anatomical locations have been identified on both shoulders of 25 patients with SI and 25 healthy and asymptomatic subjects. The map was determined from anatomical landmarks and anthropometric measurements of each individual. Of all 32 points assessed, 11 are located in bony structures, 11 in muscle bellies, 9 in tendons, 1 on the coracoacromial ligament and 1 over the acromioclavicular joint. The pressure pain threshold was evaluated at all points in the dominant and nondominant side of healthy subjects and in the symptomatic and asymptomatic sides in subjects with SI. The sides and points were randomized prior to the evaluation. The pressure pain threshold was assessed 3 times on each point (20 s of rest), and the mean of each measure was considered for analysis. Results: The methodology used allowed us to characterize a topographic map for assessing shoulder pain sensitivity in subjects with SI. There was no difference between the SI and healthy groups (p> 0,05). However, the symptomatic side of subjects with SI showed higher sensitization (p <0.05), in some locations (points 6 and 7, located on the spine of the scapula and point 10, located on the infraspinatus muscle). The tendons were the most sensitive structures, followed by the bones for both groups. There was excellent intra-rater reliability between the trials of pressure pain threshold for each point (non-dominant side of healthy subjects, ICC: 0.86-0.98; dominant side of healthy subjects, ICC: 0.89-0.96). The standard error of measurement and minimal detectable change presented range, respectively, 28.4-55.9kPa and 66.7-131.4kPa (non-dominant side), 29.4-60.8kPa and 69.6-142.2kPa (dominant side). Conclusion: The proposed topographical pressure pain sensitivity maps of the shoulder was useful for detecting the state of peripheral hyperalgesia in different anatomical structures (bones, muscles and tendons) in subjects with SI, and was reliable for assessing pressure pain sensitivity on the shoulder in healthy subjects.<br>Contextualização: A dor no ombro é uma das queixas mais comuns e incapacitantes, e a síndrome do impacto do ombro (SI) é uma das causas mais comuns desta sintomatologia. Recentemente, mapas topográficos com vários registros de limiar de dor à pressão tornaram-se ferramentas úteis para avaliar o estado de sensibilização em diversas condições musculoesqueléticas. No entanto, não há ainda estudos que tenham proposto mapas topográficos para avaliar a sensibilidade dolorosa no ombro. Objetivo: Propor e caracterizar um mapa topográfico de sensibilidade dolorosa à pressão no ombro em indivíduos com SI e comparar a indivíduos saudáveis, e analisar a confiabilidade intra-examinador do mapa topográfico de sensibilidade dolorosa à pressão no ombro em indivíduos saudáveis e assintomáticos. Métodos: Inicialmente, 29 pontos pré-determinados e 4 pontos em localizações anatômicas fixas, foram identificados em ambos os ombros de 25 portadores da SI e 25 indivíduos saudáveis e assintomáticos no ombro. O mapa foi determinado a partir de pontos anatômicos e medidas antropométricas de cada indivíduo. De 32 pontos avaliados, 11 se localizam em estruturas ósseas, 11 em ventres musculares, 9 sobre tendões ou junções miotendíneas, 1 sobre o ligamento coracoacromial e 1 sobre a articulação acrômioclavicular. O limiar de dor à pressão foi avaliado em todos os pontos, nos lados dominante e não dominante dos indivíduos saudáveis e, nos lados sintomático e assintomático dos indivíduos com SI do ombro. Os lados e os pontos a serem avaliados foram randomizados antes da coleta de dados. O limiar de dor à pressão foi examinado 3 vezes sobre cada ponto (intervalo 20 s), e a média entre cada medida foi considerada para a análise. Resultados: A metodologia utilizada permitiu caracterizar um mapa topográfico para a avaliação da sensibilidade dolorosa do ombro em indivíduos com SI. Não houve diferença entre os grupos SI e saudáveis (p>0.05). No entanto, o lado sintomático dos indivíduos com SI apresentou maior sensibilização (p<0.05) em algumas localizações (pontos 6 e 7, localizados sobre a espinha da escápula e ponto 10, localizado sobre o músculo infraespinal). Os tendões foram as estruturas mais sensíveis, seguido dos ossos, para ambos os grupos SI e indivíduos saudáveis. Houve excelente confiabilidade intra-examinador, entre as repetições de limiar de dor á pressão para cada ponto (lado não dominante dos indivíduos saudáveis, ICC: 0.86-0.98; lado dominante dos indivíduos saudáveis, ICC: 0.89-0.96). O erro padrão da medida e a mínima diferença detectável apresentaram amplitude, respectivamente, 28.4-55.9kPa e 66.7- 131.4kPa (lado não dominante); 29.4-60.8kPa e 69.6-142.2kPa(lado dominante). Conclusão: O mapa topográfico proposto foi útil para detectar o estado de hiperalgesia periférica em diferentes estruturas anatômicas (ossos, músculos e tendões) em indivíduos com SI, e mostrou-se confiável para avaliar a sensibilidade dolorosa à pressão no ombro em sujeitos saudáveis.
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Kardouni, Joseph. "Effects of Thoracic Spinal Manipulative Therapy on Thoracic Spine and Shoulder Kinematics, Thoracic Spine Flexion/Extension Excursion, and Pressure Pain Sensitivity in Patients with Subacromial Pain Syndrome." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3304.
Full textAbstract:
EFFECTS OF THORACIC SPINAL MANIPULATIVE THERAPY ON THORACIC SPINE AND SHOULDER KINEMATICS, THORACIC SPINE FLEXION/EXTENSION EXCURSION, AND PRESSURE PAIN SENSITIVITY IN PATIENTS WITH SUBACROMIAL PAIN SYNDROME By Joseph R. Kardouni, Ph.D., PT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, at Virginia Commonwealth University. Virginia Commonwealth University, 2013. Major Director: Lori A. Michener, PhD, PT, ATC, Professor, Department of Physical Therapy In patients with shoulder pain, the use of manual therapy directed at the spine and shoulder have been reported to provide superior outcomes to exercise based interventions or usual care without the use of manual therapy. Clinical trials have also reported improved pain and disability after thoracic spinal manipulative therapy (SMT) as a stand-alone treatment for shoulder pain. Although clinical efficacy is reported for the use of thoracic SMT for the treatment of shoulder pain, the mechanisms underlying the clinical benefits are not well understood. This limits the directed use of SMT. The benefits could be due to changes in spine or shoulder motion or neurophysiologic mechanisms of pain modulation. Elucidating the mechanism of manual therapy will aid the directed use of thoracic SMT for treating patients with shoulder pain. The research described in chapters 3 and 4 was performed to assess the effects of thoracic SMT in patients with subacromial pain syndrome with regard to biomechanical changes at the thoracic spine and shoulder and effects on central and peripheral pain sensitivity. Subjects with shoulder impingement pain symptoms were randomly assigned to receive 1 visit of thoracic SMT or sham SMT, applied to the lower, middle, and upper (cervicothoracic junction) thoracic spine. A 3-dimensional electromagnetic tracking system was used to measure thoracic and scapular kinematics during active arm elevation, and thoracic excursion at end-range of flexion and extension pre- post-treatment. Pressure pain threshold (PPT) was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. PPT measures at the painful shoulder were used to assess peripheral and/or central pain sensitivity, and PPT at unaffected regions measured central pain sensitivity. Patient-rated outcomes measures of pain (Numeric Pain Rating Scale-NPRS), function (Pennsylvania Shoulder Score-Penn), and global rating of change (GROC) were used to assess changes in clinical symptoms following treatment. No significant differences were found between treatment groups for the thoracic kinematics or excursion, shoulder kinematics, PPT measures, or patient-rated outcomes. No differences were noted pre- to post-treatment in either group for thoracic kinematics or excursion or PPT measures. In both groups, there was a decrease in mean scapular external rotation over time during ascending arm elevation, but the change was less than measurement error. Outcome measures of NPRS, Penn and GROC indicated clinical improvements in both groups following treatment, but there were no differences between the thoracic SMT or sham SMT groups. There were no meaningful correlations between thoracic and scapular kinematics or thoracic excursion with the outcome measures of NPRS, Penn, or GROC. There was a significant positive correlation (r=0.52 , p=0.009) between change in PPT at the lower trapezius on the unaffected side and baseline Penn scores. Biomechanically, thoracic spine extension and excursion did not change following thoracic SMT, and the SMT group had no greater changes in shoulder kinematics or patient-rated pain and function than the sham SMT group. Additionally, thoracic SMT did not improve peripheral or central pain sensitivity as measured by PPT. Furthermore, improvements in patient-rated outcomes were not found to be related to changes in thoracic spine mobility, or shoulder kinematics with SMT. The single correlation between change in PPT and baseline Penn may indicate a neurophyciologic effect of SMT in patients with higher baseline function scores, but the since no other significant relationships between PPT and outcome were seen, the implications of this finding are limited. Overall, alterations in thoracic spine mobility and pressure pain sensitivity do not appear to be responsible for improved outcomes in patients with subacromial pain syndrome. Future studies should explore the effects of SMT using other measures of thoracic spine motion and experimental pain modalities, as well as greater dosing of SMT over a longer follow-up.
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Jonsson, Per. "Eccentric training in the treatment of tendinopathy." Doctoral thesis, Umeå : Sports Medicine, Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-25856.
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Malavolta, Eduardo Angeli. "Avaliação do uso do plasma rico em plaquetas no reparo da rotura do manguito rotador." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-27022014-122547/.
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O plasma rico em plaquetas (PRP) tem sido utilizado na ortopedia como método para melhorar a cicatrização tecidual. Existem poucos estudos com alto nível de evidência sobre o seu efeito no reparo do manguito rotador e os resultados são conflitantes, não havendo consenso sobre sua eficácia. O objetivo primário deste estudo foi avaliar o efeito do uso do PRP em pacientes submetidos ao reparo do manguito rotador por via artroscópica através da escala da University of California at Los Angeles (UCLA). A avaliação clínica através da escala de Constant-Murley, de dor através da escala visual analógica (EVA), a presença de rerroturas na análise da ressonância magnética (RM) e a ocorrência de complicações foram considerados desfechos secundários. Estudo prospectivo, randomizado, duplo-cego. Dois grupos com 27 pacientes (Grupo PRP e Grupo Controle) foram submetidos ao reparo artroscópico em fileira simples de âncoras, sendo que, no Grupo PRP, foi aplicado o concentrado de plaquetas ao final do procedimento. O PRP foi obtido por aférese, aplicado na consistência líquida, com adição de trombina autóloga. Foram incluídas apenas roturas de espessura completa do supraespinal com retração inferior a 30 mm. Os procedimentos foram realizados pelo mesmo cirurgião, entre setembro de 2008 e abril de 2012. Os desfechos foram avaliados através das escalas da UCLA, de Constant-Murley, EVA e pela RM, pré-operatoriamente e aos 3, 6 e 12 meses. A EVA foi aplicada adicionalmente no primeiro e sétimo dia. O nível de significância empregado foi de 5%. Os pacientes apresentaram melhora clínica significativa com o procedimento nos dois grupos (p < 0,001). Evoluíram de 13,63 ± 3,639 para 30,04 ± 4,528 no Grupo Controle e de 13,93 ± 4,649 para 32,30 ± 3,506 no Grupo PRP aos 12 meses (p = 0,046) de acordo com a escala da UCLA, com um poder de 84% e tamanho do efeito de 0,56. De acordo com a escala de Constant-Murley, os pacientes evoluíram de 47,37 ± 11,088 para 76,89 ± 13,198 no Grupo Controle e de 46,96 ± 11,937 para 83,26 ± 11,141 no Grupo PRP aos 12 meses (p=0,061). A avaliação aos 3 e 6 meses não demonstrou diferença significativa. A avaliação pela EVA não demonstrou diferença estatística em nenhum dos tempos de seguimento, evoluindo de 7,00 ± 1,939 no Grupo Controle e de 6,67 ± 1,617 no Grupo PRP no pré-operatório para 1,70 ± 2,127 e 1,04 ± 1,808, respectivamente, aos 12 meses (p = 0,220). Na análise pela RM, o Grupo Controle apresentou uma rerrotura completa e quatro parciais, enquanto o Grupo PRP apresentou duas rerroturas parciais (p = 0,42). Ocorreu um caso de rigidez articular em cada grupo (p = 1). O PRP obtido por aférese, aplicado na consistência líquida e com adição de trombina propiciou melhores resultados pela escala da UCLA aos 12 meses de pós-operatório<br>Platelet-rich plasma (PRP) has been used in orthopedics as a method to enhance tissue healing. There are few studies with a high level of evidence about its effect on rotator cuff repair, and the results are conflicting, with no consensus about its effectiveness. Clinical assessment as measured by the UCLA (University of California at Los Angeles) shoulder rating scale was established as the primary outcome. The secondary outcomes included clinical assessment on the Constant-Murley scale, pain as measured by a visual analog scale (VAS), the retear rate assessed by magnetic resonance imaging (MRI) and the complication rate. A prospective, randomized, doubleblind trial was conducted. Two groups of 27 patients (PRP Group and Control Group) were subjected to arthroscopic single-row repair. Liquid PRP prepared by apheresis was applied to the PRP Group at the end of the surgical procedure, with autologous thrombin. Complete supraspinatus tears with retraction less than 30 mm were included. The procedures were performed by the same surgeon between September 2008 and April 2012. Outcomes were assessed using UCLA and Constant-Murley scales, VAS and magnetic resonance imaging preoperatively and at 3, 6 and 12 months. The VAS was also applied on days one and seven. The significance level was 5%. The two groups of patients exhibited significant clinical improvement (p < 0.001). The score on the UCLA scale increased from 13.63 ± 3.639 to 30.04 ± 4.528 and from 13.93 ± 4.649 to 32.30 ± 3.506 in the Control and PRP groups, respectively, between the preoperative assessment and after 12 months (p=0.046), with a 84% power and a 0.56 effect size. The score on Constant-Murley scale increased from 47.37 ± 11.088 to 76.89 ± 13.198 in the Control Group and from 46.96 ± 11.937 to 83.26 ± 11.141 in the PRP Group (p = 0.061). Assessment at 3 and 6 months did not identify significant differences. The VAS did not statistically differ at any investigated timepoint and varied from 7.00 ± 1.939 and 6.67 ± 1.617 before surgery to 1.70 ± 2.127 and 1.04 ± 1.808 at the 12-month assessment in the Control and PRP groups, respectively (p = 0.220). The Control Group exhibited one case of complete and four of partial retears, and the Group PRP exhibited two cases of partial retears (p = 0.42). PRP prepared by apheresis, applied in the liquid state with thrombin, promoted better results on the UCLA scale 12 months after surgery
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Mitonneau, Grégoire. "Plaidoyer pour l'intégration des sciences de la motricité dans la démarche de prévention des troubles musculo-squelettiques : le cas précis de l'épaule." Thesis, Saint-Etienne, 2014. http://www.theses.fr/2014STET007T/document.
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Les troubles musculo-squelettiques de l’épaule constituent un problème majeur de santé au travail. Le principal mécanisme à l’origine de ces pathologies est le conflit sous-acromial, dont le développement est intimement lié à la qualité du contrôle neuromusculaire de l’épaule. Nos données montrent que les tâches expérimentales classiquement utilisées pour l’exploration des facteurs de développement du conflit sous-acromial sont insuffisantes pour rendre compte de la complexité du contrôle neuromusculaire mis en jeu lors des tâches industrielles. Il semble primordial que les actions de lutte contre les TMS considèrent la réalité de l’organisation motrice à l’origine de leur développement. L’application dans ce travail de la technique d’enregistrement électromyographique au secteur industriel met en évidence la pertinence de cet outil afin d’orienter et d’évaluer les actions ergonomiques qui visent à réduire la charge musculo-squelettique. Un moyen complémentaire de lutte contre les TMS a été proposé afin de pallier aux limites propres à la démarche ergonomique. Il s’agit d’un exercice de recentrage dynamique de la tête humérale exécuté en chaîne cinétique fermée, déployé lors d’un programme d’intervention destiné aux opérateurs ayant des symptômes de conflit sous-acromial. Nos données mettent en évidence une diminution de la douleur et une amélioration de la fonction de l’épaule suite à cette intervention. Les bénéfices associés à cette démarche répondent au double enjeu de santé et de performance, essentiel pour les individus comme pour l’entreprise. Finalement, l’ensemble des contributions expérimentales et des applications industrielles présentées dans ce travail de thèse souligne le rôle central que peuvent jouer les spécialistes de la motricité humaine dans la démarche de lutte contre les TMS. Leur intégration dans les équipes pluridisciplinaires de prévention constitue un réel enjeu pour la réduction de ce risque professionnel majeur<br>Shoulder disorders represent a major health problem at the workplace. The most common shoulder disorder is the subacromial impingement syndrome. Shoulder neuromuscular control has a critical role in the development of shoulder disorders. Our data show that the experimental tasks generally use to investigate subacromial impingement causative factors are insufficient to represent the complexity of shoulder neuromuscular control involved during industrial tasks. It is essential that workplace interventions take into consideration the actual motor control associated with the development of work-related musculoskeletal disorders. The use of the electromyography in the industrial context, during this thesis work, highlights the interest of this tool in order to conduct and evaluate ergonomic interventions that aimed to reduce exposure to physical risk factors. Another work-related musculoskeletal disorder management way was proposed as a supplement to ergonomic interventions. It is about a dynamic closed chain humeral head centering exercise performed by assembly line workers with clinical signs of subacromial impingement syndrome. Our data demonstrated that the intervention program was effective in decreasing shoulder pain as well as improving shoulder function. This study underlined the relevance of therapeutic exercises for shoulder disorders management at the workplace. Finally, the whole of this thesis work highlights the decisive role of specialists in human motor analysis for work-related musculoskeletal disorders management
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Haik, Melina Nevoeiro. "Cinemática escapular : confiabilidade e efeitos pré e pós uma manipulação torácica em sujeitos com e sem sintomas de impacto - um estudo controlado randomizado." Universidade Federal de São Carlos, 2013. https://repositorio.ufscar.br/handle/ufscar/5313.
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Previous issue date: 2013-02-21<br>Financiadora de Estudos e Projetos<br>Background: There is a lack of studies that evaluated within day and between day reliabilities of 3-D scapular kinematics during elevation and lowering of the arm in different shoulder conditions, as well as studies about low-amplitude and high-velocity thoracic spine manipulation (TSM) effects on scapular kinematics in subjects with shoulder dysfunctions. Objective: To establish within day and between day reliability of scapular motion during elevation and lowering of the arm and at rest position and to evaluate the immediate effects of a TSM on pain and scapular kinematics during elevation and lowering of the arm, both in subjects with and without shoulder impingement syndrome (SIS). Methods: Kinematic data were collected using Flock of Birds® electromagnetic device. Subjects were divided in 2 groups: control and impingement. For reliability kinematic data were collected during elevation and lowering of the arm and at rest position on 2 different occasions separated by 3 to 5 days. Forty-nine subjects were tested for within day reliability. Forty-three subjects were reassessed for between day reliability. For kinematic evaluation pre- and ppost-manipulation, scapular kinematics was collected during elevation and lowering of the arm before and immediately after the intervention. Numeric pain rating scale was used to assess shoulder pain during arm movement at pre- and post- intervention. Fifty subjects (31.76 ± 10.91 years) with SIS and 47 subjects (25.76 ± 5.01 years) asymptomatic for shoulder dysfunctions were randomly assigned to one of the groups: manipulation or sham. Results: There was very good within day reliability for assessing scapular internal and upward rotations and tilt from both groups during elevation and lowering of the arm (ICC=0.92-0.99). In general, there was good between day reliability for assessing scapular motion during elevation and lowering of the arm from both groups (ICC=0.54-0.88). There was also good and very good between day reliability for assessing scapular rest position in both groups (ICC=0.66-0.95). Study 2: Subjects with SIS experienced reduced shoulder pain (from 3.29 to 2.45, p<0.01) during arm movement immediately after TSM. Subjects with and without SIS who received TSM and asymptomatic subjects who received sham intervention showed significant increase in scapular upward rotation at post-intervention. Increase in scapular anterior tilt at postmanipulation was also observed in asymptomatic subjects who received TSM. Conclusion: Flock of Birds® electromagnetic tracking system is a reliable device for measuring 3-D scapular motion during elevation and lowering of the arm and at rest position in subjects with and without impingement symptoms over time. TSM is associated with improved shoulder pain and scapular upward rotation in subjects with SIS. Although with questionable clinical relevance, TSM may not be immediately favorable to scapular tilt in asymptomatic subjects.<br>Além da escassez de evidências a respeito da confiabilidade entre repetições e dias da avaliação cinemática 3-D da escápula durante a elevação e descida do braço em diferentes condições do ombro, estudos sobre os efeitos da manipulação torácica de alta velocidade e baixa amplitude (MT) na cinemática escapular em sujeitos assintomáticos e portadores de disfunções no ombro também são bastante escassos. Objetivo: Determinar a confiabilidade entre repetições e entre dias das medidas do movimento 3-D da escápula durante a elevação e descida do braço e na posição de repouso e avaliar os efeitos imediatos de uma MT na dor e na cinemática da escápula durante a elevação e descida do braço, ambos em sujeitos assintomáticos e portadores da síndrome do impacto (SI). Métodos: Para a avaliação cinemática foi utilizado o dispositivo eletromagnético Flock of Birds®. Os sujeitos foram divididos em 2 grupos (controle e impacto). Os dados cinemáticos para a confiabilidade foram coletados durante a elevação e descida do braço e na posição de repouso em duas ocasiões diferentes separadas por 3 a 5 dias. Quarenta e nove sujeitos foram avaliados para a confiabilidade entre repetições e quarenta e três sujeitos foram avaliados para a confiabilidade entre dias. Para a avaliação pré e pós-manipulação os dados cinemáticos foram coletados durante a elevação e descida do braço antes e imediatamente após a intervenção. A escala numérica de dor mediu a dor durante o movimento do braço antes e após a intervenção. Cinquenta sujeitos (31,76 ± 10,91 anos) com SI e 47 sujeitos (25,76 ± 5,01 anos) assintomáticos para disfunções no ombro foram aleatoriamente designados a um dos seguintes grupos : manipulação ou sham. Resultados: A confiabilidade das medidas entre as repetições foi excelente para as rotações medial e superior e para a inclinação da escápula em ambos os grupos durante a elevação e a descida do braço (CCI=0,92-0,99). No geral, confiabilidade entre dias para avaliar os movimentos escapulares durante a elevação e a descida do braço para ambos os grupos foi boa (CCI=0,54-0,88). A confiabilidade entre dias também foi boa e excelente para as rotações escapulares durante a posição de repouso em ambos os grupos (ICC=0,66-0,95). Houve melhora significativa da dor nos sujeitos com SI (de 3,29 para 2,45, p<0,01) durante o movimento do braço imediatamente após a MT. Os sujeitos com e sem SI que receberam a MT e os sujeitos assintomáticos que receberam a intervenção sham apresentaram significativo aumento na rotação superior da escápula após a intervenção. O aumento na inclinação anterior após a manipulação também foi observado nos sujeitos assintomáticos que receberam a MT. Conclusão: O Flock of Birds® é um dispositivo eletromagnético confiável para medir ao longo do tempo o movimento 3-D da escápula durante a elevação e descida do braço e na posição de repouso em sujeitos assintomáticos e portadores de SI ao longo do tempo. A MT está associada com a melhora da dor e da rotação superior da escápula nos sujeitos com SI. E, apesar da questionável relevância clínica, a MT pode não ser imediatamente favorável para a inclinação escapular nos sujeitos assintomáticos.
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Ferreira, Ana Luísa Rodrigues Claro. "Descrição do Efeito de uma Intervenção de Fisioterapia com o Auxílio do Biofeedback Cinemático Tridimensional em Utentes com Disfunção no Ombro, na Dor, na Função e na Estabilidade Dinâmica." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2017. http://hdl.handle.net/10400.26/18684.
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Dissertação de Mestrado em Fisioterapia: Relatório de Projeto de Investigação<br>Introdução: A disfunção no ombro é muito comum e debilitante. A evidência recente sugere que a intervenção nas disfunções do complexo articular do ombro (DCAO) deve incidir no controlo do movimento da omoplata, seguindo os princípios da estabilidade dinâmica. O biofeedback cinemático tridimensional (BCin 3D) tem-se verificado útil, como meio de feedback extrínseco em tempo real durante uma tarefa/exercício, sendo que até ao momento não existe evidência sobre os efeitos da utilização do BCin 3D na melhoria da cinemática da omoplata e redução dos sintomas em utentes com DCAO. Assim, o objetivo deste estudo foi descrever o efeito da intervenção da Fisioterapia, com o auxílio do BCin 3D, usando um protocolo de intervenção baseado nos princípios da estabilidade dinâmica e da reaprendizagem motora, em utentes com DCAO, descrevendo os seus efeitos na dor, funcionalidade e estabilidade dinâmica. Abordagem metodológica:Realizou-se uma série de estudos de caso em 10 sujeitos com DCAO (média idades 30,3±9,4). Todos os sujeitos foram submetidos ao protocolo de intervenção, focado na omoplata, com o auxílio do BCin3D em tempo real. Para quantificar a Dor e a Função usou-se respetivamente a Escala Visual Análoga, o Índice de Dor e Incapacidade no Ombro e o Incapacidade do Braço, Ombro e Mão. O Padrão de Recrutamento Motor e o Controlo Motor foram medidos através da atividade eletromiográfica do Trapézio Superior e Inferior; Grande Dentado e Deltóide Anterior. Usou-se um sistema de varrimento eletromagnético para reconstruir a cinemática 3D do tórax, omoplata e úmero, como fonte de Biofeedback em tempo real. Analisou-se os resultados no início; final, após um mês Follow-up (FU), e semanalmente em cada sujeito. Resultados: Evolução positiva no que respeita aos outcomes Função, Dor e Estabilidade dinâmica da omoplata, e manutenção dos mesmos após um mês de FU. O tempo total de intervenção foi de 7,8 (±2,9) semanas. Conclusão:Do conhecimento dos autores, este parece ter sido o primeiro estudo a descrever o efeito do BCin3D associado a uma intervenção com exercícios focados na omoplata, em utentes com DCAO, com resultados positivos no Final da intervenção e um mês após a alta.<br>Introduction: Shoulder dysfunction (SD) is a common condition. The current best available evidence points to the benefits of therapeutic exercises, and to the scapular-focused retraining as an effective solution to improve shoulder dynamic stability. While biofeedback-assisted interventions are widely advocated in musculoskeletal dysfunctions, there is no published evidence about the its effect when associated with scapular-focused interventions in patients with SD. The purpose of this study was to describe the effect of a scapular-focused protocol using real-time three-dimensional (3D) kinematic feedback, on the level of pain and functioning, and scapular control in patients with SD. Methods: A series of case studies was conducted with 10 subjects (30,3±9.4 years old) with SD. All subjects were submitted to a scapular-focused protocol, based on the three phases of a motor relearning process, including scapular dynamic control exercises assisted with real-time kinematic feedback. Visual Analogue Scale, and the Disabilities of Arm Shoulder and Hand, and Shoulder Pain and Disability Index scales were used to quantify pain and functioning levels, respectively. Electromyographic activity of the upper trapezius and lower trapezius fibres, serratus anterior and anterior deltoid was collected to quantify muscles’ onset and activation intensity. Skin-mounted electromagnetic sensors were used to reconstruct the 3D kinematics of the thorax, scapula and humerus, and as a source of real-time feedback. All outcomes were assessed in the beginning, on a weekly basis, at the end of the intervention, after one month of discharge (follow-up). Results: All patients assessed improvements during the intervention period regarding the level of pain, functioning and scapular control, without recurrence of their SD within the follow-up. Mean treatment time was 7,8 (±2,9) weeks. Conclusion: To the authors’ best knowledge this is the first study describing the positive effect of a kinematic biofeedback-assisted scapular-focused intervention on patients with SD, with a decrease in pain and increase in functioning levels, and regained scapula-thoracic dynamic control.
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Yang, Shi-Pin, and 楊世斌. "Screening test validity for shoulder impingement syndrome." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/05528535699953883409.
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碩士<br>國立陽明大學<br>物理治療暨輔助科技學系<br>98<br>Background: Shoulder impingement is the most common disorder of the shoulder. It can be categorized into the primary, secondary and internal types of impingement. Many screening tests have been developed to aid for diagnosing shoulder impingement; however, the validity of the single test is not satisfactory. Because accurate diagnosis and proper management is based on accuracy of the screening tests, there is a need to improve validity of the tests for different types of shoulder impingement. Purposes: To establish validity of the screening tests for different types of shoulder impingement syndrome and to explore if combing different tests could result in better test validity as compared to single tests. Methods: This was an exploratory cross-sectional study design. Sixty subjects with possible shoulder impingement syndrome (38 males, 22 females) were recruited. We performed 15 shoulder impingement screening tests after the subjects filled out basic information and pain history. The subjects were grouped into a primary, secondary or internal impingement type based on physician’s clinical examination combined with imaging findings or by imaging diagnosis alone. Descriptive analyses were used to summarize subjects’ basic information such as age, height, weight, gender, physical activity, and pain history. We computed sensitivity, specificity, overall accuracy and positive likelihood ratio for the 15 clinical tests with the two-by-two table method. We used the Chi squared tests to compare test results between those with or without primary impingement and those with external or internal impingement. We also used a cross-matching method to form combination tests that could best discriminate among the three types of shoulder impingement syndrome. Statistical significance level (P) was set at 0.05. Results: According to the physician’s diagnosis, the painful arc test had the best diagnostic accuracy of 73% in the primary impingement type; the sulcus sign gave the best diagnostic accuracy of 93% in the secondary type; and the internal rotation resistance test yielded the best accuracy of 90% in the internal impingement type. When combining the painful arc, Neer’s, impingement relief, and the supraspinatus tests, with 2 of the 4 tests being positive, the screening accuracy would improve to 78% for the primary impingement syndrome as diagnosed by the physician. When combining the the Neer’s, Speed, Sulcus sign, apprehension-relocation, and load and shift tests, with 4 of the 5 tests being positive, the screening accuracy would improve to 97% for secondary impingement syndrome as diagnosed by the physician. When all three of the supraspinatus, apprehension-relocation and internal rotation resistance tests were positive, the screening accuracy improved to 98% for internal impingement as diagnosed by the physician. The screening validity was slightly lower in both the single and combination tests when the diagnosis was made by the imaging data alone. Conclusions: Combining different tests would yield better accuracy than the single tests in differentiating different types of shoulder impingement syndromes. The screening validity was better for diagnoses made by the physician than by imaging data alone.
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Munday, Sarah Louisa. "The efficacy of shoulder adjustments on patients suffering from shoulder impingement syndrome." Thesis, 1999. http://hdl.handle.net/10321/2699.
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Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999.<br>Impingement syndrome of the shoulder is a very common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this investigation was to investigate the effectiveness of the chiropractic adjustment in order to determine whether or not it is an effective approach in the treatment of impingement syndrome<br>M
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De, Pauw Lori Ann. "Shoulder internal and external rotation strength in impingement syndrome." 1996. http://hdl.handle.net/1993/19084.
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North, Lydia. "Range of Motion and Impingement in Reverse Shoulder Arthroplasty." Thesis, 2014. http://hdl.handle.net/1974/8684.
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Reverse shoulder arthroplasty (RSA) is a joint replacement procedure used mainly to treat patients with severe shoulder osteoarthritis combined with massive rotator cuff tears. It involves reversing the `ball and socket' orientation of the glenohumeral joint in the shoulder. While RSA has been largely successful in treating pain and improving function in these patients, complication rates remain high. Many of these complications, including joint instability and scapular notching (excessive bone wear), are caused or exacerbated by impingement of the humerus or the humeral component against the scapula. Adduction deficit refers to a patient's inability to fully adduct the arm due to impingement. Minimizing adduction deficit may improve RSA patients' functional outcomes.
An existing mechanical shoulder simulator was further developed to model glenohumeral range of motion in RSA. The three heads of the deltoid were modelled using polyethylene cable and electric linear actuators with inline load cells. RSA components were implanted in Sawbones scapula and humerus bone models. The scapula was fixed in the frame of the simulator. Triads of optical tracking markers were attached to the humerus and simulator frame and used to track segment motion.
A data analysis technique was developed to determine when joint impingement occurred. The convex and concave surfaces of the glenoid and humeral components were digitized, and a least-squares sphere fit was used to find their centres. The distance between these centres was then calculated during passive abduction and adduction of the humerus, and labeled d_GH. Impingement onset was defined as the point where d_GH was five standard deviations above its baseline value, indicating that the components were no longer concentric. This technique was used to determine the effects of humeral neck-shaft angle, socket depth, glenosphere diameter and eccentricity on range of motion and adduction deficit.
A retentive humeral cup depth increased adduction deficit by 14 degrees and reduced range of motion by 26 degrees. A decreased neck-shaft angle reduced adduction deficit by 10 degrees but had little effect on overall range of motion. Diameter and eccentricity had no effect on either measure.<br>Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2014-04-03 13:34:07.404
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"Shoulder impingement syndrome in Chinese: a functional and clinical study." Graduate School, Chinese University of Hong Kong, 1990. http://library.cuhk.edu.hk/record=b5886638.
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by Charles Yuk-Po Lo.<br>Thesis (M.Phil.)--Chinese University of Hong Kong, 1990.<br>Bibliography: leaves 179-188.<br>Abstract --- p.1<br>Chapter I. --- INTRODUCTION --- p.4<br>Chapter 1.1 --- The shoulder complex --- p.4<br>Chapter 1.2 --- Reactions of overuse --- p.6<br>Chapter 1.3 --- Controversies --- p.9<br>Chapter 1.4 --- The Cybex II isokinetic dynamometer --- p.11<br>Chapter 1.5 --- Objectives --- p.12<br>Chapter 1.6 --- Methodology --- p.16<br>Chapter 1.7 --- Scope --- p.18<br>Chapter 1.8 --- Definition of terms --- p.22<br>Chapter II. --- LITERATURE REVIEW --- p.24<br>Chapter 2.1 --- Functional anatomy of the shoulder complex --- p.24<br>Chapter 2.2 --- Shoulder impingement syndrome --- p.34<br>Chapter 2.3 --- Forces upon the supraspinatus tendon --- p.39<br>Chapter III. --- METHODOLOGY --- p.43<br>Chapter 3.1 --- Epidemiological survey --- p.43<br>Chapter 3.2 --- Standardization of assessment --- p.47<br>Chapter 3.3 --- Isokinetic evaluation --- p.60<br>Chapter 3.4 --- Biomechanical study of stress upon supraspinatus tendon --- p.77<br>Chapter 3.5 --- Data analysis --- p.88<br>Chapter IV. --- RESULTS --- p.90<br>Chapter 4.1 --- Epidemiological survey --- p.92<br>Chapter 4.2 --- Standardization of assessment --- p.105<br>Chapter 4.3 --- Isokinetic evaluation --- p.106<br>Chapter 4.4 --- Biomechanical study --- p.111<br>Chapter 4.5 --- Correlation between angle of maximal stress with isokinetic finding --- p.117<br>Chapter V. --- DISCUSSION --- p.124<br>Chapter 5.1 --- Epidemiological survey --- p.124<br>Chapter 5.2 --- Standardization of assessment --- p.129<br>Chapter 5.3 --- Isokinetic evaluation --- p.130<br>Chapter 5.4 --- Biomechanical study --- p.133<br>Chapter VI. --- CONCUSION --- p.139<br>Chapter VII. --- APPENDICES --- p.142<br>Chapter 3.1 --- Questionnaire --- p.142<br>Chapter 3.2 --- Stage score --- p.145<br>Chapter 3.3 --- Pain score --- p.146<br>Chapter 3.4 --- Activity score --- p.147<br>Chapter 3.5 --- Assessment form --- p.148<br>Chapter 3.6 --- Defining dominant side --- p.152<br>Chapter 3.7 --- Pattern of load during calibration --- p.153<br>Chapter 3.8 --- Calibration of load cell --- p.154<br>Chapter 4.1 --- Format for input of isokinetic data --- p.156<br>Chapter 4.2 --- Log command for analysing isokinetic data --- p.157<br>Chapter 4.3 --- Isokinetic performance of impingement subjects --- p.160<br>Chapter 4.4 --- Isokinetic performance of control subjects --- p.161<br>Chapter 4.5 --- Log command for the comparison between impingement and control groups --- p.162<br>Chapter 4.6 --- Comparison of isokinetic performance between impingement & control subjects --- p.164<br>Chapter 4.7 --- Format for input of body weight ratio data --- p.165<br>Chapter 4.8 --- Log command for analysing body weight ratio data --- p.166<br>Chapter 4.9 --- Format for input of biomechanical study data --- p.167<br>Chapter 4.10 --- Raw data of biomechanical study --- p.168<br>Chapter 4.11 --- Analysis of maximal stress at 100° shoulder flexion/abduction --- p.169<br>Chapter 4.12 --- Analysis of stress in biomechanical study --- p.170<br>Chapter 4.13 --- Significance of trough during 100° shoulder movement --- p.178<br>Chapter VIII. --- REFERENCES --- p.179
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Chiu, Yuan-Chun, and 邱元駿. "The immediate effect of shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/me5nuy.
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碩士<br>國立臺灣大學<br>物理治療學研究所<br>107<br>Background: Rounded shoulder posture (RSP), associated with altered scapular kinematics and imbalance of muscle activity, is one of potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of scapula. Evidence showed shoulder brace improved degree of RSP by postural correction. However, it is unknown whether shoulder brace with different characteristics (tension and direction) is optimal for muscle activity and scapular kinematics in patients with SIS and RSP. Objective: The purposes of this study were to (1) compare the effect of shoulder brace (no-brace and comfortable/forced diagonal brace) on clinical RSP measurements, muscle activities and scapular kinematics in subjects with SIS and RSP; (2) compare the effect of two directions (paraspinal muscle and diagonal orientation) and two tensions (self-comfortable and forced tension) of strap on muscle activities, muscle balance ratios and scapular kinematics during arm movements in subjects with SIS and RSP. Design: Twenty-four participants with SIS and RSP were recruited and randomly assigned into 2 groups (self-comfortable following forced tension and forced following self-comfortable tension groups) with 2 directions of strap in each tension wearing shoulder brace. Each subject had the assessment 2 times with 1-week interval. Pectoralis minor index (PMI), acromial distance (AD), scapular index (SI) and shoulder angle (SA) were used to assess degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography muscle activity were used to record the scapular kinematics, absolute muscle activity and muscular balance ratios during arm movements with or without shoulder brace. Main outcome measures: Scapular kinematics (upward/downward rotation, anterior/posterior tilt, external/internal rotation), absolute muscle activity (UT, MT, LT, SA) and muscle balance ratios (UT/LT, UT/SA) were main outcomes of the study. Results: All clinical measurements with the brace were significantly improved, including VAS, AD, PMI, SI, SA and FLEX-SF (p< 0.05). For muscle activities under forced tension, muscle activities were higher in diagonal brace than those in parallel brace for LT (1.2~2.3%MVIC, p< 0.05) and SA (2.3%MVIC, p= 0.015) while UT/LT muscle balance ratio were lower in diagonal brace than those in parallel brace (0.39, p= 0.019). For scapular kinematics under forced tension, upward rotation and posterior tilting of the scapula in diagonal direction were larger than those in parallel direction (1.5°, p= 0.038; 0.4°~0.5°, p< 0.05, respectively). For internal rotation under forced tension, degree of scapular kinematics in diagonal direction brace were less than those in parallel direction (1°~1.8°, p< 0.05). Conclusion: The application of shoulder brace with diagonal orientation and tension between comfortable and forced is suggested for SIS subjects with RSP.
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Booyens, Ryan Patrick. "The short term efficacy of thoracic spinal manipulation on shoulder impingement syndrome." Thesis, 2015. http://hdl.handle.net/10321/1347.
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Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015.<br>Background: The most common shoulder complaint seen by physicians is shoulder impingement syndrome. There has been limited success with the current conservative treatment that has been provided for this condition. Thoracic spine and rib manipulation is purported to aid in the treatment of this condition; however there is a paucity of controlled investigations. The purpose of this study was to determine the short term efficacy of thoracic and prone rib manipulation on shoulder impingement syndrome.
Methods: A randomised, placebo controlled pre-test post-test experimental design was used. Informed consent was obtained and 30 participants were recruited according to inclusion criteria and allocated to either a placebo or intervention group. Intervention consisted of thoracic spinal and rib manipulation. Data was collected, pre and post the first treatment and at a 48 hours follow up. SPSS was used to analyse the data with a p value of 0.05.
Results: No statistically significant differences were seen between the groups for pain rating, range of motion of the glenohumeral joint, lateral scapula slide test or scapula isometric pinch test. The shoulder pain and disability index (SPADI) showed significant (p = 0.04) differences between the groups in terms of disability scores, with the intervention group having a great improvement in disability. No clinically significant differences were observed between the groups.
Conclusion: Thoracic spine and rib manipulation appears to improve the disability associated with shoulder impingement syndrome, however further research is required with a larger sample size.
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Chung, Ya-Chu, and 鍾雅竹. "Altered corticospinal excitability of scapular muscles in patients with shoulder impingement syndrome." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/92658556891377863654.
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碩士<br>國立陽明大學<br>物理治療暨輔助科技學系<br>103<br>Background: Shoulder impingement syndrome is a common shoulder disease. Previous studies found that patients with shoulder impingement syndrome presented with abnormal neuromuscular control of scapular muscles, including over activation of the upper trapezius and inhibition of the lower trapezius and serratus anterior. Transcranial magnetic stimulation (TMS) is a noninvasive and painless tool used for observing cortical neuromuscular control. Several studies have observed changes in central neuromuscular control in patients with low back pain or non-traumatic shoulder instability using TMS. However, there are few studies investigating changes in the central neuromuscular control of scapular muscles in individuals with shoulder impingement syndrome. The purpose of this study was to examine changes in central neuromuscular control of trapezius muscles and serratus anterior muscles in individuals with shoulder impingement syndrome. Method: This study was an exploratory and cross-sectional study. For the transcranial magnetic stimulation experiment, we recruited 14 subjects with shoulder impingement syndrome and 14 healthy controls. The cortical representations of trapezius and serratus anterior muscles were examined while the subjects were seated with arm elevation of 90 degrees in the scapular plane. We used transcranial magnetic stimulation (TMS) (MagStim 200 stimulator, MagStim Company, UK ) to find the hot spot of the target muscles and the active motor threshold (AMT), motor evoked thresholds (MEPs), response latency and the cortical silent period (CSP) were recorded using Neuropack M1 MEB-9200 (Nihon Kohden, Tokyo, Japan). In addition, we stimulated the sites around the hotspot to find the mapping area and calculated the center gravity of the mapping area (COG) of each target muscle. For the scapular kinematics experiment, 6 subjects with shoulder impingement syndrome and 6 healthy subjects participated. We used the Liberty electromagnetic tracing system to collect the scapular kinematics data and the scapular muscle activities were measured using the electromyography (TeleMyo 2400T G2, Noraxon USA Inc., Scottsdale, AZ) at the same time. Statistical analysis: We used SPSS19.0 to analyze the data of cortical excitability representation and scapular kinematics. Mann-Whitney U test was used to compare the basic data, cortical excitability representations, scapular kinematics and scapular muscle activities between the two groups. The relationship between the cortical excitability of scapular muscles and the scapular muscle activities during arm elevation in the scapular plane were analyzed with Pearson’s correlation coefficients. The significance level was set at 0.05. Results: The active motor threshold of the lower trapezius and the serratus anterior, the cortical silent period of the lower trapezius and the center of gravity of serratus anterior muscle mapping area showed significant difference between the two groups (P=0.019 ~ 0.048). There were no significant differences in motor evoked potentials and mapping areas of scapular muscles between the two groups (P>0.05). With respect to scapular kinematics and scapular muscle activities, the minimum value of upper rotation during the lower phase of scaption was significantly different between the two groups (P=0.037), but there were no significant differences in scapular muscle activity during scaption between the patients and the controls. The center of gravity of lower trapezius and serratus anterior muscle mapping areas were correlated with serratus anterior activity during scaption (R=0.743 ~ 0.777, P=0.003 ~ 0.006). Conclusion: There were differences in cortical excitability of scapular muscles between patients with shoulder impingement and the controls. As a consequence, therapies should increase the neuromuscular motor control training of lower trapezius muscle and serratus anterior when clinically treating patients with shoulder impingement syndrome.
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HUANG, YU-TING, and 黃玉婷. "The Relevance of Shoulder Impingement Syndrome to Poor Posture in Excellent Baseball Athletes." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/96701754148398799866.
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碩士<br>國立體育大學<br>運動保健學系<br>105<br>Background and purpose: When the people with forward-head, rounded-shoulder posture will affect the scapula in the thoracic movement mode of action, and the scapula position abnormalities and scapula muscle imbalance may result in scapular dyskinesis, so that narrow the subacromial space cause shoulder impingement syndrome. Therefore, this study will explore the baseball player under the shoulder impingement syndrome and measuring their cervical and thoracic spine posture, scapula position and scapular muscle strength of all the more relevant, but also compared difference between the baseball player’s position of the scapula and the strength of the scapulae, who were not affected by the shoulder impingement syndrome. Methods: In this study, 30 high-school and college baseball players who practicing more than 3 years were recruited. The subjects are divided into shoulder impingement group (n=15) and control group (n=15) according to the American shoulder and elbow surgery (ASES) shoulder assessment form and special test. The use of baseline bubble inclinometer and hand-hold dynamometer instruments for the two groups of cervical and thoracic spine posture, scapular position and scapular muscle strength of the three categories of indicators are divided into twelve test items of measurement. Statistical analysis: Statistical analysis was performed using SPSS 20.0, descriptive statistics that the subjects of basic information. Using point-biserial correlation coefficient to explore the association of shoulder impingement syndrome with posture, scapular position and scapular muscle strength. Independent t test was used to compare the posture, scapular position and scapular muscle strength between the two groups. A paired-t test was used to compare difference as between the throwing and non-throwing side of the shoulder forward angle, scapular position and scapular muscle strength. Results: This study found a moderate negative correlation between the shoulder impingement and the cervical and thoracic spine posture (R = -.548); a low negative correlation with the scapular position (R = -170); moderate positive correlation with the scapular muscle strength (R = .470). While the cervical and thoracic spine posture indicators in the shoulder impingement group compared with the control group have more thoracic kyphosis angle (p＝.019) and forward shoulder angle (p＝.041). The scapular muscle strength refers to the upper, middle and lower trapezius muscle strength of the impingement group was smaller than the control group (p < .05), and there was no significant difference between the two groups (p> .05). Conclusions: Through the cervical and thoracic spine posture, scapular position and scapular muscle strength examination, the results found that high school and college baseball players shoulder impingement syndrome and posture and the scapular muscle strength more relevant. When the thoracic kyphosis and forward shoulder angle is larger and the trapezius muscle strength is insufficient, it is higher risk to cause baseball players shoulder impingement syndrome.
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Tsao, Pai-chin, and 曹百瑾. "The effect of combined movement therapy for patientswith shoulder impingement after subacromial injection." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/56476295979091606559.
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碩士<br>國立成功大學<br>物理治療研究所<br>97<br>Background：Patients with subacromial impingement syndrome (SAIS) have been reported to demonstrate decreased shoulder range of motion, muscle strength and abnormal scapular control strategies during shoulder movement. Sodium hyaluronate (SH) injection has been widely used for the reduction of pain or inflammation, and several studies have provided evidence to support joint mobilization techniques in reducing clinical symptoms or improving scapular control strategies especially for patients with SAIS.
However, no studies have investigated the effects of mobilization with movement (MWM) on clinical symptoms and scapular control strategy for SAIS patients who had SH injection. Purpose：The study aimed to examine the immediate effect as well as the 3-week short term effect of MWM for SAIS patients undertaking SH injection. Methods：Twenty subjects with SAIS were randomly assigned to treatment group (n=10) and control group (n=10), but 2 of control subjects failed to complete the 3-week follow-up evaluation. Pain status, shoulder range of motion (ROM)(flexion, abduction, internal rotation, external rotation), shoulder strength(upper trapezius, UT; serratus anterior, SA; lower trapezius, LT; middle deltoid, MD; shoulder external rotators, ER; shoulder internal rotators, IR; supraspinatus), functional test (hand to scapula test, lift-off test),scapula motion (scapular upward rotation, internal rotation and posterior tipping) and muscle activities(UT, SA, LT MD) during shoulder scaption were measured before SH injection and one day after injection to examine the immediate effect of subacromial injection. The treatment group was then re-evaluated to examine the immediate effect of MWM after receiving the first session of MWM which was performed 20 minutes after post-injection evaluation. Treatment group undertook MWM twice a week for 3 weeks thereafter. At last all subjects in either treatment or control groups were arranged to complete the final assessment. The assessment mainly included pain status, shoulder ROM, shoulder strength, shoulder posterior capsule tightness, shoulder pain and disability index (SPADI), functional test and scapular control strategy. Results：The results of immediate effect of MWM showed significantly reduced pain, significantly increased shoulder ROM (flexion abduction, internal and external rotation), and significantly increments of shoulder strength (SA, LT, ER) right after one-session of MWM (p<0.05). In addition, significantly increased scapular upward rotation during arm lowering process(90°~40°), and significantly increased LT and MD muscle activities during arm lowering process(UT：80°~20°, MD：50°~20°) were also found (p<0.05). The follow-up of short term effect for MWM showed significantly pain reduction, significantly increased shoulder ROM (flexion, abduction, internal rotation), and significantly increments of shoulder strength (MD, SA), and functional test (hand to scapula test, lift-off test) one day after SH injection before MWM was applied, and the effects lasted until 3 weeks after MWM especially in shoulder ROM (flexion, abduction, internal and external rotation), shoulder strength(UT, SA, IR, ER and supraspinatus) , functional test (hand to scapula test, lift-off test) and SPADI scores (p<0.05). In contrast, although significant improvement was also found in pain reduction, shoulder ROM (internal rotation) and shoulder strength(SA) one day after injection in the control group(p<0.05), the effect did not last until 3 weeks after injection except for shoulder strength(UT, DT, IR,ER, p<0.05). No significant difference was found on scapular motion 3 weeks after injection in both groups, but the treatment group has shown a trend toward decreased scapular internal rotation and increased scapulohumeral rhythm after taking 3 week MWM. On the other hand, a trend of increased scapular internal rotation, decreased scapular upward rotation and decreased scapulohumeral rhythm were found in the control group 3-week after injection. The latency of scapular muscle onset during arm scaption also decreased after taking 3 week MWM, although without significant changes. Moreover, significantly decreased UT muscle activities during arm lowering process(60°~0°) were found after taking 3 week MWM in the treatment group and significantly decreased MD muscle activities during arm elevation (20°~40°) and lowering process(30°~20°, 10°~0°) in the control group. Conclusion：Immediate effect of SH injection was found in pain reduction and the improvement of shoulder ROM (internal rotation)and shoulder strength(SA), however the effect did not last until 3 weeks after injection expect for the strength of UT, DT, IR and ER. In contrast, additional MWM after SH injection have provided more significantly immediate effect especially on shoulder ROM (flexion, abduction, external rotation), shoulder strength (LT and ER) and scapular control strategy as well as more lasting effects in shoulder ROM (flexion, abduction, external rotation and internal rotation), shoulder strength (UT, SA, IR and ER), SPADI scores, functional test and scapular control strategy at 3 weeks after injection. In conclusion, MWM treatment was strongly recommended for SAIS patients that just had one shot of SH injection for better outcome or more lasting effects .
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Deng, Huei-Ru, and 鄧惠如. "Proprioception of Glenohumeral and Scapulothoracic Joints in Individuals with and without Shoulder Impingement Syndrome." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/30422193019332990588.
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碩士<br>國立陽明大學<br>物理治療暨輔助科技學系<br>99<br>Background and purpose: The scapula plays several roles in facilitating optimal shoulder function. Without adequate neuromuscular control of the scapulothoracic articulation, the glenohumeral joint (GHJ) would not function around a stable base of support. The scapular dyskinesis, which describes as altered muscle activation patterns and movement coordination of the scapula, was often observed in patients suffering from shoulder impingement problems. Proprioception deficit has been suggested as a contributor to the scapular dyskinesis and was commonly emphasized in the rehabilitation following shoulder impingement. However, there is a lack of studies describing the measurement method for scapular proprioception and the interaction between shoulder pathology and scapular proprioception performance. Therefore, the purposes of this study was to describe and compare shoulder joint and scapular proprioception in subjects with and without shoulder impingement syndrome, and between injured and non-injured sides in subjects with shoulder impingement, and between dominant and non-dominant shoulders of the control subjects. In addition, whether scapular rotator muscles activation were related to shoulder proprioception performance was assessed. Methods: Twenty patients with shoulder impingement syndrome and 20 matched control subjects participated this study. The joint position sense (JPS) was measured as reposition error. The JPS of shoulder joint was measured elevation at 60° and 120° target position during scaption (elevation in the scapular plane). The JPS of scapular was measured in 4 scapular movements (elevation, depression, protraction and retraction). The subject was asked to reposition their scapula to the maximum and reference position in each scapular movement. The scale ruler and Liberty electromagnetic tracking system were used to collect the joint orientation and position, and surface electromyography (sEMG) of serratus anterior, upper trapezuis, middle trapezuis, and lower trapezius muscles was measured during shoulder scaption. Statistical analysis: Independent t test was used to compare the basic data between the two groups. A paired-t test was used to compare difference as between dominant and non-dominant, and between injured and non-injured arm. Two-way (group×side) repeated measures analysis of variance (ANOVA) was used to examine the reposition error scores of shoulder and scapular proprioception. Three-way (group×side×target) repeated measures analysis of variance (ANOVA) was used to examine the sEMG of scapular muscle activity. Pearson’s correlation coefficients were used to describe the relationship between the reposition errors and sEMG of scapular muscle activity. The level of significance was set at α＝0.05. Results: A significant group by side interaction was observed for shoulder and scapular proprioception (p&lt;0.05). Patients with shoulder impingement demonstrated singnificantly bigger reposition errors than the healthy control group for shoulder joint and scapular proprioception test (p&lt;0.05). The reposition error of shoulder and scapula was not significantly different between dominant and non-dominant shoulders of the control group (p>0.05). The injured arm presented with larger reposition errors compared with non-injured shoulder of the patient group (p&lt;0.05). There was a significant group by target position interaction for upper trapezuis muscle activity during scaption (p&lt;0.05). The post hoc analysis showed that upper trapezuis of the injurd shoulder presented with a trend of increased activity during arm elevation at 120° target position as compared to healthy control group (p=0.064). The reposition errors were poor but correlated with sEMG of scapular muscle activity（r=0.326~0.350, p&lt;0.05）. Conclusions: Our study indicated that shoulder and scapular proprioception was impaired in subjects with shoulder impingement. When treating patients with shoulder impingement, we recommended using the neuromuscular control exercise to improve the shoulder and scapular proprioception.
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Hari, Milan. "The effectiveness of spinal manipulative therapy versus manipulation of the acromioclavicular joint in the treatment of impingement syndrome of the shoulder /." 2004.
Find full textAbstract:
Thesis (M. Tech.(Chiropractic))--Technikon Witwatersrand, 2004.<br>Supervisor: Malany Moodley ; Co-supervisor: Neil De Villiers. Includes abstract. Includes bibliographical references (leaves 107-114). Also available via World Wide Web.
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Richards, Jacqueline. "The efficacy of rehabilitation of postural and muscular imbalances in the chiropractic management of shoulder impingement syndrome in swimmers." Thesis, 2008. http://hdl.handle.net/10210/839.
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The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only).<br>Dr. B. Losco Dr. C. Lyons
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Chen, En-Tsz, and 陳恩賜. "Effect of Myofascial Trigger Point Therapy and Subacromial Corticosteroid Injection in Patients with Unilateral Shoulder Impingement Syndrome." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/20300949378534261888.
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碩士<br>國立陽明大學<br>物理治療暨輔助科技學系<br>105<br>Background and Purpose: Shoulder impingement syndrome (SIS) is the most prevalent diagnosis of shoulder pain. Impaired shoulder function and abnormal scapulothoracic muscle function have been found in patients with painful SIS. The pain usually occurs at the acromion area during arm elevation. The pathophysiology of SIS is multifactorial, including subacromial space pathologies, scapular muscle dysfunction, and abnormal scapular kinematics. Normal kinematics and muscle function of the shoulder are believed critical to preservation of the subacromial space and prevention of impingement. Thus, restoration of normal muscle function is crucial in treating SIS. Recent studies reveal that myofascial trigger points (MTrPs) are associated with shoulder muscle dysfunction and SIS. Manual compression on MTrPs and subacromial corticosteroid injection are commonly used to reduce pain in individuals with SIS. But the evidence of MTrP therapy and corticosteroid injection for SIS is still limited. In addition, previous clinical trials did not reflect the influence of MTrP therapy and corticosteroid injection on motor control ability of the patient.Therefore, the aim of this study is to compare the immediate and short-term effects among MTrP therapy, corticosteroid injection, and combined MTrP therapy with corticosteroid injection in patients with SIS. Methods: This was a prospective, randomized controlled trial. Sixty patients with unilateral SIS (numeric pain rating scale >3/10) and MTrPs in one of the seven shoulder muscles (upper trapezius, supraspinatus, levator scapulae, rhomboid, infraspinatus, teres minor, and pectoralis minor) were randomly allocated to the MTrP therapy group (N=20, mean age=55.75 years), the corticosteroid injection group (N=20, mean age=56.10 years), and the combined therapy (corticosteroid injection and MTrP therapy) group (N=20, mean age=55.40 years). For all three groups, only one treatment session was given. Outcomes included current pain intensity, 24-hour worst pain intensity, pressure pain threshold, active pain-free shoulder mobility, shoulder movement control ability, shoulder function (Patient Specific Functional Scale) and disability (Quick Disabilities of Arm, Shoulder and Hand questionnaire), and perceived improvement (Global Rating of Change Scale). Two-way repeated measures ANOVAs were used to analyze the group by time interactions. Level of significance was set at p < 0.05. Appropriate post-hoc tests were used to compare the between-group and within-group differences on each outcome immediately and after 7 days. Level of significance was set at p < 0.017. Results: There were no significant group by time interactions in current shoulder pain intensity, shoulder disability, and shoulder function, but significant time main effects (P<0.001) were found in these outcome measures. For the worst pain intensity in 24 hours, a significant group by time interaction (P=0.010) was observed from the analysis. The combined therapy group showed significantly better effect than the other two groups on reducing the worst pain in 24 hours at 7-day follow-up. For the outcome of perceived improvement after 7 days, significantly higher percentage (65%) of patients in the combined therapy group demonstrated larger scale improvement than the corticosteroid injection group (40%). The MTrP group and the combined therapy group demonstrated significantly better treatment effects than the corticosteroid group immediately and 7 days after the intervention on movement control ability in arm flexion control (P=0.007),abduction control (P=0.028) and medial rotation control (P=0.024), pressure pain threshold (P<0.032) of the existing trigger points. Conclusion: One session of MTrP therapy, corticosteroid injection and combined therapy were all effective in reducing current pain intensity, increasing active pain-free shoulder mobility, and improving shoulder disability and function. The treatment effect could be maintained for at least 7 days. One session of MTrP therapy or MTrP therapy combined with subacromial corticosteroid injection were equally effective on decreasing pressure pain sensitivity and improving shoulder movement control ability. However, corticosteroid injection did not cause significant effect on pressure pain threshold or motor control ability. MTrP therapy could be considered to use prior to other intervention to reduce pain intensity, pressure pain sensitivity, and improving shoulder motor control ability. Significantly better treatment effects were shown in the combined therapy group than the other two groups on worst pain intensity in 24 hours and perceived improvement.
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Hari, Milan. "The effectiveness of spinal manipulative therapy versus manipulation of the acromioclavicular joint in the treatment of impingement syndrome of the shoulder." Thesis, 2008. http://hdl.handle.net/10210/977.
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Repetitive movements of the arm in or above the horizontal plane, can initiate the development of impingement syndrome of the shoulder (Wolin and Tarbet, 1997:56, 59). Impingement syndrome of the shoulder is a common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this pilot study was to determine the most effective treatment protocol in the management of impingement syndrome of the shoulder due to supraspinatus tendonitis. This randomised study consisted of three groups of ten patients, between the ages of eighteen and forty-five. All potential candidates for the trial were examined and admitted once all the exclusion and inclusion criteria had been met. Once joint restrictions were found in the cervical and/ or thoracic spine and the acromioclavicular joint, diversified chiropractic manipulative therapy was administered to all the patients. Group A received cervical and/ or thoracic spine manipulations, Group B received acromioclavicular joint manipulations, and Group C received a combination of spinal manipulations (cervical and/ or thoracic) and acromioclavicular joint manipulations. Patients were treated over a two-week treatment period. Measurements were recorded on the first, third and sixth treatments. The objective data consisted of pain free shoulder abduction range of motion, the presence of a painful arc of the shoulder, a positive supraspinatus test and/or Neers and/or Hawkins impingement test. The subjective data included the numerical pain rating scale 101 questionnaire. The statistical analysis that was conducted included the One Way ANOVA (analysis of variance) as well as the Student-Newman-Keuls Method to compare intra-group and inter-group data. Statistically significant changes were seen in all three groups. However, group A (cervical and/ or thoracic spinal manipulations) and group B (acromioclavicular joint manipulations) showed to be the most effective in treating impingement syndrome of the shoulder. This does however require further research, and a larger sample size.<br>Dr. M. Moodley Dr. G. Sher
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Hsu, Yin-Hsin, and 許映欣. "The effects of Kinesio taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/15176243885991151772.
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碩士<br>國立陽明大學<br>物理治療學系暨研究所<br>94<br>Background: Scapular dysfunction often occurs with shoulder impingement. The resultant alternations in scapular muscle performance and kinematics may lead to further shoulder injury and pain. Although Kinesio taping techniques are commonly used in treating this type of dysfunction, no research has ever conducted to investigate on the effects of Kinesio taping on the scapular kinematics and muscle performance. Purpose: This study aimed to investigate the immediate effects of Kinesio taping on scapular kinematics, scapular muscle electromyographic activity and strength in baseball players with shoulder impingement. Materials and Methods: Seventeen baseball players with shoulder impingement were recruited and randomized into an experimental-first or a placebo-first group. The Kinesio tape was used in the experimental session, and the 3M Micropore tape in the placebo session. The testing tasks included three trials of shoulder elevation in the scapular plane (scaption) with a 2 kg load in the hand. During scaption, surface electromyographic (EMG) data from the upper and lower trapezius, and serratus anterior muscles together with the 3-dimensional motion of the scapula were collected simultaneously. In addition, muscle strength of the lower trapezius was measured using a hand-held dynamometer. All measurements were performed before and after two types of taping application. Analyses of variance (ANOVA) with repeated measures were used to compare the differences in the outcome measures between the two types of taping. Results: Compared to the placebo taping, Kinesio taping significantly increased the scapular posterior tilt at 30° and 60° of scaption, as well as lower trapezius muscle activity in the 60°-30° lowering phase of the scaption. On the contrary, the placebo taping increased the upper trapezius activity in the 90°-120° elevation phase of the scaption. Conclusions: This is the first study conducted to examine the effect of Kinesio taping on the scapular muscle performance and kinematics in baseball players with shoulder impingement. The results of this study suggested that the use of Kinesio taping seemed to be beneficial for baseball players with shoulder impingement problems by increasing scapular posterior tilt and facilitating lower trapezius muscle activity during different part of arm elevation and lowering. Further research should be carried out to promote the understanding of the taping mechanisms and its long-term effect on shoulder and scapular dysfunction, injury prevention and sports performance.
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Kuo, Ting-Yi, and 郭定佾. "The development of impingement syndrome: The role of muscle imbalance and scapular control in asymptomatic subjects with shoulder crepitus." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/32781491399227863145.
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碩士<br>國立成功大學<br>物理治療研究所<br>96<br>Abstract
Background: Subacromial impingement syndrome is the most common shoulder pathology, and the prevalence is 44~65%. Besides, internal impingement is commonly seen in athletes participating in overhead activities. Previous studies have reported that patients with impingement syndrome often demonstrated altered shoulder range of motion and muscle strength, decreased subacromial space, altered scapular muscle control and crepitus sign during shoulder movement. On the other hand, 30% of young people without shoulder pain were also reported to represent crepitus sign during shoulder movement. However, little has been done with respect to the scapular control strategies of asymptomatic people with shoulder crepitus.
Purpose: The study aimed to identify the alterations in shoulder range of motion, muscle strength, static posture and scapular orientation, and scapular muscle control during arm elevation / lowering by comparing asymptomatic young subjects with shoulder crepitus and the controls.
Methods: The first part of the study recruited 21 asymptomatic young subjects with unilateral shoulder crepitus for bilateral comparisons. The second part recruited 27 asymptomatic college students with shoulder crepitus in their dominant arms (13 badminton players and 14 non-badminton players), and 9 control students without shoulder crepitus for further group comparison. The measurements including shoulder range of motion, the tightness of posterior capsule, head and shoulder posture, static scapular orientation, scapular muscle activities, including deltoid, upper trapezius, serratus anterior and lower trapezius, during arm elevation and lowering movements, and the isometric strength of scapular muscles were performed for all participants. Several paired-sample t tests were conducted for bilateral comparison and one-way ANOVA were conducted for the comparison among badminton, non-badminton and control groups.
Results: The crepitus shoulders were found to demonstrate significantly increased strength of shoulder internal rotators, significantly tighter pectoralis minor, significantly increased onset latency in ipsilateral upper trapezius, significantly greater muscle activities in lower trapezius, and significantly increased lower trapezius relative to serratus anterior ratio during arm lowering process (60°~0°) in comparison of non-crepitus shoulders except for those in badminton group. In addition, the crepitus shoulders in badminton group did not show similar scapular control strategies comparing with the crepitus shoulders in non-badminton player, yet demonstrated significantly decreased strength ratio of external to internal rotator, significantly tighter pectoralis minor, and significantly increased scapular internal rotation in static evaluation of scapular orientation.
Conclusions: Although no pain was complained, similar scapular control strategy to those reported in impinged shoulders, namely increased muscle activities of lower trapezius during arm elevation, were found in asymptomatic young subjects with shoulder crepitus. It might be a kind of compensatory strategy to compromise the decrease of subacromial space. In addition, the badminton players demonstrated different characteristics, especially in significant imbalance of rotators strength and increased scapular internal rotation in static scapular orientation. Considering the alterations of scapular control in badminton players with crepitus, it might lead to atypical alteration of subacromial space comparing with the non-badminton players. It is possible that the crepitus found in our badminton group have provided evidence for excessive contact existing between the rotator cuff and the posterior-superior glenoid labrum, thus increasing the risk of internal impingement. In conclusion, shoulder crepitus might be a critical clinical symptom in young asymptomatic people as well as an early sign of shoulder impingement syndrome.
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"The effects of spinal manipulation on the relationship between strength and muscle balance in swimmers with impingement syndrome of the shoulder." Thesis, 2009. http://hdl.handle.net/10210/2649.
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Jiang, Chuan-Jiang, and 江傳江. "Three-dimensional Kinematic analysis of Glenohumeral Joint associated with different Real Axle Position during Wheelchair Propulsion: Implication in Shoulder Impingement Syndrome." Thesis, 2002. http://ndltd.ncl.edu.tw/handle/37136537908950365293.
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碩士<br>國立陽明大學<br>物理治療研究所<br>90<br>Among manual wheelchair users (MWU), the most frequently reported injury is shoulder pain, especially the shoulder impingement syndrome. The shoulder impingement syndrome is caused by many factors. One is unfit wheelchair for individual MWU. If we can modulate the wheelchair for “proper fit”, we can prevent the shoulder impingement syndrome. The starting posture of the shoulder in wheelchair propulsion is similar to shoulder impingement position (extension, abduction and internal rotation). So, shoulder impingement is very likely to happen in this posture. Modulation of the configuration of the wheelchair, especially the axle position of the real wheel can affect the shoulder motion in wheelchair propulsion which might be one of the important factor of shoulder impingement syndrome. The purpose of this study is to investigate the effectiveness gain in different axle position to 3D shoulder kinematics and time parameters, so as to gain the most probable position that causes shoulder impingement position. There are 12 MWUs involved in this study. We choice 6 different axle positions and record the 3D shoulder kinematics data and time parameters in each condition. The statistic method is Freidman’s test (p<0.005). By the results of this study, we conclude that the more backward and upward the real axle is positioned, the more increase we find in shoulder extension and abduction. And the MWUs will get more risks of acquiring shoulder impingement syndrome in this backward and upward axle position.
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Chytilová, Martina. "Vliv stabilizačních cvičení pletence ramenního na svalovou aktivitu při přímém impaktu u hráčů ragby se subakromiálním impingement syndromem." Master's thesis, 2016. http://www.nusl.cz/ntk/nusl-349033.
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Title: The effect of shoulder girdle stabilization exercises on muscle activity during direct impact in rugby players with sub-acromial impingement syndrome Objectives: Comparison of muscle activity during direct impact while performing the rugby tackle to tackle bag and to player using amplitude analysis of electromyographic signal (EMG) before and after intervention programme for players with subacromial impingement syndrome (SIS). Application of intervention programme consisting stabilization excercises for shoulder complex and activation of deep stabilization muscles of the spine. Methods: Theoretical part contains topics about shoulder girdle, rugby and rugby injuries, mainly subacromial impingement syndrome and electromyography. Mentioned issues are included into the thesis due to the research of current literature from international sources and studies. Practical part regards the aplication of three- months long intervention programme for eight rugby players at junior national level with diagnosis of SIS, when pre-testing a post-testing is realized by clinical tests and EMG measurement. Results: Intervention programme was sufficient for changes of EMG amplitude values expressed as percentage of maximal voluntary isometric contraction (MVIC) in some of rugby players with SIS only for some...
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Lee, Ya-Fang, and 李雅芳. "The Effects of Kinesiology Taping on Proprioception of Scapulothoracic and Glenohumeral Joint, Scapular Kinematics and Muscle Activity in Individuals with Shoulder Impingement Syndrome." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/24279333084862586380.
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碩士<br>國立陽明大學<br>物理治療暨輔助科技學系<br>102<br>Background and Objectives: Impingement syndrome is one of the most common disorders of the shoulder, which often results in functional limitation and disability. Proprioception plays an important role in improving movement quality of the shoulder complex and some believe that scapular proprioception can be enhanced by kinesiology taping. But, evidence to support this hypothesis is limited. Therefore, the purposes of this study are to investigate the effect of kinesiology taping on proprioception of scapulothoracic and glenohumeral joint, scapular kinematics and muscle activity, and the relationship among the three. Methods: Thirty patients with shoulder impingement syndrome were recruited and randomly assigned into kinesiology taping or placebo taping group in this study. The joint position sense (JPS) was measured as the reposition errors at 60° and 120° arm elevation in the scapular plane (scaption) for the glenohumeral joint, and in the direction of scapular elevation, depression, protraction and retraction for the scapulothoracic joint. Liberty electromagnetic tracking system (Polhemus, Colchester, VT, USA)was used to collect the joint orientation and position. Surface electromyography (TeleMyo 2400T G2, Noraxon USA Inc, Scottsdale, AZ)was used to collect the muscle activity of upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA). Statistical Analysis: Two-way repeated measures analysis of variance (ANOVA) was used to compare the joint reposition error of the glenohumeral and the scapulothoracic joint and three-way repeated measures analysis of variance was used to analyze scapular kinematics and muscle activity before and after taping. Pearson’s correlation coefficient was used to describe the relationship among the reposition errors, scapular kinematics and muscles activity. The level of significance was set at α=0.05. Results: Compared with placebo taping, kinesiology taping significantly decreased the reposition errors of the upward/downward rotation (p=0.040) and anterior/posterior tilt (p=0.044) when performing scapular protraction, increased posterior tilt (F=6.364, p=0.027) during scaption. Scapular proprioception was related to the muscle activity of lower trapezius (－0.265，p=0.04), scapular posterior tilt (R=－0.269，p=0.04) and upward rotation (R=－0.326，p=0.01). Conclusions: Our study verified the effects of kinesiology taping on scapular proprioception, kinematics, muscle activity and the relationship among the three. We recommended that kinesiology taping could be used as an intervention tool to improve the proprioception and neuromuscular control of the shoulder complex in the individuals with shoulder impingement syndrome.
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Hall, Laurie Cathryn. "Analysis of the effect of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living." Thesis, 2010. http://hdl.handle.net/10012/5026.
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Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.