3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients

Objective

The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain.

Reliability of the Cervical Spine Device for the Assessment of Cervical Spine Range of Motion in Asymptomatic Participants

Objective

The purpose of this study was to assess the inter- and intra-assessor reliability of the cervical spine device (Formetric, DIERS International GmbH, Schlangenbad, Germany) in measuring cervical range of motion.

Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity,Low-Amplitude Spinal Manipulation Applied to the Low Back

Objectives

This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture.

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome

Purpose

In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction.

Materials and methods

Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro–Wilk test was used in the assessment of normal distribution of parameters.

Results

The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively.

Conclusion

Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.

     

Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital

Objective

To describe the use of manipulative treatment for shoulder and spine conditions among various provider types.

Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain,and clinical implications

Background

The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.

Modification of Spastic Stretch Reflexes at the Elbow by Flexion Synergy Expression in Individuals With Chronic Hemiparetic Stroke

Objective

To systematically characterize the effect of flexion synergy expression on the manifestation of elbow flexor stretch reflexes poststroke, and to relate these findings to elbow flexor stretch reflexes in individuals without neurologic injury.

Shoulder strengthening exercises adapted to specific shoulder pathologies can be selected using new simulation techniques: a pilot study

Purpose

Shoulder strength training exercises represent a major component of rehabilitation protocols designed for conservative or postsurgical management of shoulder pathologies. Numerous methods are described for exercising each shoulder muscle or muscle group. Limited information is available to assess potential deleterious effects of individual methods with respect to specific shoulder pathologies. Thus, the goal of this pilot study was to use a patient-specific 3D measurement technique coupling medical imaging and optical motion capture for evaluation of a set of shoulder strength training exercises regarding glenohumeral, labral and subacromial compression, as well as elongation of the rotator cuff muscles.

Methods

One volunteer underwent magnetic resonance imaging (MRI) and motion capture of the shoulder. Motion data from the volunteer were recorded during three passive rehabilitation exercises and twenty-nine strengthening exercises targeting eleven of the most frequently trained shoulder muscles or muscle groups and using four different techniques when available. For each exercise, glenohumeral and labral compression, subacromial space height and rotator cuff muscles elongation were measured on the entire range of motion.

Results

Significant differences in glenohumeral, subacromial and labral compressions were observed between sets of exercises targeting individual shoulder muscles. Muscle lengths computed by simulation compared to MRI measurements showed differences of 0–5%.

Conclusions

This study represents the first screening of shoulder strengthening exercises to identify potential deleterious effects on the shoulder joint. Motion capture combined with medical imaging allows for reliable assessment of glenohumeral, labral and subacromial compression, as well as muscle-tendon elongation during shoulder strength training exercises.

     

Quantitative Postural Analysis of Children With Congenital Visual Impairment

Objectives

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment.

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction

Objectives

The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment.

Changes in Cervicocephalic Kinesthetic Sensibility,Widespread Pressure Pain Sensitivity,and Neck Pain After Cervical Thrust Manipulation in Patients With Chronic Mechanical Neck Pain: A Randomized Clinical Trial

Objective

The purpose of the current randomized clinical trial was to examine the effects of cervical thrust manipulation or sham manipulation on cervicocephalic kinaesthetic sense, pain, pain-related disability, and pressure pain sensitivity in patients with mechanical neck pain.

Sekundäre Steife der Schulter

Background

In addition to idiopathic shoulder stiffness, secondary shoulder stiffness in particular is often associated with extra-articular subacromial adhesions between the rotator cuff and the surrounding anatomical structures.

Objective

The aim of this article is to present clinical results and complications as well as the surgical technique of extra-articular release in the context of secondary shoulder stiffness.

Material and Methods

Selective review of the literature and presentation of own clinical experience.

Results

Intra-articular and extra-articular release are related to a high patient satisfaction and an improved range of motion. Exact knowledge of the extra-articular anatomy is necessary to prevent iatrogenic lesions of vessels, nerves and the rotator cuff. Compared to patients with a primary stiff shoulder, patients suffering from posttraumatic stiff shoulder benefit more from arthroscopic interventions with intracapsular and extracapsular release.

Conclusion

Restrictions in range of motion of the shoulder can be related to extra-articular adhesions. These adhesions need to be specifically addressed during arthroscopic treatment of stiff shoulders.

     

Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators

Objective

The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose–response and safety studies on therapeutic benefit.

Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site

Objectives

The purpose of this study was to assess the interexaminer reliability of palpation for stiffness in the cervical, thoracic, and lumbar spinal regions.

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants

Objective

The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP).

Loading conditions in the spine,hip and knee during different executions of back extension exercises

Background

Back extension (BE) is a strength exercise for training the dorsal trunk and hip muscles. To optimise training recommendations that avoid overloading and possible injury, the aim of this study was to determine the loading conditions and the influence of different execution forms of BE on spine, hip and knee ranges of motion (RoMs), joint moments and muscle activity.

Methods

The kinematics, kinetics and muscle activity (EMG) of two execution types (BE_h: dynamic hip, BE_s: dynamic spine) and two versions (one-legged and two-legged) of BE were measured in 16 subjects. RoMs and external joint moments were calculated using an inverse dynamics approach and analysed with a linear mixed model.

Results

Although lumbar spine flexion was observed in both execution types, thoracic spine flexion predominantly occurred during BE_s, whereas thoracic spine extension was observed during BE_h. Larger maximal back and hip moments were observed for BE_h than for BE_s. The activity of the dorsal back and hip muscles, as observed using EMG, was increased for one-legged executions.

Conclusion

To strengthen the hips and lower back, BE_h seem to be more efficient due to the higher moments, with higher or similar RoMs in the hip and lower back. One-legged BE_s seem to provide an effective training for the hamstrings and hip regions without subjecting the spine to excessive loading, possibly promoting this as an effective exercise during training and rehabilitation.

     

The variable roles of the upper and lower subscapularis during shoulder motion

Background

The varied roles of the subscapularis muscle as an internal rotator of the humerus, a shoulder abductor, a humeral head depressor and an anterior stabiliser may be a result of differing innervation and lines of torque between its superior and inferior components. The aims of the study were to investigate the differences in the level of muscle activation between the upper and lower subscapularis during abduction, flexion, internal and external rotation movements, and temporal characteristics during abduction and flexion.

Methods

Intramuscular electrodes recorded electromyographic muscle activity from the upper and lower subscapularis muscles of the dominant throwing arm of twenty-four normal subjects. Participants completed ten repetitions of four shoulder movements — abduction, flexion, internal rotation and external rotation. Muscle activity was expressed as a percentage of maximum voluntary isometric contraction.

Findings

The lower subscapularis was found to activate at a higher level than the subscapularis during abduction, flexion and external rotation movements and this was significant during concentric and eccentric phases of abduction and flexion (< 0.001). During internal rotation, upper subscapularis muscle activity mirrored that of lower subscapularis, with a mean difference of 1.14%. Neither upper nor lower subscapularis had onset data commencing prior to the abduction movement; however upper subscapularis activated significantly later than lower subscapularis (P = 0.018).

Interpretation

The lower subscapularis has significantly higher muscle activity during shoulder elevation and this might reflect its greater role as a humeral head depressor and anterior stabiliser.     

Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study

Background

Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but not enough studies exist on the optimal timing of the injection.

Wirbelsäule und Sport

Background

Adequate treatment of athletes with spine complaints presupposes knowledge of the particular sport-specific stress patterns on one hand, and potentially spinal column-damaging movements on the other.

Purpose

The present work is primarily intended to present biomechanical principles and thus provide information on the motion sequences that can potentially cause damage to the spine.

Material and methods

The present literature was reviewed using PubMed and Google Scholar, as well as orthopaedic textbooks. Further references to older literature were investigated using the Google search function and the central library of the Medical University of Vienna.

Results

Special changes in the spine are most present in the performance sport sector, and especially in the case of power sports. Pure axial loads hardly lead to detectable lesions, but in combination with flexion, extension or rotation, damage is possible. The juvenile spine reacts particularly sensitively to singular and repetitive stresses.

Conclusions

Significant lesions of the vertebral column are found primarily in performance athletes; they are observed less frequently with leisure time sports and health-related exercise. However, the potentially damaging effects of regular physical activity on the spine are far outweighed by the positive effects on the whole organism.

     

The impact of selective neck dissection on shoulder and cervical spine movements

Objective

To investigate the deficits in function following a function-preserving neck dissection by comparing operative versus non-operative sides for cervical spine and shoulder movements in combination with patient self-completed questionnaires.

Participants

A consecutive cohort of 63 outpatients following levels I-III unilateral selective neck dissection were approached and all agreed to participate in the study.

Methods

Clinical examination included assessment of shoulder, shoulder girdle and cervical spine ranges of movement, measured by goniometry, tape measure and a cervical measurement system. Patient self-completed questionnaires included the University of Washington quality of life questionnaire (UW-QoL), the neck dissection impairment index and the shoulder disability questionnaire.

Results

Following unilateral selective neck dissection there was significant loss of shoulder flexion and abduction in the operated side compared to the non-operated side but not in regard to the other cervical spine and shoulder measurements. The loss of shoulder flexion averaged 9° (95% confidence interval: 3-14°) and the loss of shoulder abduction averaged 8° (95% confidence interval: 2-14°). The UW-QoL shoulder domain clearly identified patients with poor cervical spine and shoulder function.

Conclusion

This study emphasizes the problems patients encounter even with a function-preserving neck dissection. The UW-QoL questionnaire can aid physiotherapists to screen patients needing early intervention and further assessments.