An electromyographic study of arm muscles during climbing

Upper extremity muscle injuries from rock climbing are common. Knowledge of the activity of specific muscles during climbing may allow the development of training programs to reduce these injuries. This study evaluated the electrical activity of the first interosseous (IN), brachioradialis (BR), flexor digitorum superficialis (FD), and biceps brachii (BB) muscles in seven climbers by integrated electromyography (IEMG) during finger-tip pull-ups. The climbers, with forearms pronated, performed three consccutive pull-ups. Each pull-up consisted of: (1) hanging using four fingers of each hand, (2) pullup to maximum elbow flexion, (3) slow return to starting position. The IEMG during maximum voluntary contraction (MVC) was obtained for each muscle separately, and the IEMG was normalized to MVC. During hanging, FD showed the highest normalized IEMG (0.64±0.20). During pull-up, the highest IEMG was produced by FD (0.69 ±0.25) and BR (0.67±0.19), while BB showed only 0.33 ±0.12 and IN 0.09±0.06. During lowering, FD again had the highest IEMG (0.74±0.24), while the EMG from BR was decreased to 0.42±0.14 and BB to 0.15±0.15. BR and BB showed an abrupt peak in EMG during pull-up and lowering, as opposed to FD which remained constantly highly activated, which suggests that FD does not contribute to elbow flexion even though it crosses the elbow joint. The high activation of FD and BR may explain their elevated incidence of injury during climbing. Thus, a reduction in climbing-related muscle injuries may be achieved by a training program that emphasizes conditioning of the BR and FD muscles.     

Correlation between upper limb function and clinical measures of shoulder and trunk mobility and strength in overhead athletes with shoulder pain

ObjectiveTo investigate the correlation between functional performance and self-reported upper limb function and between these two functional measures and clinical measures of shoulder and trunk in overhead athletes with shoulder pain.DesignCross-sectional study.SettingsLaboratory.ParticipantsTwenty-one volleyball and handball athletes (23.6 ± 3.7 years) with shoulder pain in the dominant limb.Main outcome measuresSelf-reported dominant upper limb function using Penn Shoulder Score and Disabilities of the Arm, Shoulder, and Hand; shoulder and trunk range of motion; isometric strength of shoulder, periscapular, and trunk muscles; endurance time of trunk muscles; and functional upper limb performance using the Upper Quarter Y-Balance Test (UQYBT).ResultsA moderate correlation was observed (r = 0.45–0.58; p < 0.05) between UQYBT performance and strength of serratus anterior, lower trapezius, trunk rotators, and trunk flexors. No significant correlation was observed between UQYBT performance and the other clinical measures of shoulder and trunk (r = 0.01–0.39, p > 0.05). Self-reported upper limb function was neither significantly correlated with clinical measures (r = 0.01–0.40, p > 0.05) nor with UQYBT performance (r = 0.02–0.19, p > 0.05).ConclusionWe observed a correlation between UQYBT performance and strength of periscapular and trunk muscles.     

Motor alterations in the kinetic chain in individuals with chronic shoulder pain

BackgroundShoulder pain may be related to biomechanical dysfunctions in the kinetic chain.ObjectiveTo compare the mobility and muscular endurance of thoracolumbar spine and hip, and the neuromuscular control of the lower extremity of individuals with and without shoulder pain and to determine the discriminative capacity between groups of these variables.DesignA cross-sectional study.MethodOne hundred and two individuals with and without shoulder pain were evaluated to range of motion (ROM) of the thoracolumbar spine and hips, the muscular endurance time of the thoracolumbar spine and hips muscles, and the neuromuscular control of the lower extremity, by the Star Excursion Balance Test (SEBT).ResultsIndividuals with shoulder pain presented lower ROM and muscular endurance time in all tests evaluated (p < 0.01–p = 0.03), greater perception of pain during all ROM and muscle endurance (p < 0.01–p = 0.04) evaluations, and less neuromuscular control of the lower extremity in the compound reach (p < 0.01–p = 0.01), anterior and posteromedial (p < 0.01–p = 0.04) directions of the SEBT on both sides. The anterior reach direction of the SEBT of the contralateral limb to the shoulder pain (AUC=0.80, cut-off point=47.7%) presented excellent capacity to discriminate individuals with shoulder pain, while the other variables showed between acceptable and small capacity (AUC=0.58–0.76).ConclusionIndividuals with chronic shoulder pain presented alterations in joint mobility, muscular endurance time of the thoracolumbar spine and hips and neuromuscular control of the lower extremity. The anterior reach of the SEBT of the contralateral limb showed excellent discriminative capacity.     

Shoulder and thorax kinematics contribute to increased power output of competitive handcyclists

Current knowledge of recumbent handbike configuration and handcycling technique is limited. The purpose of this study was to evaluate and compare the upper limb kinematics and handbike configurations of recreational and competitive recumbent handcyclists, during sport‐specific intensities. Thirteen handcyclists were divided into two significantly different groups based on peak aerobic power output (PO_peak) and race experience; competitive (n = 7; 5 H3 and 2 H4 classes; PO_peak: 247 ± 20 W) and recreational (n = 6; 4 H3 and 2 H4 classes; PO_peak: 198 ± 21 W). Participants performed bouts of exercise at training (50% PO_peak), competition (70% PO_peak), and sprint intensity while three‐dimensional kinematic data (thorax, scapula, shoulder, elbow, and wrist) were collected. Statistical parametric mapping was used to compare the kinematics of competitive and recreational handcyclists. Handbike configurations were determined from additional markers on the handbike. Competitive handcyclists flexed their thorax (~5°, P < 0.05), extended their shoulder (~10°, P < 0.01), and posteriorly tilted their scapular (~15°, P < 0.05) more than recreational handcyclists. Differences in scapular motion occurred only at training intensity while differences in shoulder extension and thorax flexion occurred both at training and competition intensities. No differences were observed during sprinting. No significant differences in handbike configuration were identified. This study is the first to compare the upper limb kinematics of competitive recreational handcyclists at sport‐specific intensities. Competitive handcyclists employed significantly different propulsion strategies at training and competition intensities. Since no differences in handbike configuration were identified, these kinematic differences could be due to technical training adaptations potentially optimizing muscle recruitment or force generation of the arm.     

Comparison of lower limb stiffness between male and female dancers and athletes during drop jump landings

Repetition of jumps in dance and sport training poses a potential injury risk; however, non‐contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact‐related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men and 20 women) and 40 college‐level team sport athletes (20 men and 20 women) performed single‐legged drop landings from a 30‐cm platform. Vertical leg stiffness and joint stiffness of the hip, knee, and ankle were calculated using a spring‐mass model. Stiffness data, joint kinematics, and moments were compared with a group‐by‐sex 2‐way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip and knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (P < 0.001), knee joint (P = 0.034), and ankle joint stiffness (P = 0.043) than athletes. This was facilitated by lower knee joint moments (P = 0.012) and greater knee (P = 0.029) and ankle joint (P = 0.048) range of motion in dancers. Males had higher leg (P < 0.001) and ankle joint stiffness (P < 0.001) than females. This occurred through lower ankle range of motion (P < 0.001) and greater ankle moment (P = 0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.     

Effect of respiratory motion on quantitative myocardial gated SPECT: a simulation study

Objective  Respiratory motion is a potential cause of artefact and downgrading the quality of ECG-gated single photon emission computed tomography (SPECT) images that may result in clinical misinterpretation. We studied qualitatively the effects of respiratory motion on gated SPECT myocardial perfusion and function using Monte Carlo simulated data. Methods  NCAT phantom was used to model a human torso. The cardiac and respiratory cycles of torso were 1 and 5 s, respectively. Eight realizations of the phantom, having diaphragmatic motion amplitudes of 0–7 cm were generated. SimSET Monte Carol simulator was used to image the phantom and generate gated studies of 16 frames per cardiac cycle. Results  Our results demonstrated the underestimation of left ventricle end-diastolic, end-systolic, stroke volumes and ejection fraction and overestimation of wall motion and wall thickening (p < 0.01). In addition, the mean percentage of count in the basal-inferior, mid-inferior, apical-inferior, basal-septal and mid-septal segments were significantly lower due to respiratory motion when compared with control (p < 0.01). The changes in uptake were not significant in the apex, antroapical, apicoseptal, apicolateral, mid-anterior, basal-anterior, mid-lateral and basal-lateral segments. Conclusion  Respiratory motion has significant effect on the calculation of the left ventricular functional and regional myocardial perfusion in the GSPECT. The amount of deterioration and quality distortion of the images depends on the amplitude of the diaphragmatic motion.     

Good results after fluoroscopic-guided intra-articular injections in the treatment of adhesive capsulitis of the shoulder

The purpose of the present study was the prospective evaluation of the results of fluoroscopic-guided intra-articular cortisone injection series in the treatment of adhesive capsulitis of the shoulder. Twenty-five patients (9 m, 16 w) with a mean age of 49 ± 8 years and stage II frozen shoulder syndrome according to the Reeves classification were treated with an intra-articular cortisone injection series (3 injections at 0, 4, 12, weeks). Clinical examination, ASES score and SF 36 score were performed at 0, 4, 8, 12 weeks, 6 and 12 months. In the results, significant improvements were seen in flexion (99 ± 30°–119 ± 31°, P < .0001), abduction (72 ± 24–99 ± 34°, P < .0001), external rotation (14 ± 16°–28 ± 21°, P < .0001) and internal rotation already at first follow-up after 4 weeks of treatment. The results were confirmed at any other follow-up. ASES score improved from 28 ± 13 to 45 ± 18 after 4 weeks (P < .0001), 59 ± 21 after 8 weeks (P < .0001), 63 ± 25 at 3 months (P < .0001), 64 ± 28 (P < .0001) at 6 months and 73 ± 27 (P < .0001) points at final follow-up after 1 year. Evaluation of the SF-36 Score showed significant improvements in almost all categories (physical and mental) after 4 weeks of treatment (P < .05). In conclusion, a fluoroscopic-guided intra-articular injection series of cortisone is an effective treatment option in frozen shoulder syndrome leading to a fast pain reduction and increased range motion.     

Effects of posterior-inferior capsular plications in range of motion in arthroscopic anterior bankart repair: a prospective randomized clinical study

The effects of posterior plications associated with anterior shoulder instability surgery are still unclear both on shoulder range of motion (ROM) and on recurrence rate. The objective of this randomized study is to evaluate the influence of posterior-inferior plications, performed in association with repair of anterior Bankart lesion, on gleno-humeral (GH) range of motion. In a 24-month period, 40 patients were prospectively enrolled in this study. The criteria for inclusion were age between 17 and 40 years, traumatic unidirectional instability, no previous shoulder surgery, no more than three episodes of dislocation, no relevant glenoid bone deficiency, no clinical evidence of pathological anterior inferior laxity (measured with external rotation with the arm at the side inferior to 90° and Gagey sign negative) and arthroscopic finding of isolated anterior Bankart lesion. A total of 20 patients (group A) were randomized to treat Bankart lesion using three bioadsorbable anchors loaded with a #2 braided polyester suture. In 20 randomized patients (group B) two posterior-inferior capsular plications performed with a #1 polidioxanone suture without any capsular shift were added to the same anterior capsulorraphy performed in group A. Postoperative rehabilitation protocol was the same for all 40 patients. Patients were examined preoperatively and at a 2-year follow-up by a single independent expert physician unaware of the surgical procedure. GH ROM, Constant, UCLA and ASES rating scores as well as recurrence of instability were recorded. At follow-up, forward flexion (FF) decreased by a mean value of 14.5° (median −10°; range −5° to −35°; P < 0.001) in group B and increased by a mean value of 3.5° (median 0°; range −25° to 40°; P < 0.312) in group A; external rotation with arm adducted (ER1) increased by a mean value of 1.8° (median 0°; range −15°to 30°; P < 0.924) in group B, and increased by a mean value of 2.6° (median 2.5°; range −38° to 40°; P < 0.610) in group A; external rotation with arm abducted at 90° (ER2) decreased by a mean value of 2.9° (median 0°; range: −20° to 10°; P < 0.161) in group B and increased by a mean value of 0.7° (median 0°; range −30° to 25°; P < 0.837) in group A; the IR2 decreased by a mean value of 2.4° (median −3.5°; range −15° to 10°; P < 0.167) in group B and increased by a mean value of 2.2° (median 0°; range −20° to 30°; P < 0.456) in group A. The UCLA mean score gains by 43.1% (median 40; P < 0.001) relatively, and of 45.2% relatively (median 40; P < 0.001), respectively, in group B and A, ASES mean score relatively gains by 21.7% (median 21.2%; P < 0.001) in group B, and of 19.2% (median 18.9%; P < 0.001) in group A, and Constant mean score improves by 20.2% (median 16.5; P < 0.001) in group B, and 10.2% (median 8.4%; P < 0.001) in group A. Thus, the only statistical significant differences were the reduction of forward flexion in group B and the improvements of the scores in both groups. No recurrence of instability was found in the plicated group, while in the non-plicated group we had one traumatic recurrence. In conclusion, arthroscopic posterior-inferior plications associated with a Bankart lesion repair in a selected group of patients seem to reduce only FF, without any effect on rotation. A longer follow-up and a larger number of patients are needed to give definitive conclusions on the benefit to the recurrence rate.     

The validity of the sphygmomanometer for shoulder strength assessment in amateur rugby union players

ObjectivesTo determine the concurrent validity of a sphygmomanometer for assessing shoulder strength in the I, Y and T positions during the athletic shoulder test (ASH test). Force platforms were used as the gold standard measurement tool for this purpose.DesignShoulder strength was assessed using force platforms and a sphygmomanometer, both placed on the floor and the participant positioned prone. One rater assessed strength, taking three measurements in each of the I, Y and T positions, using the sphygmomanometer and force platforms. Concurrent validity was calculated using the force platforms as the gold standard device.SettingData was collected within the treatment room of an amateur rugby club.ParticipantsTwenty male amateur rugby players (25.15 years old ± 3.27 years) were recruited for this study.Main outcome measuresPeak force across the shoulder girdle was assessed using the force platforms and sphygmomanometer which provided values in Newtons (N) and millimetres of mercury (mmHg) respectively.ResultsResults showed high concurrent validity (Pearsons r = 0.76–0.81) between the sphygmomanometer and the force platform. Coefficient of determination (r² = 0.59–0.67) showed the sphygmomanometer to have a valid predictive model in the I, Y and T positions.ConclusionsThe sphygmomanometer is suitable for monitoring force transfer across the shoulder during the ASH test, and is able to quantify peak force in mmHg. The sphygmomanometer enables coaches and clinicians to accurately quantify force production across the shoulder girdle in order to screen and monitor players at a low cost.     

Scapulohumeral rhythm in patients after total shoulder arthroplasty compared to age-matched healthy individuals

PurposeThe coordination of the glenohumeral joint and the shoulder girdle has been known as scapulohumeral rhythm. The effects of anatomical total shoulder arthroplasty (aTSA) are still subject to research. Former studies showed a higher amount of scapula lateral rotation to compensate for reduced glenohumeral elevation. The purpose of the present study was to confirm this mechanism and examine additional effects on the sternoclavicular and acromioclavicular joints’ kinematics.Methods3D motion analysis was used to examine 23 shoulders of 16 patients with a mean age of 71.2 (SD: 5.2) years with a mean follow up of 5.4 (SD: 2.1) years after aTSA and to compare kinematics and coordination to 22 shoulders of 11 healthy age-matched individuals with a mean age of 69.6 (SD: 5.3) years while performing elevation movement in frontal and sagittal plane.ResultsThe ratio of glenohumeral to shoulder girdle contribution was reduced compared to healthy individuals: Shoulder girdle contribution to elevation was 36.5% (SD: 8.1) in the aTSA group vs. 28.5% (SD: 8.2) in the control group in the sagittal plane and 38.1% (SD: 9.1) vs. 30.2% (SD: 7.1) in the frontal plane. Kinematics of the sternoclavicular and acromioclavicular joints showed significantly different patterns.ConclusionPatients after aTSA showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation. Whether this is a result of the surgery, of limited glenohumeral range of motion or due to the preoperative status remains unclear. Further investigation with a prospective study design is necessary.     

Kinesiology taping does not alter shoulder strength,shoulder proprioception,or scapular kinematics in healthy,physically active subjects and subjects with Subacromial Impingement Syndrome

ObjectiveTo examine the effect of kinesiology tape (KT) on shoulder strength, proprioception, and scapular kinematics in healthy and Subacromial Impingement Syndrome (SAIS) subjects.DesignPlacebo-controlled quasi-experimental study.SettingResearch laboratory.ParticipantsA total of 30 physically active subjects participated. Ten healthy subjects with no previous history of shoulder pathology received KT on the dominant shoulder. Twenty subjects with shoulder pain for a minimum of two weeks and presenting with clinical signs of impingement were allotted to receive KT (n = 10) or placebo taping (PT, n = 10) on the involved shoulder.Main outcome measuresAll participants were tested pre- and post-application. Shoulder internal/external rotation (IR/ER) strength was assessed with isokinetic dynamometry (average peak torque/body weight). Shoulder IR/ER proprioception was assessed through threshold to detect passive motion (mean absolute error in degrees). Scapular position at 90° and 120° of shoulder abduction during arm raising/lowering were assessed using a 3D motion analysis system.ResultsNo significant within group or between group differences were demonstrated for any measure.ConclusionsTaping does not appear to aid/impair shoulder strength, shoulder proprioception, or scapular kinematics. Future research should explore if the effects of KT are time-dependent and similar in other pathologies.     

Gated blood pool tomoscintigraphy with 4-dimensional optical flow motion analysis quantifies left ventricular mechanical activation and synchronization

Background  Gated blood pool tomoscintigraphy has the unique capacity to accurately assess myocardial motion in paced patients. Our goal was to develop a precise radionuclide angiography analysis of cardiac dynamics to evaluate ventricular synchronization in patients undergoing biventricular pacing. Methods and Results  On the basis of a 4-dimensional deformable motion estimation algorithm, we developed a protocol allowing estimation of motion fields after gated blood pool tomoscintigraphy. We measured the mechanical activation times for 17 left ventricular (LV) segments and determined the main types of contraction pattern in 10 normal subjects, 17 patients with dilated cardiomyopathy, and 12 resynchronized patients. We analyzed intra-LV dyssynchrony: apex to base, septum to lateral wall, and anterior wall to inferior wall. Three-dimensional measurements of intra-LV activation time (r > .80, P < .001) and LV ejection fraction (r > 0.90, P < .0001) are linearly correlated to 2-dimensional values. LV contraction follows the electrical activation pattern. In normal subjects the anteroseptal and anterior segments are first activated, followed by the apex and inferolateral segments. In resynchronized patients contraction begins with the lateral and apicoseptal segments in correspondence to the LV and right ventricular lead implantation. Conclusions  By measuring mechanical activation times, this technique allows for the analysis of the regional synchronous contraction. This may help to assess the variation of the activation pattern according to the cardiomyopathy type and the role of septal resynchronization in ventricular functional recovery. An erratum to this article is available at .     

Evaluation of left ventricular wall motion, volumes, and ejection fraction by gated myocardial tomography with technetium 99m-labeled tetrofosmin: A comparison with cine magnetic resonance imaging

Background  Whether left ventricular function can be assessed accurately by gated single photon emission computed tomography (SPECT) in patients with myocardial infarction and severe perfusion defects is not well known. Methods and Results  Twenty-five patients with an acute myocardial infarction underwent ^99mTc-labeled tetrofosmin (^99mTc-tetrofosmin) gated SPECT and cine magnetic resonance imaging (MRI). Wall motion was assessed in 13 left ventricular segments using a 5-point scoring system ranging from 3 (normal) to-1 (dyskinetic). Exact agreement for wall motion scores between gated SPECT and MRI was excellent (92%, kappa=0.82). Furthermore, correlations between the two techniques were also good for end-diastolic volume (r=0.81, P<.0001), end-systolic volume (r=0.92, P<.0001), and ejection fraction (r=0.93, P<.0001). Conclusion  In patients with a recent myocardial infarction, ^99mTc-tetrofosmin gated SPECT provides reliable evaluation of global and regional ventricular function and volumes.     

Shoulder rotational profiles in young healthy elite female and male badminton players

The aim of the present study was to profile shoulder passive range of motion (ROM) and isometric strength for external (ER) and internal (IR) rotation as part of a preseason screening in adolescent national badminton players. Passive external range of motion (EROM) and internal range of motion (IROM) were examined on the dominant and nondominant shoulder in 31 adolescent national badminton players (12 females and 19 males) with a standard goniometer. Muscle strength was examined with a hand‐held dynamometer in ER and IR. Total range of motion (TROM = EROM+IROM) was lower on the dominant side compared with the nondominant side in both groups (P < 0.001). Males were generally stronger than females in all strength measurements except for IR on the dominant side (P < 0.01). In females, IR dominant side strength was greater compared with IR on the nondominant side (P < 0.05). TROM was reduced on the dominant side compared with the nondominant side in young elite badminton players, irrespective of gender. No rotational strength differences existed between the dominant and nondominant side in male players, but in female players a higher IR strength on the dominant side was not balanced by a higher ER strength.     

Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder

The purpose of the present study is the evaluation of a possible influence of the preoperative deposit stage, the postoperative deposit elimination and failed preoperative extracorporeal shockwave therapy on the surgical outcome of arthroscopic treatment of tendinosis calcarea. From 1997 to 2004, 65 patients underwent arthroscopic resection of calcific deposits of the shoulder after failed conservative treatment. Patients with rotator cuff tears, major cartilage damage, or previous surgery were excluded. Out of 50 patients 45 (17 men, 28 women) that could be contacted with a mean age of 49 ± 8 years could be followed-up with a mean of 36 months (14–89) after surgery. A total of 24 patients (53.3%) underwent preoperative extracorporeal shock-wave therapy (ESWT). For the clinical evaluation the Constant and Murley Score, the Simple Shoulder Test, the Western Ontario Rotator Cuff Index (WORC) and visual analog scales for pain, function and satisfaction were used. For the radiological evaluation, the classifications according to Gaertner and Bosworth were used. Statistical analysis was done with the Wilcoxon test, the Mann–Whitney test and ANOVA. The Constant and Murley Score improved significantly from preoperative 63.5 ± 11.4 to postoperative 93.9 ± 9.9 points (P < .0001) at follow-up, the Simple Shoulder Test from 1.7 ± 2 to 9.9 ± 2.8 points (P < .0001), the WORC score from 1,591.2 ± 337.4 to 345.4 ± 392 points (P < .0001). The visual analog scales for pain, function and patient satisfaction also significantly improved (P < .0001). Preoperative radiological evaluation according to the Gaertner classification revealed 37 type I deposits, 6 type II and 2 type III deposits; postoperative no calcific deposits were seen in 37 patients, 6 type I and 2 type III deposits. According to the Bosworth classification 13 type I, 19 type II and 13 type III deposits were seen preoperatively. Postoperative X-rays showed 6 type I and 1 type II and III deposits. There was no significant correlation of the clinical results with the pre- or postoperative findings. The 24 patients who underwent ESWT before surgery did not show significantly better results than patients without ESWT. In conclusion, arthroscopic removal of calcific deposits of the shoulder shows good clinical results for pain reduction, shoulder function and patient satisfaction. The type of calcific deposit and the preoperative treatment of the shoulder with ESWT did not have any significant impact on the postoperative results. Presented at the ISAKOS Meeting, 23–29 May 2007, Florence, Italy.     

Effects of muscle activation on shear between human soleus and gastrocnemius muscles

Lateral connections between muscles provide pathways for myofascial force transmission. To elucidate whether these pathways have functional roles in vivo, we examined whether activation could alter the shear between the soleus (SOL) and lateral gastrocnemius (LG) muscles. We hypothesized that selective activation of LG would decrease the stretch‐induced shear between LG and SOL. Eleven volunteers underwent a series of knee joint manipulations where plantar flexion force, LG, and SOL muscle fascicle lengths and relative displacement of aponeuroses between the muscles were obtained. Data during a passive full range of motion were recorded, followed by 20° knee extension stretches in both passive conditions and with selective electrical stimulation of LG. During active stretch, plantar flexion force was 22% greater (P < 0.05) and relative displacement of aponeuroses was smaller than during passive stretch (P < 0.05). Soleus fascicle length changes did not differ between passive and active stretches but LG fascicles stretched less in the active than passive condition when the stretch began at angles of 70° and 90° of knee flexion (P < 0.05). The activity‐induced decrease in the relative displacement of SOL and LG suggests stronger (stiffer) connectivity between the two muscles, at least at flexed knee joint angles, which may serve to facilitate myofascial force transmission.     

Gait modification strategies in trunk over right stance phase in patients with right anterior cruciate ligament deficiency

This study aimed to investigate the gait modification strategies of trunk over right stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Thirty-six patients with right chronic ACL-D were recruited, as well as 36 controls. A 3D optical video motion capture system was used during gait and stair ambulation. Kinematic variables of the trunk and kinematic and kinetic variables of the knee were calculated. Patients with chronic right ACL-D exhibited many significant abnormalities compared with controls. Trunk rotation with right shoulder trailing over the right stance phase was lower in all five motion patterns (P < 0.05). Compared with controls, trunk posterior lean was higher from descending stairs to walking when the knee sagittal plane moment ended (P < 0.01). Trunk lateral flexion to the left was higher when ascending stairs at the start of right knee coronal plane moment (P = 0.01), when descending stairs at the maximal knee coronal plane moment (P < 0.01), and when descending stairs at the end of the knee coronal plane moment (P = 0.03). Trunk rotation with right shoulder forward was higher at the minimal knee transverse plane moment (P < 0.01) and when the knee transverse plane moment ended (P < 0.01); during walking, trunk rotation with right shoulder trailing was lower at other knee moments during other walking patterns (all P < 0.01). In conclusion, gait modification strategies of the trunk were apparent in patients with ACL-D. These results provide new insights about diagnosis and rehabilitation of chronic ACL-D (better use of walking and stair tasks as part of a rehabilitation program).     

Shoulder strength and range of motion in elite female cricket fast bowlers with and without a history of shoulder pain

This study aimed to determine the prevalence of shoulder pain in female cricket fast bowlers and compare the shoulder rotation range of motion and strength of those bowlers with and without a history of shoulder pain. The active range of motion and isokinetic strength of the shoulder internal and external rotators was assessed in the bowling and non-bowling shoulders of 26 elite Australian female fast bowlers. Twelve bowlers had a history of shoulder pain. There were significant bilateral differences in external rotation range of motion for those bowlers without a history of shoulder pain (p < 0.05), and in internal rotation range of motion for both the total cohort and those bowlers with a history of shoulder pain (p < 0.05). There were no bilateral differences in average torques or average torque ratios, nor were there any differences in rotation range of motion, torques or torque ratios in the bowling shoulder between bowlers with and without a history of shoulder pain. There was an association between concentric internal rotation torque for the bowling shoulder and years of fast bowling (r_s = 0.45). Given the relatively small number of elite female cricketers, future research in this field will need to recruit fast bowlers from other cricket playing nations to increase the power of studies and provide more confidence in the statistical outcomes.     

Biomechanical stability of an arthroscopic anterior capsular shift and suture anchor repair in anterior shoulder instability: a human cadaveric shoulder model

It was hypothesized that an arthroscopic Bankart repair with suture anchors supplies sufficient anterior shoulder stability, which cannot be improved by an additional capsular shift. In an experimental biomechanical human cadaver study, we tested ten fresh human cadaver shoulders in a robot-assisted shoulder simulator. External rotation and glenohumeral translation were measured at 0° and 80° of glenohumeral abduction. All measurements were performed under the following conditions: on the non-operated shoulder; following the setting of three arthroscopic portals; following an arthroscopic anterior capsular shift; following a simulated Bankart lesion; and following an arthroscopic Bankart repair. The application of three arthroscopic portals resulted in a significant increase of the anterior (P = 0.01) and antero-inferior translation (P = 0.03) at 0° and 80° abduction, as well as an increase in external rotation at 80° abduction (P = 0.03). Capsular shift reduced external rotation (P = 0.03), but did not significantly decrease translation. Simulating anterior shoulder instability, glenohumeral translation significantly increased, ranging from 50 to 279% of physiological translation. Arthroscopic shoulder stabilization resulted in a decrease of translation in all tested directions to approximately physiologic levels. External rotation in 0° abduction was thus decreased significantly (P = 0.003) to an average of 19°. The study proved that an arthroscopic anterior capsular shift in a cadaveric model decreases external rotation without a significant influence on glenohumeral translation. Arthroscopic shoulder stabilization with suture anchors thus sufficiently restores increased glenohumeral translation, but also decreases external rotation in neutral abduction. An anatomic reconstruction of the Bankart lesion without overconstraining of the antero-inferior capsule should therefore be the aim in arthroscopic anterior shoulder stabilization.     

CT-guided suprascapular nerve blocks: a pilot study

Objective The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies.Design and patients CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards.Results Within 30 min of the block overall pain scores decreased from a mean (±SEM) pain score of 7.0 (±0.4) to 3.5 (±0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (±4.9, P<0.001) and 16.8% (±4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted.Conclusions In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability.