A new neurocognitive interpretation of shoulder position sense during reaching: unexpected competence in the measurement of extracorporeal space

Background.The position sense of the shoulder joint is important during reaching. Objective. To examine the existence of additional competence of the shoulder with regard to the ability to measure extracorporeal space, through a novel approach, using the shoulder proprioceptive rehabilitation tool (SPRT), during reaching. Design. Observational case-control study. Methods. We examined 50 subjects: 25 healthy and 25 with impingement syndrome with a mean age [years] of 64.52 +/− 6.98 and 68.36 +/− 6.54, respectively. Two parameters were evaluated using the SPRT: the integration of visual information and the proprioceptive afferents of the shoulder (Test 1) and the discriminative proprioceptive capacity of the shoulder, with the subject blindfolded (Test 2). These tasks assessed the spatial error (in centimeters) by the shoulder joint in reaching movements on the sagittal plane. Results. The shoulder had proprioceptive features that allowed it to memorize a reaching position and reproduce it (error of 1.22 cm to 1.55 cm in healthy subjects). This ability was lower in the impingement group, with a statistically significant difference compared to the healthy group ( < 0.05 by Mann–Whitney test). Conclusions. The shoulder has specific expertise in the measurement of the extracorporeal space during reaching movements that gradually decreases in impingement syndrome

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement : randomised, placebo surgery controlled clinical trial

OBJECTIVE To assess the efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a non-operative alternative, exercise therapy, in a more pragmatic setting. DESIGN Multicentre, three group, randomised, double blind, sham controlled trial. SETTING Orthopaedic departments at three public hospitals in Finland. PARTICIPANTS 210 patients with symptoms consistent with shoulder impingement syndrome, enrolled from 1 February 2005 with two year follow-up completed by 25 June 2015. INTERVENTIONS ASD, diagnostic arthroscopy (placebo control), and exercise therapy. MAIN OUTCOME MEASURES Shoulder pain at rest and on arm activity (visual analogue scale (VAS) from 0 to 100, with 0 denoting no pain), at 24 months. The threshold for minimal clinically important difference was set at 15. RESULTS In the primary intention to treat analysis (ASD versus diagnostic arthroscopy), no clinically relevant between group differences were seen in the two primary outcomes at 24 months (mean change for ASD 36.0 at rest and 55.4 on activity; for diagnostic arthroscopy 31.4 at rest and 47.5 on activity). The observed mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were -4.6 (95% confidence interval -11.3 to 2.1) points (P=0.18) at rest and -9.0 (-18.1 to 0.2) points (P=0.054) on arm activity. No between group differences were seen between the ASD and diagnostic arthroscopy groups in the secondary outcomes or adverse events. In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favour of ASD in the two primary outcomes at 24 months in both VAS at rest (-7.5, -14.0 to -1.0, points; P=0.023) and VAS on arm activity (-12.0, -20.9 to -3.2, points; P=0.008), but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. Of note, this ASD versus exercise therapy comparison is not only confounded by lack of blinding but also likely to be biased in favour of ASD owing to the selective removal of patients with likely poor outcome from the ASD group, without comparable exclusions from the exercise therapy group. CONCLUSIONS In this controlled trial involving patients with a shoulder impingement syndrome, arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy at 24 months.Peer reviewe

How accurate is physical examination in diagnosing subacromial impingement?

Concurrent Free Papers 5 - Sports: no. 5.14Conference Theme: Defying the Aging Spine: Our Mission ContinuesINTRODUCTION: Primary subacromial impingement occurs when coracoacromial complex impinges the rotator cuff during movement of shoulder. The study aimed to investigate the accuracy of 5 described impingement signs in predicting a type III acromion found during shoulder arthroscopy. METHODS: A total of 103 shoulder arthroscopies performed by the senior author between July 2008 and June 2013 were recruited. Significant subacromial impingement was defined as a type III ...postprin

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients

Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review

Rehabilitation of the patient with glenohumeral impingement requires a complete understanding of the structures involved and the underlying mechanism creating the impingement response. A detailed clinical examination and comprehensive treatment programme including specific interventions to address pain, scapular dysfunction and rotator cuff weakness are recommended. The inclusion of objective testing to quantify range of motion and both muscular strength and balance in addition to the manual orthopaedic clinical tests allows clinicians to design evidence-based rehabilitation programmes as well as measure progression and patient improvement

The Incidence of Shoulder Injury among Collegiate Overhead Athletes

Shoulder injury in overhead athletes, who perform repetitive overhead motions, has been well documented; however, there is a paucity of data regarding the incidence of specific shoulder injuries in these individuals. Data were collected from the preseason medical examinations and medical records maintained throughout the collegiate careers of 371 overhead athletes. Shoulder injuries were documented in 30% of the athletes during their athletic careers. Subacromial impingement syndrome and rotator cuff (RTC) tendonitis were the most common shoulder injuries for each individual sport and accounted for 27% and 24% of the total shoulder injuries respectively. These injuries had a significantly higher incidence rate (p = .001) than any other injury among the athletes. Significant incidence rates were found for baseball players diagnosed with subacromial impingement (p = .001), softball players diagnosed with subacromial impingement and RTC tendonitis (p = .001), swimmers diagnosed with subacromial impingement, RTC tendonitis, and biceps tendonitis (p = .001), and tennis players diagnosed with subacromial impingement and RTC tendonitis (p = .001). No significant incidence rates were found for the number of injured athletes per sport (p = .42) or for the total number of injuries per sport (p = .11). Rotator cuff tendonitis and subacromial impingement syndrome were the most common shoulder injuries reported for each of the five sports

Descriptive profile of scapulothoracic position, strength and flexibility variables in adolescent elite tennis players

Study design Descriptive study, cross-sectional design. Background Tennis requires repetitive overhead movement patterns that can lead to upper extremity injury. The scapula plays a vital role in injury-free playing. Scapular dysfunction has been associated with shoulder injury in the overhead athlete. Objectives The purpose of this study was to describe variables regarding scapular position, muscle strength and flexibility in young elite tennis players. Methods Thirty-five adolescent Swedish elite tennis players (19 boys, aged 13.6 (+/-1.4) years, 16 girls, aged 12.6 (+/-1.3) years), selected on the basis of their national ranking, underwent a clinical screening protocol consisting of: scapular upward rotation at several angles of arm elevation; isometric scapular muscle strength; and anthropometric measurement of pectoralis minor (PM) length. Results The players showed significantly more scapular upward rotation on their dominant side (p<0.001). For both genders, upper trapezius (p=0.003) and serratus anterior (p=0.01) strength was significantly greater on the dominant side, whereas middle and lower trapezius strength showed no side differences. PM was shorter on the dominant side (p<0.001), and in the female players (p=0.006) compared with the boys. Conclusion These results indicate some sports-related adaptations of young tennis players on their dominant side at the scapulothoracic level to exposure to their sport. These data may assist the clinician in the prevention and rehabilitation of sport-specific injuries in adolescent tennis players

Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome

Background: Platelet-leukocyte gel (PLG) is being used during various surgical procedures in an attempt to enhance the healing process. We studied the effects of PLG on postoperative recovery of patients undergoing open subacromial decompression (OSD). Methods: PLG was produced from platelet-leukocyte-rich plasma (P-LRP), prepared from a unit of whole blood. Forty patients were included in the study. Self-assessed evaluations, using the American Shoulder and Elbow Surgeons scoring system of activities of daily living (ADL), joint instability, pain levels, pain medications, and clinical evaluations for range of motion were conducted. Results: Platelet and leukocyte counts were significantly increased in the P-LRP compared to baseline counts. Treated patients demonstrated decreased visual analog scales for pain and used significantly less pain medication, had an improved range of motion during passive forward elevation, external rotation, external rotation with arm at 90 degrees abduction, internal rotation, and cross body adduction compared to control patients (p < 0.001). No differences in the instability score were observed between the groups. Furthermore, treated patients performed more ADL (p < 0.05). Conclusion: In the PLG-treated group, recovery was faster and patients returned earlier to daily activities and also took less pain medication than control subjects

Features of central sensitisation in patients with shoulder pain : A feasibility study

Design. A case-control feasibility study, comparing people with unilateral shoulder pain and pain free controls. Background. Previous studies have suggested that central sensitisation (CS) may be present in people with shoulder pain, mostly based on testing of nociception rather than mechanosensitivity, both of which can change as part of CS. Changes in mechanosensitivity are important for physiotherapy, which often involves non-noxious mechanoreceptor stimulation. Objectives. This study tested sensitivity to arangea range of mechanical stimuli potentially associated with CS in people with and without shoulder pain, compared to asymptomatic individuals. It was hypothesised that if CS was present, the response to mechanoreceptor stimulation would be increased. Methods. Both shoulders in both groups were tested for sensitivity of static and dynamic touch, vibration and punctate stimulation, plus temporal summation and pressure pain threshold (PPT). Participants completed a demographic questionnaire, pain scales, PainDETECT for neuropathic pain, and QuickDASH for upper limb function. Results. PPT was found to be significantly lower in the affected compared to the unaffected shoulders (p<0.003), but no other statistically significant between-group differences were found. Conclusion. This study found a lowered PPT in people with unilateral shoulder pain compared with asymptomatic individuals, but no evidence of a heightened response to other forms of mechanoreceptor stimulation. The study protocol was suitable for future studies and the required participant numbers were established. The variation in findings between studies suggests that a larger longitudinal study may be warranted .Peer reviewedFinal Published versio

Forces due to a Command Service Module reaction control motor plume impinging on the Saturn 5 cluster arrangement Dry workshop version

Impingement loadings on Saturn 5 workshop cluster arrangement due to command service module reaction control moto