The supporting role of the teres major muscle, an additional component in glenohumeral stability? An anatomical and radiological study

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations

Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial

Background: Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose: To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods: Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0-10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results: The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003-0.000). Conclusion: Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study. Copyright © 2021 Rodríguez-Sanz et al

Does the addition of manual therapy approach to a cervical exercise program improve clinical outcomes for patients with chronic neck pain in short-and mid-term? A randomized controlled trial

Chronic neck pain is one of today’s most prevalent pathologies. The International Classification of Diseases categorizes four subgroups based on patients’ associated symptoms. However, this classification does not encompass upper cervical spine dysfunction. The aim is to compare the short-and mid-term effectiveness of adding a manual therapy approach to a cervical exercise protocol in patients with chronic neck pain and upper cervical spine dysfunction. Fifty-eight subjects with chronic neck pain and upper cervical spine dysfunction were recruited (29 = Manual therapy + Exercise; 29 = Exercise). Each group received four 20-min sessions, one per week during four consecutive weeks, and a home exercise regime. Upper flexion and flexion-rotation test range of motion, neck disability index, craniocervical flexion test, visual analogue scale, pressure pain threshold, global rating of change scale, and adherence to self-treatment were assessed at the beginning, end of the intervention and at 3-and 6-month follow-ups. The Manual therapy + Exercise group statistically improved short-and medium-term in all variables compared to the Exercise group. Four 20-min sessions of Manual therapy + Exercise along with a home-exercise program is more effective in the short-to mid-term than an exercise protocol and a home-exercise program for patients with chronic neck pain and upper cervical dysfunction

Normal response to tibial neurodynamic test in asymptomatic subjects

BACKGROUND: The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT. OBJECTIVE: To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance. METHODS: A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2). RESULTS: The mean ROM for hip flexion at P1 was 44.22 ± 13.13 and 66.73 ± 14.30 at P2. Hip flexion was significantly greater at P2 than P1 (p 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf. CONCLUSIONS: This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance

Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial

Purpose: To compare the effectiveness of a single exercise session with manual therapy techniques in the segments of the upper cervical spine (C0–1, C1–2 and C2–3), against a single exercise session in patients with chronic neck pain and mobility deficits in the upper cervical spine. Methods: A single-blind randomized controlled trial was performed. Fifty-eight patients were recruited (29 for the manual therapy and exercise group and 29 for the exercise group) who presented chronic neck pain and upper cervical spine dysfunction. The exercise focused on the deep muscles. The manual therapy combined manipulations and mobilizations with these exercises. Cervical range of motion, flexion-rotation test, pressure pain threshold and pain intensity were measured by a blind evaluator before and after the intervention. Results: Compared to pre-intervention, after intervention, the exercise group was significantly lower in terms of the range of motion, flexion-rotation test, and pressure pain threshold (p < 0.05). The manual therapy and exercise group improved in upper cervical flexion, the flexion-rotation test and intensity of pain (p < 0.05). Conclusions: It may be necessary to normalize the mobility of the upper cervical spine before cervical stabilization training, in patients with chronic neck pain and mobility deficits in the upper cervical spine

Temperature and current flow effects of different electrode placement in shoulder capacitive-resistive electric transfer applications: a cadaveric study

Background: Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode. Methods: A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 min each by a diathermy “T-Plus” device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. Results: A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P< 0.035). All the applications showed a 5 min after treatment temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level. Conclusion: The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area

Functional Massage of the Teres Major Muscle in Patients with Subacromial Impingement Syndrome. A Randomized Controlled Case Series Study.

Objective: the purpose of the present study was to analyze the concurrent validity and reliability of a force platform clinical COBS Feedback® for the estimation of the height of vertical jumps. Design: a cross-sectional correlational and comparative study. Setting: University Human Movement and Physiotherapy Laboratory. Participants: healthy university students (14 female and 13 male) aged between 18 and 25 years old (mean = 20.074 ±1.542). Main Outcome Measures: vertical jump heights, technical error and grade of agreement between methods of measurement. Results: after the 27 subjects performed a total of 135 vertical jumps on COBS Feedback®platform while simultaneously being recorded with a high-speed camera-based method, the intraclass correlation coefficient showed an almost perfect concordance between the two methods (ICC = 0.916, CI95%= 0.882 to 0.940, p<0.001). The technical error of the COBS Feedback® against HSC-Kinovea video analysis was at 0.310±0.223m, being higher in males than in females (t= -2.822, CI95%: -0.376 to -0.574, p=0.001). Conclusions: the COBS Feedback® method provided a valid measurement of the flight times for estimate the vertical jump height as a number of well-known tests and devices.Aims: Subacromial impingement syndrome is the most common shoulder condition. Myofascial trigger points in teres major muscle can be associated with this syndrome. Our objective is to determine whether adding manual therapy specifically for teres major trigger points can produce better results in these patients. Study Design: Randomized controlled case series. Place and Duration of Study: Public Primary Care Center in the Spanish National Health System (Cornellà de Llobregat - Barcelona) and the FREMAP Mutual Society for Work-related Injuries and Occupational Illness (Arnedo - La Rioja), between January and March 2014. Methodology: Fifty-eight people were recruited but 8 subjects were lost during the follow-up period. The sample consisted of 50 patients (17 male and 33 female, age range 23-80 years) randomly assigned to one of two groups: the intervention group or the control group. Both groups received a protocolized physical therapy treatment, while the intervention group also received manual therapy for teres major trigger points. Results: Pain intensity (p=.01) and function (p=.01) showed significant improvement in the control group, whereas pain intensity (p=.01), function (p=.01) and active range of motion (p=.01) showed significant improvement in the intervention group. Between-group differences were statistically significant for abduction (p=.01), extension (p=.02) and lateral rotation (p=.02), and clinically significant (Cohen’s d) for function, flexion, extension, lateral rotation and abduction. Conclusion: Although our findings must be considered as preliminary, they suggest that adding manual therapy to treat teres major trigger points achieves better results in the glenohumeral range of motion

Is dry needling of the supinator a safe procedure? A potential treatment for lateral epicondylalgia or radial tunnel syndrome. A cadaveric study

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician

Ultrasound measurement of the effects of high, medium and low hip long-axis distraction mobilization forces on the joint space width and its correlation with the joint strain

Background: No study has evaluated the mechanical effect of different magnitudes of long axis-distraction mobilization (LADM) force on hip joint space width (JSW) or the association between the separation of joint surfaces and the strain on hip capsular ligaments. Objective: To compare the joint separation when applying three different magnitudes of LADM forces (low, medium and high) and to analyse the correlation between joint separation, strain on the inferior ilio-femoral ligament and magnitude of applied force. Design: Repeated measures controlled laboratory cadaveric study. Methods: Three magnitudes of force were applied to 11 cadaveric hip joints (mean age 73 years). Ultrasound images were used to measure joint separation, and strain gauges recorded inferior ilio-femoral ligament strain during each condition. Results: The magnitude of joint separation was significantly different between low (0.23 ± 0.19 mm), medium (0.72 ± 0.22 mm) and high (2.62 ± 0.43 mm) forces (p 0.723; p < 0.001). Conclusion: Hip joint separation and ligament strain during LADM are associated with the magnitude of the applied force

Efectos inmediatos de la fibrolisis diacutánea en deportistas con dolor anterior en la rodilla

Introducción: el dolor anterior en la rodilla es un síntoma frecuente entre los deportistas. Puede tener múltiples causas incluido un desequilibrio muscular que puede determinar mal alineamiento o mayor presión femoropatelar. En la práctica clínica, se ha observado que la fibrolisis diacutánea proporciona buenos resultados en el tratamiento de estos pacientes. El objetivo del estudio es evaluar sus efectos sobre la distancia femoropatelar y sobre el dolor percibido en flexión de rodilla, en deportistas afectados de dolor anterior de rodilla. Material y método: estudio de intervención no controlado no aleatorizado, en deportistas con dolor anterior de la rodilla relacionado con la actividad deportiva. Se realizó una sesión de fibrolisis diacutánea y se evaluó, antes y después de la sesión, la distancia femoropatelar medida con ecografía y la intensidad de dolor (EVA) percibida en apoyo monopodal en posición de 90º de flexión de rodilla. Resultados: la media de edad de los participantes era 25,6 años (DE 6,36), 4 eran mujeres y 6 hombres. La intensidad de dolor (EVA) se redujo de 2,90 a 0,93 (p < 0,01). La distancia femoropatelar se incrementó significativamente en las tres referencias medidas: en el centro de la tróclea de 0,42 a 0,50 cm (p < 0,03), en la tróclea lateral de 0,22 a 0,31 cm (p < 0,02), y en la tróclea medial de 0,18 a 0,28 cm (p < 0,02). Discusión y conclusión: en la muestra de estudio, una sesión de fibrolisis diacutánea ha podido influir en la disminución de la intensidad del dolor y en el incremento de la distancia femoropatelar, lo que podría implicar una disminución de estrés sobre el cartílago probablemente por un mecanismo similar a los estiramientos musculares. La inmediatez de efectos observados aconseja utilizar fibrolisis diacutánea como coadyuvante del tratamiento conservador de estos pacientes