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

Comparison of Upper Extremity Physical Characteristics Between Adolescent Competitive Swimmers and Nonoverhead Athletes

Alterations to upper extremity physical characteristics of competitive swimmers (posture, range of motion [ROM], and subacromial-space distance) are commonly attributed to cumulative training load during a swimmer's competitive career. However, this accepted clinical belief has not been established in the literature. It is important to understand whether alterations in posture and associated physical characteristics occur as a result of sport training or factors other than swimming participation to better understand injury risk and possible interventions

Passive range of motion of the hips and shoulders and their relationship with ball spin rate in elite finger spin bowlers

Objectives: Investigate rotational passive range of motion of the hips and shoulders for elite finger spin bowlers and their relationship with spin rate. Design: Correlational. Methods: Spin rates and twelve rotational range of motion measurements for the hips and shoulders were collected for sixteen elite male finger spin bowlers. Side to side differences in the rotational range of motion measurements were assessed using paired t-tests. Stepwise linear regression and Pearson product moment correlations were used to identify which range of motion measurements were linked to spin rate. Results: Side to side differences were found with more external rotation (p = 0.039) and less internal rotation (p = 0.089) in the bowling shoulder, and more internal rotation in the front hip (p = 0.041). Total arc of rotation of the front hip was found to be the best predictor of spin rate (r = 0.552, p =  0.027), explaining 26% of the observed variance. Internal rotation of the rear hip (r = 0.466, p =  0.059) and the bowling shoulder (r = 0.476, p =  0.063) were also associated with spin rate. Conclusions: The technique and performance of elite finger spin bowlers may be limited by the passive range of motion of their hips and shoulders. The observed side to side differences may indicate that due to the repetitive nature of finger spin bowling adaptive changes in the rotational range of motion of the hip and shoulder occur

Concussion-Assessment and -Management Techniques Used by Athletic Trainers

Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients

National Athletic Trainers\u27 Association Position Statement: Evaluation, Management, and Outcomes of and Return-to-Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

Objective: To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. Background: In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. Recommendations: Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play

THE ACUTE EFFECTS OF TWO PASSIVE STRETCH MANEUVERS ON PECTORALIS MINOR LENGTH AND SCAPULAR KINEMATICS AMONG COLLEGIATE SWIMMERS

ABSTRACT Purpose/Background: To compare the acute effects of two passive stretches on pectoralis minor length and scapular kinematics among a group of collegiate swimmers. Methods: The study was a descriptive design with repeated measures. All procedures were conducted in a biomechanics laboratory and collegiate swimming facility. Fifty asymptomatic shoulders from 29 NCAA swimmers were used (15 control shoulders, 17 focused stretch shoulders, 18 gross stretch shoulders). Preand post-test linear pectoralis minor length, as well as scapular kinematics (upward/downward rotation, external/internal rotation, anterior/posterior tilt) were measured as dependent variables. Pectoralis minor length was measured using a standard tape measure and three-dimensional scapular kinematics were measured using an electromagnetic capture system. Results: The gross stretch shoulders had a significant increase in pectoralis minor length compared to the control shoulders (P=.007). There were no other significant changes in length for either the focused stretch or control shoulders (P>.07). No statistically significant (P>.08) differences for all three scapular kinematic variables were found among any of the three groups (P>.08). Conclusions: Our results revealed no acute improvements of scapular upward rotation, external rotation, or posterior tilt after the application of either passive stretch maneuver to the pectoralis minor muscle. Level of Evidence: 2

Infraspinatus scapular retraction test: a reliable and practical method to assess infraspinatus strength in overhead athletes with scapular dyskinesis

Background Alteration of normal scapulohumeral rhythm due to the fatigue of scapular-stabilizing muscles induces decrease of rotator cuff strength. In this study we analyzed the interobserver and intraobserver realibility of the infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT) in 29 overhead athletes with scapular dykinesis, before and after 6 months of scapular musculature rehabilitation. Materials and methods Subjects with magnetic resonance imaging (MRI) findings of labral injuries (2 cases, 5%) and cuff tears (4 cases, 11%) were excluded. Scapular dyskinesis patterns were evaluated according to Kibler et al. (J Shoulder Elbow Surg 11:550-556, 2002). We found a type I dyskinesis in 24 cases (83%) and a type II in 5 cases (17%). Patients were tested by using IST and ISRT and the maximum infraspinatus strength (kg) was registered by a handheld dynamometer. Changes in shoulder IR were measured by using a standard goniometry. Rehabilitation continued for 6 months and was focused on the restoration of scapular muscular control and balance. We used a paired Student t test for the significance of the force values (alpha = 0.01). Intraclass correlation coefficient (ICC) and standard error (SE) were applied to determine the realibility of repeated values collected within testers and between testers. Results Values of ICC close to 1 at baseline and at 6 months indicated a higher interexaminer and intraexaminer realibility. IST force values registered a significant increase at 6 months for both examiners (P<0.01). The mean difference between IST and ISRT values were not significant at 6 months (P>0.01). The increase of glenohumeral internal rotation was significant at 6 months (P<0.01). Conclusion The good realibility and the easy reproducibility make the ISRT an excellent test to assess patients with infraspinatus weakness due to scapular dyskinesis and address them toward an appropriate program of rehabilitation aimed to restore scapular musculature balance and control. \ua9 The Author(s) 2010

Differences in Scapular Orientation Between Standing and Sitting Postures at Rest and in 120° Scaption: A Cross-Sectional Study

Background: Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore, a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning. Objective: To determine whether there are differences in scapular orientation between standing, neutral sitting, and habitual sitting, while adjusting for spinal posture. Design: A single group randomized repeated measures study. Setting: University laboratory. Participants: Twenty-eight participants with shoulder pain were recruited from the community. Methods: Scapular orientation between standing and seated positions was compared, with the arm by the side and at 120° of glenohumeral scaption. Thoracic kyphosis and lumbar lordosis angles were used as covariates. Main Outcome Measurements: Scapular elevation, lateral translation, upward rotation, and posterior tilt. Results: Scapular orientation was marginally but significantly different between sitting postures for lateral translation (mean 0.5 cm; 95% confidence interval [95% CI] 0.2-0.7 cm); P < .001), upward rotation (mean 3°; 95% CI 1.1-5.0°; P < .001), and posterior tilt (mean 2.3°; 95% CI 0.2-4.3°; P = .009) in the arm by side position. A small-but-significant difference between standing and neutral sitting was found for upward rotation (mean 1.8°; 95% CI 0-3.7°; P = .02), and between standing and habitual sitting for lateral translation (mean 0.6 cm; 95% CI 0-1.1 cm; P =.02) in the arm by side position. Conclusions: The results of this study suggest that scapular orientation can be slightly affected by body posture, although the clinical relevance is uncertain. To enhance scapular upward rotation or posterior tilt, it may be preferable to place the patient in neutral sitting

Posterior shoulder tightness; an intersession reliability study of 3 clinical tests.

Background Although posterior shoulder tightness (PST) has been associated with shoulder pathology and altered glenohumeral joint kinematics, uncertainty remains regarding its cause and definition. To understand the efficacy of treatments for PST, it must be possible to identify people with PST for the purposes of research and clinical decision-making. Clinical tests for PST must demonstrate acceptable levels of measurement reliability in order to identify the condition and to evaluate the response to intervention. There is currently a lack of research describing intersession reliability for measures of PST. The aim of this study was to quantify the inter-session reliability for three clinical tests used to identify PST over a 6–10 week interval. Methods A convenience sample of 26 asymptomatic adult participants (52 shoulders) were recruited from a university setting over a five-month duration. Participants attended the human movement laboratory for measurement of glenohumeral joint internal rotation, horizontal adduction and low flexion on two occasions separated by an interval of 6–10 weeks. Intra-class correlation coefficients were calculated from the mean square values derived from the within-subject, single factor (repeated measures) ANOVA. Test-retest measurement stability was evaluated by calculating the standard error of measurement and the minimum detectable change for each measurement. Results All 3 tests demonstrated good intersession intra-rater reliability (0.86–0.88), and the standard error of measurement (95%) were 7.3° for glenohumeral horizontal adduction, 9.4° for internal rotation, and 6.9° for low flexion. The minimum detectable change for glenohumeral horizontal adduction was 10.2°, internal rotation was 13.3°, and low flexion was 9.7°. Conclusion In this population of people without symptoms, the 3 measures of PST all demonstrated acceptable inter-session reliability. The standard error of measurement and minimum detectable change results can be used to determine if a change in measures of PST are due to measurement error or an actual change over time.Peer reviewe

Dynamic thoracohumeral kinematics are dependent upon the etiology of the shoulder injury

[EN] Obtaining kinematic patterns that depend on the shoulder injury may be important when planning rehabilitation. The main goal of this study is to explore whether the kinematic patterns of continuous and repetitive shoulder elevation motions are different according to the type of shoulder injury in question, specifically tendinopathy or rotator cuff tear, and to analyze the influence of the load handled during its assessment. For this purpose, 19 individuals with tendinopathy and 9 with rotator cuff tear performed a repetitive scaption movement that was assessed with stereophotogrammetry. Furthermore, static range of motion (ROM) and isometric strength were evaluated with a goniometer and a dynamometer, respectively. Dynamic measurements of maximum elevation (Emax), variablility of the maximum angle (VMA), maximum angular velocity (Velmax), and time to maximum velocity (tmaxvel) were found to be significantly different between the tendinopathy group (TG) and the rotator cuff tear group (RTCG). No differences were found in the ROM assessed with goniometry and the isometric strength. The effect of increasing the load placed in the hand during the scaption movement led to significant differences in Emax, VMA, tmaxvel and repeatability. Therefore, only the dynamic variables showed sufficient capability of detecting differences in functional performance associated with structural shoulder injury. The differences observed in the kinematic variables between patients with tendinopathy and rotator cuff tear seem to be related to alterations in thoracohumeral rhythm and neuromuscular control. Kinematic analysis may contribute to a better understanding of the functional impact of shoulder injuries, which would help in the assessment and treatment of shoulder pain.This work was funded by the Spanish Government, Secretaria de Estado de Investigacion, Desarrollo e Innovacion, and co-financed by EU FEDER funds (Grant DPI2013-44227-R). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Lopez Pascual, J.; Page Del Pozo, AF.; Serra Añó, P. (2017). Dynamic thoracohumeral kinematics are dependent upon the etiology of the shoulder injury. PLoS ONE. 12(8). https://doi.org/10.1371/journal.pone.0183954S12