121 research outputs found

    The Effect of Scapular Dyskinesis on Upper Quarter Y-Balance Test Performance

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    The Upper Quarter Y-Balance Test (UQYBT) is a functional assessment tool that measures the stability and mobility of the upper extremity, while also analyzing symmetry. Scapular dyskinesis is defined as an alteration of the positioning and function of the scapula that impacts the overall kinetic chain, inhibiting proper shoulder movement. This condition is most prevalent in athletes participating in overhead sports such as swimming and tennis. Scapular dyskinesis decreases the range of motion of the shoulder resulting in a weakened performance. While it is unknown whether scapular dyskinesis is a cause or effect, it is believed that it increases the risk for shoulder injuries to occur. PURPOSE: to investigate if scapular dyskinesis impacts the performance on the UQYBT. METHODS: Twenty subjects (23±5 years; 76±17 kg; 173±10 cm), eight females and 12 males, participated in this study. Scapular dyskinesis was assessed using the Kibler Scapular Dyskinesis Test (SDT), on all subjects. Once the SDT was completed, the subjects performed the Upper Quarter Y-Balance Test (UQYBT). The three reach directions of the UQYBT are medial reach (MR), superolateral reach (SLR), and inferolateral reach (ILR). Three consecutive trials in all three directions were performed on the right and left arm, randomly. A one-minute resting period was given for each subject between trials. The best reach score for each direction and side was collected and normalized to the right upper extremity length. Composite scores were then calculated using the average of the three reach directions, for each side. One-way ANOVA analyses were used to compare the normalized reach scores for each direction, between the shoulders with scapular dyskinesis and the normal, p\u3c.05. RESULTS: Out of the 40 shoulders tested in this study, 15 shoulders were categorized as having scapular dyskinesis and the other 25 were categorized as normal. No significant differences were found when comparing all three normalized reach scores and normalized composite score between scapular dyskinesis shoulders and normal shoulders, p\u3e.05. For the normal shoulders, %MR was 98.4±7.9%, %SR was 73.1±13.5%, %IR was 81.1±12.8%, and %composite was 84.2±8.95%. In terms of the scapular dyskinesis shoulders, %MR was 95.6±8.9%, %SR was 69.9±13.9%, %IR was 83.8±12.6%, and %composite was 83.1±10.5%. CONCLUSION: In all three reach directions and composite scores, the scapular dyskinesis shoulders were observed to have similar results when compared to the normal shoulders. These results may indicate that subjects with scapular dyskinesis shoulders are able to achieve similar scores due to compensatory patterns of the muscles surrounding the shoulder girdle complex and thorax. Further research needs to be done to investigate if there are different compensatory mechanisms in individuals with scapular dyskinesis shoulders

    Contribution of the Ankle, Knee, and Hip to Total Lower Extremity Internal/External Rotation

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    The nature of the ankle, knee, and hip interaction can profoundly impact the movement patterns of the lower extremities. The ability to internally and externally rotate the lower extremity is essential in order to effectively absorb and apply force. In previous studies, most measurements have been conducted in 2D using a protractor, while mainly evaluating the hip. Dysfunction in any joint throughout the kinetic chain can lead to inefficient movement patterns that can compromise performance and potentially lead to injury. Appreciating the complexity of the lower extremity brings to attention the importance of any segments that are compromised. PURPOSE: To investigate the contribution of the ankle, knee, and hip to the total lower extremity internal rotation (IR) and external rotation (ER) range of motion (ROM) using a 3D camera system. METHODS: Fifteen college students participated in the study (21.2±1.9 years, 72.2±12.8 kg, 170.5±8.7 cm), eight males (21.1±1.2 years, 80.7±11.4 kg, 176.2±6.3 cm) and seven females (21.3±2.5 years, 62.5±5.0 kg, 163.8±6.0 cm). Lower extremity IR and ER ROM for each side were captured using 3D camera system, at 240 Hz. Each participant was instructed to perform maximal IR and ER in standing position, using sliding disk. Participants performed three trial of each rotation. Test-retest reliability identified good to excellent reliability, ICC 3,1 .797-.959. Based on this findings highest IR and ER ROM were further analyzed. Repeated measure ANOVAs were performed to determine differences between the three joints for each rotation and each side, followed by Bonferroni post-hoc analyses, were granted, pRESULTS: Significant main effect was found for IR of the right leg, p=.001 (hip 14.2o±5.5o, knee 12.0o±4.0o, and ankle 24.4o±9.9o). Post-hoc analyses revealed that ankle IR was significantly larger than hip IR (p=.022) and knee IR (p=.001). Significant main effect was found for IR of the left leg, p=.005 (hip 13.2o±3.4o, knee 12.2o± 5.6o, and ankle 23.6o±10.6o). Post-hoc analyses revealed that ankle IR was significantly larger than hip IR (p=.019) and knee IR (p=.003). Significant main effect was found for ER of the right leg, p=.001 (hip 17.1o±5.2o, knee 16.6o±3.1o, and ankle 26.8o±7.5o). Post-hoc analyses revealed that ankle ER was significantly larger than hip ER (p=.002) and knee ER (p=.001). No significant main effect was found for ER of the left leg, p=.138 (hip 18.7o±10.0o, knee 16.8o±5.9o, ankle 23.6o±7.3o). One-way ANOVAs Comparing between gender and side did not find any significant differences, p\u3e.05.CONCLUSION: The findings suggest that the ankle joint is contributing the most for IR and ER ROM. On average, ankle contributes 42%±9% to the lower extremity ROM during ER and 47%±13% during IR. The knee contributes 29%±9% to the lower extremity ROM during ER and 24%±8% during IR. The hip contributes 29%±10% to the lower extremity ROM during ER and 29%±12% during IR. Practitioners need to be caution when interpreting lower extremity or hip IR and ER ROM. Future studies need to further investigate the influence of each of the three joints IR and ER ROM on performance and injury

    The Influence of Hip Position on Lower Extremity Internal/External Rotations and Its Reliability

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    The hip joint is important in activities of daily living (ADL), allowing tri-planar movements simultaneously. Range of motion (ROM) of the hips is essential for ADL, where a decreased hip ROM is associated with higher lower extremity injuries. Measuring ROM of the hips can assist in preventing lower extremity injuries. Goniometry is a common method used in measuring passive and dynamic hip ROM, however, limited mainly to non-weight bearing positions such as supine, prone and sitting. PURPOSE: To investigate the influence of weight bearing hip position on lower extremity internal rotation (IR) and external rotation (ER) ROM and its reliability, in the general population. METHODS: Ten participants (six males and four females, 21.9+2.4 years) participated in the study. The participants performed lower extremity IR and ER in eight randomized hip positions, on a rotational disc device with 360 dial (one-degree accuracy). The following are the eight hip positions: flexion IR (FIR), flexion ER (FER), extension IR (EIR), extension ER (EER), abduction IR (ABDIR), abduction ER (ABDER), adduction IR (ADDIR), and adduction ER (ADDER). Participants maximum IR and ER ROM was recorded using a video camera and measured in each hip position, by two raters. Participants were cued to hold the end ROM for 2 s. Each position was repeated three times for both right and left sides. A test-retest analyses were performed between the three consecutive trials in all eight hip positions, for each rater. Interrater analyses were performed between the two raters. Repeated measure ANOVAs were performed to determine the influence of different hip positions on hip IR and ER ROM, followed by Bonferroni post-hoc analyses, were granted, p\u3c.05. RESULTS: Test-retest reliability for each hip position, side, and rater were between good to excellent, ICC 3,1 .802-.945. Based on the high reliability for each rater, the third trial was chosen to run the interrater analyses. Interrater reliability for each hip position and side were between very good to excellent, ICC 3,1 .876-.997. Repeated measure ANOVAs found significant main effects in hip IR (p\u3c.001) and ER (p=.025). Bonferroni post-hoc analyses found the following: FIR (43.4±10.7) was significantly larger than EIR (31.4±8.4), p=.001; ABIR (41.2±10.3) was significantly larger than EIR, p=.003; ADIR (44.7±13.0) was significantly larger than EIR, p\u3c.001; and FER (52.5±15.0) was significantly larger than ADER (44.9±15.4), p=.011. CONCLUSION: This study found good to excellent reliabilities for the test-retest analyses and very good to excellent reliability for the interrater reliability. Furthermore, Hip starting position found to influence mainly the IR ROM. When the hip was in flexion position IR and ER ROM were the largest. Practitioners need to be aware that measuring lower extremity IR and ER ROM in different weight bearing hip starting positions may influence the measurement outcome. These findings provide important information to consider when developing injury prevention programs and rehabilitation testing protocols

    Case Presentation for Axillary Nerve Injury

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    CASE HISTORY: The patient is a 21-year-old male experiencing upper extremity numbness and tingling in the right deltoid. He began to experience these symptoms after a football injury and was seen by a doctor who referred him to a sports medicine specialist one month after the injury. The injury occurred during a football game, where he was struck by an opponent on the right inferior axillary region. The patient lost mobility of his right arm immediately following his injury, however, regain minimal mobility a week later. Right arm was checked for dislocation or any fractures, and none were found. The patient was referred to a specialist and received one follow-up visit after his initial evaluation. PHYSICAL EXAM: The patient received care from an Athletic Trainer who referred him to a doctor for further examination. The doctor tested the strength and reflexes of the upper body extremities and found a decreased in sensation at the right deltoid, compared to the left. DIFFERENTIAL DIAGNOSES: Shoulder dislocation, neuralgic amyotrophy, lymphoma, parsonage turner syndrome, cervical radiculopathy of C5-C6, quadrilateral space syndrome. TESTS & RESULTS: There was no spinal cord injury based on the Hoffman test. The Sensory Conducting Study found the right and left Antebrachial Cutaneous Nerves outside the normal range. The test displayed neuromuscular dysfunction in the Right Axillary Nerve, with very low amplitude; thus, the nerve signaling was not enough to allow movement. A Motor Nerve Conducting Study showed no significant abnormalities in six of the eight nerves but found irregularities in the Right Axillary and Right Radial Nerves. The EMG showed the Right Axillary Deltoid nerve to have a significant decrease in amplitude, 1.3 mV. An F Wave EMG showed a significant spike in the Right Median Nerve that controls the Abductor Pollicis Brevis muscle. The F wave test showed positive fibrillation, indicating the nerve was misfiring and continuing to provide signaling. There was no pattern or activation of neuromuscular response but misfiring of the Right Axillary Nerve indicated the patient has Right Axillary Neuropathy. The EMG tests were repeated during the one-month follow-up, and the results did not show a significant change. FINAL DIAGNOSIS: Right Axillary Nerve severe shock with partial laceration. DISCUSSION: Axillary Nerve damage is a common peripheral nerve injury involving the shoulder. The most common cause for Axillary Nerve damage is a dislocation of the glenohumeral joint, a fracture or a severe blow to the deltoid muscles. In extreme cases, nerve damage is caused by complications from shoulder surgery. In rare cases, Quadrilateral Space Syndrome, and Parsonage-Turner Syndrome causes unusual shoulder pain, numbness, motor weakness, and dysesthesia. In overhead athletes, subacromial impingement is common and affects the shoulder muscles\u27 functions. Other forms of sever shoulder pain can be cause by a hereditary phenomenon called Neuralgic Amyotrophy. Peripheral nerve lesions, which can range from lymphoma of a peripheral nerve to abnormalities, are uncommon but can affect the patient\u27s recovery. Diagnosis of injuries are confirmed by electrophysiological and electromyography testing, as well as nerve conduction studies. Treatment for this disorder should involve extensive rehabilitation focusing on passive and active range of motion with strengthening of the rotator cuff and deltoid muscles. OUTCOME OF THE CASE: Patient continued his care with the Athletic Trainer and gradually regained his mobility and did not return to football for the season. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient will continue his care with the Athletic Trainer and is planning to return for next year season
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