Electromyographic Assessment of Forearm Muscle Function in Tennis Players With and Without Lateral Epicondylitis

"There is no consensus about the main aetiology of Lateral Epicondylitis (LE) or Tennis Elbow. While electromyographic assessment of alterations in neuromuscular control and activation patterns of forearm muscles has received increasing interest as potential intrinsic factors in non-tennis players, there has been insufficient attention in tennis players. The purpose of present review was to search the literature for the electromyographic studies of forearm muscles in tennis players in order to 1) identify related implications for LE, 2) highlight key technical and methodological shortcomings, and 3) suggest potential pathways for future research. An electronic search of PubMed, Scopus, Web of Science, and Google Scholars (1980 to October 2014) was conducted. Titles, abstracts, and full-text articles were screened to identify “peer-reviewed” studies specifically looking into “electromyographic assessment of forearm muscles” in “tennis players”. After screening 104 articles, 13 original articles were considered in the main review involving a total of 216 participants (78% male, 22% female). There were indications of increased extensor activity in all tennis strokes and less experiences single-handed players, however with insufficient evidence to support their relationship with the development of LE. Studies varied widely in study population, sample size, gender, level of tennis skills, electrode type, forearm muscles studied, EMG recording protocol, EMG normalisation, and reported parameters. As a result, it was not possible to present combined results of existing studies and draw concrete conclusions in terms of clinical implications of findings. There is a need for establishment of specific guidelines and recommendations for EMG assessment of forearm musculature in terms of electrode and muscle selection. Further studies of both healthy controls and tennis players suffering from TE with adequate sample sizes and well-defined demographics are warranted.

Pain, Functional Disability, Psychological Status, and Health-Related Quality of Life in Patients with Subacromial Impingement Syndrome

Background Subacromial impingement syndrome (SAIS) is the comments painful shoulder condition leading to considerable functional loss. Considering numerous existing conservative and surgical interventions for SAIS, the use of optimal patient-centred outcome measures is essential. Study assessed various generic and shoulder-specific outcome measures in patients and healthy controls to provide baseline data and facilitate the development of evidence-based interventions. Methods A total of 75 participants including 39 patients and 36 healthy controls were evaluated and compared by a battery of validated outcome tools: McGill Pain Questionnaire, Oxford Shoulder Score, Constant Murley Score, The Disability of the Arm, Shoulder and Hand, Upper Limb Function Index, Functional Impairment Test–Hand and Neck/Shoulder/Arm, Hospital Anxiety and Depression Scale, Short-Form Health Survey, and shoulder muscle strength. Results All selected measures showed significant differences in the pain experience, upper limb functional capacity, psychological status (anxiety and depression), and health-related quality of life between SAIS patients and healthy controls in both female and male participant groups (p<0.05 - p<0.001). Conclusion The use of an array of patient-centred upper limb regional/joint-specific pain and functional measures combined with psychological status and quality of life tools is recommended for the evidence-based assessment of intervention outcome in patients with SAIS

POSTURAL ALTERATIONS IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME.

BackgroundAn aberrant upper body posture has been proposed as one of the etiological factors contributing to the development of subacromial impingement syndrome (SAIS). Clinicians have translated this supposition into assessment and rehabilitation programs despite insufficient and conflicting evidence to support this approach.PurposeThe purpose of this study was to compare several postural variables between the SAIS patients and asymptomatic healthy controls.Study designCase-Control Study.MethodsA total of 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated several postural variables including forward head posture (FHP), forward shoulder posture (FSP), thoracic kyphosis index (TKI), scapular index (SI), normalized scapular protraction (NSP), and the lateral scapular slide test (LSST). The variables were compared between patient and control groups according to sex.ResultsSignificant differences were observed in the female patients compared to asymptomatic controls for the FHP (49.38 + 9.6o vs 55.5o+8.38, p=0.03), FSP (45.58 + 10.1o vs 53.68 + 7.08, p=0.02), and LSST in third position (10.2 + 2.1cm vs 11.5 + 0.7cm, p=0.01). Male patients showed a significant difference only in the FSP compared to controls (61.9o+9.4o vs 49.78 + 9.28, pConclusionsWhile inadequate data on the relationship between dysfunctional posture and SAIS has led to broad variations in current rehabilitation strategies, the results of the present study revealed different patterns of postural aberrations in female and male patients with SAIS. This clarifies the need to develop individualized or sex-specific approaches for assessing posture in men and women with SAIS and rehabilitation programs based on the assessment results.Level of evidence3b

Subacromial Impingement Syndrome: An Electromyographic Study of Shoulder Girdle Muscle Fatigue

Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the 25 contributing factors to the development of subacromial impingement syndrome (SAIS). 26 Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics 27 of SAIS has not been reported. This study aimed to measure and compare fatigue progression 28 within the shoulder girdle musculature of patients and healthy controls. 75 participants 29 including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) 30 participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder 31 girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four 32 distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, 33 subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital 34 Anxiety and Depression Scale) were also assessed. The results were compared between patient 35 and control groups according to the gender. Despite marked fatigue observed in the majority 36 of muscles particularly during flexion and abduction at 90°, overall results indicated a lower 37 tendency of fatigue progression in the impingement group across the tests (0.05< p <0.05). 38 Shoulder Strength, pain experience, and psychological status were significantly different 39 between the two groups (P<0.05). Lower tendency to fatigue progression in the impingement 40 group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, 41 which in turn lead to adaptations in motor programme to reduce muscle recruitment and 42 activation. The significantly higher levels of pain experience and anxiety/depression in the 43 impingement group further support this proposition

Patient-specific Instrumentation Versus Standard Surgical Instruments in Primary Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Clinical Study.

AimsPatient-specific instrumentation (PSI) in primary shoulder arthroplasty has been studied; results supported the positive impact of the PSI on the glenoid positioning. Nevertheless, no clinical outcomes have been reported. We compare the clinical outcomes of primary reverse total shoulder arthroplasty using PSI versus the standard methods.MethodsFifty-three patients with full records and a minimum of 24-months follow-up were reviewed, 35 patients received primary standard RSTA, and 18 patients received primary PSI RSTA. All patients were operated on in a single center. The median follow-up was 46 months (53 months in the standard group vs 39 months in the PSI group).ResultsThere was an overall significant post-operative improvement in the whole cohort (PConclusionIn this series, both groups achieved comparable good outcomes. PSI did not achieve significantly better clinical outcomes than Standard after primary RSTA. Yet comparison has some limitations. PSI did not negatively impact the waiting time or the surgical time

Responsiveness of the Liverpool Elbow Score in elbow arthroplasty.

BACKGROUND Responsiveness and floor and ceiling effect are important parameters for evaluating the sensitivity of an outcome instrument in detecting the changes in the clinical condition of patients after an intervention as well as evaluating the content validity of the instrument. The aim of this prospective observational study was to assess these parameters for the Liverpool Elbow Score (LES) in total elbow replacement (TER). METHODS The study included 121 cemented TER cases with linked elbow prosthesis (Discovery Elbow, Biomet Orthopaedics, Swindon, UK) for various conditions, including inflammatory arthritis, noninflammatory arthritis, trauma, and loosening. The proportion of patients with the lowest score (0 points; floor effect) and maximum score (10 points; ceiling effect) was checked preoperatively and 1 year postoperatively. Distribution-based methods (effect size [ES], standardized response mean [SRM], Guyatt responsiveness ratio [GRR]) and anchor-based methods (receiver operating characteristic [ROC] curve and Spearman correlation coefficient) were used to assess responsiveness. Patient satisfaction after TER was used as an external anchor. RESULTS Patients were a mean age of 63 years (range, 20-86 years). Large ES (1.64), SRM (1.25), and GRR (1.69) were found during the follow-up period. Area under the ROC curve was 0.71 (95% confidence interval, 0.56-0.87; P = .03). There was significant positive correlation (Spearman correlation coefficient, 0.35; P = .004) between changes in LES and satisfaction level. LES showed no floor and ceiling effect preoperatively and at 1 year postoperatively. CONCLUSION LES is a responsive measure and has no floor and ceiling effect. LEVEL OF EVIDENCE This encourages its use as an outcome instrument for TER. Basic Science Study, Development or Validation of Outcome Instruments

Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up.

BACKGROUND Published data on the outcome of Copeland shoulder resurfacing arthroplasty (CSRA) are limited. This observational case series study reports the functional and radiological outcome of CSRA during a mean follow-up of 4 years and highlights the correlation between key outcome measures. METHODS One-hundred two consecutive patients with osteoarthritis (OA-47.1%), rheumatoid arthritis (RA-40.2%), rotator cuff arthropathy (RCA-8.8%), and avascular necrosis (AVN-3.9%) underwent CSRA. The outcome assessment included pain and satisfaction, physical limitation, Oxford Shoulder score (OSS), Constant score (CS), and SF-12. Imaging was reviewed for glenoid morphology (Walch classification) and humeral head (HH) migration. RESULTS Highest patient satisfaction and lowest pain levels were related to the primary pathology with AVN best followed by OA, RA, and with RCA having the poorest outcome. Comparing the two largest groups the CS was significantly higher in OA (61 ± 21.3) than RA (44 ± 20.5). OSS showed a significant correlation with CS and physical subscale of SF-12. Walch type A (67.6%) and HH migration (47%) were the commonest radiographic observations. OSS, CS, pain, and satisfaction were significantly different between migration and nonmigration groups. CONCLUSION The CSRA resulted in satisfactory outcome in many patients. AVN and OA were associated with the best and RCA with the poorest results. The CSRA was associated with glenoid erosion and HH migration particularly in RCA. CSRA remains an option in the treatment of arthritic conditions of the shoulder but its future use may be limited to younger patients where implanting a glenoid may be regarded as problematic