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Shoulder Abstracts 2014 TABLE OF CONTENTS SHOULDER GIRDLE 2 – 35 GLENOHUMERAL JOINT ROTATOR CUFF IMPINGMENT INSTABILITIES ADHESIVE CAPSULITIS SURGERIES SHOULDER GIRDLE Kinesio Taping Int J Sports Med. 2013 Nov;34(11):950-5. doi: 10.1055/s-0033-1334911. Epub 2013 May 13. Does the application of kinesiotape change scapular kinematics in healthy female handball players? Van Herzeele M, van Cingel R, Maenhout A, De Mey K, Cools A. Source Rehabilitation Sciences an Physiotherapy, Ghent University, Ghent, Belgium. Abstract Elastic taping is widely used in sports medicine for correcting functional alignment and muscle recruitment. However, evidence regarding its influence on scapular dynamic positioning is scarce. This study aimed to investigate the effect of a specific kinesiotaping method on scapular kinematics in female elite handball players without shoulder complaints. 25 athletes (18.0±1.5 years) active in the highest national division were recruited. All subjects received an elastic adhesive tape (K- active tape©) with the purpose to correct scapular position. 3-dimensional scapular motion measurements were performed (Fastrak®) during humeral elevation in the sagittal, frontal and scapular plane. The results showed that taping has a moderate to large effect (Cohen's d>0.7) towards scapular posterior tilting, in all 3 planes of humeral movement and for all angles of elevation (mean posteriorizing effect of 4.23°, 3.23° and 4.33° respectively for elevation in the sagittal, frontal and scapular plane, p<0.001). In addition, taping also moderately increased the scapular upward rotation at 30°, 60° and 90° of humeral abduction (mean increase of 2.90°, Cohen's d>0.7). Together these results suggest that kinesiotape application causes positive changes in scapular motion. This could support its use in sports medicine for preventing shoulder problems in overhead athletes. © Georg Thieme Verlag KG Stuttgart · New York. PMID: 23670362 Shoulder/AC joint/diagnostic accuracy BMC Musculoskelet Disord. 2013 May 1;14(1):156. [Epub ahead of print] Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non- traumatic acromioclavicular joint pain. Cadogan A, McNair P, Laslett M, Hing W. BACKGROUND: Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. METHODS: Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O'Brien's test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P<=0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. RESULTS: Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P<0.05) and combinations of traditional tests were not able to discriminate between a PAR and a negative anaesthetic response (AUC 0.507; 95% CI: 0.366, 0.647; P>0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0.41) and four positive clinical features resulted in 95% specificity (95% CI 0.90, 0.98) and a LR+ of 4.98 (95% CI 1.69, 13.84). CONCLUSIONS: In this cohort of primary care patients with predominantly subacute or chronic ACJ pain of non- traumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection- confirmed ACJ pain in this cohort. PMID:23634871 Shoulder/Claviculectomy Man Ther. 2013 Mar 18. pii: S1356-689X(13)00037-4. doi: 10.1016/j.math.2013.02.008. [Epub ahead of print] Three-dimensional shoulder kinematics after total claviculectomy: A biomechanical investigation of a single case. Camargo PR, Phadke V, Braman JP, Ludewig PM. Source Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil. Electronic address: [email protected]. Abstract Since total claviculectomy is an uncommon surgical procedure, few case reports exist in the literature. This report describes the three-dimensional scapulothoracic kinematics in a subject with unilateral total claviculectomy. Kinematic data were collected during shoulder protraction with arms at the side of the body, horizontal arm adduction at 90° of elevation, humeral internal/external rotation with the arm at 90° of elevation in the frontal plane, and elevation and lowering of the arm in the sagittal plane. Descriptive data were compared to the subject's contralateral shoulder. Scapulohumeral rhythm during arm elevation in the sagittal plane was calculated for both sides. Overall the subject demonstrated excessive scapular mobility. However, kinematics during elevation were similar to the contralateral side during elevation. The subject demonstrates good muscle control despite the lack of normal sternoclavicular and acromioclavicular joint articulations. His relatively well-preserved shoulder biomechanics belied his ongoing symptoms, especially involving pain with activities that required use of the arm away from the side. Copyright © 2013 Elsevier Ltd. All rights reserved. PMID:23518038 Scapula/exercise/orientation Conscious Correction of Scapular Orientation in Overhead Athletes Performing Selected Shoulder Rehabilitation Exercises: The Effect on Trapezius Muscle Activation Measured by Surface Electromyography Kristof De Mey, Lieven A. Danneels, Barbara Cagnie, Lies Huyghe, Elien Seyns, Ann M. Cools DOI: 10.2519/jospt.2013.4283 STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To assess the effect of conscious correction of scapular orientation on the activation of the 3 sections of the trapezius muscle during shoulder exercises in overhead athletes with scapular dyskinesis. BACKGROUND: Previous research has led to the recommendation of 4 exercises for training of the trapezius muscle: prone extension, sidelying external rotation, sidelying forward flexion, and prone horizontal abduction with external rotation. However, the extent to which conscious correction of scapular orientation impacts trapezius muscle activation levels during these exercises is unknown. METHODS: Absolute (upper trapezius [UT], middle trapezius [MT], lower trapezius [LT]) and relative (UT/MT and UT/LT) muscle activation levels were determined with surface electromyography in 30 asymptomatic overhead athletes with scapular dyskinesis, during 4 selected exercises performed with and without conscious correction of scapular orientation. Repeated-measures analyses of variance were used to determine if a voluntary scapular orientation correction strategy influenced the activation levels of the different sections of the trapezius during each exercise. RESULTS: With conscious correction of scapular orientation, activation levels of the 3 sections of the trapezius muscle significantly increased during prone extension (mean ± SD difference: UT, 5.9% ± 8.6% maximal voluntary isometric contraction [MVIC]; MT, 13.8% ± 11.0% MVIC; LT, 9.8% ± 10.8% MVIC; P<.05) and sidelying external rotation (UT, 2.2% ± 4.4% MVIC; MT, 6.7% ± 10.6% MVIC; LT, 13.3% ± 24.4% MVIC; P<.05). There was no difference between conditions for sidelying forward flexion and prone horizontal abduction with external rotation. The UT/MT and UT/LT ratios were similar between conditions for all 4 exercises. CONCLUSION: Conscious correction of scapular orientation during the prone extension and sidelying external rotation exercises can be used to increase the activation level in the 3 sections of the trapezius in overhead athletes with scapular dyskinesis. Although lack of kinematic data limits the interpretation of the results, this study suggests that conscious correction of scapular orientation can be performed without altering the favorable UT/MT and UT/LT ratios that have been previously reported for these exercises. J Orthop Sports Phys Ther 2013;43(1):3-10. Epub 16 November 2012. doi:10.2519/jospt.2013.4283 KEY WORDS: muscle balance, overhead injury, scapular dyskinesis, shoulder pathology The authors assess the effect of conscious correction of scapular orientation on the activation of the 3 sections of the trapezius muscle during shoulder exercises in overhead athletes with scapular dyskinesis.
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