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Competing Interests: Competing interests: None declared.

Context: Sport-specific adaptations in shoulder rotation range of motion (ROM) and the relationship with humeral torsion have been described in overhead-throwing sports. However, information is lacking for other shoulder-loading sports such as field hockey. Therefore, this study's purpose was to evaluate humeral torsion in elite, male field hockey players and explore its association with shoulder ROM., Design: Cross-sectional study., Methods: Twenty-five male, elite field hockey players were included. Humeral torsion and shoulder external and internal rotation ROM were evaluated bilaterally by ultrasound and an inclinometer smartphone application, respectively., Results: Field hockey players showed a significantly increased humeral retroversion on the dominant compared with the nondominant side (P < .001; Cohen d = 1.75), along with a significantly increased external (P = .004; Cohen d = -0.64) and decreased internal rotation ROM (P = .003; Cohen d = 0.65). This finding illustrates a shift in total shoulder rotational ROM arc. Correlation analysis showed a significant moderate association between the increased humeral retroversion and decreased internal rotation ROM on the dominant side (r = .523)., Conclusions: Elite male field hockey athletes show sport-specific adaptations regarding humeral torsion and shoulder rotation ROM, similar to throwing athletes. These findings increase our insight into the field hockey athlete's shoulder, which is essential to optimize performance and assist in correctly interpreting shoulder rotational ROM measurements.

Feeding whole prey to felids has shown to benefit their gastrointestinal health. Whether this effect is caused by the chemical or physical nature of whole prey is unknown. Fifteen domestic cats, as a model for strict carnivores, were either fed minced mice (MM) or whole mice (WM), to determine the effect of food structure on digestibility, mean urinary excretion time (MUET) of 15 N, intestinal microbial activity and fermentation products. Faeces samples were collected after feeding all cats a commercially available extruded diet (EXT) for 10 d before feeding for 19 d the MM and WM diets with faeces and urine collected from day 11 to 15. Samples for microbiota composition and determination of MUET were obtained from day 16 to 19. The physical structure of the mice diet (minced or not) did not affect large intestinal fermentation as total SCFA and branched-chain fatty acid (BCFA), and most biogenic amine (BA) concentrations were not different ( P > 0·10). When changing from EXT to the mice diets, the microbial community composition shifted from a carbolytic ( Prevotellaceae ) to proteolytic ( Fusobacteriaceae ) profile and led to a reduced faecal acetic to propionic acid ratio, SCFA, total BCFA ( P < 0·001), NH 3 ( P = 0·04), total BA ( P < 0·001) and para-cresol ( P = 0·08). The results of this study indicate that food structure within a whole-prey diet is less important than the overall diet type, with major shifts in microbiome and decrease in potentially harmful fermentation products when diet changes from extruded to mice. This urges for careful consideration of the consequences of prey-based diets for gut health in cats.

Introduction: The effect of dietary fiber on pig production has been extensively evaluated. Inspired by observations of the diet of wild, young piglets, this study aimed to examine the possibility of feeding grass hay to suckling piglets besides concentrated creep feed., Methods: The sow-nursed piglets in this study were divided into two groups based on balanced sow parities. The control group (CON, n = 7 sows) only received a regular, concentrated creep feed, while the treatment piglets (GH, n = 8 sows) were also provided with chopped grass hay from 2 days of age until weaning (28 days). At weaning, one piglet with a median weight was selected from each litter for post-mortem evaluation. Subsequently, six pigs around median weight per sow were grouped into nursery pens and monitored for their feed intake and body weight gain until 9 weeks of age., Results and Discussion: Piglets in GH consumed, on average, 57 g of grass hay per piglet during the entire lactation period. The emptied weight of the small and large intestine was significantly greater in GH (280 vs. 228 g, 88.8 vs. 79.3 g, respectively, p < 0.05), and the length of the large intestine was stimulated by the grass hay (164 vs. 150 cm, p < 0.05). Morphologically, the villus height in the jejunum was higher in GH ( p < 0.05). In the large intestine, the crypt depth of the mid-colon was lower in GH. Moreover, the short-chain fatty acid (SCFA) concentrations in the cecum were increased in GH compared to CON (1,179 vs. 948 µmol/g dry matter, p < 0.05), whereas in the colon, SCFA concentrations were lower in CON (341 vs. 278 µmol/g dry matter, p < 0.05). There was no major impact of grass hay inclusion on the colonic microbiota composition. Only a trend was observed for a lower inverse of the classical Simpson (InvSimpon) index and a higher abundance of Lactobacillus genera in GH. After weaning, no significant differences in feed intake and body weight gain were observed. In conclusion, supplementing the grass hay to suckling piglets led to alterations in intestinal morphology, increased SCFA fermentation in proximal sections of large intestine, stimulation of gastrointestinal tract growth, and subtle modifications in colonic microbiota., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yao, Cools, van Hees, Chiers, Mebratu, Aluwé, Maes and Janssens.)

Purpose: The primary aim was to identify and quantify differences in interlimb asymmetry magnitudes across a battery of upper extremity strength and performance tests at 4 and 6 months after glenohumeral joint stabilization surgery shoulder stabilization in contact and collision athletes compared with an un-injured group. A secondary aim was to investigate if identified asymmetry magnitudes changed from 4 to 6 months after glenohumeral joint stabilization surgery. The third aim was to explore associations within the different performance and strength variables., Methods: Fifty-six male contact and collision sport athletes who had had undergone unilateral glenohumeral joint stabilization were tested at 4 and 6 months after surgery. An un-injured control group ( n = 39 for upper extremity performance tests, n = 47 for isokinetic dynamometry) were tested on a single occasion. Three upper extremity force platform-based performance tests and angle-specific concentric internal and external isokinetic shoulder rotational strength were assessed, and interlimb asymmetries were compared between the two groups., Results: At 4 months after surgery, the glenohumeral joint stabilization group demonstrated significantly higher absolute interlimb asymmetry values than the un-injured group for almost all the performance test variables. In the ballistic upper-body performance tests, the glenohumeral joint stabilization group achieved only half the body elevation reached by the un-injured (counter-movement push-up jump height ( η2 = 0.50) and press-jump jump height ( η2 = 0.39)). At 6 months after surgery, absolute interlimb asymmetries reduced for the performance test variables, but some asymmetry persisted. The glenohumeral joint stabilization group had significantly greater absolute interlimb asymmetries for five out the eight isokinetic variables., Conclusions: Contact and collision athletes who may be cleared to return to sport at 4 to 6 months after glenohumeral joint stabilization surgery shoulder stabilization continue to demonstrate upper limb strength and performance deficits when compared with their un-injured limb and their un-injured counterparts., (Copyright © 2023 by the American College of Sports Medicine.)

This paper describes cases of urolithiasis in fattening pigs on two farms (A and B). Bladder rupture due to urethral obstruction with calculi was the principal finding during the necropsy of the pigs. An in-depth diagnostic examination was performed to elucidate possible pathophysiological mechanisms, namely Fourier-transform infrared spectrophotometry (FT-IR) analysis of the uroliths, blood analysis (farm A: 5 samples, farm B: 10 samples) for assessing concentrations of minerals, the bone resorption marker cross-linked C-telopeptide of type 1 collagen (CTX), parathyroid hormone (PTH), and vitamin D components, biochemical urinalysis (farm A: 5 samples, farm B: 7 samples), microscopic examination of urinary sediment (Farms A and B: 7 samples each), mineral composition of the feed, and analysis of the drinking water. Calcium carbonate was the main component found in stones from both farms, and calcium carbonate and struvite were the main components found in crystals from farms A and B, respectively. On farm A, urinary calcium excretion and urinary pH were high; on farm B, urinary phosphorus was high and urinary calcium was low with a normal urinary pH. The mineral compositions of the feed and drinking water were similar on both farms and could therefore not explain the difference between the two farms. Disturbances in calcium and phosphorus absorption and homeostasis might have been involved in these problems. Further research should focus on the calcium, phosphorus, and vitamin D levels in the feed and take into account other factors, such as the absorption and excretion of minerals due to gut and urinary microbiota.

Total knee arthroplasty (TKA) is a well-known surgical procedure performed to address end stage osteoarthritis. The main goal is to relieve pain, recover articular function and return to normal function as soon as possible. Over the years it is frequently performed in the elderly, but lately there is an increased demand in a younger and more active population. Up to 25% of patients feel dissatisfied about their TKA. The anterior cruciate ligament (ACL) is considered the main anteroposterior stabilizer of the knee; nevertheless the ACL is usually sacrificed during conventional TKA. Research shows this might be an unnecessary sacrifice in certain cases. The considerable dissatisfaction rate in mainly high-demanding patients, together with the literature reports on the importance of the ACL function, were the two main reasons for the development of bicruciate retaining (BCR) total knee arthroplasty. BCR TKA may offer superior knee kinematics and proprioception, through anterior cruciate ligament preservation, but requires a higher level of attention to obtain an accurate and precise component orientation to reach proper ligamentous balancing and restore the native knee biomechanics. Many surgeons abandoned its use due to its challenging technique and inconsistent results. Recent new BCR implant designs are promising. This systematic literature review aims to summarize the current state of BCR TKA and what to expect in the future.

Objective: To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system., Methods: Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system., Results: Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available ( n  = 38)., Conclusion: Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chan, Van den Broeck, Cools, Walraedt, Joniau, Verdin, Balikova, Van Nuffel, Delbeke, De Baere, Leroy and Nerinckx.)

Background: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts., Methods: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus., Results: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain; 17 items, in the "rationale and clinical reasoning" domain; 11 items, in the "subjective examination" domain; 44 items, in the "physical examination" domain; and 27 items, in the "treatment" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively)., Conclusion: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F 16,304  = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Purpose: To investigate the effectiveness of two home-based exercise programs for treating multidirectional shoulder instability (MDI) in patients diagnosed with Hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD)., Methods: Twenty-one hEDS/HSD patients with MDI were recruited from the Center for Medical Genetics of the Ghent University Hospital. Patients were randomly assigned to either the experimental or the control group. Both groups received a 6-month home-based exercise program. The primary outcome measure was the Western Ontario Shoulder Index (WOSI). Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), Tampa Scale for Kinesiophobia (TSK), Patient-Specific Functional Scale (PSFS), Global Rating of Change (GROC), and pain pressure thresholds. Outcomes were assessed at baseline, after 6 weeks, 12 weeks, and 24 weeks., Results: Significant main effects for time were observed for all questionnaires, except for the TSK ( p  = 0.12). Patients improved 240 and 325 points on the WOSI after 12 ( p  = 0.02) and 24 weeks ( p  = 0.001), respectively. Additionally, patients improved 8.6 points on the DASH ( p  = 0.002), 4.3 points on the PSFS ( p  = 0.01), and 1.02 points on the GROC ( p  = 0.001) after 24 weeks., Conclusion: No significant differences were found between group A and B. Both home-based exercise programs led to significant improvements in shoulder function. IMPLICATIONS FOR REHABILITATIONHome-based exercise therapy may be effective for treating MDI in the hEDS/HSD population.Home-based training is beneficial for improving shoulder function, but a multidisciplinary, supervised approach might be more effective for altering kinesiophobia in this patient population.

Abstract: Fernandez-Fernandez, J, Moreno-Perez, V, Cools, A, Nakamura, FY, Teixeira, AS, Ellenbecker, T, Johansson, F, and Sanz-Rivas, D. The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players. J Strength Cond Res 37(5): 1096-1103, 2023-The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR ( p < 0.001, effect size [ES] = 1.83) and ER ( p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side ( p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM ( p < 0.001, ES = 3.32) and total ROM (TROM) ( p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM ( p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances., (Copyright © 2022 National Strength and Conditioning Association.)

The composition of mother's milk is considered the ideal diet for neonates. This study investigated how conserved or variable the amino acid profile of sow colostrum and milk is throughout lactation, compared with other studies in sows and other species. Twenty-five sows (parity one to seven) from one farm with gestation lengths of 114 to 116 d were sampled on d 0, 3, and 10 after parturition. The total amino acid profile of the samples was analyzed through ion-exchange chromatography, and the results were displayed as the percentage of total amino acid and compared with literature data. Most of the amino acid concentrations in sow milk decreased significantly ( p < 0.05) throughout the lactation period, while the amino acid profile generally showed a conserved pattern, especially from d 3 to d 10, and was rather similar across different studies. Glutamine + glutamate was the most abundant amino acid in milk at all sampling moments, accounting for 14-17% of total amino acids. The proportions of proline, valine, and glycine in sow milk nearly accounted for 11%, 7%, and 6% respectively, and were higher compared to human, cow, and goat milk, while the methionine proportion was less than the other three. Compared to the large variations often reported in macronutrient concentrations, the amino acid profile of sow milk in the present study, as well as in others, seems well conserved across the lactation period. Similarities with characteristic differences were also observed between sow milk and piglet body composition, which might reflect the nutrition requirements of preweaning piglets. This study warrants further research exploring the link between the whole amino acid profile and the particular amino acids for suckling piglets and could facilitate insight for optimizing creep feed.

The present study investigated whether dietary supplementation of tripotassium citrate or NaCl reduced the prevalence of calcium oxalate dihydrate (COD) uroliths in fattening pigs on a farm with a high prevalence of COD uroliths. Each group (control, TPC, NaCl) consisted of three batches of approximately 260 fattening pigs each. Performance, water intake, markers for bone resorption (CTX) and bone formation (osteocalcin) and urinalysis from samples taken at the farm and in the slaughterhouse were investigated. Performance parameters, feed and water intake, CTX and osteocalcin were not significantly different between the groups (p > 0.05). The main crystals found were struvite, COD, calcite and amorphous crystals. The prevalence of COD crystals was lower in samples from the slaughterhouse in each group. Microscopic and biochemical examination of urine showed large differences between samples from the farm and the slaughterhouse. In conclusion, there were no beneficial effects of feed supplementation with TPC or NaCl on the prevalence of COD crystals but TPC has a clear promoting influence on the development of alkaline calcite crystals. Urinalysis from samples taken at the slaughterhouse does not fully reflect the situation on the farm.

Background: Differences in shoulder-disability among common shoulder-disorders in orthopaedic specialist care is unknown. Furthermore, rating of shoulder-disability using patient-reported outcomes is time-consuming, and a faster approach is needed., Objectives: First, compare shoulder-disability among common shoulder-disorders. Secondly, rate shoulder-disability according to the new and quick Copenhagen Shoulder Abduction Rating (C-SAR) and investigate criterion validity of C-SAR., Methods: Cross-sectional study including 325 consecutive patients with shoulder-disorders in orthopaedic specialist care. We assessed shoulder abduction range-of-motion and pain during testing (NRS:0-10), and shoulder-disability using Shoulder Pain and Disability Index (SPADI) subscales. Patients were sub-grouped using C-SAR, which is based on shoulder abduction range-of-motion and pain during testing: Severe (range-of-motion ≤90°), Medium (range-of-motion >90°, NRS:>5), Mild (range-of-motion >90°, NRS:≤5). Shoulder-disability was compared among diagnostic categories and C-SAR subgroups using ANCOVA-models., Results: Most patients were diagnosed with either subacromial impingement (n = 211) or full-thickness/complete rotator-cuff tear (n = 18), but adhesive capsulitis (n = 22) was the diagnostic category related to worst SPADI scores. Data for C-SAR subgrouping were available from 187/229 (82%) patients with rotator-cuff related disorders (subacromial impingement or rotator-cuff tears). C-SAR subgrouping was not feasible for patient with adhesive capsulitis or glenohumeral injury. Differences in shoulder-disability between Mild (n = 67) and Medium (n = 56) C-SAR subgroups were large for both SPADI-subscales (ES: 1.0, p < .0001). Only SPADI-function differed significantly between Severe (n = 64) and Medium C-SAR subgroups (ES: 0.4, p = .017)., Conclusion: In orthopaedic specialist care, adhesive capsulitis relates to highest level of shoulder-disability, while C-SAR is a promising test to rate shoulder-disability for most patients, namely those with rotator-cuff related disorders., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the test-retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured collision and contact athletes; (2) develop a normal descriptive profile of angle-specific rotational torque measurements in the same cohort; and (3) examine the effects of direction and joint angle on shoulder rotational strength interlimb asymmetries. Twenty-three collision and contact athletes were recruited for the interday reliability substudy and 47 athletes were recruited for the remaining substudies. We used intraclass correlation coefficients with 95% confidence intervals to quantify interday reliability of all variables. We used a 2-way repeated-measures analysis of variance to analyze differences in absolute interlimb asymmetries. Interday reliability for the isokinetic strength variables was good to excellent (0.78-0.90) on the dominant side and moderate to good (0.63-0.86) on the nondominant side. Maximum angle-specific torque (as well as peak torque) can be measured reliably in internally and externally rotated positions. A normal profile of clinically relevant, angle-specific shoulder rotational torque measurements for collision and contact athletes has been established which provides a reference when assessing shoulder strength in this population.

Objective: To investigate differences in electromyography (EMG), muscle activity, and scapular kinematics during elevation in the scapular plane between healthy controls, participants with multidirectional shoulder laxity (MDL), and patients with multidirectional shoulder instability (MDI) who are diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD)., Methods: Twenty-seven women with hEDS/HSD and MDI, 27 female healthy control subjects, and 28 female subjects with MDL participated in this study. Scapular 3-dimensional kinematic data were obtained using 8 Oqus Qualisys cameras. Simultaneously, surface EMG was used to measure muscle activity of the upper, middle, and lower trapezius, infraspinatus, latissimus dorsi, serratus anterior, posterior deltoid, and pectoralis major during arm elevation in the scapular plane. Group differences were assessed using statistical parametric mapping., Results: Regarding scapular kinematics, significantly less upward rotation was observed in hEDS/HSD patients with MDI compared to both healthy controls and MDL subjects. Significantly less posterior tilt was seen in hEDS/HSD patients compared to MDL subjects. Furthermore, significantly higher EMG activity of the infraspinatus, middle trapezius, and posterior deltoid was found in hEDS/HSD patients with MDI., Conclusion: hEDS/HSD patients with MDI demonstrate altered scapular kinematics and increased EMG muscle activity compared to subjects without MDI. These findings could serve as a stepping stone for future research regarding treatment strategies in patients whose conditions belong to the hypermobility spectrum., (© 2020 American College of Rheumatology.)

Background: Scapular rehabilitation exercises should target appropriate muscles. Recently, adding external rotation resistance to scapular exercises has gained interest. Moreover, clinical experts advise kinetic chain integration into shoulder rehabilitation exercises., Objective: To investigate scapular muscle activity during kinetic chain variations of a prone elevation exercise., Methods: Activity of the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles was determined with surface electromyography (EMG) in 31 asymptomatic participants during six prone elevation exercise variations. Variation was created by adding external rotation resistance, adding trunk extension, or changing exercise position (prone on a Swiss ball with knees or feet supported, or prone on a physiotable). All data were normalized as a percentage of maximal voluntary isometric contraction (% MVIC). For each muscle, a Friedman's ANOVA was conducted to analyse statistical differences in EMG signal intensity between exercises., Results: The LT was moderately (42 - 48% MVIC) and MT highly (63 - 66% MVIC) activated during all exercise variations. No significant differences between exercises for these muscles could be detected. Adding external rotation to a prone elevation exercise decreased UT activity while adding trunk extension increased UT activity. Altering exercise position had no influence on scapular muscle activity except increased UT activity when lying prone on a physiotable with trunk extension., Conclusion: Prone elevation exercises are appropriate for facilitating LT and MT activity. Adding external rotation inhibits UT activity while UT facilitation could be achieved when adding trunk extension., Competing Interests: Conflicts of interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2022 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight relief lifts (WRL)]; (2) associating these changes with wheelchair user capacity, as well as (3) identifying subject characteristics associated with subacromial space, such as sex, lesion level, time since injury, body mass index and impaired shoulder range of motion., Methods: Fifty manual wheelchair users with SCI [11 females, age = 50.5 (9.7) years, time since injury = 26.2 (11.4) years] participated in this quasi-experimental one-group pretest-posttest study. Ultrasound images were used to define AHD during an unloaded position, and during personal and instructed WRL before and after fatiguing wheelchair propulsion. Furthermore, supraspinatus and biceps thickness defined from ultrasound images were used to calculate OccRatios. Wheelchair user capacity was quantified as functional strength (maximum resultant force reached during maximum isometric forward push) and anaerobic work capacity (highest power output reached during 15-m sprint test). Multilevel mixed-effects linear regression analyses controlling for between subject variability and covariables were performed to address the research questions., Results: AHD was significantly smaller during personal WRL ( p < 0.001) and instructed WRL ( p = 0.009, AHD both 11.5 mm) compared to the unloaded position (11.9 mm). A higher wheelchair user capacity (higher anaerobic work capacity) reduced the impact of WRL on AHD decrease. The fatiguing wheelchair propulsion had no effect on AHD ( p = 0.570) and on OccRatio of supraspinatus ( p = 0.404) and biceps ( p = 0.448). Subject characteristics related to a larger subacromial space were lower lesion level, shorter time since injury, impaired external rotation, a lower body mass index and a higher anaerobic work capacity., Conclusion: This study showed a significant reduction in AHD during WRL with no effect of fatiguing wheelchair propulsion on the subacromial space in wheelchair users with SCI. A higher anaerobic work capacity was beneficial in stabilizing the shoulder during WRL. Our findings may assist clinicians in designing a shoulder injury prevention program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor RJKV declared a past co-authorship with the author UA., (Copyright © 2022 Arnet, Boninger, Cools and Bossuyt.)

Objectives: To investigate if there is a difference in muscle activity for overhead athletes before and after an intervention with correction of both core and scapula compared to no intervention and is there a difference between overhead athletes with or without shoulder pain., Design: Controlled laboratory EMG study including intervention., Setting: University EMG laboratory., Participants: Sixty overhead athletes, 30 with shoulder pain and 30 healthy controls were included performing plyometric rotational shoulder exercise., Main Outcomes: Half of the participants received an intervention the other half were controls with no intervention. EMG muscle activity from 10 scapular, thoraco-humeral and trunk muscles were measured., Results: There were no significant differences in muscle activation levels between the groups with or without intervention. For the shoulder pain group, there were significant lower activity in Upper Trapezius when repeating the exercise. The shoulder pain group had significant higher activity in Pectoralis Major compared to the Healthy Control group., Conclusions: Most differences were found between the pre- and post-test. Repetition of the exercise seems to be more important than verbal and tactile instructions. Comparing the shoulder pain group with the healthy controls confirms previous findings that, pain patients recruit muscles differently from healthy persons., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce., Objectives: A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM., Method: Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period., Results: Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation ( p = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27° ± 10.81°; angular mobilisation -5.45° ± 11.72°)., Conclusion: These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis., Clinical Implications: Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Johansson, Asker, Malmberg, Fernandez-Fernandez, Warnqvist and Cools.)

Background: The present study evaluates the analysis of routine data within quality control management by means of ERCP in a tertiary center over five years., Methods: In a retrospective study, we analyzed pseudonymized routine administrative data according § 21 KHEntgG. These data can be tracked with regard to specific indicators for all hospitals and after data revocation for each individual hospital. Indicators can be selected according to the combination of diagnoses and OPS-numbers. In the present study, the frequency of the combination of ERCP with pancreatitis (nominator) in ratio to ERCP without pancreatitis (denominator) was analyzed at the Helios Clinic Krefeld for the years 2016 to 2020. Data recruitment was done by 3M Germany. Revocation of pseudonymized data was performed by Helios. Data are expressed as absolute values, percentage, mean + SD and range., Results: Overall, 1521 patients and ERCPs with 4981 procedures, including 688 papillotomies, were analyzed. In 30-70% of cases, ERCP was performed during emergency hospitalization. Forty-seven men and 52 women with ERCP-associated pancreatitis and 718 men and 504 women with ERCP without associated pancreatitis were detected. Among these, 99 patients had a combination of ERCP and pancreatitis,Forty-one percent of the patients developed pancreatitis after (n=41) and 59% before the ERCP (n=58). Emergency admission was comparable in both groups (25-83%). All patients developed post-ERCP pancreatitis within 12 hours post intervention. The course of ERCP-induced pancreatitis (n=41) was slight in most of the patients. In 30 patients an edematous, and in 9 patients an exudative pancreatitis developed. In 2 patients, a necrotizing pancreatitis was observed and one patient died., Conclusion: The results of our study indicate that the analysis of routine administrative data allows for the simple assessment of the complication rates of elective ERCPs, even with interventions at the naive papilla., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Context: Volleyball and handball players have usually been studied collectively as "overhead athletes," since throwing present similarities in the proximal to distal movement sequencing and upper limb joints ranges of motion. However, each sport presents specificities in the objectives when accelerating the ball and a variety of possible throwing techniques. Therefore, it is expected there may be differences in the shoulder and upper body physical performance between sports., Objective: The aim of this study was to determine if there are differences in shoulder muscle strength and upper body field performance tests between volleyball and handball athletes., Design: Cross-sectional., Methods: Ninety-nine volleyball and handball female athletes aged between 13 and 20 years were evaluated for isometric shoulder abductor and rotator strength (handheld dynamometer) and upper body field performance tests: Y Balance Test-Upper Quarter, modified Closed Kinetic Chain Upper-Extremity Stability Test, and unilateral and bilateral Seated Medicine Ball Throw., Results: Handball athletes presented greater shoulder internal rotation strength (between-group difference: 2.84; effect size 0.70), higher medial (between-group difference: 9.54; effect size 0.90), superolateral (between-group differences: 8.9; effect size 0.68), and composite scores (between-group difference 5.7; effect size 0.75) of the Y Balance Test-Upper Quarter and higher unilateral (between-group difference: 41.92; effect size 0.91) and bilateral (between-group difference: 46.11; effect size 0.83) Seated Medicine Ball Throw performance. Groups were not different for Closed Kinetic Chain Upper-Extremity Stability Test, external rotation, and abduction isometric strength., Conclusion: Our findings suggest that young female handball athletes present greater internal rotator strength and better performance in Y Balance Test-Upper Quarter and Seated Medicine Ball Throw compared to volleyball players. These differences may be related to the different demands required in the throwing movements performed in each sport and should be considered when assessing these populations.

Background: Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics., Hypothesis: Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries., Study Design: A cohort study., Level of Evidence: Level 3., Methods: At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire)., Results: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries., Conclusion: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players., Clinical Relevance: Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.

The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/contact athletes and (3) to establish a normal descriptive profile of the vertical ground reaction forces from the performance tests, in a cohort of contact/collision athletes. The study was split into two sub-sections; the inter-day reliability of three upper-extremity performance tests (n = 21) and a descriptive, correlation study investigating the relationship between isokinetic dynamometry and performance tests metrics (n = 39). We used intraclass correlation coefficients (absolute agreement, 2-way mixed-effects model) with 95% confidence intervals to quantify inter-day reliability of all variables. We used Pearson correlation coefficients to investigate associations between isokinetic strength and vertical ground reaction force asymmetry variables. Inter-day reliability was moderate-to-excellent for the upper-extremity performance tests (ICC 0.67-0.97). There was no statistically significant correlation between external and internal rotational peak torque and the variables of CPMU, PJ and BDL (r range = .02-.24).These upper-extremity tests are reliable for use with male contact/collision athletes.

Background: Scapular muscle activity during shoulder exercises has been explored with surface electromyography (EMG). However, knowledge about the activity of deeper-layer scapular muscles is still limited., Purpose: To investigate EMG activation of the deeper-layer scapular stabilizers (levator scapulae [LS], rhomboid major [RM], pectoralis minor [Pm] muscles) together with superficial muscle activity (upper [UT], middle [MT], and lower trapezius [LT] and serratus anterior [SA]) during 4 exercises often used for training scapular function. Based on the amplitude EMG of the deeper-layer muscles, scapular muscle activation ratios for the 4 exercises were calculated, hereby providing knowledge of the optimal muscle balance., Study Design: Descriptive laboratory study., Methods: A total of 26 healthy participants performed 4 shoulder exercises (side-lying external rotation [ER], side-lying forward flexion, prone horizontal abduction with ER, and prone extension) while simultaneously measuring scapular muscle activity. Intramuscular electrodes were used for the deeper layer, in contrast to surface electrodes for the superficial muscles. All data were normalized to percentage of maximal voluntary isometric contraction (%MVIC), and the activation ratios (the muscle activity of the deeper layer relative to the other muscles) were calculated. A 1-way analysis of variance with Bonferroni correction was applied for statistical analysis., Results: Moderate activity was found in all exercises for the LS and RM (25%-45% MVIC). The Pm resulted in low activity during both side-lying exercises (13%-18% MVIC). Ratios involving LS or RM showed values >1 for all exercises (1.28-12.41) except for LS/MT, LS/LT, and LS/RM (0.85-0.98) during side-lying ER, and LS/MT, RM/MT and RM/LS (0.85-0.99) during side-lying forward flexion. Likewise, values <1 were found when MT (0.85) and LS (0.99) were involved with RM in the numerator during side-lying forward flexion. Ratios with Pm in the numerator showed values <1, apart from the ratios with UT and SA in the denominator., Conclusion: The study provides extended knowledge about the deeper-layer scapular muscle activity and related ratios during the 4 shoulder exercises mentioned here. Putting theory into practice, based on our results, we advise both side-lying exercises to be performed to strengthen LT and MT, even in case of hyperactivity of the Pm. However, the 4 exercises should be given carefully to patients with hyperactivity in the LS and/or RM., Clinical Relevance: The findings of this study may assist clinical decision making in exercise selection for restoring scapular function.

Objective: To assess the effectiveness of a short (5-10 minutes) shoulder external rotation (ER) strength program, using elastic bands, in adolescent handball players., Design: Randomized controlled trial., Methods: The sample included 6 adolescent handball teams (3 female, 3 male) with a total of 92 players and a mean age of 16.6 years. Players were randomized within teams to an intervention group, which completed a shoulder ER strengthening program of 2 exercises performed 3 times per week after handball training for 8 weeks, or a control group of no treatment. The primary outcome was the between-group difference in shoulder ER strength change, measured as isometric strength using a handheld dynamometer from preintervention to postintervention (8 weeks). Secondary outcomes were between-group differences in internal rotation (IR) strength and the ER/IR strength ratio from preintervention to postintervention., Results: The estimated between-group difference in dominant-shoulder ER strength was 0.06 N/kg (95% confidence interval [CI]: -0.01, 0.14) in favor of the intervention group. The estimated between-group differences in the ER/IR ratio and IR strength were 0.03 (95% CI: -0.02, 0.08) and 0.02 (95% CI: -0.08, 0.13), respectively., Conclusion: The ER strength program improved neither the ER strength nor the ER:IR ratio. J Orthop Sports Phys Ther 2021;51(4):174-187. doi:10.2519/jospt.2021.9957 .

Purpose: To examine acromio-humeral distance (AHD) and shoulder isometric strength for external rotation (ER) and internal rotation (IR) in national elite badminton players., Methods: Seven elite badminton players with asymptomatic shoulders aged 24 ± 4 (mean ± SD) from the Danish national badminton team were investigated. Shoulder AHD, isometric strength in ER and IR were bilaterally assessed with ultrasonography and a hand-held dynamometer (HHD)., Results: AHD was greater on the dominant vs. the nondominant side ( p = 0.018). Moreover, IR strength was greater on the dominant side vs. the nondominant side ( p = 0.041). Furthermore, AHD and ER strength were highly correlated on the dominant side ( p = 0.007, r = 0.900). A correlation was also shown between AHD and the ER/IR strength ratio on the dominant side ( p = 0.033, r = 0.793)., Conclusion: This preliminary study demonstrates that shoulder ER strength is strongly associated with AHD size, largely reflecting supraspinatus tendon-muscle hypertrophy as a result of sport-specific adaptation in national elite badminton players with asymptomatic shoulders. These novel data also suggest that habitual loading of the shoulder improves the supraspinatus tendon size, which may lower the mechanical stress and potentially reduce the risk of injury. This warrants strengthening the shoulder external rotators as a potential strategy to reduce the risk of future shoulder injury.

Background: Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking., Objective: This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls., Method: The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration., Results: After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface., Conclusion: There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Context: Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited., Objective: To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance., Data Sources: Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies., Study Selection: A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English., Study Design: Systematic review., Level of Evidence: Level 3., Data Extraction: A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria., Results: A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance., Conclusion: The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.

Neonatal piglets lack immunoglobulins at birth. Sufficient colostrum intake (CI) and immunoglobulin absorption are essential for an appropriate passive transfer of immunity via the colostrum. Most methods to measure immunoglobulins in serum of piglets are labour-intensive, expensive or imprecise and not designed for on-farm use. The present diagnostic test study evaluated digital Brix refractometry to measure immunoglobulins in serum of neonatal piglets and to suggest thresholds for different serum immunoglobulin concentration. Additionally, agreements between Brix refractometry and optical refractometer (serum total protein, STP) and between Brix refractometry and ELISA (immunoglobulin G, IgG) were also investigated. Forty-five sows and 269 piglets from three different farms were enrolled in the study. Piglets were weighed at birth and 24 h later to calculate the CI. Serum was collected at 24 h after birth and analysed for STP, γ-globulins (electrophoresis), % Brix and IgG. In piglets, median (interquartile range, IQR) CI was 412 (196) g per piglet. Median (IQR) STP, γ-globulin and % Brix concentrations in piglet serum were 60 (11) g/L, 35 (10) g/L and 8 (2) %, respectively. Average (±SD) IgG concentration was 49 ± 23 g/L. Passing-Bablok regression revealed a strong concordance between % Brix and STP (Kendall's tau (Τ): 0.620, P < 0.0001, n = 267) and % Brix and γ-globulin concentration (Kendall's Τ: 0.575, P < 0.0001, n = 267). The agreement between the Brix refractometer and IgG concentration was poor (Kendall's Τ: 0.267, P < 0.0001, n = 269). Receiver operating characteristic curves were performed to evaluate test characteristics of Brix refractometry for three γ-globulin cut-off values, i.e. 10, 20 and 30 g/L. The % Brix cut-off values resulting in the optimal combination of sensitivity and specificity were 5.4 (100 and 98.5%), 7.0 (100 and 89.3%) and 7.9 (90.1 and 80.6%), respectively. In conclusion, digital Brix refractometry is a sufficiently fast and practical method to assess serum γ-globulin concentrations in neonatal piglets on-farm and to evaluate them by considering the thresholds found in this study. Further studies are needed to validate those thresholds regarding piglet's survival in the pre-weaning period., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Atraumatic and degenerative rotator cuff tears are common in individuals over 55 years of age. This condition can have a high impact on social life and is associated with chronic pain, weakness and dysfunction of the upper limb. There is evidence that conservative approaches should be the first treatment option. Conservative treatment usually addresses a variety of therapeutic behaviours without providing scientific arguments for the choice and progression of exercises., Objective: To compare the effects of two different exercise programmes based on the load of the rotator cuff on a population with shoulder pain and rotator cuff tears., Methods and Analysis: This is a controlled, randomised, blinded clinical trial. Seventy-eight individuals with shoulder pain and presence of atraumatic and degenerative rotator cuff tear will participate and will be randomly distributed between two groups. The primary outcome will be quality of life (The Western Ontario Rotator Cuff Index), and secondary outcomes will include pain, function (Disabilities of the Arm, Shoulder and Hand), fear avoidance beliefs (Fear Avoidance Beliefs Questionnaire-Brazil), kinesiophobia (Tampa Scale), Pain Catastrophizing Scale, muscle strength of abductors, external and internal rotators of the shoulder, range of motion of arm elevation and patient satisfaction. The treatment will be performed for 12 weeks (2 x/week) acording to the selected group (Rotator Cuff Unloading x Rotator Cuff Loading Exercise Programme)., Ethics and Dissemination: The study protocol was approved by the Institutional Review Board. The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences., Trial Registration Number: NCT03962231., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Postpartum dysgalactia syndrome (PPDS) is a major economic problem in modern sow farms. General treatment of PPDS consists of the use of oxytocin to promote milk ejection and non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate inflammatory processes. So far, studies investigated the use of a single administration of NSAIDs after parturition in healthy and non-healthy sows. The current study investigated whether administration of meloxicam or paracetamol in sows prior to parturition improves sow and piglet health as well as performance in a farm with PPDS problems in sows. Sixty sows and 978 piglets from a Belgian farrow-to-finish farm were enrolled. Sows were randomly divided into three groups: a non-treated control group, a meloxicam-treated group and a paracetamol-treated group. Treatment was administered orally for 7 days from gestation day 113 onwards. Performance and health parameters investigated in sows were gestation length, farrowing duration, litter characteristics, colostrum yield and quality (Immunoglobulin G), litter weight gain, weaning-to-estrus interval, pregnancy rate, rectal temperature, acute phase proteins and inflammatory markers serum amyloid A, haptoglobin, interferon γ, interleukin 1β and 6 backfat, constipation and feed refusal. Performance and health parameters in piglets were birthweight, average daily weight gain, colostrum intake and mortality. Paracetamol-treated sows showed a significantly ( P = 0.04) lower rectal temperature (mean ± SD: 38.09 ± 0.18°C) than the meloxicam-treated sows (38.24 ± 0.18°C), but not than the control group (38.22 ± 0.18°C). Sows of the paracetamol-treated group had a significantly ( P = 0.001) longer gestation length (116.3 ± 0.9 days) than sows of the control group (115.3 ± 0.6 days), but not than meloxicam-treated sows (115.9 ± 0.9 days). No significant differences between the three groups were found for all the other parameters. In conclusion, the prophylactic oral administration of either meloxicam or paracetamol for 7 days starting 2 days prior to farrowing did not show beneficial effects on both health and performance parameters of sows and piglets., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Schoos, Chantziaras, Vandenabeele, Biebaut, Meyer, Cools, Devreese and Maes.)

Introduction: Proprioception encompasses the submodalities of joint position sense (JPS), kinesthesia, sense of force, and velocity. Owing to the vast mobility of the shoulder, it heavily relies on an intact sense of proprioception. Moreover, shoulder injuries are associated with a decreased sense of proprioception. What remains unclear is how shoulder proprioception is affected by pain and competing nociceptive senses., Purpose of the Study: To summarize the literature evaluating the relationship between pain and shoulder proprioception., Methods: A literature review was conducted from inception until 22 October 2018, using electronic databases (PubMed, Web of Science, Scopus, EBSCO, CINAHL, and Embase). Retrieved citations were screened for eligibility, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS)., Results: Eleven studies were included (n = 447 participants with shoulder pain, n = 20 with experimentally induced pain [EIP]/n = 600 painful shoulders and n = 20 [EIP]). The mean methodological quality of the studies was good (76%). Five studies investigated active JPS, four investigated passive JPS, six investigated kinesthesia, sense of force was measured in one study, and no study investigated sense of velocity. There is moderate evidence for impaired kinesthesia and low evidence for reduced sense of force among painful shoulders. Conflicting evidence is seen for the other proprioceptive submodalities., Conclusion: The overall impact of pain on shoulder JPS remains unclear, while moderate evidence for an affected sense of kinesthesia is possible. There is low evidence for an impaired sense of force among painful shoulders. Standardization between studies is lacking, limiting the range of our conclusions. Further investigation is required into well-controlled and pain-induced studies to better understand the influence of pain on shoulder proprioception., (Copyright © 2019 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: Athletic endeavor can require the "athletic shoulder" to tolerate significant load through supraphysiological range and often under considerable repetition. Outcome measures are valuable when determining an athlete's safe return to sport. Few data are available to guide a clinician's choice from the variety of measures available., Purpose: To describe the use of quantifiable objective outcome measures and patient-reported outcome tools after glenohumeral joint stabilization, specifically in an athletic population. The secondary aim of our study was to assess whether the method of measurement used was clearly described and standardized to aid clinical interpretation., Study Design: Systematic review; Level of evidence, 4., Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science databases was performed in December 2018 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After the application of selection criteria, a full review of identified papers, and screening of reference lists, a total of 62 studies were included in the review. All studies were independently appraised for quality, predefined data fields were populated and cross-checked for accuracy, and results were then summarized from these data fields., Results: Of the 62 included studies, 94% used a quantifiable objective clinical outcome. A majority (85%) of the studies measured range of motion, 21% recorded muscle strength, 5% measured electromyographic activity, 5% examined shoulder kinematics, and 3% assessed joint proprioception after surgery. However, only 18% of the studies clearly described a standardized method of measuring the outcome. Nearly all (95%) of the studies used at least 1 patient-reported outcome measure. The Rowe score was most commonly used (35%)., Conclusion: We must standardize and clearly describe the use of quantifiable objective outcome measures to aid clinical interpretation. A concerted effort should also be made to standardize the use of patient-reported outcome tools after shoulder stabilization in the athletic population., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by Sports Surgery Clinic, Dublin, Ireland. OSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Because of its superficial location, surface electrodes are commonly used to record lower trapezius activity. Recent evidence, however, would suggest that surface electromyography is not a valid to record activity from other superficially placed shoulder muscles. Therefore, the aim of this study was to determine the validity of using surface electrodes to record lower trapezius activity. Ten asymptomatic subjects performed ramped isometric (0-100% maximum load) and dynamic (70% maximum load) shoulder tasks. Intramuscular electrodes were inserted into lower trapezius and rhomboid major. Surface electrodes were placed over lower trapezius around the intramuscular electrodes. Differences in the recorded activity of lower trapezius between surface and intramuscular electrodes were tested using a 2 factor repeated measures analysis of variance with factors: test and electrode type. Similarity in the recorded activity patterns between the two electrodes was tested using Pearson's correlation coefficient (r). Results indicated that there was no difference in lower trapezius activity levels (p = 0.98) or activation patterns (r ≥ 0.74) recorded by the intramuscular and surface electrodes. The results of this study indicate that any potential crosstalk contamination in the surface electrode signal is having little influence on the recorded activity from lower trapezius and therefore, support the common practice of surface electromyography to investigate lower trapezius function., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Shoulder problems are common in handball, but injury risk reduction is possible by implementing a prevention program. However, player compliance to the program remains a challenge, with feedback from players that the program is too time consuming., Aim: To develop a more efficient program, we aimed to assess the effect of the Oslo Sports Trauma Research Center shoulder injury prevention program on external rotation (ER) strength and internal rotation (IR) range of motion (ROM), considered to represent key risk factors for injury., Methods: Four youth handball teams (three females, one males, 57 players, mean age 17.1 years) were randomized to an intervention or control group. The intervention program was conducted three times per week as a part of handball warm-up for 18 weeks, supervised by physical therapists. The main outcome variables were the between-group differences in ER strength and IR ROM change from baseline to postintervention. Isometric ER strength was measured with a handheld dynamometer and IR ROM with a digital goniometer., Results: Mean dominant shoulder isometric ER strength increased both in the intervention (10%) and the control group (6%) during the intervention, but there was no significant group by time interaction (group difference: 0.06 N/kg (95% CI: -0.04 to 0.17). IR ROM did not change in either group during the intervention., Conclusion: The Oslo Sports Trauma Research Center shoulder injury prevention program did not affect the risk factors ER strength and IR ROM. The preventive effect of the program must therefore be due to other factors., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Weakness of the shoulder external rotators (ER) is one of the main risk factors for shoulder pain in handball. Short, effective shoulder ER strength programs the players will adhere to are lacking., Objectives: to develop a short and effective shoulder ER strength program, handball players will adhere to., Methods: We conducted a modified Delphi study, including experts in the field of shoulder, strength training and handball. In the first round, the experts were asked to rate eight pre-defined shoulder ER exercises on efficacy and adherence and to suggest other preferred exercises. In round two, they were asked to rate the new exercises from round one. In round three, they received a statistical summary of the panels scores, their own score and a summary of the suggestions. Based on the feedback, the experts were asked to revise their response., Results: Sixteen experts completed three rounds with 100% response rate. Twenty-eight exercises were rated. We reached consensus for both efficacy and adherence for two exercises, ER in 90° abduction in a bent-over squat position and ER in 90° abduction combined with horizontal abduction and trunk rotation in a push-up position., Conclusion: We reached consensus for both efficacy and adherence for two exercises., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Development of a Short and Effective Shoulder External Rotation Strength Program in Handball: A Delphi Study)., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Study Design: This is a systematic review., Introduction: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear., Purpose of the Study: The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics., Method: MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment., Results: Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles., Discussion: Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial., Conclusion: The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts., (Copyright © 2019 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five exercises., Design: Observational study., Setting: Ghent University Hospital., Participants: Twenty-seven female patients (aged mean (SD) 35 (13) years) with hEDS/HSD and MDI and 20 female healthy controls (aged 34 (11) years) participated in this study., Interventions: The acromiohumeral (AHD) and humeralglenoid distance (HGD) were measured using ultrasound during five isometric exercises: shoulder external rotation, shoulder extension, shoulder flexion, elbow extension and holding a 2kg dumbbell., Main Outcome Measures: Ultrasound measures of the AHD and HGD., Results: During isometric shoulder extension, elbow extension and dumbbell loading, patients had a significantly larger change in AHD compared to controls. In patients, the AHD was significantly smaller during isometric shoulder flexion, extension and elbow extension compared to the AHD measured in rest. By contrast, the AHD was significantly larger during isometric external rotation and dumbbell loading compared to the AHD measured in rest. Regarding the HGD, no significant differences between patients and controls were observed. However, significantly smaller HGD values were found in patients during isometric shoulder flexion compared to the HGD in rest., Conclusions: Isometric external rotation and holding a 2kg dumbbell caused an inferior translation in patients with hEDS/HSD and MDI, whereas isometric shoulder flexion and shoulder/elbow extension respectively led to an anterior-superior and superior translation., (Copyright © 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. The purpose is to present an overview of the incidence of injuries and injury patterns in Flanders and to correlate them to possible intrinsic and extrinsic risk factors. All acute injuries that occurred in Flanders during 2009-2013, collected by the insurance, were analysed. The incidence and parameters such as date of birth, date of occurrence of the injury, gender and diagnosis were evaluated. Injury incidence varied from 7.40% up to 8.45%. Females and players at age 16-17, 14-15 and older than 30 are at higher risk. The ankle/foot region is most frequently injured. There is a higher risk of injury after season-and Christmas break. Age, gender and chronometry are risk factors to get injured. Sprains are the most frequent, while the nkle/foot region is the most susceptible to injury. Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. Female players and players at age 16-17, 14-15 and older than 30 are at higher risk to basketball injuries. The ankle/foot region is most frequently injured followed by lower arm and hand. There is a higher risk of injury after season-and Christmas break.

Objectives: To investigate if there is a difference in muscle activity patterns during high load plyometric shoulder exercises between overhead athletes with and without shoulder pain., Design: Controlled laboratory EMG study., Setting: University EMG Laboratory., Participants: Sixty overhead athletes, 30 with shoulder pain and 30 healthy controls were included., Main Outcome Measures: The EMG activity of Upper Trapezius (UT), Middle Trapezius (MT), Lower Trapezius (LT), Serratus Anterior (SA), Latissimus Dorsi (LD) and Pectoralis Major (PM) on the tested side and bilateral on Abdominal Obliques Externus (OE) muscles was registered with wireless surface EMG during 3 rotational plyometric shoulder exercises in 3 positions, prone, sidelying and standing., Results: A significant higher muscle activity was found in the shoulder pain group for MT together with an overall significant higher activity in the thoraco-humeral and abdominal muscles compared to healthy controls., Conclusions: When rehabilitating the overhead athlete with shoulder pain, shoulder muscles together with both thoraco-humeral and abdominal muscles need to be engaged., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: During nonoperative or postoperative rehabilitation after sports injuries, exercise selection is often based on minimal load on the injured/repaired glenohumeral structures, while optimally activating scapulothoracic muscles. Previous research explored scapular muscle activity during rehabilitation exercises using surface electromyography (EMG). However, limited information exists about the deeper lying muscle activity, measured with fine-wire electrodes, even more in combination with 3-dimensional scapular kinematics., Purpose: To report scapular kinematics synchronously with surface and fine-wire EMG during specific shoulder exercises for early rehabilitation., Study Design: Descriptive laboratory study., Methods: A total of 23 healthy male patients were recruited. Three-dimensional scapular kinematics were measured combined with EMG recording of 8 muscles during 4 commonly used shoulder exercises (inferior glide, low row, lawnmower, and robbery). Upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior muscle activities were measured with bipolar surface electrodes. Intramuscular electrodes were placed in the levator scapulae (LS), rhomboid major (RM), pectoralis minor (Pm), and infraspinatus (IS) muscles. All data were normalized as a percentage of maximal voluntary isometric contraction (%MVIC). A linear mixed model with Bonferroni correction was applied for statistical analysis., Results: Scapular kinematics revealed an anterior tilt position during the inferior glide, low row, and robbery ( P < .05). An upward rotation position between 20° and 30° was reached in all exercises except low row. Inferior glide (31°) and low row (42°) represented a significantly increased internal rotation position compared with lawnmower and robbery. Lawnmower and robbery showed significantly ( P < .05) more MT (lawnmower, 36% MVIC; robbery, 39% MVIC) and RM (lawnmower, 59% MVIC; robbery, 66% MVIC) activation compared with inferior glide and low row. Lawnmower and robbery showed significantly ( P < .05) less Pm activation (9.5%-12% MVIC). LS was significantly more active during robbery (58% MVIC) compared with inferior glide and low row (27%-36% MVIC) ( P < .05). IS showed moderate activity (24%-37% MVIC) for all exercises, except low row (13% MVIC)., Conclusion/clinical Relevance: This study provides new insights about scapular positions and activation of the deeper layer muscles during 4 commonly used shoulder rehabilitation exercises. The lawnmower showed a favorable position of the scapula with less Pm activity in contrast to the low row. The inferior glide, lawnmower, and robbery should not be implemented in early phases of shoulder rehabilitation because of their moderate muscle activity.

Study Design: A quasi-experimental, pretest-posttest design., Objectives: To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI)., Setting: Biomechanical laboratory Swiss Paraplegic Research., Methods: A population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured by using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast, and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels, and body weight., Results: A reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (-1.39 mm; 95% CI: -2.28; -0.51) was identified after controlling for all potential confounders. Females who fatigued (n = 4) displayed a greater reduction in supraspinatus tendon thickness as compared with those who did not fatigue (n = 7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness., Conclusions: Acute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.

Ruminants are generally considered to be less susceptible to the effects of mycotoxins than monogastric animals as the rumen microbiota are capable of detoxifying some of these toxins. Despite this potential degradation, mycotoxin-associated subclinical health problems are seen in dairy cows. In this research, the disappearance of several mycotoxins was determined in an in vitro rumen model and the effect of realistic concentrations of those mycotoxins on fermentation was assessed by volatile fatty acid production. In addition, two hypotheses were tested: (1) a lower rumen pH leads to a decreased degradation of mycotoxins and (2) rumen fluid of lactating cows degrade mycotoxins better than rumen fluid of non-lactating cows. Maize silage was spiked with a mixture of deoxynivalenol (DON), nivalenol (NIV), enniatin B (ENN B), mycophenolic acid (MPA), roquefortine C (ROQ-C) and zearalenone (ZEN). Fresh rumen fluid of two lactating cows (L) and two non-lactating cows (N) was added to a buffer of normal pH (6.8) and low pH (5.8), leading to four combinations (L6.8, L5.8, N6.8, N5.8), which were added to the spiked maize substrate. In this study, mycotoxins had no effect on volatile fatty acid production. However, not all mycotoxins fully disappeared during incubation. ENN B and ROQ-C disappeared only partially, whereas MPA showed almost no disappearance. The disappearance of DON, NIV, and ENN B was hampered when pH was low, especially when the inoculum of non-lactating cows was used. For ZEN, a limited transformation of ZEN to α-ZEL and β-ZEL was observed, but only at pH 6.8. In conclusion, based on the type of mycotoxin and the ruminal conditions, mycotoxins can stay intact in the rumen., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results

Objective: The aims of the study were to examine whether fatigue-inducing wheelchair propulsion changes neuromuscular activation and propulsion biomechanics and to determine predictor variables for susceptibility to fatigue., Design: This study with a quasi-experimental, one-group, pretest-posttest design investigates a population-based sample of wheelchair users with a spinal cord injury (n = 34, age: 50.8 ± 9.7 yrs, 82% males). Neuromuscular activation and propulsion biomechanics during treadmill propulsion at 25 W and 45 W were assessed before and after a protocol designed to cause fatigue., Results: With the induced fatigue, wheelchair users propelled with increased neuromuscular activation in the pectoralis major pars sternalis, deltoideus pars acromialis and upper trapezius (45 W, P < 0.05), and a slightly reduced push angle (25 W: 75-74 degrees, P < 0.05, 45 W: 78-76 degrees, P < 0.05). Wheelchair users susceptible to fatigue (47%) were more likely to have a complete lesion, to be injured at an older age, and had less years since injury. This group propelled in general with shorter push angle and greater maximum resultant force, had a greater anaerobic capacity, and had less neuromuscular activation., Conclusions: Compensation strategies in response to fatiguing propulsion could increase the risk for shoulder injury. Predictor variables for susceptibility to fatigue inform interventions preserving shoulder health and include lesion characteristics, propulsion technique, anaerobic capacity, and neuromuscular activation., To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain a neuromuscular compensation strategy and the corresponding muscles in response to fatiguing wheelchair propulsion; (2) Recommend propulsion biomechanics associated to reduced susceptibly to fatiguing wheelchair propulsion; and (3) List examples of predictor variables of susceptibility to fatigue., Level: Advanced., Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Background: Although it is thought that there is a relationship between neck pain and scapular dysfunction, there are controversial results and no clear information in the literature regarding this issue. This study aimed to investigate the alterations in the 3-Dimensional scapular orientation on patients with non-specific neck pain., Method: Thirty-four patients with chronic non-specific neck pain [age, 29.1 (5) years; height, 165.3 (6.1) centimeters; weight, 62.1 (9.6) kilogram] and 29 healthy controls [age, 28.2 (3.3) years; height, 166.8 (8.1) centimeters; weight, 60.9 (8.5) kilogram] were included in the study. 3-Dimensional scapular kinematics were obtained during arm elevation and lowering trials in the sagittal, scapular, and frontal planes., Findings: Compared to healthy controls, the patients with neck pain demonstrated significantly reduced upward scapular rotation on both the dominant and non-dominant sides in all three planes. Patients with neck pain had increased internal rotation in the sagittal and frontal planes on the dominant side and increased external rotation in the frontal plane on the non-dominant side. No difference was observed between groups considering posterior scapular tilt., Interpretation: There are alterations in the 3-Dimensional scapular orientations in patients with chronic non-specific neck pain compared to healthy controls. Therefore, the scapular control may also be examined in patients with neck pain and it can be included in the rehabilitation program if needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study aimed to provide an age, gender and sport-based normative database for three functional shoulder tests: Y Balance Test - Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). A second aim was to discuss gender, age and sports differences. Finally, correlation between tests was evaluated. Overhead athletes (106 male, 100 female) between 18 and 50 years old and from three different sports (volleyball, tennis, handball) performed all functional tests. A linear mixed or regression model was applied to determine significant differences in test scores between gender, age and sports. Pearson correlation coefficients were analyzed to determine the relationship between tests. Normative values were established and divided by gender, sports and age. Results showed significant gender and age differences for all tests. For YBT-UQ, also significant side and sports differences were recorded. CKCUEST is moderately correlated with SMBT and YBT-UQ. Weak correlation was found between SMBT and YBT-UQ. In conclusion, this study provides normative data for YBT-UQ, CKCUEST and SMBT, which is clinically relevant for functionally screening overhead athletes and benchmark their performance to others from the same gender, age and sports. A combination of included tests is recommended., Competing Interests: The author has no conflict of interest to declare., (© Georg Thieme Verlag KG Stuttgart · New York.)