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Context: Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes “at risk” according to cutoff values for shoulder range of motion (ROM) were also analyzed. Design: Cross-sectional study. Methods: 36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides. Results: Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were “at risk” of shoulder problems. Conclusion: Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.

BACKGROUND: Physical therapy is essential to help patients to recover their movements and function following a rotator cuff repair. However, there are uncertainties regarding how long a sling should be used for and when exercises should be started. OBJECTIVE: To investigate the current clinical practice of Brazilian physical therapists treating patients who had a rotator cuff repair. We also explored differences between shoulder specialists and non-specialists. METHODS: An online survey with 38 questions, including a clinical case, regarding the physical therapy clinical practice for patients having a rotator cuff repair. RESULTS: We analyzed 194 responses. Majority of participants were from the Southeast of Brazil (57.5%), had up to 10 years of clinical experience (61.4%) and were not shoulder-specialists (69.8%). Majority of the respondents stated that patients have their first post-operative physical therapy session within the first three weeks (51%). Patients usually use a sling for four to six weeks (60.6%). Passive mobilization is often started in the first-week post-surgery. Fifteen percent of shoulder specialists compared to only six percent of non-shoulder specialists would allow strengthening exercises to start between the first and third weeks post-surgery. CONCLUSION: Physical therapists in Brazil seems to follow similar postoperative programs to other countries. Shoulder specialists allow a faster return to activities and start of strengthening exercises.

Background Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. Objective To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. Methods This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. Conclusions The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. Clinical trial registration: NCT03528499

Objective To evaluate the association of sleep problems with weight and waist size gain during four years of follow-up. Methods We investigated 13,030 participants (35–74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicentric cohort conducted with civil servants from six academic institutions recruited between 2008 and 2010. Sleep problems were assessed at baseline by the Clinical Interview Schedule - Revised (CIS-R), designed to detect common mental disorders based on somatic, depressive and anxiety symptoms. Weight and waist size were measured at baseline and at follow-up (2012–2014). Large weight and waist size gain were defined as ≥ 90th percentile (≥1.65 kg/year and ≥2.41 cm/year, respectively). Results Sleep problems were associated with higher risk of a large weight gain (RR = 1.11; 95% CI 1.01–1.24) and large waist size gain (RR = 1.19; 95% CI 1.07–1.32), adjusted for age, sex, ethnicity, income, educational level, investigation center, smoking, alcohol intake, dietary energy intake, leisure-time physical activity and body mass index (BMI) or waist circumference at baseline. After additional adjustment for common mental disorders the associations became non-significant (RR = 0.99; 95% CI 0.88–1.12; RR = 1.08; 95% CI 0.97–1.22, respectively). Conclusion Sleep problems are associated with increased risk of developing large weight and waist size gain, but are not independently associated with common mental disorders.

Background Prospective registries are necessary to evaluate the safety of inflammatory bowel disease (IBD) treatment during pregnancy and in children in the long term. Aims The overall aim of DUMBO registry is to know the risk of serious adverse events (SAEs) during pregnancy and in children up to 4 years of age exposed during pregnancy to drugs for IBD (mainly focused on biologics), compared to unexposed children. In this analysis we aim to evaluate the risk of SAEs during pregnancy and the predictive factors of it (mainly focused on IBD drugs). Methods Prospective, observational and multicentre registry, which enrols pregnant women with IBD (Crohn’s disease, ulcerative colitis, IBD-unclassified) over 5 years in 70 centres in Spain. The registry was kicked off in September 2019. SAE was defined based on “Clinical Safety Data Management: Definitions and Standards for Expedited Reporting by European Medicines Agency”. Study protocol is summarized in figure 1. Results 433 women have been included so far; 241 got pregnant at least 9 months before this interim analysis (table 1). Mean age was 34 years, and 17% of women had active disease at any time during pregnancy. 23% of pregnancies were exposed to immumodulators (thiopurines), 25% to biologics and 10% to combo therapy (biologics and immunomodulators). 85 pregnancies (35%) were exposed to biologics (60 anti-TNF, 17 ustekinumab, and 8 vedolizumab) either in combo or in monotherapy. There were 237 newborns (227 singleton and 5 pair of twins), 9 miscarriages and 1 abortion. 72% of patients had vaginal delivery and 28% C-sections (18% due to perianal CD or active disease). A total of 59 pregnancies (24.5%) reported at least one SAE: 32% in exposed to biologics and 20.5% in non-exposed group (p>0.05) (figure 2). Four out of 17 pregnancies exposed to ustekinumab and 3 out of 8 exposed to vedolizumab had SAEs (non-related with the drug). In the multivariate analysis, adjusted by disease activity, in comparison with no immunosuppressive treatment, neither immunosuppressants [Odds ratio (OR)=1.1, 95% confidence interval (CI)=0.3–4.3] nor biologics in monotherapy or in combo (OR=0.8; 95%CI=0.2–3) were associated with higher risk of SAEs. 40 patients (17%) were hospitalised due to complications during pregnancy or delivery (figure 3). Two patients underwent surgery during pregnancy due to IBD complications Conclusion IBD treatment (either immunomodulators or biologics) does not increase the risk of SAEs during pregnancy. Nevertheless, one-quarter of IBD women suffer SAEs during pregnancy and about 20% need hospitalisation, which should be taken into account when managing IBD during pregnancy.

Made available in DSpace on 2022-04-28T19:47:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Infected cutaneous ulcers from diabetic rats with Candida albicans and Streptococcus aureus were treated with spray formulations containing green silver nanoparticles (GS), chemical silver nanoparticles (CS), or pomegranate peel extract (PS). After wound development and infection, the treatments were performed twice per day for 14 days. The wound healing was analyzed on days 2, 7, and 14 through the determination of CFUs, inflammatory infiltrate, angiogenesis, fibroplasia, myeloperoxidase, and collagen determination. Expressive improvement in wound healing was noted using both silver nanoparticles for 7 days. All the treatments were superior to controls and promoted significant S. aureus reduction after 14 days. CS presented better anti-inflammatory results, and GS and CS the highest number of fibroblasts. Despite the techniques’ limitations, GS and CS demonstrated considerable potential for managing infected wounds, especially considering no early strategies prior to the drugs, such as the debridement of these wounds, were included. Department of Dental Materials and Prosthodontics School of Dentistry São Paulo State University (UNESP) Laboratory of Research Development & Innovation Apis Flora Industrial e Comercial Ltda Department of Chemistry Federal University of São Carlos Department of Dental Materials and Prosthodontics School of Dentistry São Paulo State University (UNESP) FAPESP: 2016/04230-9

Objetivos: O estudo tem o objetivo de avaliar a implementação de protocolo de tratamento para leucemia linfoblástica (LLA) com estratificação de risco baseado em pesquisa de doença residual mínima (DRM). Material e métodos: Realizou-se estudo observacional e analítico com delineamento longitudinal retrospectivo. Incluíram-se pacientes com LLA, com idade entre 1 e 18 anos, que realizaram tratamento no Hospital da Criança de Brasília (HCB) entre 06 de 2018 e 06 de 2021. Nos dias 15, 33 e 78, realizou-se avaliação de DRM por citometria de fluxo de 8 cores de nova geração (CFNG) em medula óssea. Os pacientes foram estratificados para os braços de tratamento conforme descrito a seguir. Baixo Risco (BR): LLA-B; 5%; DRM D78 >0,01%; presença das translocações BCR-ABL ou MLL-AF4. Risco intermediário (RI): demais pacientes. Para casos específicos, aceitaram-se ajustes das classificações fora dos critérios descritos. O teste de Log Rank (Mantel-Cox) foi utilizado para comparação de curvas de sobrevida global (SG) e livre de doença (SLD). Resultados: Foram incluídos 82 pacientes, sendo 78 com LLA-B e 4 com LLA-T. Desses, 15 foram classificados como BR, 50 RI e 17 AR. Houve 14 óbitos (17,07%) e 4 recaídas (4,87%), sendo duas (2,43%) isoladas em SNC. Dos óbitos, 5 (35,71%) estavam classificados como RI e 9 (64,29%) como AR; não houve óbitos no grupo BR. Houve diferença estatística significativa para a SG entre os grupos de classificação de risco (p

Background Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. Objective The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. Design The design was a cross-sectional group comparison. Methods Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. Results The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°–8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53–2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°–28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15–185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41–55.63). Limitations These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. Conclusions Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.

L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.

The impacts of chemical fertilizers and pesticides have raised public concerns regarding the sustainability and security of food supplies, prompting the investigation of alternative methods that have combinations of both agricultural and environmental benefits, such as the use of biofertilizers involving microbes. These types of microbial inoculants are living microorganisms that colonize the soil or plant tissues when applied to the soil, seeds, or plant surfaces, facilitating plant nutrient acquisition. They can enhance plant growth by transforming nutrients into a form assimilable by plants and by acting as biological control agents, known as plant growth-promoting bacteria. The potential use of bacteria as biofertilizers in agriculture constitutes an economical and eco-friendly way to reduce the use of chemical fertilizers and pesticides. In this context, nanotechnology has emerged as a new source of quality enrichment for the agricultural sector. The use of nanoparticles can be an effective method to meet the challenges regarding the effectiveness of biofertilizers in natural environments. Given the novel sustainable strategies applied in agricultural systems, this review addresses the effects of nanoparticles on beneficial plant bacteria for promoting plant growth.

Gas sensors are used for measuring the concentration of pressure of gases around their vicinity. These sensors are equipped with highly sensitive sensing elements of nanostructured materials. They find extensive application in residences, urban areas, smart farms, military systems, and industries for detecting toxic gases, including hydrogen sulfide, ammonium, carbon monoxide, and several species of nitrogen oxide, or to control the partial pressure of oxygen inside confined spaces, such as submarines, military aircraft, or chambers for hyperbaric treatments. The rise in demand from critical industries for gas sensors is due to environmental regulation of gas emissions or the monitoring of air quality in metropolitan areas due to vehicle emissions; these are the major factors driving the growth of the gas sensors market, which can open new opportunities for small companies in high technology and nanotechnology. The advent of a new era based on the Internet of Things (IoT) in smart cities, residences, and farms, as well as on smartphones and wearable devices, also represents an opportunity for advanced gas sensors. These lower-power, more affordable sensors are becoming available and are being integrated into consumer electronics. Here our emphasis is on highlighting the market segments and the different priorities underlying the choice of environmental sensor, which varies with the application. The principal gas sensors are pellistor sensors, infrared sensors, metal oxide semiconductor (MOS) sensors, electrochemical sensors, and optical particle monitor (OPM) sensors. This chapter summarizes some examples of highly sensitive nanostructured material sensors in smart cities, smart farming, and process and manufacturing industries for detecting various toxic gases, including hydrogen sulfide, ammonium, carbon monoxide, and nitrogen dioxide.

Made available in DSpace on 2021-06-25T10:51:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain. Laboratory of Analysis and Intervention of the Shoulder Complex Universidade Federal de São Carlos (UFSCar) São Carlos Department of Dental Materials and Prosthodontics Araraquara Dental School Universidade Estadual Paulista (UNESP), Araraquara Department of Dental Materials and Prosthodontics Araraquara Dental School Universidade Estadual Paulista (UNESP), Araraquara

BACKGROUND: The unilateral and repetitive nature of overhead sports, often result in a biomechanical overload of the upper extremity. Understanding the musculoskeletal shoulder range of motion (ROM) and strength patterns in the youth sports of baseball, softball, and tennis could assist injury prevention screening and further the development of conditioning and rehabilitation programs. PURPOSE: To generate a descriptive profile of shoulder musculoskeletal characteristics and determine whether bilateral differences in shoulder ROM exist in youth baseball, softball, and tennis athletes. A secondary aim was to determine whether shoulder rotational adaptations are correlated with playing position, sport, or years of experience. STUDY DESIGN: Descriptive Laboratory METHODS: A total of 136 competitive youth overhead athletes (baseball: n = 51,12.8 ± 0.9yrs; softball: n = 63,12.3 ± 1.1yrs; and tennis: n = 22,12.5 ± 0.9yrs) participated. Bilateral shoulder internal (IR) and external (ER) passive ROM and external rotation strength were measured using an inclinometer and handheld dynamometer. RESULTS: Significant differences (p

To identify and describe phenotypes related to kinesiophobia, fear-avoidance, and pain catastrophizing, and determine clinical and demographic characteristics related to each phenotype as a function of self-reported function of the upper limbs in individuals with shoulder pain.One hundred and seventy-seven individuals with shoulder pain participated in this study. Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Numerical Pain of Rating Scale, and the angular onset of pain during the elevation of the arm were measured in all participants. A cluster analysis was performed considering kinesiophobia, fear-avoidance, and pain catastrophizing, then clinical and demographic characteristics of clusters were used to model individual's chance to belong to one of the clusters as a function of DASH.Two clusters were identified based on kinesiophobia, fear-avoidance, and pain catastrophizing. The cluster with worse pain-related fear profile presented (p 0.05) higher age, worse function, and higher pain intensity. This same cluster was also associated with involvement of the dominant side (OR = 2.10, 95% CI = 1.03, 4.41) and worse function (OR = 0.96, 95% CI = 0.94, 0.98).This study identified that individuals with worse pain-related fear profile were older, with worse function, and higher pain intensity. Worse function and involvement of the dominant side were associated with the phenotype with a worse pain-related fear condition.

IntroductionAtraumatic 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.ObjectiveTo 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 analysisThis 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 disseminationThe 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 numberNCT03962231.

Biopsychosocial aspects seem to influence the clinical condition of rotator cuff related shoulder pain (RCRSP). However, traditional bivariate and linear analyses may not be sufficiently robust to capture the complex relationships among these aspects. This study determined which biopsychosocial aspects would better classify individuals with acute and chronic RCRSP and described how these aspects interact to create biopsychosocial phenotypes in individuals with acute and chronic RCRSP. Individuals with acute (&lt, six months of pain, n = 15) and chronic (&ge, six months of pain, n = 38) RCRSP were included. Sociodemographic data, biological data related to general clinical health status, to shoulder clinical condition and to sensory function, and psychosocial data were collected. Outcomes were compared between groups and a decision tree was used to classify the individuals with acute and chronic RCRSP into different phenotypes hierarchically organized in nodes. Only conditioned pain modulation was different between the groups. However, the tree combined six biopsychosocial aspects to identify seven distinct phenotypes in individuals with RCRSP: three phenotypes of individuals with acute, and four with chronic RCRSP. While the majority of the individuals with chronic RCRSP have no other previous painful complaint besides the shoulder pain and low efficiency of endogenous pain modulation with no signs of biomechanical related pain, individuals with acute RCRSP are more likely to have preserved endogenous pain modulation and unilateral pain with signs of kinesiophobia.

Objective The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is widely used to assess patients with symptoms of subacromial pain syndrome (SPS). No study has analyzed the DASH by using the Rasch model in these patients and related the level of difficulty of the items with the International Classification of Functioning Disability and Health (ICF) domains. The purpose of this study was to evaluate the measurement properties of the DASH in individuals with SPS and to describe which ICF components are influenced by SPS based on the DASH. Methods The full version of the DASH was used to assess upper limb pain and function in individuals with SPS. Responses were assessed using the Rasch model. DASH items were grouped according to the level of difficulty and associated with the ICF domains to identify the most compromised aspect in these individuals. Results Reliability and internal consistency for the DASH were shown to be 0.93 and 0.95, respectively. Item 3 (“Turn a key”) was the easiest and 25 (“Pain during specific activity”) the most difficult. Only item 30 (“Less capable/confident/useful”) was as an erratic item. Item 15 (“Put on a sweater”) showed differential functioning by age and item 11 (“Carry a heavy object”) by sex. Seven items showed differential functioning related to the angular onset of pain during arm elevation. Sixty percent of the most difficult items belonged to the “Body function” domain of the ICF. Conclusion Although some psychometric properties of the DASH are adequate according to the Rasch model, adjustments to some items are necessary for individuals with SPS. Clinicians should be cautious when interpreting the DASH, especially in patients with angular onset of pain above 120 degrees of arm elevation. Impact The information contained in this study should be used by clinicians to interpret the results of the DASH when assessing individuals with SPS. The DASH may not be adequate to assess those with shoulder pain above 120 degrees of arm elevation. These results are not generalizable to other shoulder pathologies.

This study compared core stability, shoulder isokinetic peak torque and shoulder function in throwers with and without shoulder pain.Cross-sectional study.Throwing athletes.Thirty healthy athletes and 21 with shoulder pain were included.Endurance time of the trunk, the modified star excursion balance test, isokinetic peak torque of internal and external rotation of the shoulder, questionnaires, level of satisfaction with the throwing arm and active range of motion.The symptomatic athletes presented with shorter endurance time for the trunk lateral flexors (P .05), and decreased reach distance for both limbs in the posteromedial direction (P .05) and for takeoff limb in the posterolateral direction (P = .04), and smaller composite score for both limbs (P .05) during star excursion balance test as compared to the healthy ones. No significant differences between groups were found for peak torque of internal and external rotation of the shoulder. Athletes with shoulder pain demonstrated more shoulder disability and a lower level of satisfaction with the throwing arm (P = .000). Range of motion was not different between groups for shoulder internal and external rotation.Throwing athletes with shoulder pain have lower core stability and shoulder function compared to healthy athletes.

Upcoming generation of smart windows requires simple design, fast stimulus response and cost-effective production. Aiming these features, we reported a new approach of switchable devices based on the thermosensitive polymer poly(N-vinylcaprolactam) (PNVCL) and facile assembly of the components (FTO layers and polymer). Its optical/color change from transparent to opaque is temperature-dependent and activated by induced Joule heating of conductive substrates. Therefore, the reported devices showed fast reversible response (less than 60 s) by small input power and adjustable opaqueness according to polymer concentration. In opposite to traditional electrochromic smart windows dependence of the kinetics charge-transfer reaction, the observed features are triggered by the thermodynamic mechanism of the reversible coil-globule transition from PNVCL suspension, which can lead to stable performance of the proposed device.

Objectives: In this paper, the aim is to show how to generate a gauging table with the continuous use of electrical, hydraulic and mechanical devices that aim to provide reliability, purity and industrial safety, by not directly manipulating the fuel and actions that may vary final product or induce accidents. In addition, by making a custom gauging table for the arbitrary conditions of the tank, the uncertainty about the quantity of the liquid is reduced and, therefore, it does not discriminate on the type, shape or physical characteristics of these, because the characteristic of the tank it is carried out in the place and under the operating conditions. Methods/Analysis: The model was developed in five stages, a saber: Analysis and specification, Design and construction, Evaluation, Modification and Testing. Findings: Through the implementation of this measure system reliability, safety, and decreased operating time thanks to a methodology of continuous high flow samples and offers. Improvements: The developed model can evolve to a system with greater automation, using level and flow sensors with the same or better resolution, which does not have its own interface for reading but can be added to the communication card and flow control, needing a single USB communication port for mobile phones, with the aim of developing the application on mobile phones. Keywords: Flow, Gauging, Storage Tank, Threats, Volumetric Filling

Objectives: This paper shows the development of an application for the historical record of the values with which a wastewater treatment filter operates in the oil industry, used to eliminate traces of oil and solids, and make it suitable in the injection processes or shedding. Methods/Analysis: After analyzing the data, we proceeded to identify the variables within the filter that had to be shown in the program. After that, the programming work was done in the Programmable Logic Controller (PLC) to make this data accessible. The software Microsoft Excel and RSLinx were selected for the final development, the data was communicated from the PLC to this software, and the application was developed, together with its respective simulation and its use was demonstrated in a real case. The entire process is described in this document and, at the academic level; it can be a source of consultation or guidance for the development of applications and subsequent developments. Findings: Process that is automated and therefore uses a PLC (programmable logic controller) for control and operation, together with HMI screens (Human Machine Interface), which make it possible for operators to control and supervise their operation, but do not have software that allow to record its value over time, software that would be useful for field coordinators, maintenance managers and manufacturer representatives, in order to determine efficiency parameters and detect or correct faults. Improvements: The registration can be done to view it via WEB on any device. Keywords: Automated Register, Filters, Human Machine Interface (HMI), Programmable Logic Controller (PLC), Wastewater

Objectives: Design and build an electronic audiovisual warning device for land transport vehicles operators which allows correcting, in real time, operation errors for overstep the speed limits and/or acceleration established. Additionally, the device allows the identification by keyboard of the vehicle operator for the subsequent generation of individualized statistics. Methods/Analysis: This investigation will allow the development of an electronic equipment that alerts the land vehicles operator, in real time and at the moment when they are getting out of control in some of the critical variables for safe driving, namely speed and acceleration, allowing to correct the mistakes, thanks to a timely and easy to understand information. Findings: The incorporation of electronic early warning devices of common driving errors for land transport operators allows a significant reduction in road accident rates, thanks to the stimulation of self-care and self-control, by means of agile and timely information within the vehicle cabin. Improvements: Currently the major research in this subject is around the training and investigation of accidents but do not have many objective tools to measure and qualify operators in the application of the standards and improvement plans that are taught (industrial safety, basic driving, traffic regulations, defensive driving and basic mechanics, among others). Keywords: Accelerometers, Automotive Accident Prevention, MEMS, Microcontroller, Road Safety, Speedometer

Background With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. Methods The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. Results The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference – all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6–11 years and ≥12 years. Conclusions For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

This study aims to evaluate the influence of the degree of difficulty of the activities in Motor Activity Log (MAL) scores for patients with mild, moderate, and severe hemiparesis, and to estimate the correlation between motor impairment levels of hemiparesis and MAL scores in post-stroke patients. Sixty-six patients with chronic hemiparesis (49 with mild-moderate hemiparesis, and 17 with severe hemiparesis) were evaluated by the Fugl-Meyer upper-limb section and versions of MAL for different degrees of motor impairment. The Rasch model was used to analyze the level of difficulty of the activities of the different versions of MAL. The Spearman's correlation tested the relationship between the Fugl-Meyer Assessment upper-limb section and MAL. The MAL version, developed to evaluate patients with severe hemiparesis, does not contain the easier activities as employed by the Rasch analysis. There was positive correlation between the Fugl-Meyer Assessment upper-limb section scores and Amount of Use of the three versions of the MAL (

Mechanical hyperalgesia defined as decreased pressure pain thresholds (PPTs) is commonly associated with pain. In this narrative review, we report the current state of the art within topographical pressure sensitivity maps. Such maps are based on multiple PPT assessments. The PPTs are assessed by an a priori defined grid with special focus on both spatial and temporal summation issues. The grid covers the muscle or the body region of interest using absolute or relative values determined from anatomical landmarks or anthropometric values. The collected PPTs are interpolated by Shepard or Franke and Nielson interpolation methods to create topographical pressure sensitivity maps. This new imaging technique has proven to be valuable in various disciplines including exercise physiology, neurology, physical therapy, occupational medicine, oncology, orthopedics, and sport sciences. The reviewed papers have targeted different body regions like the scalp, low back, neck-shoulder, and upper and lower extremities. The maps have delineated spatial heterogeneity in the pressure pain sensitivity underlining the different extents of pressure pain hyperalgesia in both experimentally induced and disease-associated pain conditions. Furthermore, various intervention studies have proven the utility of topographical pressure pain sensitivity maps. Topographical pressure pain sensitivity maps have contributed to revealing the efficacy of therapeutic, ergonomic, or training interventions that aim at reducing pain.

Proper diagnosis is a first step in applying best available treatments, and prognosticating outcomes for clients. Currently, the majority of musculoskeletal diagnoses are classified according to pathoanatomy. However, the majority of physical therapy treatments are applied toward movement system impairments or pain. While advocated within the physical therapy profession for over thirty years, diagnostic classification within a movement system framework has not been uniformly developed or adopted. We propose a basic framework and rationale for application of a movement system diagnostic classification for atraumatic shoulder pain conditions, as a case for the broader development of movement system diagnostic labels. Shifting our diagnostic paradigm has potential to enhance communication, improve educational efficiency, facilitate research, directly link to function, improve clinical care, and accelerate preventive interventions.

Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia.Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables.Although an important improvement was achieved in terms of pain and quality of life (P0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P0.05, effect sizes from -0.40 to 0.46 for all kinematic variables).The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.

To assess concurrent validity, between and within-day reliability of scapular and clavicular digital inclinometer measures.Test-retest and concurrent validity.Laboratory.Twenty-three participants with and without shoulder symptoms.Static positions of scapular upward rotation, anterior/posterior tilting and clavicular elevation were measured between days with an inclinometer and compared to a 3-dimensional electromagnetic tracking system in different positions of sagittal plane humeral elevation (neutral, 30°, 60°, 90°, 120°). The two methods were compared using a two-way Analysis of Variance. Linear regressions at each arm position were also performed to further assess concurrent validity.Between-day reliability demonstrated Intraclass Correlation Coefficients ≥ 0.50 for all comparisons. There were statistically significant differences between methods or interactions of method and arm position for clavicle elevation (p = 0.004, maximum offset between methods 7.7º in the neutral position), and scapular upward rotation (p = 0.001). For scapular upward rotation, the maximum difference between methods was less than 2° across all humeral positions. Clavicle elevation (r = 0.67-0.82) and scapular upward rotation (r = 0.57-0.81) demonstrated higher correlations between measurement methods than scapular anterior/posterior tilt (r = 0.10-0.67).Concurrent validity in assessing scapular upward rotation and clavicle elevation with an inclinometer was shown when compared with electromagnetic tracking. However, the inclinometer method may not have adequate concurrent validity to clinically measure scapular anterior/posterior tilting.

Objective To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. Design Randomized controlled trial with blinded assessor and patient. Setting Laboratory. Participants Patients with shoulder impingement syndrome (N=61). Interventions Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Main Outcome Measures Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. Results Pain decreased by 0.7 points (95% confidence interval, 1.3–0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5–0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire ( P =.01) and Western Ontario Rotator Cuff Index ( P =.02) scores improved in both groups. Scapular upward rotation increased during arm lowering ( P P Conclusions TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive.

BACKGROUND: Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. OBJECTIVE: To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. METHODS: In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. RESULTS: Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P

Background: The cardiopulmonary exercise test (CPET) is the gold standard to measure aerobic fitness. However, CPET is expensive and requires specialized equipment and a qualified operator. There is a growing interest in using step tests to assess exercise capacity in subjects with chronic lung diseases due to its portability. However, the use of modified incremental step test (MIST) to evaluate exercise capacity in subjects with asthma remains unknown. Objective: To evaluate cardiopulmonary and metabolic responses during MIST in adults with moderate to severe asthma. In addition, we investigated the reliability of the MIST in this population. Methods: Fifty-four adults with asthma performed a CPET and two MIST with pulmonary gas analysis on two separate days in a randomized order. The subjects were allocated according to BMI (eutrophic, overweight and obese) and the best MIST (b-MIST) was considered at the peak of the exercise for comparison with CPET. Results: There was a difference in peak oxygen uptake (VO2peak) assessed by the CPET and the b-MIST (2,042±494; 1,749±434 mL/min, mean ± SD, respectively; p=0.01). The limits of agreement for VO2peak between the CEPT and the b-MIST with ranged from 201 to -786 ml/min. MIST was reproducible and presented a excellent intraclass correlation coefficient (CCI [95% confidence interval]) for the number of steps (0.88[0.79 - 0.93]), VO2 (0.93[0.88 - 0.96]) and maximal heart rate (0.86 [0.76 - 0.92]). Conclusion: The MIST elicits a lower VO2peak than the CPET in subjects with moderate to severe asthma regardless the BMI. However, the MIST is well tolerated and reproducible in this population.

Objective:The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched.Methods:Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results:Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45–2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4–2.4).Conclusion:Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

Objectives In newborn rodents, intestinal maturation involves delayed fructose transporter GLUT5 expression until weaning. In jejunoileal atresia (JIA), distal intestinal segments lack exposure to amniotic fluid-containing carbohydrates. We assessed in human newborns, the impact of intestinal maturation and obstruction on mucosal monosaccharide transporter expression. Methods Samples were obtained from 10 newborns operated for small intestinal atresia and from 17 adults undergoing gastroduodenoscopy and/or ileocolonoscopy. mRNA expression of the transporters SGLT1, GLUT1, GLUT2, GLUT5, and GLUT7 was measured in neonate samples proximal and distal of the atresia as well as in adult duodenum, ileum, and colon. Protein expression and localization was assessed using immunofluorescence. Results Although mRNA expression of monosaccharide transporters did not significantly differ between newborn and adult samples, luminal fructose transporter GLUT5 protein was absent in 0- to 4-day-old neonates, but expressed in adults. The mRNA expression of the 5 tested monosaccharide transporters was unchanged distal from the JIA relative to proximal. Similarly, luminal sodium-dependent glucose transporter SGLT1 and basolateral GLUT2 were expressed proximal and distal to JIA as visualized by immunofluorescence staining. With the exception of glucose transporter GLUT1 that showed highest expression levels in colon, all investigated hexose transporters showed strongest expression in duodenum, lower levels in ileum and lowest in colon. Conclusions Human newborns lack small intestinal fructose transporter GLUT5 protein expression and small intestinal atresia does not affect the expression of hexose transporters.

Using tangible interfaces for educational purposes presents considerable advantages and can provide an increase in student engagement and motivation, and showed particularly suitable in inclusive education. One of the main problems encountered in the use of tangible tabletop in the educational environment is the lack of software for programming and use that meets educational needs and is easy to use, especially for teachers who don't master programming logic. This work presents an editor of pedagogical activities developed for tangible tabletop to teachers develop pedagogical activities in inclusive context, intuitively and easily. The new editor was designed from a research with a group of undergraduate education course students, which used an available editor and evaluated its usability. After that, was carried out the new editor requirements elicitation, with the modeling and implementation of the same one. A new group of students of the same course used the new developed editor (E-dub-a) and evaluated its usability.

Background:Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements.Purpose:To evaluate the effect of experimental tissue alterations on clinical range of motion measures.Study Design:Controlled laboratory study.Methods:Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement.Results:There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline.Conclusion:Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations.Clinical Relevance:Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

Study Design Parallel-group intervention with repeated measures. Introduction Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. Purpose of the Study To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. Methods A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. Results Disabilities of the Arm, Shoulder, and Hand scores decreased ( P P > .05) were found for PM length in both groups. Scapular anterior tilt increased ( P Discussion This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. Conclusion The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the upper limbs improved in patients with shoulder pain. Level of Evidence 2b.

Aim To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS). Design Systematic review. Data sources PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases. Eligibility criteria for selecting studies Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included. Results 64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet. Conclusions Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended.

Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.

Background The trapezius is an extensive muscle subdivided into upper, middle, and lower parts. This muscle is a dominant stabilizer of the scapula, normally operating synergistically with other scapular muscles, most notably the serratus anterior. Altered activation, poor control, or reduced strength of the different parts of the trapezius have been linked with abnormal scapular movements, often associated with pain. Several exercises have been designed and studied that specifically target the different parts of the trapezius, with the goal of developing exercises that optimize scapular position and scapulohumeral rhythm that reduce pain and increase function. Methods This paper describes the anatomy, kinesiology, and pathokinesiology of the trapezius as well as exercises that selectively target the activation of the different parts of this complex muscle. Conclusions This review provides the anatomy and kinesiology of the trapezius muscle with the underlying intention of understanding how this muscle contributes to the normal mechanics of the scapula as well as the entire shoulder region. This paper can guide the clinician with planning exercises that specifically target the different parts of the trapezius. It is recommended that this paper be read as a companion to another paper: Kinesiologic considerations for targeting activation of scapulothoracic muscles – part 1: serratus anterior.

Background The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this important muscle is believed to be associated with several painful conditions involving the shoulder complex. Studies and clinical intuition have therefore identified several exercises that selectively target the activation of the SA. Methods This paper reviews the anatomy, innervation, testing, and complex actions of the SA. In addition, this paper describes the classic signs and symptoms of weakness or reduced activation of the SA. Several exercises are described and illustrated that purportedly target the activation of the SA, with the intention of optimizing muscular control and encouraging pain free shoulder motion. Conclusions This review provides the theoretical background and literature-based evidence that can help explain the SA's complex pathokinesiology, as well as guide the clinician to further develop exercises that likely challenge the muscle. This paper is written along with a companion paper entitled: Kinesiologic considerations for targeting activation of scapulothoracic muscles: part 2: trapezius. Both papers prepare the reader to expand their pallet of exercises that target and challenge these two dominant muscles, with a goal of improving function of the shoulder for several painful conditions caused by their reduced or altered activation pattern.

Context Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers. Objectives To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers. Intervention(s) Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior. Main Outcome Measure(s) Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05. Results Competitive swimmers presented more internal rotation at 90° (P = .03) and 120° (P = .047) and more anterior tilt at 90° (P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° (P = .004) and 120° (P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° (P = .02) and 90° to 120° (P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners (P = .04). No differences were found in any of the muscles for the PPT (P > .05). Conclusions Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.

Background Magnetic resonance imaging (MRI) is commonly used to diagnose structural abnormalities in the shoulder. However, subsequent findings may not be the source of symptoms. The aim of this study was to determine comparative MRI findings across both shoulders of individuals with unilateral shoulder symptoms. Materials and methods We prospectively evaluated 123 individuals from the community who had self-reported unilateral shoulder pain with no signs of adhesive capsulitis, no substantial range-of-motion deficit, no history of upper-limb fractures, no repeated shoulder dislocations, and no neck-related pain. Images in the coronal, sagittal, and axial planes with T1, T2, and proton density sequences were generated and independently and randomly interpreted by 2 examiners: a board-certified, fellowship-trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Absolute and relative frequencies for each MRI finding were calculated and compared between symptomatic and asymptomatic shoulders. Agreement between the shoulder surgeon and the radiologist was also determined. Results Abnormal MRI findings were highly prevalent in both shoulders. Only the frequencies of full-thickness tears in the supraspinatus tendon and glenohumeral osteoarthritis were higher (approximately 10%) in the symptomatic shoulder according to the surgeon's findings. Agreement between the musculoskeletal radiologist and shoulder surgeon ranged from slight to moderate (0.00-0.51). Conclusion Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders. Clinicians should be aware of the common anatomic findings on MRI when considering diagnostic and treatment planning.

Objectives To assess the influence of posterior capsule tightness and humeral retroversion on shoulder motion measurements. Design Cross-Sectional study. Setting Controlled university laboratory. Participants 75 asymptomatic individuals were assigned to one of 4 groups: control (n = 28); posterior capsule tightness only (n = 17); humeral retroversion only (n = 15); and combined posterior capsule tightness and retroversion (n = 15). Main outcome measures Six clinical measurements were compared across groups: bicipital forearm angle, low flexion, glenohumeral internal and external rotation, horizontal adduction and extension with internal rotation. Results The group with both adaptations had decreased internal rotation compared to the control and retroversion only groups, as well as increased external rotation compared to the control and posterior capsule only groups. There were no between group differences for the horizontal adduction or extension with internal rotation measurements. The retroversion only and combined groups showed decreased bicipital forearm angle compared with the control and posterior tightness groups. The posterior capsule tightness and combined groups demonstrated decreased low flexion compared to the other groups. Conclusion The combination of osseous and soft tissue adaptions alter shoulder motion measures more than a single adaption, making a comprehensive clinical assessment vital when managing individuals with shoulder pain.

Background: There is evidence that pectoralis minor (PM) length influences scapula position and that scapula position relates to glenohumeral joint (GHJ) external rotation (ER) range of motion (ROM...

There are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery.To compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed.Forty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36).The surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p .05; d = -0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls.Scapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.

Randomized controlled trial.To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome.Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen.Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold.Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: -1.5°, 7.5°) relative to baseline in the exercise-plus-manual therapy group compared to a decrease of 0.3° (95% CI: -4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period.Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics.

Many manufacturers wish to relate the physical properties of their products to customers' affective responses so that they can improve the design of their products. Rasch measurement theory is a novel approach in this context that could offer business benefits over other approaches. The aim of the research was to determine whether Rasch measurement theory can support the construction of a scale to measure the affective impression of a moisturiser cream elicited by the compliance of the moisturiser's packaging. The compliances of packaging used to develop a scale for the impression of the contents of the packaging in previous research were measured. New packaging prototypes were manufactured with a range of compliances to determine whether affective responses to them could be predicted. A new sample of 67 participants rated the prototypes against Likert statements on a five-point scale. The statements were derived from descriptions of the users' product experience. The scale was recalibrated using a multi-facet Rasch model. It was found that the affective responses to the prototypes fell within the range predicted by the original scale. The results demonstrate that Rasch measurement theory can be used to achieve the objective correspondence between affective responses and the physical properties of a product, and the information can be used in new product development.

The shoulder complex is highly loaded during swimming. No studies were found analyzing the changes in shoulder girdle strength in young swimmers, through the years.To analyze the changes in strength of internal rotators and external rotators of the arm, lower trapezius and supraspinatus and in the external rotators/internal rotators ratio in young elite swimmers through 3 years.31 adolescent elite swimmers (14-18 years, of both sexes) participated in the study. Isometric strength of the shoulder girdle muscles was performed using a handheld dynamometer during 3 years.For boys absolute data, internal rotators increased from the first to the second (p=0.0001; mean difference 45.6N; 95%CI 26.7-65.0) and third years (p=0.01; mean difference: 32.4; 95%CI: 9.3-55.5). Considering the weight-normalized data, internal rotators increased from the first to the second year (p0.0001; mean difference: 0.52; 95%CI: 0.26-0.78), external rotators decreased from the first to the third year (p=0.003; mean difference: -0.33; 95%CI: -0.53 to -0.13) and from the second to the third year (p=0.0004; mean difference: -0.29; 95%CI: -0.46 to -0.12) and supraspinatus decreased from the second to the third year (p=0.006; mean difference: -0.17; 95%CI: -0.28 to -0.06). For girls, there were no significant differences in the absolute strength. Considering the weight-normalized data, lower trapezius decreased from the first to the third year (p=0.02; mean difference: -0.15; 95%CI: -0.27 to 0.03). Considering both sexes, the external rotators/internal rotators ratio decreased from the first to the second (p0.0001; mean difference -0.12N; 95%CI -0.13 to -0.11) and third years (p0.0001; mean difference -0.15N; 95%CI -0.16 to -0.14).Muscle imbalance can occur in the shoulder girdle in young swimmers in 3 years, with increased internal rotators and decreased external rotators and supraspinatus strength in boys, and decreased strength of the lower trapezius in girls. Attention should be given in young swimmers' shoulder girdle muscle balance.