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Purpose: To evaluate muscle torque, lower extremity coordination, and knee laxity after ACL reconstruction comparing patients operated on with semitendinosus graft (ST) and patients with combined semitendinosus and gracilis (STGR) grafts., Methods: Forty-six subjects who underwent ST (n = 23) or STGR harvest (n = 23) ACL reconstruction participated in this study. Quadriceps and hamstring torque were recorded using an isokinetic dynamometer. The anterior tibial translation was measured using the Kneelax 3 Arthrometer. The eccentric and concentric motor coordination was tested by multi-joint lower-limb tracking-trajectory test. All measurements were taken 12 months after surgery. Side-to-side differences were determined for all subjects., Results: Side-to-side differences in extensor peak torque at 180°/s and 60°/s did not differ between semitendinosus (ST) and semitendinosus + gracilis (STGR) groups (n.s.). However, side-to-side differences in flexor peak torque were significantly higher at 60°/s for the STGR group than the ST group (P = 0.002). Side-to-side differences in eccentric and concentric parts of tracking-trajectory test and anterior tibial translation did not differ between the STGR and the ST groups (n.s.)., Conclusion: The outcomes of this study suggested that additional harvest of gracilis did not influence lower extremity motor control, quadriceps muscle torque, and anterior tibial translation; however, it affected knee flexion isokinetic torque negatively at low angular velocity. This finding could be important for functional activity or sports with high demands on hamstring muscle strength. It is recommended that gracilis muscle should be preserved as possible during ACL reconstruction., Level of Evidence: Prospective comparative study, Level II.

Context: The stability of the scapula in relation to the entire moving upper extremity is the key in the throwing sequence. The importance of scapular positioning in volleyball players has been well documented in the literature, but no one has compared scapular positioning between volleyball players and sedentary people., Objective: To compare measurements of scapular mobility obtained using the lateral scapular slide test between volleyball players and sedentary participants without shoulder impairments and to compare changes in scapular mobility in players according to the number of years of sport participation., Design: Randomized controlled clinical trial., Setting: University research laboratory., Patients or Other Participants: A total of 121 people at a single university volunteered. Of these, 67 were sedentary (age = 24.3 ± 2.34 years, height = 1.69 ± 0.09 m, mass = 65.1 ± 11.91 kg); 54 were volleyball players from 4 professional teams and were separated into 2 groups according to their years of sport participation. The first group was named young players (n = 31; age = 17.7 ± 2.58 years, height = 1.83 ± 0.10 m, mass = 68.3 ± 12.21 kg, sport participation ≤ 9 years), and the second group was named old players (n = 23; age = 26.9 ± 3.39 years, height = 1.95 ± 4.38 m, mass = 90.7 ± 5.75 kg, sport participation ≥ 10 years)., Main Outcome Measure(s): Study participants completed a rating scale for pain and a questionnaire about demographic and shoulder problems. One assessor performed the lateral scapular slide test and additional flexibility measurements around the shoulder girdle. Flexibility (external rotation, internal rotation) and scapular position (1, 2, 3) were compared among groups (young players, old players, sedentary people) and between sides (dominant, nondominant)., Results: In sedentary participants, we found differences for position 1 (t(66) = 3.327, P = .002), position 2 (t(66) = 2.491, P = .004), position 3 (t(66) = 2.512, P = .006), and internal rotation (t(66) = 2.592, P = .001) between the dominant and nondominant sides. In old players, we found differences for position 2 between the dominant and nondominant sides (t(22) = 2.956, P = .004). For position 2 (F(2,118) = 4.265, P = .02) and position 3 (F(2,118) = 4.702, P = .01), we found differences between young and old players. For internal rotation, we found differences between sedentary and old players (F(2,118) = 6.578, P = .002) and between young and old players (F(2,118) = 3.723, P = .01)., Conclusions: Clinicians evaluating overhead athletes need to remember that asymmetric scapular posture between the dominant and nondominant sides in unilateral overhead athletes might be normal and not necessarily related to injury.

Aim: The aim was to assess the effects of a 12-week "rope jumping" and "weighted rope jumping" training programs on functional parameters including multi-joint coordination and proprioception, strength, endurance in adolescent female volleyball players., Methods: Pretest posttest experimental design., Intervention: Weighted Rope Training group (N.=9; 15±1 years), Rope Training group (N.=9; 14.1±1.3 years) and Controls (N.=7; 14.4±1.3 years)., Main Outcome Measures: Motor coordination, proprioception, strength and endurance of the lower extremities with concentric and eccentric performances in closed kinetic chain on multi joint system assessed by the Monitorized Squat system. Absolute average error (cm) and the standard deviation for coordination and proprioception, Peak Force (N), Total Work (Nm), Average Power (Nm/s), Maximal Speed for strength and endurance tests were calculated. Kruskal-Wallis and Mann Whitney U test were utilized., Results: Weighted rope jump group had significant decrease for the deviation results of coordination on the concentric and eccentric phases for both legs (P<0.05). Rope jump and weighted rope jump groups had significantly lower results on non visible second movement deviation (P<0.05). In strength tests, the difference was found for total work that there was difference on the post assessment within groups in favour of Weighted Rope Training group in comparison to controls (P<0.05). Weighted Rope Training and control groups improved in concentric maximal speed (P<0.05). Most significant changes occured on eccentric phaese of the endurance tests that peak force increased in Weighted Rope Training group (P<0.05)., Conclusions: Adding rope jump to training programs improves joint repositioning and coordination. Weighted Rope Training group got greater gains for coordination and eccentric endurance parameters for lower extremities in a closed kinetic chain.

Context: The development pattern of motor coordination, strength, and functional ability during recovery from anterior cruciate ligament (ACL) reconstruction., Objective: To investigate the relationship between motor coordination, functional ability, and strength after ACL reconstruction., Design: Prospective clinical follow-up study., Setting: Sports-injury research laboratory., Participants: 20 subjects who underwent ACL reconstruction., Interventions: Real-time eccentric and concentric motor coordination were tested by a multijoint lower limb tracking-trajectory test, quadriceps and hamstring isokinetic strength were assessed by isokinetic dynamometer, and functional performance was tested with a single-leg-hop test 6 and 12 mo after ACL reconstruction., Main Outcome Measures: Percentage deficits of the involved lower extremity for target-tracking ability, peak torque, total work parameters of isokinetic strength, and single-leg-hop distance., Results: Deficits in hamstring-quadriceps isokinetic muscle strength and single-leg-hop distance significantly decreased from the 6th to the 12th mo after surgery (P < .05). There were no significant differences in muscle concentric and eccentric motor-coordination deficits of the involved side (P > .05)., Conclusions: Although muscle strength and functional performance clearly increased from the 6th to the 12th mo after surgery, coordination characteristics of involved side remained low. This pattern demonstrated that motor-coordination progression was not affected by strength development. Patients continued to have significant motor-coordination deficits even 12 mo postsurgery. Therefore, the authors recommend that neuromuscular-coordination exercises be included in long-term rehabilitation programs to improve motor coordination.

Unlabelled: The aim of this study was to compare the proprioceptive accuracy in the dominant and nondominant lower extremities between early and late stages of adolescence in boys. Participants displaying sexual development consistent with Tanner stages I or II were included in the early adolescent group, and those displaying development consistent with Tanner Stages IV or V were included in the late adolescent group. Proprioception was evaluated using the following 4 tests: one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test. There were statistically significant differences between the early and late stages of adolescence in nondominant ankles with regard to this single-limb-standing test. There were no statistically significant differences between the early and late adolescent stages, and between dominant and nondominant extremities with regard to the single-limb-hopping test. There were no statistically significant differences between early and late adolescent stages with regard to passive and active ankle plantar- and dorsiflexion position reproduction. Based on these findings, we concluded that sexual maturation categorized by Tanner stage does not affect proprioceptive ability in adolescent individuals., Clinical Relevance: This method, as a clinical assessment of detecting deficits in neuromuscular control examined by foot and ankle surgeons and a rehabilitation technique to treat functional instability of the ankle used by physical therapists, might be applied to adolescents. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in adolescents., (Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this randomized controlled study was to assess the efficacy of manual therapy in the treatment of patients with symptomatic supraspinatus tendinopathy., Methods: Seventy-seven patients (age range, 30 to 55 years) with supraspinatus tendinopathy, were randomly assigned to one of the three treatment groups: a supervised exercise program (Group 1), a supervised exercise program combined with joint and soft tissue mobilization (Group 2), or a home-based rehabilitation program (Group 3). All patients had rehabilitation for 12 weeks. Pain level was evaluated with a visual analogue scale (VAS) and the range of motion (ROM) was measured with a goniometer. The Modified American Shoulder and Elbow Surgery (MASES) score was used in functional assessment. Flexion, abduction, internal and external rotation strengths were measured with a manual muscle test. All patients were evaluated before, and at the 4th and 12th week of the rehabilitation., Results: All groups experienced significant decrease in pain and an increase in shoulder muscle strength and function by both the 4th and 12th weeks of treatment (p<0.05). There was no significant difference between the groups in terms of function (p>0.05). However, the greatest improvement in functionality was found in Group 2., Conclusion: Supervised exercise, supervised and manual therapy, and home-based exercise are all effective and promising methods in the rehabilitation of the patients with subacromial impingement syndrome. The addition of an initial manual therapy may improve the results of the rehabilitation with exercise.

Purpose: The purpose of this study was to investigate the effects of weight on ankle stability in adolescent basketball players., Methods: 20 non-injured subjects (age=11.05+/-1.5 years) were included in this study. Each subject performed a 15min warm-up by running or riding a stationary bike. The Star Excursion Balance Test (SEBT), single-leg balance test (performed with eyes open and eyes closed) and vertical jump test were performed with dominant lower extremity. 1 week later, same tests were performed with a schoolbag. The schoolbag contained weight bars as 20% of the players own body weight., Results: Only posteromedial component of SEBT had significant difference between non-weight measurement and weighted measurement (p=0.004). Single-leg stance test performed with eyes open (p=0.006) and closed (p=0.001) had significant difference between non-weight measurement and weighted measurement. Also the vertical jump test had significant difference between non-weight measurement and weighted measurement (p=0.001)., Conclusions: These findings indicate that 20% weight of their own body weight does not affect dynamic ankle stability and postural limitations, which are magnified by advancing weight. We are confident in our conclusions because of the three-way interaction noted with posterior/medial with weight in SEBT. Furthermore, Star Excursion Balance test is more effective both weight and non-weight in measuring functional stability of the ankle., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: To investigate the effect of a 12-wk weighted-jump-rope training program on shoulder strength., Design: Pretest to posttest experimental design., Setting: University sports physiotherapy laboratory., Participants: 24 healthy volleyball players age 13-16 y., Intervention: Group 1 took weighted-rope training (n = 9), group 2 took unweighted-rope training (n = 8), and group 3 did not train with any specific program (n = 7)., Main Outcome Measures: Players' strength determined with an isokinetic dynamometer (Isomed 2000) at 180 and 60 degrees on external and internal rotators, supraspinatus peak torque, and total work of the dominant shoulder. Kruskal-Wallis and Mann-Whitney U tests were used to determine the difference among the groups., Results: At pretraining evaluation, there were no significant differences in the test scores of the isokinetic test of full can and empty can between the groups at 60 and 180 degrees. There was no statistically significant difference for 60 and 180 degrees between pretraining and posttraining assessment (P > .05) except that total eccentric work increased in groups 1 and 3 but decreased in group 2 at 180 degrees during the full can (P < .05). There was no significant difference among the groups between the pretraining and posttraining testing at both 180 and 60 degrees for the empty can (P > .05). Internal-rotation values at 60 and 180 degrees decreased for both peak torque and total work for all groups. External-rotation peak torque and total work at 60 degrees increased for group 1. External-rotation peak torque and total work at 180 degrees increased for all groups., Conclusions: The results indicate that a jump-rope training program is a good conditioning method for overhead athletes because of its potential benefits to shoulder strength.

Introduction: Clitoral blood flow measurements using clitoral color Doppler ultrasound have been performed with increasing frequency either in order to assessment of female sexual function/dysfunction. The trials to evaluate the sexual function in healthy subjects, especially in the subgroup of female elite athletes, are limited., Aim: The aim of the study was to evaluate whether elite female athletes and sedentary healthy females differ in their clitoral blood flow and sexual function as an expression of their physical fitness status., Methods: Twenty-five female elite athletes (Group I) and healthy female subjects (Group II) were enrolled as volunteers in the study. All women were instructed to complete the Female Sexual Function Index (FSFI) questionnaire. Each subject underwent high definition color Doppler ultrasonography to measure the clitoral blood flow parameters. Main Outcome Measures. The effect of physical activity on clitoral blood flow and sexual life in women., Results: Mean age, mean age of menarche, mean marriage age, and body mass index were similar for both groups. In Group I, the mean peak systolic velocity and end-diastolic velocity were higher than those of Group II, whereas the mean RI was similar for both groups. There were statistically significant differences for total FSFI score and all domain scores, except desire domain, between both groups., Conclusion: In elite female athletes as compared with sedentary healthy females, better clitoral blood flow and better sexual function were demonstrated. Therefore it seems superior physical fitness correlates with better sexual function.

Objective: The objective of this study was to assess the effects of taping and preventive bracing on functional balance, jumping performance, multi-joint coordination and proprioception on comparison to barefoot and each other., Design: Controlled trial as an experiment with the independent variable testing in 3 trials: control (barefooted), preventive bracing, and taping., Setting: The sports physiotherapy research laboratory., Participants: Twenty physically active male university students aged between 20 and 28 who had been free from lower extremity pathology for 12 months and had no previous history of ankle sprain served as participants., Main Outcome Measures: Single leg balance (s), jumping performance (cm), coordination and proprioception assessments by the Functional Squat System. The software automatically calculated the absolute average error (cm) and the standard deviation (SD) of the average error. Average errors were independently quantified as a function of the action mode (concentric versus eccentric) and of the lower limb (dominant versus non-dominant)., Results: There was no significant difference among the groups for balance tests (p>0.05). For vertical jump performance of bilateral and the dominant leg there were significant differences that the barefoot group had better results compared to the other groups (p=0.059; 0.017). According to the coordination results of Functional Squat System participants were better in brace and tape situations since the deviations were less for all concentric and eccentric positions. Deviation results for the proprioception test were different for first visual and non-visual deviations for dominant leg (p<0.05)., Conclusion: In conclusion, bracing and taping may play an important role in preventing injury or rehabilitation of the injured ankle by improving concentric and eccentric coordination, proprioception with the ability of reproducing motion in closed kinetic chain while decreasing vertical jump performance. No superiority of brace over tape or vice versa was found in this study.

Objective: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function., Design: Pretest-posttest for 3 groups (SM, sham, and control)., Setting: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic., Participants: 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y)., Interventions: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program., Main Outcome Measures: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function., Results: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05)., Conclusions: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

Objectives: The effects of two different closed kinetic chain exercises were compared in patients with patellofemoral pain syndrome (PFPS)., Methods: Forty female patients with unilateral PFPS were randomly divided into two groups to receive exercises with the hip internally rotated (n=20, mean age 39.1 + or - 8.0 years) or externally rotated (n=20, mean age 36.1 + or - 8.7 years) with the use of the Monitored Rehab Functional Squat (MRFS) System. The duration of exercises was four weeks with a total of 20 sessions. Both groups were evaluated before therapy, after four weeks of exercises, and after six weeks of home exercise program with the MRFS System for muscle strength and proprioception, with a visual analog scale for pain, and with the Kujala questionnaire for functional assessment., Results: Among baseline features, the only significant difference between the two groups was in the mean height (p<0.05). Pain severity decreased significantly in both groups after treatment and home exercises (p<0.05). Concentric and eccentric peak forces, concentric proprioceptive deficit, and Kujala scores improved significantly in both groups after treatment (p<0.05), whereas improvements after home exercises were not significant in this respect (p>0.05). Eccentric proprioceptive deficit, however, did not change significantly both after treatment and home exercises (p>0.05). No significant differences were observed between the two groups during the study period with respect to the parameters assessed (p>0.05)., Conclusion: Our results show that functional knee squat exercises with internally and externally rotated hip positions provide similar improvements in muscle strength and proprioception in patients with PFPS.

Introduction: The purpose of this study was to evaluate the relationship between body composition parameters and lung functions including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), FEV(1):VC ratio, and FEV(1):FVC ratio in elderly men and women., Methods: The study was a cross-sectional evaluation of 99 healthy men and women (aged 60-88 years). Anthropometric and body composition parameters (including fat mass [FM], fat-free mass [FFM] and percentage body fat [%BF]) were evaluated using the skinfold method, and lung function was examined using spirometry., Results: Data analysis showed %BF, body FM and body mass index (BMI) of women to be significantly higher than men. Also, their body FFM was significantly less than men (P<0.05). Lung volume (P<0.01) and lung capacity values (P<0.05) (VC, FVC, FEV(1), FEV(1):VC, FEV(1):FVC) of women were significantly less than men. There was a positive significant relationship between the FFM versus FVC and FEV(1) values of women and men. A negative significant relationship was demonstrated between body FM, BMI and FVC of all subjects., Conclusion: This investigation showed that women aged between 60 and 88 years had a lower lung capacity compared to men of the same age. Older women were found to have a higher body fat ratio than men, and it was found that increasing %BF and BMI had a negative effect on lung functions in both sexes.

The purpose of this report was to determine a detailed description of a rehabilitation programme of a volleyball player who had a decompression surgery for suprascapular nerve entrapment and to expose the long-term functional outcomes which lead to successful results.

The aim of this prospective, randomized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self-training program. Thirty patients (Group 1, n = 15; Group 2, n = 15) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self-training program (Group 1, age 49.5 +/- 7.9 years), or by joint and soft tissue mobilization techniques (Group 2, age 48.1 +/- 7.5 years). Group 1 was instructed with the active range of motion (ROM), stretching and strengthening exercise program including rotator cuff muscles, rhomboids, levator scapulae and serratus anterior with an elastic band at home at least seven times a week for 10-15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques, ice application, stretching and strengthening exercise programs and patient education in clinic for three times per week. All patients were tested with visual analog scale (VAS) for pain level, goniometric measurement for ROM and algometry for the pain threshold. Function was measured with a functional assessment questionnaire. The VAS (10 cm) used to measure pain with functional activities and the functional assessment questionnaire (Neer) were also measured 3 months after the initiation of treatment. Subjects in both groups experienced significant decreases in pain and increases in shoulder function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pre-treatment mean (+/-SD) of 6.7 (+/-0.3) to a post-treatment mean of 2.0 (+/-2.0). In contrast, pain in the exercise group was reduced from a pre-treatment mean of 6.6 (+/-1.4) to a post-treatment mean of 3.0 (+/-1.8). ROM at flexion, abduction and external rotation in the manual therapy group improved significantly while ROM in the exercise group did not. There were statistically differences among the groups in function (P > 0.05). Group 2 showed significantly greater improvements in the Neer Questionnaire score and shoulder satisfaction score than Group 1. The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program.

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

Introduction: Treatment choice for displaced, intercondylar fractures of the distal humerus is open reduction and internal fixation (ORIF) through a posterior approach. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures., Materials and Methods: Eleven patients with intercondylar fractures of the humerus operated with this approach were reviewed. The mean follow-up was 26 (14-40) months. The aetiology of injuries was mostly fall on the elbow. There were five females and six males and the average age of the patients was 58.3 years (range 16-70 years)., Results: According to Müller et al.'s classification; five were Type C1, four were Type C2 and, two were Type C3. At the final follow-up; Type C1 and C2 fractures had a ROM of 116 degrees (range 95 degrees-140 degrees) and, Type C3 fractures had a ROM of 85 degrees which showed limitation of elbow motion. Average humerotrochlear angle is 93.4 degrees (range 90 degrees-98 degrees). Two patients had transient n. ulnaris paraesthesia and one had heterotopic ossification., Conclusion: Our results demonstrate that TRAP approach is extensile enough in treating these complex fractures however both articular reconstruction and fixation can be easily managed without creating an olecranon fracture. No significant triceps weakness and dysfunction was observed after TRAP approach in the treatment of the intercondylar fractures of the humerus.

Aim: Pubertal changes constitute a background for development of motor abilities and flexibility as an important component of physical fitness. The aim of the present study was to investigate whether the flexibility is actually related to sexual maturation stages in adolescent boys., Methods: This cross-sectional study was conducted on 69 healthy boys aged 14 years. Before testing, all participants performed a 3 min warm up and static stretch routine, emphasizing the lower body. The flexibility tests were performed in a counterbalanced design. Sit-and-reach test and goniometric measurement of hamstring flexibility was administered. The results of flexibility tests and body measures were analysed for cross-sectional comparison. Groups were formed according to Tanner's classification and consisted of boys in Stage II, III, IV, V, respectively., Results: The results of sit and reach test scores and goniometric measurements did not correlate with age in months, height, weight and BMI; and furthermore they did not correlate with the sexual maturation stages (p>0.05). The sit and reach test scores were significantly correlated with goniometric measurements (right: r=0.653, p=0.00; left: r=0.638, p=0.00)., Conclusions: The results suggest that sexual maturation stages in pubertal period would not be effective in determining the flexibility. Besides, sexual maturation is not a cause of decreased flexibility in adolescent boys aged 14 years.

The purpose of this study was to measure isokinetically glenohumeral joint movement peak torque and work in professional basketball, volleyball, handball and baseball players and determine whether significant differences exist between the dominant and non-dominant extremity in athletes and controls. Eighty healthy professional overhead athletes (basketball, volleyball, handball and baseball players) and 20 controls were tested bilaterally on a CYBEX 6000 isokinetic dynamometer at 60 degrees and 180 degrees s(-1) for diagonal pattern of the glenohumeral joint. A standardized protocol and testing guidelines were strictly followed. The range of motion of internal rotation (IR) on the dominant side of baseball players was significantly smaller than those on the dominant side of basketball, handball and volleyball players, and controls (P<0.01). Flexion/abduction/external rotation were consistently higher on the dominant arm (8.5%) for peak torque at 60 degrees s(-1) in baseball players, and bilateral ratios were lower on the dominant arm (14.8%) for peak torque at 180 degrees s(-1) in basketball players. The results of this study are important for the application and interpretation of isokinetic data and flexibility and mobility characteristics on unilaterally dominant overhead athletes. Functional weakness in external rotators, mobility impairments in IR and muscle imbalance have been shown in the dominant arm of these overhead athletes.

The shoulder joint, the most mobile joint in the human body, is at greater risks for injuries. Several factors contribute to shoulder impingement syndrome including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. Rehabilitation and training of the shoulder in throwing and overhead athletes has dramatically improved during the last decade. There are numerous reasons for rapid return to athletic training and competition. A preventive program designed for the glenohumeral joint is mainly based on an appropriate preparation, which should include overall body conditioning, flexibility, and strengthening of the musculature around the glenohumeral joint and the scapula. Activity levels represent a helpful guide in determining an appropriate rehabilitation program for shoulder patients ranging from disabled to those competing at the highest levels of athletics. This article discusses issues related to prophylactic measures, non-operative treatment, postoperative treatment, and rehabilitation programme of impingement syndrome in athletes.

An avulsion fracture of tibial tuberosity with an unusual articular involvement was treated with open reduction and internal fixation. Although the mechanism of tibial tuberosity fracture is described as passively flexing the knee while active quadriceps femoris contraction, the weight transmitted from the menisci on the lateral side of the knee joint may cause an epiphyseal disruption. We report a case of tibial tuberosity fracture with lateral plateau rim fracture in a young male adolescent, which has not been published previously in the literature.

Background: To determine range of motion and capsular characteristics of dominant and nondominant shoulders in baseball players. Our hypothesis was that there is a significant difference between dominant and nondominant range of motion in collegiate baseball players with unoperated and without shoulder pain., Design: prospective, range of motion measurements during regular season., Setting: two collegiate baseball teams in Houston., Participants: 15 pitchers and 23 position players., Main Outcome Measures: shoulder range of motion was evaluated by goniometric technique in all baseball players. Horizontal adduction (cross body reach test) and active internal rotation (reach behind back) in standing position and external rotation and internal rotation in supine lying position were measured for each player., Results: Average external rotation with the arm in 90 degrees of abduction was significantly greater and average internal rotation was less in the dominant shoulder than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in shoulder horizontal adduction. Both dominant and nondominant shoulders of pitchers had greater average range of motion in horizontal adduction and external rotation at 90 degrees of abduction and less average internal rotation than those of position players. Although there was a significant difference in active internal rotation as cm between dominant and nondominant shoulders both in both groups, no difference was found between pitchers and position players., Conclusions: Differences in the range of motion in the throwing shoulder of baseball players exist involved in overhead throwing motions and should be considered in rehabilitation of the upper extremity after injury and in the prevention of injury for pitchers and position players.

The purpose of this study was to determine the differences in the left ventricular dimensions, mass index and function in school-aged swimmers by echocardiography. The study group consisted of 82 swimmers who participated in a systematic swimming training for at least six months, and the control group consisted of 41 sedentary children of similar age, sex and weight. In the study group, left ventricular dimensions and wall thicknesses, aortic root and left atrium diameters, and left ventricle mass index were significantly greater than the normal children (p < 0.05). However, there was no difference in the left ventricular systolic function (ejection fraction, shortening fraction) or in the left ventricular filling characteristics (p > 0.05). In conclusion, in childhood swimmers there was a significant increase in left ventricular dimensions, wall thicknesses and mass index, but no differences in the systolic function and filling characteristics of the left ventricle. Thus, information on endurance training participation is necessary to interpret quantitative echocardiographic data.