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Of the 15 million people who b have a stroke each year worldwide, between 77% and 81% of the survivors have a motor deficit in the extremities. (1) The affected [...], Background. Goniometric measurements of hemiplegic arm joints must be reliable to draw proper clinical and scientific conclusions. Previous reliability studies were cross-sectional and based on small samples. Knowledge about the contributions of sources of variation to these measurement results is lacking. Objective. The aims of this study were to determine the interobserver reliability of measurements of passive range of motion (PROM) over time, explore sources of variation associated with these measurement results, and generate smallest detectable differences for clinical decision making. Design. This investigation was a measurement-focused study with a longitudinal design, nested within a 2-arm randomized controlled trial. Methods. Two trained physical therapists assessed 7 arm movements at baseline and after 4, 8, and 20 weeks in 48 people with subacute stroke using a standardized protocol. One physical therapist performed the passive movement, and the other read the hydrogoniometer. The therapists then switched roles. The relative contributions of several sources of variation to error variance were explored with analysis of variance. Results. Interobserver reliability coefficients ranged from .89 to .97. The PROM measurements were influenced by error variance ranging from 31% to 50%. The participant x time interaction made the largest contribution to error variance, ranging from 59% to 81%. Smallest detectable differences were 6 to 22 degrees and were largest for shoulder movements. Limitations. Verification of shoulder pain and hypertonia as sources of error variance led to a substantial number of unstable variance components, necessitating a simpler analysis. Conclusions. The assessment of PROM with a standardized protocol, a hydrogoniometer, and 2 trained physical therapists yielded high interobserver reliability indexes for all arm movements. Error variance made a large contribution to the variation in measurement results. The resulting smallest detectable differences can be used to interpret future hemiplegic arm PROM measurements with more confidence.

GET STRONGER THAN EVER WITH THESE JOINT-FRIENDLY ALTERNATIVES TO THE BIG THREE. BY TODD BUMGARDNER, C.S.C.S. Directions Alternate Workout 1 and Workout 2, with at least 48 hours between them. [...]

A body in motion tends to stay in motion, and a body at rest tends to stay at rest. Such is the case with your shoulder and a condition called [...]

The middle glenohumeral ligament [MGHL] demonstrates the greatest variation in size and thickness, of all the three glenohumeral ligaments seen on MR imaging of the shoulder. We report a series of patients who underwent routine MR imaging of the shoulder for unrelated pathologies in whom a significant number of MGHL variants were identified. The importance of recognizing this lies in avoiding overdiagnosing or mistaking these for labral or ligamentous pathology. We conclude with a brief review of the importance and functions of the MGHL. Keywords: MRI | shoulder | middle glenohumeral ligament, Case Report We report a series of patients who presented with varying symptomatologies in relation to the shoulder joint and underwent MR imaging for the same. Incidental normal variants of [...]

Variants of the bicipitolabral complex in MR imaging of the shoulder are important to recognise due to their close simulation of labral tears. Three types of the same are described. Keywords: MRI | shoulder | labral complex, Case Report We report a series of three patients who presented with varying symptomatologies in relation to the shoulder joint and underwent MR imaging for the same. Incidental normal variants [...]

A study is undertaken to examine the association between variable lower-limb coordination and shoulder joint kinetics and kinematics in the flat first serve in tennis. Results suggest that shoulder joint mechanics in tennis players depend on the lower-limb mechanics used in foot-up (FU), foot-back (FB) and minimal leg drive (ARM) flat serve (FS) techniques.

Byline: Smith, Ian My shoulders pop when I lift weights--no matter how much weight I use. Should I be worried? Jason, MIAMI, FL It's like clicking in the knee or [...]

Caruso JA, Foxworth JL, Stotler TW. Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC, [...], PURPOSE: A significant number of patients complaining of shoulder pain report sleeping difficulties. However, sleep postures have not been reported in this population. The purpose of this study was to provide data describing the sleep postures of patients with signs of shoulder impingement. SUBJECTS: Fifteen subjects (7 males, 8 females) with a mean age of 56.8 ± 11.1 years with insidious onset of shoulder pain completed this study. All subjects had positive Neer and Hawkins-Kennedy Impingement tests as evaluated by a physical therapist or physician. METHODS AND MATERIALS: Subjects completed a visual analogue scale (VAS), The Simple Shoulder Test (SST), and a questionnaire describing their pre-injury trunk and arm positions of their three most common sleeping postures. ANALYSES: Sleep positions were assessed for frequency of occurrence and pain associated with maintaining primary sleep position. Mean scores were calculated for VAS and SST. RESULTS: 87% of subjects reported that their shoulder pain would not allow them to sleep comfortably in pre-injury positions. 73% were unable to maintain their pre-injury primary sleep position secondary to pain. 87% reported primary sleep position was sidelying. 67% maintained their injured arm in an adducted position. The most frequently occurring sleep position (47%) was sidelying on the uninjured arm with the injured arm adducted. VAS mean scores were 7.1 ± 1.8. SST mean score was 7.3/12 ± 2.4. CONCLUSION: This study supports clinical observations that many patients with significant levels of shoulder pain and impaired function have difficulty sleeping and are unable to maintain their primary sleep position. 10 out of 15 subjects reported a previous history of sleeping with their injured arm in an adducted position. This prolonged adducted positioning seems to be consistent with the 'wringing out' effect of the critical zone of the rotator cuff blood supply, which has been previously described as a contributing factor to shoulder impingement. Instructing patient to place a small pillow between the arm and trunk while sleeping to avoid prolonged arm adduction, thereby reducing the wringing out effect, seems warranted.

Hartsell HD; Physical Therapy Graduate Program, University of Iowa, Iowa City, IA, [...], PURPOSE: The scapular plane is preferred for clinical evaluation for physiological and biomechanical reasons. However, the effects of body position and stabilization on torque (ratio) output are not known. The purpose of this study was to determine the effects of body position on isokinetic torque ratios for rotational movements of the shoulder. SUBJECTS: Eleven males (mean age = 27.2 years, SD = 2.6 years) and eleven females (mean age = 25.4 years, SD = 3.1 years) with healthy shoulders consented to testing. METHODS AND MATERIALS: Following a five-minute warm-up of general shoulder range of motion exercises, each subject performed four submaximal (50% effort) trials followed by five maximal effort trials in the scapular plane for two joint motions (external/internal rotation), two muscle contraction types (concentric/eccentric) and three velocities (60/120/180 deg/sec) using two body positions (seated/standing). ANALYSES: A three-way (body position x velocity x gender) mixed model analysis of variance with repeated measures was used to analyze the external/internal rotation (ER/IR ratio) data separately for contraction type. Tukey's tests were used for post-hoc analyses. The probability level of .05 was used. RESULTS: Concentrically, significant main effects were body position (p=.000), velocity (p=.000) and gender (p=.018). Body position x velocity x gender was the only significant interaction effect (p = .003). Eccentrically, body position (p = .000) was the only significant main effect. CONCLUSIONS: Force-velocity effects were upheld for both muscle contraction types for either body position. While considered by some to reduce stability, the standing body position produced higher ER/IR ratios at the shoulder. This position does not compromise stabilization and is more practically related to activities of daily living. Clinically, it is recommended that shoulder patients be evaluated in the scapular plane using the standing body position to maintain functionality and minimize detrimental effects to the soft tissues.

ARTICLE CONSULTANTS LOUIS U. BIGLIANI, MD, is Frank E. Stinchfield Professor and Chairman, Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons; and Director, Orthopedic Surgery Service, Columbia [...]

The causes that underlie adhesive capsulitis, or frozen shoulder, are unknown, although many have been proposed. It is possible that two shoulder structures that have been poorly studied in association with frozen shoulder, may be important. The first structure, the rotator interval, is the space between two of the muscles that connect the scapula (shoulder blade) and humerus (arm bone) and form part of the rotator cuff muscles attached to the humerus at the shoulder. The second structure, the coracohumeral ligament, originates at a projection of the scapula near the collarbone and shoulder, passes down through the rotator interval, and attaches with the fibrous capsule that surrounds the shoulder onto the humerus. This ligament supports the head of the humerus and is important in strengthening the tissues and in maintaining full shoulder joint motion. The involvement and pathological changes of the coracohumeral ligament and rotator interval in 17 patients who failed to recover after conservative therapy are described. These patients had sustained minor shoulder injuries prior to developing severe pain, restricted motion, and chronic fatigue caused by pain-related loss of sleep. In these patients, the tissues surrounding the rotator interval were contracted, thus obliterating the interval, and the coracohumeral ligament also became contracted. These changes led to restriction of shoulder movement, and associated structures became inflamed. The study suggests that in most patients with adhesive capsulitis, this process spontaneously reverses. The processes by which the condition is maintained or advances is unknown. After surgical release of the constricting structures, the patients returned to near-normal shoulder flexibility and strength, with little pain remaining. (Consumer Summary produced by Reliance Medical Information, Inc.)