Clinical Update: Measuring Shoulder Joint Motion

1998 ◽  
Vol 3 (5) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham
Keyword(s):  
External Rotation ◽  
Joint Motion ◽  
Fourth Edition ◽  
Single Plane ◽  
Reconstructive Procedures ◽  
Results Of Treatment ◽  
Shoulder Disorders ◽  
Shoulder Motion ◽  
Motion Measurements ◽  
Upper Extremity Impairment

Abstract Accurate measurement of shoulder motion is critical in assessing impairment following shoulder disorders. To this end, measuring and recording joint motion are important steps in diagnosing, determining the severity and progression of a disorder, assessing the results of treatment, and evaluating impairment. Shoulder movement usually is composite rather than in a single plane, so isolating single movements is challenging. Universal goniometers with long arms are used to measure shoulder motion, and testing must be performed and recorded consistently. Passive motion may be carried out cautiously by the examiner; two measurements of the same patient by the same examiner should lie within 10° of each other. Shoulder extension and flexion are illustrated. Maximal flexion of the shoulder also includes slight external rotation and abduction, and controlling or eliminating these components during evaluation is challenging. Abduction and adduction are illustrated. Deficits in external rotation may occur in patients who have undergone reconstructive procedures with an anterior approach; deficits in internal rotation may result from issues with shoulder instability. The authors recommend recording the shoulder's range of motion measurements according to the Upper Extremity Impairment Evaluation Record in the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition.

Evaluating Shoulder Impairment

1998 ◽  
Vol 3 (5) ◽  
pp. 1-3
Author(s):  
Richard T. Katz ◽  
Sankar Perraraju
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Sensory Loss ◽  
Motor Deficits ◽  
Nerve Lesion ◽  
Fourth Edition ◽  
Specific Patient ◽  
Industrial Medicine ◽  
Shoulder Motion ◽  
Upper Extremity Impairment

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, offers several categories to describe impairment in the shoulder, including shoulder amputation, abnormal shoulder motion, peripheral nerve disorders, subluxation/dislocation, and joint arthroplasty. This article clarifies appropriate methods for rating shoulder impairment in a specific patient, particularly with reference to the AMA Guides, Section 3.1j, Shoulder, Section 3.1k, Impairment of the Upper Extremity Due to Peripheral Nerve Disorders, and Section 3.1m, Impairment Due to Other Disorders of the Upper Extremity. A table shows shoulder motions and associated degrees of motion and can be used in assessing abnormal range of motion. Assessments of shoulder impairment due to peripheral nerve lesion also requires assessment of sensory loss (or presence of nerve pain) or motor deficits, and these may be categorized to the level of the spinal nerves (C5 to T1). Table 23 is useful regarding impairment from persistent joint subluxation or dislocation, and Table 27 can be helpful in assessing impairment of the upper extremity after arthroplasty of specific bones of joints. Although inter-rater reliability has been reasonably good, the validity of the upper extremity impairment rating has been questioned, and further research in industrial medicine and physical disability is required.

Measuring Shoulder Motion

2010 ◽  
Vol 15 (6) ◽  
pp. 3-4
Author(s):  
Christopher R. Brigham
Keyword(s):  
Range Of Motion ◽  
The Body ◽  
Single Plane ◽  
Active Motion ◽  
Warm Up ◽  
Sixth Edition ◽  
Results Of Treatment ◽  
Shoulder Range Of Motion ◽  
Shoulder Motion ◽  
Clinical Measurements

Abstract Measuring and documenting shoulder motion is important for many reasons, including diagnosis, determining the severity and progression of a disorder, assessing the results of treatment, and evaluating impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition provides guidance for the process of assessing abnormal motion of the shoulder, specifically Section 15.7a, Clinical Measurements of Motion, and Section 15.7g, Shoulder Motion. The shoulder has greater mobility than any other joint of the body, and movement there usually is composite rather than in a single plane; as a result, single movements are difficult to isolate. In the AMA Guides, universal goniometers with long arms are used to measure shoulder range of motion (ROM). Measurements of joint motion must be performed and recorded consistently because interrater reliability is reduced if instruments are incorrectly placed or if overlying soft tissue distorts the measurement. Active motion is obtained with full muscle force and cooperation after warm-up, and the ROM examination is performed by recording the active measurements from three separate ROM efforts. Patients may self-limit during the assessment of active range of motion or exert submaximal effort on manual strength testing because of pain and/or apprehension, so all measurements should fall within 10° of the mean and both sides should be tested.

Legal Update: North Dakota Supreme Court: Third Edition of Guides is “Most Current”

1999 ◽  
Vol 4 (1) ◽  
pp. 6-7
Author(s):  
James J. Mangraviti
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Measurement Techniques ◽  
Fourth Edition ◽  
Hip Motion ◽  
The Difference ◽  
The Right ◽  
Hip Flexion ◽  
Hip Rotation ◽  
Hip Extension

Abstract The accurate measurement of hip motion is critical when one rates impairments of this joint, makes an initial diagnosis, assesses progression over time, and evaluates treatment outcome. The hip permits all motions typical of a ball-and-socket joint. The hip sacrifices some motion but gains stability and strength. Figures 52 to 54 in AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, illustrate techniques for measuring hip flexion, loss of extension, abduction, adduction, and external and internal rotation. Figure 53 in the AMA Guides, Fourth Edition, illustrates neutral, abducted, and adducted positions of the hip and proper alignment of the goniometer arms, and Figure 52 illustrates use of a goniometer to measure flexion of the right hip. In terms of impairment rating, hip extension (at least any beyond neutral) is irrelevant, and the AMA Guides contains no figures describing its measurement. Figure 54, Measuring Internal and External Hip Rotation, demonstrates proper positioning and measurement techniques for rotary movements of this joint. The difference between measured and actual hip rotation probably is minimal and is irrelevant for impairment rating. The normal internal rotation varies from 30° to 40°, and the external rotation ranges from 40° to 60°.

Knee Joint Motion Quantified Using the Finite Helical Axis Method

2007 ◽  
Author(s):  
Ingrid R. Fjeld ◽  
Jessica C. Küpper ◽  
Janet L. Ronsky ◽  
Richard Frayne
Keyword(s):  
External Rotation ◽  
Cruciate Ligament ◽  
Cartilage Degeneration ◽  
Helical Axis ◽  
Joint Motion ◽  
Stable Manner ◽  
Knee Joint Motion ◽  
Anterior Cruciate ◽  
Complex Joint ◽  
Finite Helical Axis

The knee is a complex joint comprised of two main bones (femur and tibia) that articulate in a stable manner through the support of surrounding meniscus, musculature, and ligaments. The anterior cruciate ligament (ACL) is one of the main ligaments connecting the femur to the tibia. The ACL restricts anterior translation of the tibia with respect to the femur and aids in preventing internal and external rotation. The ACL is the most commonly injured ligament in the knee [1] and has been shown to increase the risk of cartilage degeneration leading to osteoarthritis (OA) [2]. The mechanics of the joint are altered following an ACL rupture, but the relations between the resulting joint instability and OA are not well understood.

scholarly journals Correlations between Capsular Changes and ROM Restriction in Frozen Shoulder Evaluated by Plain MRI and MR Arthrography

2018 ◽  
Vol 12 (1) ◽  
pp. 396-404
Author(s):  
Kenji Kanazawa ◽  
Yoshihiro Hagiwara ◽  
Takuya Sekiguchi ◽  
Kazuaki Suzuki ◽  
Masashi Koide ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
External Rotation ◽  
Mr Arthrography ◽  
Frozen Shoulder ◽  
Joint Capsule ◽  
Level Of Evidence ◽  
Level 3 ◽  
Shoulder Disorders ◽  
Magnetic Resonance Imaging Mri ◽  
Positive Correlations

Background: Evaluation of the Range Of Motion (ROM) is one of the important procedures for shoulder disorders. The purpose of this study was to investigate correlations between capsular changes and ROM restrictions evaluated by both plain magnetic resonance imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the same patients with frozen shoulder. Methods: Between March 2015 and June 2016, 24 patients with frozen shoulders (13 male and 11 female patients, mean age 60.5) with severe ROM restriction who underwent both MRI and MRA on the same affected side were evaluated. We evaluated 1) ROM, 2) the coracohumeral ligament (CHL) thickness, 3) the joint capsule thickness in the axillary recess (humeral and glenoid sides), 4) the area of the axillary recess, and 5) the capsular area of the axillary recess. Results: Positive correlations were found between the axillary area and forward flexion (FF) (R = 0.43, P = 0.035), lateral elevation (LE) (R = 0.66, P<0.001), external rotation (ER)(R = 0.43, P = 0.035), 90° abduction with external rotation (AER)(R = 0.56, P = 0.004), and hand behind the back (HBB)(R = 0.6, P = 0.002) on MRA. Negative correlations were found between the joint capsule at the glenoid side and ER and HBB in both MRI and MRA. Conclusion: The axillary area was significantly correlated with ROM restriction in FF, LE, ER, AER, and HBB on MRA. Thickness of the joint capsule at the glenoid side is an important factor for ROM restriction in frozen shoulder. Level of Evidence: Level 3, Study of Diagnostic Test.

scholarly journals The sub-supraspinatus recess and superior labral motion: an arthroscopic analysis

2018 ◽  
Vol 11 (3) ◽  
pp. 199-203
Author(s):  
Martin Bouliane ◽  
Ryan Paul ◽  
Anelise Silveira ◽  
Rob Balyk ◽  
Lauren Beaupre ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Labral Repair ◽  
Successful Outcome ◽  
Clinical Implications ◽  
Average Depth ◽  
Overhead Athletes ◽  
Static Measurement ◽  
Shoulder Motion ◽  
Minimal Information

Background Minimal information exists regarding the sub-supraspinatus recess superior to the labrum and inferior to the supraspinatus. Furthermore, movement of the superior labrum during glenohumeral range of motion has not previously been defined. The objectives of this arthroscopic study were to describe the (i) sub-supraspinatus recess dimensions and (ii) superior labral motion. Methods Forty-four patients were enrolled and underwent standardized arthroscopic assessment. Analysis consisted of static measurement of the sub-supraspinatus recess depth, as well as the amount of labral motion during passive shoulder motion. Labral movement was categorized relative to the glenoid rim (lateral to the rim, to the rim, or medial to the rim). Results All patients had a well-defined sub-supraspinatus recess varying from a depth of 0 mm to 5 mm ( n = 10; 22.7%), 5 mm to 10 mm ( n = 23; 52.3%) or >10 mm ( n = 11; 25%). External rotation in abduction demonstrated the greatest labral movement ( p < 0.001) with 28 (80%) shoulders moving medial to the rim. Conclusions The sub-supraspinatus recess is consistently present with an average depth of 5 mm to 10 mm. Superior labral motion is present in most patients and is most pronounced in external rotation in abduction. This finding likely has clinical implications for superior labral repair surgery, especially for overhead athletes and laborers who require external rotation in an abducted position for a successful outcome.

scholarly journals Effects of a six-week weighted-implement throwing program on baseball pitching velocity, kinematics, arm stress, and arm range of motion

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e6003 ◽  
Author(s):  
Joseph A. Marsh ◽  
Matthew I. Wagshol ◽  
Kyle J. Boddy ◽  
Michael E. O’Connell ◽  
Sam J. Briend ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Training Programs ◽  
External Rotation ◽  
Training Period ◽  
Valgus Stress ◽  
Joint Kinetics ◽  
Before And After ◽  
Biomechanical Parameters ◽  
Motion Measurements ◽  
Shoulder External Rotation

Background Weighted-baseball training programs are used at the high school, collegiate, and professional levels of baseball. The purpose of this study was to evaluate the effects of a six-week training period consisting of weighted implements, manual therapy, weightlifting, and other modalities on shoulder external rotation, elbow valgus stress, pitching velocity, and kinematics. Hypothesis A six-week training program that includes weighted implements will increase pitching velocity along with concomitant increases in arm angular velocities, joint kinetics, and shoulder external rotation. Methods Seventeen collegiate and professional baseball pitchers (age range 18–23, average: 19.9 ± 1.3) training at Driveline Baseball were evaluated via a combination of an eight-camera motion-capture system, range-of-motion measurements and radar- and pitch-tracking equipment, both before and after a six-week training period. Each participant received individualized training programs, with significant overlap in training methods for all athletes. Twenty-eight biomechanical parameters were computed for each bullpen trial, four arm range-of-motion measurements were taken, and pitching velocities were recorded before and after the training period. Pre- and post-training period data were compared via post-hoc paired t tests. Results There was no change in pitching velocity across the seventeen subjects. Four biomechanical parameters for the holistic group were significantly changed after the training period: internal rotational velocity was higher (from 4,527 ± 470 to 4,759 ± 542 degrees/second), shoulder abduction was lower at ball release (96 ± 7.6 to 93 ± 5.4°), the shoulder was less externally rotated at ball release (95 ± 15 to 86 ± 18°) and shoulder adduction torque was higher (from 103 ± 39 to 138 ± 53 N-m). Among the arm range of motion measurements, four were significantly different after the training period: the shoulder internal rotation range of motion and total range of motion for both the dominant and non-dominant arm. When the group was divided into those who gained pitching velocity and those who did not, neither group showed a significant increase in shoulder external rotation, or elbow valgus stress. Conclusions Following a six-week weighted implement program, pitchers did not show a significant change in velocity, joint kinetics, or shoulder external rotation range of motion. When comparing pitchers who gained velocity versus pitchers who did not, no statistically significant changes were seen in joint kinetics and shoulder range of motion.

Rating Distal Clavicle Resection

2012 ◽  
Vol 17 (1) ◽  
pp. 13-16
Author(s):  
Charles N. Books ◽  
James B. Talmage ◽  
J. Mark Melhorn
Keyword(s):  
Acromioclavicular Joint ◽  
Body Part ◽  
Nonoperative Treatment ◽  
Distal Clavicle ◽  
Fourth Edition ◽  
Joint Injury ◽  
Sixth Edition ◽  
Key Factor ◽  
Upper Extremity Impairment ◽  
Improved Function

Abstract Indications for excision of the distal clavicle include symptomatic degenerative arthritis of the acromioclavicular joint, impingement syndrome, and osteolysis of the distal clavicle if nonoperative treatment has failed. Distal clavicular resection (DCR), one could argue, is by definition an impairment because of the loss of a portion of a body part, the clavicle. Yet a competently performed and uncomplicated DCR generally results in improved function, not loss of use. DCR was first mentioned in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, which stated that a resection arthroplasty of the acromioclavicular joint warrants 10% upper extremity impairment (UEI). Rating DCR using the AMA Guides, Fifth Edition, is almost the same as using the fourth edition, but evaluators can use one of two approaches: The rating physician can select a 3% rating for DCR using the fifth edition and claim to be literally following the instructions and providing a sensible rating in view of the generally good results reported in the orthopedic literature following a DCR. Alternatively, a rating physician who is aware of the historical precedent underlying the 10% UEI in Table 16-27 could cite this and the absence of an instruction in the Arthroplasty section to justify a 10% impairment rating. In the sixth edition, DCR is a key factor in classifying an acromioclavicular joint injury or disease but is disregarded in the rating of rotator cuff or glenohumeral pathology.

The influence of total knee arthroplasty design on kneeling kinematics: a prospective randomized clinical trial

2021 ◽  
Vol 103-B (1) ◽  
pp. 105-112 ◽  
Author(s):  
Joseph T. Lynch ◽  
Diana M. Perriman ◽  
Jennie M. Scarvell ◽  
Mark R. Pickering ◽  
Catherine R. Galvin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Randomized Clinical Trial ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Rotating Platform ◽  
Single Plane ◽  
Prospective Randomized Clinical Trial ◽  
High Flexion ◽  
Total Knee

Aims Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs. Methods In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis. Results CR-FB designs had significantly lower maximal flexion (mean 116° (SD 2.1°)) compared to CR-RP (123° (SD 1.6°)) and PS-FB (125° (SD 2.1°)). The PS-FB design displayed a more posteriorly positioned femur throughout flexion. Furthermore, the CR-RP femur was more externally rotated throughout kneeling. Finally, individual patient kinematics showed high degrees of variability within all designs. Conclusion The increased maximal flexion found in the PS-FB and CR-RP designs were likely achieved in different ways. The PS-FB design uses a cam-post to hold the femur more posteriorly preventing posterior impingement. The external rotation within the CR-RP design was surprising and hasn’t previously been reported. It is likely due to the polyethylene bearing being decoupled from flexion. The findings of this study provide insights into the function of different knee arthroplasty designs in the context during deep kneeling and provide clinicians with a more kinematically informed choice for implant selection and may allow improved management of patients' functional expectations. Cite this article: Bone Joint J 2021;103-B(1):105–112.

Effect of Forearm Position on Glenohumeral External Rotation Measurements in Baseball Players

2021 ◽  
pp. 194173812110329
Author(s):  
W. Ben Kibler ◽  
Aaron Sciascia ◽  
John Stuart Mattison Pike ◽  
Michael Howell ◽  
Kevin E. Wilk
Keyword(s):  
Injury Risk ◽  
External Rotation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Baseball Players ◽  
Minor League Baseball ◽  
Minor League ◽  
Level 3 ◽  
Motion Measurements ◽  
Throwing Motion

Background: Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and the total arc of motion (TAM) have been linked with increased injury risk in the shoulder and elbow. These motions have been routinely measured with the forearm in neutral rotation (GIRN, GERN, TAMN). GER capacity appears to be especially important. The throwing motion, however, requires forearm pronation as GER occurs to achieve optimal cocking (GERP). No previous studies have evaluated GERP to determine GER capacity or pronated TAM (TAMP) values. Hypothesis: There would be significant differences between GERN and TAMN and between GERP and TAMP. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: Sixty asymptomatic male Minor League Baseball players (32 pitchers, 28 position players) participated in the study and were tested on the first day of spring training. Passive range of motion measurements were recorded using a long-arm bubble goniometer for GIRN, GERN, and GERP on both arms. TAM was calculated separately as the sum of internal and external rotational measurements under neutral and pronated conditions. Results: Within pitchers and position players, all measurements were statistically reduced for the throwing arm ( P ≤ 0.03) except for GERN of the pitchers. GERP measures were significantly less than GERN for both arms of each group ( P < 0.01): pitchers throwing arm +11.8°/nonthrowing arm +4.8°, position players throwing arm = +8.6°/nonthrowing arm +4.0°. Conclusion: The forearm position of pronation, which appears to be mediated by tightness of the biceps, decreases GER capacity and TAM. GER and TAM should be calculated in neutral and pronated positions, considering that 80% of the players have a demonstrated difference between 8° and 12°. Clinical Relevance: Measurement of GERP more accurately reflects the GER required in throwing, allows better quantification of the motion capacity necessary to withstand the loads in throwing, and may suggest interventions for at risk athletes.

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