Comparison of shoulder range of motion, strength, and upper quarter dynamic balance between NCAA division I overhead athletes with and without a history of shoulder injury

Abstract Introduction Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction. Methods The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions. Results A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%). Conclusions The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.

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The Relationship Between Shoulder Range of Motion and Arm Stress in College Pitchers: A MOTUS Baseball Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00401 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0040

Author(s):

Caleb Gulledge ◽

Toufic Jildeh ◽

Joseph Tramer ◽

Fabien Meta ◽

Kevin Taylor ◽

...

Keyword(s):

Range Of Motion ◽

Upper Extremity ◽

Internal Rotation ◽

External Rotation ◽

Outcome Measurement ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Patient Reported ◽

The Relationship ◽

Shoulder Range

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.

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The Comparison of Instrument-Assisted Soft Tissue Mobilization and Self-Stretch Measures to Increase Shoulder Range of Motion in Overhead Athletes: A Critically Appraised Topic

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0213 ◽

2018 ◽

Vol 27 (4) ◽

pp. 385-389 ◽

Cited By ~ 1

Author(s):

Matthew J. Hussey ◽

Alex E. Boron-Magulick ◽

Tamara C. Valovich McLeod ◽

Cailee E. Welch Bacon

Keyword(s):

Soft Tissue ◽

Range Of Motion ◽

Internal Rotation ◽

Proper Function ◽

Clinical Question ◽

Bottom Line ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Soft Tissue Mobilization ◽

Shoulder Range

Clinical Scenario: Shoulder range of motion (ROM) in throwing athletes relies on a balance of mobility and stability to maintain proper function and health that, if disrupted, can lead to shoulder injury. There have been several studies that address the relationship between ROM deficits and overhead injuries; however, it may be unclear to clinicians which interventions are most effective for increasing ROM in the glenohumeral joints of overhead athletes. Clinical Question: In overhead athletes who have deficient shoulder ROM, is instrument-assisted soft tissue mobilization (IASTM) more effective at acutely increasing ROM over the course of a patient’s treatment when compared with self-stretching? Summary of Key Findings: A thorough literature review yielded 3 studies relevant to the clinical question, and all 3 studies were included. Two articles found a significant increase in acute ROM when compared with a self-stretch measure. All 3 articles showed increases in internal rotation and horizontal adduction, and 1 study reported an increase in total arc of shoulder ROM. Clinical Bottom Line: There is moderate evidence to support the use of IASTM to acutely increase ROM in the glenohumeral joint of overhead athletes. Clinicians should be aware of the variability with recommended treatment times; however, positive results have been seen with treatments lasting 5 to 6 minutes per treatment region. There is no consensus for treatment intensity, and certain IASTM tools require certification. Strength of Recommendation: Grade B evidence exists that IASTM is more effective at increasing shoulder ROM (ie, internal rotation, horizontal adduction, external rotation, total arc of motion) in overhead athletes than self-stretching measures.

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A Cross-Sectional Study Examining Shoulder Pain and Disability in Division I Female Swimmers

Journal of Sport Rehabilitation ◽

10.1123/jsr.2012-0123 ◽

2014 ◽

Vol 23 (1) ◽

pp. 65-75 ◽

Cited By ~ 30

Author(s):

Shana Harrington ◽

Corinne Meisel ◽

Angela Tate

Keyword(s):

Range Of Motion ◽

Shoulder Pain ◽

Ncaa Division I ◽

Muscle Length ◽

Injury Rate ◽

Division I ◽

Competitive Swimming ◽

Shoulder Range Of Motion ◽

Pectoralis Minor ◽

Pain Subscale

Context:The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability.Methods:NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms.Results:Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029).Conclusions:The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.

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Preseason Upper Extremity Range of Motion and Strength in Relation to In-Season Injuries in NCAA Division I Gymnasts

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977090 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097709

Author(s):

Kaysha Heck ◽

Giorgio Zeppieri ◽

Michelle Bruner ◽

Michael Moser ◽

Kevin W. Farmer ◽

...

Keyword(s):

Range Of Motion ◽

Upper Extremity ◽

Ncaa Division I ◽

External Rotation ◽

Division I ◽

Extremity Injury ◽

Overhead Athletes ◽

Upper Extremity Injury ◽

Collegiate Gymnasts ◽

Extremity Injuries

Background: Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood. Purpose/Hypothesis: The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts. Study Design: Cohort study; Level of evidence, 3. Methods: Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group). Results: A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07). Conclusion: Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.

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Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100698 ◽

2020 ◽

Vol 54 (17) ◽

pp. 1019-1027 ◽

Cited By ~ 1

Author(s):

Federico Pozzi ◽

Hillary A Plummer ◽

Ellen Shanley ◽

Charles A Thigpen ◽

Chase Bauer ◽

...

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Professional Baseball ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Elbow Injuries ◽

Shoulder External Rotation ◽

Shoulder Range

ObjectiveTo characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes.DesignSystematic review and meta-analysis.Data sourcesSix electronic databases up to 22 September 2018.Eligibility criteriaInclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English.ResultsFifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01).ConclusionPreseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity.PROSPERO registration numberCRD42017072895.

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Comparing the Effects of Total Motion Release® to Stretching for Increases in Internal and External Rotation at the Shoulder

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2020-0073 ◽

2021 ◽

pp. 1-7

Author(s):

Nicole Sordello ◽

Tenli Bright ◽

Taylor Truesdell ◽

Jace Puckett ◽

Jayme G. Baker ◽

...

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Clinical Question ◽

Bottom Line ◽

Warm Up ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Shoulder Range

Focused Clinical Question: What are the effects of Total Motion Release® on shoulder range of motion compared with stretching in overhead athletes? Clinical Bottom Line: Total Motion Release® significantly improved acute dominant and nondominant shoulder ROM compared with dynamic warm-up and stretching protocols. The application of Total Motion Release® was also found to produce significantly larger increases in shoulder ROM and took substantially less time to complete when compared with dynamic warm-up protocols.

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Shoulder range of motion and strength in young competitive tennis players with and without history of shoulder problems

Physical Therapy in Sport ◽

10.1016/j.ptsp.2018.01.005 ◽

2018 ◽

Vol 31 ◽

pp. 22-28 ◽

Cited By ~ 5

Author(s):

Benoît Gillet ◽

Mickaël Begon ◽

Marine Diger ◽

Christian Berger-Vachon ◽

Isabelle Rogowski

Keyword(s):

Range Of Motion ◽

Tennis Players ◽

Shoulder Range Of Motion ◽

History Of ◽

Shoulder Range

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79 Maximizing Safe Positioning of Upper Extremities After Axillary Burn Injuries to Prevent Contractures and Maintain Function

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.083 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S51-S51

Author(s):

Connie Greiser ◽

David Lorello ◽

Eric Barto ◽

S V Gartner ◽

Dan Lyons ◽

...

Keyword(s):

Healthy Subjects ◽

Elbow Flexion ◽

Primary Objective ◽

Burn Injuries ◽

Shoulder Abduction ◽

Shoulder Injury ◽

Shoulder Range Of Motion ◽

History Of ◽

The Right ◽

Shoulder Range

Abstract Introduction Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction. Methods The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions. Results A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%). Conclusions The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours. Applicability of Research to Practice Additional research is needed to determine optimal positioning for the shoulder joint.

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Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial

Integrative Cancer Therapies ◽

10.1177/1534735420962854 ◽

2020 ◽

Vol 19 ◽

pp. 153473542096285

Author(s):

Kyungsun Han ◽

Ojin Kwon ◽

Hyo-Ju Park ◽

Ae-Ran Kim ◽

Boram Lee ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Range Of Motion ◽

Upper Limb ◽

Life Questionnaire ◽

Breast Cancer Patients ◽

Shoulder Range Of Motion ◽

Breast Cancer Related Lymphedema ◽

Shoulder Range

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment ( P = .0098) and 29.35% ( P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm ( P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.

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