scholarly journals Effect of a 6-Week Strengthening Program on Shoulder and Scapular-Stabilizer Strength and Scapular Kinematics in Division I Collegiate Swimmers

2012 ◽  
Vol 21 (3) ◽  
pp. 253-265 ◽  
Author(s):  
Elizabeth E. Hibberd ◽  
Sakiko Oyama ◽  
Jeffrey T. Spang ◽  
William Prentice ◽  
Joseph B. Myers
Keyword(s):  
Muscle Strength ◽  
Internal Rotation ◽  
Intervention Program ◽  
External Rotation ◽  
Division I ◽  
Shoulder Injuries ◽  
Scapular Kinematics ◽  
Outcome Measurements ◽  
Weight Room ◽  
Stretching Exercises

Context:Shoulder injuries are common in swimmers because of the demands of the sport. Muscle imbalances frequently exist due to the biomechanics of the sport, which predispose swimmers to injury. To date, an effective shoulder-injury-prevention program for competitive swimmers has not been established.Objective:To assess the effectiveness of a 6-wk strengthening and stretching intervention program on improving glenohumeral and scapular muscle strength and scapular kinematics in collegiate swimmers.Design:Randomized control trial.Setting:University biomechanics research laboratory.Participants:Forty-four Division I collegiate swimmers.Interventions:The intervention program was completed 3 times per week for 6 wk. The program included strengthening exercises completed using resistance tubing—scapular retraction (Ts), scapular retraction with upward rotation (Ys), scapular retraction with downward rotation (Ws), shoulder flexion, low rows, throwing acceleration and deceleration, scapular punches, shoulder internal rotation at 90° abduction, and external rotation at 90° abduction—and 2 stretching exercises: corner stretch and sleeper stretch.Main Outcome Measurements:Scapular kinematics and glenohumeral and scapular muscle strength assessed preintervention and postintervention.Results:There were no significant between-groups differences in strength variables at pre/post tests, although shoulder-extension and internal-rotation strength significantly increased in all subjects regardless of group assignment. Scapular kinematic data revealed increased scapular internal rotation, protraction, and elevation in all subjects at posttesting but no significant effect of group on the individual kinematic variables.Conclusions:The current strengthening and stretching program was not effective in altering strength and scapular kinematic variables but may serve as a framework for future programs. Adding more stretching exercises, eliminating exercises that overlap with weight-room training and swim training, and timing of implementation may yield a more beneficial program for collegiate swimmers.

scholarly journals Comparison of Shoulder Functions Between Workers With and Without Shoulder Impingement Syndrome

2020 ◽  
Author(s):  
Jun-hee Kim ◽  
Oh-yun Kwon ◽  
Chung-hwi Yi ◽  
Hye-seon Jeon ◽  
Woo-chol Joseph Choi ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Internal Rotation ◽  
External Rotation ◽  
Impingement Syndrome ◽  
Shoulder Abduction ◽  
Shoulder Impingement Syndrome ◽  
Asymmetry Ratio ◽  
Shoulder Injuries ◽  
Shoulder Impingement ◽  
The Asymmetry

The occurrence of shoulder impingement syndrome (SIS) is associated with the frequent handling and lifting of heavy loads and excessive repetitive work above the shoulder level. Thus, assembly workers have a high prevalence of shoulder injuries, including SIS. The purpose of this study was to investigate differences in shoulder ROM, muscle strength, asymmetry ratio, function, productivity, and depression between workers with and without SIS.Sixty-seven assembly line male workers (35 workers with SIS and 32 workers without SIS) participated in this study. The four shoulder ROMs and the five muscle strengths were measured using a Smart KEMA system. The asymmetry ratios were calculated using the asymmetry ratio formula; shoulder functions were measured using the shoulder pain and disability index (SPADI), disabilities of the arm, shoulder, and hand (DASH), and visual analogue scale (VAS); and Endicott work productivity scale (EWPS). Severity of depression was measured using the Beck depression inventory (BDI). Independent t-tests were performed for statistical analysis.The SPADI, DASH, and VAS values of workers with SIS were significantly higher than those of workers without SIS. Also, workers with SIS had significantly smaller shoulder internal rotation and shoulder abduction compared to workers without SIS. In addition, workers with SIS exhibited significantly lower SIR muscle strength than workers without SIS. Workers with SIS had significantly higher asymmetry ratios in shoulder internal rotation, shoulder external rotation, and elbow flexion muscle strength than workers without SIS.The SPADI and DASH scores, which indicate shoulder function, were higher, and the intensity of self-aware pain was higher in workers with SIS. Also, workers with SIS exhibited reduced SIR and SAB ROMs; decreased SIR muscle strength. Particularly, the asymmetry ratios of SIR, SER, EF muscle strength are good comparable factors for workers with and without SIS. In addition, the asymmetry ratios of shoulder muscle strengths could provide an important baseline comparison for the workers with SIS.

STRENGTHENING AND STABILIZATION EXERCISES IN PREVENTION OF SHOULDER INJURIES

sportlogia ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 149-160
Author(s):  
Bernarda Letnar ◽  
Keyword(s):  
Training Program ◽  
Internal Rotation ◽  
Shoulder Joint ◽  
External Rotation ◽  
Shoulder Injuries ◽  
Serratus Anterior ◽  
Warm Up ◽  
Overhead Athletes ◽  
Daily Training ◽  
Stretching Exercises

The shoulder joint is the most flexible joint in the human body which experiences high loads during certain sport activities involving overhead motion. Overhead athletes experience rapid shoulder elevation, abduction and external rotation during the movement and rapid deceleration after the movement, making them susceptible to shoulder injuries. Due to the extreme ranges of motion, overhead athletes tend to develop increased external rotation, combined with decreased range of internal rotation, emphasizing the need for balanced shoulder care program in the training process to prevent such occurrences. The aim of the research paper was to develop training regimen for injury prevention and shoulder maintenance that can be incorporated in daily training activities of the athletes in order to decrease the occurrence of injuries. Three part training program was designed consisting of specific warm up, strengthening and stabilization exercises and stretching exercises. The aim of the specific warm up was to prepare the shoulder for the training loads, mimicking the overhead movements and stimulating the stabilization in the joint. Strengthening and stabilization exercises aimed to strengthen external rotators in the shoulder and improve the stabilization of the shoulder joint by targeting specific muscles such as serratus anterior. The focus of stretching exercises was to stretch internal rotation muscles, which experience high loads in the overhead athlete's training. An effective training program that can be performed with minimal equipment and in a short time frame was designed to enable its simple incorporation into the daily training of overhead athletes.

scholarly journals Programa de prevención de lesiones para la mejora de la salud articular del hombro en jóvenes triatletas (Injury prevention program for the improvement of shoulder health in young triathletes)

Retos ◽  
2018 ◽  
pp. 80-86
Author(s):  
Manuel Jesús Cabeza-Carmona ◽  
Yaira Barranco-Ruiz ◽  
Emilio Villa-González
Keyword(s):  
Internal Rotation ◽  
Shoulder Joint ◽  
Intervention Program ◽  
External Rotation ◽  
Intervention Group ◽  
Control Group ◽  
Shoulder Injuries ◽  
Before And After ◽  
Injury Prevention Program ◽  
External Test

La aparición de lesiones por sobreuso del complejo articular del hombro en la disciplina de natación en triatletas jóvenes anima a una profundización en el estudio de métodos efectivos para la prevención de dichas lesiones. Objetivo: Analizar la efectividad de un programa de intervención diseñado para la prevención de lesiones del complejo articular del hombro en la disciplina de natación en jóvenes triatletas. Métodos: 26 jóvenes (edad entre 8-17 años) fueron aleatorizados en Grupo-Intervención (GI, n=17), y Grupo-Control (GC, n=9). La salud del complejo articular del hombro se evaluó antes y después de un programa de intervención (cuatro semanas de duración: dos-sesiones/30-minutos/semana), mediante los siguientes test: 1) Test del ángulo de cabeza adelantada–Ángulo hombro adelantado, 2) Test de Rotación Glenohumeral, 3) Test de opresión durante la abducción horizontal de hombro, 4) Test Longitud del Pectoral menor. Se utilizó un análisis intra-sujeto y otro análisis inter-sujeto para analizar las diferencias significativas (p<.05) en las variables de estudio, antes y después del programa de intervención. Resultados: Tras el programa de intervención se observaron mejoras significativas en el GI comparado con el GC en las variables: ángulo de adelantamiento de la cabeza (p<.001), rotación interna del hombro dominante (p=.001), rotación externa del hombro dominante, (p=.046), rotación interna del hombro no dominante (p=0.002), abducción horizontal del hombro (p=.003), longitud del pectoral derecho (p<0.001) y longitud del pectoral izquierdo (p=.001). Conclusión: Un programa de intervención diseñado para la prevención de lesiones en el complejo articular del hombro de cuatro semanas de duración (dos-sesiones/30-minutos/semana), fue efectivo mejorando la salud articular y movilidad del hombro en jóvenes triatletas.Abstract. The onset of overuse injuries of the shoulder joint complex in the discipline of swimming in young triathletes prompts the need to deepen the study of effective methods for the prevention of such lesions. Objective: To analyze the effectiveness of an intervention program designed for the prevention of injuries of the shoulder joint complex in the discipline of swimming in young triathletes. Methods: 26 youngsters (aged 8-17 years) were randomly assigned to an Intervention Group (GI, n = 17), and a Control Group (GC, n = 9). The health of the shoulder joint complex was evaluated before and after an intervention program (four weeks duration: two-sessions / 30-minutes / week), using the following tests: (1) Forward head angle test, Forward shoulder translation test, (2) Rotation Glenohumeral internal and external test, (3) Oppression during horizontal abduction of shoulder test, (4) Pectoral minor length test. An intra-subject and an inter-subject analyses were used to analyze significant differences (p <.05) in the study variables, before and after the intervention program. Results: After the intervention program, significant improvements in GI were observed compared to the CG in the variables: head advancement angle (p<.001), internal rotation of the dominant shoulder (p=.002), external rotation of the dominant shoulder (p=.046), internal rotation of the shoulder (p=.002), horizontal abduction of the shoulder (p=.003), right pectoral length (p<.001) and left pectoral length (p=.001). Conclusion: A 4-week (2-session / 30-minutes / week) intervention program designed for the prevention of shoulder injuries was effective in improving shoulder health in young triathletes.

Força dos Músculos Rotadores do Ombro em Indivíduos Saudáveis/ Rotator Cuff Muscle Strength in Healthy Individuals

1970 ◽  
Vol 1 (1) ◽  
pp. 78-82
Author(s):  
Paulo José Oliveira Cortez ◽  
José Elias Tomazini ◽  
Mauro Gonçalves
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Internal Rotation ◽  
Upper Limb ◽  
Statistical Difference ◽  
External Rotation ◽  
Healthy Individuals ◽  
Average Strength ◽  
Strength Tests ◽  
The Right

Introdução: A diminuição da capacidade de exercer esforços por parte dos músculos rotadores pode criar uma variedade de problemas. O conhecimento preciso do nível de força muscular de um indivíduo é importante, tanto para a avaliação da capacidade funcional ocupacional, como para uma apropriada prescrição de exercícios atléticos e de reabilitação. Percebe-se escassez de informação sobre as articulações do ombro, bem como os fatores envolvidos na força muscular dessa região. O objetivo deste estudo foi comparar a força gerada pelos músculos do manguito rotador entre o membro superior direito e o membro superior esquerdo em indivíduos saudáveis. Métodos: Participaram do estudo 22 sujeitos do sexo masculino, com idade de 18 e 19 anos, militares, saudáveis e sem história clínica de patologia ortopédica ou qualquer tipo de lesão no sistema musculoesquelético. Foram aplicados dois testes de força: Rotação Interna e Rotação Externa. Resultado : A força média de rotação interna no membro superior direito (MSD) foi maior que a força média de rotação interna no membro superior esquerdo (MSE) (p=0,723) e a força de rotação externa no MSD foi menor que a força média de rotação externa no MSE (p=0,788). Não houve diferença estatística na comparação dos valores de força de todos os testes de força isométrica. Conclusão: Para amostra estudada e metodologia utilizada na avaliação da força muscular, não houve diferença estatística na comparação da força gerada pelos músculos do manguito rotador do membro superior direito e do membro superior esquerdo.Rotator Cuff Muscle Strength in Healthy Individuals Introduction: Decreased ability to exert efforts by the rotator muscles can create a variety of problems. The precise knowledge of the level of muscular strength of an individual is important for both the functional capacity evaluation for occupational as an appropriate exercise prescription and rehabilitation of athletic. It is perceived scarcity of information on the shoulder joints as well as factors involved in muscle strength in this region. Objective: Develop a device for measuring the strength generated by the muscles of the upper limbs and the verification of efficiency and adaptability of this device through a comparative study of muscle strength in healthy subjects. Methods: The study included 22 male subjects, aged 18 and 19 years, military personnel, body mass between 57.7 and 93 kg (71.8 ± 9.45 kg) and height between 1.67 and 1.90 m (1.75 ± 0.06 m), healthy and without a history of orthopaedic disease or any kind of damage to the musculoskeletal system. Three strength tests were applied: Internal Rotation and External Rotation. For each type of effort three maximum voluntary contractions were required for 10 seconds, with an interval of 30 seconds between each contraction.  Results: Internal rotation in the right upper limb (RUL) was higher than the average strength of internal rotation in the left upper limb (LUL) (p = 0, 723) and the external rotation strength in RUL was lower than the average strength of external rotation in the LUL (p=0,788).  No statistical difference in comparing the strength values of all isometric strength tests. Conclusion: For sample and methodology used to assess muscle strength, there was no statistical difference in comparing the force generated by the muscles of the rotator cuff of the right and left upper limb.

scholarly journals Delayed Rehabilitation Protocol after Rotator Cuff Repair

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 29-38
Author(s):  
Alessandra Berton ◽  
Sergio De Salvatore ◽  
Vincenzo Candela ◽  
Gabriele Cortina ◽  
Daniela Lo Presti ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Internal Rotation ◽  
Outcome Measures ◽  
Rotator Cuff Repair ◽  
External Rotation ◽  
Shoulder Function ◽  
Rehabilitation Protocol ◽  
Patient Reported ◽  
Cuff Repair

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI.

Relationships between Knee Valgus, Hip-Muscle Strength, and Hip-Muscle Recruitment during a Single-Limb Step-Down

2009 ◽  
Vol 18 (1) ◽  
pp. 104-117 ◽  
Author(s):  
John H. Hollman ◽  
Barbara E. Ginos ◽  
Jakub Kozuchowski ◽  
Amanda S. Vaughn ◽  
David A. Krause ◽  
...  
Keyword(s):  
Muscle Strength ◽  
External Rotation ◽  
Frontal Plane ◽  
Gluteus Maximus ◽  
Knee Valgus ◽  
Outcome Measurements ◽  
Hip Muscle ◽  
Hip Abduction ◽  
Step Down ◽  
Rotation Strength

Context:Reduced strength and activation of hip muscles might correlate with increased weight-bearing knee valgus.Objective:To describe relationships among frontal-plane hip and knee angles, hip-muscle strength, and electromyographic (EMG) recruitment in women during a step-down.Design:Exploratory study.Setting:Laboratory.Participants:20 healthy women 20 to 30 years of age.Interventions:Frontal-plane hip and knee angles were measured. Gluteus maximus and medius recruitment were examined with surface EMG. Hip-abduction and -external-rotation strength were quantified with handheld dynamometry.Main Outcome Measurements:The authors analyzed correlation coefficients between knee and hip angles, gluteus maximus and medius EMG, and hip-abduction and -external-rotation strength.Results:Hip-adduction angles (r = .755, P = .001), gluteus maximus EMG (r = −.451, P = .026), and hip-abduction strength (r = .455, P = .022) correlated with frontal-plane projections of knee valgus.Conclusions:Gluteus maximus recruitment might have greater association with reduced knee valgus in women than does external-rotation strength during step-down tasks. Gluteus medius strength might be associated with increased knee valgus.

Rotator Cuff Training for Pitchers

1998 ◽  
Vol 7 (4) ◽  
pp. 285-299 ◽  
Author(s):  
Michael E. Powers
Keyword(s):  
Rotator Cuff ◽  
Internal Rotation ◽  
High Speed ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Muscular Endurance ◽  
Shoulder Injuries ◽  
Three Stages ◽  
Two Stages

This paper reviews the role of the rotator cuff during two key phases of the pitching sequence and presents a training program for these muscles. The program uses a periodization design consisting of three stages, beginning with a high-resistance/low-repetition eccentric strengthening stage. This is followed by a low-resistance/high-repetition stage for training muscular endurance. The core exercises for these two stages are prone external rotation in the 90/90 position, prone horizontal abduction, side-lying D2 flexion pattern, supine internal rotation in the 90/90 position, prone elevation with 100° of shoulder abduction and external rotation, and standing scapular plane elevation. The final stage of the program uses high-speed functional exercises: 90/90 external rotation, 90/90 internal rotation, D2 PNF flexion pattern, D2 PNF extension pattern, supine plyometric 90/90 internal rotation with a medicine ball, and the “arm whip” through the D2 PNF flexion pattern. The goal of this program is to prepare the muscles for the stresses of pitching and prevent shoulder injuries.

scholarly journals Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes

2011 ◽  
Vol 46 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Mithun Joshi ◽  
Charles A. Thigpen ◽  
Kevin Bunn ◽  
Spero G. Karas ◽  
Darin A. Padua
Keyword(s):  
Muscle Fatigue ◽  
Muscle Activation ◽  
External Rotation ◽  
Shoulder Injuries ◽  
Serratus Anterior ◽  
Overhead Athletes ◽  
Scapular Kinematics ◽  
Fatigue Protocol ◽  
Upper Trapezius ◽  
Lower Trapezius

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Intervention(s): We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending-phase lower trapezius activity (F1,25 = 5.098, P = .03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P = .03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P = .04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced alterations in the lower trapezius might predispose the infraspinatus to injury through chronically increased activation.

scholarly journals Glenohumeral Rotational Range of Motion in Collegiate Overhead-Throwing Athletes During an Athletic Season

2009 ◽  
Vol 44 (6) ◽  
pp. 611-616 ◽  
Author(s):  
Priscilla M. Dwelly ◽  
Brady L. Tripp ◽  
Patricia A. Tripp ◽  
Lindsey E. Eberman ◽  
Steven Gorin
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Ncaa Division I ◽  
Mean Difference ◽  
Division I ◽  
Shoulder Injuries ◽  
The Mean ◽  
Overhead Throwing ◽  
Division Ii ◽  
Over Time

Abstract Context: Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder. Objective: To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. Design: Observational, repeated-measures study. Setting: Collegiate athletic training room. Patients or Other Participants: Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age  =  19 ± 1 years, height  =  174 ± 14 cm, mass  =  77.8 ± 18.1 kg; 19 softball, 29 baseball players). Main Outcome Measure(s): We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. Results: In the dominant shoulder, ER increased during the season (F2,96  =  17.433, P &lt; .001), but IR remained the same (F2,96  =  1.839, P  =  .17). The total arc in the dominant shoulder increased between time intervals (F2,96  =  14.030, P &lt; .001); the mean difference between prefall and postspring measurements was 9.694° (P &lt; .001), and the mean difference between prefall and postspring measurements was 10.990° (P &lt; .001). In the nondominant shoulder, ER increased over the season (F2,96  =  23.395, P &lt; .001), but IR did not change over the season (F2,96  =  0.087, P  =  .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F2,96  =  18.552, P &lt; .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n  =  6) than in prespring (n  =  1) and postspring (n  =  4) (Cochran Q  =  5.2, P  =  .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n  =  6) than in prefall (n  =  5) or prespring (n  =  4) (Cochran Q  =  2.6, P  =  .27). Conclusions: Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method.

Sign in / Sign up

Export Citation Format

Share Document