scholarly journals Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis

2017 ◽  
Vol 52 (4) ◽  
pp. 231-237 ◽  
Author(s):  
Alexis A Wright ◽  
Eric J Hegedus ◽  
Daniel T Tarara ◽  
Samantha C Ray ◽  
Steven L Dischiavi
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Exercise Prescription ◽  
Evidence Synthesis ◽  
Inclusion Criteria ◽  
Single Plane ◽  
Overhead Athletes ◽  
Shoulder Pathology ◽  
Best Evidence Synthesis ◽  
Level I

ObjectiveTo produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete.DesignA systematic review of exercises used in overhead athletes including case studies and clinical commentaries.Data sourcesMEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016.MethodsWe examined data from randomised controlled trials and prospective cohort (level I–IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A–F) recommendations (Centre for Evidence-Based Medicine).ResultsThere were 33 unique exercises in six level I–IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90oof elevation. There were 102 unique exercises in 33 level V studies that met our inclusion criteria. These exercises emphasised plyometrics, kinetic chain and sport-specific training.Conclusions and relevanceOverall, evidence for exercise interventions in overhead athletes with shoulder pathology is dominated by expert opinion (grade D). There is great variability between exercise approaches suggested by experts and those investigated in research studies and the overall level of evidence is low. The strongest available evidence (level B) supports the use of single-plane, open chain upper extremity exercises performed below 90° of elevation and closed chain upper extremity exercises. Clinical expert pieces support a more advanced, global treatment approach consistent with the complex, multidimensional nature of sport.

scholarly journals An Overview of Strategies for Reducing Upper Extremity Physical Exposure Associated With Floor Mopping: A Systematic Review

2018 ◽  
Vol 61 (1) ◽  
pp. 43-63 ◽  
Author(s):  
Mari-Anne Wallius ◽  
Susanna Järvelin-Pasanen ◽  
Saara M. Rissanen ◽  
Pasi A. Karjalainen ◽  
Kimmo Räsänen
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Evidence Synthesis ◽  
Levels Of Evidence ◽  
Moderate Evidence ◽  
Positive Effects ◽  
Physical Exposure ◽  
Manual Search ◽  
Best Evidence Synthesis ◽  
The Impact

Objective: This systematic review synthesizes literature on upper extremity physical exposure associated with floor mopping, in order to (a) assess the impact of changes in mopping systems on physical exposure and (b) propose recommendations for strategies to reduce exposure. Background: Floor-cleaning tools and equipment have undergone major improvements. Existing studies have focused on mop design modifications and cleaning efficiency. However, less is known about strain responses caused by modern tools and methods. Method: Studies from 1987 to February 2017 were identified by electronic and manual search. All selected studies underwent a quality assessment. The evidence was organized into categories representing different strategies for reducing exposure. The levels of evidence were determined using a best evidence synthesis approach. Results: Eleven studies were included. Based on the review findings, currently there is moderate evidence suggesting that reduced physical exposure has been achieved through development of mopping systems. Levels of evidence for strategies associated with positive effects on physical exposure were: moderate evidence for mop design and handle type, insufficient evidence for mopping technique, and mixed evidence for mopping methods and environment modifications. Therefore, the present study suggests the use of adjustable mop handles as a strategy for reducing physical exposure. Conclusion: A more comprehensive approach to reducing physical exposure concerning floor mopping work is necessary. Application: Knowledge regarding physical exposure reduction can be applied as the basis for decision making in cleaning practice. Information can be incorporated into future research regarding development of floor-cleaning methods.

scholarly journals Elbow tendinopathy and occupational biomechanical overload: A systematic review with best‐evidence synthesis

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Stefania Curti ◽  
Stefano Mattioli ◽  
Roberta Bonfiglioli ◽  
Andrea Farioli ◽  
Francesco S. Violante
Keyword(s):  
Systematic Review ◽  
Evidence Synthesis ◽  
Best Evidence Synthesis

scholarly journals Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review

2018 ◽  
Vol 53 (4) ◽  
pp. 251-262 ◽  
Author(s):  
Dimitris Challoumas ◽  
Paul D Kirwan ◽  
Dmytro Borysov ◽  
Christopher Clifford ◽  
Michael McLean ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glyceryl Trinitrate ◽  
Strong Evidence ◽  
Evidence Synthesis ◽  
Clinical Effects ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Moderate Evidence ◽  
Best Evidence Synthesis ◽  
Topical Glyceryl Trinitrate

ObjectiveTo produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.DesignA systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.Data sourcesMEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.MethodsWe examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulderet al.ResultsA total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).Conclusions and relevanceTreatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

scholarly journals Partial articular supraspinatus tendon avulsion: Should we repair? A systematic review of the evidence

2019 ◽  
Vol 12 (4) ◽  
pp. 253-264
Author(s):  
Duncan Tennent ◽  
Gemma Green
Keyword(s):  
Systematic Review ◽  
Grey Literature ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Classification Systems ◽  
Rotator Cuff Tears ◽  
Single Plane ◽  
Functional Scores ◽  
Level I ◽  
Tendon Avulsion

Introduction Partial articular sided rotator cuff tears are described as being a common cause of shoulder pain and to have a significant impact of patient quality of life. The natural history of partial articular supraspinatus tendon avulsion lesions is not clearly defined and there is limited evidence to determine optimal management. Aims To perform a systematic review of the literature regarding the evidence for partial articular supraspinatus tendon avulsion repair and to determine whether there is any difference between operative and non-operatively managed patients. Methods Conventional and grey literature were searched with defined terms to identify studies in human adults concerning management of partial articular sided supraspinatus avulsions. Results Out of 86 papers identified by the search terms, 28 were deemed eligible for review including 1966 shoulders. 4/28 papers were of level I–II evidence but all were comparing techniques. 4/28 papers were biomechanical cadaveric studies, assessing strength of repair and effect on stability. The remaining 20 studies were level IV–V evidence and consisted of case series and technical notes identifying varying techniques of repair and their outcomes. Conclusion Current literature suggests that all techniques used to repair partial articular supraspinatus tendon avulsion lesions give increased functional scores and reduced pain. However, this represents a heterogeneous group of patients with variable degrees of tear and is not reproducible. There are limited controlled studies to determine whether partial articular supraspinatus tendon avulsion lesions require repair. Current classification systems represent a single plane and are open to user variation. No evidence exists to determine which tears are stable and which may progress.

scholarly journals Effect of Fatigue Protocols on Upper Extremity Neuromuscular Function and Implications for Ulnar Collateral Ligament Injury Prevention

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988887 ◽  
Author(s):  
Toufic R. Jildeh ◽  
Kelechi R. Okoroha ◽  
Joseph S. Tramer ◽  
Jorge Chahla ◽  
Benedict U. Nwachukwu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Injury Prevention ◽  
Upper Extremity ◽  
Muscle Force ◽  
Force Production ◽  
Ulnar Collateral Ligament ◽  
Neuromuscular Function ◽  
Inclusion Criteria ◽  
Collateral Ligament ◽  
Muscle Force Production

Background: As the incidence of overuse injuries to the medial elbow in overhead athletes continues to rise, recent evidence suggests a link between these injuries and alterations in biomechanics produced by athlete fatigue. Previous studies have evaluated the effect of fatigue on elbow injuries using a wide array of fatigue protocols/athletic tasks, and, as a consequence, the results have been heterogeneous. Purpose: To determine whether there is a uniform alteration in neuromuscular function or biomechanics as the overhead athlete fatigues. Furthermore, this study sought to determine whether player fatigue should be accounted for in ulnar collateral ligament (UCL) injury prevention programs. Study Design: Systematic review. Methods: A systematic review of the literature using PubMed and MEDLINE databases was performed. Keywords included fatigue, upper extremity, baseball, pitcher, throwing, and muscle activity. Inclusion criteria consisted of original research articles in the English language involving healthy athletes, use of fatigue protocols, and the evaluation of at least 1 upper limb biomechanical variable. Results: A total of 35 studies involving 644 athletes (90 females, 554 males; mean age, 20.2 years) met the inclusion criteria. General fatigue protocols were used in 2 investigations, peripheral protocols were used in all 35 studies, and 5 different athletic tasks were studied (simulated baseball game, overhead throwing, high-effort swimming, simulated tennis game, and overhead serving). There was a uniform decrease in muscle force production and proprioception in athletes after completing a fatigue protocol. However, there was no consistency among studies when evaluating other important upper limb biomechanical factors. The fatigue protocols did not consistently produce statistically significant changes in elbow torque, pitching biomechanics, or ball velocity. Conclusion: A uniform decrease in muscle force production and proprioception was found after fatigue protocols; however, a majority of fatigue protocols published in the current literature are inconsistently measured and produce heterogeneous results. Therefore, currently, no recommendations can be made for changes in UCL injury prevention training programs to account for potential effects of fatigue. The effect of muscle force production and proprioception on upper extremity injuries should be evaluated in future studies.

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

2020 ◽  
pp. 036354652092117 ◽  
Author(s):  
Travis L. Frantz ◽  
Andrew G. Shacklett ◽  
Adam S. Martin ◽  
Jonathan D. Barlow ◽  
Grant L. Jones ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Overhead Athletes ◽  
Overhead Athlete ◽  
Slap Repair ◽  
Slap Tear ◽  
Anterior Posterior

Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

scholarly journals Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis

2018 ◽  
Vol 52 (20) ◽  
pp. 1312-1319 ◽  
Author(s):  
Martin Asker ◽  
Hannah L Brooke ◽  
Markus Waldén ◽  
Ulrika Tranaeus ◽  
Fredrik Johansson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Injury Prevention ◽  
Evidence Synthesis ◽  
Shoulder Injuries ◽  
Prevention Measures ◽  
Shoulder Injury ◽  
Limited Evidence ◽  
Best Evidence Synthesis ◽  
Overhead Sports

ObjectiveTo assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.DesignSystematic review with best-evidence synthesis.Data sourcesMedline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.Eligibility criteria for selecting studiesRandomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.ResultsOf 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.ConclusionsAll investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.PROSPERO trial registration numberCRD42015026850.

scholarly journals Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2664
Author(s):  
Ethan Lowry ◽  
Joanne Marley ◽  
Joseph G. McVeigh ◽  
Emeir McSorley ◽  
Philip Allsopp ◽  
...  
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Evidence Synthesis ◽  
Nutritional Intervention ◽  
Poor Quality ◽  
Chronic Widespread Pain ◽  
Small Sample ◽  
Vegan Diet ◽  
Poor Sleep ◽  
Best Evidence Synthesis

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.

scholarly journals Effect of Plyometric Training on Sport Performance in Adolescent Overhead Athletes: A Systematic Review

2020 ◽  
Vol 13 (1) ◽  
pp. 37-44
Author(s):  
Leyla Eraslan ◽  
Birgit Castelein ◽  
Valentien Spanhove ◽  
Ceren Orhan ◽  
Irem Duzgun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sport Performance ◽  
Sprint Performance ◽  
Current Evidence ◽  
Training Intervention ◽  
Control Group ◽  
Plyometric Training ◽  
Inclusion Criteria ◽  
Overhead Athletes ◽  
Mesh Terms

Context: Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited. Objective: To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance. Data Sources: Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies. Study Selection: A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria. Results: A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance. Conclusion: The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.

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