Stretching Positions for the Posterior Capsule of the Glenohumeral Joint

2008 ◽  
Vol 36 (10) ◽  
pp. 2014-2022 ◽  
Author(s):  
Tomoki Izumi ◽  
Mitsuhiro Aoki ◽  
Takayuki Muraki ◽  
Egi Hidaka ◽  
Shigenori Miyamoto
Keyword(s):  
Internal Rotation ◽  
Glenohumeral Joint ◽  
Cadaver Study ◽  
Posterior Capsule ◽  
Large Strains ◽  
Reference Length ◽  
Posterior Shoulder ◽  
Fresh Frozen ◽  
Extension Strain ◽  
Scapular Plane

Background Various stretches have been introduced for the posterior shoulder; however, little quantitative analysis to measure stretching of the posterior capsule has been performed. Hypothesis The current shoulder stretching program is not sufficient to stretch the entire posterior capsule. Study Design Controlled laboratory study. Methods Using 8 fresh-frozen cadaver shoulders (average age, 82.4 years), 8 stretching positions for the posterior capsule were simulated by passive internal rotation. Stretching positions of 0°, 30°, 60°, and 90° of elevation in the scapular plane; 60° of flexion; 60° of abduction; 30° of extension; and 60° of flexion and horizontal adduction were adopted. Strain was measured in the upper, middle, and lower parts of the capsule. The measurement of strain was instituted from reference length. Results With internal rotation, mean strain on the upper capsule was 3.02% at 0° of elevation and 3.35% at 30° of extension. Strain on the middle capsule at 0° and 30° elevation was 0.78% and 4.77%, respectively; on the lower capsule, it was 5.65% and 2.24% at 30° and 60° of elevation, respectively, and 2.88% at 30° of extension. Increase in strains of the upper, middle, and lower capsule with internal rotation at 0°, 30°, and 60° of elevation were statistically significant, respectively ( P < .01). Other shoulder positions demonstrated no positive strain values. Conclusions Based on the results of this cadaver study, large strains on the posterior capsule of the shoulder were obtained at a stretching position of 30° of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30° of extension with internal rotation was effective for the upper and lower capsule. Clinical Relevance The current posterior capsule stretching program of the shoulder was not sufficient to stretch the entire posterior capsule.

Effect of Posterior Capsule Tightness on Glenohumeral Translation in the Late-Cocking Phase of Pitching

2007 ◽  
Vol 16 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Kim M. Clabbers ◽  
John D. Kelly ◽  
Dov Bader ◽  
Matthew Eager ◽  
Carl Imhauser ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Head Position ◽  
Posterior Capsule ◽  
Nonsignificant Trend ◽  
Before And After ◽  
Fresh Frozen ◽  
Head Translation

Context:Throwing injuries.Objective:To study the effects of posterior capsule tightness on humeral head position in late cocking simulation.Design:Eight fresh frozen shoulders were placed in position of “late cocking,” 90 degrees abduction, and 10 degrees adduction and maximal external rotation. 3D measurements of humeral head relationship to the glenoid were taken with an infrared motion sensor, both before and after suture plication of the posterior capsule. Plications of 20% posterior/inferior capsule and 20% entire posterior capsule were performed, followed by plications of 40% of the posterior/inferior capsule and 40% entire posterior capsule.Setting:Cadaver Lab.Intervention:Posterior capsular placation.Main Outcome Measures:Humeral head position.Results:40%, but not 20%, posterior/inferior and posterior plications demonstrated a trend to increased posterior-superior humeral head translation relative to controls.Conclusion:Surgically created posterior capsular tightness of the glenohumeral joint demonstrated a nonsignificant trend to increased posterior/superior humeral head translation in the late cocking position of throwing.

scholarly journals Posterior Glenohumeral Joint Capsule Contracture

2012 ◽  
Vol 4 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Amitabh Dashottar ◽  
John Borstad
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
Tensile Force ◽  
Joint Capsule ◽  
Posterior Capsule ◽  
Joint Mechanics ◽  
Cellular Processes ◽  
Standard Techniques

Glenohumeral joint posterior capsule contracture may cause shoulder pain by altering normal joint mechanics. Contracture is commonly noted in throwing athletes but can also be present in nonthrowers. The cause of contracture in throwing athletes is assumed to be a response to the high amount of repetitive tensile force placed on the tissue, whereas the mechanism of contracture in nonthrowers is unknown. It is likely that mechanical and cellular processes interact to increase the stiffness and decrease the compliance of the capsule, although the exact processes that cause a contracture have not been confirmed. Cadaver models have been used to study the effect of posterior capsule contracture on joint mechanics and demonstrate alterations in range of motion and in humeral head kinematics. Imaging has been used to assess posterior capsule contracture, although standard techniques and quantification methods are lacking. Clinically, contracture manifests as a reduction in glenohumeral internal rotation and/or cross body adduction range of motion. Stretching and manual techniques are used to improve range of motion and often decrease symptoms in painful shoulders.

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study

2019 ◽  
Vol 47 (6) ◽  
pp. 1434-1440 ◽  
Author(s):  
Dayana P. Rosa ◽  
Paula R. Camargo ◽  
John D. Borstad
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Posterior Capsule ◽  
Joint Range Of Motion ◽  
Motion Measurements ◽  
Humeral Retroversion ◽  
Clinical Measurements ◽  
Joint Range

Background: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. Purpose: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. Study Design: Controlled laboratory study. Methods: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. Results: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. Conclusion: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. Clinical Relevance: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics

2019 ◽  
Vol 99 (7) ◽  
pp. 870-881 ◽  
Author(s):  
Dayana P Rosa ◽  
John D Borstad ◽  
Julia K Ferreira ◽  
Paula R Camargo
Keyword(s):  
Internal Rotation ◽  
Shoulder Pain ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Posterior Capsule ◽  
Control Group ◽  
Pain Thresholds ◽  
Lower Pain ◽  
And Function ◽  
Rotation Strength

AbstractBackgroundPosterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown.ObjectiveThe purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone.DesignThe design was a cross-sectional group comparison.MethodsParticipants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA.ResultsThe SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°–8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53–2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°–28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15–185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41–55.63).LimitationsThese results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions.ConclusionsDecreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.

scholarly journals Soft Tissue Mobilization and Stretching for Shoulder in CrossFitters: A Randomized Pilot Study

2021 ◽  
Vol 18 (2) ◽  
pp. 575
Author(s):  
Marcos Jusdado-García ◽  
Rubén Cuesta-Barriuso
Keyword(s):  
Soft Tissue ◽  
Internal Rotation ◽  
Repeated Measures ◽  
Control Group ◽  
Average Weight ◽  
Average Height ◽  
Shoulder Injury ◽  
Glenohumeral Internal Rotation Deficit ◽  
Posterior Shoulder ◽  
Soft Tissue Mobilization

Background. The shoulder in CrossFit should have a balance between mobility and stability. Glenohumeral internal rotation deficit and posterior shoulder stiffness are risk factors for overhead shoulder injury. Objective. To determine the effectiveness of instrument-assisted soft tissue mobilization and horizontal adduction stretch in CrossFit practitioners’ shoulders. Methods: Twenty-one regular CrossFitters were allocated to experimental (stretching with isometric contraction and instrument-assisted soft tissue mobilization) or control groups (instrument-assisted soft tissue mobilization). Each session lasted 5 min, 2 days a week, over a period of 4 weeks. Shoulder internal rotation and horizontal adduction (digital inclinometer), as well as posterior shoulder stretch perception (Park scale), were evaluated. Shapiro–Wilk test was used to analyze the distribution of the sample. Parametric Student’s t-test was used to obtain the intragroup differences. The inter- and intra-rater differences were calculated using a repeated measures analysis of variance (ANOVA). Results. Average age was 30.81 years (SD: 5.35), with an average height of 178 (SD: 7.93) cm and average weight of 82.69 (SD: 10.82) kg. Changes were found in the experimental group following intervention (p < 0.05), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. Significant differences were found in the control group following intervention (p < 0.05), in right horizontal adduction and left internal rotation. When comparing the perception of internal rotation and horizontal adduction in both groups, significant differences were found. Conclusions. Instrument-assisted soft tissue mobilization can improve shoulder horizontal adduction and internal rotation. An instrument-assisted soft tissue mobilization technique yields the same results alone as those achieved in combination with post-isometric stretch with shoulder adduction.

scholarly journals Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Caitlin Curtis Crocker ◽  
Eildar Abyar ◽  
Sean Young ◽  
Fatemah Razaghi ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Single Incision ◽  
Plantar Flexion ◽  
Cadaver Study ◽  
Tendon Graft ◽  
Interference Screw ◽  
Flexor Hallucis Longus ◽  
Tunnel Length ◽  
Exact Test ◽  
Fresh Frozen ◽  
The Mean

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.

scholarly journals The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation

2018 ◽  
Vol 47 (2) ◽  
pp. 165
Author(s):  
Lana Hirai Gimber ◽  
Mihra S. Taljanovic ◽  
Zachary A. Rockov ◽  
Elizabeth A. Krupinski ◽  
Tyson S. Chadaz ◽  
...  
Keyword(s):  
Humeral Head ◽  
Shoulder Dislocation ◽  
Glenohumeral Joint ◽  
Posterior Shoulder Dislocation ◽  
Chi Square ◽  
Lesser Tuberosity ◽  
Radiographic Sign ◽  
Posterior Shoulder ◽  
Significant Difference ◽  
The Veil

<p><strong>Objective.</strong> To describe a new radiographic sign, “veil of obscuration”, associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs.</p><p><strong>Methods.</strong> Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the “veil of obscuration”, seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analysed with student t-test and categorical data with Chi-Square test.</p><p><strong>Results. </strong>There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and “veil of obscuration” (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while “veil of obscuration” was seen in more seizures (86%; P=0.037) and in all surgical patients.  No significant difference in presence of other classic radiographic signs in regards to surgery.</p><p><strong>Conclusion. </strong>The newly described radiographic sign of posterior shoulder dislocations named the “veil of obscuration” has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.</p>

scholarly journals Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989143
Author(s):  
Adam J. Beer ◽  
Tracy M. Tauro ◽  
Michael L. Redondo ◽  
David R. Christian ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Glenohumeral Joint ◽  
Tissue Bank ◽  
Young Athlete ◽  
The United States ◽  
Tissue Banks ◽  
Orthopaedic Surgeons ◽  
Fresh Frozen ◽  
Storage Methods ◽  
Insurance Approval

The use of allografts has become a vital option for orthopaedic surgeons in the treatment of a variety of musculoskeletal lesions, ranging from osteochondral defects in the glenohumeral joint to meniscal deficiency in the young athlete. Nevertheless, barriers to treating a patient with an allograft-based procedure may arise from concerns over disease transmission, the navigation of tissue banks that supply allografts, the process of obtaining insurance approval, or optimal storage methods. This review serves to support orthopaedic surgeons in the incorporation of allografts into their practice by quelling these potential concerns. Fresh osteochondral allografts, fresh-frozen meniscal allografts, soft tissue allografts, and off-the-shelf cartilage products are the focus of this review amid broad overviews of allograft safety and tissue bank practices in the United States.

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