scholarly journals Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms

2017 ◽  
Vol 45 (6) ◽  
pp. 1413-1419 ◽  
Author(s):  
S. Andrew Skillington ◽  
Robert H. Brophy ◽  
Rick W. Wright ◽  
Matthew V. Smith
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Elbow Flexion ◽  
Strength Loss ◽  
Complete Recovery ◽  
Progressive Increase ◽  
Shoulder Abduction ◽  
Shoulder Injury ◽  
Level Of Evidence ◽  
Cross Sectional

Background: The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Hypothesis: Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer. Results: Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Conclusion: Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.

Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries

2009 ◽  
Vol 3 (3) ◽  
pp. 173-180 ◽  
Author(s):  
James R. Bain ◽  
Carol DeMatteo ◽  
Deborah Gjertsen ◽  
Robert D. Hollenberg
Keyword(s):  
Decision Making ◽  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Complete Recovery ◽  
Shoulder Abduction ◽  
Active Movement ◽  
Gray Zone ◽  
Surgical Decision ◽  
Surgical Decision Making

Object In the literature, the best recommendations are imprecise as to the timing and selection of infants with obstetrical brachial plexus injury (OBPI) for surgical intervention. There is a gray zone (GZ) in which the decision as to the benefits and risks of surgery versus no surgery is not clear. The authors propose to describe this category, and they have developed a guideline to assist surgical decision-making within this GZ. Methods The authors first performed a critical review of the medical literature to determine the existence of a GZ in other clinical publications. In those reports, 47–89% of infants with OBPI fell within such a GZ. Complete recovery in those reported patients ranged from 9 to 59%. Using a prospective inception cohort design, all infants referred to the OBPI Clinic at McMaster Children's Hospital were systematically evaluated up to 3 years of age. The Active Movement Scale scores were compared for surgical and nonsurgical groups of infants in the GZ to identify any important trends that would guide surgical decision-making. Results In the authors' population of infants with OBPI, 81% fell within the GZ, of whom 44% achieved complete recovery. Mean scores differed significantly between surgery and no surgery groups in terms of total Active Movement Scale score and shoulder abduction and flexion at 6 months. Elbow flexion and external rotation differed at 3 months. Conclusions There is compelling evidence that there is a group of infants with OBPI in whom the assessment of the risk/benefit ratio for surgical versus nonsurgical treatment is not evident. These infants reside within what the authors have called the GZ. Based on their results, a guideline was derived to assist clinicians working with infants with OBPI to navigate the GZ.

Clinical findings in C5-C6 and C5-C7 root palsies with brachial plexus traction lesions

2012 ◽  
Vol 38 (3) ◽  
pp. 237-241 ◽  
Author(s):  
J. A. Bertelli ◽  
M. F. Ghizoni
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Clinical Findings ◽  
Hand Strength ◽  
Shoulder Abduction ◽  
Finger Extension ◽  
Root Injury ◽  
Flexion Extension

Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should be similar. In 38 patients with upper-type palsies of the brachial plexus, we examined for correlations between clinical findings and root injury level, as documented by CT tomomyeloscan. Contrary to commonly held beliefs, C5-C7 root injuries were not associated with loss of extension of the elbow, wrist, thumb, or fingers, but residual hand strength was much lower with C5-C7 vs C5-C6 lesions.

scholarly journals GAMBARAN KEKUATAN OTOT PADA LANSIA DI BPLU SENJA CERAH PANIKI BAWAH

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Prisilia M. Pinontoan ◽  
Sylvia R. Marunduh ◽  
Herlina I. S. Wungouw
Keyword(s):  
Muscle Strength ◽  
Elderly Women ◽  
Elbow Flexion ◽  
Knee Extension ◽  
Shoulder Abduction ◽  
Elderly Men ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
Shoulder Flexion ◽  
Cross Sectional Design

Abstract: The aim of this study was to find out the profile of muscle strength on elderly at BPLU Senja Cerah Paniki Bawah. This was a descriptive study with cross sectional design. There were 26 respondents who met the inclusion criteria, consisted of 10 elderly men and 16 elderly women. Respondents were selected by using purposive sampling method. The measurements of the muscle strength were done by using 1 RM method while doing elbow flexion, elbow extension, shoulder flexion, shoulder extension, shoulder abduction, knee flexion, knee extension and dorsoflexion. Data were analyzed manually and computerized then presented in tabular form. The result shows that the average muscle strength in elderly men were greater than women and the average muscle strength of respondents that were included in the age group 60-79 years old were greater than those in 80-99 years.Keywords: muscle strength, elderly.1 RMAbstrak: Tujuan dari penelitian ini yaitu untuk mengetahui gambaran kekuatan otot pada Lansia di BPLU Senja Cerah Paniki Bawah. Penelitian ini merupakan peneliltian deskriptif dengan rancangan potong lintang. Responden yang memenuhi kriteria inklusi terdiri dari 26 orang yang terdiri dari 10 orang laki-laki dan 16 orang perempuan. Sampel dipilih menggunakan cara purposive sampling. Kekuatan otot pada lansia diukur dengan menggunakan metode 1 RM yang diukur pada gerakan fleksi siku, ekstensi siku, fleksi bahu, ekstensi bahu, abduksi bahu, fleksi lutut, ekstensi lutut serta dorsofleksi. Data yang sudah didapatkan kemudian dikumpul dan diolah secara manual dan komputerisasi serta disajikan dalam bentuk tabel. Hasil penelitian menunjukkan rerata kekuatan otot responden laki-laki lebih besar dibanding perempuan dan rerata kekuatan responden yang termasuk dalam kelompok umur 60-79 tahun lebih besar dibanding kelompok umur 80-99 tahun.Kata kunci: kekuatan otot, lansia, 1 RM.

scholarly journals Risk Factors Associated With Shoulder Pain and Disability Across the Lifespan of Competitive Swimmers

2012 ◽  
Vol 47 (2) ◽  
pp. 149-158 ◽  
Author(s):  
Angela Tate ◽  
Gregory N. Turner ◽  
Sarah E. Knab ◽  
Colbie Jorgensen ◽  
Andrew Strittmatter ◽  
...  
Keyword(s):  
High School ◽  
Shoulder Pain ◽  
Age Groups ◽  
Muscle Length ◽  
Scapular Dyskinesis ◽  
Shoulder Injuries ◽  
Shoulder Injury ◽  
Cross Sectional ◽  
Pectoralis Minor ◽  
Competitive Swimmers

Context: The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction. Objective: To determine whether physical characteristics, exposure, or training variables differ between swimmers with and without shoulder pain or disability. Design: Cross-sectional study. Setting: Multisite swimming centers. Patients or Other Participants: A total of 236 competitive female swimmers aged 8 to 77 years. Data Collection and Analysis: Participants completed the Penn Shoulder Score and underwent testing of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. Swimmers were grouped by age for analysis: ages 8 to 11 years (n = 42), 12 to 14 years (n = 43), 15 to 19 years (high school, n = 84), and 23 to 77 years (masters, n = 67). Comparisons were made between groups with and without pain and disability using independent t tests for continuous data and χ2 analyses and Fisher exact tests for categorical data. Results: Nine (21.4%) swimmers aged 8 to 11 years, 8 (18.6%) swimmers aged 12 to 14 years, 19 (22.6%) high school swimmers, and 13 (19.4%) masters swimmers had shoulder pain and disability. Differences that were found in 2 or more age groups between athletes with and without shoulder pain and disability included greater swimming exposure, a higher incidence of previous traumatic injury and patient-rated shoulder instability, and reduced participation in another sport in the symptomatic groups (P < .05). Reduced shoulder flexion motion, weakness of the middle trapezius and internal rotation, shorter pectoralis minor and latissimus, participation in water polo, and decreased core endurance were found in symptomatic females in single varying age groups (P < .05). Conclusions: Female competitive swimmers have shoulder pain and disability throughout their lives. Given that exposure and physical examination findings varied between athletes with and without substantial pain and disability, a program to prevent shoulder injury that might lead to pain and dysfunction appears warranted and might include exposure reduction, cross-training, pectoral and posterior shoulder stretching, strengthening, and core endurance training.

639 Maximizing Safe Positioning of Upper Extremities after Axillary Burn Injuries to Prevent Contractures and Maintain Function

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S175-S176
Author(s):  
Connie Greiser ◽  
David Lorello ◽  
Dan Lyons ◽  
Karen J Richey ◽  
Derek Murray ◽  
...  
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.

scholarly journals Injuries in an Extreme Conditioning Program

2016 ◽  
Vol 9 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Kyle T. Aune ◽  
Joseph M. Powers
Keyword(s):  
Injury Rate ◽  
Cross Sectional Study ◽  
Injury Incidence ◽  
Shoulder Injury ◽  
Upper Arm ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Relative Safety ◽  
Fitness Training ◽  
Conditioning Programs

Background: Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. Hypothesis: The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. Results: A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with <6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. Conclusion: The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Clinical Relevance: Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs, which appears to be similar to other weight-training programs.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

2009 ◽  
Vol 37 (5) ◽  
pp. 1017-1023 ◽  
Author(s):  
Renato Rangel Torres ◽  
João Luiz Ellera Gomes
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tennis Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
Overhead Sports ◽  
The Difference

Background Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Hypothesis Asymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficit. Study Design Cross-sectional study; Level of evidence, 3. Methods Fifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization. Measurements of dominant and nondominant shoulders were compared within and between groups. Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shoulders. Results In tennis players, mean GIRD was 23.9° ± 8.4° (P < .001); in swimmers, 12° ± 6.8° (P < .001); and in the control group, 4.9° ± 7.4° (P = .035). Dominant shoulders showed significant difference between all groups, and the difference in internal rotation of the dominant shoulder between the group of tennis players in comparison with the control group (27.6°, P < .001) was greater than the difference in internal rotation of the dominant shoulder found in the group of swimmers compared with the control group (17.9°, P < .001). Between tennis players and swimmers, the difference in internal rotation of the dominant shoulder was 9.7° (P = .002). Conclusion Dominant limbs showed less glenohumeral internal rotation than the nondominant limbs in all groups, with the deficit in the group of tennis players about twice the deficit found for swimmers. Mean difference between limbs in the control group was less than 5°, which is within normal parameters according to most studies. There were statistically significant differences between all groups when dominant shoulders were compared with each other, differences that were not compensated by external rotation gain. Tennis players had the least range of motion, followed by swimmers.

scholarly journals “PREVALENCE OF SHOULDER PAIN IN PETROL PUMP WORKERS”

2017 ◽  
Vol 2 (3) ◽  
pp. 106 ◽  
Author(s):  
AFROZ Z SHAIKH ◽  
SWATI A BHISE ◽  
SHILPA A PARAB
Keyword(s):  
Shoulder Pain ◽  
Soft Tissues ◽  
Cross Sectional Study ◽  
Shoulder Injury ◽  
Musculoskeletal Problem ◽  
Cross Sectional ◽  
Pump Station ◽  
Repetitive Activities ◽  
Job Profile ◽  
Petrol Pump

Shoulder pain (SP) is the most common problem in workers exposed to repetitive shoulder activity in their occupation. The petrol pump workers, who have repetitive activities of shoulder joint by picking and keeping the nozzle at petrol pump station.  This repetitive activity increases the demand on the muscles, ligaments, soft tissues of musculoskeletal system. This activity is carried out in standing posture. So the purpose of the present study is to know the prevalence of shoulder pain in petrol pump workers.AIM: - To study the prevalence of shoulder pain in petrol pump workers.METHODOLOGY:-A Observational –Cross sectional study done on 100 Petrol Pump Workers selected randomly with the job profile of filling the fuel with nozzle in vehicles 20 – 40 years of age  working since > 6months, without any shoulder injury, trauma and  neurological musculoskeletal problem. Questionnaire was prepared and validated.Non Parametric Test Were Applied. In this study only 49% Petrol Pump Workers people had shoulder pain where as 51% did not shoulder pain had.CONCLUSION: - The study shows that Petrol Pump workers ageing from 31 – 40 years who have experience of profession more than 5 years often suffer from shoulder pain which may be associated with repetitive activity of shoulder and faulty posture while working.

scholarly journals Neuromuscular shoulder activity during exercises with different combinations of stable and unstable weight mass

2019 ◽  
Author(s):  
Omar Baritello ◽  
Mina Khajooei ◽  
Tilman Engel ◽  
Stephan Kopinski ◽  
Andrew Quarmby ◽  
...  
Keyword(s):  
Muscle Activation ◽  
External Rotation ◽  
Muscular Activity ◽  
Shoulder Injury ◽  
Serratus Anterior ◽  
Maximal Voluntary Isometric Contraction ◽  
Cross Sectional ◽  
Neuromuscular Activity ◽  
Custom Made ◽  
Flexion Extension

Abstract Background:Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand. Methods:Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 sec.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different training conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root mean square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR : U.TA/L.TA; U.TA/SA) and contraction (CR : concentric/eccentric) ratios were analyzed (paired t-test; a = 0.05; Bonferroni adjusted a = 0.008). Results:PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p> 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles. Conclusion:Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an unstable weight mass increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.

Subscapularis Trigger Points as a Predictor for Frozen Shoulder Syndrome: Correlation Study

2020 ◽  
Vol 8 (4) ◽  
pp. 1447-1449
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Frozen Shoulder ◽  
Pressure Pain Threshold ◽  
Trigger Points ◽  
Correlation Study ◽  
Shoulder Abduction ◽  
Shoulder Region ◽  
Shoulder Syndrome ◽  
Restrict Movement

Trigger points in the shoulder region muscles restrict movement of shoulder and create pain on movement and at rest. The key muscle that must be examined is the subscapularis muscle. The aim of this study is to investigate the relationship between subscapularis trigger with shoulder pain, shoulder abduction and shoulder external rotation. 50 patients diagnosed with frozen shoulder. Data obtained regarding pressure pain threshold (PPT) using pressure algometry, shoulder pain and disability index (SPADI)using questionnaire, shoulder abduction and external rotation ROM using digital inclinometer were statistically analysed and compared. Strong negative significant correlation between PPT with SPADI, strong positive significant correlation between PPT with shoulder abduction and external rotation. Subscapularis trigger points in patients with frozen shoulder affect shoulder pain, shoulder abduction, and external rotation.

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