Relations of Standing Spinal Sagittal Alignment with Scapular Position and Glenohumeral Joint Abduction Range of Motion

Abstract Background There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables. Results In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p < 0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (− 25.6 vs − 12.1, p < 0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001). Conclusion Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease. Trial registration This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018–11-007).

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Shoulder Range of Motion and Strength Characteristics in Circus Acrobats

Medical Problems of Performing Artists ◽

10.21091/mppa.2020.3025 ◽

2020 ◽

Vol 35 (3) ◽

pp. 145-152

Author(s):

Carlie Huberman ◽

Melissa Scales ◽

Srikant Vallabhajosula

Keyword(s):

General Population ◽

Range Of Motion ◽

Glenohumeral Joint ◽

External Rotation ◽

Hand Dominance ◽

Cross Sectional ◽

Shoulder Range Of Motion ◽

Shoulder Strength ◽

Shoulder Complex ◽

Shoulder Range

OBJECTIVES: To begin to establish normative data for shoulder range of motion (ROM) and strength in the circus acrobats and to compare these values based on age, sex, hand dominance, and acrobatic subgroup. METHODS: Active (AROM) and passive (PROM) of the full shoulder complex and PROM of the isolated glenohumeral joint were measured in 193 circus acrobats using standardized techniques for anterior elevation (flexion), posterior elevation (extension), lateral elevation (abduction), and external and internal rotation. Shoulder strength was measured using a hand-held dynamometer in all planes of motion. Measurements were taken twice and averaged. Mixed ANOVA were performed. One-sample t-tests were used to compare with general population. RESULTS: Several significant differences were noted between dominant and non-dominant sides, but not between the sex or age groups tested. Acrobats who did both aerial and ground acrobatics had significantly greater full shoulder complex flexion AROM than the aerial group, and AROM extension than the ground group. Circus acrobats had significantly greater AROM full shoulder complex extension, abduction, internal and external rotation, and shoulder strength than the general population. CONCLUSION: Overall, results from this cross-sectional study revealed that circus acrobats had greater shoulder strength and ROM than the general population, which could affect the way these patients should be treated in a clinical setting. Age and sex seemed to have minimal effects, but there was clearly an effect of hand dominance. Acrobats who train both aerial and ground acrobatics may have greater ROM in certain planes than those who train in only one type of discipline.

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COMPARISON OF GLENOHUMERAL JOINT ROTATION RANGE OF MOTION IN YOUNG ATHLETES

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220192501141465 ◽

2019 ◽

Vol 25 (1) ◽

pp. 53-57

Author(s):

Felipe Ribeiro Pereira ◽

Gabriela G. Pavan Gonçalves ◽

Deborah Rocha Reis ◽

Izabel C. P Rohlfs ◽

Luciana De Michelis Mendonça ◽

...

Keyword(s):

Range Of Motion ◽

Functional Performance ◽

Glenohumeral Joint ◽

Young Athletes ◽

Level Of Evidence ◽

Joint Rotation ◽

Shoulder Range Of Motion ◽

Medial Rotation ◽

Lateral Rotation ◽

Overhead Throwing

ABSTRACT Introduction: Overhead-throwing athletes undergo changes in shoulder range of motion (ROM) due to sports activities, such as excessive amplitude, lateral rotation (LR) increase and medial rotation (MR) restriction. Asymmetry greater than 20° may render athletes more prone to injuries. There are similarities among sports featuring overhead throwing due to the considerable amount of movements involving maximum lateral rotation. In these sports, medial rotation (MR) restriction, excess of lateral rotation (LR) and shoulder pain are common, particularly in overhead-throwing athletes. Objective: To assess shoulder MR and LR ROM in athletes participating in different sports, considering the influence of these variables on injuries and functional performance. Methods: The rotation ROM of the glenohumeral joint was assessed in 477 young athletes, who were categorized in three sports groups: swimming, overhead-throwing and non-overhead throwing, distributed by age group. Analyses of Variance (ANOVA) were performed to verify if there were differences in MR and LR between groups and paired Student t test was used to verify differences between sides (asymmetry). Results: Youngest athletes showed significant shorter LR than the oldest, in both sides. This study demonstrated that the right side has less MR and greater LR in all groups. Conclusion: The findings showed that overhead-throwing and swimming groups have similarities in shoulder rotation ROM. Level of evidence III; Diagnostic Studies - Investigating a Diagnostic Test.

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Vacuum phenomenon in the shoulder of a child

BMJ Case Reports ◽

10.1136/bcr-2018-226724 ◽

2019 ◽

Vol 12 (3) ◽

pp. e226724

Author(s):

Partha Ray ◽

Ian CC King ◽

Philip Stephen William Thomas

Keyword(s):

Range Of Motion ◽

Glenohumeral Joint ◽

Full Range ◽

Left Shoulder ◽

Left Clavicle ◽

Plain Radiographs ◽

Vacuum Phenomenon ◽

Open Injury ◽

Life Threatening ◽

Greenstick Fracture

A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.

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Spinal sagittal alignment and head control in patients with cerebral palsy

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190160 ◽

2020 ◽

Vol 14 (1) ◽

pp. 17-23 ◽

Cited By ~ 1

Author(s):

Brice Ilharreborde ◽

Adrien de Saint Etienne ◽

Ana Presedo ◽

Anne-Laure Simon

Keyword(s):

Cerebral Palsy ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sacral Slope ◽

Trunk Control ◽

Level Of Evidence ◽

Sagittal Vertical Axis ◽

Spinal Sagittal Alignment ◽

Trunk Posture ◽

Radiological Analysis

Purpose Spinal sagittal alignment restoration has been associated with improved functional outcomes and with reduced complications rates. Several limitations exist for radiological analysis in cerebral palsy (CP) patients. The goal of this study was to summarize the existing literature and report the important considerations to evaluate in a CP patient undergoing spinal surgery. Methods A retrospective radiological analysis was performed, including non-ambulant CP children with progressive scoliosis. Full-spine sitting radiographs performed pre-and postoperatively were required to measure spino-pelvic sagittal parameters. Result A total of 23 non-ambulating CP patients were included, mean age 16.0 years (standard error of the mean 0.5). Two distinct groups of patients were identified. Group 1 (61%) were patients with less trunk control (lumbar lordosis (LL) < 50°), retroverted and vertical pelvis (mean sacral slope (SS) 11.4° and pelvic tilt (PT) 38.1°) and anterior imbalance (mean sagittal vertical axis (SVA) 5.9 cm) and Group 2 (39%) were patients with better trunk control (LL > 60°, anteverted and horizontal pelvis (mean SS 49.3°, PT 9.7°) and posterior imbalance (mean SVA 5.8 cm). Postoperative measures showed significant impact of surgery with a PT reduction of 19° (p = 0.007), a mean SS increase of 15° (p = 0.04) and a LL gained of 10° (p = 0.2). Conclusion Sagittal spino-pelvic alignment in non-ambulating CP patients remains difficult to assess. The current literature is poor but our radiological study was able to define two distinct groups among Gross Motor Function Classification System (GMFCS) level V patients, based on the quality of their trunk control. All possible factors that may influence head and trunk posture should be systematically considered and optimized. Level of evidence Level IV

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Can hemi shoulder arthroplasty restore the normal range of motion in activities of daily living in patients with degenerative osteoarthritis of the glenohumeral joint? A prospective 3D Video Motion Analysis Study

Gait & Posture ◽

10.1016/j.gaitpost.2013.07.065 ◽

2013 ◽

Vol 38 ◽

pp. S31-S32 ◽

Cited By ~ 2

Author(s):

Michael W. Maier ◽

Mirjam Niklasch ◽

Thomas Dreher ◽

Felix Zeifang ◽

Oliver Rettig ◽

...

Keyword(s):

Activities Of Daily Living ◽

Range Of Motion ◽

Motion Analysis ◽

Shoulder Arthroplasty ◽

Daily Living ◽

Glenohumeral Joint ◽

Normal Range ◽

Degenerative Osteoarthritis ◽

Analysis Study ◽

Video Motion Analysis

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Changes in Abduction and Rotation Range of Motion in Response to Simulated Dorsal and Ventral Translational Mobilization of the Glenohumeral Joint

Physical Therapy ◽

10.1093/ptj/82.6.544 ◽

2002 ◽

Vol 82 (6) ◽

pp. 544-556 ◽

Cited By ~ 24

Author(s):

Ar-Tyan Hsu ◽

Tom Hedman ◽

Jia Hao Chang ◽

Chuong Vo ◽

Larry Ho ◽

...

Keyword(s):

Range Of Motion ◽

Glenohumeral Joint ◽

Physical Therapists ◽

Frozen Shoulder ◽

Testing System ◽

Before And After ◽

Medial Rotation ◽

Fresh Frozen ◽

Lateral Rotation ◽

Improved Function

AbstractBackground and Purpose. Translational mobilization techniques are frequently used by physical therapists as an intervention for patients with limited ranges of motion (ROMs). However, concrete experimental support for such practice is lacking. The purpose of the study was to evaluate the effect of simulated dorsal and ventral translational mobilization (DTM and VTM) of the glenohumeral joint on abduction and rotational ROMs. Methods. Fourteen fresh frozen shoulder specimens from 5 men and 3 women (mean age=77.3 years, SD=10.1, range=62–91) were used for this study. Each specimen underwent 5 repetitions of DTM and VTM in the plane of scapula simulated by a material testing system (MTS) in the resting position (40° of abduction in neutral rotation) and at the end range of abduction with 100 N of force. Abduction and rotation were assessed as the main outcome measures before and after each mobilization procedure performed and monitored by the MTS (abduction, 4 N·m) and by a servomotor attached to the piston of the actuator of the MTS (medial and lateral rotation, 2 N·m). Results. There were increases in abduction ROM for both DTM (X̄=2.10°, SD=1.76°) and VTM (X̄=2.06°, SD=1.96°) at the end-range position. No changes were found in the resting position following the same procedure. Small increases were also found in lateral rotation ROM after VTM in the resting position (X̄=0.90°, SD=0.92°, t=3.65, P=.003) and in medial rotation ROM after DTM (X̄=0.97°, SD=1.45°, t=2.51, P=.026) at the end range of abduction. Discussion and Conclusion. The results indicate that both DTM and VTM procedures applied at the end range of abduction improved glenohumeral abduction range of motion. Whether these changes would result in improved function could not be determined because of the use of a cadaver model.

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Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years

Journal of Neurosurgery Spine ◽

10.3171/2009.7.spine0946 ◽

2009 ◽

Vol 11 (6) ◽

pp. 688-695 ◽

Cited By ~ 26

Author(s):

Poong-Gi Ahn ◽

Keung Nyun Kim ◽

Sung Whan Moon ◽

Keun Su Kim

Keyword(s):

Cobb Angle ◽

Range Of Motion ◽

Early Phase ◽

Sagittal Alignment ◽

Late Phase ◽

Total Disc Replacement ◽

Disc Replacement ◽

Cage Group ◽

Adjacent Segments

Object This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc. Methods Eighteen patients who underwent C5–6 total disc replacement were followed for an average of 27 months. Cervical neutral and flexion-extension lateral radiographs were obtained before and at 1 and 3 months after surgery for early-phase observations and at the last follow-up for late-phase observation. Segmental ROM values in the treated, superior, and inferior adjacent segments were measured. For whole-neck motion, C2–7 ROM was also measured. The percentage contributions of ROM at functional and adjacent segments to whole-neck motion were calculated. For evaluating sagittal alignment, C2–7 and C5–6 Cobb angles were measured. All data from ProDisc-C arthroplasty were compared with the results obtained in 22 patients who underwent C5–6 interbody fusion in which a Solis cage was used and who were followed for an average of 25 months Results In the ProDisc-C group, C2–7 and C5–6 ROM significantly decreased in the early phase after surgery and returned to preoperative levels in the late phase. Both superior and inferior adjacent segments showed significantly decreased ROM in the acute phase after surgery and returned to the preoperative values in the late phase. In terms of contributions to whole-neck motion, the ROM of the functional and adjacent segments did not change significantly compared with the preoperative ROM. In the cage group, C2–7 ROM was also significantly decreased in the early phase after surgery and returned to preoperative levels at the late phase. Both superior and inferior adjacent segments exhibited significantly increased ROM and percentage contributions to whole-neck motion in the early and late phases. Sagittal alignment of the whole cervical spine became significantly more lordotic in the late phase in the ProDisc-C group. The C5–6 Cobb angle became significantly lordotic in the ProDisc-C group, whereas there was no significant change in C5–6 Cobb angle in the cage group. Conclusions In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.

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