Does the critical shoulder angle decrease after acromioplasty? A systematic review and meta-analysis

Background Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications. Methods A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis. Results A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 (p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] (p < 0.00001). Conclusions Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.

Evaluation of a four-week Adjunct Compensatory Training for the treatment of climbing-specific overstrain syndromes of the shoulder

Background Although climbing is an increasingly popular sport, there is a lack of scientific evaluation of suitable training methods for climbers, especially with a view to prevention and rehabilitation. A specific rehabilitation program, Adjunct Compensatory Training (ACT), has recently been presented, but it has not been evaluated scientifically to date. Objective To investigate the effects of Adjunct Compensatory Training on climbing-specific overstrain syndromes of the shoulder. Methods Twenty active boulderers and climbers with an average age of 28.9 (± 7.4) years performed a guided shoulder program of six specific exercises from the ACT program over a period of four weeks. They were examined before and after the intervention. Pre- and post-interventional measurements included the Constant-Murley Score, the QuickDASH Score and the measurement of shoulder ROM (range of motion). Results The Constant-Murley Score increased from 82 (± 10.0) to 104.1 (± 8.2) at follow-up (p < 0.001). The VAS value for bouldering and climbing decreased from 5.25 (± 1.4) before to 2.4 (± 1.6) after the intervention (p < 0.001). Shoulder flexion increased from 167.5 (± 14.9) to 173.1 (± 7.7) after the intervention (p < 0.05), abduction from 172.5 (± 14.9) to 179.6 (± 5.9) (n. s.), external rotation from neutral zero position from 77.6 (± 16.8) to 86.3 ± (8.3) (p < 0.05). Feasibility and acceptance of the intervention were good. Ninety-five percent of the participants continued to exercise, and 100 percent recommended the program to others. Conclusion The ACT led to an improvement in pain, activities of daily living, range of motion and strength in boulderers and climbers with overstrain symptoms of the shoulder. It is also classified as a realistically feasible workout. The extent to which this effect will continue, and whether or not the program can prevent injuries, remains to be seen. It can only be presumed that regular exercises prevent shoulder injuries in the climbing population.

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

Isolating In-Situ Grip and Push Force Distribution from Hand-Handle Contact Pressure with an Industrial Electric Nutrunner

Objectives: Grip force during hand tool operation is the primary contributor to tendon strain and related wrist injuries, whereas push force is a contributor to shoulder injuries. However, both cannot be directly measured using a single measurement instrument. The objective of this research was to develop and test an algorithm to isolate the grip and push force distributions from in-situ hand-handle pressure measurements and to quantify their distributions among industrial workers using an electric nutrunner. Methods: Experienced automobile assembly line workers used an industrial nutrunner to tighten fasteners at various locations and postures. The pressure applied by the hand on the tool handle was measured dynamically using pressure sensors mounted on the handle. An algorithm was developed to compute the push force applied to the handle of an electric pistol-grip nutrunner based on recorded pressure measurements. An optimization problem was solved to find the contribution of each measured pressure to the actual pushing force of the tool. Finally, the grip force was determined from the difference between the measured pressure and the calculated pushing pressure. Results: The grip force and push force were successfully isolated and there was no correlation between the two forces. The computed grip force increased from low to high fastener locations, whereas the push force significantly increased during overhead fastening. A significant difference across the participants’ computed grip forces was observed. The grip force distribution showed that its contribution to total hand force was larger than other definitions in the literature. Conclusions: The developed algorithm can aid in better understanding the risk of injury associated with different tasks through the notion of grip and push force distribution. This was shown to be important as even workers with considerable power tool experience applied significantly more grip and push force than other participants, all of whom successfully completed each task. Moreover, the fact that both forces were uncorrelated shows the need for extracting them independently.

Risk Factors of Shoulder and Elbow Injuries in Baseball: A Scoping Review of 3 Types of Evidence

Background: Shoulder and elbow overuse injuries are the most common problems in baseball players. No scoping review has compared the findings from different types of evidence. Purpose: To map the broad evidence from 3 types of evidence (epidemiological, biomechanical, and narrative) on potential risk factors for shoulder and elbow injuries in baseball and identify gaps in the existing literature to guide future research. Study Design: Scoping review. Methods: Eight electronic databases were searched from inception to May 14, 2020. Any peer-reviewed papers that investigated or discussed potential risk factors for shoulder and elbow injuries in baseball were included. Results: A total of 302 studies (107 epidemiological studies, 85 biomechanical studies, and 110 narrative reviews) were included. Risk factors were categorized into 9 domains: sports profiles, physical characteristics/functions, pitching mechanics, performance, behavioral, psychosocial, biological and developmental, injury/sports profiles, and environmental factors. Studies were consistent in supporting limited shoulder range of motion (ROM) and player positions (pitchers or catchers) as risk factors for shoulder injuries. For elbow injuries, the majority of the included studies suggested that being pitchers or catchers and working with higher ball velocity can be risk factors. Conclusion: Findings were consistent in some risk factors, such as limited shoulder ROM and positions. However, findings were inconsistent or limited for most factors, and substantial research gaps were identified. Research assessing those factors with inconsistent or limited evidence in the current literature were recognized to be priorities for future studies.

Surveillance of Injury Types, Locations, and Intensities in Male and Female Tennis Players: A Content Analysis of Online Newspaper Reports

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players’ economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Biomechanical characteristics of scapula and glenohumeral movements during pitching motion in injury-prone college baseball pitchers

Coordination of glenohumeral and scapular movements plays an important role in the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated glenohumeral and scapular movements. Therefore, the objectives of the present study were to demonstrate biomechanical differences in scapular and glenohumeral movements during pitching between injury-prone pitchers and healthy college baseball pitchers. Thirty collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (N=15, 20.7±1.4 years, 180.1±6.5 cm, 78.9±5.4 kg) and control group (N=15, 20.9±1.1 years, 177.1±6.6 cm, 72.3±6.7 kg). We obtained the pitching motion data using the three-dimensional motion analysis technique with four high-speed cameras. The horizontal abduction angles of the glenohumeral joint during cocking and acceleration phases were significantly greater in injury-prone pitchers [19.0° (95% CI: 14.4–23.6) at foot contact, −4.0° (95% CI: −7.7 to −0.2) at maximum external rotation (MER), and −0.3° (95% CI: −4.8 to −4.2) at ball release] than in healthy controls [11.7 °(95%CI:7.1 to 16.3) at foot contact, −10.0°(95%CI: −13.7 to −6.3) at MER, and −6.9°(95%CI: −11.4 to −2.4)]( p <0.01). In addition, the external rotation angle (ER) of the scapula at MER was significantly greater in the injury-prone group [−0.1° (95% CI: −5.0 to 4.8)] than in the control group [−12.3° (95% CI: −17.2 to −7.4)] (p<0.01), but there was no difference in the scapular ER during foot contact between the two groups. These results suggests that injury-prone pitchers have less internal rotation of the scapula and more horizontal abduction of the glenohumeral joint during cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay more attention to coordination of scapular and glenohumeral movements during the cocking and acceleration phases of pitching for prevention of shoulder injuries.

Perceptions and Attitudes Towards Shoulder Padding and Shoulder Injury in Rugby Union

Purpose To develop an understanding of the role of shoulder padding in rugby union by investigating player perceptions and attitudes towards shoulder padding and extending research into shoulder injuries in rugby. Methods An online survey was distributed to past and current rugby players over 13 years old in 2018. Questions related to the participants’ demographic, attitudes to shoulder padding and shoulder injury history. Results Six hundred and sixteen rugby players responded to the survey; 66.1% of respondents had worn shoulder padding at some point. The age group 24–29 years old (∆R2 = 0.03, B = − 0.53, P = 0.015) had an inverse association with padding effectiveness while playing experience groups 1–2 years (∆R2 = 0.03, B = 0.8, P = 0.032), 3–5 years (∆R2 = 0.03, B = 0.70, P = 0.002) and 6–9 years (∆R2 = 0.03, B = 0.41, P = 0) had a positive association. There are 37.1% of respondents considering shoulder padding to be effective at preventing cuts and abrasions with 21.9% finding it very effective; 50.3% considered it to be effective or very effective (9.7%) at preventing contusion; 45.5% wore padding for injury prevention, while 19.2% wore padding to protect from reoccurring injury. Sprain/ligament damage (57.5%) and bruising (55.5%) were the most commonly reported injuries. Conclusions The primary reason for wearing shoulder padding was as a means of injury prevention. Research should focus on quantifying the injury preventive capabilities of shoulder padding. Bruising, cuts and abrasion injuries to the shoulder are prevalent presenting new findings that these injuries are underreported.