Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial

Objectives The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design Single-blind randomized clinical trial. Setting Outpatient setting. Subjects Patients with frozen shoulder. Intervention Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45–40.13) vs. 10.17 (1.02–19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. Conclusions Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.

Effectiveness of Acromioclavicular Joint Mobilization and Physical Therapy vs Physical Therapy Alone in Patients with Frozen Shoulder: A Randomized Clinical Trial

Background: Frozen shoulder (FS) is a prevalent musculoskeletal condition characterized by an often prolonged pain, disability and limited active and passive range of motion (ROM), however its management remains challenging yet. The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and physical therapy versus physical therapy in treatment of FS.Methods: In this single-blind randomized clinical trial, patients with diagnosis of FS were randomly allocated into mobilization + physical therapy (n=28) as experiment group, and physical therapy (n=28) as control group in two outpatient clinics of Tabriz University of Medical Sciences, Iran. The primary outcomes were self-reported shoulder pain-related disability measured by the Shoulder Pain and Disability Index (SPADI) questionnaire and goniometric assessment of shoulder ROM. The secondary outcome was the Visual Analogue Scale (VAS). Measures were performed at the baseline, immediately and one month after beginning the treatments.Results: Totally 51 patients with 25.73 ± 6.88 years old of age completed the study and their data were analyzed. VAS, SPADI, pain and disability improved more significantly in experiment group compared to control group immediately [-4.63 (-5.58- -3.67) vs. -2.22 (-2.96- -1.47), p<0.001; -23.08 (-28.63- -17.53) vs. -13.04 (-17.93- -8.16), p=0.008; -26.00 (-31.71- -20.29) vs. -16.35 (-23.39- -9.31), p=0.034 and -21.25 (-29.11- -13.39) vs. -10.98 (-17.53- -4.43), p=0.042, respectively] and one month after beginning of treatment [-5.58 (-6.45- -4.72) vs. -3.61 (-4.60- -2.62), p<0.001; -33.43 (-40.85- -26.01) vs. -20.03 (-26.00- -14.07), p=0.001; --42.83 (-49.09- -36.57) vs. -25.57 (-33.92- -17.21), p<0.001 and -27.55 (-36.19- -15.94) vs. -16.58 (-24.48- -8.67), p=0.041, respectively]. Active abduction ROM was also improved more significantly immediately after treatment in experiment group compared to control group [25.83 (11.45- 40.13) vs. 10.17 (1.02- 19.15), p=0.025], however there were no significant differences between two groups concerning other measured ROMs immediately and one month after treatment (all p>0.05). Conclusions: Acromioclavicular mobilization along with conventional physical therapy was more efficient in decreasing pain and disability and improving active abduction ROM compared to physical therapy in patients with FS. These findings would suggest a new therapeutic method for shoulder disorders with pain and disability.Trial registrationwww.irct.ir, IRCT20100605004104N7, registered 06.01.2019 (https://www.irct.ir/trial/35900)

Quantitative assessment of normal middle deltoid muscle elasticity at various arm abduction using ultrasound shear wave elastography

The objective of this study is to assess the change in the normal MD elasticity using shear wave elastography (SWE) through measuring the middle deltoid (MD) elasticity in healthy participants at various arm abduction (with bilateral arms at 0 degrees abduction and 90 degrees active abduction) and analyzing the factors affecting normal MD elasticity. Mean shear wave velocity (SWV) of the MD in healthy right-handed participants were evaluated using SWE at different arm abduction, and potential factors (gender, MD thickness, age, body mass index) affecting MD elasticity were analyzed. Different arm abduction positions of each participant were as follows: (i) 0° abduction of bilateral arm (L0° and R0°), (ii) 90° active abduction of bilateral arm (L90° and R90°). Mean SWV was significantly higher at L90° than L0°, higher at R90° than R0°, higher at R0° than L0°, and higher at R90° than L90° (all P < 0.0001). SWV was significantly higher in males at both L0° (P < 0.05) and R0° (P < 0.01) than in females. Neither MD thickness, age nor body mass index influenced MD elasticity. Reference ranges of normal MD elasticity were 2.4–3.1 m/s in males and 2.2–2.9 m/s in females at L0° and 2.5–3.3 m/s in males and 2.4–3.2 m/s in females at R0°, and were 4.9–6.7 m/s at L90°, 5.2–7.1 m/s at R90° for both males and females. SWE is a feasible technique to assess normal MD elasticity at various arm abduction. Our results suggest that normal MD elasticity at L0°, R0°, L90°, and R90° with SWE are different. Moreover, these reference ranges may serve as quantitative baseline measurements for assessment of normal MD elasticity in the future.

The impact of mobilization on hip osteoarthritis

BACKGROUND: Osteoarthritis is one of the most common joint disorders. It causes pain, stiffness and a decreased range of motion which have a significant impact on daily activities and gait, consequently leading to disability. OBJECTIVE : The aim of this study is to compare hip mobilization with non-weight bearing exercises. METHODS: A total of 57 females aged between 55–65 were divided into 2 groups. In the control group non-weight bearing exercises were conducted, whereas the research group received hip mobilization. RESULTS: The Lequesne index significantly improved in the research group as compared with the control group. Hip function improved both in the control and research groups. Active hip extension increased by 0.54, while active abduction rose by 2.14 after non-weight bearing exercises. In the control group after mobilization both passive and active hip extension increased significantly by 3.53, active abduction by 5 and passive by 4.41, while active and passive internal rotation by 3.82 and 4.56, respectively. In both groups pain decreased. CONCLUSIONS: Mobilization increases hip range of motion, decreases pain and improves hip function more than non-weight bearing exercises.

Quantitative assessment of middle deltoid elasticity during different shoulder abduction using shear wave elastography: A preliminary study

Background: To measure the middle deltoid (MD) elasticity in healthy participants during different shoulder abduction (with bilateral shoulder in 0 degree abduction and 90 degree active abduction) using shear wave elastography (SWE) and analyze the factors that may affect the MD elasticity, and the objective of this study is to establish the reference ranges of normal MD elasticity during different shoulder abduction by using SWE. Methods: Mean shear wave velocity (SWV) of the MD in 70 healthy right-handed participants (35 females, 35 males) were evaluated using SWE during different shoulder abduction, and potential factors that may affect MD elasticity including gender, MD thickness, age, body mass index were analyzed. Different shoulder abduction positions of each participant were as follows: (i) 0° abduction of bilateral shoulder (L0° and R0°), (ii) 90° active abduction of bilateral shoulder (L90° and R90°). Reference ranges of normal MD elasticity were calculated using normal distribution method. Results: Mean SWV was significantly higher at L90° than L0°, higher at R90° than R0°, higher at R0° than L0°, and higher at R90° than L90° (all p< 0.0001). Mean SWV was significantly higher in males at both L0° (p< 0.05) and R0° (p< 0.01) than in females. Neither MD thickness, age nor body mass index influenced MD elasticity. Normal reference ranges of the MD elasticity were 2.4-3.1 m/s in males and 2.2-2.9 m/s in females at L0° and 2.5-3.3 m/s in males and 2.4-3.2 m/s in females at R0°, and were 4.9-6.7 m/s at L90°, 5.2-7.1 m/s at R90° for both males and females. Conclusions: Our results suggest that the normal MD elasticity at L0°, R0°, L90°, and R90° with SWE are different. A separate reference range of normal MD elasticity at L0°, R0°, L90°, and R90° should be used. Moreover, the reference ranges of normal MD elasticity at L0° and R0° shoulder be divided by gender. These values may serve as quantitative baseline measurements for assessment of normal MD elasticity.

Game Simulasi Gerakan Pasien Cedera Bahu Menggunakan Jaringan Saraf Tiruan Backpropagation

Bahu merupakan bagian dari lengan yang mudah mengalami cedera. Cedera pada bahu antara lain peradangan sendi, pergeseran tulang (dislokasi), dan bahu kaku (frozen shoulder) serta pasca stroke. Selain itu, penyebab bahu cedera karena olahraga yang menitikberatkan lengan sebagai tumpuan. Latihan terapi yang terjadwal merupakan upaya merehabilitasi bahu untuk memulihkan dan mengembalikan fungsi bahu. Namun kegiatan rehabilitasi medik memerlukan jangka waktu lama dan terkesan monoton yang berakibat menurunnya motivasi pasien dalam menjalani latihan terapi. Sementara itu, perkembangan teknologi yang memudahkan berbagai aspek kehidupan khususnya dibidang kesehatan menjadikan video game dan perangkat sensor Kinect dapat diterapkan sebagai media dalam simulasi latihan terapi cedera bahu. Penelitian ini telah membangun game simulasi sebagai visualisasi untuk mendukung latihan terapi cedera bahu dan kemampuan dalam memprediksi pemulihan cedera bahu pasien yang terbagi atas tiga kelas yaitu “Meningkat”, “Tetap”, dan “Menurun”. Pasien melakukan gerakan untuk mengontrol game dengan mengangkat lengan menjauhi garis tengah terhadap bidang frontal pada tubuh atau disebut sebagai gerakan Shoulder Active Abduction. Gerakan dilakukan oleh salah satu lengan cedera yang akan menghasilkan nilai sudut bervariasi dengan rentang 0°-180°. Gerakan yang dilakukan direkam sensor Kinect yang dapat memvisualisasikan peta gerakan kerangka tubuh atau disebut matchstick skeleton. Keluaran dari sensor Kinect berupa nilai koordinat yang direpresentasikan ke dalam nilai sudut. Data latih diperoleh dari lima naracoba yang menghasilkan nilai sudut berbeda. Nilai-nilai sudut dilakukan pelatihan menggunakan Backpropagation yang selanjutnya menghasilkan nilai akurasi. Hasil pelatihan dengan learning rate 0,01 menunjukan akurasi sebesar 82% untuk prediksi data yang sudah dilatih, sedangkan pengujian data baru menunjukan akuarasi sebesar 66,7%.

The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics

Background There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion. Methods A custom RSA implant capable of measuring forces across the joint with varying polyethylene constraint was tested in six cadaveric shoulders. Standard-, low- and high-constraint (retentive) polyethylene liners were tested, and joint kinematics, loads and muscle forces were recorded. Results When polyethylene constraint was altered, joint load and load angle during active abduction were not affected significantly ( p > 0.19). Additionally, the force required by the deltoid for active abduction was not affected significantly by cup constraint ( p = 0.144). Interestingly, active abduction range of motion was also not affected significantly by changes in cup constraint ( p > 0.45). Conclusions Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.

Range of Motion as a Predictor of Clinical Shoulder Pain During Recovery From Delayed-Onset Muscle Soreness

Context: Athletic trainers use clinical pain and range of motion (ROM) to gauge recovery after musculoskeletal injury. Limited evidence to date suggests which shoulder ROM measures can predict symptomatic relief and functional recovery after delayed-onset muscle soreness (DOMS). Objective: To determine whether shoulder passive internal rotation, passive external rotation, active abduction, and active flexion and evoked pain with abduction are associated with resting pain experienced after exercise-induced DOMS. Design: Descriptive laboratory study. Setting: Controlled research laboratory. Patients or Other Participants: A total of 110 healthy, right-hand–dominant participants (44 men: age = 25.39 ± 7.00 years, height = 178.93 ± 7.01 cm, weight = 78.59 ± 14.04 kg; 66 women: age = 22.98 ± 6.11 years, height = 164.64 ± 6.94 cm, weight = 61.86 ± 11.67 kg). Intervention(s): Participants completed an exercise-induced DOMS protocol for the external rotators of the dominant shoulder to replicate muscle injury. Main Outcome Measure(s): Current resting pain was assessed daily for 96 hours using the Brief Pain Inventory. We evaluated functional recovery with measures of ROM in abduction, internal rotation, external rotation, and flexion. Evoked pain with active abduction was reported, and the pain rating served as the dependent variable in the regression model. Results: Impairment measures explained resting pain at 48 (R2 = 0.392) and 96 hours (R2 = 0.164). Abduction and internal-rotation ROM and evoked pain with abduction predicted resting pain at 48 hours (P &lt; .001). At 96 hours, evoked pain with abduction of the injured arm (P &lt; .001) was the significant contributor to resting pain. Conclusions: These models suggest that resting pain after experimentally induced DOMS occurs at 48 hours and is associated with specific ranges of motion and evoked pain with abduction.