Search Results (372)

This study aimed to examine the proximal effects of blood flow restriction (BFR) training on shoulder muscle function and subjective discomfort during low-intensity external rotation exercise. Twenty-four healthy adults were randomly assigned to a BFR group or a control group and performed shoulder stabilization exercises with or without BFR. Outcome measures included shoulder external rotation range of motion, maximal isometric strength, muscle endurance, electromyographic activity of the rotator cuff muscles, and perceived discomfort. Both groups demonstrated significant within-group improvements in all outcomes except posterior deltoid and supraspinatus activity (p < 0.05). Between-group comparisons showed significantly greater gains in maximal strength and infraspinatus and teres minor activation in the BFR group than in the control group (p < 0.05), while discomfort and fatigue scores were also higher in the BFR group (p < 0.05). These findings suggest that BFR applied at the proximal upper arm can enhance the strength and activation of key rotator cuff muscles even when cuff placement near the shoulder is limited by anatomy. Proximal BFR may serve as an effective intervention for improving shoulder function when high-intensity exercise is contraindicated, although strategies to minimize discomfort are needed to improve clinical feasibility. Full article

Swimming research has determined that rounded shoulders, forward head, and scapular dyskinesis are common imbalances that may lead to injury without correction. This case study aimed to evaluate a preventative exercise program designed to reduce injuries, correct postural deviations, and improve shoulder function over one collegiate swimming season. Twenty female NCAA Division I swimmers (average age = 21.6 ± 1.3 years) participated over 25 weeks, completing pre-, mid-, and post-season assessments of injury rates, shoulder range of motion, and stability using standardized tests. Injuries were included as diagnosed and reported by an athletic trainer. Testing included internal rotation, external rotation, the Hawkins-Kennedy test, Neer’s sign, Sulcus sign, and the Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST). Compared to the season prior with no intervention, swimmers who completed the program were 44% less likely to sustain an upper-extremity injury, as assessed from the CKCUEST scores (p < 0.01 for all metrics), shoulder internal rotation (p < 0.01 for both shoulders), and total range of motion (p < 0.01 for both shoulders). These findings suggest that a targeted corrective exercise program can effectively reduce injury rates and improve shoulder mobility and function in collegiate athletes. The interpretation of these results is limited by the study’s non-randomized design and absence of a control group. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Results: Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Conclusions: Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches. Full article

Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions. Full article

Background: There are differing opinions in the literature regarding the optimal treatment modality for adolescents with completely displaced, complex clavicle fractures. This study aims to determine outcome differences between surgical and non-surgical treatment for adolescent Z-type clavicle fractures and to ascertain if differences exist in outcomes between the two interventions. Methods: This was a single-center, retrospective chart review performed at a level 1 trauma center. Inclusion criteria included pediatric patients ages 12 to 16 years who presented with a comminuted, displaced clavicle shaft fracture with a comminuted fragment more than 1 cm in length and were treated either operatively or nonoperatively between January 2019 and December 2022. The outcomes were radiographic union status (i.e., union versus non-union versus malunion), follow-up period, shoulder range of motion, return to athletic activities, and patient reported pain level. Results: Of the 24 patients, 11 were treated surgically and 13 non-surgically. Patients who were treated surgically were more likely to be older (mean 1.5 years, p = 0.039) and have a longer follow-up by 9 months average duration compared to the cohort treated non-surgically (p = 0.0009). There was no significant difference between patient reported pain, radiographic union status, return to athletic activity, or shoulder range of motion between the cohorts. The small sample size and retrospective study design limits the statistical power of our results. Conclusions: The decision between treating these complex fractures operatively versus nonoperatively should be left to a lengthy discussion between the surgeon, parents, and the patient. Full article

A 10-month-old Poodle was presented with intermittent non-weight-bearing lameness of the left thoracic limb. Orthopedic and radiographic examinations revealed medial shoulder luxation and markedly reduced elbow extension. A two-stage surgical approach was performed. In the first stage, selective myotomy of periarticular structures, including the biceps brachii–brachialis complex and the extensor carpi radialis muscle, was conducted via medial and lateral approaches. A trans-articular external skeletal fixator was applied to maintain elbow extension. Elbow extension improved from 105° preoperatively to 142°. After confirming functional recovery of the elbow joint, the second stage involved shoulder arthrodesis using a circular osteotomy technique with a radial saw, which enabled fine-tuned intraoperative adjustment of limb alignment based on the contralateral limb posture. At nine months postoperatively, the patient exhibited a symmetrical gait, full weight-bearing, and no evidence of discomfort on range of motion assessment. This case highlights the clinical relevance of secondary elbow contracture associated with congenital shoulder instability and suggests that a combination of targeted muscle release and adjustable arthrodesis may offer favorable outcomes in managing complex joint dysfunction. Full article

This scoping review assessed the current use of wearable sensors in monitoring recovery following reverse shoulder arthroplasty (RSA). A systematic search of electronic databases was undertaken (MEDLINE, EMBASE, CINAHL, and Web of Science) between 2005 and 2024 following the PRISMA-ScR protocol. Studies were eligible if they were peer reviewed, available in full text, and reported the use of wearable sensors to evaluate shoulder motion or activity in postoperative RSA patients. Fifty-seven studies were identified, of which six met the inclusion criteria. Studies were either focused on assessing shoulder motion (n = 3) or on measuring upper limb activity counts or activity intensities (n = 3); however the calculation of output variables were different across most studies. Sensors were positioned on the operated upper arm in all studies, though sensor placement on the sternum and the wrist varied. Session durations ranged from 24 h to continuous monitoring beyond seven days. Daily wear times were most commonly during full waking hours. The large variation in wearable sensor configuration, testing protocols, and the calculation of output variables limited the comparability across studies. Standardization in sensor protocols and outcomes is required to enable the reliable wearable assessment of postoperative recovery after RSA. Full article

Background: Radial shock wave therapy (RSWT) has increasingly been integrated into treatment protocols for adhesive capsulitis. While associations with diabetes and other systemic disorders are well documented, the role of obesity remains underexplored, particularly in relation to RSWT outcomes. Methods: Forty patients with adhesive capsulitis completed a 10-day treatment protocol combining RSWT with conventional physiotherapy. Pain (VAS), disability (SPADI), and range of motion (ROM) were assessed at baseline and immediately after treatment. At one-month follow-up, VAS and SPADI were reassessed alongside the Patient Global Impression of Change (PGIC). Correlations between body mass index (BMI) and clinical outcomes were analyzed, and potential confounding effects of comorbidities and affected-side dominance were examined. Clinical relevance was assessed using minimal clinically important differences (MCID) and effect sizes (Cohen’s d). Results: All clinical outcomes improved significantly post-treatment and at follow-up, with most changes exceeding MCID thresholds and showing large effect sizes. Higher BMI was significantly correlated with greater improvements in SPADI, VAS, shoulder extension, and internal rotation. Most comorbidities were negatively associated with outcomes, except neurologic conditions, which supported mobility improvement. Conclusions: RSWT appears effective in alleviating symptoms of adhesive capsulitis. The observed association between higher BMI and greater mobility improvement suggests potential benefits in overweight and obese patients. These findings warrant further investigation. Full article

(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific validation. This study presents a novel motion analysis protocol featuring a customized marker set, aimed at assessing UL movements in the three anatomical planes across different age groups, with a focus on pediatric applicability. (2) Materials and Methods: A SmartDX motion capture system was used, with 30 markers positioned on the upper body, referencing the trunk as the root of the kinematic chain. Ten healthy participants (mean age: 18.69 ± 12.45 years; range: 8.0–41.4) without UL impairments were recruited. The broad age range was intentionally selected to assess the protocol’s transversal applicability. (3) Results: Results showed excellent intra-operator reliability for shoulder and wrist kinematics (ICC > 0.906) and good reliability for elbow movements (ICC > 0.755). Inter-operator reliability was good to excellent (shoulder ICC > 0.958; elbow ICC > 0.762; wrist ICC > 0.826) Usability, measured via the System Usability Scale, was rated as good (83.25). (4) Conclusions: The proposed protocol demonstrated strong reliability and practical usability, supporting its adoption in clinical and research settings. Its design allows for adaptability across motion capture platforms, promoting wider implementation in pediatric UL functional assessment. Full article

The assessment of upper limb (UL) movement patterns plays a critical role in the rehabilitation of individuals with motor impairments resulting from neuromotor disorders, which significantly affect essential activities of daily living (ADLs) such as drinking and eating. However, conventional clinical evaluation methods often lack objective and quantitative insights into the biomechanics of movement. To enable accurate identification of pathological patterns, it is first necessary to establish normative biomechanical and electrophysiological benchmarks in healthy individuals. In this study, a previously developed, low-cost, wearable, and portable prototype device was employed to objectively assess UL movement. The system, specifically designed for clinical applicability, integrates surface electromyography (EMG) sensors and an inertial measurement unit (IMU) to capture muscle activity and kinematic data, respectively. Thirty healthy participants were recruited to perform standardized drinking and eating tasks. The analysis focused on characterizing muscle activation patterns and joint range of motion during different task phases. Results revealed consistent variations in muscle contraction and joint kinematics, allowing the identification of distinct activation profiles for key shoulder muscles. The findings contribute to the establishment of a normative dataset that can serve as a reference for the assessment of clinical populations. Such data are essential for informing rehabilitation strategies and developing predictive models of UL function during ADLs in individuals with neuromotor disorders. Full article

Background: The management of irreparable posterosuperior rotator cuff tears with an isolated loss of external rotation presents significant challenges. Latissimus dorsi tendon transfer in conjunction with medialized reverse total shoulder arthroplasty has been employed to rectify external rotation deficits; however, lateralized RTSA designs may yield similar outcomes with a reduced incidence of complications. The objective of this study was to compare the clinical outcomes of lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer against medialized RTSA with LDT in patients with ILER and a positive external rotation lag sign. Methods: This retrospective cohort study involved 34 patients diagnosed with CTA and severe external rotation deficiency, characterized by a positive ER lag sign and 0° active ER. The patients were treated with either lateralized reverse total shoulder arthroplasty (n = 21) or medialized RTSA with LDT (n = 13). Outcomes evaluated preoperatively and at the 24-month follow-up comprised range of motion, ER lag sign, Constant–Murley Score, SPADI, and radiographic offset parameters. Statistical analyses were adjusted for age, sex, and baseline values. Results: At follow-up, 70% of patients undergoing lateralized RTSA exhibited resolution of ER lag, compared to 23% in the LDT group (p < 0.05). Active external rotation improvement was more significant in the LDT group (34.6° compared to 18.5°, p < 0.05). However, both groups exhibited comparable final external rotation and functional scores (CMS: 63 ± 9 vs. 63 ± 16; SPADI: 73 ± 20 vs. 74 ± 22). Lateralized RTSA demonstrated superior preservation of internal rotation, as evidenced by a higher percentage of patients achieving a negative Apley scratch test (67% compared to 23%, p < 0.05). A greater glenoidal offset correlated with improved postoperative external rotation and resolution of external rotation lag. The influence of teres minor integrity was more significant in the LDT group. Conclusions: Lateralized reverse total shoulder arthroplasty without latissimus dorsi tendon transfer provides similar functional restoration of external rotation in irreparable posterosuperior rotator cuff tear patients, accompanied by reduced complications, shorter surgical durations, and improved preservation of internal rotation. LDT has the potential to provide enhanced ER gains from a low baseline; however, it is characterized by increased invasiveness and technical complexity. Prosthetic lateralization is a biomechanically effective method for restoring external rotation in patients with rotator cuff arthropathy and external rotation deficits. Full article

During the coronavirus 2019 pandemic, sports activities were restricted, raising concerns about their impact on the physical condition of adolescent athletes, which remained largely unquantified. This study was designed with two primary objectives: first, to precisely quantify and elucidate the differences in the physical condition of adolescent athletes before and after activity restrictions due to the pandemic; and second, to innovatively develop and validate a non-contact medical checkup application. Medical checks were conducted on 563 athletes designated for sports enhancement. Participants were junior high school students aged 13 to 15, and the sample consisted of 315 boys and 248 girls. Furthermore, we developed a smartphone application and compared self-checks using the application with in-person checks by orthopedic surgeons to determine the challenges associated with self-checks. Statistical tests were conducted to determine whether there were statistically significant differences in range of motion and flexibility parameters before and after the pandemic. Additionally, items with discrepancies between values self-entered by athletes using the smartphone application and values measured by specialists were detected, and application updates were performed. Student’s t-test was used for continuous variables, whereas the chi-square test was used for other variables. Following the coronavirus 2019 pandemic, athletes were stiffer than during the pre-pandemic period in terms of hip and shoulder joint rotation range of motion and heel–buttock distance. The dominant hip external rotation decreased from 53.8° to 46.8° (p = 0.0062); the non-dominant hip external rotation decreased from 53.5° to 48.0° (p = 0.0252); the dominant shoulder internal rotation decreased from 62.5° to 54.7° (p = 0.0042); external rotation decreased from 97.6° to 93.5° (p = 0.0282), and the heel–buttock distance increased from 4.0 cm to 10.4 cm (p < 0.0001). The heel–buttock distance and straight leg raising angle measurements differed between the self-check and face-to-face check. Although there are items that cannot be accurately evaluated by self-check, physical condition can be improved with less contact by first conducting a face-to-face evaluation under appropriate guidance and then conducting a self-check. These findings successfully address our primary objectives. Specifically, we demonstrated a significant decline in the physical condition of adolescent athletes following pandemic-related activity restrictions, thereby quantifying their impact. Furthermore, our developed non-contact medical checkup application proved to be a viable tool for monitoring physical condition with reduced contact, although careful consideration of measurable parameters is crucial. This study provides critical insights into the long-term effects of activity restrictions on young athletes and offers a practical solution for health monitoring during infectious disease outbreaks, highlighting the potential for hybrid checkup approaches. Full article

This study aimed to compare isometric strength, range of motion (RoM), and strength ratios of shoulder internal and external rotators between female volleyball and hand ball players Twenty-five volleyball players (age = 21.8 ± 4.8 years, height = 178.5 ± 7.1 cm, mass = 69.3 ± 7.7 kg) and twenty-four handball players (age = 19.5 ± 2.9 years, height = 169.7 ± 6.4 cm, mass = 67.6 ± 8.4 kg), all competing in the Slovenian 1st national league, participated. Maximal isometric strength and passive RoM of internal and external rotation were measured bilaterally using a handheld dynamometer and goniometer, respectively. A significant group × side interaction was observed for internal rotation RoM (F = 5.41; p = 0.024; η² = 0.10), with volleyball players showing lower RoM on the dominant side (p = 0.001; d = 0.89), but this was not the case for handball players (p = 0.304). External rotation strength also showed a significant interaction (F = 9.34; p = 0.004; η² = 0.17); volleyball players were stronger in the non-dominant arm (p = 0.033), while handball players were stronger in the dominant arm (p = 0.041). The external-to-internal rotation strength ratio was significantly lower on the dominant side in volleyball players compared to handball players (p = 0.047; d = 0.59). Findings suggest sport-specific adaptations and asymmetries in shoulder function, emphasizing the need for sport-specific and individually tailored injury prevention strategies. Volleyball players, in particular, may benefit from targeted strengthening of external rotators and flexibility training to address imbalances. Full article

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy. Full article