Shoulder impingement rehabilitation

Sindrom subakromialne utesnitve ramena (SIS) je najpogostejši vzrok
funkcijsko prizadetega ramena po 40. letu. Vzroki za nastanek SIS so zelo različni, a vsi povzročajo bolečino zaradi ukleščenje mehkih tkiv v subakromialnem prostoru med določenim gibom roke. Cilj naše raziskave je bil preveriti kakšen je takojšnji učinek manualne terapije na bolečino izzvano s kliničnimi testi pri osebah s SIS.
Izbrali smo 5 preiskovancev, ki so imeli unilateralni SIS 1 ali 2 stopnje.
Fizioterapevt, ki ni seznanjen z raziskavo je izvedel 4 klinične teste značilne za SIS: Test spuščanja roke, Yocum manever, Hawkins–Kennedy test in Neerov kompresijski test. Preiskovanec je ocenil prisotnost bolečine med posameznim testom in sicer na vizualni analogni lestvici od 0 do 10. Artrokinematično mobilizacijo abdukcije smo izvajali na glenohumeralnem sklepu kot jo opisuje Cyriax. Izkušen manualni terapevt je izvedel 3 sete po 12 ponovitev. Med posameznimi seti je bila 1 minuta odmora. Takoj po izvedbi intervencije smo ponovili klinične teste. S statistično analizo Wilcoxon matched pairs smo primerjali ocene bolečine pred in po intervenciji. Statistična značilnost je bila določena na ravni p < 0.05. Rezultati so pokazali, da je artrokinematična mobilizacija abdukcije
statistično značilno vplivala na zmanjšanje bolečine pri naslednjih kliničnih testih: Test spuščanja roke, Yocum manever in Hawkins–Kennedy test. Z artrokinematično mobilizacijo abdukcije naj bi spremenili razmerje med humerusom in glenoidom. Količina kotaljenja glavice humerusa naj bi se zmanjšala medtem ko naj bi se količina striženja glavice humerusa povečala. Na ta način naj bi povečali subakromialni prostor in zmanjšali možnost ukleščenja mehkih tkiv. Zaradi majhnega števila preiskovancev, ki so bili zajeti v raziskavo, moramo biti previdni pri interpretaciji rezultatov. Priporočamo da se raziskava izvede z večjim številom preiskovancev, da se uvede kontrolna skupina in da se preiskovance razdeli v podskupine glede na vzrok za SIS. Zanimivo bi bilo tudi kontrolirati dolgoročni
učinek artrokinematične mobilizacije.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with end ran...

""Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen
shoulder is questionable and the combination of therapies has contradictory results. Objectives: The
purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound
therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in
alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen
shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and
End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of
shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered
as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically
significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with
end range mobilization had„t‟ value of 1.8342 in comparison to that of cryotherapy combined with
stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result
than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment
of frozen shoulder.
Keywords: Frozen shoulder, ultrasound therapy, end range mobilization, cryotherapy, stretching""

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p<0.05 as statistically significant and the‗t‘ values were estimated. It was found that ultrasound when combined with end range mobilization had a value of 3.4498 in comparison to 1.7773 of cryotherapy combined with stretching group. Conclusion: Ultrasound with end range mobilization produced a better result than cryotherapy with stretching and therefore can be recommended in the treatment of second stage adhesive capsulitis of shoulder.

The throwing shoulder is subjected to extreme forces secondary to the complex motions that occur during the act of hurling
a five-ounce spherical object through space. Numerous conditions can develop as a result of chronic microtrauma to the structures
surrounding the glenohumeral joint. Posterior superior glenoid impingement (PSGI) involves irnpingement of the articular side of
the rotator cuff against the posterior superior glenoid labrum. This occurs in conjunction with an uruderlying subtle instability of the
glenohumeral joint. The mechanism is that of abduction, maximal external rotation and horizontal extension or that mechanism
which is similar to the throwing motion. Because of the complex nature of the glenohumeral joint and the surrounding structures,
the examiner must be knowledgeable regarding the functional anatomy of the shoulder girdle and how it relates to the mechanisms
involved in the before mentioned conditions. The purpose of this paper is to describe clinical methodology, which may assist the
examiner in the diagnosis and managernent of the throwing athlete with posterior superior glenoid impingement.

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and ...

Despite the high prevalence of rotator cuff disease in the aging adult population, the basic mechanisms initiating the disease are not known. It is known that changes occur at both the bone and tendon after rotator cuff tears. However, no study has focused on early or “pretear” rotator cuff disease states. The purpose of this study was to compare the bone mineral density of the greater tuberosity in normal subjects with that in subjects with impingement syndrome and full-thickness rotator cuff tears.Digital anteroposterior shoulder radiographs were obtained for 3 sex- and age-matched study groups (men, 40-70 years old): normal asymptomatic shoulders (control), rotator cuff disease without full-thickness tears (impingement), and full-thickness rotator cuff tears (n = 39 per group). By use of imaging software, bone mineral densities were determined for the greater tuberosity, the greater tuberosity cortex, the greater tuberosity subcortex, and the cancellous region of the humeral head.The bone mineral density of the greater tuberosity was significantly higher for the normal control subjects compared with subjects with impingement or rotator cuff tears. No differences were found between the two groups of patients with known rotator cuff disease. The greater tuberosity cortex and greater tuberosity subcortex outcome measures were similar.Bone mineral changes are present in the greater tuberosity of shoulders with rotator cuff disease both with and without full-thickness tears. The finding of focal diminished bone mineral density of the greater tuberosity in the absence of rotator cuff tears warrants further investigation.

INTRODUCTION OF PERIODIZATION AND TYPICAL REHAB PROTOCOL P eriodization is a strategic plan that can be used to coordinate proper training towards the success of an athletic event (e.g., football, baseball, marathons, triathlons, power lifting competition, etc.) or preparatory tactical operations. Periodization schedules can lead to physiological adaptations of the body and can be focused on endurance, maximal strength, or power, as examples (19). The duration of the periodization program rests largely on the sport or tactical task at hand. Periodization is a concept that has been the cornerstone of most athletic strength and conditioning programs. While periodization is commonly used in athletic strength and conditioning programs, its application can also be useful in restorative function/rehabilitation settings as well. The specific region of the body that will be examined in this article is the the shoulder joint. According to literature, military personnel, regardless of deployment, have underreported nontraumatic injuries such as overuse injuries (7). In 2010, it was estimated that out of the 743,547 injuries reported to the United States Department of Defense, 82% were inflammatory/overuse injuries (7). The shoulder was the largest subcategory of the upper extremity injury, comprising 63% of upper extremity injuries and 9% of all injuries overall (7). Therefore, based on the large percentage of non-traumatic injuries that were sustained in the shoulder region, this article will discuss the shoulder joint through the lense of a periodization program.

The acromion is one of the two processes of the scapula. It plays a role in the field of orthopedics by having a correlation with some diseases. The morphology of this process has a significant role in upper limb pathology. The aim of the present study was to describe the different types of acromion process based on its morphology and to discuss its relation to some orthopedics diseases. We carried out a research which included 30 scapulae of unknown sex and age, provided by the Medical University of Sofia. Digital Vernier caliper and goniometer were used to calibrate the parameters (length, width etc.) of the process. We established three types of acromion process: type 1 – flat, type 2 – curved and type 3 – hooked. Our study showed that type 2 (curved) was the most commonly observed – around 80 % of the fixed materials; type 1 (flat) was seen in 11% and type 3 (hooked) – in 9%. People with type 3 (hooked) acromion process tend to suffer more often from the subacromial impingement syndrome. Knowledge of the morphology of the acromion process may help with the diagnosis and treatment of various diseases discussed in the present study and may supplement the work of shoulder surgeons and people occupied with this field of work.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with end ran...

Reviewed this Article for the "Year Book of Hand and Upper Limb Surgery, 2015"

Objectives
To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation.

Background
Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion.

Methods
Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction.

Results
Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction.

Conclusion
The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions. J Orthop Sports Phys Ther 2014;44(9):636–645. Epub 7 August 2014. doi:10.2519/jospt.2014.5339