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Timothy F. Tyler, Anthony Cuoco, Aaron K. Schachter, Gregory C. Thomas and Malachy P. McHugh

Context:

Scapular strengthening is thought to be an important component of the rehabilitation of patients with internal impingement.

Objective:

To determine the effect of scapular-retractor-muscle fatigue on internal- and external-rotation-torque production in patients with internal impingement.

Design:

Case control study.

Setting:

Outpatient clinic.

Participants:

15 patients and 18 healthy subjects.

Intervention:

A scapular-retractor-fatigue protocol.

Main Outcome Measure:

Shoulder-rotation- torque production.

Results:

After the scapular-retractor-fatigue protocol external- rotation strength was reduced in patients (involved 25%, noninvolved 19%; P < .001).

Conclusion:

Fatigue in the scapular retractors resulted in lower shoulder-rotation-torque production. These findings emphasize the importance of the scapular retractors for proper function of the shoulder rotators with the arm in an abducted position in patients with internal impingement.

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Deb West, Gisela Sole and S. John Sullivan

Objectives:

To establish muscle-strength and -balance profiles for shoulder external rotation (ER) and internal rotation (IR) in master’s swimmers.

Design:

Cross-sectional study.

Setting:

Laboratory.

Participants:

Six male and seven female master’s swimmers and a matched control group.

Measurements:

Concentric and eccentric ER and IR shoulder movements were recorded (Kin-Com™ isokinetic dynamometer). Peak-torque values, concentric ER:IR ratios, eccentric ER:IR (conventional) ratios, and eccentric ER:concentric IR (functional) ratios were examined between groups.

Results:

Mean peak-torque values ranged from 21.23 to 37.69 N · m for the swimmers, which, although 15% to 27% greater than those of the controls, were not statistically different. Conventional (0.78:0.86) and functional (1.06:1.17) ratios did not differ between groups.

Conclusions:

These data will contribute to the development of guidelines for assessing shoulder-muscle strength in Master’s swimmers.

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Osamu Yanagisawa, Kenta Wakamatsu and Hidenori Taniguchi

leg  Flexion .06  Extension −.21  Total ROM of flexion and extension −.11  Abduction .07  Adduction −.05  Total ROM of abduction and adduction .02  External rotation −.13  Internal rotation .12  Total ROM of external and internal rotation −.02 Stride leg  Flexion −.21  Extension −.58*  Total ROM of

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Charles Goulet and Isabelle Rogowski

were the maximal isometric strength of the shoulder external rotator muscles. The secondary outcome measurements were the maximal isometric strength of the shoulder internal rotator muscles, the glenohumeral range of motion in external and internal rotation and the velocity and accuracy of the tennis

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Sebastian Klich, Bogdan Pietraszewski, Matteo Zago, Manuela Galli, Nicola Lovecchio and Adam Kawczyński

Objectives: The aim of the study was to investigate supraspinatus tendon thickness, acromiohumeral distance (AHD), and stiffness/creep measures of the shoulder girdle in overhead asymptomatic athletes in muscle fatigue conditions. Design: Observational, case series study. Setting: Biomechanics and motion analysis lab. Participants: Twenty-four male overhead volleyball (n = 8), handball (n = 8), and tennis (n = 8) athletes. All subjects were without shoulder injury history. Main Outcome Measure: The subjects were tested for supraspinatus tendon thickness (in short and long axis), AHD using ultrasound scans and stiffness/creep of upper trapezius, infraspinatus, anterior and posterior deltoid, and pectoralis major using the myotonometer device before and immediately after a fatigue protocol. Intervention: The fatigue protocol consisted of 3 sets of 32 maximum isokinetic concentric contractions performing shoulder internal and external rotation at isokinetic speed of 120°/s. Results: A significant increase in supraspinatus tendon thickness (both in short and long axis) (P = .045 and P = .01, respectively) and a reduction in AHD (P = .01) were found after an isokinetic protocol. The stiffness increased significantly in upper trapezius (P ≤ .01), infraspinatus (P = .003), posterior deltoid (P = .047), and pectoralis major (P = .01), whereas the creep showed a significant decrement for upper trapezius (P = .001) and infraspinatus (P = .003). Conclusion: The present study has demonstrated the postexercise fatigue in overhead athletes. The increase of stiffness (reduction of muscle creep) and tendon thickness (simultaneous to the reduction of AHD) may indicate rotator cuff overloading as a primary intrinsic tendon pathology process.

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Cyril Genevois, Philippe Berthier, Vincent Guidou, Franck Muller, Boris Thiebault and Isabelle Rogowski

Context:

In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength.

Objective:

This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players.

Design:

Crossover study.

Setting:

National elite handball training center.

Participants:

25 elite female high school handball players.

Interventions:

The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone.

Main Outcomes:

Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides.

Results:

After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017).

Conclusions:

This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

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James Onate, Nelson Cortes, Cailee Welch and Bonnie Van Lunen

Context:

A clinical assessment tool that would allow for efficient large-group screening is needed to identify individuals potentially at risk for anterior cruciate ligament (ACL) injury.

Objective:

To assess the criterion validity of a jumplanding assessment tool compared with 3-dimensional (3D) motion analysis and evaluate interrater reliability across an expert vs novice rater using the Landing Error Scoring System (LESS).

Design:

Validity protocol.

Setting:

Controlled, laboratory.

Participants:

Nineteen female (age 19.58 ± .84 y, height 1.67 ± .05 m, mass 63.66 ± 10.11 kg) college soccer athletes volunteered.

Main Outcome Measurement:

Interrater reliability between expert rater (5 y LESS experience) vs novice rater (no LESS experience). LESS scores across 13 items and total score. 3D lower extremity kinematics were reduced to dichotomous values to match LESS items.

Interventions:

Participants performed drop-box landings from a 30-cm height with standard video-camera and 3D kinematic assessment.

Results:

Intrarater item reliability, assessed by kappa correlation, between novice and experienced LESS raters ranged from moderate to excellent (κ = .459–.875). Overall LESS score, assessed by intraclass correlation coefficient, was excellent (ICC2,1 = .835, P < .001). Statistically significant phi correlation (P < .05) was found between rater and 3D scores for knee-valgus range of motion; however, percent agreement between expert rater and 3D scores revealed excellent agreement (range of 84–100%) for ankle flexion at initial contact, knee-flexion range of motion, trunk flexion at maximum knee flexion, and foot position at initial contact for both external and internal rotation of tibia. Moderate agreement was found between rater and 3D scores for trunk flexion at initial contact, stance width less than shoulder width, knee valgus at initial contact, and knee-valgus range of motion.

Conclusions:

Our findings support moderate to excellent validity and excellent expert vs novice interrater reliability of the LESS to accurately assess 3D kinematic motion patterns. Future research should evaluate the efficacy of the LESS to assess individuals at risk for ACL injury.

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Matthew Rivera, Lindsey Eberman, Kenneth Games and Cameron J. Powden

) Digital inclinometer placement for total arc of motion assessment. Total Arc of Motion The TAM was assessed using a digital inclinometer to measure terminal external and internal rotation of the glenohumeral (GH) joint. 14 Participants were placed supine on a standard treatment table with their arm in a 90

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Samuele Contemori, Andrea Biscarini, Fabio M. Botti, Daniele Busti, Roberto Panichi and Vito E. Pettorossi

participants were assessed for both shoulder abduction and external and internal rotation strength. Abduction strength was measured in a standing position, shoulder abducted at 90° in the scapular plane, elbow extended, and pronated forearm. External and internal rotation strength were measured in a standing

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Jin Hyuck Lee, Ji Soon Park and Woong Kyo Jeong

forward flexion test without any neurological abnormalities such as sensory or motor deficits. Muscle strength in each position, including external and internal rotations, abduction, and flexion was measured by using an isokinetic device (see Supplementary File 2 [available online]). Magnetic resonance