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John Andrew Badagliacco and Andrew Karduna

.04.002 11. Grigg P . Peripheral neural mechanisms in proprioception . J Sport Rehabil . 1994 ; 3 : 2 – 17 . doi:10.1123/jsr.3.1.2. 10.1123/jsr.3.1.2 12. Lephart SM , Warner JJP , Borsa PA , Fu FH . Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders

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Page Wornom Zanella, S Matthew Willey, Sonia L Seibel and Christopher J Hughes

Context:

There is a lack of research on the effects of scapular tape on shoulder joint repositioning.

Objective:

To quantify the effects of scapular taping on shoulder joint repositioning during flexion and abduction.

Design:

Repeated measures before and after trial.

Setting:

Academic institution.

Participants:

36 subjects without shoulder pathology.

Intervention:

Scapular taping with flexion and abduction.

Main Outcome Measures:

Lateral scapular slide test, plumb-line assessment, and a depth measurement. Absolute error in joint repositioning in flexion and abduction at 3 angles with and without scapular taping was measured.

Results:

No differences were found for tape vs no tape in flexion (P = .92) or abduction (P = .40) or between winging and nonwinging subjects in flexion (P = .62) or abduction (P = .91).

Conclusions:

Scapular taping has no effect on joint repositioning during active shoulder flexion or abduction. Scapular winging does not affect active joint repositioning after scapular taping.

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Carly May Green, Paul Comfort and Lee Herrington

Context:

A reduction in joint position sense (JPS) is sometimes a consequence of shoulder injury that may adversely affect the ability to maintain dynamic joint stability.

Objective:

To compare shoulder JPS between previously injured and noninjured judokas.

Design:

Cohort study.

Participants:

Twenty-nine noninjured subjects (10.93 ± 3.45 years) and eleven injured subjects (15.09 ± 3.39 years).

Main Outcome Measures:

JPS was tested at 45° and 80°of shoulder external rotation at 90° of abduction.

Results:

No signifcant difference in JPS was found between previously injured and noninjured judokas at either joint position.

Conclusion:

Despite evidence that JPS acuity decreases following shoulder injury, this study did not demonstrate a difference in average error between previously injured and noninjured judokas. Uncontrolled confounding factors, such as age and time since injury, may have affected the results. Sport-specifc shoulder joint loading patterns may also be an important factor that affects JPS.

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Yin-Liang Lin and Andrew Karduna

While synchronous movement of the glenohumeral and scapulothoracic joints has been emphasized in previous kinematics studies, most investigations of shoulder joint position sense have treated the shoulder complex as a single joint. The purposes of this study were to investigate the joint position sense errors of the humerothoracic, glenohumeral, and scapulothoracic joints at different elevation angles and to examine whether the errors of the glenohumeral and scapulothoracic joints contribute to the errors of the humerothoracic joint. Fifty-one subjects with healthy shoulders were recruited. Active joint position sense of the humerothoracic, glenohumeral, and scapulothoracic joints was measured at 50°, 70°, and 90° of humerothoracic elevation in the scapular plane. The results showed that while scapulothoracic joint position sense errors were not affected by target angles, there was an angle effect on humerothoracic and glenohumeral errors, with errors decreasing as the target angles approached 90° of elevation. The results of a multiple regression analysis revealed that glenohumeral errors explained most of the variance of the humerothoracic errors and that scapulothoracic errors had a weaker predictive relationship with humerothoracic errors. Therefore, it may be necessary to test scapular joint position sense separately in addition to the assessment of the overall shoulder joint position sense.

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Semyon M. Slobounov, Shannon T. Poole, Robert F. Simon, Elena S. Slobounov, Jill A. Bush, Wayne Sebastianelli and William Kraemer

Assessment and enhancement of joint position sense is an inexact science at best. Anew method of evaluating and improving this sense using motion-tracking technology that incorporates computer visualization graphics was examined. Injured and healthy subjects were evaluated for their abilities to determine shoulder joint position, after abduction, in two tasks. The first was active reproduction of a passively placed angle. The second was visual reproduction of such an angle. A training protocol was added to determine the effectiveness of proprioceptive training in conjunction with 3-D visualization techniques. The primary findings were (a) a significant difference (p = .05) in the level of joint position sense in injured vs. healthy subjects; (b) significantly less accurate reproduction of larger shoulder abduction vs. the smaller movement in the active reproduction task; (c) significantly greater ability to accurately reproduce angles actively vs. visually; and (d) that proprioception training using 3-D visualization techniques significantly increased active and visual reproductions of passively placed angles.

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Hande Guney-Deniz, Gulcan Harput, Ugur Toprak and Irem Duzgun

that could cause overload on the soft tissues around the shoulder joint. 18 , 19 Therefore, the rehabilitation programs primarily focus on the exercises for restoring scapular motions in shoulder problems. 20 Scapula retraction exercise consisting of scapular posterior tilt and external rotation is

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Arnel L. Aguinaldo, Janet Buttermore and Henry Chambers

High rotational torques during baseball pitching are believed to be linked to most overuse injuries at the shoulder. This study investigated the effects of trunk rotation on shoulder rotational torques during pitching. A total of 38 pitchers from the professional, college, high school, and youth ranks were recruited for motion analysis. Professional pitchers demonstrated the least amount of rotational torque (p = .001) among skeletally mature players, while exhibiting the ability to rotate their trunks significantly later in the pitching cycle, as compared to other groups (p = .01). It was concluded that the timing of their rotation was optimized as to allow the throwing shoulder to move with decreased joint loading by conserving the momentum generated by the trunk. These results suggest that a specific pattern in throwing can be utilized to increase the efficiency of the pitch, which would allow a player to improve performance with decreased risk of overuse injury.

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Jessica R. Fairbairn and Kellie C. Huxel Bliven

Clinical Scenario: Until recently, injury epidemiology data on elite Paralympic athletes were limited. Current data suggest high rates of shoulder injury in wheelchair athletes. Differences in shoulder injury rates between sports have not been reported in this population. Clinical Question: Is the incidence of shoulder injury in elite wheelchair athletes different between sports? Summary of Key Findings: Shoulder injury rates are high in elite wheelchair athletes, particularly in sports such as field events and fencing that require a stable base (eg, trunk, core control) from which to perform. Wheelchair racing requires repetitive motions that contribute to shoulder injuries, but rates are lower than field sports and fencing. Wheelchair curling and sledge hockey have low shoulder injury risk. Clinical Bottom Line: Shoulder injury rates vary based on sport in elite wheelchair athletes. In addition to incorporating shoulder complex specific rehabilitation for overuse shoulder injuries, clinicians should focus on core and trunk stabilization in elite wheelchair athletes competing in sports, such as field events and fencing. Strength of Recommendation: Grade C evidence exists that reports shoulder injury rates among elite wheelchair athletes differ based on sport participation.

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Hande Guney, Gulcan Harput, Filiz Colakoglu and Gul Baltaci

Context:

Glenohumeral (GH) internal-rotation deficit (GIRD) and lower eccentric external-rotator (ER) to concentric internal-rotator (IR) strength (ER:IR) ratio have been documented as risk factors for shoulder injuries, but there is no information on whether GIRD has an adverse effect on ER:IR ratio in adolescent overhead athletes.

Objectives:

The aim of this study was to investigate the effects of GIRD on functional ER:IR ratio of the adolescent overhead athletes.

Design:

Cross-sectional study.

Setting:

University research laboratory.

Participants:

52 adolescent overhead athletes.

Main Outcome Measures:

To determine GIRD, the range of GH IR and ER motion was measured with a digital inclinometer. An isokinetic dynamometer was used to assess eccentric and concentric IR and ER muscle strength of the dominant and nondominant shoulders. One-way ANCOVA where sport type was set as a covariate was used to analyze the difference between athletes with and without GIRD.

Results:

After standardized examinations of all shoulders, the athletes were divided into 2 groups, shoulders with (n = 27) and without GIRD (n = 25). There was a significant difference between groups in functional ER:IR ratio (P < .001). Athletes with GIRD had lower ER:IR ratio (0.56) than athletes without GIRD (0.83).

Conclusions:

As GIRD has an adverse effect on functional ratio of the shoulder-rotator muscles, interventions for adolescent overhead athletes should include improving GH-rotation range of motion.

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Sally J. McLaine, Karen A. Ginn, Cecilia M. Kitic, James W. Fell and Marie-Louise Bird

Context: The reliable measurement of shoulder strength is important when assessing athletes involved in overhead activities. Swimmers' shoulders are subject to repetitive humeral elevation and consequently have a high risk of developing movement-control issues and pain. Shoulder-strength tests performed in positions of elevation assist with the detection of strength deficits that may affect injury and performance. The reliability of isometric strength tests performed in positions of humeral elevation without manual stabilization, which is a typical clinical scenario, has not been established. Objective: To establish the relative and absolute intrarater reliability of shoulder-strength tests functional to swimming in 3 body positions commonly used in the clinical setting. Design: Repeated-measures reliability study. Setting: Research laboratory. Subjects: 15 university students and staff (mean ± SD age 24 ± 8.2 y).Intervention: Isometric shoulder-strength tests were performed in positions of humeral elevation (flexion and extension in 140° abduction in the scapular plane, internal and external rotation in 90° abduction) on subjects without shoulder pain in supine, prone, and sitting. Subjects were tested by 1 examiner with a handheld dynamometer and retested after 48 h. Main Outcome Measures: Relative reliability (ICC3,1) values with 95% CI. Absolute reliability was reported by minimal detectable change (MDC). Results: Good to excellent intrarater reliability was found for all shoulder-strength tests (ICC .87-.99). Intrarater reliability was not affected by body position. MDC% was <16% for every test and ≤11% for tests performed in supine. Conclusions: Shoulder flexion, extension, and internal- and external-rotation strength tests performed in humeral elevation demonstrated excellent to good intrarater reliability regardless of body position. A strength change of more than 15% in any position can be considered meaningful.