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Jeffery T. Podraza and Scott C. White

Background:

Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis.

Case Description:

A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively.

Outcomes:

Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome.

Discussion:

The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical modality when it is used judiciously with the proper postoperative restrictions and rehabilitation.

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Michelle A. Sandrey

where instability tests would be valued 2 , 10 , 11 : lumbar spondylolisthesis 10 and the stabilization classification group. 1 , 2 , 11 , 12 In the stabilization classification group, lumbar segmental instability may be apparent along with other clinical signs such as aberrant movement, Gower’s sign

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Yong Wook Kim, Na Young Kim, Won Hyuk Chang and Sang Chul Lee

damaged sensory receptors and changed muscular adjustment patterns, trigger instability in postural balance and limited trunk movement adjustment. 6 The traditional stabilizing exercise interventions are successful at treating LBP; however, there is often recurrence of LBP that has been illustrated in

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Fariba Hasanbarani and Mark L. Latash

variable (orthogonal to the UCM, V ORT ). The inequality V UCM  >  V ORT has been viewed as a sign of a synergy at the level of EVs stabilizing the salient PV. Most studies used the framework of the UCM hypothesis to explore relatively artificial laboratory tasks or well-practiced tasks, such as walking

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Hooman Minoonejad, Mohammad Karimizadeh Ardakani, Reza Rajabi, Erik A. Wikstrom and Ali Sharifnezhad

measure of feedback neuromuscular control, in individuals with CAI. 14 Various interventions, including a hop stabilization intervention, have also resulted in feedback neuromuscular control improvements in the ankle musculature. 15 , 16 However, lateral ankle sprains and CAI are recommended to be

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Megan Q. Beard, Samantha A. Boland and Phillip A. Gribble

compare the four testing positions when performed with and without a stabilization strap. We hypothesized that the with-strap conditions would yield higher intersession and interexaminer reliability compared to the without-strap conditions. Methods Participants Participants recruited from a university and

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Kazem Malmir, Gholam Reza Olyaei, Saeed Talebian, Ali Ashraf Jamshidi and Majid Ashraf Ganguie

both for preventing injury and successfully performing an action. Time to stabilization (TTS) and dynamic postural stability index (DPSI) have been suggested as the measures of dynamic stability. 4 , 5 These measures can indicate the ability of a person to maintain his or her stability during

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Francesco Campa, Hannes Gatterer, Henry Lukaski and Stefania Toselli

applied after a period of controlled exercise. We hypothesized that 60 minutes was the time duration needed to stabilize bioimpedance values and that a cold shower considerably speeds up the time course. Methods Participants In total, 10 male rugby players (age 26.2 [4.1] y and body mass index 23.9 [1

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Sébastien Viel, Marianne Vaugoyeau and Christine Assaiante

In the current study, we adopted the hypothesis that the body scheme disturbances occurring during adolescence might lead subjects to transiently neglect proprioceptive information and that adolescents might rely more strongly on vision to control their orientation and stabilize their body. To check this point, we asked adolescents 14–15 years to maintain vertical stance while very slow sinusoidal oscillations in the frontal plane were applied to the supporting platform at 0.01 Hz (below the detection threshold of the semicircular canal system) and at 0.06 Hz (above) with the eyes open and closed. Two postural components, orientation and segmental stabilization, were analyzed at the head, shoulder, trunk, and pelvis levels. At the lowest frequency without vision, the performances of adolescents were much less efficient than those of adults. Moreover, this study showed that vision plays a predominant role in adolescents’ control of orientation and body stabilization. At 0.06 Hz without vision, a clearcut difference was observed between the strategies used by girls and boys; specifically, the maturation of the segmental stabilization processes was found to be more advanced in girls than in boys. However, no such difference was observed at 0.01 Hz. Lastly, comparisons between the data obtained in adolescents and those previously obtained in young adults (Vaugoyeau, Viel, Amblard, Azulay, & Assaiante, 2008) clearly show that adolescents use different postural strategies and that they are not yet capable of reaching comparable postural performance levels to those observed in adults. Because adolescents were not able to use the proprioceptive information available to improve their postural control, we concluded that they showed a maturational lag in comparison with adults. This suggests that the mechanisms underlying postural control are still maturing during adolescence, which might constitute a transient period of proprioceptive neglect in sensory integration of postural control.

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Marco Jacono, Maura Casadio, Pietro G. Morasso and Vittorio Sanguineti

The sway-density curve (SDC) is computed by counting, for each time instant, the number of consecutive samples of the statokinesigram falling inside a circle of “small” radius R. The authors evaluated the sensitivity of the curve to the variation of R and found that in the range 3–5 mm the sensitivity was low, indicating that SDC is a robust descriptor of posturographic patterns. In addition, they investigated the relationship between SDC and the underlying postural stabilization process by decomposing the total ankle torque into three components: a tonic component (over 69% of the total torque), an elastic torque caused by ankle stiffness (about 19%), and an anticipatory active torque (about 12%). The last component, although the smallest in size, is the most critical for the overall stability of the standing posture and appears to be correlated with the SDC curve.