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Kyle Southall, Matt Price and Courtney Wisler

Key Points ▸ This case presents the signs and symptoms of an athletics-related Morel-Lavallée lesion in the upper extremity. ▸ Morel-Lavallée lesions in the athletics setting can be easily misdiagnosed and/or mismanaged. ▸ Proper management can significantly decrease prolonged symptoms and long

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Mark A. Sutherlin

measures may not be equivalent across sports. Swimming is another overhead sport where the majority of injuries occur at the shoulder. 4 Clinicians who administer PRO measures during care may then opt to implement a single shoulder-specific or upper extremity region-specific PRO measure to help reduce

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Allison J. Nelson, Patrick T. Hall, Katherine R. Saul and Dustin L. Crouch

, muscle activations and joint moments) during motor tasks. Many existing WPSEs were designed and evaluated for occupational settings to support the weight of the upper extremity while the shoulder maintains static elevated postures. 29 , 30 However, it is unclear whether a WPSE designed for static tasks would be

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Kevin E. Wilk, Christopher A. Arrigo and James R. Andrews

The use of closed kinetic chain exercise has grown in the past several years. Closed kinetic chain exercises for the lower extremity have been firmly established in the literature and have been strongly recommended as an integral part of rehabilitation of the patient with anterior cruciate ligament injury. While the scientific and clinical rationale for using closed kinetic chain exercise for the lower extremity appears obvious, the scientific rationale for using closed kinetic chain exercise for the upper extremity is less clear. The purpose of this manuscript is to discuss the scientific rationale for closed kinetic chain for the upper extremity patient. In addition, exercise drills to enhance dynamic stability of the glenohumeral joint are discussed, and a rationale for using these exercises for specific glenohumeral joint pathologies is provided. The concepts of closed and open kinetic chain as applied to the lower extremity may not apply to the upper extremity due to the unique anatomical and biomechanical features as well as the function of the shoulder. It is recommended that clinicians use both closed kinetic chain and open kinetic chain exercises when treating the shoulder patient.

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Elizabeth Lawinger, Tim L. Uhl, Mark Abel and Srinath Kamineni

Objective:

The overarching goal of this study was to examine the use of triaxial accelerometers in measuring upper-extremity motions to monitor upper-extremity-exercise compliance. There were multiple questions investigated, but the primary objective was to investigate the correlation between visually observed arm motions and triaxial accelerometer activity counts to establish fundamental activity counts for the upper extremity.

Study Design:

Cross-sectional, basic research.

Setting:

Clinical laboratory.

Participants:

Thirty healthy individuals age 26 ± 6 y, body mass 24 ± 3 kg, and height 1.68 ± 0.09 m volunteered.

Intervention:

Participants performed 3 series of tasks: activities of daily living (ADLs), rehabilitation exercises, and passive shoulder range of motion at 5 specific velocities on an isokinetic dynamometer while wearing an accelerometer on each wrist. Participants performed exercises with their dominant arm to examine differences between sides. A researcher visually counted all arm motions to correlate counts with physical activity counts provided by the accelerometer.

Main Outcome Measure:

Physical activity counts derived from the accelerometer and visually observed activity counts recorded from a single investigator.

Results:

There was a strong positive correlation (r = .93, P < .01) between accelerometer physical activity counts and visual activity counts for all ADLs. Accelerometers activity counts demonstrated side-to-side difference for all ADLs (P < .001) and 5 of the 7 rehabilitation activities (P < .003). All velocities tested on the isokinetic dynamometer were shown to be significantly different from each other (P < .001).

Conclusion:

There is a linear relationship between arm motions counted visually and the physical activity counts generated by an accelerometer, indicating that arm motions could be potentially accounted for if monitoring arm usage. The accelerometers can detect differences in relatively slow arm-movement velocities, which is critical if attempting to evaluate exercise compliance during early phases of shoulder rehabilitation. These results provide fundamental information that indicates that triaxial accelerometers have the potential to objectively monitor and measure arm activities during rehabilitation and ADLs.

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Karyn L. Hamilton, Michael C. Meyers, William A. Skelly and Robert J. Marley

The purpose of this study was to investigate the influence of creatine monohydrate (CrH2O) on upper extremity anaerobic response in strength-trained females involved in overhand sports. Two movements were utilized in this evaluation: elbow flexion (EF) and shoulder internal rotation (IR). Subjects were pair-matched and assigned to receive placebo (n = 13) or 25 g CrH2O (n = 11) for 7 days. Pre- and post-treatment measurements included peak concentric and eccentric isokinetic torque, isotonic 1RM, and fatigue (FAT) during EF; isotonic 1RM, FAT, and peak velocity during IR; and body weight. MANOVAs revealed significant interaction between treatment and trial for EF (p < .05) but not for IR or weight. Univariate analysis indicated a significantly greater change in EFFAT following CrH2O than following placebo. Thus, CrH2O did not influence peak EF or IR strength, IR work to fatigue, or IR velocity, but was associated with greater work capacity during fatiguing EF. These data suggest that CrH2O may enhance upper extremity work capacity, but this enhancement may not extend to the muscles primarily responsible for overhand sports performance.

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Todd A. McLoda, Kate M. Murphy and Steve Davison

Context:

Inertial training of the shoulder.

Objective:

To determine the differences of functional and EMG measures between a control group and an exercise group of overhead throwers.

Design:

Repeated measures.

Setting:

Research laboratory.

Participants:

17 intercollegiate baseball players and 19 intercollegiate softball players divided into 2 equal-size groups, control and exercise.

Main Outcome Measures:

Preliminary data were recorded, including throwing velocity, throwing accuracy, and EMG activity of the biceps brachii, upper pectorals, and posterior deltoid. The exercise group completed a 4-week training regimen on the Impulse Inertial Trainer. All participants returned for follow-up measures.

Results:

No significant group-by-time interaction occurred relative to ball velocity, accuracy, or EMG activity.

Conclusion:

For experienced throwers, functional measures and muscle activity during throwing were not affected by inertial training of the upper extremity.

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Jeffrey B. Taylor, Alexis A. Wright, James M. Smoliga, J. Tyler DePew and Eric J. Hegedus

Context:

Physical-performance tests (PPTs) are commonly used in rehabilitation and injury-prevention settings, yet normative values of upper-extremity PPTs have not been established in high-level athletes.

Objective:

To establish normative data values for the Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST) and Upper-Quarter Y-Balance Test (UQYBT) in college athletes and compare results between sports and to analyze the relationship between the 2 tests.

Design:

Observational.

Setting:

Laboratory/athletic facility.

Participants:

257 (118 male, 139 female) Division I athletes participating in basketball, soccer, baseball, lacrosse, volleyball, track and field, and cross-country.

Intervention:

CKCUEST and UQYBT scores were recorded as part of a comprehensive injury-risk screening battery.

Main Outcome Measure:

Pearson correlations assessed the relationship between all measures of the CKCUEST and UQYBT. A factorial ANOVA and a repeated-measures ANOVA (arm dominance) were used to assess interactions between sex, year in school, and sport for CKCUEST and UQYBT scores.

Results:

Normative values for the CKCUEST and UQYBT were established for 9 men’s and women’s college sports. No significant relationships were found between PPT scores. Men scored significantly higher than women for the CKCUEST (P = .002) and UQYBT (P = .010). Baseball players scored significantly higher than athletes from all other sports for the UQYBT (P < .001) but showed nonsignificant trends of lower scores for the CKCUEST than lower-extremity-dominant athletes such as runners (P = .063) and lacrosse players (P = .058).

Conclusions:

Results suggest that average CKCUEST and UQYBT scores in Division I athletes are distinct from those previously reported in recreationally active populations and that performance differences exist between sexes and sports. In addition, the CKCUEST and UQYBT appear to measure different constructs of performance and may complement each other as part of a screening battery.

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Scott M. Lephart and Timothy J. Henry

The confusion between the terms open kinetic chain and closed kinetic chain becomes even greater with application to the upper extremity. Upper extremity function is very difficult to define, due to the numerous shoulder positions and the great velocities with which the shoulder can move. Classifying exercises for rehabilitation of the upper extremity is very difficult due to the complexity of the joint. Many definitions and classification systems have been proposed; however, none of these entirely encompass rehabilitation of the upper extremity. Using previous classifications we have developed a Functional Classification System that is designed to serve as a template for upper extremity rehabilitation. This system has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms. The objective of our new Functional Classification System is to restore functional stability of the shoulder by reestablishing neuromuscular control for overhead activities.

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Sue Hillman

The kinetic chain is open in the upper extremity skills used in most sports. Although closed chain exercises will increase stability, open chain strengthening is more sport specific. This article addresses general concepts of upper extremity rehabilitation, including exercises to restore normal range of motion, joint mechanics, and muscle strength. The roles of proprioceptive neuromuscular facilitation, plyometric training, and elastic band exercises are also discussed. Finally, a progression of specificity training is presented to return the athlete to successful sport performance.