Biomedical subjects

Paula M Ludewig

Publications and source records attributed to Paula M Ludewig.

18 recordsLinked to original sources

PubMed2006

Clinical measurement of posterior shoulder flexibility.

The objectives of this study were to determine both the intra-rater reliability and the smallest real difference necessary to detect meaningful clinical changes over an 8-12 week period for three clinical measures of posterior shoulder flexibility. Posterior shoulder tightness has been associated with abnormal humeral head translations that narrow the subacromial space and contribute to impingement. Posterior shoulder stretching to normalize joint kinematics is often used when treating individuals with subacromial impingement. Currently there is no measurement of posterior shoulder flexibility that has been demonstrated to be reliable or responsive in patients over a treatment interval. Construction workers with overhead work exposure were recruited to an impingement group (n=37), and an asymptomatic group (n=22). Three flexibility measurements were taken on each subject at baseline and 8-12 weeks later by the same physical therapist. Intra-rater reliability was determined using intra-class correlation coefficients (ICCs) and standard errors of measurement (SEM). The smallest real difference value (SRD) determined the smallest detectable intervention-related measurement change over time. ICCs for the three measurements ranged from poor (0.40) to good (0.79). The SEM and SRD values reflected high test-retest variability in all three measurements. None of the three measures were proven to be highly stable indicators of posterior shoulder flexibility over this time period, nor were they able to detect small changes over this interval due to the high trial to trial variance in a non-intervention sample. Caution should be used when interpreting these clinical measurements over prolonged time periods.

Analysis of Variance↗

PubMed2006

Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: Investigate the relationship between glenohumeral internal rotation range-of-motion deficit and 3-dimensional scapular angular positioning during active arm movements in participants with recent participation in overhead sports activity. BACKGROUND: Subacromial impingement is one of the most common shoulder pathologies and is multifactorial in etiology. Posterior glenohumeral joint capsule tightness has been theorized to contribute to one potential causal factor: abnormal scapular positioning. METHODS AND MEASURES: Twenty-three subjects, who had participated in competitive sports involving overhead activity within the last 5 years, were categorized into 2 groups based on the degree of glenohumeral internal rotation deficit (20% deficit threshold). Scapular angular positioning of subjects performing shoulder internal rotation from 90 degrees flexion and abduction shoulder positions was evaluated using 3-dimensional electromagnetic surface tracking. Additional sensors monitored trunk and humeral motion. Scapular position data at end range glenohumeral internal rotation, along with glenohumeral internal rotation range of motion measurements, were used to analyze the relationship between glenohumeral internal rotation deficit and scapular position using 2-way ANOVA and regression analyses. RESULTS: The internal rotation deficit group had significantly greater scapular anterior tilt (9.2 degrees difference, P = .04) across positions, as compared to the control group. Regression analysis demonstrated a significant association between glenohumeral internal rotation deficit and scapular position (tilting) during flexed internal rotation (r(2) = 0.37, P = .03) and for scapular position (anterior tilting and upward rotation) during abducted internal rotation (r = 0.35, P = .036). CONCLUSIONS: These findings demonstrate a significant relationship between glenohumeral internal rotation deficit and abnormal scapular positioning, particularly increased anterior tilt. This relationship identifies a possible mechanism for development of excessive scapular anterior tilt.

Adult↗

PubMed2006

Clinical trial of exercise for shoulder pain in chronic spinal injury.

BACKGROUND AND PURPOSE: The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS: Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS: The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS: Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION: A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.

Adult↗

PubMed2005

The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals.

STUDY DESIGN: Two-group comparison. OBJECTIVE: To compare scapular kinematics during arm elevation between groups distinguished by pectoralis minor resting length. BACKGROUND: Studies have demonstrated that individuals with subacromial impingement have altered scapular kinematics, such as loss of posterior tipping and increased internal rotation. One proposed mechanism for these alterations is an adaptively short pectoralis minor. This anterior scapulothoracic muscle may impact normal scapular kinematics if adaptively short. METHODS AND MEASURES: Fifty volunteers without shoulder pain were divided into long or short groups according to normalized pectoralis minor resting length. An electromagnetic motion capture system determined the angular orientation of the scapula, humerus, and trunk during arm elevation in 3 separate planes. Groups were compared for 3-dimensional scapular orientation relative to the trunk at arm elevation angles of 30 degrees, 60 degrees, 90 degrees, and 120 degrees, using a mixed-model analysis of variance (ANOVA). RESULTS: There were statistically significant interaction effects between group and arm elevation angle for scapular tipping in all planes of arm elevation, with the scapula for the short group staying anteriorly tipped at higher angles. There was also a significant interaction for scapular internal rotation at lower arm elevation angles in the coronal plane only, with individuals with a shorter pectoralis minor demonstrating a more internally rotated scapula. CONCLUSIONS: The group distinguished by a short pectoralis minor demonstrated scapular kinematics similar to the kinematics exhibited in earlier studies by subjects with shoulder impingement. These results support the theory that an adaptively short pectoralis minor may influence scapular kinematics and is therefore a potential mechanism for subacromial impingement.

Adult↗

PubMed2005

Correlation of 3-dimensional shoulder kinematics to function in subjects with idiopathic loss of shoulder range of motion.

BACKGROUND AND PURPOSE: People with idiopathic loss of shoulder range of motion (ROM) have difficulty completing activities of daily living. This investigation was performed to determine the association between active glenohumeral ROM and function and to develop a multiple regression equation to explain variation in function in people with idiopathic loss of shoulder motion. SUBJECTS AND METHODS: This was a comparative study of 21 subjects (18 female, 3 male), using measurements of shoulder kinematics and administration of the Shoulder Rating Questionnaire (SRQ). Electromagnetic tracking sensors monitored the 3-dimensional position of the scapula and humerus throughout active shoulder motions. Correlations were performed between the active ROMs of interest and various demographic factors and the SRQ. A multiple regression equation was generated. RESULTS: A multiple regression equation including scapular-plane abduction, external rotation at the side, external rotation at 90 degrees of abduction, and weight explained 69% of the variation in the SRQ scores. DISCUSSION AND CONCLUSION: The results suggest that active ROM can be used to predict function in people with idiopathic loss of shoulder ROM.

Activities of Daily Living↗

PubMed2004

Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion.

BACKGROUND: Subjects with idiopathic loss of shoulder motion have difficulty sleeping, performing overhead activities, and completing activities of daily living. Treatment has been variable in approach and success. Cyriax's proposed shoulder capsular pattern was external rotation most limited followed by abduction followed by internal rotation. This investigation was performed to determine if a consistent pattern of motion loss was present in subjects with idiopathic loss of shoulder motion. METHODS: Repeated measurement of 25 (22 female) subjects' bilateral shoulder patterns of motion were compared. The three-dimensional position of the scapula and humerus throughout active shoulder abduction, external rotation, flexion, internal rotation, and scapular plane abduction was evaluated with an electromagnetic motion capture system. Patterns of motion loss were determined for both shoulders. The proportions of peak shoulder motion to mean maximum non-involved shoulders abduction, external, and internal rotation were utilized to determine the pattern of motion loss. FINDINGS: There was a significant difference in motion loss patterns between the involved and non-involved shoulders with the arm at the side. The internal rotation less than abduction less than external rotation pattern was demonstrated in 14 of 25 (56%) involved shoulders. No pattern was present in 14 of 21 (67%) non-involved shoulders. With the arm abducted, internal rotation was the most limited motion in 23 of 25 (92%) involved shoulders. INTERPRETATION: The results did not support Cyriax's proposed glenohumeral capsular pattern. Defining the pattern of motion loss in subjects with idiopathic loss of shoulder motion may assist in diagnosis and treatment.

Adult↗

PubMed2004

Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises.

BACKGROUND: Serratus anterior strengthening is used in prevention and treatment programs for poor scapular control. In certain clinical cases, exercises substantially activating the serratus with minimal upper trapezius activation are preferred. HYPOTHESIS: The standard push-up plus would show both the highest serratus anterior activation and lowest upper trapezius/ serratus ratios for both groups and all phases. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty subjects, grouped as healthy or with mild shoulder dysfunction, were evaluated performing standard push-up plus exercises and modifications on elbows, knees, and against a wall. Surface electromyography of the serratus anterior and upper trapezius was compared between exercises. RESULTS: Both groups responded similarly across exercises. The standard push-up plus demonstrated the highest activation of the serratus (to 123%) and lowest trapezius/serratus ratios (<0.2) during plus phases. The wall push-up plus and phases of other exercises demonstrated higher upper trapezius/serratus ratios (to 2.0). CONCLUSIONS: In clinical cases where excess upper trapezius activation or imbalance of serratus and trapezius activation occurs, the push-up plus is an optimal exercise. Other cases may benefit from a progression of modified push-up exercises. CLINICAL RELEVANCE: Clinical selection of exercises for improving scapular control should consider both maximum serratus activation and upper trapezius/serratus anterior ratios.

Adolescent↗

PubMed2004

Dorsal mobility and first ray stiffness in patients with diabetes mellitus.

BACKGROUND: Limited joint mobility in diabetic patients has been identified as a risk factor in the development of plantar ulcers. We examined dorsal mobility and passive first ray stiffness in patients with diabetes and investigated the relationship between first ray mobility and ankle joint dorsiflexion. METHODS: Forty individuals were studied: 20 with diabetes (mean estimated duration of 16 +/- 10 years) and 20 matched controls. Dorsal first ray mobility was measured using a mechanical device. Force-vs-dorsal mobility displacement values were collected at 10 N increments to a load limit of 55 N. Ankle joint dorsiflexion motion was measured with a goniometer. The "prayer sign," a clinical indicator of limited joint mobility, was evaluated in each patient. Subjects were separated into the two groups for data analysis. RESULTS: Patients in the diabetic group had more stiffness and less dorsal first ray mobility than the control group (p <.05). In particular, patients with a positive prayer sign had significant first ray stiffness (p <.05). Patients with diabetes also had less ankle dorsiflexion (p <.05). CONCLUSION: Patients with diabetes have more stiffness and less first ray mobility and less ankle dorsiflexion than those without diabetes. The presence of a positive prayer sign correlates with stiffness and loss of first ray mobility. Soft-tissue stiffness may contribute to the development of foot ulcers in diabetic patients with neuropathy.

Adult↗

PubMed2004

Three-dimensional clavicular motion during arm elevation: reliability and descriptive data.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To determine the reliability of a surface sensor measurement of clavicular motion during arm elevation and to describe 3-dimensional clavicular motion in an asymptomatic population. BACKGROUND: Abnormal scapular motion on the thorax has been implicated in shoulder pathology. Without the ability to measure clavicular motion, it is not possible to identify if abnormal scapular motions derive from the sternoclavicular or acromioclavicular joints. METHODS AND MEASURES: Thirty-nine subjects participated in the investigation, including an asymptomatic group (n = 30) and a group with a history or current symptoms of shoulder pathology (n = 9). Clavicular angles relative to the thorax were tracked with surface electromagnetic sensors on the thorax, clavicle, and humerus as subjects completed humeral flexion, scapular plane abduction, and abduction. Within-day reliability was assessed using intraclass correlation coefficients and SEM. Descriptive statistics quantified sternoclavicular joint motions for the various arm movements. RESULTS: Reliable measurements were obtained, with intraclass correlation coefficients ranging from 0.93 to 0.99, and SEMs from 0.9 degrees to 1.8 degrees. Between-day reliability SEM values were generally 2 degrees to 4 degrees. During elevation of the arm, the clavicle with respect to the thorax generally undergoes elevation (11 degrees-15 degrees maximum), retraction (15 degrees-29 degrees maximum), and posterior long-axis rotation (15 degrees-31 degrees maximum), with variability between subjects and planes of motion regarding the magnitude of motion. CONCLUSION: Rehabilitation approaches attempting to improve shoulder motion should benefit from improved knowledge of 3-dimensional contributions of the clavicle to normal and abnormal scapular kinematics.

Adolescent↗

PubMed2004

The effect of forefoot and arch posting orthotic designs on first metatarsophalangeal joint kinematics during gait.

STUDY DESIGN: Repeated-measures analysis of variance. OBJECTIVE: To examine the effect of 2 different orthotic posting designs on first metatarsophalangeal (first MTP) joint kinematics during gait. BACKGROUND: Common orthotic designs used to control abnormal pronation incorporate the use of a medial post in the forefoot and/or rearfoot locations. Although this design may favorably alter rearfoot and lower-limb kinematics, the incorporation of a forefoot post has been theorized to negatively impact first MTP joint function by limiting hallux dorsiflexion during push off. An alternative design that has been proposed to be more favorable for function of the hallux and first metatarsal is the medial arch support. METHODS AND MEASURES: Eighteen subjects with a mean age of 28.2 years (SD, 8.3 years) completed the study. All subjects were judged to have excessive pronation based on a clinical orthopaedic examination. Two different pairs of orthoses were custom molded for each subject. One design incorporated an extrinsic rearfoot and forefoot post and the second design had a high medial longitudinal arch in combination with an extrinsic rearfoot post. The "Flock of Birds" electromagnetic tracking device was used to collect 3-dimensional position and orientation data of 3 body segments (hallux, first metatarsal, and calcaneus) during the stance phase of walking for 3 conditions (no orthosis and each of the 2 different orthotic designs). A repeated-measures analysis of variance was used to assess differences in first MTP joint dorsiflexion at midstance and during the push-off period of gait, as well as metatarsal declination angle changes during relaxed stance. An exploratory regression analysis was used to investigate factors that related to the change in peak dorsiflexion for the orthotic conditions. RESULTS: Peak first MTP joint dorsiflexion averaged between 38 degrees and 40 degrees across all conditions. Although slight increases in first MTP joint dorsiflexion values were noted with both types of orthotic designs, these differences were not significant at either phase of the stance cycle (P = .50). The metatarsal declination angle in relaxed stance significantly increased (P = .001) under both orthotic conditions. Considerable individual variability was present. For the rearfoot-forefoot posted orthosis, a change in the declination angle of the first metatarsal during relaxed stance with the orthosis was a significant nonlinear predictor of change in peak dorsiflexion during push off. CONCLUSIONS: Foot orthoses that incorporate a medial forefoot post do not have a consistent negative effect of reducing first MTP joint dorsiflexion during walking.

Adult↗

PubMed2003

Three-dimensional shoulder kinematics during a pressure relief technique and wheelchair transfer.

OBJECTIVE: To assess 3-dimensional scapulothoracic and glenohumeral kinematics in able-bodied subjects during a weight-relief raise and while transferring to and from a wheelchair. DESIGN: Repeated-measures analysis of variance. SETTING: Research laboratory. PARTICIPANTS: Twenty-five able-bodied subjects without spinal cord injury or shoulder symptoms (20 men, 5 women; age range, 20-37y). INTERVENTIONS: Completion of weight-relief raise and transfer tasks. MAIN OUTCOME MEASURES: An electromagnetic motion capture system tracked 3-dimensional position and orientation of the thorax, scapula, and humerus. Absolute angular values assessed included scapular downward and upward rotation, internal and external rotation, and posterior and anterior tipping all relative to the thorax, as well as humeral internal and external rotation relative to the scapula. Data were compared across 3 phases of the weight-relief raise and for transfer direction (leading arm, trailing arm). RESULTS: Key findings included significantly increased anterior tipping and internal rotation of the scapula and decreased scapular upward rotation and external rotation of the humerus during the weight-relief raise. The leading arm showed significantly greater scapular anterior tipping and internal rotation and less scapular upward rotation and humeral external rotation than the trailing arm during the final phase of the transfer. CONCLUSIONS: Both the weight-relief raise and transfer result in scapular and humeral positions and directions of motion that may negatively impact the available subacromial space. This may present increased risk for injury or progression of shoulder pain in persons who must routinely perform these tasks.

Adult↗

PubMed2003

Shoulder kinematics in subjects with frozen shoulder.

OBJECTIVES: To describe 3-dimensional humeral motion in subjects with frozen shoulder and to determine whether a consistent capsular pattern of restriction was present. DESIGN: Descriptive study including repeated measurements of shoulder kinematics. SETTING: Motion-analysis laboratory. PARTICIPANTS: Ten (9 women, 1 man) volunteers with a diagnosis of idiopathic adhesive capsulitis and 10 (9 women, 1 man) subjects with asymptomatic shoulders as comparison subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Electromagnetic tracking sensors monitored the 3-dimensional position of the trunk, scapula, and humerus throughout active shoulder motions. Peak humeral positions relative to the trunk and scapula were determined for shoulder flexion, abduction, scapular plane abduction, external rotation (ER), and internal rotation (IR). Descriptive statistics (means, standard deviations, percentage of normal) were calculated and capsular patterns described. RESULTS: For humeral position relative to the trunk, subjects' mean peak motion was as follows: abduction, 98.4 degrees; ER at the side, 4.5 degrees; ER with the arm abducted, 33.5 degrees; flexion, 116.9 degrees; IR at the side, 54.3 degrees; IR with the arm abducted, 17.8 degrees; and scapular plane abduction, 113.4 degrees. For humeral position relative to the scapula, subjects' mean peak motion was as follows: abduction, 46.4 degrees; ER at the side, 34.7 degrees; ER with the arm abducted, 45.3 degrees; flexion, 70.5 degrees; IR at the side, 10.3 degrees; IR with the arm abducted, -6.4 degrees; and scapular plane abduction, 61.7 degrees. CONCLUSIONS: Symptomatic subjects demonstrated substantial kinematic deficits during humeral range of motion. No single capsular pattern emerged.

Biomechanical Phenomena↗

PubMed2002

Measuring forefoot alignment with a table-mounted goniometric device.

Evaluating the need for orthotic treatment may include the measure of forefoot-to-hindfoot alignment. This paper describes a table-mounted goniometric device that improves intra-rater reliability and simplifies the measurement of forefoot alignment. Instructions for constructing the device are provided. Use of this device may help clinicians evaluate forefoot alignment when making orthotic correction of the foot.

Calibration↗

PubMed2002

Comparison of two methods used to assess first-ray mobility.

Mobility of the first-ray is associated with several common lower extremity disorders. However, the reliability and validity of clinical measurement remains unclear. In this study we examined first-ray mobility by using one hand to stabilize the lesser metatarsals while the clinician's other hand applied a displacement force to the head of the first metatarsal. The amount of mobility was graded as stiff, normal or hypermobile. We then used a well-validated mechanical device to perform similar tests and assessed validity, intrarater reliability and interrater reliability. Three clinicians having varied levels of experience graded first-ray mobility on 15 subjects. A separate investigator measured dorsal mobility with a mechanical device. Both methods of testing were repeated to assess measurement reliability. Reliability was estimated by kappa (K) statistics. Spearman correlation assessed the relationship between mobility graded manually and dorsal mobility measured by device. Manual examination intrarater K values ranged from 0.50 to 0.85, and interrater agreement from 0.09 to 0.16. Manual grading was not related (r = -0.21) to the absolute measure of total dorsal mobility made by device. This brings into question the validity and reliability of manual estimates of first-ray mobility.

Adult↗

PubMed2002

Dorsal first ray mobility in women athletes with a history of stress fracture of the second or third metatarsal.

STUDY DESIGN: Retrospective case-control study. OBJECTIVE: To examine the amount of dorsal first ray mobility in subjects having a history of stress fracture of the second or third metatarsal as compared to control subjects, and to test the influence of navicular drop, length of the first ray, and generalized joint laxity on the measure of dorsal mobility. BACKGROUND: [corrected] Instability of the first ray may cause the lesser metatarsals to carry greater weight and contribute to the incidence of metatarsal stress fracture. Stability of the first ray is believed to be compromised when subtalar joint pronation continues into late stance, the first metatarsal is short, or an individual has generalized joint laxity. To date, no research has assessed the relationship of these etiological factors to the measure of first ray mobility. METHODS AND MEASURES: Fifteen women athletes having a history of a second or third metatarsal stress fracture were matched by age, body mass, and sport activity to women athletes without fracture. Dorsal first ray mobility was quantified by a device using a standard load of 55 N. Change in vertical height of the navicular during stance was the measure of foot pronation. Relative length of the first ray navicular segment compared to the length of the second ray navicular segment was measured by caliper. Generalized joint laxity was evaluated using the Beighton 9-point scale. Within-day repeated measures assessed reliability. Differences between groups were determined by independent t test. Multiple polynomial regression analysis assessed the relationship between dorsal mobility and navicular drop, length of the first ray, and joint laxity. RESULTS: Interrater reliability coefficients ranged from 0.36 for metatarsal length to 0.71 for navicular drop. The intrarater reliability coefficient for dorsal first ray mobility was 0.93. Dorsal first ray mobility was not significantly different between the 2 groups. With regression analysis, the Beighton score was the only variable retained as a significant predictor of dorsal mobility (R2 = 0.24). CONCLUSION: Results do not support the theory that describes the unstable first ray as a common cause of metatarsal stress fracture. In addition, this investigation found generalized joint laxity to be a significant predictor of dorsal first ray mobility.

Adolescent↗

PubMed2002

Translations of the humerus in persons with shoulder impingement symptoms.

STUDY DESIGN: Two-group mixed-model analysis of covariance and correlation analysis. OBJECTIVES: To determine whether differences in humeral translations exist between patients with shoulder impingement symptoms and an asymptomatic comparison group, and if so, to determine if shoulder range-of-motion (ROM) measures are associated with abnormal translations. BACKGROUND: Abnormal translations of the humeral head are believed to reduce the available subacromial space and to contribute to the development or progression of shoulder impingement symptoms. These abnormal translations have also been theorized to be related to tightness of the posterior capsule and decreased shoulder ROM. METHODS AND MEASURES: Three-dimensional humeral translations were tracked in symptomatic construction workers and an asymptomatic comparison group while elevating the arm in the scapular plane under no-load, 2.3-kg, and 4.6-kg hand-load conditions. Between-group comparisons were made across 3 phases of motion (30 degrees-60 degrees, 60 degrees-90 degrees, and 90 degrees-120 degrees) and the association between humeral translations and cross-body adduction and shoulder internal rotation ROM measures were determined by Pearson correlation analysis. RESULTS: Persons with shoulder symptoms demonstrated small but significant changes in anterior-posterior translations of the humerus. These changes for the 90 degrees-120 degrees phase of humeral elevation were moderately negatively associated with available cross-body adduction ROM. CONCLUSIONS: The identified kinematic deviations are consistent with possible reductions of the subacromial space. Further study of relationships between posterior capsule tightness, rotator cuff function, and abnormal humeral translations is warranted to better delineate underlying kinematic mechanisms that may contribute to shoulder impingement symptoms and to refine rehabilitation techniques.

Adult↗

PubMedDate not supplied

Comparison of three stretches for the pectoralis minor muscle.

Pectoralis minor adaptive shortening in healthy individuals is associated with altered scapular kinematics similar to the alterations demonstrated in individuals with subacromial impingement. This associative relationship suggests that stretching of the pectoralis minor may improve scapular kinematics and assist in the management of shoulder impingement. Several stretches for the pectoralis minor are used clinically, although it is not known which stretch optimally lengthens the muscle. The purpose of this analysis was to compare the mean length change for 3 pectoralis minor stretches. Fifty subjects without shoulder pathology were examined for the change in length of the pectoralis minor during 3 separate stretches by use of an electromagnetic motion-capture system. The stretches analyzed were a unilateral self-stretch, a supine manual stretch, and a sitting manual stretch. Each stretch was significantly different from the other two (df, 2/98; F ratio, 39.09; P < .00001), with the unilateral self-stretch demonstrating the greatest length change (2.24 cm), followed by the supine manual stretch (1.69 cm) and the sitting manual stretch (0.77 cm). Knowledge of the most effective method of elongating the pectoralis minor muscle may improve clinical decision making when targeting this anterior scapulothoracic muscle as part of intervention for or prevention of shoulder impingement.

Adult↗

PubMedDate not supplied

Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane.

OBJECTIVE: To compare scapular orientation during both the concentric (elevation) and eccentric (lowering) phases of scapular plane abduction in subjects with and without shoulder impingement. DESIGN: Mixed model analysis of variance with one between-subjects factor (group) and within-subjects factors of phase, humeral angle, and trial. BACKGROUND: Abnormal scapular kinematics have been identified in shoulder impingement patients during the concentric phase of arm elevation, and under static conditions. Because abnormal scapular motion is observed clinically during the eccentric phase of arm elevation, analysis of this phase of motion is warranted. METHODS: Twenty-six symptomatic and 26 healthy subjects performed five repetitions of humeral scapular plane abduction. An electromagnetic tracking device described three-dimensional scapular kinematics during arm elevation and lowering. Angular values for scapular anterior/posterior tipping in the sagittal plane, upward/downward rotation in the scapular plane, and internal/external rotation in the transverse plane were calculated. Scapular orientation relative to the thorax at humeral angles of 40 degrees, 60 degrees, 80 degrees, 100 degrees, and 120 degrees was statistically tested for effects of phase and trial, or for interactions of phase with group or humeral angle. RESULTS: Internal rotation was significantly increased in the eccentric phase for both groups at the 100 degrees angle (P<0.05) and for the symptomatic group only at the 120 degrees angle (P<0.05). Scapular anterior tipping was significantly decreased during the eccentric phase in both groups at the 80 degrees (P<0.001), 100 degrees (P<0.0001), and 120 degrees (P<0.0001) angles. CONCLUSIONS: Small but statistically significant differences in scapular tipping and internal rotation during the eccentric phase of arm elevation were identified at higher humeral angles in both subject groups, while no significant phase differences for scapular upward rotation or for scapular variables at lower humeral angles were found. Averaged across phases, the symptomatic group demonstrated significant reductions in upward rotation at lower humeral elevation angles, and significant increases in anterior tipping at higher elevation angles as compared to the healthy group. RELEVANCE: Normal and abnormal scapular kinematics during varying types of motion need to be understood in order to optimally design rehabilitation programs for individuals with impingement syndrome.

Adult↗