Neck or Shoulder? Establishing Consensus for Spine Screening in Patients with Shoulder Pain: an International Modified Delphi Study.

Objective: There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.

Methods: A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel.

Effects of Scapular Angular Deviations on Potential for Rotator Cuff Tendon Mechanical Compression.

Background: One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration.

Purpose: To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction.

Study Design: Descriptive laboratory study.

The long head of the biceps tendon undergoes multiaxial deformation during shoulder motion.

The long head biceps tendon (LHBT) is presumed a common source of shoulder joint pain and injury. Despite common LHBT pathologies, diagnosis and preferred treatment remain frequently debated. This Short Communication reports the development of a subject-specific finite element model of the shoulder joint based on one subject's 3D reconstructed anatomy and 3D in vivo kinematics recorded from bone-fixed electromagnetic sensors.

Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification.

Background: Recent evidence suggests that internal impingement, or rotator cuff tendon deformation against the glenoid, occurs during overhead motions and may therefore be a mechanism of pathology even in non-athletes. Clinically, knowing how movement impacts potential injury mechanisms would be useful to guide movement-based treatment strategies.

Objective: To compare the distance between the glenoid and rotator cuff footprint between two groups classified based on scapulothoracic upward rotation (UR) magnitude (i.

To what extent do typical components of shoulder clinical evaluation explain upper-extremity disability? A cross-sectional study.

Background: Physical therapists use several evaluation measures to identify the most important factors related to disability. However, the degree to which these evaluation components explain shoulder disability is not well known and that may detract clinicians from the best clinical reasoning.

Objective: To determine how much evaluation components explain shoulder function.

Kinematics and biomechanical validity of shoulder joint laxity tests as diagnostic criteria in multidirectional instability.

Background: Clinical laxity tests are commonly used together to identify individuals with multidirectional instability (MDI). However, their biomechanical validity in distinguishing distinct biomechanical characteristics consistent with MDI has not been demonstrated.

Objective: To determine if differences in glenohumeral (GH) joint laxity exist between individuals diagnosed with multidirectional instability (MDI) and asymptomatic matched controls without MDI.

Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion.

Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation.

Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity.

Errors in Measuring Glenohumeral Arthrokinematics With 2-Dimensional Fluoroscopy.

Two-dimensional fluoroscopic imaging allows measurement of small magnitude humeral head translations that are prone to errors due to optical distortion, out-of-plane imaging, repeated manual identification of landmarks, and magnification. This article presents results from in vivo and in vitro fluoroscopy-based experiments that measure the errors and variability in estimating the humeral head translated position in true scapular plane and axillary views. The errors were expressed as bias and accuracy.

Finite element analysis of the rotator cuff: A systematic review.

Background: Finite element modeling serves as a promising tool for investigating underlying rotator cuff biomechanics and pathology. However, there are currently no concrete guidelines for reporting in finite element model studies. This has compromised the reliability, validity, and reproducibility of literature due to omission of pertinent items within publications.

The Coupled Kinematics of Scapulothoracic Upward Rotation.

Background: Scapulothoracic upward rotation (UR) is an important shoulder complex motion allowing for a larger functional work space and improved glenohumeral muscle function. However, the kinematic mechanisms producing scapulothoracic UR remain unclear, limiting the understanding of normal and abnormal shoulder movements.

Objective: The objective of this study was to identify the coupling relationships through which sternoclavicular and acromioclavicular joint motions contribute to scapulothoracic UR.

Shoulder kinematics impact subacromial proximities: a review of the literature.

Background: Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space.

Objective: The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities.

Conclusions: A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs.

The effect of tactile and verbal guidance during scapulothoracic exercises: An EMG and kinematic investigation.

Background: Clinician-led training through tactile and verbal guidance to improve muscle activity and joint motion are a common but understudied focus of therapeutic interventions for shoulder pain. The purpose of this study was to determine if clinician guidance changes scapulothoracic muscle activity and kinematics compared to unguided shoulder exercises.

Methods: Eleven participants with shoulder pain were studied.

Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain.

Background: Magnetic resonance imaging (MRI) is commonly used to diagnose structural abnormalities in the shoulder. However, subsequent findings may not be the source of symptoms. The aim of this study was to determine comparative MRI findings across both shoulders of individuals with unilateral shoulder symptoms.

The Impact of Decreased Scapulothoracic Upward Rotation on Subacromial Proximities.

Background: Decreased scapulothoracic upward rotation has been theorized to increase an individual's risk for rotator cuff compression by reducing the clearance for the tendons in the subacromial space (ie, subacromial proximities). However, the impact of decreased scapulothoracic upward rotation on subacromial proximities has not been tested during dynamic in vivo shoulder motion.

Objective: To determine the impact of decreased scapulothoracic upward rotation on subacromial proximities.

MRI vs CT-based 2D-3D auto-registration accuracy for quantifying shoulder motion using biplane video-radiography.

Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models.

The effect of glenohumeral plane of elevation on supraspinatus subacromial proximity.

Shoulder pain is a common clinical problem affecting most individuals in their lifetime. Despite the high prevalence of rotator cuff pathology in these individuals, the pathogenesis of rotator cuff disease remains unclear. Position and motion related mechanisms of rotator cuff disease are often proposed, but poorly understood.

Validation of single-plane fluoroscopy and 2D/3D shape-matching for quantifying shoulder complex kinematics.

Fluoroscopy and 2D/3D shape-matching has emerged as the standard for non-invasively quantifying kinematics. However, its accuracy has not been well established for the shoulder complex when using single-plane fluoroscopy. The purpose of this study was to determine the accuracy of single-plane fluoroscopy and 2D/3D shape-matching for quantifying full shoulder complex kinematics.

CHANGING OUR DIAGNOSTIC PARADIGM: MOVEMENT SYSTEM DIAGNOSTIC CLASSIFICATION.

Proper diagnosis is a first step in applying best available treatments, and prognosticating outcomes for clients. Currently, the majority of musculoskeletal diagnoses are classified according to pathoanatomy. However, the majority of physical therapy treatments are applied toward movement system impairments or pain.

Concurrent validity of inclinometer measures of scapular and clavicular positions in arm elevation.

Objective: To assess concurrent validity, between and within-day reliability of scapular and clavicular digital inclinometer measures.

Design: Test-retest and concurrent validity.

Setting: Laboratory.

Thickness of the Rotator Cuff Tendons at the Articular Margin: An Anatomic Cadaveric Study.

Background: With a substantial portion of the population experiencing rotator cuff pathology, the importance of understanding mechanisms of rotator cuff disease remains critical. Current research aimed at understanding relationships between shoulder movement and cuff injuries has been hindered by our limited knowledge of the thickness of soft tissue structures within the shoulder. Therefore, the purpose of this study is to measure the thicknesses of all four rotator cuff tendons at the articular margin.

Effect of glenohumeral elevation on subacromial supraspinatus compression risk during simulated reaching.

Mechanical subacromial rotator cuff compression is one theoretical mechanism in the pathogenesis of rotator cuff disease. However, the relationship between shoulder kinematics and mechanical subacromial rotator cuff compression across the range of humeral elevation motion is not well understood. The purpose of this study was to investigate the effect of humeral elevation on subacromial compression risk of the supraspinatus during a simulated functional reaching task.

Improving Shoulder Kinematics in Individuals With Paraplegia: Comparison Across Circuit Resistance Training Exercises and Modifications in Hand Position.

Background: Circuit resistance training (CRT) should promote favorable kinematics (scapular posterior tilt, upward rotation, glenohumeral or scapular external rotation) to protect the shoulder from mechanical impingement following paraplegia. Understanding kinematics during CRT may provide a biomechanical rationale for exercise positions and exercise selection promoting healthy shoulders.

Objective: The purposes of this study were: (1) to determine whether altering hand position during CRT favorably modifies glenohumeral and scapular kinematics and (2) to compare 3-dimensional glenohumeral and scapular kinematics during CRT exercises.

Scapulothoracic and Glenohumeral Kinematics During Daily Tasks in Users of Manual Wheelchairs.

Background: Rates of shoulder pain in individuals who use manual wheelchairs (MWCs) as their primary means of mobility have been reported to be as high as 70% during activities of daily living. Current prevailing thought is that mechanical impingement of the soft tissues that reside within the subacromial space between the humeral head and coracoacromial arch is a major contributor to the shoulder pain in users of MWCs. The subacromial space size is directly related to the kinematics at the shoulder joint.