Comparison of passive torque during shoulder internal rotation before and after a pitching in college baseball pitchers / 体力科学

Previous study reported that baseball pitchers had a decreased shoulder internal rotation (IR) range of motion after pitching. However, whether the decreased range of motion associated with pitching is caused by tightness of the posterior shoulder has not been clarified yet. The joint stiffness in the passive torque can be compared with posterior shoulder tightness before and after pitching. Hence, this study aimed to compare shoulder IR stiffness based on passive torque before and after pitching in baseball pitcher. Eleven health male collage baseball pitchers were recruited. Passive torque during IR (max IR, peak torque and stiffness) of dominant and non-dominant arms was measured using an isokinetic dynamometer. Measurements were taken before, after, and post 24 hours after pitching (105 pitches). It was observed that after pitching, max IR and peak torque were significantly decreased compared to those before pitching. However, there was no difference in the stiffness of passive torque among three measurements. In conclusion, healthy college baseball pitchers have a decreased IR range of motion after pitching. However, this result is not due to posterior shoulder tissue tightness, but because of altered stretch tolerance.

¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Comparison between Hip Internal Rotation Assistive Device and Conventional Radiograph Positioning: An Experimental Study

@#Introduction: Plain anteroposterior radiograph of the hip plays an important role in diagnosing hip pathology. However, one of the most common mistakes is image distortion because the hip is externally rotated due to natural femoral neck anteversion. Thus, the lower extremities should be internally rotated by 15°–20°. The researchers developed a hip internal rotation assistive device and compared it with conventional radiograph positioning. Materials and methods: A hip internal rotation assistive device was designed. This study consisted of 20 volunteers without clinical hip pathology. The volunteers were informed to do a hip radiograph twice to compare the efficacy of the developed device with a conventional positioning. The thickness of the lesser trochanter (TLT) was measured and interpreted by an orthopedist and a radiologist. Statistical significance and inter- and intra-observer reliabilities were analysed. Results: According to the orthopaedist’s measurement, the mean TLT distance was 4.42 + 3.2mm and 4.97 + 3.16mm for the conventional technique and assistive device, respectively, without statistical significance between both groups (p = 0.05). Consistent with the musculoskeletal radiologist, the mean TLT distance was 4.00 + 2.06mm for the conventional technique and 3.92 + 2.27mm for the assistive device, without statistical significance between both groups (p = 0.56). Intra-observer reliability was 0.900 and 0.898 for the orthopaedist and the radiologist, respectively. Interobserver reliability of the assistive device and conventional technique were 0.800 and 0.588, respectively. Conclusion: The efficacy of the developed device was similar to that of the conventional technique. Inter/intra-observer reliabilities were at a good agreement level in both methods. The developed device would also be useful in clinical applications, especially in decreasing unnecessary radiation exposure of medical personnel.

A Proposed Novel Inhibitor Stretching Procedure For Posterior Shoulder Tightness

Background: Posterior shoulder tightness has been proposed to contribute to or cause a myriad of shoulder conditions. The tightness of the posteroinferior capsule and the teres minor and infraspinatus muscles of the posterior cuff has been hypothesized to cause osteokinematic [e.g., limited glenohumeral (GH) internal rotation] and arthrokinematic dysfunctions (e.g., decentralization of the humeral head). A number of interventions have been successful in the restoration of or at least improvement in posterior shoulder flexibility including joint mobilizations (e.g., posterior glide) and posterior cuff stretches. The two most common posterior cuff stretches, the sleeper stretch and the crossbody stretch, mimic the position of two common impingement Orthopaedic provocation tests. Despite the success of stretching to help optimize tissue extensibility to help prevent injuries, these stretches have been reported to cause pain in some symptomatic subjects. For these reasons, the authors propose creating an alternate posterior shoulder self-stretching technique that facilitates the inhibition of the target region. Aim: Therefore, this paper aims to introduce a novel stretching protocol that utilizes a form of reflex inhibition to help relax the muscle during the stretching procedure to increase efficiency and reduce pain during the stretching maneuver. Underlying Principles for the Proposed Stretching Maneuver: This novel stretch is an active-assisted maneuver using a form of reciprocal inhibition. The authors propose that muscular inhibition through Ia afferents can be applied in a more global manner by muscle contraction of the anatomically remote posterolateral hip cuff musculature (gluteus maximus and medius) to inhibit the target muscles of the posterior rotator cuff of the scapulohumeral joint (infraspinatus and teres minor). This novel inhibitory stretching technique is referred to as Inhibition Stretching (IS), and the specific technique utilized in this study is the Clam Shell Bridging Maneuver. This technique is recommended for overhead athletes with and without shoulder pain and limited GH IR. Summary: The authors have proposed a novel stretching procedure, the Clam Shell Bridging Maneuver, that is hypothesized to reduce the muscles guarding, and resistance of the shoulder girdle during stretching and also position the athlete in a way that helps minimizes pain and impingement during the stretch while still providing stabilization to the scapula.

Variations in shoulder loading due to differences in the site of stepping foot contact during baseball pitching - Comparison between flat ground and mound conditions - / 体力科学

This study examined variations in shoulder loading due to differences in the site of stepping foot contact during baseball pitching, while comparing flat ground and mound conditions. Measurement was performed, involving 10 right-handed pitchers who belonged to university baseball clubs, under original flat ground and mound conditions. Pitching movements were classified into 3 categories: [normal], [narrow], and [outside]. Through 3-dimensional motion analysis using a motion capture system, the following results were obtained: 1. The pitching velocity was significantly higher in the [normal] compared with [narrow] and [outside] conditions and under the mound compared with flat ground condition. 2. The peak torque of the shoulder internal rotation was markedly lower in the [narrow] compared with [normal] condition. There were no significant differences between the [normal] and [outside] conditions or between the flat ground and mound conditions. 3. The posterior, superior, and inferior shearing forces, as well as the proximal traction force, which influence the humeral head of the shoulder, were markedly greater in the [normal] compared with [narrow] and [outside] conditions. The anterior and posterior shearing forces and proximal traction force were significantly greater under the mound compared with flat ground conditions. Based on the results, the internal rotation torque of the shoulder, as well as the shearing and traction forces influencing the humeral head of the shoulder, may vary due to differences in the site of stepping foot contact during baseball pitching and between flat ground and mound conditions. The former may also be useful to prevent pitching-related shoulder injuries.

Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit

Background: The glenohumeral joint consists of dynamic and static stabilizer, which works, in concert to allow for stability and mobility through a large arc of motion, in recent years there has been significant focus on shoulder motion, particularly in overhead throwing athletes. Glenohumeral internal rotation deficits (GIRD) are common physical impairments in evaluated both adolescent and overhead sports such as baseball, cricket, and tennis. Therefore the aim of the study firstly was to determine the effectiveness of mobilization with exercise in patients with glenohumeral internal rotation deficit and secondly to determine whether mulligan internal rotation MWM with stretching in patients with glenohumeral internal rotation deficit. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. All the subjects were randomly selected and assigned to each group. A pretest measurement with the help of two measures - Oxford Shoulder Instability Score (OSI) for disability, and inclinometer for an internal range of motion shoulder was Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Jaideep Lad. Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit. IAIM, 2018; 5(5): 138-145. Page 139 done in each group. Subjects in Group-A were given mobilizations with stabilization exercise for capsule for a total of 12 minutes a minimum of 4 times per week over a 4-week period and Group-B were given mulligan mobilization with Posterior Capsule Stretching As follows, 1st day 3 glides, 2 nd day 3 sets of six glides, 3rd day 3 sets of 10 glides were given and 4th day again 3 sets of 10 was given. A patient who failed to come for 4 days with stretching performed 3–5 repetitions each repetition was held for 30 seconds, four days a week for four weeks total 16 sessions. Results: On comparing Group A and Group B for post-treatment OSI score, results showed a significant difference (p=0.001) in improvement in terms of OSI. On comparing Group A and Group B for post-treatment inclinometer score, results showed a significant difference in improvement in terms of the inclinometer. This study showed that Mulligan MWM along with stretching exercises was more effective to that patient as compared to mobilization with strengthening exercises given to a patient with glenohumeral internal rotation deficit. Conclusion: The study showed a significant difference between both the groups when the values obtained were analysed. It indicated that Group B in Range mulligan mobilization with Posterior Capsule Stretching of Motion in internal rotation and external rotation. Their scores in Index Oxford Shoulder Instability Score (OSI) have reduced which indicates the decreased level of disability and better functional ability.

Surgical treatment of shoulder joint posterior dislocation secondary to internal rotation contractnre deformity in brachial plexus birth palsy / 中华显微外科杂志

ObjectiveTo observe the functional recovery of shoulder joint and the reduction of posterior dislocated humeral head in children with shoulder joint internal rotation contracture and humeral head posterior dislocation secondary to brachial plexus birth palsy treated by a modified surgical procedure through the anterior combined posterior approach of the shoulder. MethodsNinteen patients,ranging in age from 2.5 to 8.5 years (average 5 years),suffered posterior dislocation of the shoulder joint secondary to internal rotation contracture in brachial plexus birth palsy. The gleno-humeral joint deformity was confirmed by X-ray and CT examination and classified as type Ⅳ in 15 eases and typeⅤin 4 cases according to the modified water's criteria.The surgical procedure was as follows:the contracture soft tissue around the anterior of shoulder joint was released firstly through the anterior approach, and the posterior-inferior capsule of the shoulder was exposed and separated with the pseudoglenoid through the posterior approach,the humeral head was reduced by external rotation the arm,then the posterior-inferior capsule was retighten.A plaster cast was used to fix the shoulder at the neutral position of 0° for 4 weeks. ResultsAfter 12 to 36 months follow up(average of 20 months), the Mallet score of the shoulder was from 11.4 ± 1.7 (range 7-16)preoperative to 15.5 ± 1.8(range 13-19) postoperative,the difference was significantly (P ＜ 0.05).The central relocation of humeral head was achieved in 16 patients, but the humeral head was still dislocated to posterior in 3 cases.ConclusionsThe posterior-inferior capsule was separated with the pseudo-glenoid and retighten through the posterior approach,and reduction of the humeral head by soft tissue releaseing through the anterior approach can recover the concentric relationship of gleno-humeral joint and improve the function of shoulder joint with posterior dislocation secondary to internal rotated contracture deformity in brachial plexus birth palsy.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.