Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures.

INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20%) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20 percent) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60 percent and 57.80 percent and non-surgical, 62.06 percent and 54.06 percent, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27 percent; non-surgical, 98.61 percent). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

Profile of isokinetic eccentric-to-concentric strength ratios of shoulder rotator muscles in elite female team handball players.

The purpose of this study was to establish the isokinetic profile of shoulder rotator muscles strength in female handball players. Twenty-seven handball players performed concentric and eccentric strength tests of both dominant and non-dominant upper limbs on an isokinetic dynamometer. Internal and external rotator muscles peak torque was assessed at 1.05, 3.14, and 5.23 rad . s(-1) in concentric mode and at 3.14 and 5.23 rad . s(-1) in eccentric mode. Concentric balance ratio and functional ratio were obtained. Bi-lateral deficiency was compared. Concentric strength for internal and external rotation was significantly greater for the dominant than for the non-dominant limb for all speeds (P < or = 0.0001). For eccentric actions, internal rotator muscles were stronger in the dominant than the non-dominant limb (P < or = 0.0001) at both speeds. Concentric balance and functional balance ratios did not differ between sides at 3.14 rad . s(-1) (P = 0.1631), but at 5.23 rad . s(-1) the functional balance ratio in the dominant limb was lower than for the non-dominant limb (P = 0.0500). Although the dominant side was stronger than the non-dominant side, balance concentric ratios remained the same, with only the functional strength ratio different at 5.23 rad . s(-1). Our results suggest that concentric strength exercises be used for internal and external rotators on the non-dominant side, and functional exercise that improves eccentric rotation strength for prevention programmes.

Shoulder functional ratio in elite junior tennis players.

OBJECTIVE: To evaluate shoulder rotation strength and compare the functional ratio between shoulders of elite junior tennis players. DESIGN: This cross-sectional study evaluated muscular rotation performance of 40 junior tennis players (26 male and 14 female) with an isokinetic dynamometer. MAIN OUTCOME MEASURES: Strength variables of external (ER) and internal rotators (IR) in concentric and eccentric modes were considered. For the peak torque functional ratio, the eccentric strength of the ER and the concentric strength of the IR were calculated. RESULTS: All variables related to IR were significantly higher on the dominant compared to the non-dominant side in males and females (p<0.05), but only boys exhibited this dominance effect in ER (p<0.05 and p<0.001). Regarding functional ratios, they were significantly lower for the dominant shoulder (p<0.001) and below 1.00 for both groups, indicating that the eccentric strength of the ER was not greater than the concentric strength of the IR. CONCLUSION: Elite junior tennis players without shoulder injury have shoulder rotation muscle strength imbalances that alter the normal functional ratio between rotator cuff muscles. Although these differences do not seem to affect the athletic performance, detection and prevention with exercise programs at an early age are recommended.

Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial.

OBJECTIVE: To assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in muscle strengthening exercises. METHODS: A total of 60 patients diagnosed with shoulder impingement syndrome were selected from the clinics of the Federal University of São Paulo and randomly distributed into experimental and control groups. Patients were evaluated regarding pain, function, quality of life, muscle strength, and the number of antiinflammatory drugs and analgesics taken. Patients then participated in the progressive resistance training program for the musculature of the shoulder, which was held twice a week for 2 months, while the control group remained on a waiting list. RESULTS: Sixty patients were randomly allocated to the experimental group (21 women and 9 men, mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years). Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on a 10-cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm (P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P < 0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains from the Short Form 36. There was a statistically significant difference in improvement in pain and function between patients in the experimental group and those in the control group (P < 0.05). CONCLUSION: The progressive resistance training program for the musculature of the shoulder in patients with shoulder impingement syndrome was effective in reducing pain and improving function and quality of life.

Exact moment of tendon of pectoralis major muscle rupture captured on video.

A powerlifting athlete ruptured his left tendon of the pectoralis major muscle while attempting to lift 160 kg in a Brazilian bench press championship. The injury seemed to occur in the concentric phase of exercise; however, the more common mechanism of rupture is during the eccentric phase. The tendon was reinserted to the humerus 3 weeks later with screws and washers. The athlete returned to competitive activities after 5 months. One year later he lifted 170 kg and won the national championship.

Força muscular isocinética de jogadores de futebol da seleção paraolímpica brasileira de portadores de paralisia cerebral / Isokinetic muscular strength of paralympic athletes with cerebral palsy ( CP ) from the Brazilian soccer team

INTRODUÇÃO E OBJETIVO: A fraqueza muscular, a assimetria de forças e o desequilíbrio entre músculos antagonistas são reconhecidamente fatores de risco para lesão dos joelhos. Futebolistas portadores de paralisia cerebral (PC) possivelmente apresentam estes fatores de risco exacerbados em decorrência desta doença e do esporte. O objetivo do presente estudo foi avaliar a presença destes fatores de risco para lesão do joelho em atletas, portadores de PC, da seleção paraolímpica brasileira de futebol. MÉTODO: Vinte e um futebolistas paraolímpicos, portadores de PC, com hemiparesia espástica, submeteram-se à avaliação dos músculos flexores e extensores dos joelhos, por meio do dinamômetro isocinético Cybex 6000. Para análise da força muscular foi medido o pico de torque a 60°/s, que foi utilizado para analisar a deficiência contralateral, a relação entre músculos flexores e extensores do joelho e a fraqueza muscular comparando com valores previstos para indivíduos normais (Neder et al., 1999). O teste t-Student pareado foi utilizado para a análise estatística (p < 0,05). RESULTADOS E CONCLUSÃO: Os valores de pico de torque para flexores (PTF) e extensores (PTE) foram menores do lado acometido (PTF = 88,4 ± 26,0Nm e PTE 155,4 ± 37,2Nm) em relação ao não acometido (PTF = 116,2 ± 24,8Nm e PTE = 201,6 ± 38,8Nm). Apenas os músculos extensores do lado acometido foram inferiores aos previstos, embora na análise individual nove indivíduos também apresentassem fraqueza dos músculos flexores deste lado. As médias das relações entre músculos flexores e extensores dos joelhos estão dentro da faixa de normalidade, porém, três indivíduos apresentaram relação baixa do lado não acometido e nove do lado acometido. CONCLUSÃO: Futebolistas altamente treinados portadores de PC apresentam assimetria de forças, fraqueza do músculo quadríceps e desequilíbrio entre músculos antagonistas do joelho, que são fatores de risco para lesão dos joelhos. Assim, um programa de avaliação e fortalecimento muscular direcionado está indicado para esta população.