Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial.

BACKGROUND: Musculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20. METHODS: A randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test. DISCUSSION: DM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04817514. Registered on March 26, 2021.

Association Between Lower Trapezius Isometric Strength and Y-Balance Test Upper Quarter Performance in College Volleyball Players.

CONTEXT: Knowing the possible association between the isometric strength of the shoulder rotators, scapular muscles, and the Y-balance test upper quarter (YBT-UQ) performance could help identify which indicators of shoulder stability should be considered in this field test. This study aimed to determine whether the isometric strength of the shoulder rotators and scapular muscles is associated with the YBT-UQ performance of the dominant upper limb in amateur volleyball players. DESIGN: Cross-sectional study. METHODS: A convenience sample of 22 male and 18 female volleyball players (≥12 h of training/week) between 18 and 26 years of age. The isometric strength of the middle trapezius, lower trapezius, serratus anterior, internal, and external rotator muscles was assessed with a handheld dynamometer. Participants performed the YBT-UQ in the superolateral, medial, and inferolateral directions. The absolute isometric peak force (in Newtons) was normalized to body weight (in Newtons per kilogram) for each muscle test. For each YBT-UQ direction, the distance (in centimeters) was normalized for upper limb length (in percentage). A backward multiple linear regression analysis was used to determine the associations between variables. RESULTS: The analysis revealed that the isometric strength of the lower trapezius (ß = 26.82; 95% confidence interval, 21.24-32.40) is associated with inferolateral YBT-UQ performance (adjusted R2 = .706; P < .001). This factor explains 70% of the variability of the YBT-UQ in the inferolateral direction. CONCLUSIONS: Lower trapezius isometric strength is associated with inferolateral YBT-UQ performance of the dominant upper limb in amateur volleyball players. These findings could help in the development of more specific training programs and rehabilitation goals according to the performance of the athletes in the test.

Changes in shoulder girdle strength in 3 consecutive years in elite adolescent swimmers: a longitudinal cohort study.

BACKGROUND: The shoulder complex is highly loaded during swimming. No studies were found analyzing the changes in shoulder girdle strength in young swimmers, through the years. OBJECTIVE: To analyze the changes in strength of internal rotators and external rotators of the arm, lower trapezius and supraspinatus and in the external rotators/internal rotators ratio in young elite swimmers through 3 years. METHODS: 31 adolescent elite swimmers (14-18 years, of both sexes) participated in the study. Isometric strength of the shoulder girdle muscles was performed using a handheld dynamometer during 3 years. RESULTS: For boys absolute data, internal rotators increased from the first to the second (p=0.0001; mean difference 45.6N; 95%CI 26.7-65.0) and third years (p=0.01; mean difference: 32.4; 95%CI: 9.3-55.5). Considering the weight-normalized data, internal rotators increased from the first to the second year (p<0.0001; mean difference: 0.52; 95%CI: 0.26-0.78), external rotators decreased from the first to the third year (p=0.003; mean difference: -0.33; 95%CI: -0.53 to -0.13) and from the second to the third year (p=0.0004; mean difference: -0.29; 95%CI: -0.46 to -0.12) and supraspinatus decreased from the second to the third year (p=0.006; mean difference: -0.17; 95%CI: -0.28 to -0.06). For girls, there were no significant differences in the absolute strength. Considering the weight-normalized data, lower trapezius decreased from the first to the third year (p=0.02; mean difference: -0.15; 95%CI: -0.27 to 0.03). Considering both sexes, the external rotators/internal rotators ratio decreased from the first to the second (p<0.0001; mean difference -0.12N; 95%CI -0.13 to -0.11) and third years (p<0.0001; mean difference -0.15N; 95%CI -0.16 to -0.14). CONCLUSION: Muscle imbalance can occur in the shoulder girdle in young swimmers in 3 years, with increased internal rotators and decreased external rotators and supraspinatus strength in boys, and decreased strength of the lower trapezius in girls. Attention should be given in young swimmers' shoulder girdle muscle balance.

Quantifying humeral retrotorsion in young swimmers and association with swim volume.

OBJECTIVES: To compare the humeral retrotorsion (HRT) among non-athletes, amateur swimmers and competitive swimmers and to analyze the relationship between HRT and swim volume in competitive swimmers. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Ninety children and adolescents, both genders (30 non-athletes: 11.50 ± 1.94 years; 30 amateur swimmers: 11.56 ± 1.81 years; and 30 competitive swimmers: 12.63 ± 2.02 years). MAIN OUTCOME MEASURES: HRT measurement through the bicipital forearm angle (BFA), by palpation, using an inclinometer to obtain the angle. RESULTS: Competitive swimmers showed lower BFA (higher HRT) compared to the amateurs (mean difference: 8.3°; p = 0.013; effect size: 0.82) and to the non-athletes (mean difference: 8.5°; p = 0.010; effect size: 0.80). A significant fair negative relationship (r = -0.37; p = 0.04) was found between BFA and volume of swim. CONCLUSION: Competitive young swimmers present increased HRT and a higher volume of swim is associated with a lower BFA (higher HRT) in these athletes. These results can help to improve the understanding of osseous adaptations in young swimmers.

Swimming Practice and Scapular Kinematics, Scapulothoracic Muscle Activity, and the Pressure-Pain Threshold in Young Swimmers.

CONTEXT: Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers. OBJECTIVES: To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers. INTERVENTION(S): Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior. MAIN OUTCOME MEASURE(S): Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05. RESULTS: Competitive swimmers presented more internal rotation at 90° ( P = .03) and 120° ( P = .047) and more anterior tilt at 90° ( P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° ( P = .004) and 120° ( P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° ( P = .02) and 90° to 120° ( P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners ( P = .04). No differences were found in any of the muscles for the PPT ( P > .05). CONCLUSIONS: Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.

Differences in scapular kinematics and scapulohumeral rhythm during elevation and lowering of the arm between typical children and healthy adults.

Scapular kinematics in healthy adults is well described in the literature but little is known on typical children. This study aimed to compare the three-dimensional (3-D) scapular kinematics and scapulohumeral rhythm during the elevation and lowering of the arm in the scapular plane in typical children and healthy adults. Twenty-six healthy adults (35.34±11.65 years, 1.70±0.10m, 70.00±12.30kg) and 33 typical children (9.12±1.51 years, 1.40±0.10m, 35.40±10.45kg) participated in this study. 3-D scapular kinematics were obtained using an electromagnetic tracking device. The subjects were asked to elevate and lower their arm in the scapular plane. Children showed less scapular protraction compared to adults at 120° during arm elevation, more anterior tilt than adults in the elevation and also at 60°, 90° and 120° during lowering of the arm. Children also showed higher scapulohumeral rhythm during lowering of the arm compared to adults from 90° to 60°. It was also found a low to little correlation between scapular position and age. The study showed small but significant differences in scapular kinematics and scapulohumeral rhythm between children and adults. These results can help clinicians to improve diagnosis and treatment protocols directed to children with dysfunction, as reference values on scapular kinematics in healthy children are also provided in this study.

Assessment of global motor performance and gross and fine motor skills of infants attending day care centers.

OBJECTIVE: To analyze the global motor performance and the gross and fine motor skills of infants attending two public child care centers full-time. METHODS: This was a longitudinal study that included 30 infants assessed at 12 and 17 months of age with the Motor Scale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). This scale allows the analysis of global motor performance, fine and gross motor performance, and the discrepancy between them. The Wilcoxon test and Spearman's correlation coefficient were used. RESULTS: Most of the participants showed global motor performance within the normal range, but below the reference mean at 12 and 17 months, with 30% classified as having "suspected delays" in at least one of the assessments. Gross motor development was poorer than fine motor development at 12 and at 17 months of age, with great discrepancy between these two subtests in the second assessment. A clear individual variability was observed in fine motor skills, with weak linear correlation between the first and the second assessment of this subtest. A lower individual variability was found in the gross motor skills and global motor performance with positive moderate correlation between assessments. Considering both performance measurements obtained at 12 and 17 months of age, four infants were identified as having a "possible delay in motor development". CONCLUSIONS: The study showed the need for closer attention to the motor development of children who attend day care centers during the first 17 months of life, with special attention to gross motor skills (which are considered an integral part of the child's overall development) and to children with suspected delays in two consecutive assessments.

Avaliação do desempenho motor global e em habilidades motoras axiais e apendiculares de lactentes frequentadores de creche / Assessment of global motor performance and gross and fine motor skills of infants attending day care centers

OBJETIVO: Analisar o desempenho motor global em habilidades motoras axiais e apendiculares de lactentes que frequentavam, em tempo integral, duas Escolas Municipais de Educação Infantil. MÉTODOS: Estudo longitudinal do qual participaram 30 lactentes avaliados aos 12 e 17 meses de vida com a escala motora das Bayley Scales of Infant and Toddler Development-III, que possibilita a análise do desempenho motor global, apendicular e axial e a discrepância entre eles. Utilizaram-se o teste de Wilcoxon e o Coeficiente de Correlação de Spearman. RESULTADOS: A maioria dos participantes apresentou desempenho motor global dentro dos limites de normalidade, porém abaixo da média de referência aos 12 e 17 meses, com 30 por cento classificados como suspeitos de atraso em pelo menos uma das avaliações. O desempenho motor axial foi inferior ao apendicular aos 12 e aos 17 meses, com grande discrepância entre eles especialmente na 2ª avaliação. Observou-se marcada variabilidade individual nas habilidades motoras apendiculares, com fraca correlação linear no desempenho entre a 1ª e a 2ª avaliações nesse domínio. Nas habilidades axiais e no desempenho motor global, encontrou-se menor variabilidade individual, com correlações moderadas e positivas entre a 1ª e a 2ª avaliações. Identificaram-se quatro lactentes com suspeita de atraso no desenvolvimento motor em ambas as avaliações. CONCLUSÕES: O estudo aponta necessidade de maior atenção ao desenvolvimento motor durante os primeiros 17 meses de crianças que frequentam creches, com especial vigilância à motricidade axial (considerando que ela é parte integrante do desenvolvimento global da criança) e às crianças com desempenho suspeito de atraso em duas avaliações consecutivas.

OBJECTIVE: To analyze the global motor performance and the gross and fine motor skills of infants attending two public child care centers full-time. METHODS: This was a longitudinal study that included 30 infants assessed at 12 and 17 months of age with the Motor Scale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). This scale allows the analysis of global motor performance, fine and gross motor performance, and the discrepancy between them. The Wilcoxon test and Spearman's correlation coefficient were used. RESULTS: Most of the participants showed global motor performance within the normal range, but below the reference mean at 12 and 17 months, with 30 percent classified as having "suspected delays" in at least one of the assessments. Gross motor development was poorer than fine motor development at 12 and at 17 months of age, with great discrepancy between these two subtests in the second assessment. A clear individual variability was observed in fine motor skills, with weak linear correlation between the first and the second assessment of this subtest. A lower individual variability was found in the gross motor skills and global motor performance with positive moderate correlation between assessments. Considering both performance measurements obtained at 12 and 17 months of age, four infants were identified as having a "possible delay in motor development". CONCLUSIONS: The study showed the need for closer attention to the motor development of children who attend day care centers during the first 17 months of life, with special attention to gross motor skills (which are considered an integral part of the child's overall development) and to children with suspected delays in two consecutive assessments.