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.

Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability.

OBJECTIVES: To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN: Reliability study. SETTING: Clinical measurement. PARTICIPANTS: Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES: Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS: Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS: The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.

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. PARTICIPANTS: Twenty-three participants with and without shoulder symptoms. MAIN OUTCOME MEASURES: Static positions of scapular upward rotation, anterior/posterior tilting and clavicular elevation were measured between days with an inclinometer and compared to a 3-dimensional electromagnetic tracking system in different positions of sagittal plane humeral elevation (neutral, 30°, 60°, 90°, 120°). The two methods were compared using a two-way Analysis of Variance. Linear regressions at each arm position were also performed to further assess concurrent validity. RESULTS: Between-day reliability demonstrated Intraclass Correlation Coefficients ≥ 0.50 for all comparisons. There were statistically significant differences between methods or interactions of method and arm position for clavicle elevation (p = 0.004, maximum offset between methods 7.7º in the neutral position), and scapular upward rotation (p = 0.001). For scapular upward rotation, the maximum difference between methods was less than 2° across all humeral positions. Clavicle elevation (r = 0.67-0.82) and scapular upward rotation (r = 0.57-0.81) demonstrated higher correlations between measurement methods than scapular anterior/posterior tilt (r = 0.10-0.67). CONCLUSIONS: Concurrent validity in assessing scapular upward rotation and clavicle elevation with an inclinometer was shown when compared with electromagnetic tracking. However, the inclinometer method may not have adequate concurrent validity to clinically measure scapular anterior/posterior tilting.

Kinesio taping of the deltoid does not reduce fatigue induced deficits in shoulder joint position sense.

BACKGROUND: Muscle fatigue is known to decrease shoulder proprioceptive acuity, potentially contributing to injuries. It has been suggested that Kinesio taping can improve proprioception. Therefore, the aim of this study was to investigate the effects of Kinesio taping on shoulder joint position sense after muscle fatigue. METHODS: Twenty-four healthy subjects were evaluated in a randomized, crossover, single-blind study design. Shoulder joint position sense was assessed during active repositioning tests at the target angles of 50°, 70° and 90° of arm elevation in scapular plane, in three sessions: control (no taping), Kinesio taping (Kinesio taping applied over the deltoid muscle with tension) and sham (Kinesio taping applied over deltoid without tension). Joint position sense was assessed three times: before taping; following taping application or rest, in the control session; and following a fatigue protocol. The constant error (repositioned angle-target angle) was considered for statistical analysis, using a 3-way repeated-measure ANOVA (within subject factors: taping, time and target angle). FINDINGS: There was no interaction or main effect involving taping. An interaction between time and angle was found and the simple effect showed that the constant error increased following fatigue at 70° and 90°, but not at 50°. INTERPRETATION: The results of this study does not support the use of Kinesio taping applied over the deltoid muscle for compensating or preventing shoulder joint position sense deficits caused by muscle fatigue of shoulder abductors.

Scapular kinematics and muscle performance in a single case of Parsonage-Turner.

This study characterized the impairments of range of motion, three-dimensional scapulo-thoracic kinematics, isokinetic muscle performance and disability in a patient with Parsonage-Turner Syndrome. The patient had a history of 2.5-years of shoulder pain, and electroneurodiagnostic testing indicative of suprascapular neuropathy. The patient-rated Disabilities of the Arm, Shoulder and Hand (DASH) score was 33.3% (0 = no symptoms/disability), and reduced shoulder internal rotation, external rotation, and flexion as compared bilaterally. There were deficits in isokinetic muscle performance at slow and fast speeds during abduction, lateral and medial rotations as compared to the uninvolved side. Alterations in scapular kinematics were decreased posterior tilt, increased internal rotation, and increased upward rotation during arm elevation and lowering. This information can be used to assist clinicians in developing treatment programs to address the alterations caused by this neuralgic amyotrophy.

Joint position sense is not altered during shoulder medial and lateral rotations in female assembly line workers with shoulder impingement syndrome.

This study evaluated joint position sense (JPS) during medial and lateral rotations of the shoulder in female workers with and without shoulder impingement syndrome (SIS). Three groups were assessed. The case group consisted of 15 female assembly line workers (35.5, SD 5.8 years) with unilateral SIS. Control group 1 consisted of 15 female assembly line workers asymptomatic for SIS (34.4, SD 5.5 years) and control group 2 consisted of 15 female subjects (33.1, SD 6.2 years) asymptomatic for SIS and with no exposure to activities with the upper limbs. The JPS was evaluated bilaterally during passive (2°/sec) and active (5°/sec) repositioning tests using an isokinetic dynamometer. The target angles were 45° of lateral rotation (achieved by medially rotating the shoulder from 90° of lateral rotation) and 75° of lateral rotation (achieved by laterally rotating the shoulder from neutral rotation). There were no differences between sides for all groups (p  >  0.05). There were no differences in any of the variables between the case group and the control groups (p  >  0.05). The results of this study suggest that JPS during medial and lateral rotations of the shoulder is not altered in female assembly line workers with SIS.

Shoulder internal and external rotations torque steadiness in overhead athletes with and without impingement symptoms.

OBJECTIVES: This study aimed to investigate torque steadiness of shoulder internal and external rotations in regularly training overhead athletes with and without impingement symptoms. DESIGN: Cross-sectional laboratory study. METHODS: Three groups were evaluated: athletes with impingement symptoms (n=21), asymptomatic athletes (n=25) and non-athletes (n=21). To assess torque steadiness, the participants performed 3 submaximal contractions (35% of peak torque) for 10s each, with the arm at 90° of shoulder abduction and 90° of external rotation. The standard deviation, coefficient of variation, mean exerted torque and time to stability were measured from the steadiness trials. RESULTS: The standard deviation of internal rotation was higher in asymptomatic athletes than in non-athletes (p<0.01); however, there was no difference between the athletes with impingement symptoms and the other groups. The other variables presented no differences among the groups. CONCLUSIONS: Higher torque fluctuation of shoulder internal rotation in asymptomatic athletes may point to neuromuscular adaptations related to throwing training. However, the steadiness patterns of athletes with impingement symptoms did not differ from those of asymptomatic athletes or non-athletes.

Functional torque ratios and torque curve analysis of shoulder rotations in overhead athletes with and without impingement symptoms.

In this study, we evaluated the peak torque, functional torque ratios, and torque curve profile of the shoulder rotators in overhead athletes with impingement symptoms so as to examine possible alterations in response to sports training and shoulder pain. Twenty-one overhead athletes with impingement symptoms were compared with 25 overhead athletes and 21 non-athletes, none of whom were symptomatic for impingement. The participants performed five maximal isokinetic concentric and eccentric contractions of medial and lateral shoulder rotations at 1.57 rad · s(-1) and 3.14 rad · s(-1). Isokinetic peak torque was used to calculate the eccentric lateral rotation-to-concentric medial rotation and the eccentric medial rotation-to-concentric lateral rotation ratios. An analysis of the torque curve profiles was also carried out. The eccentric lateral rotation-to-concentric medial rotation torque ratio of asymptomatic athletes was lower than that of non-athletes at both test velocities. The concentric medial rotation isokinetic peak torque of the asymptomatic athletes, at 3.14 rad · s(-1), was greater than that of the non-athletes, and the peak appeared to occur earlier in the movement for athletes than non-athletes. These findings suggest that there may be adaptations to shoulder function in response to throwing practice. The eccentric medial rotation-to-concentric lateral rotation torque ratio was altered neither by the practice of university-level overhead sports nor impingement symptoms.

Isokinetic dynamometry applied to shoulder rotators - velocity limitations in eccentric evaluations.

The objectives of this study were to evaluate if collegiate overhead athletes, with and without shoulder pain, and non-athletes could reach a preset velocity in internal and external shoulder rotation isokinetic evaluations; and to evaluate the correlation between torque and velocity. Controlled laboratory study, cross-sectional. Evaluations were performed using the isokinetic dynamometer Biodex System 3. Participants were assessed seated, with the arm at 90° of shoulder abduction and 90° of elbow flexion, from neutral rotation to 90° of external rotation. Five maximal contractions of isokinetic concentric and reactive eccentric internal and external rotation were performed at the velocities 90°/s, 180°/s and 240°/s. Data were processed with using MatLab. Most participants did not reach the isokinetic phase during eccentric tests at 180°/s and 240°/s, particularly in the external rotators evaluation. High correlations between torque and velocity of eccentric tests were found. The groups presented no differences in maximal velocity attained in trials which preset velocity was not reached. These results call into question the use of reactive eccentric tests at velocities higher than 180°/s for the isokinetic evaluation of shoulder external rotators in collegiate overhead athletes and non-athletes in this specific position. In such cases, careful evaluation of the velocity is recommended to determine if the isokinetic phase was reached.