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.

Serratus anterior sEMG - sensor placement and test position for normalization purposes during maximal and submaximal exertions.

There is great variability regarding serratus anterior sEMG sensor placement and test positions during normalization procedures. We investigated between-trials reliability of serratus anterior sEMG, acquired at two sensor placements and four test positions, during maximal and submaximal isometric contractions. Twenty young healthy women participated. sEMG was captured at the 7th intercostal space and at the xiphoid process level, in the mid-axillary line, during maximal and submaximal isometric contractions, in four test positions. Intraclass Correlation Coefficient (ICC2,1), coefficient of variation and standard error of measurement were calculated. Interactions between sensor placements and test positions were investigated using a two-way repeated-measures ANOVA. All test conditions presented ICC2,1 > 0.8. There was no interaction between sensor placement and test position. Signal obtained from the sensor at 7th intercostal space was more stable between-trials and showed higher amplitude, during maximal and submaximal contractions, at seated positions with shoulder protracted at both 90° or 125° of flexion. We suggest to acquire serratus anterior sEMG at the 7th intercostal space and perform maximal or submaximal isometric contractions for signal normalization with shoulder protracted and flexed, at seated position.

Shoulder Strength and Upper Body Field Performance Tests in Young Female Handball and Volleyball Athletes: Are There Differences Between Sports?

CONTEXT: Volleyball and handball players have usually been studied collectively as "overhead athletes," since throwing present similarities in the proximal to distal movement sequencing and upper limb joints ranges of motion. However, each sport presents specificities in the objectives when accelerating the ball and a variety of possible throwing techniques. Therefore, it is expected there may be differences in the shoulder and upper body physical performance between sports. OBJECTIVE: The aim of this study was to determine if there are differences in shoulder muscle strength and upper body field performance tests between volleyball and handball athletes. DESIGN: Cross-sectional. METHODS: Ninety-nine volleyball and handball female athletes aged between 13 and 20 years were evaluated for isometric shoulder abductor and rotator strength (handheld dynamometer) and upper body field performance tests: Y Balance Test-Upper Quarter, modified Closed Kinetic Chain Upper-Extremity Stability Test, and unilateral and bilateral Seated Medicine Ball Throw. RESULTS: Handball athletes presented greater shoulder internal rotation strength (between-group difference: 2.84; effect size 0.70), higher medial (between-group difference: 9.54; effect size 0.90), superolateral (between-group differences: 8.9; effect size 0.68), and composite scores (between-group difference 5.7; effect size 0.75) of the Y Balance Test-Upper Quarter and higher unilateral (between-group difference: 41.92; effect size 0.91) and bilateral (between-group difference: 46.11; effect size 0.83) Seated Medicine Ball Throw performance. Groups were not different for Closed Kinetic Chain Upper-Extremity Stability Test, external rotation, and abduction isometric strength. CONCLUSION: Our findings suggest that young female handball athletes present greater internal rotator strength and better performance in Y Balance Test-Upper Quarter and Seated Medicine Ball Throw compared to volleyball players. These differences may be related to the different demands required in the throwing movements performed in each sport and should be considered when assessing these populations.

Clinical Assessment of Chronic Musculoskeletal Pain-A Framework Proposal Based on a Narrative Review of the Literature.

The assessment of chronic musculoskeletal pain (CMP) is a challenge shared by several health professionals. Fragmented or incomplete assessment can cause deleterious consequences for the patient's function. The objective of this paper was to propose a framework for clinical assessment of CMP based on the current literature and following the conceptual model of the International Classification of Functioning and Health (ICF). We propose that the ICF rationale may help to guide the processes, acting as a moderator of the clinical assessment, since it changes the perspective used to obtain and interpret findings during anamnesis and physical examination. Additionally, updated specific knowledge about pain, including that of pain domains and mechanisms, along with effective patient-clinician communication may act as a mediator of CMP assessment. We conduct the readers through the steps of the clinical assessment of CMP using both the proposed moderator and mediators and present a clinical example of application. We suggest that the proposed framework may help clinicians to implement a CMP assessment based on the biopsychosocial model using a critical and updated rationale, potentially improving assessment outcomes, i.e., clinical diagnosis.

Corrigendum: Self-Perception of Changes in Routines in Adults and Older Adults Associated to Social Distancing Due to COVID-19-A Study in São Paulo, Brazil.

[This corrects the article DOI: 10.3389/fpsyg.2021.607559.].

Self-Perception of Changes in Routines in Adults and Older Adults Associated to Social Distancing Due to COVID-19-A Study in São Paulo, Brazil.

COVID-19 is an acute respiratory illness with higher mortality in older adults. This condition is spread person-to-person through close contact, and among policies employed to decrease transmission are the improvement of hygiene habits and physical distancing. Although social distancing has been recognized as the best way to prevent the transmission, there are concerns that it may promote increased depression symptoms risk and anxiety, mainly in older adults. This cross-sectional study aimed to verify self-concept of social distancing in adults compared to older adults. All participants, over 18 years and residents of São Paulo state (Brazil), were invited to join this research study by a message application and answered an interdisciplinary questionnaire during the period from May 23 to June 23, 2020. The questions were divided into the following aspects: sociodemographic data, financial conditions, routine-related perception, perception of health, physical and emotional state, and eating habits. The younger adult group was composed of 139 participants, with a mean age of 43.15 years (±10.92), and the older adult group was composed of 437 participants with a mean age of 67.59 years (±6.13) of both sex. Changes in routine during the period of social distance were reported by 95% of adults and 96.8% of older adults, but adults indicated more significant alterations in routine. Although there was no difference between groups for several aspects, adults revealed greater alterations in sleep quality, evacuation frequency, and more difficulty to perform daily activities at home. Further studies are necessary to follow up the impacts of social distancing among adults and older adults in different socioeconomic contexts to better understand the long-term alterations and the necessity of interventions.

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 handheld dynamometer measurements for scapular protraction strength.

BACKGROUND: Handheld dynamometers (HHD) provide quick and low-cost assessments of muscle strength and their use has been increasing in clinical practice. There is no available data related to the validity of HHD for this measurement. OBJECTIVE: To verify the concurrent validity of scapular protraction measurements using an HHD. METHODS: Individuals with traumatic anterior glenohumeral instability were allocated in Instability Group (n=20), healthy swimmers were allocated in Athletes Group (n=19) and healthy subjects were allocated in Sedentary Group (n=21). Concurrent validity was verified by the Pearson correlation test between HHD and isokinetic measurements. The agreement between instruments was verified by Bland-Altman plots, for each of the two HHD positions. RESULTS: A moderate correlation was observed between seated (r=0.59) and lying supine HHD (r=0.54) and isokinetic dynamometer measurements for the all groups. Separated group analysis exhibited a strong correlation between seated HHD and isokinetic dynamometer measurements in the Instability Group (r=0.80), Sedentary Group (r=0.79) and Athletes Group (r=0.76). The Bland-Altman plot showed greater agreement in the seated position than the lying supine position when comparing measurements with the HHD and isokinetic in both the general sample and separated groups. CONCLUSION: The HHD may be considered a valid tool for assessing scapular protraction muscle strength among healthy athletes, non-athletes and subjects with shoulder instability. We recommend to assess subjects in the seated position and to be aware that the HHD tends to overestimate the peak force, compared with the gold-standard isokinetic dynamometer.

Scapular muscles weakness in subjects with traumatic anterior glenohumeral instability.

OBJECTIVE: To investigate possible alterations on scapular muscle strength in subjects with traumatic anterior glenohumeral instability. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PARTICIPANTS: Fifty-two subjects of both sexes: 26 healthy and 26 with traumatic anterior glenohumeral instability. MAIN OUTCOME MEASURES: Subjects performed maximal isometric and concentric isokinetic contractions of shoulder protraction and retraction in scapular and sagittal planes, at slow (12.2 cm/s) and fast (36.6 cm/s) speeds. RESULTS: Subjects with glenohumeral instability presented lower peak force of protraction and retraction during isometric and fast speed tests in the scapular plane; and of isometric protraction in the sagittal plane. CONCLUSIONS: People with traumatic anterior glenohumeral instability present muscle weakness of scapular protractors and retractors. Considering the importance of the scapulothoracic muscles for the dynamic stability of the glenohumeral joint, strengthening of these muscles is recommended for rehabilitation of traumatic anterior glenohumeral instability.

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.

Normalization of the trapezius sEMG signal - a reliability study on women with and without neck-shoulder pain.

OBJECTIVE: To evaluate within- and between-days reliability of two normalization methods of surface electromyography (sEMG) recordings of the trapezius muscle. METHODS: Nineteen women were allocated into 2 groups (healthy and with neck-shoulder pain). The sEMG was recorded in two sessions with 7 days in between sessions. The four portions of the trapezius muscle (the clavicular and acromial fibers of the upper trapezius, the middle and the lower trapezius) were evaluated during maximal and submaximal isometric voluntary contractions. The within- and between-days reliability of both maximal and submaximal contractions were assessed through Intraclass Correlation Coefficient (ICC(2,1) was used for within-day analyses of both maximal and submaximal contractions, and for between-days analyses of maximal contractions while ICC(2,3) was used for between-days analyses of submaximal contractions), Coefficient of Variation, Standard Error of Measurement, and Bland-Altman analysis. RESULTS: In general, submaximal contractions presented higher within-day reliability, with higher ICC values (e.g., middle trapezius - mean of 0.97), smaller Coefficient of Variation and Standard Error of Measurement ranges compared to maximal contractions (ICC values, e.g. for middle trapezius - mean of 0.94) in both groups. The same pattern was observed for between-days analyses, with submaximal contractions presenting higher ICC values (e.g., middle trapezius - mean of 0.84), smaller Coefficient of Variation and Standard Error of Measurement ranges than maximal contractions (ICC values, e.g. for middle trapezius - mean of 0.73) in both groups. CONCLUSION: Submaximal contractions are recommended for normalization procedures of trapezius sEMG, in both subjects with neck-shoulder pain and healthy individuals.

Effects of Kinesio taping on scapular kinematics of overhead athletes following muscle fatigue.

Scapular kinematics alterations have been found following muscle fatigue. Considering the importance of the lower trapezius in coordinated scapular movement, this study aimed to investigate the effects of elastic taping (Kinesio taping, KT) for muscle facilitation on scapular kinematics of healthy overhead athletes following muscle fatigue. Twenty-eight athletes were evaluated in a crossover, single-blind, randomized design, in three sessions: control (no taping), KT (KT with tension) and sham (KT without tension). Scapular tridimensional kinematics and EMG of clavicular and acromial portions of upper trapezius, lower trapezius and serratus anterior were evaluated during arm elevation and lowering, before and after a fatigue protocol involving repetitive throwing. Median power frequency decline of serratus anterior was significantly lower in KT session compared to sham, possibly indicating lower muscle fatigue. However, the effects of muscle fatigue on scapular kinematics were not altered by taping conditions. Although significant changes were found in scapular kinematics following muscle fatigue, they were small and not considered relevant. It was concluded that healthy overhead athletes seem to present an adaptive mechanism that avoids the disruption of scapular movement pattern following muscle fatigue. Therefore, these athletes do not benefit from the use of KT to assist scapular movement under the conditions tested.

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.

Isokinetic Assessment and Musculoskeletal Complaints in Paralympic Athletes: A Longitudinal Study.

OBJECTIVE: The aim of this study was to assess and monitor the peak torque of the knee extensor and flexor muscles in flexion and extension and the reports of musculoskeletal complaints in members of the main Brazilian Paralympic athletics team through 1 yr. DESIGN: Fourteen healthy athletes from both sexes were assessed three times in 1 yr. The volunteers were assessed for the presence of musculoskeletal complaints and muscle strength at three time points: (1) at the onset of the preparatory phase on December 2009, (2) at a follow-up assessment on June 2010, and (3) before actual competition on December 2010. The athletes' self-reported musculoskeletal complaints were assessed in structured interviews, and the muscle strength was assessed by means of isokinetic dynamometry. RESULTS: The knee flexor and extensor muscle strength exhibited significant increase in both the right and left lower limbs at the second and third assessments compared with the first one (P < 0.05). Muscle imbalance was associated with knee and thigh complaints at all three assessments (P < 0.05). CONCLUSIONS: The knee flexor and extensor muscle strength exhibited a gradual increase in both lower limbs during the course of the three assessments. In parallel, muscle imbalance was associated with the occurrence of knee and thigh complaints.

EMG of upper trapezius--electrode sites and association with clavicular kinematics.

The upper trapezius (UT) has been widely studied and related to alterations in clavicular kinematics in subject with shoulder disorders. However, the most common electrode site used to capture UT EMG is between C7 and the acromion, placing the electrodes over the acromial fibers rather than clavicular ones. Therefore, this study aimed to investigate the relationship between clavicular movements (elevation and retraction) and UT EMG recorded from three electrode sites (traditional electrode positioning and two different sites proposed for clavicular fibers evaluation). Furthermore, the position associated with the highest EMG during maximal isometric voluntary contractions (MVIC), for each electrode site, was determined for normalization purposes. EMG was simultaneously captured in the three electrode sites of 20 healthy subjects, during MVIC at five different positions and during shoulder elevation and abduction in scapular plane. Clavicular kinematics was recorded using an electromagnetic tracking system during the dynamic contractions. Shoulder abduction with head rotation and lateral flexion elicited the highest EMG amplitude on the three electrode sites and was used to normalize the signals. A cross-correlation analysis showed high correlations between all electrode sites and clavicular movements. However, the traditional electrode site seems to record more informative signals in healthy subjects.

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.

Shoulder rotator strength and torque steadiness in athletes with anterior shoulder instability or SLAP lesion.

OBJECTIVES: To investigate shoulder rotator strength and steadiness in athletes with anterior instability and superior labrum anterior posterior (SLAP) lesion. DESIGN: Cross-sectional laboratory study. METHODS: Athletes with anterior shoulder instability (instability group, n=10) and a SLAP lesion (SLAP group, n=10) were compared with healthy athletes matched by age, anthropometrics and sport (control group for shoulder instability, n=10 and control group for SLAP, n=10). Torque steadiness was evaluated with three 10s submaximal isometric contractions (35% of peak torque) with the arm at 90° of shoulder abduction and 90° of external rotation. The mean isometric torque, standard deviation and coefficient of variation were measured from the steadiness trials. To evaluate shoulder rotator strength, concentric isokinetic tests (90°/s, 180°/s) were performed at the 90-90° position and peak torque to body mass and shoulder external to internal rotation ratio variables were analyzed. The variables were tested with the instability and control groups with respect to shoulder instability and between the SLAP and control groups for SLAP lesion using the Mann-Whitney test. RESULTS: The SLAP group presented a higher coefficient of variation than the SLAP control group (p=0.003). Regarding shoulder strength, the internal and external shoulder rotators were weaker in the instability group than in the instability control group (p<0.05). CONCLUSIONS: Athletes with anterior shoulder instability presented shoulder rotation weakness, while athletes with a SLAP lesion showed higher torque fluctuation during internal rotation. These results indicate that there are different alterations to strength and sensory motor control in each condition.

Queixas musculoesqueléticas e procedimentos fisioterapêuticos na delegação brasileira paralímpica durante o mundial paralímpico de atletismo em 2011 / Musculoskeletal complaints and physiotherapeutic procedures in the brazilian paralympic delegation during the paralympic athletics world championship in 2011

INTRODUÇÃO: O atletismo é uma modalidade esportiva que apresenta grande incidência de lesões musculoesqueléticas. No entanto, são poucas as informações na literatura a respeito das lesões no atletismo paralímpico. OBJETIVO: Descrever o perfil das queixas musculoesqueléticas, a localização anatômica e os recursos fisioterapêuticos utilizados durante o Mundial Paralímpico de Atletismo em Christchurch Nova Zelândia 2011. MÉTODOS: A Delegação Brasileira foi composta por 34 atletas. Foram feitos registros de todos os atendimentos do setor da fisioterapia, diariamente, quanto à queixa, região anatômica acometida e os recursos fisioterapêuticos utilizados. Os atendimentos eram realizados no hotel em que a delegação estava hospedada, bem como no local da competição. Dos 34 atletas, 25 (73,5%) foram atendidos no setor de fisioterapia. RESULTADOS: As principais queixas foram as mialgias (38,4%), seguida pelas artralgias (23%). As regiões mais referidas nas queixas dos atletas foram na coxa (n = 8, 30,7%), seguida pelo joelho (n = 6, 23%). No total foram realizados 428 atendimentos fisioterapêuticos. No hotel, o recurso terapêutico mais utilizado foi o ultrassom (35,1%), seguido do TENS (31,2%), da crioterapia (23,3%). No local da competição, o recurso terapêutico que prevaleceu foi a crioterapia (44,1%), seguida pela massoterapia (37,2%). CONCLUSÃO: Estes resultados contribuem para o conhecimento das principais lesões nesta modalidade esportiva, auxiliando no desenvolvimento de programas direcionados à prevenção das mesmas.

INTRODUCTION: Athletics is an umbrella sport with high incidence of musculoskeletal injuries; however, the literature presents little information on injuries in Paralympics athletics. OBJECTIVE: This study was to describe the profile of the musculoskeletal complaints, their anatomical locations, and physiotherapeutic resources used during the Paralympic Athletics World Championships in Christchurch in 2011. METHODS: The Brazilian delegation included 34 athletes. Their musculoskeletal complaints, affected anatomical regions, and the physiotherapy resources used were daily recorded for all of the physiotherapy sessions. The sessions were held in the hotel that hosted the delegation and at the competition venue. RESULTS: Out of the 34 athletes, 25 (73.5%) were treated at the Department of Physiotherapy. The main complaints were myalgia (38.4%), followed by arthralgia (23%). The region of the body with the most complaints was the thigh (n = 8, 30.7%), followed by the knee (n = 6, 23%). A total of 428 physiotherapy sessions were performed. At the hotel, the mostly used therapeutic approach was the ultrasound (35.1%), followed by TENS (31.2%) and cryotherapy (23.3%). At the competition venue, the mostly used therapeutic approach was cryotherapy (44.1%), followed by massage (37.2%). CONCLUSION: The results of this study contribute to a better understanding of the major injuries in this sport and help to develop programs aimed for injury prevention.

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.