The purpose of this study was to determine whether shoulder rotational strength was greater in the plane of the scapula or the frontal plane. Isokinetic shoulder rotational strength was evaluated in 20 subjects. Using the Merac (Universal Gym Equipment, Inc., Cedar Rapids, IA), test data was gathered in the right shoulders, in 45 degrees abduction, at a speed of 60 deg/sec, in the plane of the scapula and the frontal plane. Each subject returned within 1 week for retests to establish reliability. The average correlational coefficient across tests was 0.87. The Merac computer system was used to analyze data. Mean and standard deviations for peak torque to body weight were calculated. A paired t-test was used to examine the difference in the means for internal and external rotation between the two positions. The results indicated no significant difference between the two positions for shoulder internal rotational strength values. However, shoulder external rotational strength values in the plane of the scapula were statistically significantly higher than in the frontal plane (P less than 0.001). These preliminary results suggest isokinetic strength training and testing may be preferable in the plane of the scapula rather than the frontal plane.
Clinicians should consider combined posting or rear-foot posting alone when maximal control of rear-foot frontal-plane pronation is desired, though forefoot posting alone and the orthotic shell also provide control of rear-foot frontal-plane pronation.
Patient Outcome Following Rehabilitationfor Rotator Cuff Repair Surgery: The Impact of Selected Medical Comorbidities r otator cuff tears become increasingly common after the age of 40 years, with the incidence of partial thickness tears peaking during the fifth and sixth decade, and full-thickness tears peaking during subsequent decades. Five percent to forty percent of the population over the age of 60 years has evidence of a fullthickness rotator cuff tear. 14,17,25 Rotator cuff tears can have a debilitating effect on activities that require overhead upper extremity motion. Common manifestations associated with the subsequent loss of function are shoulder pain (including night pain), weakness, and decreased range of motion. 2,18 Besides the decreased ability to use the affected limb, these disorders have also been shown to have a negative impact on patients' general health status.18 Rotator cuff repair surgery is often the choice of intervention for patients who do not respond to conservative care.t study desiGn: Prospective, multicenter research design.t oBJectives: To assess functional and health status outcomes in patients following a physical therapy program after rotator cuff repair surgery, and to determine the impact of selected patient medical comorbidities on rehabilitation outcomes.t BackGround: While authors have studied the influence of multiple factors on patient outcomes after rotator cuff repair surgery, little research has been done on the impact of comorbidities, particularly as it relates to establishing an accurate patient prognosis. t methods and measures: One hundred eighteen patients who had recently undergone a rotator cuff repair surgical procedure were recruited at 1 of 30 Physiotherapy Associates, Inc outpatient clinics located in 13 states. A rehabilitation protocol was implemented and included the following interventions, as indicated: therapeutic exercise, manual therapy, electrotherapeutic modalities, and physical agents. Patient health history factors were documented during the initial examination, including age, race, body mass index, smoking, rotator cuff tear size, type of surgical procedure, and selected medications and comorbidities. The Disabilities of the Arm, Shoulder, and Hand (DASH) and the Short-Form-36 (SF-36) were completed prior to rehabilitation, at discharge, and at 6 months postdischarge.t results: DASH and most SF-36 domain mean scores obtained postrehabilitation were significantly improved from pretherapy scores. Most health status outcomes were maintained at 6-month follow-up, with slight further improvement noted in SF-36 physical dimensions and DASH scores. Having a greater number of comorbidities was associated with worse postrehabilitation SF-36 scores, but not with the DASH shoulder function scores. The mean change scores (difference between prerehabilitation and postrehabilitation status) for the DASH and SF-36 were not significantly different for patients with 0 to 1, 2, or at least 3 or more comorbidities (except for emotional role).In regression anal...
Study Desi gn: Observational study of static and dynamic foot postures in professional baseball players. Background: Throughout the course of a professional baseball season, running, cutting, and sprinting activities can produce a breakdown in players' foot function, causing overuse injuries. Objectiws: To investigate the relationship between static and dynamic foot postures; to determine the occurrence of abnormal foot postures in professional baseball players and the incidence of overuse injuries in the lower extremity; and to compare the foot postures of pitchers to those of positional players. Methods a d Mewres: The foot postures of 74 professional baseball players were evaluated at rest and during gait. Measures of static foot posture were obtained with a goniometer and included the subtalar neutral position, forefooVrearfoot position, ankle joint dorsiflexion, tibia1 angle in standing, and calcaneal angle in standing. The FootTrak motion analysis system provided measures of dynamic foot posture (rearfoot supination and pronation) during the stance phase of gait. A questionnaire was completed by players who reported previous lower extremity injuries. The chi-square statistic was used to determine the associations between forefoot position (varus or valgus) and the amount of foot pronation during gait. Results: The forefoot varus and calcaneal valgus in standing was significantly associated with the maximum pronation during the stance phase of gait. Of the 65 players who demonstrated excessive pronation (> 8 degrees), 28 (43%) also reported a previous lower extremity injury. No statistically significant difference occurred, however, between injured and uninjured players with respect to the mean values of static or dynamic foot posture. In addition, foot postures were not associated with a player's position. Conclusions: Selected measures of static rearfoot and forefoot postures may have value in predicting dynamic rearfoot movement during the stance phase of gait. Excessive pronation in the baseball players we studied was not found to be a significant contributing factor in the development of overuse injuries.) Some of the more common causes of overuse injuries in athletes are training errors, poor shoe selection, and a b normal postures of the foot and ankle.24.9J2J3 Several authors have identified specific biomechanical and anatomic factors of the lower leg, foot, and ankle in athletes with overuse i n j u~-i e s .~~~J~*~~ Specifically, abnormal subtalar joint pronation has been frequently observed in runners with overuse injuries of the lower e~tremity.~.~J~ To treat athletes with lower extremity injuries effectively, the clinician must identify abnormal foot postures.Root et all7 defined abnormal pronation as a compensation at the subtalar joint for a variety of lower extremity postures, resulting in excessive or prolonged eversion movement of the rearfoot during the stance phase of gait. They defined "excessive" as pronation movement of greater than 4 to 6 degrees. Eng and Pierrynowski5" and Johanson ...
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