This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using -statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60-3.54; P<0.05) if handball players had an imbalanced muscular strength profile. In youth female handball players IR and ER muscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile.

As part of the development of a methodology for investigating flow and transport in fractured rocks, a large‐scale experiment was recently performed at Fanay‐Augères, France. In a companion paper (Cacas et al., this issue) (paper 1) the results of the flow measurements were analyzed. In this paper, the results of the tracer experiments are interpreted. A particle following is coupled to the flow model, described in paper 1. Microscopic dispersion in the fractures and retardation effects due to unevenness of the flow paths are taken into account. The transport model is calibrated on in situ tracer tests, whereas the parameters of the hydraulic model were initially fitted on structural and hydraulic measurements (paper 1). The dispersive properties of the model are reasonably comparable to those of the real site. It tends to confirm the validity of the preliminary hydraulic calibration of the model and thus to validate further the approach used to simulate hydraulic and transport phenomena.

Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Exercise intolerance and undue fatigue are common complaints in patients with Charcot-Marie-Tooth (CMT) disease. Reduced physical ability is due directly to the disease, but it is also due to physical deconditioning. The aim of this study was to test whether 24 weeks of interval-training exercise (ITE) cycling can significantly improve physiological, neuromuscular, and functional capacities and alleviate fatigue in CMT patients. Eight CMT patients (4 CMT1A and 4 CMT2) participated in ITE for 3 nonconsecutive days per week. Cardiovascular fitness, muscle strength, fatigue resistance, and functional capacities were measured before and after 12 weeks of supervised hospital training and again after another 12 weeks of unsupervised home training. Training was well tolerated. There were significant improvements in cardiorespiratory capacities, isokinetic concentric strength, and functional ability measurements. All patients experienced an improvement in their self-reported visual analogic scale for fatigue and pain during training. However, there was no significant change in their isometric force production and indices of fatigue resistance after training. Although the improvement in exercise tolerance may be due in part to reversal of the deconditioning effect of their related sedentary lifestyle, this clinical trial suggests that ITE can benefit CMT patients especially in their functional performance and subjective perception of pain and fatigue. Moreover, the improvement observed at the end of the first supervised period ITE was maintained after the second unsupervised home period, although there was no further improvement in performance and tolerance.

Context: Isokinetic assessment of shoulder internal-(IR) and external-rotator (ER) strength is commonly used with many different postures (sitting, standing, or supine) and shoulder positions (frontal or scapular plane with 45° or 90° of ab duction). Objective: To conduct a systematic review to determine the influence of position on the intersession reliability of the assessment of IR and ER isokinetic strength, to identify the most reliable position, and to de termine which isokinetic variable appears to be most stable in intersession relia bility. Evidence Acquisi tion: A systematic literature search through MEDLINE and Pascal Biomed data bases was performed in October 2009. Criteria for inclu sion were that studies be written in English or French, describe the isokinetic evaluation methods, and de scribe statistical analysis. Evidence Synthesis: Sixteen studies meeting the inclu sion criteria were included. Variable reliability of ER and IR peak torque (PT) were generally reported for all assessment positions; intraclass correlation coefficients were .44-.98 in the seated position with 45° of shoulder abduction, .09-.77 in the seated position with 90° of shoulder abduction, .86-.99 (coefficient of variation: 7.5-29.8%) in the supine position with 90° of shoulder abduction, .82-.84 in the supine position with 45° of shoulder abduction, and .75-.94 in standing. The ER:IR ratio reliability was low for all posi tions. Conclusions: The seated position with 45° of shoulder abduction in the scapular plane seemed the most reliable for IR and ER strength assessment. The standing position or a shoulder posture with 90° of shoulder abduction or in the frontal plane must be used with caution given the low reliability for peak torque. Good reliability of ER and IR PT was generally reported, but ER:IR ratio reliabil ity was low.

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