UNASSIGNED: The Band Pull-Apart (BPA) exercise is used to strengthen the periscapular muscles. It was recently stated that the lower extremity and trunk movements should be included in the shoulder rehabilitation programs to optimize an effective energy transfer throughout the kinetic chain.
UNASSIGNED: The aim of this study is to investigate the effects of kinetic chain based BPA exercise on the muscle activations of the sternocleidomasteideous (SCM) and the trapezius muscles in individuals with and without forward head posture (FHP).
UNASSIGNED: Eighteen individuals with FHP and 18 individuals without FHP were included. Photographic measurements were made to identify individuals with FHP. The muscle activations of SCM, Upper Trapezius (UT), Middle Trapezius (MT), and Lower Trapezius (LT) were measured with surface EMG. BPA exercise was performed in the standing, unipedal standing, squat, unipedal squat, and Bulgarian split squat (BSS).
UNASSIGNED: There was no Group × Exercise interaction for the SCM, UT, MT, LT muscle activations, or for the UT/MT and UT/LT ratios (p> 0.05). While there was a difference in the activation of all muscles between individuals with and without FHP (p< 0.05), both ratios were similar (p> 0.05). There was a statistically significant difference between exercises for SCM, MT, and LT muscle activations (p< 0.000 for these muscles), UT/MT (p< 0.000) and UT/LT ratios (p= 0.004). SCM muscle activation in squat was lower than activation in standing (Mean Difference (MD) = 2.5% Maximal Voluntary Isometric Contractions (MVIC); p= 0.004) and in unipedal standing (MD = 2.1% MVIC; p= 0.002). MT muscle activation in squat was higher than activation in standing (MD = 9.7% MVIC), unipedal standing (MD = 7.8% MVIC), unipedal squat (MD = 6.9% MVIC) and BSS (MD = 9.4% MVIC; p< 0.000 for these positions). LT muscle activation in the squat was higher than activation in the standing (MD = 8.5% MVIC) and unipedal squat (MD = 8.1% MVIC; p< 0.004 for these positions). UT/MT ratio in the squat was lower than standing (MD = 0.3), unipedal standing (MD = 0.2) and BSS (MD = 0.3; p< 0.000 for these positions). UT/LT ratio in squat was lower than unipedal squat (MD = 0.5) and BSS (MD = 0.6; p= 0.002; for these positions).
UNASSIGNED: Performing the BPA exercise in the squat position is suggested in cases where lower SCM and UT muscle activation, lower UT/MT, and UT/LT ratios and higher MT and LT muscle activations are needed for individuals with and without FHP.

The rotator cuff, comprising the subscapularis, supraspinatus, infraspinatus, and teres minor muscles, plays a crucial role in stabilizing the glenohumeral joint by securing the head of the humerus within the glenoid cavity of the scapula. The tendinous insertions of these muscles generate tension within the capsule, enhancing joint stability during muscular activity. The rotator cuff is susceptible to damage from disease, injury, or trauma, which can result in tears or ruptures of one or more tendons. The evaluation of the infraspinatus muscle and tendon is vital for diagnosing and managing various shoulder pathologies. Accurate imaging to determine the specific muscle involvement and injury severity significantly impacts treatment decisions. Diagnostic musculoskeletal ultrasound (MSK-US) has emerged as a valuable tool for assessing the infraspinatus muscle and tendon, offering real-time, dynamic assessment capabilities essential for precise diagnosis and effective rehabilitation planning. This article reviews the utility and advantages of MSK-US in evaluating the infraspinatus muscle and tendon, emphasizing technique specifics, diagnostic accuracy, and comparative efficacy against other imaging modalities. It details a systematic approach to the ultrasound examination technique for the infraspinatus, including patient positioning and identification of common pathologies such as tears, tendinopathy, and calcifications. With recent advancements in transducer strength, image resolution, and operator training, ultrasound serves as an excellent alternative imaging modality for diagnosing rotator cuff tears. This article aims to equip rehabilitation professionals with a comprehensive understanding of MSK-US as a diagnostic tool for the infraspinatus, promoting more precise diagnosis, treatment planning and improved patient outcomes.

UNASSIGNED: In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA).
UNASSIGNED: The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines.
UNASSIGNED: This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed.
UNASSIGNED: Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\\<0.05).
UNASSIGNED: Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA.
UNASSIGNED: 3b.

BACKGROUND: Information about outcomes after revision rotator cuff repair (RCR) is limited. A more thorough investigation of pain, range of motion (ROM), strength, and functional outcomes is needed. Comparing outcomes between primary and revision rotator cuff repair patients can help surgeons guide patient expectations of the revision procedure. The aim of this study was to compare the outcomes of a revision repair group to a control group of primary RCR patients. We expect revision RCR patients to have worse clinical outcomes than primary RCR patients.
METHODS: A retrospective review of patients who underwent primary or revision RCR between 2012 to 2020 was performed. The case group included 104 revision patients, and the control group included 414 primary RCR patients. Patient visual analog score (VAS) for pain, ROM, strength, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at baseline, 12 months, 24 months, and final follow-up.
RESULTS: The average final follow-up was 43.9 months for primary patients and 63.8 months for revision patients. 352 primary patients and 55 revision patients had a final follow-up of 2 or more years. By final follow-up, primary patients had less pain than revision patients (Δ of 2.11, P < .0001), but both groups improved overall. Primary patients had significant improvements in forward flexion, external rotation, internal rotation, and abduction at 2 years that were lost by final follow-up, but revision patients did not experience any long-term improvement in ROM. These differences in ROM between groups were not significant. Supraspinatus strength in the revision group did not improve nor decline by final follow-up. By final follow-up, both primary and revision patients had improved SST and ASES scores from baseline. Primary patient ASES scores were 17.9 points higher (P < .0001) than revision patients by final follow-up, and there was no difference between groups in SST scores at this time.
CONCLUSIONS: Revision RCR significantly improves patient pain, SST score, and ASES score at 4 years. Revision patients should not expect to see the improvements in range of motion that may occur after primary repair.

BACKGROUND This study was conducted to investigate physical risk factors in patients with non-specific neck pain. The correlations among pain intensity, pressure pain threshold, range of motion (ROM), and disability index were analyzed in 50 patients with non-specific neck pain at a hospital in Korea. MATERIAL AND METHODS We enrolled 50 patients diagnosed with non-specific neck pain by a doctor. All subjects were evaluated for pain intensity, pressure threshold, degree of disability, active range of motion (ROM) of the neck, upper cervical rotation ROM, muscular endurance of deep cervical flexor, compensatory movements for neck flexion, forward head posture, shoulder height difference, and rounded shoulder posture. The correlation between each variable was analyzed. RESULTS Pain intensity had a significant correlation between cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, shoulder height difference, and forward head posture (P<.05). There was a significant correlation between the pressure pain threshold and the cervical extension ROM, cervical flexion-rotation ROM, and rounded shoulder height (P<.05). The disability index had a significant correlation between the cervical rotation ROM, cervical flexion-rotation ROM, rounded shoulder posture, and the compensatory movement of neck flexion (P<.05). CONCLUSIONS Physical risk factors for non-specific neck pain included cervical rotation ROM, upper cervical rotation ROM, rounded shoulder posture, shoulder height difference, and cervical flexion compensatory movements, which can affect pain intensity and pressure pain threshold.

UNASSIGNED: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM.
UNASSIGNED: A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer.
UNASSIGNED: Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM.
UNASSIGNED: This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

OBJECTIVE: To develop and validate an open-source deep learning model for automatically quantifying scapular and glenoid morphology using CT images of normal subjects and patients with glenohumeral osteoarthritis.
METHODS: First, we used deep learning to segment the scapula from CT images and then to identify the location of 13 landmarks on the scapula, 9 of them to establish a coordinate system unaffected by osteoarthritis-related changes, and the remaining 4 landmarks on the glenoid cavity to determine the glenoid size and orientation in this scapular coordinate system. The glenoid version, glenoid inclination, critical shoulder angle, glenopolar angle, glenoid height, and glenoid width were subsequently measured in this coordinate system. A 5-fold cross-validation was performed to evaluate the performance of this approach on 60 normal/non-osteoarthritic and 56 pathological/osteoarthritic scapulae.
RESULTS: The Dice similarity coefficient between manual and automatic scapular segmentations exceeded 0.97 in both normal and pathological cases. The average error in automatic scapular and glenoid landmark positioning ranged between 1 and 2.5 mm and was comparable between the automatic method and human raters. The automatic method provided acceptable estimates of glenoid version (R2 = 0.95), glenoid inclination (R2 = 0.93), critical shoulder angle (R2 = 0.95), glenopolar angle (R2 = 0.90), glenoid height (R2 = 0.88) and width (R2 = 0.94). However, a significant difference was found for glenoid inclination between manual and automatic measurements (p < 0.001).
CONCLUSIONS: This open-source deep learning model enables the automatic quantification of scapular and glenoid morphology from CT scans of patients with glenohumeral osteoarthritis, with sufficient accuracy for clinical use.

BACKGROUND: Total shoulder arthroplasty is performed by orthopedic surgeons with various fellowship training backgrounds. Whether surgeons performing shoulder arthroplasty with different types of fellowship training have differing rates of complications and reoperation remains unknown.
METHODS: The PearlDiver Mariner database was retrospectively queried from the years 2010-2022. Patients undergoing shoulder arthroplasty were selected using the CPT code 23472. Those undergoing revision arthroplasty and those with a history of fracture, infection, or malignancy were excluded. Fellowship was determined and verified via online search. Only surgeons who performed a minimum of 10 cases were selected; and PearlDiver was queried using their provider ID codes. Primary outcome measures included 90-day, 1-year, and 5-year rates of complication and reoperation. A Bonferroni correction was utilized in which the significance threshold was set at p≤0.00023 RESULTS: In total, 150,385 patients met the inclusion criteria and were included in the study. Analysis of surgical trends revealed that Sports Medicine and Shoulder and Elbow fellowship- trained surgeons are performing an increasing percentage of all shoulder arthroplasty over time, with each cohort exhibiting am 11.3% and 4.2% increase from 2010 to 2022, respectively. The geographic region with the highest proportion of cases performed by Sports Medicine surgeons was the West, while the Northeast has the highest proportion of cases performed by Shoulder and Elbow surgeons. Shoulder and Elbow surgeons operated on patients that were significantly younger and had fewer comorbidities. Both Shoulder and Elbow and Sports Medicine surgeons had lower rates of postoperative complications at 90 days, 1 year and 5 years in comparison to surgeons who completed another type of fellowship or no fellowship. Across each time point, the rates of individual complications between Sports Medicine and Shoulder and Elbow were comparable, but the pooled complication rate was lowest in the Shoulder and Elbow cohort.
CONCLUSIONS: Surgeons who have completed either a Sports Medicine or Shoulder and Elbow fellowship are performing an increasing proportion of shoulder arthroplasty over time. Sports Medicine and Shoulder and Elbow-trained surgeons have significantly lower complication rates at 90 days, 1 year and 5 years postoperatively. The individual complication rates between Sports Medicine and Shoulder and Elbow are comparable, but Shoulder and Elbow has the lowest pooled complication rates overall.

UNASSIGNED: Bilateral combined fractures of the greater tuberosity with anterior internal shoulder dislocation are extremely rare, presenting challenges in treatment due to their uncommon occurrence and lack of standardized management protocols.
METHODS: We report the case of a 22-year-old patient who experienced bilateral anterior shoulder dislocations with associated fractures of the greater tuberosities following a seizure-induced fall. Clinical Discussion: The unique aspect of our case is the unusual mechanism of injury. Unlike typical convulsive seizures, which often result in bilateral posterior dislocations, our patient suffered bilateral anterior dislocations and fractures of the greater tuberosities. Therapeutic management of greater tuberosity fractures lacks a standardized approach, but surgical intervention is warranted if displacement exceeds 0.5 cm. Treatment options include open reduction and internal fixation (ORIF), percutaneous screw fixation, arthroscopic procedures with suture anchors for double-row repair, or a combination of arthroscopic techniques and screw fixation. ORIF with plate osteosynthesis may be recommended for comminuted fractures with large fragments. To assess functional outcomes, commonly used scoring systems include the UCLA Shoulder Score, ASES Score, and Constant-Murley Score.
CONCLUSIONS: Bilateral anterior shoulder dislocation associated with combined fractures of the greater tuberosity is an extremely rare occurrence. Given its anatomopathological significance and impact on functional recovery, careful and individualized management of greater tuberosity fractures is crucial, considering its role as a point of insertion for the rotator cuff tendons.

Round-shoulder posture (RSP) is a common postural condition, characterized by protraction, downward rotation, anterior tilting and internal rotation of the scapula. RSP can lead to shoulder dysfunction. Different methods have been proposed for rehabilitating and correcting the altered posture in RSP including stretching, strengthening exercises, and shoulder brace or taping. However, the findings are controversial and studies are ongoing to develop more effective method. The present study is aimed at investigating the effects of scapular posterior tilting (SPT) exercise in different support positions on scapular muscle activities in men and women with RSP. In a prospective observational clinical study, we assessed demographic, basic clinical parameters and study variables of the subjects with RSP (n = 20) (men/women = 9/11) attending Daegu University in Gyeongsan, South Korea. To do so, we compared electromyographic (EMG) activities of lower trapezius and serratus anterior muscles between men and women with RSP during SPT exercise on four different support surfaces to determine any difference in the EMG activities. The results revealed that women showed significant differences in EMG activities in the lower and left upper trapezius and serratus anterior muscles, while men showed significant differences in EMG activity only in the lower trapezius muscle during SPT exercise on four different surfaces (P < 0.05). The post-hoc analysis revealed significantly greater EMG activity values in the lower trapezius and serratus anterior muscles during SPT exercise on the upper body unstable surface and whole-body unstable surface (p < 0.05). Independent t-tests after the Bonferroni correction showed no significant differences in muscle activities between men and women on the four different surfaces (p > 0.0125).