Shoulder biomechanics

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilita- tion protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biologi- cal factors while the patient’s work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist’s choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biolog- ical tissue healing, surgical technique and focused reha- bilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabilis- er reinforcement, are done. Phase three consists of pro- gressive active arm mobilisation dry or in water integrat- ed with proprioceptive exercise and “core” stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilita- tion protocol for each patient.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically significant and the"t" value were estimated. It was found that ultrasound therapy when combined with end range mobilization had"t" value of 1.8342 in comparison to that of cryotherapy combined with stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment of frozen shoulder.

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians. r

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with end ran...

""Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen
shoulder is questionable and the combination of therapies has contradictory results. Objectives: The
purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound
therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in
alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen
shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and
End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of
shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered
as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically
significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with
end range mobilization had„t‟ value of 1.8342 in comparison to that of cryotherapy combined with
stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result
than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment
of frozen shoulder.
Keywords: Frozen shoulder, ultrasound therapy, end range mobilization, cryotherapy, stretching""

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p<0.05 as statistically significant and the‗t‘ values were estimated. It was found that ultrasound when combined with end range mobilization had a value of 3.4498 in comparison to 1.7773 of cryotherapy combined with stretching group. Conclusion: Ultrasound with end range mobilization produced a better result than cryotherapy with stretching and therefore can be recommended in the treatment of second stage adhesive capsulitis of shoulder.

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians. r

The throwing shoulder is subjected to extreme forces secondary to the complex motions that occur during the act of hurling
a five-ounce spherical object through space. Numerous conditions can develop as a result of chronic microtrauma to the structures
surrounding the glenohumeral joint. Posterior superior glenoid impingement (PSGI) involves irnpingement of the articular side of
the rotator cuff against the posterior superior glenoid labrum. This occurs in conjunction with an uruderlying subtle instability of the
glenohumeral joint. The mechanism is that of abduction, maximal external rotation and horizontal extension or that mechanism
which is similar to the throwing motion. Because of the complex nature of the glenohumeral joint and the surrounding structures,
the examiner must be knowledgeable regarding the functional anatomy of the shoulder girdle and how it relates to the mechanisms
involved in the before mentioned conditions. The purpose of this paper is to describe clinical methodology, which may assist the
examiner in the diagnosis and managernent of the throwing athlete with posterior superior glenoid impingement.

Ever since it was first observed and especially so in recent years, the phenomenon of the so-called "sticking point'" in resistance training has attracted a substantial amount of sports and exercise science research. Broadly speaking the sticking point is understood as the position in the range-of-motion of a lift at which a disproportionately large increase in the difficulty to continue the lift is experienced. Hence the sticking point is inherently the performance bottleneck and is also associated with an increased chance of exercise form deterioration or breakdown. Understanding the aspects of lifting performance which should be analysed in order to pinpoint the cause of a specific sticking point and therefore devise an effective training strategy to overcome it, is of pervasive importance to strength practitioners and instrumental for the avoidance of injury and continued progress. In this paper we survey a range of physiological and biomechanical mechanisms which contribute to the development of sticking points, and led by this insight review and analyse the findings of the existing observational research on the occurrence of sticking points in three ubiquitous exercises: the bench press, the squat, and the deadlift. The findings of our analysis should be used to inform future research and current resistance training practice.

Cuff tear arthropathy (CTA) is a shoulder pathology characterized by a massive and irreparable rotator cuff tear and an abnormal contact between the humeral head and the acromion. CTA is often associated with shoulder pseudo-paralysis. However, the fact that some patients still maintain a functional shoulder remains unexplained. The goal of the present work was to numerically assess the biomechanical parameters that influence the function of the shoulder with CTA. The specific objectives were to show the influence of: (1) a variation of the medial offset of the proximal humerus on the destabilizing forces at the intact (healthy) shoulder; (2) the elevation plane and the friction coefficient on the “mechanics of CTA” and; (3) the geometrical parameters of the humeral head on the “mechanics of CTA” in the context of an hemiarthroplasty.

Study #1 assessed the influence of a minimum (0 mm), average (7 mm) and maximum (14 mm) medial offset on the destabilizing glenohumeral forces (transverse to the glenoid) at the intact (healthy) shoulder. Study #2 assessed the influence of the elevation plane (frontal, scapular, sagittal) and the contact friction (coefficient of 0.15, 0.3 and 0.6) on the “mechanics of CTA” (i.e. deltoid length and force; contact forces (glenoid and acromion)). Study #3 assessed the influence of a large medial offset (17 mm) associated with an oversized humeral head hemiprosthesis (120 %) on the same “mechanics of CTA” as in study #2.

Study #1 showed that the maximum medial offset (14 mm) greatly decreases the destabilizing action of the deltoid without affecting the stabilizing action of the rotator cuff. The CTA model of study #2 showed that the elevation plane influences the mechanics of CTA, but that the contact condition (friction) combined with the poor mechanics of the deltoid is more likely to lead to a poor function. Study #3 showed that the combination of a large medial offset with an oversized humeral head hemiprosthesis decreases the acromio-humeral contact force and increases the range of motion more significantly compared to a simple oversized prosthetic head.

The present work highlights the potential of the AnyBody software to study the sensitivity of the human musculoskeletal system (intact and injured) to morphological parameters. This work also brings new lines of thoughts regarding biomechanical parameters that influence the function of the shoulder with CTA. Finally, this work proposes an oversized humeral hemiprosthesis with a large medial offset as an alternative CTA treatment for young patients with poor function, thus leaving more room for revision surgery.

The shoulder external rotator muscles and the different portions of the trapezius muscle have never been studied in exclusivity. However, the literature has provided several exercises which have been used in this study. Purpose: To quantify electromyographic activity of the shoulder external rotator muscles and the upper, middle and lower trapezius in seven exercises. Methods: 20 healthy males performed 7 exercises in random order. Surface electromyography was recorded for the posterior deltoid, infraspinatus, teres minor, upper, middle and lower trapezius. Results: The four prone exercises presented the highest levels of EMG activation in the External Rotators Synergy (the average activation of arm external rotator muscles group) and in the Trapezius Synergy (the average activation of the three portions of trapezius). The infraspinatus muscle obtained the highest activation values in exercises 1 (prone horizontal abduction at 90° with full external rotation, thumb up ), 4 (prone external rotation at 90º abduction and elbow at 90º), and 5 (side-lying ER with elbow on the trunk). The highest activation level of the teres minor muscle was found in Exercise 1.

The aim of the present study was to determine how the intra-muscular segments of three shoulder muscles were coordinated to produce isometric force impulses around the shoulder joint and how muscle segment coordination was influenced by changes in movement direction, mechanical line of action and moment arm (ma).

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians. r

Link segment models are extremely useful for increasing the comprehension of joint overload. The aim of the present study was to analyze proximal joint reaction forces and moments during different movements performed with and without external load. One subject performed shoulder flexion, extension and abduction, and elbow flexion movements
(with and without external load) Kinematic data were obtained
by videogrammetry (frequency sample 50 fields/s). One link segment model was used to obtain kinetic data. The model is governed by Newton/Euler movement equations. The results suggested a not proportional increasing of proximal joint reaction forces and moments. The proximal joint reaction force longitudinal component was the only one that increased proportionally to the external load. Proximal joint reaction force shearing components and proximal moments presented
increasing values of different magnitudes. The use of external load promoted increased magnitudes of proximal joint reaction force and moment, although it was not proportional. Proximal joint reaction force and moment are influenced in different ways by the external load. This suggests the need of a strict control of the prescribed exercises for different shoulder dysfunctions.

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and ...

Frozen Shoulder (FS) by many specialists is still considered a benign, self-limiting condition, which usually resolves without intervention. This concept originated in the 70', stating that FS will proceed from "the freezing" phase, with the predominance of inflammation and pain to "the frozen" phase with marked stiffness in the joint and "the thawing" phase, with a progressive return to the normal Range Of Motion (ROM) and function. Nevertheless, numerous authors have recently challenged this concept, arguing that most patients with FS will never fully recover, and suffer from residual pain and loss of function. Lack of early intervention, when a patient does not improve with conservative treatment, might lead to disability. We have discussed the recent concepts in the natural course of the disease and discussed both noninvasive and surgical methods in the treatment of FS.

Study design: Pretest post-test observational parallel-group design. Objectives: To evaluate the efficacy of passive knee extension mobilization in addition to exercise therapy on extension range of motion (ROM) in patients with osteoarthritis (OA) of the knee. Secondary objectives were to determine changes in pain and functional abilities. Background: Patients with knee OA complain of pain, limited range of motion, and impaired activities. Efficacy of mobilization as a treatment option next to exercises has not been studied rigorously. Methods and measures: Thirty-four participants with persistent knee pain, a positive radiography for knee OA, and a passive extension deficit were included. Seventeen participants (mean age ± SD, 59.8 ± 6.1 years) were treated with an exercise protocol and were additionally given manual mobilizations to improve passive extension ROM. The other group (mean age ± SD, 61.5 ± 7.3 years) with equal characteristics was treated with an identical exercise therapy protocol only. Prior to participation, detailed ROM measurements were recorded next to muscle function tests, pain (VAS), six-minute walking tests (6MWTs), a condition-specific questionnaire, and the patient-specific function scale (PSFS). Participants in both groups completed 16 treatment sessions each. Results: Passive mobilization significantly improved extension ROM in the intervention group (5.2 versus 8.6°, p = .017). The manually mobilized group also had better physical capacities as assessed by 6MWT, less pain, and a lower PSFS score. Conclusion: A combined protocol including exercise therapy and passive mobilization was beneficial for patients with OA of the knee complaining of pain, decreased extension ROM and decreased limited abilities. Level of evidence: Therapy, 2b.

Aim: Our work investigates the use of "external momentum" in the context of hypertrophy oriented training. This is momentum supplied to the load (such as a dumbbell) used in an exercise by means of action of muscles not inherently involved in the exercise. We challenge the general consensus that the use of such momentum often described as "cheating" is counterproductive.

Methods: We focus on the use of external momentum in the shoulder lateral raise and adopt a framework whereby exercise execution is simulated on a computer. This is achieved using a physical model of motion which is combined with anthropomorphic measurements and empirical data of muscular recruitment from previous work.

Results: The introduction of moderate momentum (producing initial angular velocities around 57.5 deg/s) increases the torque of the target muscles even without an increase in the load used. A moderate increase in the load and the use of momentum allows the torque to be increased even further. In contrast, excessive use of momentum results in lower demands on the target muscles, while an excessive increase of the load reduces the total hypertrophy stimulus by virtue of the decreased number of repetitions which can be performed successfully and thus the dramatically shortened time under tension.

Conclusion: Our results disprove the conventional belief that the use of external momentum necessarily reduces the overload of the target muscles. A moderate use of external momentum increases both the per-repetition peak torque and the total hypertrophy stimulus in a set.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically significant and the"t" value were estimated. It was found that ultrasound therapy when combined with end range mobilization had"t" value of 1.8342 in comparison to that of cryotherapy combined with stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment of frozen shoulder.

Frozen Shoulder (FS) by many specialists is still considered a benign, self-limiting condition, which usually resolves without intervention. This concept originated in the 70’, stating that FS will proceed from “the freezing” phase, with the predominance of inflammation and pain to “the frozen” phase with marked stiffness in the joint and “the thawing” phase, with a progressive return to the normal Range Of Motion (ROM) and function. Nevertheless, numerous authors have recently challenged this concept, arguing that most patients with FS will never fully recover, and suffer from residual pain and loss of function. Lack of early intervention, when a patient does not improve with conservative treatment, might lead to disability. We have discussed the recent concepts in the natural course of the disease and discussed both noninvasive and surgical methods in the treatment of FS.

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians. r

Abstract: Many people with shoulder problems suffer needlessly because of a delay in treatment. People often ignore early symptoms of shoulder problems. Pain in the front or back of the shoulder, difficulty reaching into a back pocket, aching at night or a sharp twinge when raising the arm, are all indications of a problem. Integrative Manual Therapy addresses these issues on a regular basis. The shoulder is a complex joint and used all day as we go about our busy lives. Because of this it is often injured or overused. By the time an individual feels pain or experiences any loss of function the problem has progressed.

Keywords: Shoulder pain, sports therapy, integrative manual therapy,

Burnham, K. and S. Yonemoto (2006). "Addressing Shoulder Pain with Integrative Manual Therapy." Health & Recovery, The Newsletter About Integrative Manual Therapy - The Science of Whole Body Health 3. [Full Text] https://www.academia.edu/17361844/Addressing_Shoulder_Pain_with_Integrative_Manual_Therapy

Despite the high prevalence of rotator cuff disease in the aging adult population, the basic mechanisms initiating the disease are not known. It is known that changes occur at both the bone and tendon after rotator cuff tears. However, no study has focused on early or “pretear” rotator cuff disease states. The purpose of this study was to compare the bone mineral density of the greater tuberosity in normal subjects with that in subjects with impingement syndrome and full-thickness rotator cuff tears.Digital anteroposterior shoulder radiographs were obtained for 3 sex- and age-matched study groups (men, 40-70 years old): normal asymptomatic shoulders (control), rotator cuff disease without full-thickness tears (impingement), and full-thickness rotator cuff tears (n = 39 per group). By use of imaging software, bone mineral densities were determined for the greater tuberosity, the greater tuberosity cortex, the greater tuberosity subcortex, and the cancellous region of the humeral head.The bone mineral density of the greater tuberosity was significantly higher for the normal control subjects compared with subjects with impingement or rotator cuff tears. No differences were found between the two groups of patients with known rotator cuff disease. The greater tuberosity cortex and greater tuberosity subcortex outcome measures were similar.Bone mineral changes are present in the greater tuberosity of shoulders with rotator cuff disease both with and without full-thickness tears. The finding of focal diminished bone mineral density of the greater tuberosity in the absence of rotator cuff tears warrants further investigation.

3D model for analysis of resultant proximal
reaction forces and moments for the upper limb

Objectives: The aim of this study was to implement a biomechanical model, with linked segments associated with inverse dynamics, to analyze proximal net forces and moments during different upper limbs’ activities. Methods: one male subject performed flexion, extension and abduction of the shoulder and flexion of the elbow. The model is composed
of five connected rigid segments (hand, forearm, arm, scapula and trunk). The Newton-Euler motion equations were used to quantify proximal net reaction forces and moments. For kinematics recording, five cameras with a frequency sample of 50 fps were used. Videogrammetry accuracy was, on average, 1,7mm. The following muscles had their activities monitored: deltoid (anterior, medial, posterior), biceps brachialis, triceps brachialis, pectoralis major. The model was evaluated by qualitative comparison of proximal net moments with electromyographic signal of agonist muscles. Results: The results showed a temporal synchronism between the proximal net moments and agonist EMG activity. Conclusions: The model was able to estimate proximal net
forces and moments during different upper limbs’ activities.

Purpose: The purpose of this study was to evaluate the influence of shoulder and chamfer margin design on stress distribution
pattern in different all ceramic restorations.
Materials and methodology: Six three-dimensional finite element models representing mandibular second premolar tooth
were constructed, using a Finite Element Analysis Software (ANSYS version 14; ANSYS Inc., Canonsburg, PA, USA). Three models
each with shoulder and chamfer finish line were created after tooth preparation by reverse engineering, using Pro E software. Each
model with shoulder finish line margin had Bruxzir (Glidewell labs), Lava (3M ESPEE) and IPS e.max Press (Ivoclar Vivadent) all
ceramic restorations fabricated over them. Same was done with the models having chamfer finish margin. A distributed load of 600
N was applied on the restorations to analyze the stress distribution pattern in different all ceramic restorations having different
marginal geometry. The stress distribution in different groups was compared using one-way ANOVA and Tukey’s honest significance
test.
Results: Von Mises stresses in the margin region were seen to be lowest in Lava (3M ESPEE) all ceramic restoration with
shoulder finish margin when subjected to masticatory bite force. The areas of maximum stress concentration were found in the
cervical portion of the all ceramic restorations when subjected to loading forces.
Conclusion: The type of material used, and the type of margin configuration affects the stress distribution pattern within
posterior all ceramic restorations.

Background: Frozen shoulder is an insidious condition that begins with pain and gradual restriction of movement in the shoulder region. There are various methods of treating frozen shoulder (both surgical and non-surgical).Among the non-surgical methods there is no specific method accepted universally. Purpose of this study is to determine the combined effectiveness of Glenohumeral End-Range Mobilization and Contract-Relax technique for glenohumeral internal rotators in patients with adhesive capsulitis.
Methods: 60 frozen shoulder patients randomized 30 subjects into each experimental and control group. Group A (experimental group) received Glenohumeral End-Range Mobilization, Contract-Relax Technique for glenohumeral internal rotators and Shoulder Pendular Exercises 2 times a week for a period of 4 weeks (8 sessions).Group B (control group) received Shoulder Pendular exercises 2 times a week for a period of 4 weeks (8 sessions). Outcome measures included are VAS, SPADI and goniometry for assessing pain, functional ability and ROM for the shoulder joint.
Results: The average improvement of VAS for Group A and Group B were 4.5 and 3 respectively using median. The U-value was 176, which is statistically highly significant (p value = 0.000).The average improvement of Shoulder Pain and Disability Index for Group A and group B were 56.9333 and 10.3667 respectively using mean and Standard Deviation. The t-value was 35.91181, which is statistically highly significant (p value = 0.000).
Conclusion: The results indicated that both Group A and Group B had significant improvement in the scores of VAS, SPADI and GONIOMETRY scores at the 4th week when compared to base line values, but when comparing the end results of group A and group B it has been found out that group A intervention is more effective then Group B in treating the internal rotators of patients with adhesive capsulitis

INTRODUCTION OF PERIODIZATION AND TYPICAL REHAB PROTOCOL P eriodization is a strategic plan that can be used to coordinate proper training towards the success of an athletic event (e.g., football, baseball, marathons, triathlons, power lifting competition, etc.) or preparatory tactical operations. Periodization schedules can lead to physiological adaptations of the body and can be focused on endurance, maximal strength, or power, as examples (19). The duration of the periodization program rests largely on the sport or tactical task at hand. Periodization is a concept that has been the cornerstone of most athletic strength and conditioning programs. While periodization is commonly used in athletic strength and conditioning programs, its application can also be useful in restorative function/rehabilitation settings as well. The specific region of the body that will be examined in this article is the the shoulder joint. According to literature, military personnel, regardless of deployment, have underreported nontraumatic injuries such as overuse injuries (7). In 2010, it was estimated that out of the 743,547 injuries reported to the United States Department of Defense, 82% were inflammatory/overuse injuries (7). The shoulder was the largest subcategory of the upper extremity injury, comprising 63% of upper extremity injuries and 9% of all injuries overall (7). Therefore, based on the large percentage of non-traumatic injuries that were sustained in the shoulder region, this article will discuss the shoulder joint through the lense of a periodization program.

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians.

The acromion is one of the two processes of the scapula. It plays a role in the field of orthopedics by having a correlation with some diseases. The morphology of this process has a significant role in upper limb pathology. The aim of the present study was to describe the different types of acromion process based on its morphology and to discuss its relation to some orthopedics diseases. We carried out a research which included 30 scapulae of unknown sex and age, provided by the Medical University of Sofia. Digital Vernier caliper and goniometer were used to calibrate the parameters (length, width etc.) of the process. We established three types of acromion process: type 1 – flat, type 2 – curved and type 3 – hooked. Our study showed that type 2 (curved) was the most commonly observed – around 80 % of the fixed materials; type 1 (flat) was seen in 11% and type 3 (hooked) – in 9%. People with type 3 (hooked) acromion process tend to suffer more often from the subacromial impingement syndrome. Knowledge of the morphology of the acromion process may help with the diagnosis and treatment of various diseases discussed in the present study and may supplement the work of shoulder surgeons and people occupied with this field of work.