Background: Limitations of shoulder range of motion (ROM), particularly shoulder internal rotation (SIR), are commonly associated with musculoskeletal disorders in both the general population and athletes. The limitation can result in connective tissue lesions such as superior labrum tears and symptoms such as rotator cuff tears and shoulder impingement syndrome. Maintaining the center of rotation of the glenohumeral joint during SIR can be challenging due to the compensatory scapulothoracic movement and anterior displacement of the humeral head. Therefore, observing the path of the instantaneous center of rotation (PICR) using the olecranon as a marker during SIR may provide valuable insights into understanding the dynamics of the shoulder joint. Objects: The aim of the study was to compare the displacement of the olecranon to measure the rotation control of the humeral head during SIR in individuals with and without restricted SIR ROM. Methods: Twenty-four participants with and without restricted SIR ROM participated in this study. The displacement of olecranon was measured during the shoulder internal rotation control test (SIRCT) using a Kinovea (ver. 0.8.15, Kinovea), the 2-dimensional marker tracking analysis system. An independent t-test was used to compare the horizontal and vertical displacement of the olecranon marker between individuals with and without restricted SIR ROM. The statistical significance was set at p < 0.05. Results: Vertical displacement of the olecranon was significantly greater in the restricted SIR group than in the control group (p < 0.05). However, no significant difference was observed in the horizontal displacement of the olecranon (p > 0.05). Conclusion: The findings of this study indicated that individuals with restricted SIR ROM had significantly greater vertical displacement of the olecranon. The results suggest that the limitation of SIR ROM may lead to difficulty in rotation control of the humeral head.

Background: The Trunk Stabilization Exercise and Respiratory Muscle Exercise may help address the complex biomechanical and neuromuscular issues that contribute to shoulder joint disorders and can help improve patient outcomes in terms of pain relief, range of motion, and functional ability. Objectives: To investigated the effects of conventional physical therapy, trunk stabilization exercise, and respiratory muscle exercise, on the Range of Motion (ROM), ULF and balance in patients with shoulder joint disorder. Design: A randomized controlled trial. Methods: This study randomly allocated 18 subjects to the control group, 19 to the trunk stabilization exercise group, and 19 to the respiratory muscle exercise group, while all interventions were performed five times a week for four weeks. The result measurement involved the ROM, the upper limb function test (ULT), and balance tests. Results: The respiratory muscles exercise group indicated significant improvement in ROM and balance tests than the trunk stabilization exercise group and control group. Conclusion: The respiratory muscle exercise is a more effective way to improve ROM and balance ability than trunk stabilization exercise for patients with shoulder joint disorder.

Background: Studies using Smovey and Vibration foam rollers are mostly conducted with normal adults, breast cancer patients, and athletes. However, there are not many studies applied to stroke patients to date. Objectives: The purpose of this study is to investigate the effect of vibration exercise on the range of motion of the shoulder and knee joints in stroke patients. Design: A randomized controlled trial. Methods: A total of 36 stroke patients, with 12 in the Smovey and Vibration foam roller group (SVG), 12 in the Smovey and Non-Vibration foam roller group (SNVG), and 12 in the control group (CG) were randomly assigned to exercise three times a week for 6 weeks. The range of motion of the shoulder and knee joints was measured for each group before and after 6 weeks of exercise. For joint range of motion, shoulder flexion and extension and knee flexion and extension were measured using BPMpro. Results: In terms of the difference in time, the flexion and extension of the shoulder and the flexion and extension of the knee on the paretic side were significant in the SVG and SNVG. The CG was not significant. Shoulder flexion and extension and knee flexion and extension on the unaffected side were all insignificant. The differences between each group were significant between the SVG and the CG and the SNVG and the CG. SVG and SNVG were not significant. Conclusion: It was found that vibration exercise had a positive effect on the range of motion of the shoulder and knee joints. Therefore, it is thought that vibration exercise can be provided as a clinical intervention method for shoulder and knee range of motion.

Background: Patients who underwent rotator cuff repair (RCR) require management to control pain and prevent re tear and stiffness. Thoracic mobilization has been applied for the improvement of vertebra and shoulder movements and pain reduction. Also, core stability exercise is an intervention necessary for rehabilitation after shoulder surgery. Objectives: To examine the short term benefits of thoracic mobilization and core stability exercise for patients after RCR. Design: Randomized controlled trial with multi arm parallel group and single blind assessor. Methods: 30 participants after RCR were recruited. Participants were categorized into conventional physical therapy (CPT) group, thoracic mobilization (TM) group, and core stability exercise (CSE) group according to the randomization program. Each treatment, transcutaneous electrical nerve stimuli (TENS), TM, and CSE was applied to each group. 3 physical therapists only conducted evaluations; VAS (visual analogue scale), ROM (range of motion), and Korean version of Shoulder Pain and Disability Index (SPADI). Results: VAS and SPADI were statistically reduced, and ROM was statistically improved in all 3 groups. In between three group comparisons of changes in outcome variables, there was not a significant difference in VAS, but there was a significant difference in ROM and SPADI. In the post hoc test, ROM and SPADI showed a significant difference in TM and CSE compared to CPT. Conclusion: TM according to Maitland concept and CSE had beneficial effects compared to CPT in patients after RCR.

Background: Sling exercises are frequently used for the rehabilitation process of patients with shoulder joint injuries, but research on the significant frequency intensity and appropriate treatment duration for sling exercises with local vibration stimulation is lacking. Objects: The aim of this study was to investigate the effects of sling exercise with vibration on shoulder range of motion (ROM), muscle strength, pain, and dysfunction in patients with a medical diagnosis of shoulder joint injury. Methods: Twenty-two patients were randomly assigned to the experiment and control groups. Six sling exercises with and without 50 ㎐ vibrations were applied in the experiment and control groups, respectively. Each exercise consisted of 3 sets of 5 repetitions performed for 6 weeks. The assessment tools used included shoulder joint range of motion, muscle strength, pain level, and shoulder pain and disability index for functional disability. We conducted re-evaluations before and 3 and 6 weeks after intervention. The changes in the measurement variables were analyzed and compared between the two groups. Results: The ROM of the external rotation of the shoulder joint had a significant interaction between the group and the measurement point (F=3.652, p<.05). In both groups, we found a significant increase in external rotation angle between the measurement points (p<.05). The flexor strength of the shoulder joint significant interaction between the group and the measurement point (F=4.247, p<.05). Both the experiment (p<.01) and control groups (p<.05) showed a significant increase in shoulder flexor strength at the measurement points. After 6 weeks of the interventions, both the groups showed significantly improved VAS (p<.01), SPADI (p<.01), and orthopedic tests (p<.01). However, there was no significant difference between the group and the measurement point in terms of the clinical outcomes observed. Conclusion: The sling exercise with local vibration of 50 ㎐ affected the external rotation of the shoulder range of motion and improved shoulder flexor strength in the patients with shoulder injuries. Therefore, we propose the use of the sling exercise intervention with vibration in the exercise rehabilitation of patients with shoulder joint injuries.

Background:Rounded shoulder posture (RSP), a postural abnormality, might cause shoulder pain and pathologic conditions. Although most previous research has investigated RSP focusing on the proximal structures of the shoulder, such as the scapula and pectoralis muscles, the relationship between RSP and anterior distal structures of the upper extremity, such as the biceps brachii muscle and elbow joint, is not clearly understood.Objects:This study aimed to investigate the correlations between RSP and the biceps brachii length, elbow joint angle (EJA), pectoralis minor length, general pectoralis major length, humeral head anterior translation (HHAT), glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HAD).Methods:Twelve subjects with RSP (6 male, 6 female) were recruited. All subjects fulfilled the RSP criteria indicated by a distance ≥2.5 cm from the posterior aspect of the acromion to the table in the supine position. The examiner measured each of the following parameters twice: RSP, biceps brachii length, EJA, pectoralis minor length, pectoralis major length, HHAT, glenohumeral IR, ER, and HAD. Pearson’s correlation coefficient(r) was used to assess the correlation between RSP and all the variables.Results:There was a significant moderate positive correlation between RSP and biceps brachii length (r=.55, p=.032), moderate negative correlation between RSP and pectoralis minor length (r=-.62, p=.015), and moderate positive correlation between RSP and HHAT (r=.53, p=.038).Conclusion:The biceps brachii length, pectoralis minor length, and HHAT could be used to evaluate patients with RSP. Better understanding of the correlation between these factors and RSP could help in the development of effective methods to treat patients with this condition in clinical management.

This study used both kinesiotaping and extracorporeal shock wave therapy on patients diagnosed with frozen shoulder - a common musculoskeletal disorder in adults - in order to observe the effects on the joint range of motion. 21 adult(male 12, female 9) were selected and distributed into randomized groups. One group received kinesiotaping (n=10) and the other group received kinesiotaping together with extracorporeal shockwave therapy (n=11). After a 6 week duration of receiving kinesiotaping and extracorporeal shockwave therapy, changes in the joint range of motion in the patients were observed. Post-treatment of frozen shoulder, the changes in abduction within the shoulder joint were as follows: in both groups there was a noticeable increase in the joint range of motion (p<.05). Post-treatment of frozen shoulder, the changes in external rotation within the shoulder joint were as follows: both groups showed a significant increase in the joint range of motion (p<.05). The result of suggest that, it can be inferred that both the extracorporeal shockwave therapy and kinesiotaping are effective in increasing the joint range of motion in patients with frozen shoulder.

Background: Patients after rotator cuff (RC) surgery experienced pain, weakness and limited of motion of the shoulder. Physical therapists have used heat therapy, electrotherapy, range of motion (ROM) exercise and other methods to treat patients after RC surgery. In addition, functional taping is also used to support joint movement and to increase shoulder joint stability. Objects: The purpose of this study was to determine the initial effects of functional taping using non-elastic tape on pain, strength and ROM of the shoulder following RC surgery. Methods: Forty-eight patients with who underwent RC surgery volunteered for this study. The subjects were randomly divided into an experimental group (EG, n1=25) and a control group (CG, n2=23). First, non-allergic tape was applied to the shoulder to prevent skin irritation. The EG applied functional taping using non-elastic tape and the CG applied sham taping using elastic tape. Assessment tools included the shoulder pain and disability index for functional activity score, visual analog scale for level of pain, shoulder muscle strength, hand grip strength and ROM testing. Results: Pain score in the both group significantly decreased (p<.05), and change in pain score of in the EG increased significantly than in the CG (p<.05). Shoulder strength and ROM in the both group significantly increased (p<.05). Especially external rotation and extension of the shoulder ROM in the EG increased significantly more than in the CG (p<.05), but the rate of change in the two groups showed no significant difference. Conclusion: These results suggest that functional taping using non-elastic tape was initially effective in decreasing pain score level in patients with RC surgery.

Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE. Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain. Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention. Results: GSE resulted in significantly better shoulder stability (p=.046, from 8.67±7.54 score to 13.93±9.40) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472). Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.

Background: Shoulder horizontal adduction (HA) is performed in many activities of daily living. The limited range of motion (LROM) of HA is affected by the tightness of the posterior deltoid, infraspinatus, teres major, and posterior capsule of glenohumeral joint. The LROM of shoulder HA contributes to excessive scapular abduction. Objects: The aim of this study is to compare the scapular abduction distance and three-dimensional displacement of the scapula during shoulder horizontal adduction between subjects with and without the LROM of shoulder HA. Methods: 24 subjects (12 people in LROM group and 12 people in normal ROM group) participated. Subjects with less than 115° of HA ROM were included in LROM group. Shoulder HA was performed 3 times for measuring scapular abduction distance and three-dimensional displacement of the scapula. Tape measure was used for measuring scapular abduction distance. Scapular abduction distance was normalized by dividing the scapular size. Polhemus Liberty was used for measuring the three-dimensional displacement of the scapula. Results: Normalized scapular abduction distance was significantly greater in LROM group than normal ROM group (p<.001). Three-dimensional displacement of the scapula during shoulder HA was greater in LROM group than normal ROM group (p<.05). Conclusion: LROM group had a greater scapular abduction and three-dimensional displacement of the scapula during shoulder HA compared to normal ROM group.

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a “downstream” effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly postversus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p˃.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, n1=30), a shoulder surgery group (SS, n2=30) and a control group (n3=30). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.

The purpose of this study were to determine the intra-rater and inter-rater reliability of shoulder passive range of motion measurement using the “Clinometer + bubble level”, a smartphone application and to compare with the intra-rater and inter-rater reliability of measurement using a goniometer. Twenty six patients with stroke were recruited for this study. Two raters measured the passive range of motion of four types of shoulder movements (forward flexion; FF, abduction; ABD, external rotation at 90° abduction; ER90 and internal rotation at 90° abduction; IR90) using a goniometer and a smartphone to determine within-day inter-rater reliability. A retest session was performed thirty minutes later to determine within-day intra-rater reliability. The reliability was assessed using intraclass correlation coefficients (ICC) and the standard error of measurement (SEM). The ICC (2,1) for the inter-rater reliabilities of the goniometer and smartphone were good in FF and ABD [ICC (2,1)=.75∼.87] and excellent in ER90 [ICC (2,1)=.90∼.95]. The intra-rater reliabilities for the goniometer and smartphone were good or more than good, with an ICC (3,1) value >.75, the exception was IR90 measured by rater 2 on the smartphone. These results suggest that smartphone could be used as an alternative method tool for measurement of passive shoulder range of motion in patients with stroke.

The purpose of this study was to measure intra-rater and inter-rater reliability and range of motion for measurement of passive shoulder internal rotation range of motion and to compare anterior glide distance of humeral head in three methods. Fifty healthy subjects and fifty patients with shoulder musculoskeletal pain were recruited for this study. The subjects' passive shoulder internal rotation range of motion was measured by visual estimation, manual stabilization, and pressure biofeedback unit methods. In two trials, measurements were performed on each subject by two examiners. Intraclass correlation coefficient (ICC(3,1)) was used to determine the reliability of each measurement. The intra-rater reliability of the three methods was excellent (ICC=.77~.93) in both groups. The inter-rater reliability of the visual estimation method was poor (ICC=.20, .29), the manual scapular stabilization method was poor and fair (ICC=.09, .50), and the pressure biofeedback unit method was excellent (ICC .86, .75) in the experimental and control groups. In the experimental group, the difference of examined range of motion by each examiner was significant in the visual estimation method and manual scapular stabilization method, but there was an insignificant difference between the groups is the pressure biofeedback unit method. This result suggests that the intra-rater and inter-rater reliability of a pressure biofeedback unit was better than the other methods. The difference in distance of the anterior glide of humeral head was insignificant among all the methods. The pressure biofeedback unit method was the most reliable method, so it is proposed to be a new and reliable method to measure internal rotation range of motion.

For effective rehabilitation of the shoulder, physical therapists must have correct knowledge of shoulder movements. The purpose of this study was to determine the relationship between shoulder movements and the rotation of the humerus in the sagittal, coronal and scapular planes. Fifty normal subjects(25 male, 25 female) were tested using a Dualar-plus digital goniometer and an air-splint. The subjects performed active shoulder elevation in each plane with the humerus rotated in both medial and lateral directions. The range of motion(ROM) of the glenohumeral joint was measured three times. The paired t-test was used to determine the difference in ROM between medial and lateral rotation of the humerus. Results showed that, in the sagittal and the coronal planes, there was a significant difference(p < 0.01) in ROM of the shoulder between medial rotation and lateral rotation which was greater. But in the scapular plane, there was no difference between medial and lateral rotation. Physical therapists should consider these results when the goal of treatment is to increase ROM of the shoulder.

이 연구는 동결견 진단을 받은 환자에 대한 한국전통 정골요법(이하 KTO)을 적용하여 통증완화에 대한 유의성 연구가 진행하였던 환자를 대상으로 통증의 감소가 견관절의 가동범위도 증가하는지를 추가적으로 확인하기 위하여 진행하였다. 대상자는 총 14명으로 구성되어 있으며, 두 개 그룹으로 나누어 7명의 실험군과 7명의 대조군으로 하여 2그룹으로 나누어 연구를 진행하였다. 7명은 KTO를 총 10회 시술하고, 7명은 시술하지 않았다. 견관절의 가동범위의경우 항목별로 살펴보면 KTO를 적용한 그룹은 가동치의 변화를 살펴보았을 때 굴곡(7.33) 신전(10.00) 외전(8.76)내전(9.05) 외회전(8.10) 내회전(10.00)의 변화가 나타났다. KTO를 적용하지 않은 그룹의 가동치의 변화를 살펴보았을 때 굴곡(4.67), 신전(7.50), 외전(7.14), 내전(9.14), 외회전(6.59), 내회전(9.31)의 변화가 나타났다. 동결견 환자에게 한국전통정골요법을 적용하면 견관절의 가동범위 증가를 가져올 수 있음을 확인하였다.