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Concept: Glenohumeral joint


Changes in muscle activities are commonly associated with shoulder impingement and theoretically caused by changes in motor program strategies. The purpose of this study was to assess for differences in latencies and deactivation times of scapular muscles between subjects with and without shoulder impingement. Twenty-five healthy subjects and 24 subjects with impingement symptoms were recruited. Glenohumeral kinematic data and myoelectric activities using surface electrodes from upper trapezius (UT), lower trapezius (LT), serratus anterior (SA) and anterior fibers of deltoid were collected as subjects raised and lowered their arm in response to a visual cue. Data were collected during unloaded, loaded and after repetitive arm raising motion conditions. The variables were analyzed using 2 or 3 way mixed model ANOVAs. Subjects with impingement demonstrated significantly earlier contraction of UT while raising in the unloaded condition and an earlier deactivation of SA across all conditions during lowering of the arm. All subjects exhibited an earlier activation and delayed deactivation of LT and SA in conditions with a weight held in hand. The subjects with impingement showed some significant differences to indicate possible differences in motor control strategies. Rehabilitation measures should consider appropriate training measures to improve movement patterns and muscle control.

Concepts: Muscle, Humerus, Shoulder, Deltoid muscle, Clavicle, Glenohumeral joint, Scapula, Serratus anterior muscle


Shoulder pathologies of the rotator cuff of the shoulder are common in clinical practice. The focus of this pictorial essay is to discuss the anatomical details of the rotator interval of the shoulder, correlate the anatomy with normal ultrasound images and present selected pathologies. We focus on the imaging of the rotator interval that is actually the anterosuperior aspect of the glenohumeral joint capsule that is reinforced externally by the coracohumeral ligament, internally by the superior glenohumeral ligament and capsular fibers which blend together and insert medially and laterally to the bicipital groove. In this article we demonstrate the capability of high-resolution musculoskeletal ultrasound to visualize the detailed anatomy of the rotator interval. MSUS has a higher spatial resolution than other imaging techniques and the ability to examine these structures dynamically and to utilize the probe for precise anatomic localization of the patient’s pain by sono-palpation.

Concepts: Biology, Anatomy, Medical school, Human anatomy, Anatomical terms of location, Shoulder, Rotator cuff, Glenohumeral joint


The scapula functions as a bridge between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability of the neck/shoulder region. The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the relationship between neck pain and scapular dysfunction have only recently begun to emerge. Although several authors have emphasised the relevance of restoring normal scapular kinematics through exercise and manual therapy techniques, overall scapular rehabilitation guidelines decent for both patients with shoulder pain as well as patients with neck problems are lacking. The purpose of this paper is to provide a science-based clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant.

Concepts: Vertebral column, Shoulder, Cervical vertebrae, Glenohumeral joint, Scapula, Acromion


The reverse fly machine is a popular exercise for strengthening the horizontal shoulder abductors including the posterior deltoid. . There seems to be little consensus as to which hand position most effectively targets the posterior deltoid despite this option on most machines. This study investigated the impact of varying one’s hand position, and consequently altering shoulder joint rotation, on muscle activity in various glenohumeral muscles during exercise on the reverse fly machine. Nineteen resistance trained men (mean age = 23.2 ± 4.3 years; height =176.9 ± 7.1 centimeters; body mass = 81.3 ± 10.5 kilograms; body mass index = 25.9 ± 2.6) were recruited from a university population to participate in the study. In a repeated measures design, subjects grasped the hand bars on the machine with either a pronated (PRO) or neutral (NEU) grip and performed dynamic horizontal abduction repetitions to muscular failure using a load equating to approximately 75% body weight. The order of performance of the hand positions was counterbalanced between participants so that approximately half of the subjects performed PRO first and the other half performed NEU first. Surface electromyography was used to record both mean and peak muscle activity of the posterior deltoid, middle deltoid, and infraspinatus. Results showed that mean EMG activity for the posterior deltoid was significantly greater in NEU compared to PRO (p = 0.046; 95% CI = 0.1 to 7.4% MVIC). Similarly, mean EMG activity of the infraspinatus also was significantly greater in NEU compared to PRO (p = 0.002; 95% CI = 3.7 to 13.6% MVIC). The results of this study show that performing exercise on the reverse fly machine with a neutral hand position significantly increases activity of the posterior deltoid and infraspinatus muscles compared to a pronated hand position.

Concepts: Muscle, Mass, Body mass index, Electromyography, Shoulder, Rotator cuff, Deltoid muscle, Glenohumeral joint


McAllister, MJ, Schilling, BK, Hammond, KG, Weiss, LW, and Farney, TM. Effect of grip width on electromyographic activity during the upright row. J Strength Cond Res 27(1): 181-187, 2013-The upright row (URR) is commonly used to develop the deltoid and upper back musculature. However, little information exists concerning muscle recruitment during variations of this exercise. Sixteen weight-trained men completed 2 repetitions each in the URR with 3 grip conditions: 50, 100, and 200% of the biacromial breadth (BAB). The load was the same for all grip conditions and was equal to 85% of the 1RM determined at 100% BAB. Repeated measures analyses of variance were used to compare the maximal activity of the anterior deltoid (AD), lateral deltoid (LD), posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), and biceps brachii (BB) during the 3 grip widths for eccentric and concentric actions. Significant differences (p < 0.05) were noted in concentric muscle activity for LD (p < 0.001) and PD (p < 0.001), and in eccentric muscle activity for AD (p = 0.023), LD (p < 0.001), UT (p < 0.001), MT (p < 0.001), and BB (p = 0.003). Bonferroni post hoc analysis revealed significant pairwise differences in the concentric actions from the LD (50% vs. 200% BAB and 100% vs. 200% BAB) and PD (50% vs. 200% BAB and 100% vs. 200% BAB), and eccentric actions of the LD (all comparisons), UT (all comparisons), MT (50% vs. 200% BAB and 100% vs. 200% BAB), and BB (50% vs. 200% BAB), with large-to-very-large effect sizes (ESs). Moderate-to-large ESs were noted for several nonsignificant comparisons. The main findings of this investigation are increased deltoid and trapezius activity with increasing grip width, and correspondingly less BB activity. Therefore, those who seek to maximize involvement of the deltoid and trapezius muscles during the URR should use a wide grip.

Concepts: Muscle, Biceps brachii muscle, Electromyography, Muscle contraction, Deltoid muscle, Muscles of the upper limb, Clavicle, Glenohumeral joint


BACKGROUND: Ablation of locally advanced head and neck cancers generally results in large composite oro-facial defects. Due to the often-large segment of mandible missing, as well as the need to provide skin coverage and oral lining, reconstructive options are limited. We present our experience in oncologic head and neck reconstruction using chimaeric subscapular system free flaps. METHODS: We performed a retrospective chart review of patients presenting important through-and-through oro-facial defects following ablation of T3, T4a or T4b tumours in two university centres between 2005 and 2011. All defects were reconstructed with a subscapular system free flap that was harvested in a dorsal decubitus position. RESULTS: Sixteen patients (15 M, 1 F; mean age = 60 years) underwent mandibular reconstruction with latissimus dorsi flaps with one or two skin paddles and one bony component based on the angular branch of the thoracodorsal artery. Fifteen patients received adjuvant radiotherapy. We experienced no flap loss. Donor-site complications were minimal, albeit a limitation of shoulder range of motion was found in four patients. Eight patients presented postoperative complications requiring re-intervention. Fourteen patients were able to recommence oral nutrition and their diction returned to normal in all but one. The mean follow-up period was 25 months. Aesthetic results were satisfactory upon atrophy of the latissimus dorsi muscle. CONCLUSIONS: In cases of extensive oro-facial defects involving a large mandibular segment, reconstruction with subscapular system free-tissue transfer is a safe and reliable technique that offers satisfactory functional and aesthetic results.

Concepts: Cancer, Oncology, Latissimus dorsi muscle, Iliac crest, Thoracodorsal nerve, Subscapular artery, Glenohumeral joint, Thoracodorsal artery


The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and “frozen” shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders.

Concepts: Orthopedic surgery, Shoulder, Adhesive capsulitis of shoulder, Hydrodilatation, Glenohumeral joint


The primary role of the shoulder joint in tennis forehand drive is at the expense of the loadings undergone by this joint. Nevertheless, few studies investigated glenohumeral (GH) contact forces during forehand drives. The aim of this study was to investigate GH compressive and shearing forces during the flat and topspin forehand drives in advanced tennis players. 3D kinematics of flat and topspin forehand drives of 11 advanced tennis players were recorded. The Delft Shoulder and Elbow musculoskeletal model was implemented to assess the magnitude and orientation of GH contact forces during the forehand drives. The results showed no differences in magnitude and orientation of GH contact forces between the flat and topspin forehand drives. The estimated maximal GH contact force during the forward swing phase was 3573 ± 1383 N, which was on average 1.25 times greater than during the follow-through phase, and 5.8 times greater than during the backswing phase. Regardless the phase of the forehand drive, GH contact forces pointed towards the anterior-superior part of the glenoid therefore standing for shearing forces. Knowledge of GH contact forces during real sport tasks performed at high velocity may improve the understanding of various sport-specific adaptations and causative factors for shoulder problems.

Concepts: Force, Classical mechanics, Shoulder, Euclidean vector, Deltoid muscle, Normal force, Glenohumeral joint, Contact force


PURPOSE: Objective of this study is to evaluate the diagnostic values of the Arm Squeeze Test. The test consists in squeezing the middle third of the upper arm. METHODS: 1,567 patients were included in this study. Diagnosis of cervical nerve root compression or shoulder disease was clinically formulated and confirmed with imaging before performing test. 350 healthy volunteers were recruited as controls. The test was positive when score on a VAS Scale was 3 points or higher on squeezing the middle third of the upper arm compared to acromioclavicular (AC) joint and anterolateral-subacromial area. RESULTS: Patients were subdivided as follows: 903 with rotator cuff tear, 155 with shoulder adhesive capsulitis, 101 with AC joint arthropathy, 55 with calcifying tendonitis, and 48 affected by glenohumeral arthritis. The study sample included 305 patients with cervical nerve root compression from C5 to T1 with shoulder radicular pain. The test was positive in 295/305 (96.7 %) of patients with cervical nerve root compression, compared to 35/903 (3.87 %), 3/155 (1.93 %), 0/101 (0 %), 1/55 (1.81 %) and 4/48 (8.33 %) of those with rotator cuff tear, adhesive capsulitis, AC arthropathy, calcifying tendonitis and glenohumeral arthritis, respectively. A positive result was obtained in 14/350 asymptomatic subjects (4 %). If patients with cervical nerve root compression were compared to controls and patients with shoulder diseases, the test had sensitivity of 0.96 and specificity from 0.91 to 1. CONCLUSIONS: The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.

Concepts: Diseases and disorders, Humerus, Shoulder, Upper limb anatomy, Rotator cuff, Adhesive capsulitis of shoulder, Glenohumeral joint, Soft tissue disorders


Shoulder pain is a common musculoskeletal complaint that is difficult to treat because of the biomechanical complexity of the shoulder region, the interplay between mobility and stability, and the vital role played by the shoulder in moving, positioning, and providing stability for hand function. Despite advances in biomechanics and pain science, there is still much to learn about how impairments influence shoulder function and health. One impairment, posterior shoulder tightness (PST), is often noted in individuals with shoulder pain and consequently has generated much discussion and debate in recent years. Range-of-motion shifts and deficits are the clinical indicators of PST, with 3 tissue alterations potentially contributing to these modifications: (1) increased humeral retrotorsion (retroversion), (2) reduced posterior glenohumeral joint capsule extensibility, and (3) reduced posterior shoulder muscle/tendon extensibility. The significance of each alteration for shoulder function and the interaction among them remain unclear. It is also unknown if, or to what extent, these impairments can be resolved through interventions. This raises a clinically relevant and straightforward question: when PST is present, should we treat or not treat? In this Viewpoint, we will debate this question and propose that physical therapy interventions have the potential to improve only 1 of the 3 tissue alterations contributing to PST. J Orthop Sports Phys Ther 2018;48(3):133-136. doi:10.2519/jospt.2018.0605.

Concepts: Physical therapy, Biomechanics, Shoulder, Potential, Rotator cuff, Shoulder problems, Deltoid muscle, Glenohumeral joint