Isokinetic Strength Analysis

In order to test the passive sufficiency of a bi-articular structure, such as a muscle, both joints which that structure crosses must first be identified. Additionally, the movements of those two joints which will constrain that structure must be identified. Next, one joint must be selected, and placed into the position that may constrain the structure. At the same time, the other joint must be placed in the position which will NOT put further strain on that structure. The selected joint must then be measured for its range of motion. Next, the same must be done with the selected joint, but in contrast, the other joint must be placed in the position which WILL further constrain the bi-articular structure. Once that has been done, the selected joint’s range of motion must be measured once more.

A pitcher with a great amount of throwing power and technique can decrease the amounts of hits, and essentially limit the amounts of runs scored by the opposing team. Training for this type of athlete will include an incorporation of muscular endurance, muscular strength, muscular power, muscular power endurance, and flexibility, agility, and speed for maximal performance. Increasing each factor can help reduce the risk of injury by strengthening the muscles around the joints that are easily injured due to the amount of power and torque exerted on the tendons by each pitch (Wilk, Macrina, Fleisig, Aune, Porterfield, Harker, Evans, 2014). Several studies show the importance of strength and conditioning on injury prevention, however, pitchers with more balanced rotator cuff musculature may be at lower risk for injury and have a greater range of motion (ROM). Given the high demands placed on the shoulder in all defensive positions, professional baseball pitchers may be at higher risk of injury without proper conditioning due to constant usage. This can lead to the tightening of tendons and reduced ROM causing greater risk of injury. Although arm strength and power are important to increase a pitchers velocity, lower extremity strength and conditioning are also thought to be crucial in the transfer of energy during pitching and thus should be included for a pitchers success (Wilk,

The patient was an active participant in both contact as well as non-contact athletic activities. The patient reported occurrence of different symptoms that included; pain, weakness, instability, paresthesia, crepitus, as well as instability of the shoulder during sleep. Sulculus sign was conducted to assess the rotator interval and load and shift test for determination of the patient’s posterior stability. The doctor diagnosed positive for multidirectional instability. The patient’s multidirectional instability was not caused by a traumatic event. The patient had not exercised the joint over a long period of time, hence he had a weak shoulder joint, particularly the rotator cuff. The doctor recommended that the patient should be treated for the pain and inflammation of the shoulder caused by the multidirectional instability and then placed on physical therapy aimed for one year aimed at helping in the strengthening of the muscles of the patient that support the scapula (shoulder blade) and the rotator cuff (shoulder joint) so as to help the patient in returning to normal physical activity and also prevent an injury at the same place

Manual muscle testing of the left glenohumeral joint with flexion, abduction and external rotation is 4/5. Patient is with limited use of the left upper extremity and has slow progress noted with precautions of pacemaker limiting aggressive stretching. Plan is to progress with ROM and mobility strength.

^8,5 ASI occurs when the arm is in adduction with the shoulder internally rotated. The biceps complex pulley, also known as a capsuloligamentous complex, adjoins the anterior glenoid causing injury when in extreme motions. With the PSI, the pulley is put into risk with abduction and external rotation on the posterosuperior glenoid. ^8 PSI is also associated with partial-thickness tears on the deep side of the articular surface of the rotator cuff. ^5 This can be a common cause for a peel-back mechanism associated with a SLAP lesion. ^8 Peel-back mechanisms can be produced many different ways, but are mostly seen with a SLAP lesion or internal impingement. These can occur when the shoulder is placed into abduction and extreme external rotation with a torsional force added to the labro-bicipital complex that is at the base of the biceps on the posterior superior labrum. ^1,5 This causes fatigue and failure of the humeral head that rotates medially over the upper rim of the glenoid fossa creating a shearing force. ^1,5 Increased superior labral strain in overhead athletes occurs during the late-cocking phase of throwing when arm is externally rotated. ^1

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

I have been fortunate enough to observe my coach perform various techniques to restore mobility and motion.  One such technique that I was able to survey was the rehabilitation of an anterior shoulder dislocation. During the acute phase of therapy, isometric exercises were used to strengthen the rotator cuff muscles. The next phase was to achieve full range of motion without pain and continue to strengthen the muscles. This was done through abduction and external rotation, wall climbs/slides, and pulley’s.

The participants included 87 individuals (28 men, 49 women) with various shoulder dysfunctions who were assessed during a routine clinical evaluation and consented for shoulder arthroscopy. Also, all individuals were required to have a magnetic resonance image (MRI), to have completed the dedicated special tests of interest in the study, and to have a detailed diagnosis after arthroscopic surgery.

For shoulder flexion 61% of the variance could be accounted for by the sit-and-reach. A correlation was also found between the modified sit-and-reach test and both the shoulder extension and hip flexion tests. For shoulder extension 33% of the variance was accounted for by the modified sit-and-reach and for hip flexion 22% of the variance was accounted for by the modified sit-and-reach.

Isometric contractions appear when there is no change in the length of the contracting muscle. This occurs when carrying an item in front of you. As the weight of the item is pulling your arms down, but your muscles are contracting to hold the items at the same level. Isokinetic contractions are really similar to isotonic, in that the muscle changes length during the contraction. Where they are different is that Isokinetic contractions produce movements of a constant speed. What you need to measure this is something called a isokinetic dynamometer. Concentric contractions are those which cause the muscle to shorten. An example is bending the elbow from straight to fully extended, causing a concentric contraction of the Bicep muscle. Eccentric

The prime movers in the left shoulder that move it back to its neutral position are the anterior deltoid and the bicep brachii. Concentric contractions followed by eccentric contractions of both of these muscles move the shoulder from extension and abduction to it neutral state by flexing and adducting the shoulder. The prime movers in the right shoulder are again the anterior and middle deltoid along with the supraspinatus that contract isometrically to keep the shoulder in horizontal abduction. When the right shoulder is let down after follow through, the prime movers are the triceps and the posterior deltoids which eccentrically contract to extend the shoulder to its neutral position. Therefore the muscles of the shoulder are exceedingly imperative to the action of shoot a

The first was a questionnaire for symptoms, disability, and the SF36 health survey. The second assessment was performed by a blinded orthopaedic specialist and third an ultrasound and MRI of the shoulder. In the first stage the subjects took a Nordic- style questionnaire that focused on pain in the upper limb. The second stage was performed by an experienced orthopaedic specialist. The specialist assessed both shoulders by determining the range of motion and pull force at a 90 degrees of abduction in the scapular plane. A constant score was calculated for both shoulders. If the constant score was below normal female values, their shoulder was considered abnormal. Third a blinded musculoskeletal radiologist performed an ultrasonography of both shoulders in all subjects. If they had an inconclusive finding they completed the assessment with an MRI. The subjects were not allowed to report any pain they were having during the

Also, the right upper extremity was kept in protection with arm adducted and internally rotates, possibly subconsciously. All left upper extremity range of motion was within normal limits, no pain, no decreased range, some tightness of pectoralis muscles observed and some scapula dyskinesis. Right upper extremity was found limited to an active range of motion (AROM) performed in standing for flexion and abduction, the pain was present with instability, compensation and scapula dyskinesis. Following this step, the patient was supine position to measure passive range of motion (PROM), also pain was a limiting factor with muscle guarding end feel. Following, manual length test (MLT) of biceps was limited with replication of pain, mainly for the long head than for the short head. Additionally, manual muscle test was performed in sitting with a result of 3+/5 with pain present, and fear physiognomy was observed during testing. Additionally, special tests were performed to confirm diagnosis of the labrum tear; positive Speed test performed in a sitting position and Compression rotation test performed in supine position. Both special tests present with outstanding sensitivity and specificity. Limitations with activities like reaching up cabinets and washing his back were functionally addressed. Additionally, recreation activities like weight

The Motricity Index (MI) will also be used for measuring the participant’s upper extremity power. In this outcome measure, it involves grading strength by basing on patient’s ability to activate a muscle group, move a segment of the upper extremity through a range of motion and resist force from the examiner. Criterion and construct validity of this tool has been undertaken in a study and has shown significant correlations with other outcome measures such as the use of Manual Muscle Testing and dynamometer. (Bohannon,

Patients in Group 2 (stretch kinesiatrics group) performed repetitive joint exercises for 15 minutes, using an isokinetic dynamometer (CYBEX 6000®, Lumex Inc. Ronkonkoma, NY, USA). Before starting the stretch exercise, the seat of the isokinetic dynamometer was folded to the rear; depending on the presence or absence of hip joint flexion establishment, the patients took a position somewhere between supine and the hip joint flexion position (maximum position at 30° of flexion). Since the angular velocities of joints prevent possible muscle damage resulting from long hours of joint exercises, relatively low velocities of 30 °/sec and 60 °/sec were chosen to simulate natural joint exercises. For the bending and stretching joint exercises, four