Elsevier

Manual Therapy

Volume 14, Issue 1, February 2009, Pages 81-87
Manual Therapy

Original article
Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders

https://doi.org/10.1016/j.math.2007.11.004Get rights and content

Abstract

Measurement of anterior/posterior shoulder tightness, humeral external/internal rotation range of motion (ROM), scapular upward rotation/tipping ROM, and functional limitations were made in 46 patients with unilateral stiff shoulders (SSs) using a clinical measurement (shoulder tightness), a three-dimensional electromagnetic tracking device (shoulder ROM), and self-reports of function. Patients with SSs in their dominant shoulder demonstrated statistically greater posterior shoulder tightness compared to nondominant shoulder. Control dominant shoulders demonstrated decreased internal ROM as compared with control nondominant shoulders (p = 0.021). In SSs, significant relationships were found between humeral internal rotation ROM and posterior shoulder tightness (R = 0.49, p < 0.0005), humeral external rotation ROM and anterior shoulder tightness (R = 0.59, p = 0.0002), scapular tipping and anterior shoulder tightness (R = 0.57, p = 0.004). Specifically, in patients with dominant SSs, posterior shoulder tightness and functional limitation were related (R = 0.56, p = 0.002). In patients with dominant involved shoulders, emphasise on posterior tightness stretch may improve functional ability directly. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the rehabilitation of patients with SSs.

Section snippets

Subjects

Forty-six patients suffering from unilateral SS (22 male, 24 female) between the ages of 48 and 85 (mean = 58.1, SD = 16.3) years agreed to have measurements taken as part of a routine clinical examinations. The affected shoulders (24 dominant shoulders and 22 nondominant shoulders) of the 46 patients were tested. Descriptive data of the subjects' characteristics are summarized in Table 1. The inclusion criteria of patients with SSs were: (1) a limited ROM of a shoulder joint (ROM losses of 25% or

Results

Table 2 presents measurements of anterior tightness, posterior tightness, humeral external rotation/internal rotation ROM, and scapular upward rotation/tipping ROM bilaterally in patients with SSs. Patients with SSs in either their dominant or nondominant shoulders demonstrated a statistically significant greater anterior/posterior shoulder tightness (p < 0.005), loss of humeral internal/external rotation ROM (p < 0.005), and loss of scapular upward rotation/tipping ROM (p < 0.005) as compared with

Discussion

ROM deficits have been documented in patients with SSs (Reeves, 1975, Wadsworth, 1986, Warner et al., 1990, Griggs et al., 2000Rundquist et al., 2003). It has been postulated that loss of humeral internal rotation and external rotation of the involved shoulder are the result of posterior shoulder tightness and anterior shoulder tightness, respectively (Tyler et al., 1999, Tyler et al., 2000, Rundquist et al., 2003, Warner et al., 1990). The results of the present study support this assumption.

Conclusions

Shoulder tightness, limited humeral and scapular ROM, and functional deficits were present in subjects with SSs. Humeral internal and external rotation ROM had moderate relationships with posterior and anterior shoulder tightness, respectively, in this population. Scapular tipping ROM was significantly correlated with anterior shoulder tightness. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the

References (25)

  • D.T. Harryman et al.

    Translation of the humeral head on the glenoid with passive glenohumeral motion

    Journal of Bone and Joint Surgery American Volume

    (1990)
  • R.L. Johansen et al.

    A modified internal rotation stretching technique for overhand and throwing athletes

    Journal of Orthopaedic and Sports Physical Therapy

    (1995)
  • Cited by (13)

    • Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial

      2021, Brazilian Journal of Physical Therapy
      Citation Excerpt :

      Loss of glenohumeral IR is attributed to posterior shoulder muscle or posterior capsule tightness (PCT).7,8,16-18 Importantly, PCT is also associated with decreased rotator cuff strength,7 altered scapula and humerus kinematics,8,13,19-21 and sensitization8 – the same alterations noted in those with SIS. This interaction among PCT, SIS, and biomechanical and impairment-level factors suggests that an intervention specifically targeting PCT may reduce symptoms and improve movement in those with shoulder pain.

    • The reliability, validity, and methodologic quality of measurements used to quantify posterior shoulder tightness: a systematic review of the literature with meta-analysis

      2019, Journal of Shoulder and Elbow Surgery
      Citation Excerpt :

      For HA, the methodologic quality was mixed. Of the 11 studies that investigated hypothesis testing and/or construct validity related to HA,7,9,18,19,22,28,31,36,37,39,40 5 (examining the supine and/or horizontal method) received a poor methodologic quality rating7,9,22,31,37 and 6 (examining the supine and/or side-lying method) received a methodologic quality rating of fair.19,20,28,36,39,40 One of the studies examined both the supine and side-lying methods.28

    • Scapular positioning assessment: Is side-to-side comparison clinically acceptable?

      2013, Manual Therapy
      Citation Excerpt :

      It may look like a symmetric scapular behavior during elevation of the arms despite the different positioning on the thorax. In people with scapular dyskinesis, on the other hand, the scapular kinematics of the symptomatic shoulder is expected to behave differently from the “normal”, as a result of some potential biomechanical mechanisms already highlighted elsewhere in this manuscript (Lukasiewicz et al., 1999; Ludewig and Cook, 2000; Borstad, 2006; Matias and Pascoal, 2006; McClure et al., 2006; Ogston and Ludewig, 2007; Yang et al., 2009). Thus, testing posture-dynamics association of scapular kinematics (or semi-dynamics as in this study) bilaterally would be preferred to clinically interpret the asymmetry given that scapular posture alone is unlikely to provide sufficient discriminative information about the presence of shoulder symptoms or scapular dyskinesis (Nijs et al., 2005; Lewis and Valentine, 2007).

    • Detecting fraudulent whiplash claims by support vector machines

      2010, Biomedical Signal Processing and Control
    View all citing articles on Scopus
    View full text