• PNF and Movement
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• 제17권1호
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• pp.41-46
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• 2019

Purpose: Continuous use of a smartphone increases the angle of forward bending of the user's cervical vertebrae, causing pain in the shoulders and back, including the thorax, lumbar region, and vertebrae. Although there are many studies on changes in the cervical spine due to smartphone usage, the changes in the shoulders, thoracolumbar spine, and pelvic have rarely been compared. The purpose of this study is to investigate the change in the spinal segments, shoulders, and pelvic when using a smartphone with both hands while in the standing position. Methods: This study was conducted on 35 adults in their twenties. The selection criteria for the subjects were limited to those in a similar age group, thus excluding posture differences according to age, and to those who did not have specific diseases or pain in the spinal and musculoskeletal system for 12 months prior to the study. In this study, we used a 3D spinal diagnostic imaging system (Back Mapper, Frickenhausen) to compare the changing conditions in each vertebral segment before and during smartphone usage with both hands while in the standing position. Posture differences according to smartphone usage were compared using the paired t-test for the motion of each spinal segment. Results: This study showed that the thoracic and lumbar angle increased posteriorly during smartphone usage (p<0.05). In addition, the anterior rotation angle of the shoulder bone significantly increased, but no significant difference occurred in the pelvic region. Conclusion: Based on the results of this study, smartphone usage with both hands while in the standing position showed that the spine, as a whole, forms a kyphotic curve. Therefore, we propose to present a postural guideline for correct smartphone usage, considering the change in each vertebral segment.

• PNF and Movement
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• 제19권1호
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• pp.31-42
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• 2021

Purpose: The purpose of this study was to investigate the effect of visual and auditory feedback combined with theraband exercise in rounded shoulder posture. Methods: There were 43 adults with rounded shoulder posture who had a distance of 2.5 cm or more from the posterolateral of the acromion to the table in the supine position that participated. The participants were randomly divided into four groups: those with visual feedback from the lateral view (visual feedback; VFB, n = 11) provided, those with auditory feedback of praise (auditory feedback; AFB, n = 10) provided, those with visual feedback and auditory feedback (visual auditory feedback; VAFB, n = 11) provided, and those without any feedback (control group; CON, n = 11). Theraband exercise with or without feedback was carried out three times per week for three weeks. To confirm the effect of theraband exercise with visual feedback and auditory feedback on pain, range of motion (ROM), posture, and psychological variables were measured before and after exercise in participants with rounded shoulder posture. Results: The VAFB group showed significant differences in pain, ROM, posture, and psychological variables when compared before and after treatment. However, the differences among the VAFB, VFB, AFB, and CON groups were significant in the ROM of abduction, the New York Posture Rating, and the scapular index. Conclusion: In conclusion, theraband exercise combined with visual feedback from the lateral view and auditory feedback by praise improved rounded shoulder posture. Moreover, auditory feedback was more significant statistically than visual feedback.

• 대한물리의학회지
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• 제16권4호
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• pp.55-65
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• 2021

PURPOSE: This study compared the effects of sit-to-stand training with various foot positions combined with visual feedback on the postural alignment and balance. METHODS: Thirty stroke patients were assigned randomly into three groups of standing with a symmetrical foot position (SSF) (n = 10), asymmetrical foot position with the affected foot at the rear (SAF) (n = 10), and visual feedback and asymmetrical foot position (SVAF) (n = 10). Sit-to-stand training with different foot positions was performed for 30 minutes a day, five times a week, for a total of four weeks, and the effects on postural alignment and balance were assessed. RESULTS: The angle between the midline and scapula peak of the affected side was decreased significantly at sitting and thigh-off in the SAF group and at sitting, thigh-off, and standing in the SVAF group (p < .05). The angle between the midline and scapula peak of the non-affected side was increased significantly at sitting and thigh-off in the SAF group and at sitting, thigh-off, and standing in the SVAF group, the difference in the angle between the scapular peaks of the left and right sides was decreased significantly at sitting and thigh-off in SSF group, and at sitting in SAF group (p < .05). In the SVAF group, the angle at sitting, thigh-off, and standing was decreased significantly (p < .05). A comparison of the balance ability showed that BSS in the SVAF group was improved significantly (p < .05). CONCLUSION: Based on these results, the postural alignment and balance ability were improved in stroke patients who participated in sit-to-stand with visual feedback and asymmetrical foot position training.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• 대한정형도수물리치료학회지
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• 제29권2호
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• pp.59-67
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• 2023

Background: The purpose of this study is to analyze the effect of shoulder and neck stabilization exercise using a gym ball for healthy women in their 20s with round shoulder and forward head posture, it is intended to try and find improvement for posture. Methods: The subjects of the study were 25 women who understood the purpose of the research and voluntarily agreed to participate in the experiment. They carried out the shoulder and neck stabilization exercise program using a gym ball, which was conducted for 35 minutes, 3 times a week for 4 weeks. The position of the round shoulder and shoulder bones was measured using an tape measurement and were recorded in both at pre, 2 weeks, and post intervention. The craniovertebral angle (CVA) and craniorotational angle (CRA) was measured using an image J. Results: The round shoulder posture left was statistically significantly different within group (p<.05); however, the round shoulder posture right wasn't statistically significantly different (p>.05). As a result of this contrast, test were significant different in both at pre, 2 weeks and post. The scapular position on the left and right were statistically significantly different within the group (p<.05). As a result of the contrast, test were significant different in both at pre, 2 weeks and post (p<.05). The CVA and CRA on the left and right were statistically significantly different within the group (p<.05). As a result of the contrast, test were significant different in both at pre, 2 weeks and post (p<.05). Conclusion: The gym ball exercises improved the posture of women in their 20s. Therefore, gym ball exercises can help improve the quality of life of those with shoulder and neck pain.

• Clinics in Shoulder and Elbow
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• 제26권1호
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• pp.93-106
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• 2023

Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.274-281
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• 2022

Background: In the present study, the age- and sex-adjusted Constant score (CS) in a normal Indian population was calculated and any differences with other population cohorts assessed. Methods: The study participants were patients who visited the outpatient department for problems other than shoulder and healthy volunteers from the local population. Patients without shoulder pain/discomfort during activity were included in the study. Subjects with any problem that might affect shoulder function (e.g., cervical, thoracic spine, rib cage deformity, inflammatory arthritis) were excluded. Constant scoring of all participants was performed by trained senior residents under the supervision of the senior faculty. Shoulder range of movement and strength were measured following recommendations given by the research and Development Committee of the European Society for Shoulder and Elbow Surgery (2008). A fixed spring balance was used for strength measurement; one end was fixed on the floor and the other end tied with a strap to the wrist of the participant, arm in 90° abduction in scapular plane with palm facing down. Results: Among the 248 subjects (496 shoulders), the average age was 37 years (range, 18-78 years), 65.7% were males (326 shoulders) and 34.3% females (170 shoulders). The mean CS was 84.6±2.9 (males, 86.1±3.0; females, 81.8±2.9). CS decreased significantly after 50 years of age in males and 40 years of age in females (p<0.05). The mean CS was lower than in previous studies for both males and females. Heavy occupation workers had higher mean CS (p<0.05). A linear standardized equation was estimated for calculating the adjusted CS for any age. Conclusions: Mean CS and its change with age differed from previous studies among various population cohorts.

• 한국전문물리치료학회지
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• 제31권1호
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• pp.55-62
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• 2024

Background: The serratus anterior (SA) is a muscle that performs protraction of the scapulothoracic joint and plays a role in stabilizing the scapula. Imbalances or weaknesses in SA activation are associated with a variety of shoulder dysfunctions, making selective SA strengthening important for rehabilitation. Objects: We aimed to compare the muscle activation of the pectoralis major (PM), SA, external oblique (EO), and internal oblique (IO) during the push-up plus (PUP) exercise with isometric hip adduction (HA) and abdominal drawing-in maneuver (ADIM). Methods: Nineteen healthy male participants performed three PUP exercises: standard PUP, PUP with ADIM, and PUP with HA. Surface electromyography was used to measure and analyze the muscle activity for PM, SA, EO, and IO. Results: PUP with HA showed the lowest PM activity and highest SA activity, and no significant difference was observed between PUP and PUP with ADIM. PUP with ADIM showed significantly the highest EO and IO activity, followed by PUP with HA and PUP. Additionally, PUP with HA showed the lowest PM/SA ratio, and no significant difference was noted between PUP and PUP with ADIM. Conclusion: PUP with HA was able to show high SA muscle activity while reducing PM muscle activity. In addition, PUP with HA can lead to higher EO and IO muscle activity than standard PUP. This exercise could be used as a practical exercise method to selectively strengthen SA and improve scapular muscle stability during early shoulder rehabilitation.

• The Korean Journal of Pain
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• 제37권1호
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• pp.51-58
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• 2024

Background: The rise in national health care costs has emerged as a global problem given the ever-aging population and rapid development of medical technology. The utilization of interventional pain management has, similarly, shown a continued rise worldwide. This study evaluates the differences in the medical costs in the field of interventional pain treatment (IPT) between two countries: Korea and Japan. Methods: Korean medical insurance costs for 2019 related to pain management focused on IPT were compared to those of Japan. Purchasing power parity (PPP) was used to adjust the exchange rate differences and to compare prices in consideration of the respective societies' economic power. Results: The cost of trigger point injections in Japan was 1.06 times higher than that of Korea, whereas the perineural and intraarticular injection prices were lower in Japan. The cost of epidural blocks was higher in Japan compared to Korea in both cervical/thoracic and lumbar regions. As for blocks of peripheral branches of spinal nerves, the cost of scapular nerve blocks in Japan was lower than that in Korea, given a PPP ratio 0.09. For nerve blocks in which fluoroscopy guidance is mandatory, the costs of epidurography in Japan were greater than those in Korea, given a PPP ratio 1.04. Conclusions: This is the first comparative study focusing on the medical costs related to IPT between Korea and Japan, which reveals that the costs differed along various categories. Further comparisons reflecting more diverse countries and socio-economic aspects will be required.

• 대한물리치료과학회지
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• 제31권1호
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• pp.33-45
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• 2024

Background: This study aimed to investigate the effect of elastic band-resistive exercise using audio-visual medium on pain, proprioception, and motor function in adults with chronic neck and shoulder pain. Design: One group pretest-posttest follow-up experimental design. Method: Twenty adult women with neck and shoulder pain voluntarily participated in this study. Elastic band-resistive exercise using audio-visual medium including cervical flexion and extension, shoulder external rotation, and scapular retraction-protraction motions was conducted 5 times a week for 3 weeks. The Numerical Rating Scale, pressure threshold tool, CROM goniometer, and Image J software were used to assess subjective pain level, tenderness threshold (pain), joint position sense error (proprioception), joint range of motion, and postural alignment (motor function), respectively. Result:: The pain intensity and threshold and joint position sense error showed significant decreases after the intervention, whereas the joint range of motion angle revealed significant increases. The postural alignment including forward head posture and rounded shoulder revealed significant improvements after the intervention. Conclusions: Therefore, we suggest that elastic band-resistive exercise through audio-visual medium would be helpful in preventing and managing pain and physical dysfunction in individuals with chronic neck and shoulder pain, and then it would support the development of health management-related online education content.