• Physical Therapy Korea
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• v.29 no.2
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• pp.106-116
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• 2022

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. However, during exercise, excessive activation of the posterior deltoid compared to the infraspinatus causes the humeral head to move anteriorly in an abnormal position. Many researchers have emphasized selective activation of the infraspinatus during shoulder external rotation exercise. Objects: This study aims to delineate the optimal exercise method for selective activation of infraspinatus by investigating the muscle activities of the infraspinatus and posterior deltoid according to the four shoulder exercise methods and two forearm positions. Methods: Thirty healthy individuals participated in this study. The participants were instructed to perform shoulder external rotation exercises following four exercise methods: sitting external rotation (SIER); standing external rotation at 90° abduction (STER); prone external rotation at 90° abduction (PRER); side-lying external rotation (SLER), and two forearm positions (neutral, supinated). The electromyography (EMG) signal amplitude was measured during each exercise. Surface EMG signals were recorded from the posterior deltoid, infraspinatus, and biceps brachii. Results: EMG results of the infraspinatus and posterior deltoid in PRER, were significantly higher than that of the other exercises (p < 0.01). The EMG ratio (infraspinatus/posterior deltoid) in SIER was significantly higher than that of the other exercises. EMG activation of the posterior deltoid in SIER, PRER, and SLER was significantly higher in neutral than in supinated (p < 0.01). Furthermore, the EMG of the infraspinatus in SIER was significantly higher in neutral than in supinated (p < 0.01). The EMG ratio (infraspinatus/ posterior deltoid) in SIER was significantly higher in neutral than in supinated (p < 0.05.) Contrarily EMG ratios in PRER and SLER were significantly higher in supinated than in neutral (p < 0.05). Conclusion: The results show that clinicians should consider these exercise methods and forearm positions when planning shoulder external rotation exercises for optimal shoulder rehabilitation.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.52-61
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• 2024

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.

• The Journal of Korean Physical Therapy
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• v.35 no.1
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• pp.13-18
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• 2023

Purpose: The purpose of this study was to investigate the effects of posterior oblique sling activation on the muscle activities of the gluteus maximus (GM), multifidus (MF), and biceps femoris (BF) during three different prone hip extension exercises in healthy male individuals. Methods: Twenty healthy subjects participated in this study. An electromyography device was used to measure the muscle activities of the GM, MF, and BF. Each subject was asked to perform three different prone hip extensions as follows: [1) Prone hip extension with knee flexion + hip abduction 30°; PHE1, 2) Prone hip extension with knee flexion + hip abduction 30° and shoulder abduction 125°; PHE2, 3) Prone hip extension with knee flexion + hip abduction 30° and shoulder abduction 125° with 1kg loading; PHE3, in random order. A one-way repeated measures analysis of the variance and a Bonferroni post hoc test were used to analyze the results. The statistical significance was set at α=0.01. Results: The muscle activity of the GM was significantly different between the three positions (P_adj<0.01). The muscle activity of the GM was significantly greater during PHE3 compared with PHE1 and PHE2 (P_adj<0.01). The BF muscle activity was significantly lower during PHE3 compared with PHE1 and PHE2 (P_adj< 0.01). There was no significant difference in the muscle activity of the MF (P_adj<0.01). The ratio of the muscle activity (ratio=GM/BF) during PHE3 was significantly greater compared to PHE1 and PHE2 (P_adj< 0.01). Conclusion: The GM activity and GM/BF ratio during the PHE3 exercise were significantly greater compared to that during PHE1 and PHE2. Therefore, the PHE3 exercise could be recommended as a selectively effective GM activation exercise while decreasing the muscle activity of the BF.

• Journal of Korean Medicine Rehabilitation
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• v.15 no.2
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• pp.155-167
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• 2005

Objectives : The purpose of this study is evaluate of the effect of Dong-gi Acupuncture(DGA) on rehabilitation after stroke. Methods : 32 patients who had a stroke of paralysis were randomized into two groups. 17 patients were treated with DGA on sound side combined active or passive exercise on affected side. The other 15 patients were exclusive DGA group and the method retaining needles on acupoints of affected side for about 20 minutes were applied. We evaluated by Manual muscle test, Range Of Motion(ROM), Visual Analog Scale(VAS) and Modified Barthel index(MBI) before treatment, after 10 days and after 20 days. Results : In terms of power of lower limb, active ROM of shoulder abduction and MBI, the sample group showed statistically significant improve. In terms of power of lower limb ROM of hip joint abduction and affected side pain, significant difference between two groups was not shown. Conclusions : In this clinical study, Dong-gi Acupuncture therapy can be used for improving the power of upper limb, active ROM of shoulder abduction and MBI score after hemiplegic stroke.

• The Journal of the Convergence on Culture Technology
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• v.1 no.2
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• pp.77-83
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• 2015

The purpose of this study is to prove the increase of range of motion of shoulder joint in the patients with shoulder adhesive capsulitis by applying the vibratory stimulation. In terms of subjects of the study, the experimental group 15(4 male, 11 female)and the control group 15(5 male, 10 female) were divided. The measurement of the shoulder range of motion was taken by measuring the degrees of flexion, abduction, and external rotation with a goniometer from pre treatment to one to four weeks. The results were as follows : In the experimental group and control group, there was the statistical significance in the range of motion of the shoulder flexion, abduction, and external rotation during four weeks. In summary, the vibratory stimulation are effective interventions for improving shoulder adhesive capsulitis, patient's range of motion of shoulder joint.

• The Journal of Korean Physical Therapy
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• v.28 no.2
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• pp.88-94
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• 2016

Purpose: The purpose of this study was to compare therapeutic climbing exercise and general isometric exercise in patients with shoulder impingement syndrome. Methods: Among 20 adults, study subjects were arbitrarily classified into an experimental group of 10 and a control group of 10. The control group performed general isometric exercise (ISE) and the experimental group performed therapeutic climbing exercise (TC) (3 sets, 3 times per week for 8 weeks). To evaluate the effects of exercise, subjects were evaluated using a Disabilities of the arm, shoulder and hand score (DASH), a goniometer for range of motion, and shoulder activity measured serratus anterior, upper trapezius, and lower trapezius. Independent and paired t-test were used for comparison of the effect between groups. Results: DASH scores showed a significant decrease in both groups after 8 weeks of treatment (p<0.001) and significant difference was observed between the TC groups (p<0.01). Flexion and abduction were significantly increased after 8 weeks of treatment in the ISE group (p<0.001) and flexion, abduction, external and internal rotation were significantly increased after 8 weeks of treatment in the TC group (p<0.001). Serratus anterior and lower trapezius activity were significantly increased after 8 weeks of treatment (p<0.001) and upper trapezius activity was not significantly increased after 8 weeks of treatment in the ISE group (p>0.05). Serratus anterior, lower trapezius, and upper trapezius activity were significantly increased after 8 weeks of treatment in the TC group (p<0.001). Conclusion: Scapular stabilizing exercise using a therapeutic climbing exercise increases range of motion and decreases DASH, and increases activity of shoulder muscles in patients with impingement syndrome.

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.61-68
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• 2007

The purpose of this study was to analyze the shoulder joint torque and muscle pattern performing as Tennis serve by Isokinetic motions on Isomed 2000. The subject, who was 5 males Korean national high school tennis players. By analyzing the flexion/extension of the shoulder, the peak torque of the internal/external rotation motion(at 60,180 and 300 degree/sec) at peak torque degree, the weight, peak torque, and power. combined with the timing of the electrode of the attached trapezius and posterior deltoid at the three part. From the data analysis & discussion the following conclusions were drawn. When doing a shoulder extension, the peak torque can be widely seen at 60degree per second. However the degree may be different depending on angular velocity. When doing an internal rotation at 90degree abduction, peak torque per weight was seen at 60degree per second. The degree of peak torque was at 31.6-44.2 and peak power was faster when angular velocity was increased. The aspect of muscle pattern was seen more at the internal rotation in the 90degree abduction rather than the shoulder extension. However the angular velocity was not influenced by muscle mobilization(in order of anterior deltoid, posterior deltoid and trapezius. To properly apply the above conclusion, when tennis players serve it is better the elbow be impacted by the extension. when doing isokinetic motion it is better to increase angular velocity and improve muscle power. also the anterior deltoid amongst the shoulder muscle should be improved to develop serve speed.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.7
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• pp.2468-2474
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• 2010

The purpose of this study was to investigate the effects of taping therapy and passive range of motion exercises for the elderly aged 65 above with shoulder pain and limited of range of motion. This study was a nonequivalent control group pretest-posttest design. Data were collected about shoulder pain, range of motion, hand dexterity from 40 of elderly(exp.:20, con.:20) in B city from August to September, 2009. Collected data were analyzed using SPSS Win 12.0. Shoulder pain was significantly decreased. Range of motion which was flexion, extension, abduction, horizontal abduction. and hand dexterity were significantly increased in the taping group and PROM group. Shoulder pain and hand dextrity was non significantly between taping group and PROM group. Range of motion which was extension more increased taping group than PROM group. It was proven that taping therapy and PROM was effective for shoulder pain, articular range of motion and hand dexterity.

• Physical Therapy Korea
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• v.30 no.2
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• pp.160-168
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• 2023

Background: Individuals with scapular winging have a weak serratus anterior (SA) muscle, and to compensate, the pectoralis major (PM) and upper trapezius (UT) muscles excessively activate, which can cause upper extremity dysfunction. This study aimed to compare the effects of isometric horizontal abduction (IHA) on SA, PM, and UT muscle activity, as well as the SA/PM and SA/UT muscle activity ratios during knee push-up plus (KPP) at 90° and 120° of shoulder flexion. Objects: This study aimed to compare the effects of IHA on SA, PM, and UT muscle activity, as well as the SA/PM and SA/UT muscle activity ratios during KPP at 90° and 120° of shoulder flexion. Methods: This study, conducted at a university research laboratory, included 20 individuals with scapular winging. Participants performed KPP with and without IHA at 90° (KPP90) and 120° (KPP120) of shoulder flexion. SA, PM, and UT muscle activity were measured using surface electromyography. Results: PM activity in KPP90 with IHA was significantly lower than KPP90 and in KPP120 was significantly lower than KPP90. UT activity was significantly greater with IHA than without IHA and at 120° than 90° of shoulder flexion. SA/PM muscle activity ratio was significantly higher in KPP90 with IHA than without IHA and in KPP120 than in KPP90. SA/UT muscle activity ratio was significantly lower with IHA than without IHA. Conclusion: KPP90 with IHA and KPP120 are effective exercises to reduce PM activity and increase SA/PM muscle activity ratio. However, applying IHA in KPP90 also reduces SA/UT muscle activity ratio, implying that it would be preferable to apply KPP120 in individuals overusing their UT muscles.

• Journal of Yeungnam Medical Science
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• v.20 no.1
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• pp.13-27
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• 2003

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.