• Physical Therapy Korea
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• v.11 no.4
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• pp.7-17
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• 2004

Individuals who propel wheelchairs have a high prevalence of upper extremity injuries (i.e., carpal tunnel syndrome, elbow/shoulder tendonitis, impingement syndrome). Musculoskeletal injuries can result from overuse or incorrect use of manual wheelchairs, and can hinder rehabilitation efforts. To better understand the mechanisms of upper extremity injuries, this study investigates the motion of the wrist during wheelchair propulsion. This study also examines changes in the variables that occur with fatiguing wheelchair propulsion to determine how the time parameters of wheelchair propulsion and the state of fatigue influence the risk of injury. A two dimensional (2-D) analysis of wrist movement during the wheelchair stroke was performed. Twenty subjects propelled a wheelchair handrim on a motor-driven treadmill at two different velocities (50, 70 m/min). The results of this study were as follows; The difference in time parameters of wheelchair propulsion (cadence, cycle time, push time, recovery time, and PSP ratio) at two different velocities was statistically significant. The wrist kinematic characteristics had statistically significant differences at two different velocities, but wrist radial deviation and elbow flexion/extension had no statistically significant differences. There were statistically significant differences in relation to fatigue in the time parameter of wheelchair propulsion (70 m/min) between initial 1 minute and final 1 minute. The wrist kinematic characteristics between the initial 1 minute and final 1 minute in relation to fatigue had statistically significant differences but the wrist flexion-extension (50 m/min) had no statistically significant differences. According to the results, the risk of musculoskeletal injuries is increased by fatigue from wheelchair propulsion. To prevent musculoskeletal injuries, wheelchair users should train in a muscle endurance program and consider wearing a splinting/grove. Moreover, wheelchair users need education on propulsion posture, suitable joint position, and proper recovery patterns of propulsion.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.3
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• pp.369-378
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• 2013

PURPOSE: The purpose of present study was to ascertain how the activity of the serratus anterior muscle, the upper trapezius muscle and the pectoral major muscle was affected while the upper arm was being flexed at 70, 90 and 110 degrees respectively in a closed kinetic chain exercise (wall push up plus) and an open kinetic chain exercise (static hug). METHODS: Sixteen healthy young men subjects participated in the study. Surface electromyography (EMG) data were collected from the dominant-side muscles during a closed kinetic chain exercise and an open kinetic chain exercise. The activity of each muscle was measured quantitatively, and by the use of the two-way repeated ANOVA, the data were compared with each other according to exercises and shoulder flexion angles. RESULTS: Results indicated that the closed kinetic chain exercise did not interact with the open kinetic chain exercise (p>.05). In both the closed kinetic chain exercise and the open kinetic chain exercise, the activity of the serratus anterior muscle became different significantly according to angles (p<.05). Its activity increased in order of 70, 90 and 110 degrees (p<.05). In both exercises and all angles, muscle activity was significantly higher in the serratus anterior muscle than in the upper trapezius muscle and the pectoral major muscle (p<.05). CONCLUSION: The above results show that there is a need to selectively control the exercise stress of the serratus anterior muscle in the case of the patients with the shoulder impingement syndrome characterized by the winged scapula, insufficient scapular protraction and upward rotation.

• Journal of Acupuncture Research
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• v.38 no.1
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• pp.20-31
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• 2021

The objective was to evaluate the effectiveness and safety of acupuncture for patients with rotator cuff diseases. There were 12 electronic databases and 3 trial registries searched up to November 30th, 2019. All randomized trials were eligible, regardless of language, date of publication, or settings. The primary outcomes were pain, shoulder function, and proportion of improved participants assessed within 12 weeks of randomization of the trial. The Cochrane risk of bias for the studies was assessed. Effects sizes were presented as a risk ratio, mean difference, or standardized mean difference with a 95% confidence intervals. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to rate certainty of evidence. Of the 3,686 records screened, 28 randomized trials (2,216 participants) were included in this review. The types of acupuncture included manual acupuncture, dry needling, electroacupuncture, acupotomy, warm needle acupuncture, and fire needle acupuncture. All of the studies had an unclear or high risk of bias related to more than 1 domain. Significant benefits of acupuncture in terms of pain and shoulder function were observed in all comparisons, however, the proportion of improved participants was not described in 2 comparisons. There was substantial heterogeneity among meta-analyzed trials. No serious harm was observed. For primary outcomes, the overall certainty of evidence was very low. There was very low certainty of evidence for the benefits of acupuncture for patients with rotator cuff diseases. The safety of acupuncture remains unclear due to the incompleteness of reporting. Future well-designed randomized trials with transparent reporting are required.

• Physical Therapy Korea
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• v.29 no.2
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• pp.131-139
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• 2022

Background: Shoulder impingement syndrome, a major cause of shoulder pain, involves weakness of the scapular retractor muscles. The major scapular retractor muscles are the middle trapezius and rhomboid major muscles; however, the latter is excluded in most studies. Objects: We aimed to measure the thickness of the middle trapezius and rhomboid major muscles using an ultrasonic diagnostic imaging system while performing four different shoulder retraction exercises and comparing the thicknesses and ratio of the thicknesses of these muscles. Methods: The thickness of the middle trapezius and rhomboid major muscles was measured in 24 healthy adults using ultrasound. Muscle thickness was measured three times in the Reference posture and four times while performing four different exercises that involved scapular retraction. The averages and standard deviations of the measured muscle thicknesses were obtained and compared. The ratio of muscle thickness and rate of changes in muscle thickness between the reference posture and the four exercises were compared. Results: For both, male (n = 10) and female (n = 14), there was a significant difference in the thickness of the middle trapezius muscle between the reference posture and the four exercises (p < 0.05) and in the thickness of the middle trapezius and rhomboid major muscles between male and female (p < 0.05); however, there was no significant difference in the ratio of the thicknesses of these muscles. Although a significant difference in the rate of change in muscle thickness during the four exercises was noted, there was no significant difference in the ratio of change in muscle thickness. Conclusion: This study demonstrates the ratio of the thicknesses of the middle trapezius and rhomboid major muscles and the rate of change in their thickness during exercises involving scapular retraction in healthy people in their 20s-30s.

• Physical Therapy Korea
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• v.9 no.2
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• pp.19-32
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• 2002

The purpose of this paper is to provide the reader with a pertinent information and research trends of biomechanics in wheelchair propulsion. Biomechanical studies for wheelchair propulsion mainly focus on the most suitable propulsion performance and methods for preventing upper extremity injuries. Recent issues have concentrated on wheelchair propulsion style and cycle mainly because of the high prevalence of repetitive strain injuries in the upper extremely such as shoulder impingement and carpel tunnel syndrome. Optimizing wheelchair propulsion performances as well as medical reflections are presented throughout the review. Information on the underlying musculoskeletal mechanisms of wheelchair propulsion has been introduced through a combination of data collection under experimental conditions and a more fundamental mathematical modelling approach. Through a synchronized analysis of the movement pattern and muscular activity pattern, insight has been gained in the wheelchair propulsion dynamics of people with a different level of disability (various level of physical activity and functional potential). Through mathematical modelling simulation, and optimization (minimizing injury and maximizing performance), underlying musculoskeletal mechanisms during Wheelchair propulsion is investigated.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.136-141
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• 2002

Purpose : The role of biceps pulley is stabilizing sling for the long head of the biceps tendon against anterior shearing stress in the rotator interval. The purpose of this study was to classify arthroscopic findings of biceps pulley and to evaluate the relationship with shoulder pathology. Materials and Methods : From January 2002 through July 2002, we observed biceps pulley in 49 cases of shoulder pathology treated with arthroscopically. There were 22 cases of anterior instability, 12 cases of rotator cuff tear, 5 of impingement syndrome, 6 of frozen shoulder, 2 of superior labral injury and 1 of each scapulothoracic bursitis and biceps dislocation. We classified biceps pulley as four types according to the arthroscopic appearance. Type I its stretched type. type II as sling type, type III at detached sling type, and type IV as concealed type. Results : We observed stretched type in 24 cases $(49\%)$, sling type in 5 cases $(10\%)$, detached sling type in 2 cases, concealed type in 1 case, and unidentified cases in 17 cases $(35\%)$. Conclusion : Development and variation of biceps pulley may have symptomatic correlation according to the degree of shoulder motion or pathologic status.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.68-75
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• 2021

Purpose: The purpose of this study was to analyze the motion of the shoulder joint dynamically through a depth sensor-based motion analysis system for the normal group and patients group with shoulder disease and to report the results along with a review of the relevant literature. Materials and Methods: Seventy subjects participated in the study and were categorized as follows: 30 subjects in the normal group and 40 subjects in the group of patients with shoulder disease. The patients with shoulder disease were subdivided into the following four disease groups: adhesive capsulitis, impingement syndrome, rotator cuff tear, and cuff tear arthropathy. Repeating abduction and adduction three times, the angle over time was measured using a depth sensor-based motion analysis system. The maximum abduction angle (θ_max), the maximum abduction angular velocity (ω_max), the maximum adduction angular velocity (ω_min), and the abduction/adduction time ratio (t_abd/t_add) were calculated. The above parameters in the 30 subjects in the normal group and 40 subjects in the patients group were compared. In addition, the 30 subjects in the normal group and each subgroup (10 patients each) according to the four disease groups, giving a total of five groups, were compared. Results: Compared to the normal group, the maximum abduction angle (θ_max), the maximum abduction angular velocity (ω_max), and the maximum adduction angular velocity (ω_min) were lower, and abduction/adduction time ratio (t_abd/t_add) was higher in the patients with shoulder disease. A comparison of the subdivided disease groups revealed a lower maximum abduction angle (θ_max) and the maximum abduction angular velocity (ω_max) in the adhesive capsulitis and cuff tear arthropathy groups than the normal group. In addition, the abduction/adduction time ratio (t_abd/t_add) was higher in the adhesive capsulitis group, rotator cuff tear group, and cuff tear arthropathy group than in the normal group. Conclusion: Through an evaluation of the shoulder joint using the depth sensor-based motion analysis system, it was possible to measure the range of motion, and the dynamic motion parameter, such as angular velocity. These results show that accurate evaluations of the function of the shoulder joint and an in-depth understanding of shoulder diseases are possible.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.4
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• pp.11-20
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• 2018

Objectives To systematically explore the effects of acupuncture treatment for rotator cuff disorders and review the clinical trials. Methods We searched 9 electronic databases (PubMed, Cochrane central, Embase, China National Knowledge Infrastructure [CNKI], Korea Institute of Science and Technology Information [KISTI], National Digital Science Library [NDSL], Korean studies Information Service System [KISS], Research Information Sharing Service [RISS], Oriental Medicine Advanced Searching Integrated System [OASIS]) to find randomized controlled trials that used acupunture treatment for rotator cuff disorders. We assessed the designs of the randomized controlled trials and the method of acupuncture treatment according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The methodological quality of randomized controlled trials were assessed using the Cochrane Risk of Bias (RoB) tool. Results Total 5 trials were reviewed. 4 out of 5 randomized clinical trials reported meaningful effects of acupuncture treatments compared to control group. However risk of bias seemed high. Conclusions Although the results suggest that acupuncture treatment has favorable effects for rotator cuff disorders, most of the studies included methodologically high risk of bias. Thus, well designed randomized clinical trials which evaluate the effects of acupuncture treatment for rotator cuff disorders should be encouraged.

• Journal of Life Science
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• v.32 no.4
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• pp.325-330
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• 2022

While swimming is a very popular competitive sports activity, swimming injuries are unique due to the repetitive nature of the swimming stroke and demanding training programs that can result in upper limb overuse. Therefore, the primary objective of this review was to analyze swimmers' injury areas, injury types by stroke type, and swimming rehabilitation, as well as to discuss safety management for improving swimming performance. In this study, the injuries incurred in swimming events were discussed in the order of upper limb injuries (neck, shoulder, arm, and wrist), lower limb injuries (knee and ankle), and waist injuries. An analysis by stroke type found that shoulder injuries occurred most often with freestyle, backstroke, and butterfly strokes, followed by rotator cuff injury, impingement syndrome, and SLAP (superior labral tear from anterior to posterior) lesions. Knee injuries were associated with the breaststroke, whereas spinal cord injuries occurred with the breaststroke and butterfly stroke. Finally, back injuries were associated with the butterfly stroke. During the freestyle stroke, the shoulder undergoes repetitive overhead movement; hence, shoulder and musculoskeletal pain are the most common and well-documented complaints of swimmers. For safety management, coaches and instructors must ensure that athletes do sufficient warm-up and cool-down exercises to avoid injuries. In case of an injury, they should be familiar with first aid measures so that secondary damage can be prevented with its quick application. In addition, coaches and instructors need to be trained in injury prevention and treatment so that they can provide appropriate rehabilitation treatment for athletes. Although swimming-related injuries cannot be completely eliminated, to reduce them to a minimum, leaders need the knowledge to apply scientific and systematic training principles and methods individualized for each athlete.