• Biomaterials and Biomechanics in Bioengineering
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• v.3 no.2
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• pp.115-127
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• 2016

Shoulder pain, injury and discomfort are public health and economic issues world-wide. The function of these joints and the stresses developed during their movement is a major concern to the orthopedic surgeon to study precisely the injury mechanisms and thereby analyze the post-operative progress of the injury. Shoulder is one of the most critical joints in the human anatomy with maximum degrees of freedom. It mainly consists of the clavicle, scapula and humerus; the articulations linking them; and the muscles that move them. In order to understand the behavior of individual muscle during abduction arm movement, an attempt has been made to analyze the stresses developed in the shoulder muscles during abduction arm movement during the full range of motion by using the 3D FEM model. 3D scanning (ATOS III scanner) is used for the 3D shoulder joint cad model generation in CATIA V5. Muscles are added and then exported to the ANSYS APDL solver for stress analysis. Sensitivity Analysis is done for stress and strain behavior amongst different shoulder muscles; deltoid, supraspinatus, teres minor, infraspinatus, and subscapularies during adduction arm movement. During the individual deltoid muscle analysis, the von Mises stresses induced in deltoid muscle was maximum (4.2175 MPa) and in group muscle analysis it was (2.4127MPa) compared to other individual four rotor cuff muscles. The study confirmed that deltoid muscle is more sensitive muscle for the abduction arm movement during individual and group muscle analysis. The present work provides in depth information to the researchers and orthopedicians for the better understanding about the shoulder mechanism and the most stressed muscle during the abduction arm movement at different ROM. So during rehabilitation, the orthopedicians should focus on strengthening the deltoid muscles at earliest.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.217-220
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• 2015

Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. Results: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of $2.4{\pm}2.1$ points, which was lower, with statistical significance, than the VAS score of group 2, which was $4.4{\pm}3.1$ points (p<0.001). Conclusions: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.

• 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.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.11 no.3
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• pp.281-291
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• 2004

Purpose: This study was done to investigate the effects of a rehabilitation program including Koryo Hand-Acupuncture on physical function, self-esteem, and quality of life of post-stroke elderly patients. Method: A nonequivalent control group pre-post test research design was used. Participants in the study were 44 post-stroke elderly people (22 in an experimental group, 22 in a control group) enrolled in a social welfare center and a hospital in K city. Data were collected from April 6 to August 20, 2004. The program consisted of Koryo Hand-Acupuncture, ROM exercise, health education and supportive care. The analyses were carried using frequencies, percentages, $x^2$-test, Fisher exact and t-test with SPSS 10.0. Results: The patients in the experimental group, who took part in the 10-weeks rehabilitation program including Koryo Hand-Acupuncture, had significant increases in shoulder joint flexion, shoulder joint abduction, elbow joint flexion, hip joint flexion, knee joint flexion, knee joint extension, flexibility, self-esteem and quality of life as compared to the control group. Conclusion: These results suggest that a rehabilitation program including Koryo Hand-Acupuncture may be utilized as an effective nursing program to improve physical function, self-esteem and quality of life for post-stroke elderly patients.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.258-261
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• 2010

We report a 66-year-old woman with complex regional pain syndrome (CRPS) 1 treated with combined medical and active physical therapy. She was diagnosed with CRPS 1 following partial shoulder prosthesis due to proximal humerus fracture. Despite continuous medication and physical therapy, there was no improvement in her pain and functional outcome. Her overall pain was decreased by stellate ganglion block 3 times in two weeks conducted during the second month of the follow-up period. Following the ganglion blockades, pain and the other symptoms were decreased intermittently but range of motion (ROM) and functional status were not satisfied as much as expected. After the third month of follow-up, her passive and active ROM of the shoulder joint was increased after application of manipulation under general anesthesia. In conclusion, because CRPS 1 remains one of the most difficult pain syndromes, early diagnosis and treatment are important to have adequate functional results from physical therapy. Manipulation under general anesthesia may be an additional effective treatment tool to obtain functional improvement in some patients diagnosed with CRPS 1.

• Journal of the Korean Society of Physical Medicine
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• v.8 no.2
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• pp.153-161
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• 2013

PURPOSE: This study aimed to investigate the effect of complex theraputic exercise on visual analog scale of pain, shoulder' range of motion for middle-aged women with breast cancer related lymphedema. METHODS: The 14 middle-aged women involved voluntary in this study and then they were divided into two groups(n =7 per group). The complex exercise program was implemented over 4 weeks, 60 minutes per day, with 3 types of exercise for stimulation whereas the control group was performed a classical decongestive physiotherapy in a same day. For data analysis, the mean and standard deviation were estimated; 2 way repeated measures ANOVA was carried out. RESULTS: First, The level of VAS was significantly reduced on time, interaction effect in the group. Second, most factors of ROM were significantly increased on time, interaction effect whereas extension was not significantly increased. CONCLUSION: In conclusion, Our results showed that complex therapeutic exercise could improve or maintain VAS and ROM of shoulder joint for middle-aged women with breast cancer related lymphedema.

• Korean Journal of Applied Biomechanics
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• v.19 no.3
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• pp.549-555
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• 2009

The purpose of this study was to quantify the isokinetic peak torque and range of motion at the shoulder in 8 national male volleyball players who played during the 2008 professional leagues. In this study the strength and range of motion data in the internal rotation(IR) and external rotation(ER) of shoulder joint were measured with isokinetic measurement system(Biodex Inc) and motion analysis system (Simi motion system Inc.) from 3 volleyball players with atrophy of the infrasupinatus and 5 volleyball players without atrophy of the infraspinatus. Peak torques were determined using isokinetic measurement on the shoulder joint rotator at the point of angular velocities of $60^{\circ}$/s. Significant difference was found in the peak torque, IR / ER ratio and the range of motion through assessment of the dominant shoulder between two groups. we recommended functional exercises that improve both external rotators strength and stretching exercise for internal rotation in the dominant side during the prevention programs in volleyball players.

• Journal of Acupuncture Research
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• v.28 no.6
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• pp.159-167
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• 2011

Objectives : The objective of this case report was to investigate the effect of electroacupuncture for the management of shoulder pain caused by stroke. Methods : Electroacupuncture at $LI_{15}$ and $TE_{14}$ was performed to five patients who complained of shoulder pain after stroke. We have evaluated the efficacy of treatments by measuring the changes of pain rating score (PRS) and range of motion (ROM) of shoulder joint once a week. Results : PRS was significantly decreased after treatment ($p$<0.05). ROM of shoulder was also decreased but there was not statistical significance. Conclusions : These results suggest that electroacupuncture at $LI_{15}$ and $TE_{14}$ will be beneficial for the treatment of shoulder pain caused by stroke.

• The Journal of Korean Physical Therapy
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• v.36 no.2
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• pp.53-60
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• 2024

Purpose: This study aimed to investigate changes in upper extremity joints and leisure satisfaction in children with brain lesions through sports stacking activities. Methods: A sports stacking program was conducted on three children with brain lesions who had upper extremity joint limitations and joint range of motion lower than the normal range. It was conducted 10 times, 1 to 2 times a week, 40 minutes each time. Upper extremity joint angles were measured using a goniometer in the order of shoulder, elbow, wrist, and fingers, and leisure satisfaction was measured using a smile evaluation. Results: As a result of measuring the upper extremity joint angles, all three children showed slight angle changes in the shoulder, elbow, and wrist areas. Differences in joint angles appeared differently for each child. Smile evaluation results were evaluated in various psychological, educational, and physical aspects. Only child A was evaluated for Smile Evaluation No. 1. Conclusion: Sports stacking activities changed the upper extremity function of children with brain lesion disorders and showed differences in psychological, physical, and educational aspects of leisure satisfaction. As this is a short-term study result, the change in upper extremity function is minimal, but if sports stacking activities are continued, it will be a rehabilitation program that can prevent upper extremity dysfunction and improve physical strength. Accordingly, continuous attention should be paid to increasing accessibility and enjoyment of daily life according to individual characteristics and level.

• Journal of Korean Physical Therapy Science
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• v.8 no.1
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• pp.917-921
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• 2001

The purpose of this study was to examine the difference in measurements of passive range of motion(PROM) of shoulder when motions are assessed in sitting, as compared with supine and the intratester and intertester reliabilities for goniometric measurements of shoulder PROM using two different sizes of goniometers. * A thesis submitted to the committee of Graduate School of Public Health, Chungnam National University in partial fulfillment of the requirements for the degree of Master of Public Health conferred in February 2001. Fifty one adult male subjects were measured three times, in random order, for the six shoulder motions(flexion, extension, abduction, adduction, external rotation, and internal rotation) while sitting and supine by three different therapists. Data were analyzed to determine intraclass correlation coefficients (ICCs) and paired "t" values between trials for measurements with different goniometer and betweensitting and supine trials. There was statistical difference in measurement of shoulder motion between supine and sitting position and no statistical difference in goniometric type. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .98. The ICCs for the intertester reliability of PROM measurements of all shoulder motion ranged from .26 to .89. These findings suggest that reliable measures of PROM of the shoulder can be obtained using standard goniometry in a proper position.