Dataset Information

Isokinetic Dynamometry as a Tool to Predict Shoulder Injury in an Overhead Athlete Population: A Systematic Review.

ABSTRACT: Prospective and cross-sectional studies have used pre-season isokinetic dynamometry strength and endurance measurements of shoulder internal rotation (IR) and external rotation (ER) to determine if they can be correlated to injury. However, to date, no review has provided a synthesis of all available literature on this topic. The aim of this systematic review was to identify isokinetic dynamometry studies that assess shoulder IR and ER strength and endurance in the overhead athletic population in relation to shoulder injury. Electronic databases (PubMed, CINAHL, and SportDiscus) were searched through September 2019 using pre-determined search terms. Both prospective and cross-sectional studies were included in this review. Studies were assessed for quality using either Appraisal Tool for Cross-sectional Studies (AXIS) or Critical Appraisal Skills Programme (CASP). Data on outcome measures of strength and endurance peak torque (PT) and ratios (ER:IR) were extracted and further analysed using a best evidence synthesis approach. A total of 13 articles met the inclusion criteria. Conflicting evidence was found when reviewing all studies without differentiating by study type. Prospective study designs revealed strong evidence that reduced IR endurance and reduced strength ratios are predictive of shoulder injury. Cross-sectional literature showed only conflicting and limited evidence for all outcome measures. At this stage, more research is needed in individual sporting populations using prospective cohort designs.

SUBMITTER: Bagordo A

PROVIDER: S-EPMC7552688 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Isokinetic Dynamometry as a Tool to Predict Shoulder Injury in an Overhead Athlete Population: A Systematic Review.

Bagordo Andrea A Ciletti Kimberly K Kemp-Smith Kevin K Simas Vini V Climstein Mike M Furness James J

Sports (Basel, Switzerland) 20200908 9

Prospective and cross-sectional studies have used pre-season isokinetic dynamometry strength and endurance measurements of shoulder internal rotation (IR) and external rotation (ER) to determine if they can be correlated to injury. However, to date, no review has provided a synthesis of all available literature on this topic. The aim of this systematic review was to identify isokinetic dynamometry studies that assess shoulder IR and ER strength and endurance in the overhead athletic population i ...[more]

PMID: 32911789

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Project description:Elbow injuries are a significant and increasing issue in baseball. Elbow injuries account for 16% of all injuries sustained at the professional level and collegiate level. Because of the continued rise in injury rates, loss of performance value, and medical burden, sports medicine clinicians have attempted to research the causes underlying this injury epidemic in an attempt to help mitigate baseball elbow injuries. Shoulder range of motion (ROM) is the most researched clinical metric related to elbow injuries in baseball and has the greatest consensus as a viable prognostic factor specifically for medial elbow injury. Shoulder ROM is easy to measure, can be modified through stretching and manual therapy interventions, and can be easily assessed during preseason screening throughout all baseball levels. Despite a large number of studies and the widespread use of shoulder ROM in injury risk screening, current findings are unclear as to whether there is a true cause-effect relation with baseball elbow injuries. We argue that the conflicting findings revolving around the value of shoulder ROM measurements associated with baseball elbow injuries are the result of 4 gaps in the research approaches implemented to date: ambiguous research questions, mixed study populations, statistical models used, and shoulder ROM methodology. Specifically, there is a mismatch of methods, statistical models, and conclusions such as (1) investigating the association (i.e., correlation) between shoulder ROM measurements and injury and (2) investigating the cause-effect relation of shoulder ROM to baseball injuries. The purpose of this article is to detail the required scientific steps to evaluate whether preseason shoulder ROM is a potential causal factor for pitching elbow injury. We also provide recommendations to allow for future causal inferences to be made between shoulder ROM and elbow injury. This information will ultimately assist in informing clinical models of care and decision making for baseball throwers.

Project description:CONTEXT:? Despite an increase in the literature, few definitive guidelines are available to determine when an athlete has been fully rehabilitated after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE:? To examine countermovement jump and isokinetic dynamometry measures to (1) identify which measures can best distinguish between ACLR and control participants and (2) provide normative values for identified measures in young adult male multidirectional field-sport athletes. DESIGN:? Cross-sectional study. SETTING:? Orthopaedic hospital. PATIENTS OR OTHER PARTICIPANTS:? Young adult male multidirectional field-sport athletes (n = 118) who had undergone unilateral patellar-tendon graft ACLR at least 6 months earlier and healthy male participants (n = 44) with no previous knee injury. INTERVENTION(S):? Single-legged countermovement jump (SL CMJ). MAIN OUTCOME MEASURE(S):? Three-dimensional biomechanical analysis of the SL CMJ and mean peak concentric knee-extension and -flexion torque using isokinetic dynamometry (ISO) were compared in the 2 groups. A stepwise logistic regression was carried out to identify the best predictors of ACLR- or control-group membership (SL CMJ height, limb symmetry index, peak power, joint power contribution, ISO peak torque, limb symmetry index variables). RESULTS:? The control group differed strongly from the ACLR group in isokinetic knee-extension peak torque (d = -1.33), SL CMJ performance (d > 0.4), and limb symmetry measures in both ISO and jump outcomes (d > 1.1). The combination of measures from both ISO and SL CMJ identified group membership with an accuracy of 89%. CONCLUSIONS:? Rehabilitation of ACLR patients may be complete when they achieve isokinetic knee-extension peak torque of 260% (±40%) body mass, SL CMJ performance of >17 cm (±4 cm), and reach-limb symmetry measures of >90% in both strength and jump outcomes. The outcomes in the control group can inform return-to-play criteria for young adult male multidirectional field-sport athletes after ACLR.

Project description:BackgroundMusculoskeletal injuries are a primary source of disability. Understanding how risk factors predict injury is necessary to individualize and enhance injury reduction programs.HypothesisBecause of the multifactorial nature of musculoskeletal injuries, multiple risk factors will provide a useful method of categorizing warrior athletes based on injury risk.Study designProspective observational cohort study.Level of evidenceLevel 2.MethodsBaseline data were collected on 922 US Army soldiers/warrior athletes (mean age, 24.7 ± 5.2 years; mean body mass index, 26.8 ± 3.4 kg/m2) using surveys and physical measures. Injury occurrence and health care utilization were collected for 1 year. Variables were compared in healthy versus injured participants using independent t tests or chi-square analysis. Significantly different factors between each group were entered into a logistic regression equation. Receiver operating characteristic curve and accuracy statistics were calculated for regression variables.ResultsOf the 922 warrior athletes, 38.8% suffered a time-loss injury (TLI). Overall, 35 variables had a significant relationship with TLIs. The logistic regression equation, consisting of 11 variables of interest, was significant (adjusted R2 = 0.21; odds ratio, 5.7 [95% CI, 4.1-7.9]; relative risk, 2.5 [95% CI, 2.1-2.9]; area under the curve, 0.73). Individuals with 2 variables had a sensitivity of 0.89, those with 7 or more variables had a specificity of 0.94.ConclusionThe sum of individual risk factors (prior injury, prior work restrictions, lower perceived recovery from injury, asymmetrical ankle dorsiflexion, decreased or asymmetrical performance on the Lower and Upper Quarter Y-Balance test, pain with movement, slower 2-mile run times, age, and sex) produced a highly sensitive and specific multivariate model for TLI in military servicemembers.Clinical relevanceA better understanding of characteristics associated with future injury risk can provide a foundation for prevention programs designed to reduce medical costs and time lost.

Project description:PurposeTo determine whether differences in return-to-play (RTP) rate and performance-based outcomes exist following shoulder arthroscopy in athletes from the National Football League (NFL), National Basketball League (NBA), Major League Baseball (MLB), and National Hockey League (NHL).MethodsProfessional athletes from the NFL, NBA, MLB, and NHL who underwent shoulder arthroscopy between January 1998 and December 2016 were identified through an established review of injury reports and public archives. Sport-specific statistics were collected before and after shoulder arthroscopy for each athlete, providing a performance score. RTP was defined as the first game played postsurgery.ResultsOf the 208 professional athletes who met the inclusion criteria, 167 (80.3%) returned to play following shoulder arthroscopy, with MLB players returning at a significantly lower rate than those of other sports (P < .0001). NBA players had significantly shorter recovery times (201 days; P < .01) and MLB players had significantly longer recovery times (413 days; P < .001) when compared with athletes in other sports. The mean number of seasons played after shoulder arthroscopy was 3.7, 4.7, 4.8, and 5.8 for MLB, NFL, NHL, and NBA, respectively. NBA players performed worse in their first season postoperative compared with their preoperative performance (P = .0017), but their postoperative season 2 performance returned to their preoperative performance level (P = .1893). Similarly, NHL players performed worse in their postoperative season 1 compared with preoperative performance (P = .0274), but their postoperative season 2 performance improved upon their preinjury performance level (P = .0861).ConclusionsThere is a modest RTP rate among professional athletes following shoulder arthroscopy. MLB players have the longest average time to RTP and the shortest postinjury careers following shoulder arthroscopy. However, they demonstrate no significant decline in performance following their injury. Conversely, NBA players had the shortest average time to RTP and the longest post-injury career. Both NBA and NHL athletes experienced a decrease in performance in post-operative season one.Level of evidenceLevel III, retrospective comparative study.

Project description:BackgroundWe investigated interactions between genetic and psychological factors in predicting shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes.Subjects and methodsAltogether, 190 participants completed a 5-day experimental protocol. An experimental shoulder injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype.ResultsStrong statistical evidence was provided for interactions between: 1) IL-1β (rs1143634) and fear of pain for predicting loss of shoulder flexion and abduction, 2) IL-1β (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1β (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss.ConclusionPro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1β [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss).

Project description:ContextCurrent perception dictates that glenohumeral internal rotation deficit (GIRD) is a chronic adaptation that leads to an increased risk of pathologic conditions in the dominant shoulder or elbow of overhead athletes.ObjectiveTo determine whether adaptations in glenohumeral range of motion in overhead athletes lead to injuries of the upper extremity, specifically in the shoulder or elbow.Data sourcesAn electronic database search was performed using Medline, Embase, and SportDiscus from 1950 to 2016. The following keywords were used: GIRD, glenohumeral internal rotation deficit, glenohumeral deficit, shoulder, sport, injury, shoulder joint, baseball, football, racquet sports, volleyball, javelin, cricket, athletic injuries, handball, lacrosse, water polo, hammer throw, and throwing injury.Study selectionSeventeen studies met the inclusion criteria for this systematic review. Of those 17 studies, 10 included specific range of motion measurements required for inclusion in the meta-analysis.Study designSystematic review and meta-analysis.Level of evidenceLevel 4.Data extractionData on demographics and methodology as well as shoulder range of motion in various planes were collected when possible. The primary outcome of interest was upper extremity injury, specifically shoulder or elbow injury.ResultsThe systematic review included 2195 athletes (1889 males, 306 females) with a mean age of 20.8 years. Shoulders with GIRD favored an upper extremity injury, with a mean difference of 3.11° (95% CI, -0.13° to 6.36°; P = 0.06). Shoulder total range of motion suggested increased motion (mean difference, 2.97°) correlated with no injury ( P = 0.11), and less total motion (mean difference, 1.95°) favored injury ( P = 0.14). External rotational gain also favored injury, with a mean difference of 1.93° ( P = 0.07).ConclusionThe pooled results of this systematic review and meta-analysis did not reach statistical significance for any shoulder motion measurement and its correlation to shoulder or elbow injury. Results, though not reaching significance, favored injury in overhead athletes with GIRD, as well as rotational loss and external rotational gain.

Dataset Information

Isokinetic Dynamometry as a Tool to Predict Shoulder Injury in an Overhead Athlete Population: A Systematic Review.

Publications

Isokinetic Dynamometry as a Tool to Predict Shoulder Injury in an Overhead Athlete Population: A Systematic Review.

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