In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies.
OBJECTIVE:
This study set about to compare the role of posterior capsule tightness in different shoulder problems.
METHODS:
One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb.
RESULTS:
It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05).
CONCLUSIONS:
This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.
BurkhartSS, MorganCD, KiblerWB. The disabled throwing shoulder: Spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003; 19: 404-20.
2.
LaudnerKG, MolineMT, MeisterK. The relationship between forward scapular posture and posterior shoulder tightness among baseball players. Am J Sports Med. 2010; 38: 2106-12.
3.
LinJJ, LimHK, YangJL. Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders. J Orthop Res. 2006; 24: 1044-51.
4.
YangJL, LuTW, ChouFC, ChangCW, LinJJ. Secondary motions of the shoulder during arm elevation in patients with shoulder tightness. J Electromyogr Kinesiol. 2009; 19: 1035-42.
5.
BachHG, GoldbergBA. Posterior capsular contracture of the shoulder. J Am Acad Orthop Surg. 2006; 14: 265-77.
6.
HallaçeliH CA, CavlakU, Günalİ. Ranges of scapular elevation and depression in healthy male subjects. Eklem Hastalik Cerrahisi (Joint Diseases and Related Surgery). 2006; 17: 85-8.
7.
BaydarCL, HallaceliH, BaydarML, GunalI, UzunI, OyarO, et al. Does scapular elevation occur with glenohumeral flexion and abduction? A study through open magnetic resonance imaging and autopsy. Eklem Hastalik Cerrahisi (Joint Diseases and Related Surgery). 2011; 22: 39-42.
8.
McClurePW, MichenerLA, SennettBJ, KardunaAR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001; 10: 269-77.
9.
TylerTF, NicholasSJ, RoyT, GleimGW. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med. 2000; 28: 668-73.
10.
Harryman, 2ndDT, SidlesJA, ClarkJM, McQuadeKJ, GibbTD, Matsen, 3rdFA. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990; 72: 1334-43.
11.
MorrisonDS, FrogameniAD, WoodworthP. Non-operative treatment of subacromial impingement syndrome. J Bone Joint Surg Am. 1997; 79: 732-7.
12.
OvesenJ, NielsenS. Anterior and posterior shoulder instability. A cadaver study. Acta Orthop Scand. 1986; 57: 324-7.
13.
TerryGC, HammonD, FranceP, NorwoodLA. The stabilizing function of passive shoulder restraints. Am J Sports Med. 1991; 19: 26-34.
14.
WarnerJJ, MicheliLJ, ArslanianLE, KennedyJ, KennedyR. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med. 1990; 18: 366-75.
15.
TylerTF, NicholasSJ, LeeSJ, MullaneyM, McHughMP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010; 38: 114-9.
16.
TylerTF, RoyT, NicholasSJ, GleimGW. Reliability and validity of a new method of measuring posterior shoulder tightness. J Orthop Sports Phys Ther. 1999; 29: 262-9.
HayesK, WaltonJR, SzomorZR, MurrellGA. Reliability of five methods for assessing shoulder range of motion. Aust J Physiother. 2001; 47: 289-94.
19.
NadeauS, KovacsS, GravelD, PiotteF, MoffetH, GagnonD, et al. Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: A study on reliability and validity. Physiother Theory Pract. 2007; 23: 179-87.
20.
MyersJB, LaudnerKG, PasqualeMR, BradleyJP, LephartSM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006; 34: 385-91.
21.
MichenerLA, McClurePW, KardunaAR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon). 2003; 18: 369-79.
22.
UhthoffHK, BoileauP. Primary frozen shoulder: global capsular stiffness versus localized contracture. Clin Orthop Relat Res. 2007; 456: 79-84.
23.
ScibekJS, CarpenterJE, HughesRE. Rotator cuff tear pain and tear size and scapulohumeral rhythm. J Athl Train. 2009; 44: 148-59.
24.
SullivanGM, FeinnR. Using Effect Size-or Why the P Value Is Not Enough. J Grad Med Educ. 2012; 4(3): 279-82.
25.
PearsallAW, SpeerKP. Frozen shoulder syndrome: diagnostic and treatment strategies in the primary care setting. Med Sci Sports Exerc. 1998; 30: S33-9.
26.
LewisJS, GreenAS, DekelS. The Aetiology of Subacromial Impingement Syndrome. Physiotherapy. 2001; 87(9): 458-69.
27.
GuyverPM, BruceDJ, ReesJL. Frozen shoulder - A stiff problem that requires a flexible approach. Maturitas. 2014; 78(1): 11-6.
28.
MyersJB, OyamaS, GoergerBM, RucinskiTJ, BlackburnJT, CreightonRA. Influence of humeral torsion on interpretation of posterior shoulder tightness measures in overhead athletes. Clin J Sport Med. 2009; 19: 366-71.
29.
GinnKA, CohenML. Exercise therapy for shoulder pain aimed at restoring neuromuscular control: A randomized comparative clinical trial. J Rehabil Med. 2005; 37(2): 115-22.
30.
CroftP, PopeD, ZoncaM, OneillT, SilmanA. Measurement of Shoulder Related Disability - Results of a Validation-Study. Ann Rheum Dis. 1994; 53(8): 525-8.
31.
EdwardsTB, BostickRD, GreeneCC, BarattaRV, DrezD. Interobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level. J Shoulder Elbow Surg. 2002; 11(1): 40-2.
32.
RichardsRR, AnKN, BiglianiLU, FriedmanRJ, GartsmanGM, GristinaAG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994; 3(6): 347-52.
33.
MallonWJ, HerringCL, SallayPI, MoormanCT, CrimJR. Use of vertebral levels to measure presumed internal rotation at the shoulder: A radiographic analysis. J Shoulder Elbow Surg. 1996; 5(4): 299-306.
34.
GinnKA, CohenML, HerbertRD. Does hand-behind-back range of motion accurately reflect shoulder internal rotation?J Shoulder Elbow Surg. 2006; 15(3): 311-4.
35.
ThomasSJ, SwanikCB, HigginsonJS, KaminskiTW, SwanikKA, BartolozziAR, et al. A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players. J Shoulder Elbow Surg. 2011; 20(5): 708-16.
36.
BaltaciG BA, TunayVB, ErgunN. The effect of manual therapy in the conservative management of impingemet syndrome in shoulder. Eklem Hastaliklari Cerrahisi (Joint Diseases and Related Surgery). 2002; 13: 27-33.
