Ben Kibler

BACKGROUND AND PURPOSE: Scapular muscle detachment is a rare orthopedic problem that has been described in the literature in patients following traumatic events involving traction, direct trauma, or a motor vehicle accident. The purpose of this case report is to describe the post-operative rehabilitation following scapular muscle reattachment surgery. Unique to this case report is the patient's perspective, an orthopedic physical therapist with 25 years of experience. CASE DESCRIPTION: A 47-year-old female physical therapist experienced a traction injury to bilateral upper extremities during a medical procedure resulting in bilateral rhomboid, and bilateral lower trapezius muscles were detached from the medial scapular border...

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Compared with other joints in the body, examination of the shoulder continues to be a challenge for practitioners, whether they be trainers, physical therapists, primary care physicians, or orthopedic surgeons. There are many reasons for this challenge, the primary being the highly complex architecture of bony and soft-tissue anatomy which allows for the greatest range of motion of any joint of the body. As a result, the clinical examination as Ralph Hertel, MD, has commented "perhaps it is just not easy." His comment reflects that one cannot just expect to understand how to interpret the examination unless the observer has some knowledge of how the shoulder complex works, how to perform the basics of the examination, how to interpret radiographs, and how to integrate these variables into a diagnosis...

PURPOSE: Session RPE (sRPE) is used to track internal training/competition load in athletes using a metric known as the acute to chronic workload ratio (ACWR). Research that reported on team sports has determined that if the acute load is higher than the chronic load, athletes are likely to sustain injury. No studies, however, have attempted to investigate internal load and injury in a tennis population despite the rigorous training loads. Therefore, the purpose of this study was to investigate if sRPE ACWR is associated with injury in junior tennis players over a 7-month time period...

PURPOSE OF REVIEW: This review will outline scapular function in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and present an algorithm that encompasses guidelines for evaluation and can serve as a basis for treatment. RECENT FINDINGS: Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies...

Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation stiffness. They may be based on inherent neuromuscular architecture, but are commonly affected by positive or negative adaptations to imposed functional demands. Positive neuromuscular adaptations improve the efficiency of performing the task, which can result in less energy expenditure, maximum force delivered to the task, and protection of involved joints from excessive loads/motions, and improve the effectiveness of task performance...

HYPOTHESIS: We hypothesized that the patient-reported status following treatment of traumatic scapular muscle detachment would improve from the preoperative status and that higher pain catastrophizing scores would be more common in patients with poor postsurgical outcomes. METHODS: We studied 50 patients who met the diagnostic criteria for scapular muscle detachment and in whom rehabilitation failed. American Shoulder and Elbow Surgeons (ASES) scores were collected preoperatively and postoperatively...

BACKGROUND: An observational tennis serve analysis (OTSA) tool was developed using previously established body positions from three-dimensional kinematic motion analysis studies. These positions, defined as nodes, have been associated with efficient force production and minimal joint loading. However, the tool has yet to be examined scientifically. PURPOSE: The primary purpose of this investigation was to determine the inter-observer reliability for each node between two health care professionals (HCPs) that developed the OTSA, and secondarily to investigate the validity of the OTSA...

BACKGROUND: Assessment of health-related status has been shown to vary between patients and physicians, although the degree of patient-physician discordance in the assessment of the change in status is unknown. METHODS: Ninety-nine patients with shoulder dysfunction underwent a standardized physician examination and completed several self-reported questionnaires. All patients were prescribed the same physical therapy intervention. Six weeks later, the patients returned to the physician, when self-report questionnaires were re-assessed and the Global Rating of Change (GROC) was completed by the patient...

Much effort is being made to quantitate and improve the outcomes associated with medical treatment. These outcomes are defined as how the patient did after an intervention and may be termed "value on the back end" of the treatment process. The diagnosis guides the content and timing of the treatment, and may be considered the "value on the front end" that optimizes the treatment process. The diagnosis can be defined as "that body of information, collected through the process of evaluating the patient's health problem, that determines the content and timing of the treatment of the health problem...

PURPOSE: To report functional and objective outcomes resulting from surgical treatment of patients with symptomatic type III through V acromioclavicular (AC) joint injury by use of a modification of the anatomic AC joint reconstruction developed by Carofino and Mazzocca. METHODS: The study included all patients treated in 2009-2014 who presented with a history of direct trauma to the shoulder; deformity of the AC joint on clinical examination; radiographic findings that would classify the injury as a Rockwood type III, IV, or V injury; AC joint instability on clinical examination; and self-reported deficits of arm function on initial presentation, in whom a comprehensive and directed nonoperative program failed...

The scapula fulfils many roles to facilitate optimal function of the shoulder. Normal function of the shoulder joint requires a scapula that can be properly aligned in multiple planes of motion of the upper extremity. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. As such, it may be the underlying cause or the accompanying result of many forms of shoulder pain and dysfunction...

BACKGROUND: A sport-specific conditioning program can help tennis players train for competition or return to play from injury. This study determined the actual tennis serve volume in elite play and used these data to construct an interval training program based on stroke volume. HYPOTHESIS: There will be no differences in serve volume between male and female tennis players at the professional and junior levels. STUDY DESIGN: Retrospective cohort study...

BACKGROUND: Alterations in glenohumeral (GH) rotation especially internal rotation and total range of motion have been associated with altered GH kinematics and susceptibility to injury. Researchers have evaluated long-term change in baseball and tennis players, and short-term changes in baseball players. However, acute (short-term) changes in GH rotation have not been evaluated in tennis players. HYPOTHESES/PURPOSE: The purpose of this study was to quantify short-term glenohumeral rotational changes within a group of professional women's tennis players following competitive play...

The clavicle is the most frequently injured bone in the human body. In most cases, fractures that occur in the midshaft of the clavicle can be managed nonsurgically. An increasing number of studies suggest that displaced midshaft clavicle fractures have improved outcomes after surgical management, and equivalent outcomes can be achieved with both plating and intramedullary techniques. Distal clavicle fractures are managed according to the disruption of the coracoclavicular ligaments. Fractures with disruption of the ligaments usually will require fixation, whereas fractures with intact ligaments may be treated with closed management...

The overhead throwing motion is a complex activity that is achieved through activation of the kinetic chain. The kinetic chain refers to the linkage of multiple segments of the body that allows for transfer of forces and motion. The lower extremities and core provide a base of support, generating energy that is transferred eventually through the throwing arm and hand, resulting in release of the ball. The kinetic chain requires optimal anatomy, physiology, and mechanics and is involved in all 6 phases of overhead throwing: windup, stride, arm cocking, acceleration, deceleration, and follow-through...

PURPOSE: To analyze current literature reporting surgical treatment of SLAP lesions to examine the consistency of reported surgical details (surgical indications, surgical technique, and postoperative rehabilitation) that are deemed important for best treatment outcomes and to try to establish a consensus regarding treatment. METHODS: A systematic review of papers reporting surgical treatment of a SLAP lesion was performed. Each paper was analyzed for the description of (1) the arthroscopic indications for surgery; (2) surgical aspects including type, location, and number of anchors and sutures; (3) description of criteria for determination of completeness of the repair; and (4) postoperative rehabilitation details...

PURPOSE: To evaluate current practice reported in the literature for making a SLAP lesion diagnosis and compare the findings with a survey sent to experienced shoulder surgeons assessing how they make a SLAP diagnosis. METHODS: We performed a systematic review of articles reporting surgical repair of SLAP lesions, documenting the use of 4 diagnostic areas of evaluation: history, clinical examination, imaging, and diagnostic arthroscopy. A survey was distributed electronically to 175 surgeons with expertise in shoulder surgery...

The shoulder is a closed-chain mechanism that balances the mobility required by the ranges of motion in normal activities with the stability required to act as a stable ball and socket base for those activities. The scapula plays key roles in the closed-chain mechanism by being mobile enough to place the glenoid in optimal relation to the humerus to facilitate concavity/compression and by being a stable base for coordinated muscle activation to compress the humerus into the glenoid. Scapular dyskinesis alters these roles and is frequently present in many types of glenohumeral instability...

CONTEXT: Recent establishment of G-codes by the US government requires therapists to report function limitations at initial evaluation. Limited information exists specific to the most common limitations in patients with shoulder pain. OBJECTIVE: To describe the most commonly expressed shoulder limitations with activities and their severity/level of impairment from a patient's perspective on the initial evaluation. DESIGN: Descriptive. SETTING: Patients reporting pain with overhead activity and seeking medical attention from one orthopedic surgeon were recruited as part of a cohort study...