Measurement of Shoulder Range of Motion in Patients with Adhesive Capsulitis Using a Kinect

Range of motion (ROM) measurements are essential for the evaluation for and diagnosis of adhesive capsulitis of the shoulder (AC). However, taking these measurements using a goniometer is inconvenient and sometimes unreliable. The Kinect (Microsoft, Seattle, WA, USA) is gaining attention as a new motion detecting device that is nonintrusive and easy to implement. This study aimed to apply Kinect to measure shoulder ROM in AC; we evaluated its validity by calculating the agreement of the measurements obtained using Kinect with those obtained using goniometer and assessed its utility for the diagnosis of AC. Both shoulders of 15 healthy volunteers and affected shoulders of 12 patients with AC were included in the study. The passive and active ROM of each were measured with a goniometer for flexion, abduction, and external rotation. Their active shoulder motions for each direction were again captured using Kinect and the ROM values were calculated. The agreement between the two measurements was tested with the intraclass correlation coefficient (ICC). Diagnostic performance using the Kinect ROM was evaluated with Cohen’s kappa value. The cutoff values of the limited ROM were determined in the following ways: the same as passive ROM values, reflecting the mean difference, and based on receiver operating characteristic curves. The ICC for flexion/abduction/external rotation between goniometric passive ROM and the Kinect ROM were 0.906/0.942/0.911, while those between active ROMs and the Kinect ROMs were 0.864/0.932/0.925. Cohen’s kappa values were 0.88, 0.88, and 1.0 with the cutoff values in the order above. Measurements of the shoulder ROM using Kinect show excellent agreement with those taken using a goniometer. These results indicate that the Kinect can be used to measure shoulder ROM and to diagnose AC as an alternative to goniometer.     

Limited forearm motion compensated by thoracohumeral kinematics when performing tasks requiring pronation and supination

This study investigates the altered thoracohumeral kinematics when forearm rotation is restricted while performing five activities requiring pronation and supination. Two splints simulated both a fixed-supinated or fixed-neutral forearm in six healthy subjects; the three-dimensional coupled relationship among motion about the forearm, elbow, and shoulder were analyzed. In using a screwdriver, the normal range of forearm rotation of 77.6° (SD = 30.8°) was reduced in the fixed-supinated to 11.3° (SD = 2.9°) and fixed-neutral to 18.2° (SD = 6.2°). This restriction from the fixed-supinated and fixed-neutral forearms was compensated at the shoulder by a significant increase in the total range of (1) ad/abduction by 57.3° and 62.8° respectively (p < .001), (2) forward-reverse flexion (24.3° and 18.2° respectively; p < .05) and (3) internal-external rotation (37.1° and 44.2° respectively; p < .001). A similar result was demonstrated for the doorknob activity. The elbow did not significantly contribute to forearm rotation (p = .14), and is believed to be due to the elbow axis being orthogonal and oblique to the forearm axis. For open kinetic-chain activities, with a fixed-supinated forearm performing there was a significant coupled increase in ad/abduction (p < .05) and int/external rotation (p < .05) for the phone and feeding tasks, with the phone task also having a significantly increased forward shoulder flexion (p < .05). For the fixed-neutral forearm, significant compensatory movement was only seen in the feeding task with increased ad/abduction and internal-external shoulder rotation (p < .05) and the card inserting task with increased ad/abduction and forward-reverse shoulder flexion. Limited forearm function requires compensatory motion from adjacent joints to perform activities that require pronation and supination.     

Muscles within muscles: Coordination of 19 muscle segments within three shoulder muscles during isometric motor tasks.

The aim of the present study was to determine how the intra-muscular segments of three shoulder muscles were coordinated to produce isometric force impulses around the shoulder joint and how muscle segment coordination was influenced by changes in movement direction, mechanical line of action and moment arm (ma). Twenty male subjects (mean age 22 years; range 18-30 years) with no known history of shoulder pathologies, volunteered to participate in this experiment. Utilising an electromyographic technique, the timing and intensity of contraction within 19 muscle segments of three superficial shoulder muscles (Pectoralis Major, Deltoid and Latissimus Dorsi) were studied and compared during the production of rapid (e.g. approximately 400ms time to peak) isometric force impulses in four different movement directions of the shoulder joint (flexion, extension, abduction and adduction). The results of this investigation have suggested that the timing and intensity of each muscle segment's activation was coordinated across muscles and influenced by the muscle segment's moment arm and its mechanical line of action in relation to the intended direction of shoulder movement (e.g. flexion, extension, abduction or adduction). There was also evidence that motor unit task groups were formed for individual motor tasks which comprise motor units from both adjacent and distant muscles. It was also confirmed that for any particular motor task, individual muscle segments can be functionally classified as prime mover, synergist or antagonist - classifications which are flexible from one movement to the next.     

Lessons learnt from the painful shoulder; a case series of malignant shoulder girdle tumours misdiagnosed as frozen shoulder

Adhesive capsulitis or frozen shoulder is a common condition characterized by shoulder pain and stiffness. In patients in whom conservative measures have failed, more invasive interventions such as arthrographic or arthroscopic distension can be very effective in relieving symptoms and improving range of movement. However, absolute contraindications to these procedures include the presence of neoplasia around the shoulder girdle. We present five cases referred to our institution where the diagnosis of shoulder joint malignancy was delayed, following prolonged, ineffective treatment for frozen shoulder. These cases highlight the importance of careful review of the radiology and the need for reconsideration of the diagnosis in refractory "frozen shoulder".     

The effectiveness of traditional and sling exercise strength training in women

Strength training often combines closed-kinetic-chain exercises (CKCEs) and open kinetic-chain exercises (OKCEs). The CKCE may be more effective for improving performance in lower-body training. Recently, we reported upper-body CKCE (using a commercially available system of ropes and slings, Redcord AS, Staubo, Norway) was as effective as OKCE training for strength gains and that CKCE was more effective than OKCE for improving throwing performance. To our knowledge the effectiveness of a strength training program that uses exclusively CKCE is unknown. In this study, we examined the effectiveness of CKCE vs. OKCE strength training programs in women enrolled in an introductory strength training program. Twenty-six participants were randomized to OKCE (traditional exercises) or CKCE (sling-based exercises). Participants completed 6 sets per week for 13 weeks. Pre and posttraining evaluations included the following: 1 repetition maximum (1RM) leg and bench press; sling exercise push-ups; isokinetic dynamometry; lateral step-down test; and the Star Excursion Balance Test. Both groups significantly improved bench press (by an average of 4-6 kg) and leg press (by an average of 23-35 kg) (p < 0.001). There was a significant group × time interaction (p < 0.001) for sling exercise push-ups (OKCE pre = 5.5 ± 8.6, OKCE post = 6.1 ± 8.2, CKCE pre = 6.8 ± 6.0, CKCE post = 16.9 ± 6.6). Isokinetic measures of knee extension, knee flexion, shoulder internal rotation, and shoulder external rotation increased (improvements ranged from 2.7 to 27.7%), with no group differences. Both OKCE and CKCE strength training elicited similar changes in balance. We conclude that CKCE training is equally as effective as OKCE training during the initial phases of a strength training program in women. The fact that only CKCE improved sling exercise push-ups supports previous findings suggesting functional superiority of CKCE.     

Upper limb joint angle measurement in occupational health

Usual human motion capture systems are designed to work in controlled laboratory conditions. For occupational health, instruments that can measure during normal daily life are essential, as the evaluation of the workers' movements is a key factor to reduce employee injury- and illness-related costs. In this paper, we present a method for joint angle measurement, combining inertial sensors (accelerometers and gyroscopes) and magnetic sensors. This method estimates wrist flexion, wrist lateral deviation, elbow flexion, elbow pronation, shoulder flexion, shoulder abduction and shoulder internal rotation. The algorithms avoid numerical integration of the signals, which allows for long-time estimations without angle estimation drift. The system has been tested both under laboratory and field conditions. Controlled laboratory tests show mean estimation errors between 0.06° and of 1.05°, and standard deviation between 2.18° and 9.20°. Field tests seem to confirm these results when no ferromagnetic materials are close to the measurement system.     

Characterizing upper limb muscle volume and strength in older adults: a comparison with young adults

Aging is associated with the loss of muscle volume (MV) and force leading to difficulties with activities of daily living. However, the relationship between upper limb MV and joint strength has not been characterized for older adults. Quantifying this relationship may help our understanding of the functional declines of the upper limb that older adults experience. Our objective was to assess the relationship between upper limb MV and maximal isometric joint moment-generating capacity (IJM) in a single cohort of healthy older adults (age ≥ 65 years) for 6 major functional groups (32 muscles). MV was determined from MRI for 18 participants (75.1±4.3 years). IJM at the shoulder (abduction/adduction), elbow (flexion/extension), and wrist (flexion/extension) was measured. MV and IJM measurements were compared to previous reports for young adults (28.6±4.5 years). On average older adults had 16.5% less total upper limb MV compared to young adults. Additionally, older adult wrist extensors composed a significantly increased percentage of upper limb MV. Older adult IJM was reduced across all joints, with significant differences for shoulder abductors (p<0.0001), adductors (p=0.01), and wrist flexors (p<0.0001). Young adults were strongest at the shoulder, which was not the case for older adults. In older adults, 40.6% of the variation in IJM was accounted for by MV changes (p≤0.027), compared to 81.0% in young adults. We conclude that for older adults, MV and IJM are, on average, reduced but the significant linear relationship between MV and IJM is maintained. These results suggest that older adult MV and IJM cannot be simply scaled from young adults.     

Hip circumduction is not a compensation for reduced knee flexion angle during gait

It has long been held that hip abduction compensates for reduced swing-phase knee flexion angle, especially in those after stroke. However, there are other compensatory motions such as pelvic obliquity (hip hiking) that could also be used to facilitate foot clearance with greater energy efficiency. Our previous work suggested that hip abduction may not be a compensation for reduced knee flexion after stroke. Previous study applied robotic knee flexion assistance in people with post-stroke Stiff-Knee Gait (SKG) during pre-swing, finding increased abduction despite improved knee flexion and toe clearance. Thus, our hypothesis was that hip abduction is not a compensation for reduced knee flexion. We simulated the kinematics of post-stroke SKG on unimpaired individuals with three factors: a knee orthosis to reduce knee flexion, an ankle-foot orthosis commonly worn by those post-stroke, and matching gait speeds. We compared spatiotemporal measures and kinematics between experimental factors within healthy controls and with a previously recorded cohort of people with post-stroke SKG. We focused on frontal plane motions of hip and pelvis as possible compensatory mechanisms. We observed that regardless of gait speed, knee flexion restriction increased pelvic obliquity (2.8°, p < 0.01) compared to unrestricted walking (1.5°, p < 0.01), but similar to post-stroke SKG (3.4°). However, those with post-stroke SKG had greater hip abduction (8.2°) compared to unimpaired individuals with restricted knee flexion (4.2°, p < 0.05). These results show that pelvic obliquity, not hip abduction, compensates for reduced knee flexion angle. Thus, other factors, possibly neural, facilitate exaggerated hip abduction observed in post-stroke SKG.     

Assessing the validity of surface electromyography for recording muscle activation patterns from serratus anterior

PurposeNo direct evidence exists to support the validity of using surface electrodes to record muscle activity from serratus anterior, an important and commonly investigated shoulder muscle. The aims of this study were to determine the validity of examining muscle activation patterns in serratus anterior using surface electromyography and to determine whether intramuscular electromyography is representative of serratus anterior muscle activity.MethodsSeven asymptomatic subjects performed dynamic and isometric shoulder flexion, extension, abduction, adduction and dynamic bench press plus tests. Surface electrodes were placed over serratus anterior and around intramuscular electrodes in serratus anterior. Load was ramped during isometric tests from 0% to 100% maximum load and dynamic tests were performed at 70% maximum load. EMG signals were normalised using five standard maximum voluntary contraction tests.ResultsSurface electrodes significantly underestimated serratus anterior muscle activity compared with the intramuscular electrodes during dynamic flexion, dynamic abduction, isometric flexion, isometric abduction and bench press plus tests. All other test conditions showed no significant differences including the flexion normalisation test where maximum activation was recorded from both electrode types. Low correlation between signals was recorded using surface and intramuscular electrodes during concentric phases of dynamic abduction and flexion.ConclusionsIt is not valid to use surface electromyography to assess muscle activation levels in serratus anterior during isometric exercises where the electrodes are not placed at the angle of testing and dynamic exercises. Intramuscular electrodes are as representative of the serratus anterior muscle activity as surface electrodes.     

Immediate effects and short-term retention of multi-modal instruction compared to written only on muscle activity during the prone horizontal abduction exercise in individuals with shoulder pain

In rehabilitation, exercise instructions are multi-modal and can include a focus of increasing mean activity of a target muscle and inhibiting aberrant synergistic muscle activity, particularly during shoulder exercises, such as the prone horizontal abduction (PHA). The objective was to compare the immediate effects and short-term retention of multi-modal exercise instruction by a physical therapist written only instruction on normalized mean upper and lower trapezius muscle activity during three phases (concentric/isometric/eccentric) versus of an isotonic PHA exercise between participants with and without shoulder pain. Surface electromyography (EMG) was recorded from fourteen healthy participants and twelve participants with shoulder pain during the PHA exercise under two conditions: (1) written only instructions and (2) multi-modal instruction. Retention of multi-modal instruction on muscle activity was assessed one week later. Results demonstrate 12.8–16.0% increase in lower trapezius muscle activity during the concentric and isometric phases with multi-modal instructions in both groups. Inhibition of the upper trapezius did not occur in either group. Facilitation effects were maintained in short-term follow-up. Findings suggest that regardless of shoulder pain, multi-modal instruction by a physical therapist facilitates greater neuromuscular activity of a targeted muscle compared to written instructions alone and these effects are retained.     

Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects

ObjectiveTo characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation.MethodsThirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper.ResultsParetic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation.ConclusionChronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.     

Cineradiographic study of forelimb movements during quadrupedal walking in the brown lemur (Eulemur fulvus, Primates: Lemuridae)

Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.     

Shoulder movements during quadrupedal locomotion in arboreal primates

The kinematics of scapula and shoulder joint movements were analyzed in three species of arboreal quadrupedal primates using cineradiography. Our findings indicate that scapular movement is highly important for forelimb movement in primates with this ancestral mode of locomotion. Retroversion of the scapula (syn. caudal rotation or extension) during the stance phase contributes more than 40% to the stride length of the forelimb. Lateral forelimb excursions, a general feature for arboreal primates, are based on complex three-dimensional scapular movements guided by the clavicle. Humeral abduction is achieved by scapular abduction and transversal rotation of the scapula about its longitudinal axis, and is therefore strikingly different from humeral abduction in humans. At the same time, the movements of the shoulder joint are limited to flexion and extension only.     

Influence of strength training on adult women's flexibility

The purpose of the current study was to investigate the effect of 10 weeks of strength training on the flexibility of sedentary middle-aged women. Twenty women were randomly assigned to either a strength training group (n = 10; age, 37 +/- 1.7 years; body mass, 65.2 +/- 10.7 kg; height, 157.7 +/- 10.8 cm; and body mass index, 25.72 +/- 3.3 kg x m(-2)) or a control group (n = 10; age, 36.9 +/- 1.2 years; body mass, 64.54 +/- 10.18 kg; height, 158.1 +/- 8.9 cm; and body mass index, 26.07 +/- 2.8 kg x m(-2)). The strength training program was a total body session performed in a circuit fashion and consisted of 7 exercises performed for 3 circuits of 8 to 12 repetitions maximum (RM), except for the abdominal exercise which was performed for 15 to 20 RM. Flexibility measurements were taken for 10 articulation movements pre and post training: shoulder flexion and extension, shoulder horizontal adduction and abduction, elbow flexion, hip flexion and extension, knee flexion, and trunk flexion and extension. Pre and post training, 10 RM strength significantly increased (p < 0.05). Of the movements examined, only shoulder horizontal adduction, hip flexion and extension, and trunk flexion and extension demonstrated significant increases (p < 0.05). Neither elbow nor knee flexion showed a significant change with weight training. The control group showed no significant change in any of the flexibility measures determined. In conclusion, weight training can increase flexibility in previously sedentary middle-aged women in some, but not all joint movements.     

前哨淋巴结活检术联合保乳治疗对早期乳腺癌患者临床疗效、术后并发症及肩关节功能的影响

目的:探讨前哨淋巴结活检术联合保乳治疗对早期乳腺癌患者临床疗效、术后并发症及肩关节功能的影响。方法:选取2014年10月至2017年2月就诊于我院的乳腺癌患者,按照患者手术方式分为联合组与对照组,其中联合组行前哨淋巴结活检手术联合保乳治疗,对照组行传统腋窝淋巴结清扫术治疗,每组各选取50例,随访时间为6个月。比较两组手术情况、并发症、乳腺美容效果及肩关节功能情况。结果:联合组手术时间、总出血量、引流管拔除时间、总引流量均明显低于对照组(P0.05)。手术治疗后,联合组并发症比例为6%,明显低于对照组38%。术后,两组患者随访6个月,联合组乳腺美容效果明显高于对照组(P0.05)。术前,两组肩关节功能各指标水平比较差异不显著(P0.05);术后,两组肩关节屈曲活动度、外旋活动度、后伸活动度、外展活动度相较于术前均明显降低(P0.05),联合组内旋活动度相较于术前降低不显著(P0.05),而对照组内旋活动度相较于术前降低显著(P0.05)。术后,联合组肩关节屈曲活动度、外旋活动度、内旋活动度、后伸活动度、外展活动度均显著高于对照组(P0.05)。结论:前哨淋巴结活检术联合保乳治疗早期乳腺癌创伤小,美容效果明显,可显著降低术后并发症发生率并减轻对患者肩关节功能的损害,远期疗效仍有待于进一步随访观察。     

Muscle specificity in tests of cervical flexor muscle performance.

The deep cervical flexor (DCF) muscles are considered to be of substantial clinical importance in the management of neck pain. While conventional cervical flexion (CF) dynamometry methods have been used frequently to assess the capacity of the cervical flexor muscles, it has been suggested that cranio-cervical flexion (CCF) methods may provide a more specific test of DCF muscle performance. This study compared the activation of the deep and superficial cervical flexor muscles between tests of isometric cranio-cervical flexion (CCF) and conventional cervical flexion (CF) dynamometry. Normalised root-mean-square values were recorded for the deep cervical flexor (DCF), sternocleidomastoid (SCM), anterior scalene (AS), and sternohyoid (SH) muscles during isometric CCF and CF tests at maximal voluntary contraction (MVC), 50% MVC, and 20% MVC in ten healthy volunteers. The results demonstrated significantly greater electromyography (EMG) amplitude for the SCM (P<.001-.002) and AS (P<.001-.001) muscles in the CF test conditions (MVC, 20%MVC, and 50%MVC) compared to CCF test conditions. Moreover, the SH muscle demonstrated significantly greater EMG amplitude during CF compared to CCF but only in the 50% MVC and 20% MVC conditions (P=.007 and .02 respectively). These results demonstrate that dynamometry tests of CF result in greater activity of the superficial cervical flexor muscles compared to tests of CCF. As a result, CCF dynamometry may provide a more specific method to assess and retrain DCF muscle performance, compared to conventional CF in which superficial muscle activity may mask impaired performance of the DCF muscles.     

Reduction in subluxation and improved muscle function of the hemiplegic shoulder joint after therapeutic electrical stimulation.

Seventeen hemiplegic patients with chronic shoulder subluxation secondary to a cerebrovascular accident (CVA) were divided into three groups, two of which were subjected to 6 weeks of therapeutic electrical stimulation (TES) for 15 minutes twice a day, in order to assess the effectiveness of the treatment in reducing subluxation, and in improving shoulder abduction function. The third group was used as a control (C group). After 6 weeks of electrical stimulation of the supraspinatus (S group) and deltoid (D group), a significant (p<0.05) reduction in subluxation was observed in both groups when compared to the C group. The maximal force of shoulder abduction showed a tendency to increase in the S group (p<0.10). A significant increase in maximal force was also observed in the D group. In most of the TES-treated muscles, the interference pattern of EMG at maximum voluntary contraction increased. The amplitude of the EMG activity of the stimulated muscle also increased. Thus, we concluded that electrical stimulation therapy of the supraspinatus and the deltoid muscle is an effective treatment modality for shoulder subluxation and shoulder abduction function in hemiplegic patients.     

Focus: Vaccines: Shoulder Pain and Injury after COVID-19 Vaccination

Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon’s practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man; he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0° flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman; she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief.     

Shoulder strength and range-of-motion characteristics in bodybuilders

The purpose of this study was to compare shoulder range-of-motion (ROM) and strength values between bodybuilders and nonbodybuilders. Fifty-four men (29 bodybuilders and 25 nonbodybuilders) between the ages of 21 and 34 years participated in the study. Goniometric measurements were used to assess shoulder flexion and internal and external rotation ROM. Isometric manual muscle tests were performed using a handheld dynamometer. Shoulder flexion, internal and external rotation, abduction, and prone shoulder retraction and elevation strength were tested. Independent t-tests were used to determine levels of statistical significance between the groups. Bodybuilders showed an overall loss of shoulder rotation ROM (166 degrees vs. 180 degrees ) and a significantly decreased internal rotation ROM (-11 degrees ) compared with the control group. Bodybuilders were significantly stronger on all isometric shoulder-strength tests than nonbodybuilders, except for the assessment of lower trapezius strength when expressed as a percentage of body weight. The results of this study indicate that bodybuilders have imbalances regarding strength and ROM at the shoulder that may make them susceptible to shoulder pathology.     

Effects of Estrogen and Testosterone on Resting Energy Expenditure in Older Men

The mechanisms by which sex hormones cause changes in body composition are unclear. Sex steroid deficiency might directly reduce energy expenditure/fat oxidation and thereby predispose to increased body fat. Alternatively, sex steroid deficiency could result in lean tissue loss and thus reduced energy expenditure. Our objective was to examine the independent and combined effects of acute testosterone and estrogen withdrawal on respiratory exchange ratio (RER) and resting energy expenditure (REE) in men. The objective of the study was to examine the independent and combined effects of acute estrogen and testosterone withdrawal on RER and REE in men. A total of 54 men aged 50–80 years, BMI range of 17–35 kg/m² underwent a 3‐week eugonadal run‐in hormone‐treatment period involving suppression of endogenous sex steroids using letrozole and leuprolide acetate (Lupron) while sex steroid concentrations were maintained with transdermal testosterone (T) and estradiol (E). A second Lupron injection was then given and participants were randomized to one of the following four 3‐week treatment groups: group A (?T, ?E), group B (?T, +E), group C (+T, ?E), and group D (+T, +E). REE and RER were measured via indirect calorimetry before and after the 3‐week treatment period. Three‐week suppression and/or repletion of estrogen or testosterone did not produce changes in RER or REE within or between groups. We conclude that abrupt changes in sex steroids does not change resting substrate oxidation, indicating that changes that can be observed after more prolonged periods of deficiency are most likely due to direct effects of sex steroids on body composition.