Research of Shoulder Activities in Range of Motion

Transcription

1 Research of Shoulder Activities in Range of Motion - Pei-Hung Wang *, Fong-Gong Wu ** *National Cheng Kung University Tainan Taiwan R.O.C., P @mail.grad.ncku.edu.tw **National Cheng Kung University Tainan Taiwan R.O.C., fonggong@mail.ncku.edu.tw Abstract: This paper discusses and researches the influence of shoulder movement direction on different shoulder activities movements. Then present recommend of therapy treatment is based on findings. This research is divided into two parts. First, to find out effective shoulder movement direction that may be more effective therapy, emphasized on influence of range of shoulder motion. Second, indicate and estimate movement direction when and how shoulder muscles are used. Therefore, those findings in this paper can help us to avoid further hurts and can improve effect of therapy treatment. The experiment includes 5 groups, 50 normal people with healthy shoulders, are observed, aging from 40 to 60. There are 5 different kinds of shoulder movement direction, including shoulder abduction, forward flexion, backward extension, shoulder external rotation, and shoulder internal rotation. Based on individual group, patients would do one assigned shoulder movement direction, 3 to 5 minutes a time, twice a day, and total 4 weeks. Results indicate that there is interaction of treatment between shoulder abduction and forward flexion. In other words, when shoulder abduction is effective, range of motion of shoulder abduction increases, as well as range of motion of forward flexion. Doing flexion also increases range of motion of forward flexion and shoulder abduction. On the other hand, there is also interactive rotation and shoulder internal rotation. The results of EMG indicate that not only fewer muscles are used, but also smaller powers are released, because observed estimated IEMG become smaller. Therefore, muscles become stronger. Key words: EMG, ROM, Shoulder Movement, Shoulder Mobilization 1. Introduction The appropriate therapy of rehabilitation can promote the recovery, improve the mental, functional and social disability and save huge government reimbursements as well as social resources. Furthermore, the study of it could make progress in the skill and design of rehabilitation. The maximum ROM(range of motion)of human body lies in shoulder joints. Kibler(1988)indicated that shoulders have over 1600 kind of position in three dimensions and the activity model of muscles of scapula are correspondingly complex. Mary (1999) who studied geometrical characteristics, mainly in the exam of male body, of muscles of scapula understood the length of muscle fiber and tendon and the area of interaction. According to that model, activities of arm are divided into 7 parts, 303 intervals. Each analyzed position is composed of 104 muscles and decompose it onto 16 shoulder muscles, and shoulder joints are used so frequently that they fatigue, got hurt easily and often result in chronic degeneration. Adhesive causalities which is also called frozen shoulder is the most common one of chronic degeneration.

2 The therapy of frozen shoulder patients mainly is increasing ROM of affected side so we also name that shoulder mobilization. Until now there is no any documents to access the efficiency of each motion. This research precisely confers the effect which may resulted from the motion of each shoulder mobilization. The main discussible object is the shoulder activity of normal people in this research. And, we study the conditions of variety of muscle strength of scapula while doing 5 kinds of shoulder mobilization. We expect to find out more effective shoulder mobilization, which will be treated as the most credible reference data of therapy, to increase the effect of the therapy by experiment. The purposes of research are followed: (1) We can get the EMG of the muscles of shoulder joint while doing shoulder mobilization by experiments. (2) By mean of understanding the condition of the activities of the muscles of scapula of people from 40 to 60 by experiments, we can offer the data to related scholar for conferring them. (3) The experiment can be accessed the effects of the shoulder mobilization. It also help us comprehend them and an be the reference data of the design of therapy equipments. (4) The different shoulder mobilization will result in the distinct effects of the different part of the muscles. To understand the relation among them can help us understand the shoulder mobilization and evaluate the effects. (5) The result of the research can be offered to clinician. The clinician can give different diagnosis of shoulder mobilization to the different the distinct symbols of the different frozen shoulder. As a result of it, it can make the shoulder mobilization work better. The ROM for the joint of the shoulder is quite wide. We can divide the motion into 5 cases. The first case is the upward movable direction of the upper arm. It includes: the Forward flexion, which upholds the arm around the sagittal section and the Abduction, which upholder the arm around the vertical section in the scapular Plane Elevation. The ROM is about 0 to 180 degree. The second case is the backward movable direction of the upper arm. It includes: The Horizontal Extension, which the arm is moving backward extension in the horizontal section. The ROM is about 0 to 45 degree. And, the Backward Extension, that the ROM is about 0 to 60 degree. The third case is the horizontal movable direction of the upper arm. It is mainly the horizontal flexion. The ROM is about 0 to 135 degree. The forth case is the lower movable direction. It s mainly the adduction that the arm is approaching the body. The ROM is the same with upward movable direction (the first case). The fifth case is the rotation movable direction of the upper arm. It includes: the External Rotation and the Internal Rotation that the arm is rotating around the humerus axis. The ROM is related with the location of the upper arm. The ROM is about 0 to 180 degree. Because the movable range is quite wide, we discussed the actions of the shoulder mobilization. After consulted the doctor, we decided to use a set of the actions of the shoulder in the shoulder mobilization. (1) Shoulder Abduction: The motion is upholding the arm in the vertical section as the Fig (2) Forward Flexion: The motion is upholding the arm in the sagittal section as the Fig (3) Backward Extension: The motion is upholding the arm backward as the Fig (4) Shoulder External Rotation: The motion is rotating around the humerus axis and body outside. It is related with the location of the upper arm as Fig The experiment is setting the upper arm in the downcast and external location (0 degree).

3 (5) Shoulder Internal Rotation: The motion is rotating around the humerus axis and body inside. It is related with the location of the upper arm as Fig The experiment is setting the upper arm upward in the vertical section (90 degree). The location of the upper arm is horizontal and internal. Fig. 2.1 Fig. 2.2 Fig. 2.3 Fig. 2.4 Fig Method There are two major steps in the experiments plan. First, measurement of testers shoulder movement range will be taken. Testers will be asked to do shoulder activities movement after the first measurement, and then second measurement will be taken for the purpose of compare. Second, measure testers shoulder movement range by using EMG. After testers do shoulder activities movement, ask testers to take another EMG exam again. 2.1 Experiment Planning After general introduction of environment and experiment procedure, testers basic data such as age, height, and weight, is recorded. Experiment plan is summarized as below: (1) Method: EMG measurements and maximum shoulder movement range records are measured before and after four-week shoulder activities movement. (2) Tester: age between 40 to 60 years old, normal shoulder movement. Testers are 50 people and divided into 5 groups equally, 10 for each group. (3) Movement: 5 types, including shoulder abduction, forward flexion, backward extension, shoulder external rotation, and shoulder internal rotation; one for each group. (4) Testing Groups: 5 groups, one movement for each group only. The exam will continue for 4 weeks. (5) Frequency: one movement for each person, 3 to 5 minutes per time, two times a day. A record form will be distributed to all testers, see appendix. After testers have done group movement requests for 4 weeks, second step will be launched. EMG measurement and shoulder movement range will be measured. In addition, results of second step will be compared with the first step. 2.2 Measurement of shoulder movement range A protractor is used to measure testers shoulder movement range. Measurement will be taken before and after four-week shoulder activities movement. Researcher will show testers how to move their shoulder in order to obtain correct measurement records. Researcher will use a protractor to measure5 orientations of shoulder movement. Testers measurement results will be recorded. There is one key point needed to pay attention during experiment. Upper arm and forearm must remain vertical when testers do movement of internal and external rotation. Elbow joint must keep straight while doing other movements.

4 2.3 Measurement of EMG After measuring shoulder movement range, EMG measurement must be launched Location EMG measurement is taken to understand how muscle functions regularly, including Teres major of (Extensors, Supraspinatus of Rotator cuff, Infraspinatus, Teres minor, and Deltoid of Deltoid. According to Anatomic Guide For The Electromyographer, measurement locations are shown as below: Chart 2.1 Supraspinatus Chart 2.2 Infraspinatus Chart 2.3 Teres major Chart 2.4 Teres minor Chart 2.5 Deltoid (Perotto,1994) Measurement steps of EMG (1) General introduction of environment and experiment procedure. (2) Let testers practice movement requests 5 shoulder activities movement. (3) Use ethanol to clean surface of shoulder skin (4) Use tape to stabilize location of electrode, electrode must be removed after finishing whole session of experiment (5) Take first EMG measurement with testers arms normally drooping. (6) Ask testers to do 5 shoulder activities movement, one at a time and take one-minute break for EMG measurement between each shoulder activities movement. (7) Finish session, remove electrode properly (8) Ask testers to continue doing shoulder activities movement at home, and come back for second measurement four weeks later EMG singles adjustment Rectification:Average value of EMG signals approaches zero. Therefore, rectification of original EMG signals must be taken. There two types of rectifications half-wave rectification and full-wave rectification. Half-wave rectification is to take all negative values of EMG singles. Full-wave rectification is to estimate absolute value of EMG signals. Full-wave rectification is launched in this research. Smoothing: In order to obtain better quality of singles, high frequency singles must be filtered out by launching method of low-pass filtering. IEMG (Integration electromyography): known as the best indicator of muscle power evaluation. Therefore, this research chooses this indicator. As long as measurement values are retrieved, advanced statistical analysis and compare can be launched. 3. Results and Discussions

5 3.1 Testers Basic Information There are 50 testers total, 25 females and 25 males. Testers ages are located from 43 to 62. Female s height range is from 148 cm to 166 cm, while male s height range is from 157cm to 176cm. They all prefer using right hands. Table 3.1 Testers Basic Information Male (n=25) Female (n=25) Average Standard Error Average Standard Error Age Height (cm) Weight (Kg) Shoulder Movement Range The purpose of this experiment is to indicate the degree of difference before and after shoulder activities movement, moreover, among different shoulder activities movements. First, estimate angle variance of shoulder activities movement, which is defined as angle value of measurement before shoulder activities movement minus the angle values of measurement after. If angel variance is positive, shoulder activities movement has significant effect on shoulder movement range. According to Table 3.2, all average angle variances are positive. Table 3.2 Statistics of Group Variance Group1 Group2 Group3 Group4 Group5 Average Abduction Standard Error Forward Average flexion Standard Error Backward Average extension Standard Error Internal Average rotation Standard Error External Average rotation Standard Error Based on the statistical results, second group (Forward flexion) is significantly correlated with Abduction, as well as Forward flexion. In other words, second group of testers increase their shoulder movement range of Abduction and Forward flexion, after 4-week shoulder activities movement of Abduction, and Forward flexion. Third group (backward extension) is only correlated with itself. Fourth group (external rotation) and fifth group (internal rotation) are significantly correlated with each other. In other words, fourth and fifth group of testers increase their shoulder movement range of external rotation and internal rotation, after 4-week shoulder activities movement of external rotation and internal rotation. Abduction is significantly correlated with forward flexion. In other words, effective movement of abduction

6 increases shoulder movement range of not only abduction, but also forward flexion, vice versa. External rotation is significantly correlated with internal rotation. In other words, effective movement of external rotation increases shoulder movement range of not only external rotation, but also internal rotation, vice versa. Internal rotation and external rotation are the most significant groups based on analysis of t-test. Findings of each experiment group as below: (1) Supraspinatus: At the beginning, movement of abduction and forward flexion increases significantly. It indicates that Supraspinatus is the major functional muscle while doing movement of abduction and forward flexion. Effect of Supraspinatus increases until over 90-degree angle. On the other hand, effect of Supraspinatus increases because angle becomes bigger while doing movement of backward extension. (2) Infraspinatus: significant effect while doing movement of forward flexion and External rotation. (3) Teres major: significant effect while doing movement of internal rotation. (4) Teres minor: significant effect while doing movement of external rotation. (5) Deltoid: significant effect while doing movement of abduction, forward flexion, and backward extension. Effect is relative to angle of lifting. Findings of each experiment group as below: (1) Supraspinatus: At the beginning, movement of abduction and forward flexion increases significantly. It indicates that Supraspinatus is the major functional muscle while doing movement of abduction and forward flexion. Effect of Supraspinatus increases until over 90-degree angle. On the other hand, effect of Supraspinatus increases because angle becomes bigger while doing movement of backward extension. (2) Infraspinatus: significant effect while doing movement of forward flexion and External rotation. (3) Teres major: significant effect while doing movement of internal rotation. (4) Teres minor: significant effect while doing movement of external rotation. (5) Deltoid: significant effect while doing movement of abduction, forward flexion, and backward extension. Effect is relative to angle of lifting. 3.3 EMG analysis IEMG is adapted as the major analysis method in this research. Results as below: Table 3.3 Group1 Abduction Supraspinatus Infraspinatus Teres minor Teres major Deltoid Abduction 0.037* Forward flexion 0.049* * Backward extension * External rotation Internal rotation *P value<0.05,significant According to the result of t-test, IEMG value of Supraspinatus changes significantly while doing movement of abduction. In the mean time, IEMG value of supraspinatus and deltoid also changes significantly while doing movement of forward flexion. IEMG value of supraspinatus and deltoid changes significantly while doing

7 movement of backward extension. Table 3.4 Group2 Forward flexion Supraspinatus Infraspinatus Teres minor Teres major Deltoid Abduction 0.038* * Forward flexion 0.013* 0.005* * Backward extension External rotation Internal rotation *P value<0.05,significant According to the result of t-test, IEMG value of supraspinatus and deltoid changes significantly while doing movement of abduction. EMG value of supraspinatus, infraspinatus, and deltoid changes significantly while doing movement of forward flexion. Table 3.5 Group3 Backward extension Supraspinatus Infraspinatus Teres minor Teres major Deltoid Abduction Forward flexion 0.027* Backward extension 0.009* External rotation Internal rotation *P value<0.05,significant According to the result of t-test, IEMG value of Supraspinatus changes significantly while doing movement of abduction. In the mean time, IEMG value of supraspinatus and deltoid also changes significantly while doing movement of forward flexion. IEMG value of supraspinatus, infraspinatus, teres minor, and deltoid changes significantly while doing movement of backward extension. Table 3.6 Group4 External rotation Supraspinatus Infraspinatus Teres minor Teres major Deltoid Abduction Forward flexion Backward extension External rotation * Internal rotation * 0.014* *P value<0.05,significant According to the result of t-test, IEMG value of Infraspinatus changes significantly while doing movement of Forward flexion. In the mean time, IEMG value of supraspinatus, Infraspinatus, Teres minor, and Teres major also changes significantly while doing movement of External rotation. IEMG value of supraspinatus, Infraspinatus, Teres minor, and Teres major changes significantly while doing movement of Internal rotation. Table 3.7 Group5 Internal rotation Supraspinatus Infraspinatus Teres minor Teres major Deltoid Abduction Forward flexion Backward extension

8 External rotation 0.042* Internal rotation 0.020* * *P value<0.05,significant According to the result of t-test, IEMG value of Supraspinatus changes significantly while doing movement of External rotation. In the mean time, IEMG value of supraspinatus, Infraspinatus, Teres minor, and Teres major also changes significantly while doing movement of Internal rotation. 4. Conclusions This paper discusses and researches the influence of shoulder movement direction on different shoulder activities movements. Then present recommend of therapy treatment is based on findings. Abduction is significantly correlated with forward flexion. In other words, effective movement of abduction increases shoulder movement range of not only abduction, but also forward flexion, vice versa. External rotation is significantly correlated with internal rotation. In other words, effective movement of external rotation increases shoulder movement range of not only external rotation, but also internal rotation, vice versa. Internal rotation and external rotation are the most significant groups based on analysis of t-test. The results of EMG indicate that not only fewer muscles are used, but also smaller powers are released, because observed estimated IEMG become smaller. Therefore, muscles become stronger. Results indicate that there is interaction of treatment between shoulder abduction and forward flexion. In other words, when shoulder abduction is effective, range of motion of shoulder abduction increases, as well as range of motion of forward flexion. Doing flexion also increases range of motion of forward flexion and shoulder abduction. On the other hand, there is also interactive rotation and shoulder internal rotation. By mean of understanding the condition of the activities of the muscles of scapula of people from 40 to 60 by experiments, we can offer the data to related scholar for conferring them. It can be accessed the effects of the shoulder mobilization. It also help us comprehend them and can be the reference data of the design of therapy equipments. The different shoulder mobilization will result in the distinct effects of the different part of the muscles. The result of the research can be offered to clinician. The clinician can give different diagnosis of shoulder mobilization to the different the distinct symbols of the different frozen shoulder. As a result of it, it can make the shoulder mobilization work better. References 1. Bak K, Magnusson S., Shoulder strength and range of motion in symptomatic and pain free elite swimmers, Am J Sports Med, 5:4, pp.54-60, Blevins, F.T., Rotator cuff pathology in athletes, Occupational Health and Industrial Medicine, Volume: 38, Issue: 1, pp.45, Bradley J, Tibone J., Electromyographic analysis of muscle action about the shoulder, Clinics Sports Med, 10:, pp , 1991

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