STUDY DESIGN: Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. OBJECTIVES: To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. BACKGROUND: Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. METHODS AND MEASURES: Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. RESULTS: The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean ± SD increase, 16.9° ± 23.2°; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. CONCLUSION: KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported.  LEVEL OF EVIDENCE: Therapy, level 1b-.

J Orthop Sports Phys Ther. 2008;38(7):389-395, published online 29 May 2008. doi:10.2519/jospt.2008.2791

KEY WORDS:  impingement, rehabilitation, taping

STUDY DESIGN: Resident’s case problem. BACKGROUND: An 18-year-old man presented to physical therapy 3 days after insidious onset of painless left shoulder girdle weakness. DIAGNOSIS: Decreased light touch sensation was noted on the lateral left shoulder. In addition, weakness was present with shoulder abduction, flexion, external rotation, and internal rotation. Results of magnetic resonance imaging and radi­ography of the cervical spine, brachial plexus, and left shoulder were normal. Electromyography and nerve conduction velocity study findings were con­sistent with axillary nerve palsy. The results of the physical examination and diagnostic studies were most consistent with axillary nerve mononeuropa­thy, probably caused by traction or pressure due to wearing a pack while hiking or firing a weapon. DISCUSSION: With sling protection, limitation of physical activity, and gradual return to progres­sive resistance exercises, the patient had full return of strength and function 2½ months after onset of symptoms. The differential diagnosis for shoulder girdle weakness should be well under­stood by physical therapists. This knowledge will help the therapist promptly identify the cause of shoulder girdle weakness and initiate appropriate treatment. If the condition requires further evalu­ation or treatment by another healthcare provider, prompt identification of pathology will allow appro­priate timely referral.  

J Orthop Sports Phys Ther. 2007;37(3):140-147. doi:10.2519/jospt.2007.2249 

KEY WORDS: axillary nerve mononeuropathy, pack palsy, rucksack palsy

The dynamic muscle stabilizers of the shoulder are critical to high performance in the overhead athlete. Previous evaluations of shoulder strength have focused on the concentric strength of the rotator cuff. Functionally, the rotator cuff muscles interact in an eccentric/concentric fashion. This is the first study to evaluate the end range eccentric antagonist/concentric agonist ratios of the shoulder rotators. Seventy-five asymptomatic college-level males were tested through a range of 20° of lateral rotation to 90° of medial rotation using the Kin-Com computer-assisted, hydraulic-resisted, isokinetic dynamometer at a speed of 90°/sec. The end range (60-90°) ratios for the medial rotators functioning eccentrically and lateral rotators functioning concentrically were 2.39:1 and 2.15:1 for the dominant and nondominant shoulders, respectively. End range (10° of lateral rotation-20° of medial rotation) ratios for lateral rotators functioning eccentrically and medial rotators functioning concentrically were 1.08:1 and 1.05:1 for the dominant and nondominant shoulders, respectively. The application of this functional assessment of strength testing results may provide important information in the evaluation of the injured shoulder in the overhead athlete, for prescreening, and to gauge return to sports after injury or surgery.

J Orthop Sports Phys Ther. 1997;25(3):203-207.

Key Words: shoulder, muscle, dynamic strength

Study Design: Resident’s case problem.
Background: A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21⁄2 weeks prior, which completely resolved within 24 hours of onset.
Diagnosis: Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker’s cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. Diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE).
Discussion: A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.

J Orthop Sports Phys Ther. 2006;36(9):686-697. doi:10.2519/jospt.2006.2251

Key Words: blood, pulmonary embolism, screening