Objectives: To assess outcomes of total hip arthroplasty (THA) by comparing range of motion (ROM), muscle strength, and postural stability in the surgical hip to those of the uninvolved hip 1 year postsurgery. An additional objective was to assess degree of relationship among ROM, strength, and postural stability impairments to a measure of self-assessed function.

Background: Most patients who have THA receive physical therapy that consists mainly of self-care instructions and an exercise protocol that emphasizes mobility during the acute phase of recovery. But, outcomes of THA 1 year postsurgery indicate that current physical therapy programs used during the acute phase of recovery do not effectively restore physical and functional performance.

Methods and Measures: Subjects consisted of 11 women and 4 men (mean age ± standard deviation = 62 ± 8 years) with unilateral THA performed 1 year prior to data collection. Assessment variables consisted of self-assessment of function and measures of postural stability, muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for self-assessment of function. Three separate repeated measures MANOVA were used to compare the involved side to the uninvolved side in measures of postural stability, strength, and ROM. The Spearman’s rho was used to assess degree of association between the subjects’ score of self-assessed function and impairments in strength and postural stability.

Results: Measures of postural stability were significantly lower (P = 0.01) on the side of the replaced hip. Differences in strength values between the involved and uninvolved sides were not statistically significant. Correlations between scores of self-assessed function and hip abductor and knee extensor strength were statistically significant (r = 0.56, P = 0.03). Self-assessed function was not significantly correlated to postural stability impairments.

Conclusion: The brief postsurgical rehabilitation program received by patients with THA may not be sufficient. A second phase of rehabilitation implemented 4 months or more after surgery that emphasizes weight bearing and postural stability may be advisable.

J Orthop Sports Phys Ther. 2002; 32(6):260–267.

Key Words: isometric strength, postural stability, self-assessed function, THA

]]> http://www.jospt.org/issues/articleID.142/article_detail.asp http://www.jospt.org/issues/articleID.141/article_detail.asp Thomas M. Cook, Paula M. Ludewig
Study Design: Two-group mixed-model analysis of covariance and correlation analysis.

Objectives: To determine whether differences in humeral translations exist between patients with shoulder impingement symptoms and an asymptomatic comparison group, and if so, to determine if shoulder range-of-motion (ROM) measures are associated with abnormal translations.

Background: Abnormal translations of the humeral head are believed to reduce the available subacromial space and to contribute to the development or progression of shoulder impingement symptoms. These abnormal translations have also been theorized to be related to tightness of the posterior capsule and decreased shoulder ROM.

Methods and Measures: Three-dimensional humeral translations were tracked in symptomatic construction workers and an asymptomatic comparison group while elevating the arm in the scapular plane under no-load, 2.3-kg, and 4.6-kg hand-load conditions. Between-group comparisons were made across 3 phases of motion (30°–60°, 60°–90°, and 90°–120°) and the association between humeral translations and cross-body adduction and shoulder internal rotation ROM measures were determined by Pearson correlation analysis.

Results: Persons with shoulder symptoms demonstrated small but significant changes in anterior-posterior translations of the humerus. These changes for the 90°–120° phase of humeral elevation were moderately negatively associated with available cross-body adduction ROM.

Conclusions: The identified kinematic deviations are consistent with possible reductions of the subacromial space. Further study of relationships between posterior capsule tightness, rotator cuff function, and abnormal humeral translations is warranted to better delineate underlying kinematic mechanisms that may contribute to shoulder impingement symptoms and to refine rehabilitation techniques.

J Orthop Sports Phys Ther. 2002; 32(6):248–259.

Key Words: biomechanics, kinematics, shoulder motion abnormalities

]]> http://www.jospt.org/issues/articleID.141/article_detail.asp http://www.jospt.org/issues/articleID.140/article_detail.asp Todd S. Ellenbecker
]]> http://www.jospt.org/issues/articleID.140/article_detail.asp http://www.jospt.org/issues/articleID.143/article_detail.asp James R. Andrews, Jeffrey R. Dugas, Kevin E. Wilk, Michael M. Reinold
Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medicine settings. Overhead athletes often exhibit a certain degree of acquired laxity that can lead to various pathologies. Unfavorable results often observed with traditional open procedures to correct instability in the overhead athlete have led to the development of arthroscopic thermal-assisted capsular shrinkage (TACS). TACS is not commonly used as an isolated procedure in overhead athletes; various procedures are often performed concomitantly. The overall outcome greatly depends on a postoperative rehabilitation program that must be assessed and adjusted frequently based on several factors. Knowledge of the basic science of TACS as well as emphasis on dynamic stabilization, proprioception, and neuromuscular control are vital to the rehabilitation program for overhead athletes. The purpose of this paper is to discuss the basic science and clinical application of thermal-assisted capsular shrinkage of the glenohumeral joint as well as the postoperative rehabilitation for the overhead athlete and the patient with congenital laxity and related multidirectional instability. J Orthop Sports Phys Ther. 2002; 32(6):268–292. Key Words: dynamic stabilization, glenohumeral instability, neuromuscular control, overhead athlete, SLAP lesions]]> http://www.jospt.org/issues/articleID.143/article_detail.asp