A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed.
The present study was undertaken to evaluate the effects of intermittent weight-bearing (IWB) combined with β2-agonist clenbuterol (Cb) medication for suppressing muscle atrophy during progressive disuse atrophy. Male Wistar rats (age: 8weeks, body weight: 232 ± 14 g) were divided into a control group (CON) and an experimental group. The experimental group was further subdivided into a Cb medication group under normal conditions and a hindlimb unweighting (HU) treatment group. The HU treatment group was composed of four groups: HU treatment-only, HU treatment + IWB, HU treatment + Cb medication and HU treatment + IWB + Cb medication. IWB was performed by temporarily removing the suspension device for one hour daily. On Day 14, bilateral soleus muscle (SOL) and extensor digitorum longus muscle (EDL) were extracted. Muscles from the right side were used for the measurement of contractile properties (physiological functional evaluations). Muscles from the left side were used for histochemical and biochemical analysis. During HU, IWB combined with Cb medication worked to preserve the wet weight and relative weight of SOL as compared to CON. Its contractile properties were affected by weight-bearing, while the cross-sectional area of type I fiber and protein concentration were affected by Cb. This combined therapy had marked effects on the morphology of EDL, particularly on the cross-sectional area of type II fiber. The protein concentration and contractile properties of EDL were unaffected by this combined therapy. The effect of a combination of IWB and Cb medication was specific to fiber-type and region. The data suggested that 1) IWB was effective on functional aspects such as contractile properties and useful for physical therapy, 2) Cb medication exerted the atrophy-suppressive effect in morphological parameters and manifested less effect on functional aspects. The results in this study indicated the possibility of elevating the efficacy of IWB by Cb medication in SOL.
We investigated the changes of an 8-week cardiac rehabilitation (CR) program on physiological outcomes and health-related quality of life (HRQL) in Japanese cardiac surgery patients. Subjects were 47 consecutive outpatients (32 men, 15 women; mean age 59.4 ± 12.6 years) recovering from cardiac surgery. Patients performed both aerobic exercise on a treadmill at anaerobic threshold intensity and moderate resistance training 2 days per week, 60 min per session, from 1 to 3 months after cardiac surgery. Differences in the eight SF-36 subscale scores and physiological outcomes within the patient group at 1 month and at 3 months after cardiac surgery were analyzed. Peak oxygen uptake, handgrip strength, and knee extension strength were used as physiological outcome measures. HRQL was assessed with the Japanese version Medical Outcome Study Short Form 36 (SF-36). Significant change in overall physiological outcome from 1 month to 3 months was observed. There was also significant change in seven of the eight SF-36 health status subscale scores (physical functioning, role-physical, bodily pain, general health, vitality, role-emotional, and mental health). However, with the exception of physical functioning and mental health scores, values did not reach those of the average healthy Japanese. In conclusion, we found that CR exercise training for Japanese cardiac surgery patients during the recovery phase changes not only physiological outcomes but also HRQL as assessed by the SF-36.
The present study aimed to clarify the effects of inspiratory muscle training (IMT) and expiratory muscle training (EMT) on ventilatory muscle strength, pulmonary function and responses during exercise testing. Young healthy women were randomly assigned to 3 groups: IMT (n=16); EMT (n=16); or untrained normal controls (NC, n=8). Subjects in the IMT and EMT groups trained for 15 minutes twice daily over 2 weeks at loads of 30% maximal inspiratory and expiratory muscle strength, respectively. Ventilatory muscle strength (maximal inspiratory and expiratory muscle strength; PImax and PEmax, respectively), pulmonary function and progressive exercise testing was performed. Both PImax and PEmax increased in the IMT group, and PEmax increased in the EMT group. Neither trained group demonstrated any change in pulmonary function or peak values during exercise testing. In the IMT group, exercise-induced increases in heart rate, oxygen uptake (VO2/kg) and rating of perceived exertion (RPE) decreased with training, as did increases in VO2/kg and RPE in the EMT group. The increased ventilatory muscle strength in both IMT and EMT groups might improve ventilatory efficacy during exercise, and increased inspiratory muscle strength might facilitate oxygen delivery through improved circulatory responses.
The purpose of the present study was to compare differences in physiological outcomes and health-related quality of life (HRQOL) in relation to degree of illness in patients with chronic heart failure (CHF) and to compare HRQOL in CHF patients with that of a normal Japanese population. One hundred and twenty-five patients with stable CHF (93 men, 32 women, mean age 63.3 ± 12.4 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the present study. We used New York Heart Association (NYHA) functional class as an index of degree of illness. In 64 of the 125 patients, physiological outcome measures included peak oxygen uptake (peak VO2) and VE/VCO2 slope. HRQOL was assessed with the medical outcome study short form-36 (SF-36) Japanese version. In addition, SF-36 scores of CHF patients were compared against Japanese standard values. Age and LVEF did not differ according to NYHA functional class. The eight SF-36 subscale scores and peak VO2 decreased with increases in the NYHA functional classes, whereas VE/VCO2 slope increased with increases in NYHA functional class (p<0.05). Of the 8 SF-36 subscales measured in CHF patients, only the bodily pain score attained that of the normal Japanese population. These findings suggest that HRQOL decreases as NYHA functional class increases and other physiological measures worsen. In addition, HRQOL values of CHF patients were low in comparison with standard values of a normal Japanese population.
Dysfunction of limb coordination may be divided into two categories; intra and inter-limb incoordination. To make clear differential character in these two limb incoordination, we measured 13 patients mainly with cerebellar ataxia and 27 patients mainly with parkinsonism during pedaling of an ergometer with left and right pedals that can be rotated independently. As a result, interlimb incoordination was predominantly observed in patients with parkinsonism, while patients with cerebellar ataxia showed relatively preserved interlimb coordination but intralimb incoordination. We concluded that impairment of intralimb coordination was a character in patients with cerebellar ataxia, while impairment of interlimb coordination was a character in patients with parkinsonism.