Publications by authors named "Yang-Jing Lan"

23 Publications

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[Clinical anatomical study on the treatment of tarsal tunnel syndrome with four-point vertical acupotomy].

Zhongguo Gu Shang 2022 Jun;35(6):543-7

Department of Acupuncture, China-Japan Friendship Hospital, Beijing 100029, China.

Objective: To explore safety and accuracy of four-point acupotomy for the treatment of tarsal tunnel syndrome regarding release of ankle tunnel flexor retinaculum to provide an anatomical basis of clinical treatment.

Methods: Twenty-nine adult specimens (15 males and 14 females) fixed with 10% formalin, aged from 47 to 98 years old with an average age of (81.10±11.14) years old, 29 on the right side and 29 on the left side, which were selected for the study from September 2020 to October 2020. Simulate the operation of loosening flexor retinaculumt with a needle knife on the human specimen, and place the specimen on the frog position of lower limbs with medial malleolus upward to determine the center of medial malleolus. Choose 4 different positions near the flexor retinaculum to insert the needle so that the needle body was perpendicular to skin and cutting edge direction was perpendicular to the running direction of the flexor retinaculum. The needle knife penetrates the skin and explores slowly. When the flexor retinaculum was reached, the needle tip may touch the tough tissue. At this time, the cutting is loosened for 4 times. After acupotomy release operation was completed, make a lateral incision on the skin surface along acupotomy direction, open the area of the exposed flexor retinaculum, dissecting layer by layer, observe and record the needle knife and its surrounding anatomical structure. The length of acupotomy cutting marks of flexor retinaculum was measured by electronic vernier caliper. The safety and accuracy of acupotomy loosening of ankle canal flexor retinaculum were evaluated by observing the number and degree of ankle canal contents such as tendons and nerves injured by needle knife. The safety is to count the number of cases of acupotomy injury to the contents of the ankle canal, and to calculate the injury rate, that is, the number of injury cases/total cases × 100%. The effective release was defined as the release length L ≥ W/2(W is the width of the flexor retinaculum, defined as 20 mm).

Results: For safety, there were no acupotomy injuries to nerves or blood vessels in 58 cases, 26 cases injuried to posterior tibial tendon which 17 of these tendon injury cases, the tendon was penetrated and severely injured, and flexor digitorum longus tendon was injured in 12 cases. Among these cases, tendon was penetrated and severely injured in 4 cases, and total injury rate was 32.14%. No nerve and vessel injury on c3 and c4 point. For accuracy, 58 specimens were successfully released. The length Lc of releasing trace for acupotomy was (10.40±1.36) cm, and length range 6.38 to 12.88 cm. Among all cases, the length of releasing trace was ≥10 mm in 37 cases. The overall success rate of release was 100.00%. Layered structure of ankle tube flexor retinaculumt:fiber diaphragm from flexor retinaculum divides contents of ankle tube into different chambers inward, and fiber diaphragm meets here to synthesize a complete flexor retinaculum at the midpoint of the line between the medial malleolus tip and calcaneal tubercle(above the neurovascular course).

Conclusion: Four-point needle-knife method of releasing flexor retinaculum for the treatment of tarsal tunnel syndrome is performed at the attachment of the two ends of flexor retinaculum;the tendon, but not the nerves and blood vessels, is easily damaged. It is safe to insert needle on the side of calcaneus. The extent of release is relatively complete, but due to the "layered" structure of the flexor retinaculum, classic surgical technique could only release one layer of flexor retinaculum when a needle is inserted at the edge of the bone and cannot achieve complete release of the full thickness of the flexor. Therefore, it remains to be determined whether the desired effect can be achieved clinically.
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http://dx.doi.org/10.12200/j.issn.1003-0034.2022.06.008DOI Listing
June 2022

The immediate effects of a shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture: A randomized crossover design.

Gait Posture 2020 06 4;79:162-169. Epub 2020 May 4.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan. Electronic address:

Background: Round shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.

Research Question: The purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.

Methods: Twenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.

Results: All clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2-2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°-0.5°, p < 0.05, respectively).

Significance: Different characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.
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http://dx.doi.org/10.1016/j.gaitpost.2020.04.028DOI Listing
June 2020

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

J Athl Train 2020 Mar 26;55(3):265-273. Epub 2019 Dec 26.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University.

Context: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task.

Objective: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering.

Design: Randomized controlled clinical trial.

Setting: Research laboratory.

Patients Or Other Participants: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41).

Main Outcome Measure(s): Three-dimensional kinematics and EMG were recorded before and after feedback training.

Results: Lower trapezius muscle activity increased (4.2%-18%, < .011) and UT/LT decreased (0.56-1.17, < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, = .024).

Conclusions: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS.

Trial Registration Number: ClinicalTrials.gov: NCT03252444.
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http://dx.doi.org/10.4085/1062-6050-490-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093932PMC
March 2020

Kinesiology taping with exercise does not provide additional improvement in round shoulder subjects with impingement syndrome: A single-blinded randomized controlled trial.

Phys Ther Sport 2019 Nov 3;40:99-106. Epub 2019 Sep 3.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan. Electronic address:

Objective: Round shoulder posture (RSP) may exaggerate symptoms of subacromial impingement. The effects of kinesiology taping with exercise on posture, pain, and functional performance were investigated in subjects with impingement and RSP.

Design: This study was a single-blinded randomized controlled trial.

Setting: An outpatient rehabilitation clinic in a university hospital.

Participants: Thirty-four subjects with subacromial impingement and RSP.

Interventions: Kinesiology taping with and without tension was applied 2 times per week for 4 weeks. Both groups also performed strengthening and stretching exercises 3 times per week for 4 weeks.

Main Outcome Measurements: The pain level, shoulder angle and self-reported score were evaluated at pre-intervention, 2-week post-intervention and 4-week post-intervention time points.

Results: Functional performance improved after intervention in both groups (p = 0.027). A greater decrease in pain level was related to better functional performance of the shoulder in both groups (r = -0.760 and -0.674; p < 0.010). Moderate correlations were found for posture and functional performance of the shoulder in the intervention group (0.48).

Conclusion: Four weeks of strengthening and stretching exercises with or without kinesiology taping improved functional performance in subjects with impingement and RSP. Improvement in clinical symptoms was related to better performance of posture.
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http://dx.doi.org/10.1016/j.ptsp.2019.09.001DOI Listing
November 2019

Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis.

Phys Ther Sport 2019 Nov 9;40:19-26. Epub 2019 Aug 9.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Objective: Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults.

Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot.

Results: We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively.

Conclusion: Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.
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http://dx.doi.org/10.1016/j.ptsp.2019.08.003DOI Listing
November 2019

Pain quality descriptors and sex-related differences in patients with shoulder pain.

J Pain Res 2018 11;11:1803-1809. Epub 2018 Sep 11.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.

Background: Pain quality assessment is applicable to pain evaluation and treatment. However, shoulder pain quality descriptors mostly remain unknown. Furthermore, sex-related differences considerably affect clinical pain experience. The aim of this study was to investigate pain quality descriptors and to compare sex-related differences in using pain descriptors among patients with shoulder pain.

Materials And Methods: A sample of 120 patients (41 males and 79 females) with shoulder pain was recruited from Department of Physical Medicine and Rehabilitation. Shoulder pain quality descriptors were investigated using a 36-item pain quality list. Sex-related differences in the number and frequency of pain quality descriptors were compared using independent -test and test, respectively.

Results: Fifteen commonly used shoulder pain quality descriptors were identified. Among them, "sore" was the most frequently used, followed by "pulled". Deep pain sensations (eg, sore, pulled, torsion, and taut) were relatively more predominant than superficial pain sensations (eg, pricking and lacerating). In terms of sex-related differences, female patients used more pain quality descriptors than the male patients (5.5 vs 3.7, <0.001). The frequency of paroxysmal, dullness, and constriction-related pain quality descriptors, such as "shooting", "faint", "clicking", and "squeezing", were higher in females than in males (all <0.05).

Conclusion: The results provide commonly used shoulder pain quality descriptors that are useful for assessing shoulder pain and for developing a new shoulder pain assessment tool. Because the shoulder pain quality profiles differed between male and female participants, clinicians and researchers should consider sex-related differences in assessing and treating shoulder pain.
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http://dx.doi.org/10.2147/JPR.S169006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140732PMC
September 2018

Progressive conscious control of scapular orientation with video feedback has improvement in muscle balance ratio in patients with scapular dyskinesis: a randomized controlled trial.

J Shoulder Elbow Surg 2018 Aug 6;27(8):1407-1414. Epub 2018 Jun 6.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: Video feedback (VF) can guide patients to consciously control scapular orientation without inappropriate substitution. This study investigated whether progressive conscious control with VF improves scapular muscle activation and movements during arm elevation in patients with subacromial impingement and scapular dyskinesis.

Methods: The study recruited 38 amateur overhead athletes with subacromial impingement and scapular medial border prominence who were randomly assigned to the VF or control group. The participants in both groups controlled the scapular position and progressively practiced from 0° to 45° and from 0° to 90° of arm elevation. Participants in the VF group also controlled the scapular position with a video presentation of the scapula on a screen. We investigated the scapular kinematics, muscle activation, and balance ratio for outcome collection in the preintervention and postintervention conditions with and without VF conditions.

Results: Decreased upper trapezius (UT) activation (3%-13%, P < .0083), increased lower trapezius (LT) activation (3%-17%, P < .0083), restored UT/LT ratios (0.67-3.13, P < .0083), and decreased scapular internal rotation (1.8°-6.1°, P < .003) relative to the preintervention condition were demonstrated in the 2 postintervention conditions in both groups. The VF group also demonstrated decreased UT/serratus anterior ratios (0.21-0.30, P < .0083) in 2 postintervention conditions relative to the preintervention condition.

Conclusions: The progressive control of scapular orientation with or without VF can be used to reduce the UT/LT ratio and improve scapular internal rotation during arm elevation. Control training with VF can further decrease the UT/serratus anterior ratio.
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http://dx.doi.org/10.1016/j.jse.2018.04.006DOI Listing
August 2018

Kinesio taping and manual pressure release: Short-term effects in subjects with myofasical trigger point.

J Hand Ther 2016 Jan-Mar;29(1):23-9. Epub 2015 Nov 6.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.

Study Design: Randomized controlled trial.

Introduction: Myofascial pain syndrome is characterized by myofascial trigger points (MTrPs) and fascia tenderness.

Purpose Of The Study: We investigated the effects of manual pressure release (MPR) alone or in combination with taping (MPR/MKT) in subjects with MTrPs.

Methods: Fifteen and 16 subjects received MPR and MPR/MKT respectively. Outcomes including Pressure pain threshold, muscle stiffness, mechanomyography were assessed at baseline, post-intervention and 7-days later.

Results: Pressure pain threshold improved significantly (d = 1.79, p < 0.005) in both groups. Significant improvement in muscle stiffness in the MPR/MKT group (0.27-0.49 mm) as compared to the MPR group (-0.02-0.23 mm). Mechanomyography amplitude in the MPR/MKT group was significantly higher than that of the MPR group (p < 0.05).

Conclusion: MPR and MPR/MKT are effective in reducing pain in these subjects. MPR/MKT has a greater effect on muscle stiffness and contraction amplitude.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jht.2015.10.003DOI Listing
November 2016

Reliability and Validity of Transversus Abdominis Measurement at the Posterior Muscle-Fascia Junction with Ultrasonography in Asymptomatic Participants.

J Manipulative Physiol Ther 2015 Oct 26;38(8):581-6. Epub 2015 Sep 26.

Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Objective: The purposes of this study were (1) to establish the intrarater sliding and change in thickness of the transversus abdominis (TrA) measurement at the posterior muscle-fascia junction and (2) to examine the relationship between the muscle thickness and sliding of the TrA at the anterior and posterior sites.

Methods: Asymptomatic participants (n = 20) were placed into the hook-lying position to perform the abdominal drawing-in maneuver viewed in B-mode with a 5- to 12-MHz linear ultrasound transducer. The outcome variables included the resting thickness, the thickness during contraction, the change of thickness, and the change of sliding length. Both intraclass correlation coefficient and Pearson correlation were used for analysis.

Results: Measuring the thickness and sliding of the TrA at the posterior muscle-fascia junction showed good reliability (intraclass correlation coefficient (3,3), 0.89-0.98). The correlations between the sliding measurements of the TrA at the anterior and posterior sites were moderate to good (r = 0.41-0.74).

Conclusion: This study found that measuring the musculofascial corset from the posterior site using ultrasonography is reliable, allowing for ultrasound measurements at both the anterior and posterior sites of the TrA to provide a comprehensive evaluation of the TrA fascia.
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http://dx.doi.org/10.1016/j.jmpt.2014.12.010DOI Listing
October 2015

Shoulder physical activity, functional disability and task difficulties in patients with stiff shoulders: interpretation from RT3 accelerator.

Man Ther 2014 Aug 5;19(4):349-54. Epub 2014 Mar 5.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

We determined whether the degree of symptom-related functional disability was related to daily physical activity of the shoulder in subjects with stiff shoulders (SSs). Responsiveness and a clinically meaningful level of discrimination between improvement and non-improvement for shoulder physical activity (SPA) were determined. Twenty-six subjects with SSs participated. Shoulder physical activity was assessed by RT3 accelerometers fixed on the humerus during daily 14-h data collection periods twice a week for 2 weeks. A moderate correlation coefficient was found between SPA and functional disability (β = .47). Based on our cohort design and sample, we suggest that SPA (higher than 101.8 counts, hard-moderate or hard tasks) during daily activity are associated with (with at least 83% probability) non-improvement in an individual with SS. Compared to the non-improvement group, the improvement group had less duration of sedentary activity, less frequency and duration of hard tasks, and more frequency and duration of easy tasks (p < 0.01). Appropriate guidance on shoulder physical activities for subjects with SS is important to consider in rehabilitation strategies for these subjects. In our sample, a hard level of shoulder physical activity and sedentary activity should be cautious for these subjects. Further study is needed to validate therapeutic effect of physical activity on the course of patient improvement in subjects with SSs.
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http://dx.doi.org/10.1016/j.math.2014.02.005DOI Listing
August 2014

Inter-session reliability of the measurement of the deep and superficial layer of lumbar multifidus in young asymptomatic people and patients with low back pain using ultrasonography.

Man Ther 2013 Dec 28;18(6):481-6. Epub 2013 May 28.

Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Study Design: Reliability study.

Objective: To investigate the inter-session reliability of measuring the thickness of deep (dMF) and superficial layer of lumbar multifidus (sMF) using ultrasonography for participants with and without low back pain (LBP).

Background: The lumbar multifidus is an important muscle in maintaining spinal stability. The dMF is considered important in maintaining tonic contraction and joint stability. Motor control impairment is also discovered in patients with LBP. However, no study to date has investigated the method of observing both the sMF and dMF through ultrasound imaging (USI).

Methods: Twenty subjects aged 18-35 years old with LBP (N=10) and without LBP (N=10) were recruited. Every subject extended the upper trunk in prone lying with maximal isometric contraction. Simultaneously, the examiner measured the thickness of the dMF and the sMF using ultrasonography after ensuring the muscle belly was located. The participants performed three trials of isometric trunk extension in each session, with 30 min between each session. The reliability of measuring the change of thickness is represented by the intra-class correlation coefficient (ICC).

Results: Through averaging three trials of measurement, the reliability of measuring the thickness of the dMF or the sMF in static or in the contracted condition, and the change of the thickness during contraction, is reliable (ICC=0.84-1.00).

Conclusions: The intra-rater inter-session reliability of measurement of the dMF and the sMF with USI has been established. This method could be applied to the qualification of the activation level of the dMF and the sMF with specific tasks.
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http://dx.doi.org/10.1016/j.math.2013.04.006DOI Listing
December 2013

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness.

BMC Musculoskelet Disord 2012 Mar 27;13:46. Epub 2012 Mar 27.

Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Background: Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.

Methods: A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.

Results: Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.

Conclusions: Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.

Trial Registration: This clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".
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http://dx.doi.org/10.1186/1471-2474-13-46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339516PMC
March 2012

Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial.

Man Ther 2012 Feb 25;17(1):47-52. Epub 2011 Sep 25.

Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, No.1 Changde Street, Zhongzheng District, Taipei City 100, Taiwan.

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference=0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference=22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.
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http://dx.doi.org/10.1016/j.math.2011.08.006DOI Listing
February 2012

Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness.

J Electromyogr Kinesiol 2010 Apr 12;20(2):206-11. Epub 2009 Jun 12.

Department of Rehabilitation and Physical Medicine, National Taiwan University Hospital, 100 Taipei, Taiwan.

The purpose of the present study was to determine (1) if joint position sense (JPS) in subjects with shoulder stiffness (SS) differs from that in controls; (2) if, when JPS is reduced in SS, it is related to scapular muscular activities in the mid/end ranges of motion; and (3) if a person's function is associated with his or her level of JPS. Eighteen subjects with unilateral SS and 18 controls were included. Each subject performed abduction by self-selecting an end/mid range position. The electromagnetic motion-capturing system collected kinematic data while surface electromyography collected muscle activities (upper trapezius, lower trapezius, and serratus anterior muscles). Subjects were asked to move the upper limb to the target position (end/mid range) accurately without visual guidance. Reduced JPS was observed in subjects with SS (2.7 degrees in mid range, p<0.05). The JPS was enhanced by an increased scapula muscular activation level in the end range of motion (R=-0.61 for SS and -0.41 for controls) and by coordination among muscles' activation in the mid-range of motion (R=-0.87 for SS and R=-0.53 for controls). Impaired JPS was also related to self-reported functional status (R=-0.56) in subjects with SS. Shoulder JPS in subjects with chronic SS is impaired in comparison with controls. In the mid-range motion, the coordination of scapula muscular activation is related to shoulder JPS. Impaired JPS is also function-related in subjects with SS. These findings suggest that the coordination among scapula muscles' activation were important to consider in the rehabilitation of patients with chronic SS.
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http://dx.doi.org/10.1016/j.jelekin.2009.04.007DOI Listing
April 2010

Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study.

Support Care Cancer 2009 Nov 8;17(11):1353-60. Epub 2009 Feb 8.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Zhongzheng District, Taipei 100, Taiwan, Republic of China.

Goals Of Work: The purpose of this study is to compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression (PC) and modified DLT, in which the use of a short-stretch bandage is replaced with the use of Kinesio tape (K-tape) combined with PC.

Materials And Methods: Forty-one patients with unilateral breast-cancer-related lymphedema for at least 3 months were randomly grouped into the DLT group (bandage group, N = 21) or the modified DLT group (K-tape group, N = 20). Skin care, 30-min manual lymphatic drainage, 1-h pneumatic compression therapy, application of a short-stretch bandage or K-tape for each group, and a 20-min physical therapy exercise were given during every treatment session. Patient evaluation items included physical therapy assessment, limb size, water composition of the upper extremity, lymphedema-related symptoms, quality of life, and patients' acceptance to the bandage or tape.

Main Results: There was no significant difference between groups in all outcome variables (P > 0.05) through the whole study period. Excess limb size (circumference and water displacement) and excess water composition were reduced significantly in the bandage group; excess circumference and excess water composition were reduced significantly in the tape group. The acceptance of K-tape was better than the bandage, and benefits included longer wearing time, less difficulty in usage, and increased comfort and convenience (P < 0.05).

Conclusions: The study results suggest that K-tape could replace the bandage in DLT, and it could be an alternative choice for the breast-cancer-related lymphedema patient with poor short-stretch bandage compliance after 1-month intervention. If the intervention period was prolonged, we might get different conclusion. Moreover, these two treatment protocols are inefficient and cost time in application. More efficient treatment protocol is needed for clinical practice.
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http://dx.doi.org/10.1007/s00520-009-0592-8DOI Listing
November 2009

Secondary motions of the shoulder during arm elevation in patients with shoulder tightness.

J Electromyogr Kinesiol 2009 Dec 16;19(6):1035-42. Epub 2008 Dec 16.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City 100, Taiwan, ROC.

An analysis of secondary shoulder motions (humeral rotation, humeral head anterior/posterior translation, scapular tipping, and scapular upward/downward rotation) in subjects with anterior/posterior shoulder tightness provides the opportunity to examine the role of tightness as a means of affecting shoulder motions. Subjects with shoulder tightness (anterior, n=12; posterior, n=12) elevated their arms in the scapular plane. Three replicated movements were performed to the maximum motions. Kinematics data were collected by FASTRAK 3D electromagnetic system. To determine if a significant difference of the secondary motions existed between anterior/posterior shoulder tightness, two-factor mixed ANOVA models with the repeated factor of elevation angle (five elevation angles) and the independent factor of group were calculated. The relationships between the self-reported functional scores (Flexilevel Scale of Shoulder Function, FLEX-SF) and abnormal shoulder kinematics were assessed. For humeral head anterior/posterior translation, the subjects with posterior tightness demonstrated anterior humeral head translation (10mm, p=0.019) compared to subjects with anterior tightness. The subjects with anterior tightness demonstrated less posterior tipping (2.2 degrees , p=0.045) compared to subjects with posterior tightness. The humeral anterior translation had moderate relationships with FLEX-SF scores (r=-0.535) in subjects with posterior tightness. The scapular tipping had moderate relationships with FLEX-SF scores (r=0.432) in subjects with anterior tightness. In conclusion, the secondary motions were different between subjects with anterior and posterior shoulder tightness. During arm elevation, less scapular posterior tipping and less posterior humeral head translation in subjects with anterior and posterior shoulder tightness, respectively, are significantly related to self-reported functional disability in these subjects.
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http://dx.doi.org/10.1016/j.jelekin.2008.10.011DOI Listing
December 2009

Proprioception assessment in subjects with idiopathic loss of shoulder range of motion: joint position sense and a novel proprioceptive feedback index.

J Orthop Res 2008 Sep;26(9):1218-24

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

We examined the effects of elevation range and plane on shoulder joint proprioception in subjects with idiopathic loss of shoulder range of motion (ROM). Joint position sense (JPS) and a novel proprioceptive feedback index (PFI), including difference magnitude and the similarity index, were used to assess proprioception. Twelve subjects (eight male, four female) with involved stiff shoulders and normal opposite shoulders were recruited from a university hospital. Subjects attempted to repeat six target positions. Target positions consisted of arm elevation in three planes (frontal, scapular, and sagittal planes) and two ranges (end/mid range). Six trials of each target position were used to determine acceptable trials for stabilization of the data, less than 5% of the cumulative mean values for at least three successive trials. The data stabilized at the sixth repetition. Compared to control shoulders, involved shoulders had enhanced proprioception during end range movements (p < 0.05). The magnitude of the repositioning error and difference magnitude decreased (1.6 degrees -3.5 degrees for repositioning error and 22.2 degrees -62.1 degrees for difference magnitude), whereas similarity index improved at end range movements compared to mid range movements (p < 0.05) in involved stiff shoulders. Results of JPS and PFI suggest that both capsuloligamentous and musculotendinous mechanoreceptors play an important role in proprioception feedback during active movements in subjects with idiopathic loss of shoulder ROM.
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http://dx.doi.org/10.1002/jor.20627DOI Listing
September 2008

Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders.

Man Ther 2009 Feb 20;14(1):81-7. Epub 2008 Feb 20.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Measurement of anterior/posterior shoulder tightness, humeral external/internal rotation range of motion (ROM), scapular upward rotation/tipping ROM, and functional limitations were made in 46 patients with unilateral stiff shoulders (SSs) using a clinical measurement (shoulder tightness), a three-dimensional electromagnetic tracking device (shoulder ROM), and self-reports of function. Patients with SSs in their dominant shoulder demonstrated statistically greater posterior shoulder tightness compared to nondominant shoulder. Control dominant shoulders demonstrated decreased internal ROM as compared with control nondominant shoulders (p=0.021). In SSs, significant relationships were found between humeral internal rotation ROM and posterior shoulder tightness (R=0.49, p<0.0005), humeral external rotation ROM and anterior shoulder tightness (R=0.59, p=0.0002), scapular tipping and anterior shoulder tightness (R=0.57, p=0.004). Specifically, in patients with dominant SSs, posterior shoulder tightness and functional limitation were related (R=0.56, p=0.002). In patients with dominant involved shoulders, emphasise on posterior tightness stretch may improve functional ability directly. In addition to stretching program in patients with SSs, internal rotation ROM of control dominant shoulder is also important to consider in the rehabilitation of patients with SSs.
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http://dx.doi.org/10.1016/j.math.2007.11.004DOI Listing
February 2009

Shoulder kinematic features using arm elevation and rotation tests for classifying patients with frozen shoulder syndrome who respond to physical therapy.

Man Ther 2008 Dec 2;13(6):544-51. Epub 2007 Oct 2.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Physical therapy is an intervention commonly used in the treatment of subjects with frozen shoulder symptoms, with limited proven effect. The purpose of this study was to identify the kinematic features of patients with frozen shoulder who are more likely to respond to physical therapy. Thirty-four subjects presenting frozen shoulder syndrome were studied to determine altered shoulder kinematics and functional disability. Subjects received the same standardized treatment with passive mobilization/stretching techniques, physical modalities (i.e. ultrasound, shortwave diathermy and/or electrotherapy) and active exercises twice a week for 3 months. Initially, subjects were asked to perform full active motion in 3 tests: abduction in the scapular plane, hand-to-neck and hand-to-scapula. During the test, shoulder kinematics were measured using a 3-D electromagnetic motion-capturing system. In the initial and follow-up sessions, the self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) was used to determine functional disability from symptoms. Improvement with treatment was determined using percent change in FLEX-SF scores over three months of treatment [(final score-initial score)/initial score x 100, >20% improvement and < = 20% nonimprovement]. Shoulder kinematics were first analysed for univariate accuracy in predicting improvement and then combined into a multivariate prediction method. A prediction method with two variables (scapular tipping >8.4 degrees during arm elevation, and external rotation >38.9 degrees during hand to neck) were identified. The presence of these two variables (positive likelihood ratio=15.71) increased the probability of improvement with treatment from 41% to 92%. It appears that shoulder kinematics may predict improvement in subjects with frozen shoulder syndrome. Prospective validation of the proposed prediction method is warranted.
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http://dx.doi.org/10.1016/j.math.2007.07.006DOI Listing
December 2008

Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial.

Phys Ther 2007 Oct 7;87(10):1307-15. Epub 2007 Aug 7.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Background And Purpose: The purpose of this study was to compare the use of 3 mobilization techniques--end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)--in the management of subjects with frozen shoulder syndrome (FSS).

Subjects: Twenty-eight subjects with FSS were recruited.

Methods: A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics.

Results: Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did.

Discussion And Conclusion: In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.
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http://dx.doi.org/10.2522/ptj.20060295DOI Listing
October 2007

Reliability of function-related tests in patients with shoulder pathologies.

J Orthop Sports Phys Ther 2006 Aug;36(8):572-6

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Study Design: Nonexperimental.

Objective: To investigate the intertester and intratester reliability of a battery of function-related tests in patients with shoulder pathologies and associated reduced range of motion.

Background: A battery of function-related tests has the potential to complement assessment of functional limitation in patients who have shoulder pathologies.

Methods And Measures: Three function-related tests (hand to neck, hand to scapula, and hand to opposite scapula) were conducted on 46 patients with shoulder pathologies, and 46 age- and gender-matched control subjects. The tests were performed by 2 independent physiotherapists to test intertester reliability. Intratester reliability was examined by investigating the reproducibility of the tests performed twice, with 3 to 5 days between tests, by the same physiotherapist. Comparison of the scores on the function-related tests between patients and controls was evaluated. A correlation matrix was calculated to test the level of association among the tests.

Results: Intratester and intertester reliability on the 3 tests (weighted K) varied from 0.83 to 0.90. The patient's test performances were decreased in comparison to the control group. The correlation matrix demonstrated a level of associations among the 3 tests varying from r = 0.64 to r = 0.66.

Conclusion: The results of this study indicate that function-related tests are reliable and could be used in clinical practice to document reduced function of the shoulder. The level of association among the tests indicates that each test measured different aspects of shoulder function.
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http://dx.doi.org/10.2519/jospt.2006.2133DOI Listing
August 2006

Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders.

J Orthop Res 2006 May;24(5):1044-51

School of Physical Therapy and National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chun-Shan S Rd, Taipei, Taiwan, Republic of China.

Shoulder tightness may cause altered kinematics and lead to development of subacromial impingement, tendinitis, and degenerative changes. In this investigation, the humeral head translations, scapular kinematics, and scapulohumeral rhythm were determined with a three-dimensional electromagnetic tracking device during arm elevations in six subjects with anterior shoulder tightness and in six subjects with posterior shoulder tightness to study the effects of anterior/posterior tightness on shoulder kinematics. Subjects with anterior tightness showed lower slopes in curves of glenohumeral elevation plotted against scapular upward rotation (scapulohumeral rhythm, 0.11 to 0.32; p = 0.021) and less posterior scapular tilt (2.9 to 7.5 degrees; p = 0.002) during arm elevations when compared to the group with posterior tightness. The humeral head was positioned less posteriorly (2.2 to 3.4 mm; p = 0.004) and more superiorly (3.8 to 7.0 mm; p < 0.0005) during arm elevation in subjects with posterior tightness. The alternations in shoulder kinematics between subjects with anterior and posterior shoulder tightness may be relevant to the development of subacromial impingement, tendinitis, and degenerative changes as seen in subjects with stiff shoulders.
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http://dx.doi.org/10.1002/jor.20126DOI Listing
May 2006

Reliability and validity of shoulder tightness measurement in patients with stiff shoulders.

Man Ther 2006 May 10;11(2):146-52. Epub 2005 Aug 10.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 7 Chun-Shan S Rd, Taipei, Taiwan.

The purposes of this study were (1) to examine intratester and intertester reliability of measurement of anterior and posterior shoulder tightness in patients with stiff shoulders (SS), and (2) to assess construct validity by determining the relations between shoulder tightness, shoulder range of motion (ROM), and self-report measures of functional limitation. Anterior and posterior shoulder tightness were measured by two testers in below-chest abduction and cross-chest adduction tests with an inclinometer, respectively, in 16 patients with SS. Both the intratester and intertester reliability for shoulder tightness measurements were good (intratester ICC=0.84 and 0.91; intertester ICC=0.82 and 0.89). The limit of intra-tester and inter-tester agreement (mean, -0.3+/-4.4 degrees ) was acceptable as compared to the standard deviations of the measurements (range, 6.2-7.4 degrees ). Significant relationships between internal rotation and posterior shoulder tightness (R2=0.448, P=0.002), external rotation and anterior shoulder tightness (R2=0.499, P=0.003), and functional disabilities and posterior shoulder tightness (R2=0.432, P=0.006) were found. Significant correlations between shoulder internal rotation and cross-chest adduction, shoulder external rotation and below-chest abduction were observed, indicating that internal and external rotations might be related to posterior and anterior shoulder stiffness. The study also revealed significant relationship between functional disabilities and cross-chest adduction. Below-chest abduction and cross-chest adduction were found to provide reliable data. The construct validity of the abduction and adduction tests is supported by the relationship among these measurements, shoulder ROM, and functional disabilities in patients with SS.
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http://dx.doi.org/10.1016/j.math.2005.05.002DOI Listing
May 2006
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