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Richard J. Hawkins - One of the best experts on this subject based on the ideXlab platform.
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Subscapularis Muscle Activity during Selected Rehabilitation Exercises
American Journal of Sports Medicine, 2017Co-Authors: Michael J. Decker, John M. Tokish, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:BackgroundThe upper and lower portions of the Subscapularis Muscle are independently innervated and activated.HypothesisUpper and lower portions of the Subscapularis Muscle demonstrate different activation levels and require different exercises for rehabilitation.Study DesignControlled laboratory study.MethodsFifteen healthy subjects performed seven shoulder-strengthening exercises. Electromyographic data were collected from the latissimus dorsi, teres major, pectoralis major, infraspinatus, supraspinatus, and upper and lower Subscapularis Muscles.ResultsUpper Subscapularis Muscle activity was greater than lower Subscapularis Muscle activity for all exercises except for internal rotation with 0° of humeral abduction. The push-up plus and diagonal exercises consistently stressed the upper and lower Subscapularis Muscles to the greatest extent.ConclusionsHumeral abduction was found to have a strong influence on the selective activation of the upper versus the lower Subscapularis Muscle and thus supported th...
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the belly press test for the physical examination of the Subscapularis Muscle electromyographic validation and comparison to the lift off test
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P <.05). The belly-press test was found to activate the upper Subscapularis Muscle significantly more than the lift-off test (P <.05), whereas the lift-off test was found to pose a significantly greater challenge to the lower Subscapularis Muscle than the belly-press test (P <.05). These findings may improve the clinical testing and assessment of the Subscapularis Muscle.
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The belly-press test for the physical examination of the Subscapularis Muscle: electromyographic validation and comparison to the lift-off test.
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P
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Validation of the Lift-Off Test and Analysis of Subscapularis Activity During Maximal Internal Rotation
American Journal of Sports Medicine, 1996Co-Authors: Patrick E. Greis, John E. Kuhn, Jeanne M. Schultheis, Robert Hintermeister, Richard J. HawkinsAbstract:We used electromyographic analysis to determine the Muscle activity of the shoulder Muscles during the lift-off test and during resisted internal rotation. The activity in the upper and lower Subscapularis Muscle during a lift-off test from the region of the midlumbar spine was approximately 70% of maximal voluntary contraction. This level was significantly higher than for all the other Muscles tested (P < 0.05). The lift-off test with the hand placed in the region of the midlumbar spine resulted in one-third more electromyographic ac tivity in the Subscapularis Muscle than when the test was modified and performed with the hand at the but tocks region. A resisted lift-off test resulted in higher activities in all the Muscles, but only a small increase in the pectoralis major Muscle. The pectoralis major mus cle was significantly more active during resisted inter nal rotation with the arm in front of the body. Compar ison of activity in the upper Subscapularis with that in the lower Subscapularis Muscle sh...
Edward G. Mcfarland - One of the best experts on this subject based on the ideXlab platform.
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Prevention of Axillary Nerve Injury in Anterior Shoulder Reconstructions Use of a Subscapularis Muscle-Splitting Technique and a Review of the Literature
2016Co-Authors: Edward G. Mcfarland, Prachan BanchasuekAbstract:Background: Previous authors have suggested that the axillary nerve should be explored or palpated during all anterior shoulder stabilization procedures. Objective: The goal of this study was to document the axillary nerve injury rate in a cohort of patients who had undergone anterior shoulder stabilization without axillary nerve dissection. Hypothesis: Use of a Subscapularis Muscle-splitting approach by using a retractor along the scapular neck does not result in significant risk of injury to the axillary nerve, and exploration of the axillary nerve is not necessary using this approach. Study Design: Prospective cohort study. Methods: One hundred and twenty-eight anterior stabilizations were performed with a Subscapularis Muscle-splitting approach that has been previously described. In all cases a retractor was placed along the inferior scapular neck to protect the axillary nerve. The axillary nerve was not exposed or palpated in any case. All patients were evaluated on the 1st postoperative day and again within 10 days for symptoms of axillary nerve palsy, including sensory loss and return of Muscle function. One patient (0.8%) had paresthesia in an axillary nerve distribution; recovery occurred without the need for electromyography or other interventions. There were no clinically detected cases of axillary nerve motor dysfunction. Conclusions: Routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a Subscapularis Muscle-splitting approach if proper precautions are taken to protect the nerve. Other techniques of anterio
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Prevention of axillary nerve injury in anterior shoulder reconstructions: use of a Subscapularis Muscle-splitting technique and a review of the literature.
American Journal of Sports Medicine, 2002Co-Authors: Edward G. Mcfarland, Juan Carlos Caicedo, Tae Kyun Kim, Prachan BanchasuekAbstract:Background: Previous authors have suggested that the axillary nerve should be explored or palpated during all anterior shoulder stabilization procedures.Objective: The goal of this study was to document the axillary nerve injury rate in a cohort of patients who had undergone anterior shoulder stabilization without axillary nerve dissection.Hypothesis: Use of a Subscapularis Muscle-splitting approach by using a retractor along the scapular neck does not result in significant risk of injury to the axillary nerve, and exploration of the axillary nerve is not necessary using this approach.Study Design: Prospective cohort study.Methods: One hundred and twenty-eight anterior stabilizations were performed with a Subscapularis Muscle-splitting approach that has been previously described. In all cases a retractor was placed along the inferior scapular neck to protect the axillary nerve. The axillary nerve was not exposed or palpated in any case. All patients were evaluated on the 1st postoperative day and again wi...
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the anatomic relationship of the brachial plexus and axillary artery to the glenoid implications for anterior shoulder surgery
American Journal of Sports Medicine, 2001Co-Authors: Edward G. Mcfarland, Juan Carlos Caicedo, Marie Isabel Guitterez, Paul S SherbondyAbstract:Iatrogenic brachial plexus injury is an uncommon but potentially severe complication of shoulder reconstruction for instability that involves dissection near the Subscapularis Muscle and potentially near the brachial plexus. We examined the relationship of the brachial plexus to the glenoid and the Subscapularis Muscle and evaluated the proximity of retractors used in anterior shoulder surgical procedures to the brachial plexus. Eight fresh-frozen cadaveric shoulders were exposed by a deltopectoral approach. The Subscapularis Muscle was split in the middle and dissected to reveal the capsule beneath it. The capsule was split at midline, and a Steinmann pin was placed in the equator of the glenoid rim under direct visualization. The distance from the glenoid rim to the brachial plexus was measured with calipers with the arm in 0°, 60°, and 90° of abduction. The brachial plexus and axillary artery were within 2 cm of the glenoid rim, with the brachial plexus as close as 5 mm in some cases. There was no stat...
M. Nedim Doral - One of the best experts on this subject based on the ideXlab platform.
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Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study
Knee Surgery Sports Traumatology Arthroscopy, 2003Co-Authors: Alp Bayramoglu, Deniz Demiryürek, Mine Erbil, Onur Tetik, Eray Tüccar, M. Mustafa Aldur, M. Nedim DoralAbstract:The purpose of the study was to determine anatomical variations at the suprascapular notch for better understanding of possible predisposing factors for suprascapular nerve entrapment. We dissected 32 shoulders of 16 cadavers between the ages of 39 and 74 years. We observed abnormally oriented superior fibers of the Subscapularis Muscle in five shoulders of the 16 cadavers, which were covering the entire anterior surface of the suprascapular notch and significantly reducing the available space for the suprascapular nerve. We also detected anterior coracoscapular ligament in six of the 32 shoulders, and calcified superior transverse scapular ligament in four of the shoulders. In this study, we classified the variations for the superior transverse scapular ligament. In conclusion, knowing the anatomical variations in detail along the course of the suprascapular nerve might be important for better understanding of location and source of the entrapment syndrome, especially for individuals who are involved in violent overhead sports activities such as volleyball and baseball. To our knowledge, close relationship of Subscapularis Muscle with the suprascapular nerve as a possible risk factor for suprascapular nerve entrapment has not been mentioned previously.
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Hypertrophy of the Subscapularis Muscle might be an etiologic factor for suprascapular nerve entrapment at the suprascapular notch
2002Co-Authors: Alp Bayramoglu, Deniz Demiryürek, Mine Erbil, Mustafa Aktekin, Onur Tetik, M. Nedim DoralAbstract:During the routine dissection of a 57 year old male cadaver, a hypertrophied Subscapularis Muscle was detected on the right side. Hypertrophied Subscapularis Muscle originated from the anterior surface of the scapula and inserted to the lesser tubercle of the humerus. Its superior part covered the entire anterior surface of the suprascapular notch and lay on the suprascapular nerve while it travelled through the notch under the superior transverse scapular ligament. Since the Subscapularis Muscle functions actively in the repetetive movements of the shoulder joint, hypertrophy of this Muscle like in our case might be one of the reasons for the suprascapular nerve entrapment seen at the suprascapular notch specially for the ones who are involved in the overhead activities such as volleyball players and baseball pitchers.
John M. Tokish - One of the best experts on this subject based on the ideXlab platform.
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Subscapularis Muscle Activity during Selected Rehabilitation Exercises
American Journal of Sports Medicine, 2017Co-Authors: Michael J. Decker, John M. Tokish, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:BackgroundThe upper and lower portions of the Subscapularis Muscle are independently innervated and activated.HypothesisUpper and lower portions of the Subscapularis Muscle demonstrate different activation levels and require different exercises for rehabilitation.Study DesignControlled laboratory study.MethodsFifteen healthy subjects performed seven shoulder-strengthening exercises. Electromyographic data were collected from the latissimus dorsi, teres major, pectoralis major, infraspinatus, supraspinatus, and upper and lower Subscapularis Muscles.ResultsUpper Subscapularis Muscle activity was greater than lower Subscapularis Muscle activity for all exercises except for internal rotation with 0° of humeral abduction. The push-up plus and diagonal exercises consistently stressed the upper and lower Subscapularis Muscles to the greatest extent.ConclusionsHumeral abduction was found to have a strong influence on the selective activation of the upper versus the lower Subscapularis Muscle and thus supported th...
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the belly press test for the physical examination of the Subscapularis Muscle electromyographic validation and comparison to the lift off test
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P <.05). The belly-press test was found to activate the upper Subscapularis Muscle significantly more than the lift-off test (P <.05), whereas the lift-off test was found to pose a significantly greater challenge to the lower Subscapularis Muscle than the belly-press test (P <.05). These findings may improve the clinical testing and assessment of the Subscapularis Muscle.
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The belly-press test for the physical examination of the Subscapularis Muscle: electromyographic validation and comparison to the lift-off test.
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P
Michael J. Decker - One of the best experts on this subject based on the ideXlab platform.
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Subscapularis Muscle Activity during Selected Rehabilitation Exercises
American Journal of Sports Medicine, 2017Co-Authors: Michael J. Decker, John M. Tokish, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:BackgroundThe upper and lower portions of the Subscapularis Muscle are independently innervated and activated.HypothesisUpper and lower portions of the Subscapularis Muscle demonstrate different activation levels and require different exercises for rehabilitation.Study DesignControlled laboratory study.MethodsFifteen healthy subjects performed seven shoulder-strengthening exercises. Electromyographic data were collected from the latissimus dorsi, teres major, pectoralis major, infraspinatus, supraspinatus, and upper and lower Subscapularis Muscles.ResultsUpper Subscapularis Muscle activity was greater than lower Subscapularis Muscle activity for all exercises except for internal rotation with 0° of humeral abduction. The push-up plus and diagonal exercises consistently stressed the upper and lower Subscapularis Muscles to the greatest extent.ConclusionsHumeral abduction was found to have a strong influence on the selective activation of the upper versus the lower Subscapularis Muscle and thus supported th...
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The Influence of Arm and Shoulder Position on the Bear-Hug, Belly-Press, and Lift-Off Tests An Electromyographic Study
American Journal of Sports Medicine, 2011Co-Authors: Andrew T. Pennock, Michael J. Decker, Michael R. Torry, W. Wesley Pennington, Suketu B. Vaishnav, Matthew T. Provencher, Peter J. Millett, Thomas R. HackettAbstract:Background: Clinical testing for the integrity of the Subscapularis Muscle includes the belly-press, lift-off, and bear-hug examinations. While these tests have been widely applied in clinical practice, there is considerable variation in arm positioning within each clinical examination.Hypothesis: To determine the ideal arm and shoulder positions for isolating the Subscapularis Muscle while performing the bear-hug, belly-press, and lift-off tests.Study Design: Controlled laboratory study.Methods: The activity of 7 Muscles was monitored in 20 healthy participants: upper and lower divisions of the Subscapularis, supraspinatus, infraspinatus, latissimus dorsi, teres major, triceps, pectoralis major. Electromyogram data were collected and compared across each clinical test at varying arm positions: bear-hug (ideal position, 10° superior, 10° inferior to the shoulder line), belly-press (ideal position, maximum shoulder external rotation, and maximal shoulder internal rotation), and lift-off (ideal position, ha...
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the belly press test for the physical examination of the Subscapularis Muscle electromyographic validation and comparison to the lift off test
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P <.05). The belly-press test was found to activate the upper Subscapularis Muscle significantly more than the lift-off test (P <.05), whereas the lift-off test was found to pose a significantly greater challenge to the lower Subscapularis Muscle than the belly-press test (P <.05). These findings may improve the clinical testing and assessment of the Subscapularis Muscle.
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The belly-press test for the physical examination of the Subscapularis Muscle: electromyographic validation and comparison to the lift-off test.
Journal of Shoulder and Elbow Surgery, 2003Co-Authors: John M. Tokish, Michael J. Decker, Henry B. Ellis, Michael R. Torry, Richard J. HawkinsAbstract:The purpose of this study was to determine the validity of the belly-press test as a clinical test for the Subscapularis Muscle with the use of electromyography (EMG). In addition, the belly-press and lift-off tests were compared to determine whether the two physical examination techniques are equivalent in their evaluation of the upper and lower portions of the Subscapularis Muscle. EMG data of 7 Muscles (upper Subscapularis, lower Subscapularis, infraspinatus, latissimus dorsi, teres major, pectoralis major, and supraspinatus) were studied in 16 healthy volunteers. Average EMG amplitudes were contrasted within and between tests. Both the belly-press and lift-off tests activated the upper and lower portions of the Subscapularis Muscle greater than all other Muscles, indicating that both tests are valid and specific for evaluation of the Subscapularis Muscle (P
