Arthrofibrosis Nightmares: Prevention and Management Strategies.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: C.L.C. reports personal fees and nonfinancial support from Arthrex, nonfinancial support from Zimmer Biomet, nonfinancial support from Stryker Corporation. A.J.K. reports grants from Aesculap/B.Braun, other from American Journal of Sports Medicine, personal fees and other from Arthrex Inc., grants from Arthritis foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International society of Arthroscopy, Knee surgery, and orthopaedic sports medicine, other from Minnesota Orthopedic society, personal fees and other from Musculoskeletal Transplant Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF, grants from Exactech, grants from Gemini Medical, personal fees from Responsive Arthroscopy. M.J.S. reports involvement in the editorial or governing board for the American Journal of Sports Medicine, grants and personal fees from Arthrex Inc., grants from Stryker. M.P.A. reports involvement in the board or committee member of AAOS, publishing royalties, financial or material support from Springer, and IP royalties from Stryker. B.A.L. reports personal fees from Arthrex Inc.: IP royalties; Paid consultant, grants from Biomet: Research support, editorial or governing board for Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Orthopedics Today; grants and personal fees from Smith & Nephew: Paid consultant; Research support, grants from Stryker: Research support, personal fees from Linvatec: Faculty/speaker, personal fees from COVR Medical LLC. The remaining authors declare no conflict of interest. 4. J Orthop Sports Phys Ther. 2009 Feb;39(2):90-104. doi: 10.2519/jospt.2009.2808. The association of scapular kinematics and glenohumeral joint pathologies. Ludewig PM(1), Reynolds JF. Author information: (1)Department of Physical Medicine and Rehabilitation, The University of Minnesota, Minneapolis, MN 55455, USA. Ludew001@umn.edu There is a growing body of literature associating abnormal scapular positions and motions, and, to a lesser degree, clavicular kinematics with a variety of shoulder pathologies. The purpose of this manuscript is to (1) review the normal kinematics of the scapula and clavicle during arm elevation, (2) review the evidence for abnormal scapular and clavicular kinematics in glenohumeral joint pathologies, (3) review potential biomechanical implications and mechanisms of these kinematic alterations, and (4) relate these biomechanical factors to considerations in the patient management process for these disorders. There is evidence of scapular kinematic alterations associated with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumeral instability, adhesive capsulitis, and stiff shoulders. There is also evidence for altered muscle activation in these patient populations, particularly, reduced serratus anterior and increased upper trapezius activation. Scapular kinematic alterations similar to those found in patient populations have been identified in subjects with a short rest length of the pectoralis minor, tight soft-tissue structures in the posterior shoulder region, excessive thoracic kyphosis, or with flexed thoracic postures. This suggests that attention to these factors is warranted in the clinical evaluation and treatment of these patients. The available evidence in clinical trials supports the use of therapeutic exercise in rehabilitating these patients, while further gains in effectiveness should continue to be pursued. LEVEL OF EVIDENCE: Level 5. DOI: 10.2519/jospt.2009.2808 PMCID: PMC2730194