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2091249 Sonographic Assessment of Lower Trapezius Thickness During a Laboratory Induced Shrug Sign
S160
Ultrasound in Medicine and Biology
displacement, its quantification can assist clinicians in identifying joint hypomobility or hypermobility. Historically, stiffness measurements have been determined using expensive and often complicated motion analysis systems along with wired load cells and force transducers. Ultrasound imaging (USI), can monitor joint surfaces providing displacement measurements while handheld dynamometry (HHD) can reliably measure forces used during the application of manual translational forces. Stiffness can then be calculated and compared to uninvolved joints to assist with differential diagnosis. The purpose of this study was to determine the intratester reliability of posterior glenohumeral stiffness utilizing ultrasound imaging and hand held dynamometry. Methods: 28 healthy adults consented to participate. With the subject supine, the shoulder was positioned in 55 degrees of abduction and 30 degrees of horizontal adduction. The ultrasound transducer was placed over the anterior glenohumeral joint and a posterior translatory force applied through a hand held dynamometer. The maximum force was recorded. This process was repeated three times on each shoulder. End range stiffness was calculated as the amount of movement per unit of force. Descriptive statistics and an intraclass correlation coefficient (ICC) were calculated for stiffness. An ANOVA was used to determine the association between dominance and stiffness. Results: Mean posterior stiffness of the glenohumeral joint was .06 mm/ N (SD5.02) with the standard error of the mean 5 .002mm/N. Intratester reliability was excellent with the ICC for stiffness 5 .905. Stiffness was significantly greater in the dominant arm with less movement per unit force as compared to the nondominant arm. Conclusions: This study provides support for the utilization of ultrasound imaging and hand-held dynamometry to reliably measure posterior stiffness of the glenohumeral joint. Incorporating stiffness measurements into examinations of individuals with shoulder dysfunctions may assist in identifying potential underlying etiology and increase efficacy of treatment. 2091249 Sonographic Assessment of Lower Trapezius Thickness During a Laboratory Induced Shrug Sign Nancy Talbott, Dexter William Witt University of Cincinnati, Cincinnati, OH, United States Objectives: Abnormal elevation of the scapula during overhead movement of the arm is often associated with shoulder dysfunction. This increase in elevation, referred to as a shrug sign, is thought to alter scapular mechanics by increasing activation of the upper trapezius muscle and inhibiting contraction of the lower trapezius (LT). By comparing the thickness of the LT during normal overhead motion and during motion that occurs with scapular elevation, patterns of abnormal muscle firing can be identified, information that will assist with differential diagnosis. The purpose of this study was to determine the pattern of LT thickness during a laboratory induced shrug sign. Methods: 18 healthy adults consented to participate. With the subject sitting, an ultrasound transducer was placed over T7 and the fibers of the LT identified. As the subject actively elevated the arm from 0 to 90 degrees of flexion, a continuous video of the LT was recorded. After resting for 10 seconds, the subject maximally elevated the scapula and maintained that scapular position while flexing the arm to 90 degrees. A continuous US video of the LT was, again, recorded. Each test condition (normal and shrug) was repeated three times on the dominant arm. Measurements of LT thickness were taken when the arm was at two positions: 0 and 90 degrees. Descriptive analyses and an ANOVA were performed. Results: During normal overhead movement from 0-90, LT thickness significantly increased from 3.50mm to 4.07mm. When a shrug sign was simulated, LT thickness did not significantly increase. When comparing LT thickness between conditions, LT thickness varied in both positions. At 0 degrees, LT thickness was 3.50mm without scapular
Volume 41, Number 4S, 2015 elevation and 3.26mm with maximal scapular elevation. At 90 degrees of flexion, LT thickness was 4.07mm with normal scapular mechanics and 3.17mm when the shrug sign was actively induced. Conclusions: Results support a significant change in activation of the LT muscle during a simulated shrug sign. The inhibition appears to accompany active scapular elevation, occurring before shoulder movement is initiated and continuing through 90 degrees of flexion. Even without resistance, LT thickening was reduced by approximately 25%. 2091264 Manual Application of Inferior Glenohumeral Mobilizations: An Ultrasound Investigation of The Effect of Shoulder Position on Movement and Force Dexter William Witt, Nancy Talbott Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, United States Objectives: The open packed position (OPP) of the glenohumeral joint is often utilized during assessment of inferior glenohumeral (GH) movement and inferior mobilization techniques by practitioners of manual therapy. With the shoulder in 50 degrees of abduction, 30 degrees of horizontal adduction and no rotation, the OPP is thought to allow maximal intraarticular movement. Another movement associated with inferior humeral mobilization is long axis distraction. With the shoulder in a neutral position (NP), the humerus is distracted in an inferior direction resulting in an inferior movement of the humerus. Few studies have compared these two positions as to which may be most effective in inducing humeral inferior translation. The purpose of this study was to determine if inferior humeral movement was significantly different with the shoulder in the OPP versus the NP utilizing ultrasound imaging. Methods: 23 healthy adults consented to participate. Subjects were placed in the OPP and an ultrasound transducer placed over the superior GH joint. As 3 progressive inferior mobilization forces were applied through a hand held dynamometer, ultrasound images were taken at rest and during the 3 grades of inferior mobilization. This was repeated with the subject in the NP. Maximum forces for each grade were recorded. The humeral head position was measured in reference to the acromion and the amount of movement determined by the distance the humeral head moved from the rest position. Results: Movement was significantly greater in the NP than in the OPP during grade 1 mobilizations (1.77mm versus 0.96mm) and during grade 2 (3.83mm versus 2.44mm). Although grade 3 movements followed a similar trend, the inferior movement in the NP was not significantly different from the movement in the OPP. Forces utilized during all grades of inferior mobilization in the NP were significantly greater than forces utilized during similar mobilizations in the OPP. Conclusions: This research supports the use of the OPP for GH assessment or treatment techniques in which full inferior translation is desired. 2091265 Test Diagnostic Accuracy of Lung Ultrasonography in Acute Respiratory Distress Syndrome Among Preterm Infants Hong Liu, Jie Zhou, Hai-tao Gu Cardiothoracic Surgery, Nanjing Medical University, Nanjing, China Objectives: To evaluate the diagnostic yields of lung ultrasonography (LUS) in detecting acute respiratory distress syndrome in preterm infants, in addition to the potential role of the demographic and clinical characteristics. Methods: A prospective double-blind pilot study included consecutive 50 preterm infants diagnosed as having known or suspected ARDS on the basis of clinical and radiographic signs. Whereas the 50 healthy infants as control were selected by age. LUS was available for the ARDS preterm infants using both transthoracic and transabdominal approaches on the first day after birth and the subsequent investigations, in comprasion with the findings of chest X-ray. Receiver operating Characteristic
Ultrasound in Medicine and Biology
displacement, its quantification can assist clinicians in identifying joint hypomobility or hypermobility. Historically, stiffness measurements have been determined using expensive and often complicated motion analysis systems along with wired load cells and force transducers. Ultrasound imaging (USI), can monitor joint surfaces providing displacement measurements while handheld dynamometry (HHD) can reliably measure forces used during the application of manual translational forces. Stiffness can then be calculated and compared to uninvolved joints to assist with differential diagnosis. The purpose of this study was to determine the intratester reliability of posterior glenohumeral stiffness utilizing ultrasound imaging and hand held dynamometry. Methods: 28 healthy adults consented to participate. With the subject supine, the shoulder was positioned in 55 degrees of abduction and 30 degrees of horizontal adduction. The ultrasound transducer was placed over the anterior glenohumeral joint and a posterior translatory force applied through a hand held dynamometer. The maximum force was recorded. This process was repeated three times on each shoulder. End range stiffness was calculated as the amount of movement per unit of force. Descriptive statistics and an intraclass correlation coefficient (ICC) were calculated for stiffness. An ANOVA was used to determine the association between dominance and stiffness. Results: Mean posterior stiffness of the glenohumeral joint was .06 mm/ N (SD5.02) with the standard error of the mean 5 .002mm/N. Intratester reliability was excellent with the ICC for stiffness 5 .905. Stiffness was significantly greater in the dominant arm with less movement per unit force as compared to the nondominant arm. Conclusions: This study provides support for the utilization of ultrasound imaging and hand-held dynamometry to reliably measure posterior stiffness of the glenohumeral joint. Incorporating stiffness measurements into examinations of individuals with shoulder dysfunctions may assist in identifying potential underlying etiology and increase efficacy of treatment. 2091249 Sonographic Assessment of Lower Trapezius Thickness During a Laboratory Induced Shrug Sign Nancy Talbott, Dexter William Witt University of Cincinnati, Cincinnati, OH, United States Objectives: Abnormal elevation of the scapula during overhead movement of the arm is often associated with shoulder dysfunction. This increase in elevation, referred to as a shrug sign, is thought to alter scapular mechanics by increasing activation of the upper trapezius muscle and inhibiting contraction of the lower trapezius (LT). By comparing the thickness of the LT during normal overhead motion and during motion that occurs with scapular elevation, patterns of abnormal muscle firing can be identified, information that will assist with differential diagnosis. The purpose of this study was to determine the pattern of LT thickness during a laboratory induced shrug sign. Methods: 18 healthy adults consented to participate. With the subject sitting, an ultrasound transducer was placed over T7 and the fibers of the LT identified. As the subject actively elevated the arm from 0 to 90 degrees of flexion, a continuous video of the LT was recorded. After resting for 10 seconds, the subject maximally elevated the scapula and maintained that scapular position while flexing the arm to 90 degrees. A continuous US video of the LT was, again, recorded. Each test condition (normal and shrug) was repeated three times on the dominant arm. Measurements of LT thickness were taken when the arm was at two positions: 0 and 90 degrees. Descriptive analyses and an ANOVA were performed. Results: During normal overhead movement from 0-90, LT thickness significantly increased from 3.50mm to 4.07mm. When a shrug sign was simulated, LT thickness did not significantly increase. When comparing LT thickness between conditions, LT thickness varied in both positions. At 0 degrees, LT thickness was 3.50mm without scapular
Volume 41, Number 4S, 2015 elevation and 3.26mm with maximal scapular elevation. At 90 degrees of flexion, LT thickness was 4.07mm with normal scapular mechanics and 3.17mm when the shrug sign was actively induced. Conclusions: Results support a significant change in activation of the LT muscle during a simulated shrug sign. The inhibition appears to accompany active scapular elevation, occurring before shoulder movement is initiated and continuing through 90 degrees of flexion. Even without resistance, LT thickening was reduced by approximately 25%. 2091264 Manual Application of Inferior Glenohumeral Mobilizations: An Ultrasound Investigation of The Effect of Shoulder Position on Movement and Force Dexter William Witt, Nancy Talbott Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, United States Objectives: The open packed position (OPP) of the glenohumeral joint is often utilized during assessment of inferior glenohumeral (GH) movement and inferior mobilization techniques by practitioners of manual therapy. With the shoulder in 50 degrees of abduction, 30 degrees of horizontal adduction and no rotation, the OPP is thought to allow maximal intraarticular movement. Another movement associated with inferior humeral mobilization is long axis distraction. With the shoulder in a neutral position (NP), the humerus is distracted in an inferior direction resulting in an inferior movement of the humerus. Few studies have compared these two positions as to which may be most effective in inducing humeral inferior translation. The purpose of this study was to determine if inferior humeral movement was significantly different with the shoulder in the OPP versus the NP utilizing ultrasound imaging. Methods: 23 healthy adults consented to participate. Subjects were placed in the OPP and an ultrasound transducer placed over the superior GH joint. As 3 progressive inferior mobilization forces were applied through a hand held dynamometer, ultrasound images were taken at rest and during the 3 grades of inferior mobilization. This was repeated with the subject in the NP. Maximum forces for each grade were recorded. The humeral head position was measured in reference to the acromion and the amount of movement determined by the distance the humeral head moved from the rest position. Results: Movement was significantly greater in the NP than in the OPP during grade 1 mobilizations (1.77mm versus 0.96mm) and during grade 2 (3.83mm versus 2.44mm). Although grade 3 movements followed a similar trend, the inferior movement in the NP was not significantly different from the movement in the OPP. Forces utilized during all grades of inferior mobilization in the NP were significantly greater than forces utilized during similar mobilizations in the OPP. Conclusions: This research supports the use of the OPP for GH assessment or treatment techniques in which full inferior translation is desired. 2091265 Test Diagnostic Accuracy of Lung Ultrasonography in Acute Respiratory Distress Syndrome Among Preterm Infants Hong Liu, Jie Zhou, Hai-tao Gu Cardiothoracic Surgery, Nanjing Medical University, Nanjing, China Objectives: To evaluate the diagnostic yields of lung ultrasonography (LUS) in detecting acute respiratory distress syndrome in preterm infants, in addition to the potential role of the demographic and clinical characteristics. Methods: A prospective double-blind pilot study included consecutive 50 preterm infants diagnosed as having known or suspected ARDS on the basis of clinical and radiographic signs. Whereas the 50 healthy infants as control were selected by age. LUS was available for the ARDS preterm infants using both transthoracic and transabdominal approaches on the first day after birth and the subsequent investigations, in comprasion with the findings of chest X-ray. Receiver operating Characteristic