Journal of the Korean Society of Physical Medicine
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v.11
no.3
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pp.49-54
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2016
PURPOSE: This study was implemented to measure the muscle activity of muscles surrounding shoulder during push-up exercise according to the slope angle. METHODS: This study has research subject consisting of 25 normal male adults without neurologic or musculoskeletal injury in shoulder part. EMG was used as a tool for measuring muscle activity and four muscles including upper trapezius (UT), middle trapezius (MT), Lower Trapezius (LT), and Serratus Anterior (SA) were chosen for measuring the muscle activity of muscles surrounding shoulder. Tilting table slope was set at $0^{\circ}$, $30^{\circ}$, $45^{\circ}$, and $60^{\circ}$ and push-up motion was performed three time for each case to use the average value. The measured value was used after generalization process to create %RVC value where the measured value was standardized by using $0^{\circ}$ as a standard. RESULTS: There was a difference of muscle activity according to the tilting table slope during push-up exercise. In UT, MT, and SA, there was no significant $0^{\circ}$ and $30^{\circ}$, $45^{\circ}$ and $60^{\circ}$. But there was significant $30^{\circ}$ and $45^{\circ}$. LT was significant difference between $45^{\circ}$ and $60^{\circ}$ (p<.05). CONCLUSION: There are cases where push-up exercise should be selectively implemented due to shoulder problems. According to this results between $0^{\circ}$ and $30^{\circ}$, push up will be able to more effectively exercise. Applying proper angle of tilting table for push-up to patients who have difficulties in performing motions along with physical consumption can deliver effective and easy exercise program.
Background: Forward head posture (FHP) is a postural alignment of the cervical vertebrae that leads to increased gravitational load on cervical segmental motions. The overhead arm lift test assesses the ability to actively dissociate and control low cervical flexion and move the shoulders through overhead flexion. Objects: The purpose of this study was to explore muscle activities in the upper trapezius (UT), serratus anterior (SA), sternocleidomastoid (SCM), and lower trapezius (LT) alongside changes in head position during the overhead arm lift test in individuals with FHP. Methods: Fifteen subjects with forward head posture and fifteen subjects with normal subjcects were enrolled in this study. The patients performed the overhead arm lift test, and muscle activities of the UT, SCM, SA, and LT were measured using surface electromyography and by evaluating changes in head position. Independent t-tests were used to detect significant differences between the two groups and Cohen's d was calculated to measure the size of the mean difference between the groups. Results: The FHP group demonstrated significantly increased muscle activity of the UT ($32.46{\pm}7.64$), SCM ($12.79{\pm}4.01$), and LT ($45.65{\pm}10.52$) and significantly decreased activity in the SA ($26.65{\pm}6.15$) than the normal group. The change in head position was significantly higher in the FHP group ($6.66{\pm}2.08$) than the normal group. Effect sizes for all parameters assessed were large between the two groups. Conclusion: The subjects with excessive FHP displayed were unable to fix their heads in position during the overhead arm lift test. The overhead arm lift test can thus be used in clinical settings to confirm control of the neck in these subjects.
Background: Push-up are effective exercises for shoulder stability. Previous studies have documented the effects of support plane and hand position and width on muscle activities during a push-up. Objects: This study aimed to investigate the changes in muscle activities in the upper extremity when performing the standard and the knee-flexed push-up with different hand shapes. Methods: A total of twenty-six healthy males participated in this study. Three different hand shapes (finger abduction, finger adduction, and fists) and two types of push-up posture (standard and knee-flexed push-up) were set as the independent variables. Electrograms were used to measure the muscle activity of the upper trapezius (UT), triceps brachii (TB), pectoralis major (PM), and serratus anterior (SA). Each participant performed the randomly assigned push-up to the sound of the metronome. The mixed-effect linear regression model was used to detect the changes in muscle activities after changing the hand shape and push-up posture. Statistical significance was set at α = 0.05. Results: The UT muscle activity was statistically significantly higher when performing push-up with fists than finger abduction (p = 0.035) or finger adduction (p = 0.044). During the standard push-up, the muscle activity in all muscles was that the push-up with fists showed the highest muscle activity compared to the finger abduction (p < 0.01) and finger adduction (p < 0.01). Regardless of the shape of the hand, UT had the lowest muscle activity compared to other muscles (p < 0.001). In contrast, the SA muscle had the highest muscle activity among four muscles during the standard push-up. Conclusion: Based on the results of this study, we suggest hand shape is related to the difficulty level of push-up either in the standard or the knee-flexed push-up, especially in the push-up with fists. In addition, knee push-up can be recommended as shoulder muscle-strengthening exercises for individuals with low shoulder muscle strength.
Purpose: Breast surgeons usually insert tissue expander or implant beneath the subpectoral - subglandular dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape because there is implant migration due to the pectoralis major muscle contraction and gravity. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm$^{(R)}$(LifeCell Corp., Branchburg, N.J.) sling. Methods: The AlloDerm$^{(R)}$ sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm$^{(R)}$ was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral - subAlloDerm dual pocket. Results: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape. In conclusion, patients obtain relatively natural breast shape. There was no complication except one case of capsular contracture and one case of breast cellulitis. Conclusion: Implant breast reconstruction using AlloDerm$^{(R)}$ sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.
Background: The CKCUES test evaluates the functional performance of the shoulder joint. The CKCUES test scores CKC exercises of the upper limbs to examine shoulder stability. Although the CKCUES test provides quantitative data on functional ability and performance, no study has determined the relationship between CKCUES scores and SA and TB muscle strength. Objects: The objective of this study is to determine the relationship between the CKCUES test scores and the strength of the SA and TB muscles in the CKCUES and unilateral CKCUES tests. Methods: Sixty-six healthy male volunteers participated in the study. A Smart KEMA strength sensor measured SA and TB muscle strength. Two parallel lines on the floor indicated the initial hand placement to start CKCUES tests. For 15 seconds, the subject raises one hand and reaches over to touch the supporting hand, then returns to the starting position. Results: The correlation between the CKCUES test scores and the strength of the SA was strong (r = 0.650, p < 0.001), and the TB was moderate (r = 0.438, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the SA of the supporting side was strong (r = 0.605, p < 0.001), and swing side was strong (r = 0.681, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the TB of the supporting side was moderate (r = 0.409, p < 0.001), and swing side was moderate (r = 0.482, p < 0.001). Conclusion: Our study showed that the CKCUES test had a strong association with isometric strength of SA and moderate association with that of TB. These findings suggest that the CKCUES test can evaluate the function of the SA. Moreover, the unilateral CKCUES test can evaluate unilateral shoulder function.
Purpose: The purpose of this study was to assess how much neurac technic affects the stability muscles of the shoulder according to the supporting surface in crawling position. Method: 29 healthy adult males participated in this experiment. The experiment consists of 2 experimental groups and 1 control group. It is conducted for 3 weeks. Each group exercised for 7 seconds and then rested for 3 seconds. Using EMG, the average value of serratus anterior, upper trapezius, and lower trapezius was repeated three times. Experimental group 1 conducted push up plus exercise applied neurac technic with sling on unstable supporting surface. Experimental group 2 conducted push up plus exercise applied neurac technic with sling on stable supporting surface. Control group conducted the push up plus exercise on stable supporting surface. One-way ANOVA was used for statistical analysis. Result: It was noticeable that the result of Experimental group 1 affects stability muscles of more than Experimental group 2 and Control group. Conclusion: Push up plus position applied neurac technic with sling on unstable supporting surface was the most effective in activating the stability muscles of the shoulder.
The aim of this study was to compare the electromyographic (EMG) activity levels of the scapular upward rotators [upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA)] and other scapular muscles [posterior deltoid (PD), levator scapulae (LS), and infraspinatus (IS)] during isometric lower trapezius exercises. Twenty males with no medical history of shoulder pain or upper extremity disorders were recruited for this study. EMG activity was recorded from the UT, LT, SA, PD, LS, and IS while subjects performed three different exercises: Prone arm lift (PAL), Backward rocking diagonal arm lift (BRDAL), Modified Prone Cobra (MPC). One-way analysis of variance (ANOVA) was used to determine any significant differences among the three exercises. A lower relative activation of UT, LT, and SA was seen with the MPC than with the other exercises (p<.05). The relatively lower activation of the UT identified, the MPC exercise as the preferred choice for preferential strengthening the LT (p<.05). However, a higher activation in the PD, LS, and IS occurred with the MPC than with the other exercises (p>.05). The recruitment pattern of synergist varied depending on the exercise posture. These findings suggest that exercise posture is an important factor in the selection of strengthening exercise for weak muscle.
The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neuro-surgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.
Background: Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery. Methods: This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed. Results: Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min. Conclusions: The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.
Kim, Bo-been;Lee, Ji-hyun;Jeong, Hyo-jung;Cynn, Heon-seock
Physical Therapy Korea
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v.23
no.2
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pp.57-66
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2016
Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a "downstream" effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly post-versus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p>.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.
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