RESEARCH PROPOSAL
EFFECT OF SHOULDER IMPAIRMENTS ON GRIP STRENGTH:
A CROSS SECTIONAL STUDY
MPT (MUSCULOSKELETAL & SPORTS PHYSIOTHERAPY)
MS. CORREA REGINA JOSEPH
DEPARTMENT OF PHYSIOTHERAPY
FR. MULLER MEDICAL COLLEGE, MANGALORE-575002
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / MS. CORREA REGINA JOSEPH
DEPARTMENT OF PHYSIOTHERAPY
FATHER MULLER MEDICAL COLLEGE
MANGALORE-575002
2. / NAME OF THE
INSTITUTION / FATHER MULLER MEDICAL COLLEGE
3. / COURSE OF THE STUDY
AND SUBJECT / MASTER OF PHYSIOTHERAPY (MUSCULOSKELETAL DISORDERS & SPORTS)
4. / DATE OF ADMISSION TO
THE COURSE / 15.07.2013
5. / TITLE OF THE TOPIC:
EFFECT OF SHOULDER IMPAIRMENTS ON HAND GRIP: A CROSS-SECTIONAL STUDY
BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY:
Shoulder pain is a very common condition that often has a multifactorial underlying pathology and is associated with high societal cost and patient burden.1 The statistics of shoulder pain in US shows that approximately 16 percent of all musculoskeletal complaints, with a yearly incidence of 15 new episodes per 1,000 patients are seen in the primary care setting.2
Shoulder pain may be triggered more commonly by lifting, reaching and pulling movements that strain the muscles and tendons or sprain ligaments surrounding the shoulder joint. Injury may not be realized during activity. Discomfort may develop days later. Repetitive movements can lead to pain at the shoulder. These overuse type injuries are not limited to sports activities, even daily tasks or manual labor can lead to shoulder pain over time.3Shoulder pain is a common reason for seeking care as it impacts on a range of activities of daily living, including sleep.4Approximately 10% of the general adults experience an episode of shoulder pain once in their lifetime.5
Shoulder impairment or pain can result frombursitis,tendinitis,rotator cuff tear,adhesive capsulitis,impingement syndrome, avascular necrosis, glenohumeral osteoarthritis(OA), and other causes ofdegenerative joint diseaseor from traumatic injury, either in combination or as a separate entity. Rotator cuff disorders,adhesive capsulitis, and glenohumeralOA commonly causes persistent shoulder pain, accounting for about 10%, 6%, and 2% to 5%, respectively, of all shoulder pain.1
Grip strength is one of the main components tested while evaluating hand function and also provides an objective index of the functional integrity of the upper extremity.4 In performing the power grip the object must be taken hold of, and then the fingers must clench themselves around the object to hold it more firmly. In power grip the combined fingers form 1 jaw of the clamp with the palm as the other jaw. The fingers are almost flexed according to the size of the object and rotated laterally and inclined towards the ulnar side.6 As fingers take hold of the object they are strongly drawn by the flexor profundus which keeps them in a position which ensures an efficient grip. The so called phalangeal tendons of the interossei which include the abductor digiti minimi are most eminently suited to contribute the power involved in actual grasp.6
The myoelectric activity of the shoulder muscles with the dynamometer in hand was compared to the EMG activity during static contractions of hand. There was a correlation between static handgrip and shoulder muscle activity, as revealed by EMG. These findings imply that high static hand grip force, increases the load on some shoulder muscles particularly in elevated arm position. Some muscles did show a positive correlation between degree of intensity of exertion and degree of shoulder muscle activity in most of the tested arm positions. The stabilizing muscles (the rotator cuff) were more recruited than the motor muscles by hand activity. Thus it is important to evaluate hand grip activity while assessing shoulder in clinical evaluations of patients with shoulder pain.7 This therefore gives an impetus to find out the correlation between shoulder impairment or shoulder pain and grip strength variation in the affected and unaffected arm.
OPERATIONAL DEFINITIONS:
1.Shoulder pain:
Shoulder pain is a broad term and includes any pain that arises in and around shoulder. Shoulder pain may originate in the joint itself or from any of the many surrounding muscles, ligaments or tendon.
2.Hand grip:
Hand grip is divided into power grip and precision grip. Power grip is a result of forceful contraction of fingers and precision is the skilful placing of objects between fingers and thumb.
RESEARCH QUESTION:
Is there an influence of shoulder pain on grip strength?
HYPOTHESIS(H1)
Shoulder pain causes decrease in hand grip strength.
NULL HYPOTHESIS(H0)
Shoulder pain does not have an effect on hand grip strength.
REVIEW OF LITERATURE:
An EMG analysis on static hand contractions conducted on 9 subjects conveys that static hand activity influenced the muscle activity in the 4 investigated shoulder muscles namely the supraspinatus, infraspinatus ,middle deltoid and descending part of trapezius, and in addition, they had also presented that isometric hand activity influenced the activity of different shoulder muscles. They also concluded that handload dependence is greater for stabilizing muscles and hence there is an increased need to stabilize the shoulder joint with hand activity.7
Shea J4 showed that grip strength had been thought as the possible predictor for overall body strength. Strength of the rotator cuff muscles had been correlated to the strength of one’s grip. Yasou et al as reported by Shea J found that grip strength and muscle strength were associated when shoulder was in 45 degree abduction and external rotation on the affected side. One of the similar studies conducted by Budoff as reported by Shea J had revealed that there is an increased rotator cuff weakness on the same side of hand injury.
Further a retrospective study was performed in which records of 37 patients receiving home care were used. Discriminant construct validity was examined by comparing their dynamometry measurements with measurements of age- and gender-matched healthy individuals reported in the literature. Convergent construct validity was described by the correlations of their dynamometry measurements and manual muscle test scores of the upper extremities. The patients' dynamometer-measured grip forces were significantly less than reported normative values. The patients' dynamometer measured grip forces were correlated significantly with their manual muscle test scores. These findings support the construct validity of hand-grip dynamometry for characterizing upper extremity strength impairment among adults treated in a home care setting .8
Another study was done in ten female subjects who performed maximal arm exertions at two different heights and five directions using both specified and preferred grip forces. Electromyography was recorded from eight muscles of the right upper extremity. The preferred grip condition produced grip forces that were dependent on the combination of arm height and force direction and were significantly greater, lower, or similar to the specified grip condition. Regardless of the direction of the preferred grip force, the grip resulted in decreased maximal arm strength and muscle activity in all conditions.9
6.3 OBJECTIVE OF THE STUDY:
To find out the correlation of shoulder impairment with hand grip strength.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
SAMPLE POPULATION: Subjects with shoulder pain.
PLACE OF THE STUDY: Father Muller Medical College, Hospital, Mangalore, Karnataka.
7.3METHOD OF DATA COLLECTION:
STUDY DESIGN: Cross sectional study.
INCLUSION CRITERIA:
(1) Age: 31 to 60 yrs of age
(2) Subjects with localised shoulder pain.
EXCLUSION CRITERIA:
(1) Subjects with injury to hand and elbow
(2) Operated shoulder
(3) Diabetes mellitus
(4) Wrist pain
(5) Any neurological deficits in the upper limb or cervical pain radiating to entire arm.
SAMPLE SIZE:
60 Subjects.
SAMPLING TEHNIQUE: Convenience sampling.
INSTRUMENT:
Hand dynamometer baseline evaluation instrument.
METHOD:
Subjects will be first screened for the inclusion and exclusion criteria. Study will be explained in detail to the eligible subjects. Written consent will be taken from the patient stating their approval for the study. Subjects for the study are in the age group of 31 to 60 years. The participant will be asked to hold the baseline dynamometer and asked to use maximum force of hand squeeze around the dynamometer. Patient will be encouraged to squeeze with more force, then their grip strength will be measured in 2 different positions of the shoulder. The procedure will be demonstrated by the examiner. The hand grip strength will be recorded in kilograms. Then.3 trials will be performed for each position and the mean of the 3 readings will be calculated. Break of 10 seconds will be given after each trial. For this study we will have subjects of males and females. Same test will be carried out in control group of same age group.
POSITION OF THE SUBJECT:
Subject is standing
Position 1: Shoulder in neutral, elbow extended, forearm in midprone and wrist in neutral.
Position 2: Shoulder abducted to 90 degrees and externally rotated, elbow extended, forearm in supination and wrist in neutral position.
STATISTICAL ANALYSIS:
Descriptive statistics, comparison between group – independent ‘t’ test
7.3 Does the study require any investigation or intervention to be conducted on patients or animals? If yes please comment.
Yes, grip strength will be evaluated using baseline hand dynamometer.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
LIST OF REFERENCES:
1) Meislin RJ, Sperling JW, Stitik TP. Persistent shoulder pain: epidemiology, pathophysiologylogy, and diagnosis. American journal of orthopaedics. [2005, 34(12 Suppl):5-9]
2) Barclay L, Vega C. Management of Chronic Shoulder Disorders Reviewed.2008; 77:453-460.
3) Shoulder pain.[internet].[updated 2010 march; cited on 2013 oct 15]. Available from:
http://www.healthcentre.vt.edu/assets/docs/MCOrthoRehab-shoulder.pdf.
4) Shea J. The importance of grip strength.[internet].[cited on 2013 oct 15]. Available from :
http://www.apec-s.com/up-content/uploads/2011/12/The-importance-of-grip.pdf.
5) University of Queensland. Acute shoulder pain: Evidence based management. 2002 dec: 144-198.Available from:
http://www.uq.edu.au/health/pdf/shoulder.pdf.
6) Landsmeer JMF. Power grip and Precision Handling. Ann Rheum Dis.1962 june; 21(2):164-70.
7) Sporrong H, Palmerud G, Herberts P. Hand grip increases shoulder muscle activity. Acta Ortho Scand.1996; 67(5):485-490.
8) Bohannon RW. Hand grip dynamometer provides a valid indication of upper extremity strength impairment in home care patients. Journal of hand therapy. 1998; 11(4):258-260.
9) Smets MP,Potvin JR,Keir PJ. Constrained handgrip force decreases upper extremity muscle activation and arm strength. Ergonomics.2009sept; 52(9):1144-52.
Appendix 1
CONSENT FORM
You are requested to participate in the study titled-“Effects of shoulder impairments on grip strength”, being conducted by Ms. Regina Correa, MPT (Musculoskeletal disorders and Sports), Father Muller Medical College Mangalore. This is a part of the curriculum of the MPT course, run by Rajiv Gandhi University of Health Sciences. The purpose of this study is to evaluate the effect of shoulder impairment on grip strength.
Once enrolled in the study, you will be screened for any neurological deficits in the upper extremity and any traumatic injury to the shoulder or hand. If eligible, you will be asked to sign on this consent form. Then your basic details like your Name, Age, Gender and Occupation will be noted down. Following this your grip strength will be assessed using a hand held baseline dynamometer. Grip strength will be measured in two different shoulder positions making 3 trials and its mean will be recorded. No feedback will be given to you at the time of the data collection.
Kindly be assured that the procedure used in the study is not harmful.
We will clarify any of your queries regarding the study. Your identity will remain confidential. You are free to leave this study at any time.
You are hereby requested to sign this consent form.
I______voluntarily agree to participate in this study. The possible benefits as well as the procedure of the study have been explained to me.
The question and queries I have posed have been answered to my satisfaction and I am aware that my identity will be kept confidential. I am also aware that I can discontinue the study at any time I wish to do.
Date:
Name and Signature/thumb impression of the subject
Place:
Name and signature of the investigator:
Appendix 2
PROFORMA:
Name:
Age:
Gender:
Identification no:
Date of assessment:
Place of assessment:
Date of birth:
Grip strength:
TRIAL 1 / TRIAL 2 / TRIAL 3 / MEANSHOULDER IN NEUTRAL / R:
L:
SHOULDER IN 90 DEGREE ABDUCTION / R:
L:
9.SIGNATURE OF CANDIDATE
10.REMARKS OF THE GUIDE
11.1NAME AND DESIGNATION
OF GUIDE / Mr. SUDEEP M.J.PAIS
ASSISTANT PROFESSOR
11.2SIGNATURE
11.3HEAD OF THE DEPT. / MR. NARASIMMAN.S
PROFESSOR
11.4 SIGNATURE
12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL
12.2 SIGNATURE
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