The Effect of Cyclic Loading Simulating Oscillatory Joint Mobilization on the Posterior Capsule of the Glenohumeral Joint: A Cadaveric Study

Abstract

Study Design Experimental laboratory design. Objectives To examine the effect of force and repetition during oscillatory joint mobilizations on the posterior capsule of the glenohumeral joint. Background The optimal external force and frequency to be used during joint mobilization to elongate the posterior capsule of the glenohumeral joint has yet to be identified. Methods Twenty-one posterior capsules were harvested from fresh-frozen shoulders. A cyclic loading test simulating oscillatory posterior joint mobilization on the shoulder specimens was performed with a material testing machine. The specimens were assigned to 3 different loading groups simulating joint mobilization in the toe (5 N), transition (20 N), and beginning of the linear regions (40 N) of the load displacement curve. Displacement of the humeral head at an applied load of 5 N was recorded at the 1st, 100th, 200th, 300th, 400th, 500th, and 600th cycles and at 1 hour after completion of the cyclic loading. Furthermore, stiffness was calculated after the 1st and 600th cycles and 1 hour after testing. Results Humeral head displacement was significantly greater for the 100th to 600th cycle, compared to the 1st cycle, for all 3 loading groups. Significant increases in displacement and stiffness were observed between the 1st cycle and 1 hour after completion of the cyclic tests for both the 20-N and 40-N loading groups. Conclusion While oscillatory joint mobilization to a force of 5 N resulted in temporary elongation of the posterior capsule, mobilization to loads of 20 and 40 N resulted in sustained elongation of the capsule for up to 1 hour. Our findings also suggest that mobilization up to loads that represent the beginning of the linear region of the load displacement curve could be performed without serious damage to the posterior capsule. J Orthop Sports Phys Ther 2011;41(5):311–318, Epub 18 February 2011. doi:10.2519/jospt.2011.3448

Glenohumeral joint capsular tissue tension loading correlates moderately with shear wave elastography: a cadaveric investigation

“…These results are in line with a previous in vivo study that evaluated GHJ capsular thickness and elasticity in two different positions, with an intra-rater reliability value of 0.93 for posterior-inferior capsule elasticity [12]. Previous studies reported ROM changes after mobilization [5,18] and tissue elongation after simulated oscillations [29], but a better understanding of how these interventions affect tissue properties is needed. This study demonstrated that SWE technology may allow non-invasive measurement of tissue changes during joint loading and capsule stretching procedures.…”

“…This is the first study to assess the reliability of SWE and correlations between the durometer and SWE for GHJ capsular tissue properties under clinically applicable tensile loads using cadaveric tissue to eliminate neuromuscular influences. Tensile loads were selected based on pilot testing of the durometer for capsular tissue with good reliability (ICC 3,5 , 0.87; 95% CI, 0.68 to 0.95) and a high correlation between the tensile load applied and durometer measurements for loads of 1, 2, and 5 kg, as well as other prior studies of GHJ tissue properties [17,18,29]. The SWE measurements for reliability and correlation in this study were performed by one observer in 1 day.…”

Histopathological Changes in Joint Components in a Rat Knee Joint Contracture Model Following Mobilization

“…We consider that mobilization effec- tively led to such density decreases, as the treatment group showed significant improvement. Studies using shoulder joint specimens from fresh cadavers [6][7][8] reported that mobilization (repetitive stretch stimulation) increased the range of joint motion and altered the rigidity of the joint capsule. It is possible that only the cross-linking between collagen fibers was damaged, though we did not investigate cross-linking.…”

“…The joint capsule can be extended by mobilization 3) , and many recent clinical studies have reported its effectiveness when the range of joint motion is limited 4,5) . These studies in which the effectiveness was verified by basic medical examination reported results derived only from the examination of fresh cadavers [6][7][8] , which led to incomplete understanding of the technique.…”

EMG activity of selected rotator cuff musculature during grade III distraction and posterior glide glenohumeral mobilization: results of a pilot trial comparing painful and non-painful shoulders

“…1 The glenohumeral posterior glide and distraction mobilizations have been well researched in regard to their ability to produce tissue deformation and stretch of the glenohumeral joint capsule. 5,[11][12][13] The posterior glide technique has demonstrated the ability to create significant accessory glenohumeral movement and capsular deformation utilizing Kaltenborn grade III mobilization forces. 11,12 Previous work has demonstrated that during posterior translational mobilizations, the posterior rotator cuff serves as a passive restraint resisting as much as 35% of the overall posterior force at 60° abduction in a cadaver model.…”