Background: Physical therapists use tests that could determine strength and weaknesses of the shoulder for overhead throwing athletes to enhance performance, prevent injury, and safely progress rehabilitation. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) has been proposed to assess muscular capacity and dynamic shoulder stability in overhead athletes, which could provide information to determine a risk of injury. Purpose: To investigate if the CKCUEST is an appropriate test to implement within team elite handball players to evaluate dynamic shoulder stability across sexes and in the screening of shoulder pain. Study design: Cross-sectional study Methods: Elite team handball players were recruited and performed the CKCUEST from which three different scores (raw, touch, and power) were calculated and compared among handball players playing with shoulder pain, previous pain, and no pain. Results: A total of 106 handball players were included: 49 females (1.74±0.03 m, 70.4±6.7 kg, and 22±4.9 years) and 57 males (1.90±0.08 m, 91.6±11.4 kg, and 22±5.4 years), A significant difference was found between the female and male handball players when comparing all three CKCUEST scores (p<0.01). No significant differences were found in the CKCUEST scores among the three different groups (F≤1.23, p≥0.30, η²≤0.03). Among the female participants, no significant differences were found between performing the CKCUEST and the modified test. A significant correlation was found between height and the power score for men (r=0.661, p≤0.001) and women (r=0.434, p=0.01). Conclusion: A comparison of scores across sexes appears unsuitable, due to the possible positive influence of height on the final score. But within the female group, performances of the CKCUEST and the modified CKCUEST were comparable. Additionally, the CKCUEST was not able to differentiate among elite handball players who are playing with shoulder pain, previous shoulder pain, and no pain. Level of evidence: 3

Non-traumatic shoulder injuries are common in team handball. However, many athletes continue to throw, despite pain in the shoulder. This study investigated upper body kinematics and muscle activation while throwing in female elite handball players with and without shoulder pain. Thirty female elite team handball players, 15 with pain (age 22.2 ± 2.9 yrs.) and 15 without pain (age 20.4 ± 2.6 yrs.) performed five standing throws in which joint kinematics and muscle activity were measured in the following muscles: pectoralis major, infraspinatus, serratus anterior, latissimus dorsi, and upper-, middle-, and lower trapezius. The main findings revealed that peak joint angles and angular velocities were not different between groups; however, group differences were observed in earlier timing of position and longer time spent in maximal shoulder extension and external shoulder rotation in the pain group compared with the no pain group. The pain group also revealed a significant lower muscle peak activity in the serratus anterior during the cocking phase compared to the no pain group. After the cocking phase and at ball release, the groups had similar activation. In conclusion, the present study showed group differences in appearance and time spent in maximal humerus extension and external rotation and a different serratus anterior muscle peak activity between elite handball players playing with and without shoulder pain, which are identified as possible mechanisms of adaptation to avoid pain.

Background/Objectives: Spasticity in children with cerebral palsy (CP) can impair motor-related functions. The objective of this exploratory, prospective study was to examine if transcutaneous electrical nerve stimulation (TENS) in a whole-body suit leads to changes in spasticity and other related effects. Methods: Thirty-one children with CP GMFCS III–V, with a median age of 11.0 years (age range of 7–17 years), were consecutively included, and they used the suit with TENS for 24 weeks. The primary outcome was spasticity measured using the Modified Ashworth Scale (MAS). Functional motor-related tasks were evaluated by the Goal Attainment Scale (SMART GAS). The Modified Tardieu Scale (MTS), passive Range of Motion (pROM), GMFM-66, and Posture and Postural Ability Scale (PPAS) assessments were performed. Results: Seventeen subjects (17/31) completed the 24 weeks. Dropout was due to difficulty in donning the suit. The level of overall spasticity, most pronounced in the proximal arms and legs, was reduced according to the MAS, but not the MTS or pROM. Subject-relevant motor-related goals improved significantly in standing/walking and hand/arm function. Changes in the GMFM-66 and PPAS were not significant. Conclusions: Although there were statistically significant but underpowered changes in the MAS after 24 weeks, there were no clinically relevant effects. Exploratorily, we found observer-reliant motor-related functional improvements, which, however, we were unable to detect when trying to quantify them. Donning the suit led to dropout throughout the study. Caregivers need to allocate time, mental capacity and have the physical skill set for donning the suit for long-term use.

Background: The prevalence of overuse shoulder injuries is unfortunately common in team handball, potentially impacting sport participation and quality of life after players’ professional careers. Shoulder rotational strength and glenohumeral range of motion have been proposed to influence the development of shoulder injuries. Purpose: This study aimed to compare external and internal shoulder rotation range of motion and isometric strength among elite male and female handball players with current shoulder pain, previous shoulder pain, and no shoulder pain. Study design: An explorative cross-sectional study Methods: Maximal isometric shoulder internal and external rotator strength and shoulder internal and external rotation range of motion were measured and compared between sexes and among players with current shoulder pain, previous shoulder pain, and no shoulder pain. All data distributions were tested for normality with the Shapiro–Wilk test, histograms, and qq plots. An ANOVA was used to compare the internal and external shoulder range of motion and strength. Results: A total of 136 elite team handball players, 57 women (1.74±0.06 m, 72.4 ± 8.3 kg, and 22.4±4.9 years) and 79 men (1.89±0.08 m, 90.8 ± 11.8 kg, and 22.3 ± 5.2 years) participated. A significant difference in maximal internal (p<0.001) and external (p=0.004) shoulder rotator strength was found between sexes, with no significant difference in range of motion. When categorized by groups, male athletes in the no-pain group had greater internal rotator strength than males in the current and previous pain groups (p<0.042). Furthermore, female athletes in the no-pain group showed significantly less internal and external rotation range of motion compared to those playing with shoulder pain and those with previous pain. Conclusion: Greater maximal isometric shoulder strength was found for men than women, primarily of the internal rotators, among all three groups. However, the men in the no-pain group had greater strength of the internal rotators than the two other groups. Range of motion was comparable between sexes, but the women without shoulder pain demonstrated significantly less internal and external rotation range of motion compared to those playing with shoulder pain and those with previous pain. Level of evidence: 3