Effective stretching positions for the posterior shoulder capsule as determined by shear wave elastography.

BACKGROUND Stretching is often used to prevent and treat posterior shoulder capsule tightness; however, the most effective stretching positions are not clearly defined. The purpose of this study was to identify the stretching positions that specifically applied the greatest passive tension on the posterior shoulder capsule by evaluating the elastic characteristics of posterior capsules and muscles in various stretching positions using ultrasound shear wave elastography (SWE). METHODS We evaluated nine fresh-frozen shoulders (mean age 86.6±7.7 years) without osteoarthritis or rotator cuff tears. All posterior shoulder tissues were preserved intact. Shear moduli of the middle and inferior posterior shoulder capsules and the posterior shoulder muscles were evaluated using SWE. We obtained shear modulus measurements in nine stretching positions using a combination of glenohumeral elevation planes and angles (frontal, sagittal, scapular; -30°, 0°, 30°, 60°, respectively). A 4-Nm torque for shoulder internal rotation or horizontal adduction was applied in each position. We also measured shear moduli in the resting position (0° elevation with neutral shoulder internal/external rotation). We compared the shear moduli of all stretching and resting positions using one-way repeated-measures analysis of variance (p<0.05). In addition, we compared the shear modulus in two positions (i.e., resting and each stretching) among tissues (i.e., capsules and muscles) with repeated-measures using two-way analysis of variance (p<0.05). RESULTS Shear modulus values for the middle posterior capsules in "internal rotation at 30° in scapular plane elevation" (28.7±14.3 kPa, p=0.01) and in "horizontal adduction at 60° of elevation" (31.1±13.1 kPa, p<0.001) were significantly higher than that of the resting position (11.0±7.3 kPa). The shear modulus value for the inferior posterior capsule in "internal rotation at 30° of flexion" was significantly higher than that of the resting position (39.0±17.3 vs. 15.4±13.9 kPa, respectively; p=0.004). Additionally, the shear modulus values for the posterior capsules in "internal rotation at 30° in scapular plane elevation and flexion" were significantly higher than that of the posterior shoulder muscles. CONCLUSION Effective middle posterior shoulder capsule stretching positions were shoulder "internal rotation at 30° of scapular plane elevation" and "horizontal adduction at 60° of elevation." Shoulder "internal rotation at 30° of flexion" was the most effective position for the inferior posterior shoulder capsule. Stretching in these positions could relieve posterior shoulder capsule tightness and contribute to the prevention and treatment of throwing injuries of the shoulder.