Type of Article:  Original Research

Volume 7; Issue 5 (October 2019)

Page No.: 3220-3231

DOI: https://dx.doi.org/10.16965/ijpr.2019.168


Shivani Chowdhury Salian *1, Mansi Modi 2, Divya Desai 3.

*1 PhD (Electrotherapy), Professor and Head, Department of electrotherapy and Electrodiagnosis, School of Physiotherapy, D.Y.Patil deemed to be University, Nerul, Navi Mumbai, India.

2 Postgraduate student, Department of electrotherapy and Electrodiagnosis, School of Physiotherapy, D.Y.Patil deemed to be University, Nerul, Navi Mumbai, India

3  Junior Resident, Department of Radiology, D.Y.Patil Hospital and Research Centre, Nerul, Navi Mumbai, India.

Corresponding Author: Dr. Shivani Chowdhury Salian, Professor and Head, Department of electrotherapy and Electrodiagnosis, School of Physiotherapy, 6th Floor Medical College Building, D.Y.Patil deemed to be University, Nerul,  Sector-5, Navi Mumbai, P O Box no. 400706, India.  Mobile: 9167015833

E-Mail: shivani.chowdhury@dypatil.edu, chowdhury.shivani@gmail.com


In the present research study 4 shoulder muscles-the supraspinatus, infraspinatus, the middle deltoid and the upper part of the trapezius-were assessed for muscle thickness using real time ultrasonography  (RUSI) in various degrees of abducted and flexed arm positions, in 30 patients with acute and sub-acute shoulder pain  and 30 asymptomatic healthy subjects (N=60). The symptomatic and asymptomatic subjects were further subdivided according to affection of dominant (n=15) and non-dominant (n=15) shoulder joint. Muscle thickness (mm) was measured using real time ultrasonography of dominant and non-dominant shoulder in different range of movement of shoulder abduction and flexion in symptomatic patients and asymptomatic subjects with and without gripping action on the dynamometer. The subjects were asked to produce a static handgrip force of in 8 different arm positions. In all positions, the subjects held a dynamometer in the hand. The activity in the shoulder muscles was assessed using RUSI while the participating subjects produced a handgrip with maximal force.

Muscle thickness and changes with activity was similar in symptomatic and asymptomatic individuals. Muscle activity increased in the middle deltoid muscle in humeral flexion and abduction from 0 0 through  800, whereas supraspinatus and lower trapezius showed increased muscle thickness only in the initial ranges of movement of shoulder flexion, whereas, infraspinatus did not show exhibit any significant change.

Our findings imply that high static hand grip force, particularly in elevated arm positions, increases the load on some shoulder muscles, independent of presence of pain in the shoulder.  Handgrip activity is important to evaluate while assessing shoulder load in manual work and in clinical evaluations of patients with shoulder pain. Also, while rehabilitation it would be possible to make use of hand gripping activity and load the shoulder muscles differently and distinctly throughout the ranges of movement of shoulder joint.

Key word: Hand Grip force, Shoulder muscle activity, ROM, Ultrasonographic imaging, muscle thickness.


  1. Singh S et al. Prevalence of shoulder disorders in tertiary care centre, International Journal of Research in Medical Sciences 2015 Apr;3(4):917-920.
  2. Van der Windt DAWM, Koes BW, De Jong BA, Bouter LM. Shoulder disorders in general practice: Incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54(12):959-64.
  3. Luime JJ, Koes BW, Hendriksen IJM, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol. 2004;33(2):73-81.
  4. Hasvold T, Johnsen R. Headache and neck or shoulder pain frequent and disabling complaints in the general population. Scand J Prim Health Care. 1993;11:219-24.
  5. Nygren A, Berglund A, Von Koch M. Neck and shoulder pain, an increasing problem. Strategies for using insurance material to follow trends. Scand J Rehab Med. 1995;32:107-12.
  6. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. Br Med J. 2005;331:1124-8.
  7. Chakravarty KK, Webley M. Disorders of the shoulder: an often unrecognised cause of disability in elderly people. Br Med J. 1990;300:848-9.
  8. Chard MD, Hazelman R, Hazelman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rheum. 1991;34(6):766-9.
  9. Bot SDM, van der Waal JM, Terwee CB, Van der Windt DAWM, Schellevis FG, Bouter LM. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis. 2005;64(1):118-23.
  10. Feleus A, Bierma-Zeinstra SM, Miedema HS, Bernsen RM, Berhaar JA, Koes BW. Incidence of non-traumatic complaints of arm, neck and shoulder in general practice. Man Ther. 2008;13:426-33.
  11. Kumar VK, Kumar SP, Baliga MR. Prevalence of work-related musculoskeletal complaints among dentists in India: a national cross-sectional survey. Indian J Dent Res. 2013;24(4):428-38.
  12. Sankar SG, Reddy PV, Reddy BR, Vanaja KKE.The prevalence of work-related musculoskeletal disorders among Indian orthodontists. J Indian Orthop Soc. 2012;46(4):264-8.
  13. Vijay SA. Work-related musculoskeletal health disorders among the information technology professionals in India: a prevalence study. Int J Mgmt Res Bus Strat. 2013;2(2):118-28.
  14. Chopra A, Saluja M, Patil J, Tandale HS. Pain and disability, perceptions and beliefs of a rural Indian population: a WHO-ILAR COPCORD study. WHO-International League of Associations for Rheumatology. Community Oriented Program for Control of Rheumatic Diseases. J Rheumatol. 2002 Mar;29(3):614-21.
  15. Joshi VL, Chopra A. Is There an Urban-Rural Divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. J Rheumatol. 2009;36(3):614-22.
  16. Hagberg M. Occupational musculoskeletal disorders — a new epidemiological challenge? Progress in occupational epidemiology. Elsevier Science, Amsterdam 1988;15–26.
  17. Bjelle A, Hagberg M, Michaelsson G. Occupational and individual factors in acute shoulder-neck disorders among industrial workers. Br J Ind Med 1981;38:356–363.
  18. Lannersten L, Harms-Ringdahl K. Neck and shoulder muscle activity during work with different cash register systems. Ergonomics 1990;33:49–65.
  19. Milerad E, Ericson MO, Nisell R, Kilbom A. An electromyographic study of dental work. Ergonomics 1991;34:953–962.
  20. Jarvholm U, Palmerud G, Kadefors R, Herberts P. The effect of arm support on supraspinatus muscle load during simulated assembly work and welding. Ergonomics 1991;34:57–66.
  21. Chaffin DB. Localized muscle fatigue-definition and measurement. J Occup Med 1973;15:346–354.
  22. Herberts P, Kadefors R, Broman H. Arm positioning in manual tasks. An electromyographic study of localized muscle fatigue. Ergonomics 1980;23:655–665.
  23. Hagberg M. Work load and fatigue in repetitive arm elevations. Ergonomics 1981;24:543–555.
  24. Sigholm G, Herberts P, Almström C, Kadefors R. Electromyographic analysis of shoulder muscle load. J Orthop Res. 1984;1:379–386.
  25. Campbell Semple J. Tenosynovitis, repetitive stress injury, cumulative trauma disorder, and overuse syndrome, etc. J Bone Joint Surg [Br] 1991;73-B:536–538.
  26. SporrongH, PalmerudG, Herberts P. Influences of handgrip on shoulder muscle activity.Eur J Appl Physiol 1995; 71: 485-92.
  27. Ian Horsley, Lee Herrington et al; Do changes in hand grip strength correlate with shoulder rotator cuff function?; Shoulder and Elbow Journal 2016;8(2): 124-129.
  28. Balogum JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Arch Phys Med Rehabil 1991; 72:280-3.
  29. Kuzala EA,Vargo MC. The relationship between elbow position and grip strength. Am J Occup Ther 1992;46:509-12.
  30. Hakan Sporrong, Gunnar Palmerud et al; Hand grip increases shoulder muscle activity: An EMG analysis with static handcontractions in 9 subjects; Acta Orthopedic Scandinavica 1996; 67(5), 485-490.
  31. Cynthia C. Norkins et al, Joint Structure and Function: A Comprehensive Analysis; Fifth edition ; 262-4.
  32. Kuzala EA,Vargo MC. The relationship between elbow position and grip strength. Am J Occup Ther 1992;46:509-12.
  33. NT, Keir PJ. Effects of posture, movement and hand load on shoulder muscle activity. Journal of Electromyography and Kinesiology 2010; 20: 191–198.
  34. Nazanin Nakhaie et al, Review Paper: Activation of Shoulder Girdle Muscles during Gripping Task: a Systematic Review of Literature, PHYSICAL TREA MENTS April 2014;4(1):3-8.
  35. O, Fisher. A.C, Kemp. G.J, Karthik Vishwanathan, S.P. Frostick. Shoulder muscle activation and fatigue during a controlled forceful hand grip task. Journal of Electromyography and Kinesiology 2011;21:478–482.

Cite this article: Shivani Chowdhury Salian, Mansi Modi, Divya Desai. THE EFFECTS OF HAND GRIP FORCE ON SHOULDER MUSCLE ACTIVITY AT DIFFERENT ANGLES OF SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER PAIN. Int J Physiother Res 2019;7(5):3220-3231. DOI: 10.16965/ijpr.2019.168