Investigating the Relationship between Upper Extremity Functions and Kyphosis Angle in Elderly Women

Research Article

Phys Med Rehabil Int. 2016; 3(7): 1107.

Investigating the Relationship between Upper Extremity Functions and Kyphosis Angle in Elderly Women?

Taspinar B, Aksoy CC, Sahin NY and Taspinar F*

Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Turkey

*Corresponding author: Ferruh Taspinar, Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey

Received: November 12, 2016; Accepted: December 02, 2016; Published: December 05, 2016


Objectives: The aim of this study is to examine the relationship between upper extremity functions and angle of kyphosis in elderly women.

Materials and Methods: Sixty-four female mean age of 71.29 ± 4.2 years were included in this study. Spinal Mouse Device, Held-Hand Dynamometer, Goniometer, Upper Extremity Functional Index (UEFI) and Minnesota Placing Test (MPT) (Minnesota Manual Dexterity Subtest) were used for angles of kyphosis, muscle strengths, range of motions, upper extremity functionality and hand skills of subjects respectively.

Results: Mean age, height, weight and Body Mass Index of subjects were 71.29±4.2, 163.45±5, 81.79±10.5, 30.58±3.3 respectively, while angles of kyphosis, MMDT scores and UEFI scores were 57.42±7.4, 72.96±11.6, 73.45±4.2 respectively. A statistically significant and moderate level negative association was determined between UEFI and angle of kyphosis. (r= - 0.42 / p=0.001). On the other hand, a statistically significant and low level positive association was determined between MPT score and angle of kyphosis (r=0.32 / p=0.01).

Conclusion: Hyperkyphosis occurring with age leads to a reduction of the speed and the ability to functions with activities of daily living including the upper limbs. Therefore, measures of hyperkyphosis need to be taken in early stage and individuals should be informed about this issue. It is thought that the arrangement of rehabilitative programs in first step will be useful in terms of prevention of reduction of functionality in old age.

Keywords: Kyphosis; Hyperkyphosis; Upper extremity function; Body Mass Index


Vertebral colon is a column, which consists of 34 vertebrae and the disc between these vertebrae, and this structure has backward and forward curves in sagittal plane [1,2]. The degenerative changes that are seen along with the aging result in differentiations in structure of vertebral colon. In 2/3 of women and 1/2 of men in elderly population, the increasing in kyphosis is observed [2-5]. Because of the support of vertebral colon to upper body and the localization of thoracic vertebrae, the differentiations in thoracic region negatively influence the structures in lower and upper segments. Increasing kyphosis in thoracic region may cause shoulder, neck, back and lumbar pain, as well as it may be the reason for respiratory problems by negatively affecting the mobility of costae, where the thoracic vertebraejointed to. Besides that, the increased thoracic kyphosis also alters the position of scapula-thoracic joint and consequently that of scapula. Because of the important role of scapula on the shoulder mobility, the changes in position of scapula may result in the problems in shoulder joint. The problems related with the shoulder joint cause limitation in daily life activities of specially the elderly people [4-8].

In literature, there is limited number of studies on thoracic kyphosis in elderly population. Considering the results of these studies, it can be seen that there is a negative relation between the increased kyphosis of elderly people and the muscle strength. Besides that, it has also been reported that increased thoracic kyphosis in adults underlies the sub-acromial impingement syndrome. Although restoration of kyphosis posture has an important role in both of protecting from the shoulder problems and treatment of these problems, it has been emphasized in literature that the relationship between the kyphosis and shoulder problems and upper body functionis not sufficiently understood [5,9,10].

Even though there is a close relationship between the increased kyphosis in thoracic region and the shoulder complex, there is limited number of studies on examining the relationship between thoracic kyphosis and shoulder function. For this reason, the present study was planned in order to examine the effects of thoracic kyphosis on the functions of shoulder complex that has vital importance for daily life.

Materials and Methods

In this study, 64 healthy individuals aged more than 65 years and having no history of operation in neck, back, and upper extremity regions were involved. The exclusion criteria were determined to be the function loss in upper extremity due to any disease or trauma such as rheumatologic diseases, neurological disorders, or orthopedic diseases. All of the subjects were informed prior to the examination, and their informed consents were obtained. Also, this study was funded by Scientific Research Projects Coordination Unit of Dumlupinar University (Project Number: 2014-11). The demographic data of subjects such as age, height, weight, and BMI were recorded in prepared form.

In present study, the thoracic kyphosis angles, muscle strengths, range of motions (ROM), upper extremity functions, and hand skills of the subjects were evaluated. The results of these evaluations are presented below.

Measurement of thoracic kyphosis angle (posture evaluation system)

Spinal Mouse Device used for measuring the thoracic kyphosis angle. Spinal alignment in vertebral colon was measured by using a procedure, which was documented in 2004, in standing position [11]. Spinal mouse was movedfrom T1 to T12 in standing position. The positions of joint edges of T1 and T12, which consists of the interrelated movement of both vertebras, were measured in orderto determine the thoracic kyphosis angle [12]. In order to minimize the errors, the measurements were repeated in three times, and the mean values were recorded.

Muscle test

In order to measure the muscle strength, Manual Muscle Test System™ hand-held dynamometer (HHD) was used. Prior to the test, each of the subjects was verbally informed about test procedure. “Make Test” method, which requires isometric contraction during the test, was used. Make Test is the protocol, where the practitioner holds the dynamometer stable and the person subjected to the measurement applied force against the device [13]. Before initiating the test, the subjects were asked to perform sub-maximal contraction against the hand of practitioner in order to reveal the accurate movement. After each of muscle tests, the subjects were asked to maintain the maximum isometric contraction for 5 seconds (sec.). The mean value of 3 subsequent maximum contraction measurements performed with 30sec interval was computed.

The muscle test was performed for shoulder flexion, abduction, external rotation, and internal rotation.

Evaluation of ROM

Goniometric measurement was utilized for evaluating the ROM. The subjects were informed prior to test about the position, requested movement, and the requested speed. ROMs of shoulder flexion, abduction, and internal and external rotation were evaluated [14].

Upper Extremity Functional Index (UEFI)

Evaluation of the subjects’ upper extremity functions was performed using UEFI. UEFI consists of 20 items, where it is questioned if the subjects have difficulties in different upper extremity activities. Each item is scored between 0 and 4, and the total score is 80. Higher scores indicate better function, while lower scores mean worse functional status. 0: Excessive difficulty or inability, 1: high level of difficulty, 2: mid-level of difficulty, 3: mild difficulty, 4: no difficulty [15].

Minnesota Manual Dexterity Test (MMDT)

Within the scope of present study, MMDT was employed in order to evaluate the hand-arm skills, and upper extremity endurance and performance of subjects. Among 5 sub-tests constituting this test, the Minnesota PlacingTest (MPT) was employed in present study. The flexion and extension movements of shoulder and elbow joints are required for the test. Considering the importance of these joints in daily life activities, this test was chosen. While in sitting position, the subjects were asked to immediately place 58 discs, which were placed in front of the test table, on the table having 58 gaps on it, and the results were recorded as second [16].

Statistical analysis

The analysis of obtained data was performed by SPSS for Windows 20.0 program. Descriptive data was presented by mean values and standard deviation. The correlation between kyphosis angles and muscle strength, ROM, speed, and functionality of upper extremity was analyzed using Pearson’s correlation coefficient and significance test.


64 female subjects having mean age of 71.29±4.2 years were involved in the study. The demographic data of subjects are presented in Table 1. Mean muscle strength and ROM of subjects were shown in Table 2, while the results regarding the mean kyphosis angle and upper extremity functionin standing position were presented in Table 3.