Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain

Effects of scapular treatment on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP.

METHODS

Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023.

RESULTS

A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment.

CONCLUSION

Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.

Effects of slouched sitting posture on clavicular and scapular orientations and movements in individuals with neck pain with scapular dysfunction

BACKGROUND

It has been suggested that sitting posture affects clavicular, scapular and spinal kinematics, however its effects in people with neck pain and scapular dysfunction remain unknown. The study aimed to determine the clavicular and scapular kinematics in different sitting postures in patients with neck pain and scapular dysfunction.

METHODS

Thirty-four participants with neck pain and scapular dysfunction were recruited into the study. Kinematics of the clavicle and scapula were recorded using motion analysis at rest and during arm elevation (at 30, 60, 90, and 120 degrees) in a slouched and upright sitting posture.

RESULTS

Compared to the upright sitting posture, the slouched sitting posture had increased clavicular protraction and elevation as well as scapular internal rotation and anterior tilt at rest and during the arm raising and lowering phases (at 30, 60, 90, and 120 degrees) (p < 0.05). The slouched sitting also had increased scapular upward rotation in the lowering phase at all angles (p < 0.05).

SIGNIFICANCE

The slouched sitting posture has a significant influence on clavicular and scapular kinematics. Awareness of good sitting posture should be encouraged in patients with neck pain and scapular dysfunction.

Neck and Shoulder Pain with Scapular Dyskinesis in Computer Office Workers

Background and Objectives: Computer office workers spend long periods in front of a computer, and neck and shoulder pain are common. Scapular dyskinesis (SD) is associated with neck and shoulder pain. However, SD in computer office workers has not been elucidated. We aimed to investigate the prevalence of SD, neck and shoulder pain, disability, and working hours in computer office workers. Materials and Methods: In total, 109 computer office workers participated in this study. The results of a scapular dyskinesis test (SDT), lateral scapular slide test (LSST), neck disability index (NDI), shoulder pain and disability index (SPADI), visual analog scale (VAS) scores of the neck and shoulder, and working hours were recorded. Results: Ninety-eight computer office workers (89.9%) had SD. Computer office workers with SD had significantly higher NDI (p = 0.019), neck VAS (p = 0.041), and dominant shoulder VAS scores (p = 0.043). The LSST results showed a significantly greater distance (p = 0.016) in participants with SD. Conclusions: The prevalence of SD was very high in computer office workers, and neck and shoulder pain were more prevalent in workers with obvious SD.

Axioscapular and neck extensor muscle behavior during isometric shoulder exertions in patients with nonspecific neck pain with and without a scapular downward rotation posture

BACKGROUND

A common observation in persons with neck pain is scapular downward rotation (SDR) with altered muscle behavior. Evidence of changes in axioscapular muscles in neck pain patients remains inconclusive, which may reflect population heterogeneity in previous studies.

RESEARCH QUESTION

Are there differences in behavior of the axioscapular (upper trapezius: UT, lower trapezius: LT and serratus anterior: SA) and neck extensor (NE) muscles during isometric shoulder tasks in patients with neck pain with SDR, patients with no scapular dysfunction and healthy controls?

METHODS

Sixty participants with nonspecific neck pain (30 with SDR and 30 without scapular dysfunction) and 30 controls were recruited. Electromyographic signals were recorded unilaterally from the UT, LT, SA and NE during different isometric shoulder tasks (30° flexion, 30°abduction and 30°external rotation) at 20%, 50% and 100% maximal voluntary contraction (MVC). Activity of UT, LT, SA and NE was normalized with respect to reference contractions. The UT/LT, UT/SA and LT/SA ratios were calculated for each task.

RESULTS

The neck pain group with SDR had increased UT activity in 30°flexion (20%MVC) and 30°abduction (20% and 50%MVC) compared to the neck pain and control groups without scapular dysfunction (p < 0.05). There were no between group differences in LT and SA activity (p > 0.05). The neck pain groups had greater NE activity in all tasks (p < 0.001). Finally, the neck pain group with SDR had higher UT/LT and UT/SA ratios in a few tasks at low force levels (p ≤ 0.01).

SIGNIFICANCE

Greater UT activity and UT/LT and UT/SA ratios during particularly low force isometric shoulder tasks suggest that SDR is associated with altered axioscapular motor control. Greater NE activity in both neck pain groups suggests altered motor control related to neck pain. Changes in the NE and UT behavior should be considered in management of patients with neck pain with observable SDR.

Effect of Scapula Focused Interventions on Pain and Disability in Neck Pain with Mobility Deficits- Protocol for a Single Blinded Randomized Controlled Trial

BACKGROUND

Neck pain with mobility deficits is a common non-specific disorder often observed in younger individuals. The abnormal position of the scapula has also been identified as a risk factor in individuals with neck pain and mobility deficits. Though literature exists regarding the effects of scapular strengthening exercises, there is a lack of studies that have examined the effects of scapular strengthening exercises in individuals with neck pain and mobility deficits. This randomized controlled trial aims to examine the effects of scapula-focused exercises on pain and disability in individuals with neck pain and mobility deficits.

METHODS

A single-blind (assessor-blinded) randomized controlled trial will be performed. One hundred and eight participants will be recruited and randomly assigned into two groups. The intervention group will receive scapula-focused exercises, and the control group will receive neckspecific exercises. Both groups will receive supervised sessions 3 days per week for 6 weeks and unsupervised sessions for the remaining weeks. Disability, pain, range of motion, pain pressure threshold, muscle strength, EMG activity, and sensory-motor functions will be assessed at the baseline, the 6th week, and the 12th week.

RESULTS

This study aims to provide the effectiveness of scapular-focused exercises and its effect on neck pain with mobility deficits.

CONCLUSION

Analyzing the results can provide insight into how effective scapular-focused exercises are when compared to neck exercises.

3D measurement of clavicular and scapular orientations: The association with clinical characteristics and responsiveness to scapular repositioning in patients with neck pain

BACKGROUND

Clavicular and scapular orientations vary between neck pain patients as do clinical features and responses (changes in pain and rotation range) to scapular repositioning. Associations between these factors are unknown.

OBJECTIVES

To identify subgroups of neck pain patients based on three-dimensional (3D) measures of clavicular and scapular orientations and differences between subgroups in clinical characteristics and responses to scapular repositioning.

DESIGN

Cross-sectional study.

METHODS

Eligible participants were recruited as part of a larger study. The 3D clavicular and scapular orientations were analyzed on the more painful side of the neck using a hierarchical cluster analysis. Clinical characteristics were neck pain location, intensity, duration, disability and presence of headache. Responses to scapular repositioning were classified as "yes and no".

RESULTS

Fifty-eight participants (29 responsive; 29 non-responsive to scapular repositioning) participated in the study. Analysis identified two distinct subgroups: subgroup1 had greater clavicular retraction and scapular downward rotation (n = 26) and subgroup2 had greater clavicular elevation and scapular internal rotation and anterior tilt (n = 32). Headache and dominant pain in the upper neck were more frequent in subgroup 1 while dominant pain in the lower neck was frequent in subgroup 2 (p < 0.01). Most participants who responded positively to scapular repositioning (88.5%) were in subgroup1 and most non-responsive participants (81.2%) in subgroup2.

CONCLUSIONS

The 3D clavicular and scapular orientations identified two subgroups of neck pain patients. Participants with predominantly downward scapular rotation were distinguished by pain in the upper neck, presence of headache and a positive response to scapular repositioning.

Clavicular and scapular, but not spinal kinematics vary with scapular dyskinesis type during arm elevation and lowering in persons with neck pain

BACKGROUND

Scapular dyskinesis is often observed in patients with neck pain. However, it is unknown whether clavicular, scapular and spinal kinematics vary with different types of scapular dyskinesis during arm movement.

RESEARCH QUESTION

Are there differences in clavicular, scapular and spinal kinematics during unilateral arm elevation and lowering among neck pain patients presenting with (i) scapular winging, (ii) with dysrhythmia, (iii) with no scapular abnormality and (iv) healthy controls?

METHODS

Sixty participants with neck pain (20 in each group) and 20 asymptomatic controls were recruited. The 3D kinematic data were measured during unilateral arm elevation and lowering at 30°, 60°, 90°, and 120° in the scapular plane. A three-way mixed-effects ANOVA was used to determine the main effects (group, phase and angle) and the interactions between three independent variables on the kinematic data.

RESULTS

The neck pain group with scapular winging had decreased clavicular retraction and increased scapular internal rotation and anterior tilt compared to the other neck pain and control groups at all angles during both phases of arm movement (p < 0.01). The neck pain group with scapular dysrhythmia had decreased scapular upward rotation compared to all other groups (p < 0.01). Some alterations in the kinematics existed during the lowering phase compared to the raising phase for all groups (p < 0.05). Spinal kinematics were similar across all groups (p > 0.05).

SIGNIFICANCE

Specific patterns of clavicular and scapular kinematics were identified during arm movement relevant to the type of observed scapular dyskinesis in patients with neck pain. Such findings stand to inform more precise and relevant motor training in rehabilitation and improve understanding of the association between altered scapular kinematics and neck pain.

Live and video observations of scapular dyskinesis in individuals with nonspecific neck pain: A reliability study

BACKGROUND

Scapular dyskinesis (SD) has been demonstrated in neck pain patients, however reliability of SD test in this population is still lacking.

OBJECTIVE

To investigate inter-rater and intra-rater (live versus video) reliability of SD by observation in neck pain patients.

METHODS

Sixty-nine participants with nonspecific neck pain (31.7 ± 14.3 years) were recruited. SD was tested on the ipsilateral side of neck pain during unilateral and bilateral arm elevation. Two examiners categorized SD using two classification systems: simple (yes/no) and specific type (winging, dysrhythmia, mixed abnormality or normal). Video recordings were reviewed by one examiner.

RESULTS

For inter-rater reliability, agreement and kappa (κ) values for unilateral test were 94.20%, 0.82 by simple classification and 72.46%, 0.59 by specific type. Agreement and κ values for bilateral test were 91.30%, 0.68 by simple classification and 65.22%, 0.52 by specific type. For intra-rater reliability, agreement and κ values for unilateral test were 92.75%, 0.77 by simple classification and 71.01%, 0.57 by specific type. Agreement and κ values for bilateral test were 91.30%, 0.65 by simple classification and 65.22%, 0.52 by specific type.

CONCLUSION

Observation assessment demonstrated good-to-very good inter-rater and moderate-to-good intra-rater (live versus video) reliability for assessing SD in neck pain patients.

Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction

Background and Objectives: Neck and shoulder injuries commonly occur during boxing, and scapular dyskinesis is related to those injuries. This study investigated scapular dyskinesis with neck disability and shoulder malfunction in elite boxers. Materials and Methods: Seventy-two elite boxers participated in this study. Scapular dyskinesis was evaluated as normal, subtle, and obvious. Neck disability index (NDI), shoulder internal (IR), and external (ER) range of motion (ROM), isometric strength of IR and ER, and pectoralis minor length were measured and compared with the severity of scapular dyskinesis. Results: Thirty-eight boxers (52.7%) showed scapular dyskinesis. NDI score was significantly different (normal = 3.89 ± 3.08, obvious = 7.36 ± 4.95, p = 0.025). Isometric IR strength was significantly different (normal = 10.48 ± 2.86, obvious = 8.46 ± 1.74, p = 0.01). The length of the pectoralis minor was significantly different (normal = 10.17 ± 0.67, subtle = 9.87 ± 0.79, obvious = 9.47 ± 0.85; p = 0.001), and the dominant and non-dominant arm IR ROM was significantly different (dominant = 57.43 ± 11.98, non-dominant = 64.62 ± 10.3, p = 0.001). Conclusions: The prevalence of scapular dyskinesis is high among elite boxers. Boxers with scapular dyskinesis presented shoulder malfunction as well as neck disability. Further investigation is necessary to examine the relationship between scapular dyskinesis and neck disability in boxers.

Response rate and comparison of clinical features associated with positive or negative responses to a scapular positioning test in patients with neck pain and altered scapular alignment: a cross-sectional study

Objective

To investigate the frequency and clinical aspects of patients with neck pain who responded and did not respond to scapular repositioning and to determine the clinical features associated with a positive response.

Design

Cross-sectional study.

Setting

Research unit, Department of Physical Therapy, Chiang Mai University.

Participants

Volunteers with non-specific neck pain aged 18–59 years were recruited between May 2020 and February 2021 from hospitals, clinics, university and community.

Outcome measures

Clinical data documented were neck pain (intensity, duration and disability), the presence of headache, type of scapular dysfunction, cervical musculoskeletal impairment (range of motion (ROM), flexion rotation test (FRT) and location of any symptomatic cervical joint dysfunction), upper limb functional limitation and self-reported disability. Manual scapular repositioning was performed on the side of neck pain. Participants were categorised as responsive or non-responsive based on a change in pain and/or cervical rotation range.

Results

A total of 219 people with neck pain responded to advertisements, of which 144 were eligible. Of the eligible participants, 107 (74.3%) demonstrated a clinically relevant improvement in either neck pain or rotation range or both following the scapular repositioning and 37 (25.7%) had no relevant improvement. The responsive group had a high incidence of scapular downward rotation, greater neck pain intensity, headache and cervical musculoskeletal impairment (reduced ROM, positive FRT and symptomatic C1-3 dysfunction) compared with the non-responsive group (p<0.05). A logistic regression model revealed that features strongly associated with a positive response were the presence of headache (Exp(B)=6.0, 95% CI 2.3 to 15.8), scapular downward rotation (Exp(B)=5.3, 95% CI 2.3 to 12.6) and a positive FRT (Exp(B)=4.0, 95% CI 1.5 to 10.6).

Conclusion

Almost 75% of neck pain patients with altered scapular alignment responded to scapular repositioning. The predominance of upper cervical dysfunction with a downwardly rotated scapular in this group suggests a role of poor axioscapular muscle function which might benefit from rehabilitation.

Focus on the Scapular Region in the Rehabilitation of Chronic Neck Pain Is Effective in Improving the Symptoms: A Randomized Controlled Trial

Chronic neck pain is a common human health problem. Changes in scapular posture and alteration of muscle activation patterns of scapulothoracic muscles are cited as potential risk factors for neck pain. The purpose of this study was to compare the effects of neck exercise training (NET) with and without scapular stabilization training (SST) on pain intensity, the scapula downward rotation index (SDRI), forward head angle (FHA) and neck range of motion (ROM) in patients with chronic neck pain and scapular dyskinesia. A total of sixty-six subjects with chronic neck pain and scapular dyskinesia were randomly divided into three groups: neck exercise training, n = 24, combined training (NET + SST), n = 24 and a control group, n = 24. Pain intensity, SDRI, FHA and ROM were measured by the numerical rating scale, caliper, photogrammetry and IMU sensor, respectively. When the combined intervention group consisting of NET and SST was compared with NET alone at six weeks, there was a statistically significant difference in pain intensity, SDRI, FHA and cervical ROM for flexion and extension (p ≤ 0.05). Adding scapular exercises to neck exercises had a more significant effect in decreasing pain intensity, SDRI, FHA and increased cervical ROM than neck exercises alone in patients with chronic neck pain. These findings indicate that focus on the scapular posture in the rehabilitation of chronic neck pain effectively improves the symptoms.

The repeatability of 3-dimensional scapular kinematic analysis during bilateral upper extremity movements

Although three-dimensional electromagnetic systems are widely used to evaluate the 3-dimensional scapular kinematics their reliability when testing bilateral upper extremity tasks is unknown. The purpose of this study was to investigate the repeatability of the scapular kinematic analyses using the Flock of Birds (FOB) system during bilateral upper extremity movements. Twenty-one volunteers without shoulder problems were included (aged 24.8 years; body mass index averaged 21.2 kg/m²) to the study. Scapular internal-external rotation, upward-downward rotation, and anterior-posterior tilt was recorded during bilateral arm elevation on sagittal, scapular and frontal planes. Measurements were repeated at 5-7 days intervals. Intra-session and inter-session repeatability were determined using intraclass correlation coefficients (ICC) scores and standard errors of measurements (SEM). The ICC scores were found to be 0.81 to 0.99 for intra-session measurements and 0.60 to 0.83 for inter-session measurements. The SEM scores were 0.8°-3.4° and 2°-7.2° for the intra and inter-session measurements respectively. The repeatability of the FOB system was excellent for the intra-session measurements, but it was weaker for the inter-session measurements. These results support the use of the FOB system for assessing scapular orientation but the analyses should be conducted more carefully when it is applied to the longitudinal measurements.