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Paksoy A, Akgün D, Gebauer H, Karczewski D, Lacheta L, Tokish JM, Chamberlain A, Moroder P. The latissimus dorsi creates a dynamic track for the inferior angle of the scapula during arm abduction in humans. J Orthop Surg Res 2024; 19:193. [PMID: 38504340 PMCID: PMC10953177 DOI: 10.1186/s13018-024-04659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The importance of several scapulothoracic muscles, including trapezius and serratus anterior, in maintaining physiological scapula kinematics has been highlighted in the past. However, the relationship between the scapula and the latissimus dorsi muscle remains unclear. Our clinical surgical observation is that the latissimus dorsi does not directly attach but rather runs superficial to the inferior angle of the scapula. Based on this observation, we hypothesise that the latissimus dorsi creates a dynamic track on which the scapula glides under the muscle belly during elevation of the arm, creating the latissimus-scapula overlap (LSO). METHODS All consecutive patients who had a whole-body computed tomography scan (CT) in case of polytrauma evaluation between 2018 and 2021, with complete depiction of the scapula and latissimus dorsi muscle, were analysed. 150 shoulders in 90 patients with arms up were matched according to their age (within five years), gender, and affected side with 150 shoulders in 88 patients with arms down. Patients with pathologies of the upper extremities or thorax that potentially could alter LSO measurements were excluded. LSO was calculated as a ratio of the measured area of the latissimus dorsi projection on the scapula and the total scapula area. RESULTS The mean age of the 178 patients (48 females; 13 males) was 60 years. The arms-up group showed a significantly higher LSO than the arms-down group (19.9 ± 6.3% vs. 2.7 ± 2.2%; p < 0.0001). In the arms-up group, approximately one fifth of the scapula was overlapped inferiorly by the muscle belly of the latissimus dorsi, contrary to the almost non-existing LSO in the arms-down group. CONCLUSION With arms up, humans show a significantly higher LSO in comparison to arms down indicating that the latissimus dorsi indeed creates a dynamic track on which the scapula is forced to travel during abduction of the arm. This finding of increased LSO during the elevation of the arm warrants further consideration of the role of the latissimus dorsi in scapula kinematics and potentially scapular dyskinesis. LEVEL OF EVIDENCE Level two diagnostic study.
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Affiliation(s)
- Alp Paksoy
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany.
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Henry Gebauer
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Lucca Lacheta
- University Hospital rechts der Isar, Technical University Munich, German, Germany
| | | | - Aaron Chamberlain
- Center for Advanced Medicine Orthopedic Surgery Center, St. Louis, MO, USA
- Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, MO, USA
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Zhong Z, Zang W, Tang Z, Pan Q, Yang Z, Chen B. Effect of scapular stabilization exercises on subacromial pain (impingement) syndrome: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1357763. [PMID: 38497039 PMCID: PMC10940535 DOI: 10.3389/fneur.2024.1357763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the effectiveness of scapular stabilization exercises (SSE) in the treatment of subacromial pain syndrome (SAPS). Methods Clinical randomized controlled trials (RCTs) on SSE in the treatment of SAPS were searched electronically in PubMed, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, Physiotherapy Evidence Database (PEDro), Web of Science, and other databases from 2000 to 2022, supplemented by manual search. Final RCTs were selected based on inclusion and exclusion criteria, and the Physiotherapy Evidence Database scale was used to evaluate the methodological quality of the study. A meta-analysis was conducted on data using the RevMan5.4 software. Results Eight RCTs involving 387 participants were included. The meta-analysis showed that the experimental group (SSE) had greater improvements in the Visual Analog Scale score [Weighted Mean Difference (WMD) = -0.94, 95% CI (-1.23, -0.65), p < 0.001] and the Shoulder Pain and Disability Index score [WMD = -10.10, 95% CI (-18.87, -1.33), p = 0.02] than the control group (conventional physical therapy). However, range of motion (ROM) was not found to be greater in the experimental group than in the control group. Conclusion Existing evidence moderately supports the efficacy of SSE for reducing pain and improving function in SAPS, without significant improvement in ROM. Future research should focus on larger, high-quality, standardized protocols to better understand SSE's effects across diverse SAPS populations, treatment, and outcome measures. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307437, CRD42022307437.
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Affiliation(s)
- Ziyi Zhong
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Wanli Zang
- Postgraduate School, Harbin Sport University, Harbin, China
| | - Ziyue Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiaodan Pan
- School of Medicine, Tongji University, Shanghai, China
| | - Zhen Yang
- Department of Movement Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Bin Chen
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Konghakote S, Kamnardsiri T, Warner MB, Uthaikhup S. Effects of slouched sitting posture on clavicular and scapular orientations and movements in individuals with neck pain with scapular dysfunction. Gait Posture 2024; 109:78-83. [PMID: 38286062 DOI: 10.1016/j.gaitpost.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
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.
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Affiliation(s)
- Supatcha Konghakote
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Teerawat Kamnardsiri
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Martin B Warner
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
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Ueda A, Matsumura A, Shinkuma T, Oki T, Nakamura Y. Shoulder kinetic during pitching in baseball players with scapular dyskinesis. J Bodyw Mov Ther 2024; 37:57-62. [PMID: 38432842 DOI: 10.1016/j.jbmt.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 09/22/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players. METHOD Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18-camera motion-capture system. SD was classified into four types (I-IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed. RESULTS The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I-Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group. CONCLUSIONS These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching.
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Affiliation(s)
- Atsushi Ueda
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan.
| | | | | | - Takeshi Oki
- Department of Orthopaedic Surgery, Hankai Hospital, Japan
| | - Yasuo Nakamura
- Department of Health and Sports Science, Doshisha University, Japan
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Deniz V, Sariyildiz A, Buyuktas B, Basaran S. Comparison of the activation and mechanical properties of scapulothoracic muscles in young tennis players with and without scapular dyskinesis: an observational comparative study. J Shoulder Elbow Surg 2024; 33:192-201. [PMID: 37579939 DOI: 10.1016/j.jse.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND In tennis athletes with scapular dyskinesis, the activation of the scapulothoracic muscles during serve is not known. Also, the mechanical properties (tone, elasticity, and stiffness) of the scapulothoracic muscles of the tennis athletes with scapular dyskinesis are likely to change. The study aimed to evaluate the activation of the scapulothoracic muscles while performing tennis serve and to determine the changes in the mechanical properties of the same muscles in young tennis athletes with scapular dyskinesis. METHODS Seventeen tennis athletes with scapular dyskinesis aged between 11 and 18 years (the scapular dyskinesis group) and age- and gender-matched 17 asymptomatic tennis athletes (the control group) were included in the study. Activation of scapulothoracic muscles (descending-transverse-ascending trapezius and serratus anterior) in the 3 phases (preparation, acceleration, and follow-through) of the serve was evaluated using surface electromyography, and the mechanical properties of the same muscles were measured at rest by myotonometry. RESULTS Ascending trapezius activation in the follow-through phase was lower in the scapular dyskinesis group compared with the control group (mean difference 95% confidence interval: -22.8 [-41.2 to -4.5]) (P = .017). The tone and stiffness of the transverse trapezius (P = .043 and P = .017, respectively) were higher, whereas the same parameters of the ascending trapezius were lower (P = .008 and P = .010, respectively) in the scapular dyskinesis group compared with the control group. CONCLUSIONS Activation of the ascending trapezius and the tone and stiffness of the transverse-ascending trapezius were altered in tennis athletes with scapular dyskinesis. Implementations to improve these changes can be included in the rehabilitation or training programs of young tennis athletes with scapular dyskinesis.
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Affiliation(s)
- Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Tarsus University Faculty of Health Sciences, Mersin, Turkey.
| | - Aylin Sariyildiz
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Bilgihan Buyuktas
- Department of Physical Education and Sports Teacher, Cukurova University Faculty of Sports Sciences, Adana, Turkey
| | - Sibel Basaran
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
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Vongsirinavarat M, Wangbunkhong S, Sakulsriprasert P, Petviset H. Prevalence of scapular dyskinesis in office workers with neck and scapular pain. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:50-55. [PMID: 34927576 DOI: 10.1080/10803548.2021.2018855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives. This study aimed to investigate the presence of scapular dyskinesis (SD) in office workers with neck and scapular complaints. The postural malalignment and related muscle adaptations were also explored. Methods. SD and its subtypes were determined. Postural deviations and the length of commonly reported muscle tightness were evaluated. Results. Among 99 participants, 90% of them had SD. Considering both sides or 198 scapula, 90.4% were identified as having painful scapula and 19% as having painless scapula. There was a difference in the proportion of SD on painful (93%) and painless (69%) sides. Postural deviations including rounded shoulder (100%), forward head (43.3%) and thoracic hyperkyphosis (54.5%) were prevalent. Persons with type III SD had a higher percentage of forward head than other types. There was also tightness of the pectoralis minor (100%), levator scapulae (93.0%) and upper trapezius (98.3%) muscles without different proportions among types of SD. The greatest proportion of persons with SD had tightness of the levator scapulae. Conclusions. There was a high prevalence of SD among office workers with neck and scapular complaints. SD was also associated with abnormal posture and muscle tightness. The proper management of SD and working posture is warranted.
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Affiliation(s)
| | - Sukhon Wangbunkhong
- Physical Medicine and Rehabilitation Department, Rajavithi Hospital, Thailand
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Huang TS, Weng YH, Chang CC, Tsai YS, Lin JJ. Pitching Biomechanics and Shoulder Function in Baseball Pitchers with Scapular Dyskinesis. Int J Sports Med 2023; 44:369-375. [PMID: 36807277 DOI: 10.1055/a-1939-7229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The primary purpose was to investigate the influence of scapular dyskinesis (SD) on pitching biomechanics and shoulder function in high school baseball pitchers. The secondary purpose was to identify possible factors associated with shoulder function in pitchers with SD. Thirty-eight pitchers were classified into the SD group (n=26) or the non-SD group (n=12). They were evaluated with the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow (KJOC) scale and clinical measurements of shoulder characteristics, and with measurements of scapular kinematics, muscle activation, and ball speed during fastball pitching. Compared to the controls, the pitchers with SD had less scapular external rotation (difference=11.3 degrees, ES=0.92, p=0.012) during overall pitching and less upper trapezius (UT) activation during the late cocking (difference=7.1%, ES=0.79, p=0.019) and acceleration phases (difference=12.5%, ES=0.75, p=0.035). Higher UT activation during the late cocking phase was significantly associated with higher KJOC scores (standardized β=0.415, p=0.039). In conclusion, deficits in scapular external rotation and decreased UT activation during pitching were found in pitchers with SD. Higher UT activation may be important for shoulder function in pitchers with SD.
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Affiliation(s)
- Tsun-Shun Huang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsuan Weng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Che-Chia Chang
- Graduate Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Yung-Shen Tsai
- Graduate Institute of Sports Equipment Technology, University of Taipei, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Kuniki M, Iwamoto Y, Kito N. Effects of core stability on shoulder and spine kinematics during upper limb elevation: A sex-specific analysis. Musculoskelet Sci Pract 2022; 62:102621. [PMID: 35926474 DOI: 10.1016/j.msksp.2022.102621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Upper limb elevation begins with core stabilization, but the effects of core stability on shoulder and spine kinematics are unknown. Sex differences also exist in shoulder kinematics and core stability. OBJECTIVE To clarify the effects of core stability on shoulder and spine kinematics during upper limb elevation by taking sex into account. DESIGN Cross-sectional. METHODS The Sahrmann Core Stability Test, lumbar spine motor control test battery, and Y Balance Test (lower and upper quarters) were performed in 50 healthy young adults. For each test, a principal component (PC) analysis was conducted according to sex; the overall core stability score was calculated. The top and bottom third of the PC scores were defined as high and low score groups, respectively (each group: nine males and eight females). Shoulder and spine kinematics during upper limb elevation were compared separately for males and females. RESULTS Spinal extension was greater in the low score group by a maximum of 1.9° in males (P < .001; η2 = 0.068) and 1.6° in females (P < .001; η2 = 0.141). In the low score group of females, the scapular posterior tilt was a maximum of 5.6° smaller (P < .001; η2 = 0.221) and glenohumeral elevation was a maximum of 4.5° larger (P < .001; η2 = 0.113) than the high score group of females. CONCLUSION Core stability affected spine and female scapular and glenohumeral kinematics during upper limb elevation. Core stability may be one of the potential contributors to shoulder kinematics, particularly in females.
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Affiliation(s)
- Masahiro Kuniki
- Graduate School of Medical Welfare Sciences, Medical Engineering, Hiroshima International University, 555-36, Kurose-gakuendai, Higashi-hiroshima, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3 Kasumi 1-chome, Minami-ku, Hiroshima, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, 555-36, Kurose-gakuendai, Higashi-hiroshima, Hiroshima, Japan.
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Wannaprom N, Jull G, Treleaven J, Warner MB, Kamnardsiri T, Uthaikhup S. Clavicular and scapular, but not spinal kinematics vary with scapular dyskinesis type during arm elevation and lowering in persons with neck pain. Gait Posture 2022; 97:48-55. [PMID: 35872483 DOI: 10.1016/j.gaitpost.2022.07.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Nipaporn Wannaprom
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Gwendolen Jull
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Julia Treleaven
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Martin B Warner
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Teerawat Kamnardsiri
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
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Sathe T, Prabhu A, Vishal K. Within-Subject Changes in Shoulder Girdle Muscle Activation After Soft Tissue Mobilization of the Upper Trapezius. J Chiropr Med 2022; 21:149-156. [PMID: 36118108 PMCID: PMC9479171 DOI: 10.1016/j.jcm.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 10/16/2022] Open
Abstract
Objective The purpose of this study was to investigate the effect of the integrated neuromuscular inhibition technique (INIT) of the upper trapezius (UT) on shoulder muscle activity in chronic shoulder pain. Methods Twenty-two patients (mean age 42.5 ± 16.07) with chronic unilateral shoulder pain with UT myofascial trigger points (MTrPs) (n = 27) and scapular dyskinesis received a single session of INIT (∼15 minutes for each MTrP). The pain on the visual analog scale, along with surface electromyographic activity, maximum voluntary contraction in % (in arm raising and lowering in scapular plane), and pressure pain threshold (PPT) of 5 girdle muscles UT, lower trapezius, serratus anterior, middle deltoid, and infraspinatus were measured before and immediately after treatment. Wilcoxon signed-rank test was used for analysis (at α ≤ 0.05). Results Muscle activity of all the muscles, especially the lower trapezius, was reduced during arm raising in the scapular plane (76.69%-71.14% [p = 0.003]). UT activity decreased during arm lowering also (56.70%-45.99% [p ˂ 0.001]). The intensity of shoulder pain reduced (50.50 mm to 22 mm, [p ˂ 0.001]), and PPT values of all 5 muscles improved post-treatment. Conclusion The findings of this study provide preliminary evidence for the application of a single session of INIT on UT MTrPs in reducing activity in the scapular muscles, improving shoulder pain, and PPT in chronic unilateral shoulder pain.
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Affiliation(s)
| | | | - Kavitha Vishal
- Corresponding author: Kavitha Vishal, MPT, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka, India 576104
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Boontha N, Chen S, Lin JJ. Impairment of scapular control in individuals with chronic obstructive pulmonary disease (COPD): Systematic review and meta-analysis. Physiother Theory Pract 2022:1-16. [PMID: 35403547 DOI: 10.1080/09593985.2022.2060885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Upper quadrant geometrical changes in individuals with chronic obstructive pulmonary disease (COPD) appear to have negative influences on geometrical arrangements of the thorax and scapula. OBJECTIVE The purpose of this systematic review was to assess the impairment of scapular control in individuals with COPD as compared with healthy controls. METHODS We systematically searched seven electronic databases from inception to June 2021 and updated the searches again in December 2021. Eligible studies included the participants with COPD and compared scapular control outcomes (scapular/shoulder kinematic or related muscle activity) with a control group. Two researchers independently searched for, screened, extracted data from, and evaluated the quality of all articles. RESULTS Seven studies met the inclusion criteria and only five studies with 190 subjects were included in the meta-analyses. Subgroup analyses showed that the control group exhibited more scapular anterior tilt (SMD: 0.46; 95% CI: 0.01 to 0.90) and shoulder flexion (SMD: -1.02; 95% CI: -1.79 to -0.26) as compared with the COPD group. Conversely, the COPD group exhibited more scapular elevation (SMD: -1.03; 95% CI: -1.69 to -0.37), internal rotation (SMD: -1.65; 95% CI: -3.19 to -0.10), and protraction (SMD: -0.75; 95% CI: -1.18 to -0.32) compared with the control group. All other outcomes revealed non-significant findings. CONCLUSION This review demonstrated scapular control impairments, such as scapular elevation, internal rotation, protraction, and anterior tilt in a static position in patients with COPD. To validate these findings, high-quality randomized control trials with large sample sizes and reliable outcome measures should be conducted.
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Affiliation(s)
- Natharin Boontha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C)
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Shiauyee Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University–Wan Fang Hospital Taipei Taiwan (R.O.C.)
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C)
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Shoulder Kinesio Taping Does Not Change Biomechanical Deficits Associated With Scapular Dyskinesis. J Appl Biomech 2022; 38:95-102. [PMID: 35245895 DOI: 10.1123/jab.2021-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 01/12/2023]
Abstract
Observable scapular dyskinesis is associated with biomechanical deficits. Preventative interventions aimed at correcting these deficits may aid in preventing the development and resolution of shoulder pain. Our purpose was to investigate the effects of kinesio taping (KT) on common biomechanical deficits associated with scapular dyskinesis and shoulder pain. Participants (n = 51) with observable scapular dyskinesis, and without shoulder pain were randomized to KT, KT-placebo, or a no-treatment control group. Measurements taken before, immediately after taping, and 3 days later included pectoralis minor muscle length, lower trapezius muscle strength, scapular upward rotation angle at 0° to 120° in scapular plane humeral elevation and acromiohumeral distance. There were no changes in scapular upward rotation, lower trapezius strength, and acromiohumeral distance immediately after taping or 3 days later compared to baseline (P > .05). The pectoralis minor increased in length in the KT group on day 3 compared to directly after taping (P = .03), but no difference between groups or interaction between time and group were determined (P > .05). Scapular dyskinesis prevalence did not change over time in any group (P > .05). In people with scapular dyskinesis free from shoulder pain, KT applied to the shoulder cannot be recommended to ameliorate the biomechanical deficits associated with shoulder pain.
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Lower trapezius transfer for massive posterosuperior rotator cuff defects. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 34:34-44. [DOI: 10.1007/s00064-021-00756-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
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Ueda A, Matsumura A, Shinkuma T, Oki T, Nakamura Y. Scapular dyskinesis type is associated with glenohumeral joint and scapular kinematic alteration during pitching motion in baseball players. J Bodyw Mov Ther 2021; 28:332-340. [PMID: 34776160 DOI: 10.1016/j.jbmt.2021.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/10/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Scapular dyskinesis (SD) is associated with an increased risk of throwing-related shoulder injury onset, resulting in abnormalities in glenohumeral joint (GH) and scapular motions during pitching. The effects of SD on shoulder motion during pitching remain unknown. This study aimed to investigate kinematic alterations in GH and scapular motions during pitching in baseball players with type I SD. METHODS Sixty-seven university and independent-league baseball players with and without SD were included. Pitching motion was measured using an optical three-dimensional motion capture system, and a SD test was conducted to evaluate SD. SD was classified into types I-IV. The inter-rater reliability of SD assessment was calculated using kappa coefficients. Three-dimensional GH and scapular kinematics during pitching motion were analyzed. RESULTS The percentage of agreement representing the inter-rater reliability of SD assessment was 77.6% (52/67; kappa coefficient: 0.72). Overall, 24 and 27 participants were categorized into abnormal (type I SD) and normal group (type IV SD), respectively, with normal scapular motion; one individual with type III SD was excluded. The abnormal group exhibited a significantly increased GH external rotation angle (9°) and decreased scapular posterior tilt angle (6°) during the maximum external rotation period compared with the normal group. CONCLUSIONS Baseball players in the abnormal group showed increased GH motion and decreased scapular motion during pitching. The SD test for the evaluation of type I SD can help predict excessive GH external rotation and decreased scapular posterior tilt during pitching.
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Affiliation(s)
- Atsushi Ueda
- Graduate School of Health and Sports Science, Doshisha University, Japan; Department of Rehabilitation, Hankai Hospital, Japan.
| | | | | | - Takeshi Oki
- Department of Orthopaedic Surgery, Hankai Hospital, Japan
| | - Yasuo Nakamura
- Department of Health and Sports Science, Doshisha University, Japan
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Tang L, Chen K, Ma Y, Huang L, Liang J, Ma Y. Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial. Trials 2021; 22:713. [PMID: 34663424 PMCID: PMC8522102 DOI: 10.1186/s13063-021-05654-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Periarthritis of the shoulder is a common disease leading to dysfunction of the shoulder joint and have a significant impact on patients’ daily life. Evidence shows that there is a close relationship between scapular dyskinesis (SD) and shoulder diseases. Scapular stabilization exercise has been proved to be efficacious in relieving pain and improving function. However, there is no targeted exercise based on the type of scapular dyskinesis. This study will investigate the potential of scapular stabilization exercise based on the type of scapular dyskinesis in treating periarthritis of the shoulder. Methods This study is a prospective, randomized controlled, parallel-group trial, intending to recruit 90 patients diagnosed with periarthritis of the shoulder. Patients will receive scapular stabilization exercise training based on the type of scapular dyskinesis or receive traditional rehabilitation training conducted for 30 min, once a day, for 6 weeks. The primary outcome is Constant-Murley score (CMS), and other outcomes include pain degree, range of motion (ROM), type of scapular dyskinesis, scapula position, and patients’ satisfaction with shoulder function. Assessments will be performed at baseline, 2-, 4- and 6-week treatment, and at the 6-week follow-up after the end of treatment. Discussion This study will be the first study to investigate the clinical efficacy of scapular stabilization exercise based on the type of scapular dyskinesis in patients with periarthritis of the shoulder. The results may provide evidence of the effect of targeted scapular stabilization exercise in improving shoulder function and correcting scapular dyskinesis, and provide valuable information for future research. Trial registration This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2100044332 at March 14, 2021.
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Affiliation(s)
- Lan Tang
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Kang Chen
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yuhui Ma
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Lihua Huang
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Juan Liang
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
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Yildiz TI, Castelein B, Harput G, Duzgun I, Cools A. Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review. J Hand Ther 2021; 33:361-370. [PMID: 30962122 DOI: 10.1016/j.jht.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a systematic review. INTRODUCTION Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. PURPOSE OF THE STUDY The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics. METHOD MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment. RESULTS Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles. DISCUSSION Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial. CONCLUSION The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey.
| | - Birgit Castelein
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Gulcan Harput
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | - Irem Duzgun
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
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Effects of Intended Scapular Posterior Tilt Motion on Trapezius Muscle Electromyography Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179147. [PMID: 34501737 PMCID: PMC8431594 DOI: 10.3390/ijerph18179147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022]
Abstract
The intended scapular motion is a strategy to strengthen the lower trapezius (LT). However, few studies have explored the effects of the intended scapular posterior tilt motion on selective LT activation. Thus, the present study investigated the effect of the intended scapular posterior tilt on the electromyography (EMG) activity of trapezius muscles during prone shoulder horizontal abduction (PSHA). Eighteen asymptomatic men performed three types of PSHA: (1) preferred PSHA, (2) PSHA with the intended scapular posterior tilt, and (3) PSHA with the intended scapular posterior tilt and trunk extension. EMG activity of the upper trapezius (UT), middle trapezius (MT), and LT were measured during PSHAs. Scapular posterior tilt angle, with and without the intended scapular posterior tilt, were measured using inclinometer. The results indicated that LT muscle activity increased when scapular posterior tilt was applied with and without trunk extension (14-16%), compared to the preferred condition, during PSHA (p < 0.05). However, the addition of trunk extension to PSHA with the intended scapular posterior tilt increased the UT muscle activity (28%) and the UT/LT (29%) and UT/MT (31%) ratios (p < 0.05). The scapular posterior tilt angle was higher (15%) when applying the intended scapular posterior tilt (p = 0.020). These findings suggest that the intended scapular posterior tilt may be a useful strategy for selective LT muscle activation.
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Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR. Scapulothoracic Dyskinesis: A Concept Review. Curr Rev Musculoskelet Med 2021; 14:246-254. [PMID: 33822304 DOI: 10.1007/s12178-021-09705-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Scapulothoracic dyskinesis (SD) occurs when there is a noticeable disruption in typical position and motion of the scapula, which can result in debilitating pain. The purpose of this review is to describe the current knowledge regarding the diagnosis and management of scapulothoracic dyskinesis by providing an evidence-based overview of clinical exams and treatment modalities available for orthopedic surgeons and provide insight into which treatment modalities require further investigation. RECENT FINDINGS SD is highly prevalent in athletes, particularly those participating in overhead activities (e.g., baseball, tennis, and swimming) and can coexist with several shoulder pathologies. A holistic approach in the diagnosis of SD has been supported in the literature; however, it is important to recognize that diagnosis is currently limited to the absence of a quantitative SD clinical assessment. The main goal of the treatment of SD is to regain proper scapular positioning and dynamics. The standard of care for the management of SD is conservative interventions aimed at optimizing scapular kinematics. Surgical intervention is only considered in the presence of concomitant pathology requiring surgery. Due to the complexity of coordinated movement of the shoulder girdle, recent literature has begun to move away from the use of traditional orthopedic tests, in favor of a more system-based approach for the diagnosis of SD. We present a concise review of clinical exams and treatment modalities available for orthopedic surgeons in the management of SD.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Daisy A Ference
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Eric X Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Kelechi R Okoroha
- Mayo Clinic, Department of Orthopedic Surgery, 600 Hennepin Avenue, Suite 310, Minneapolis, MN, 55403, USA
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Totlis T, Kitridis D, Tsikopoulos K, Georgoulis A. A computer tablet software can quantify the deviation of scapula medial border from the thoracic wall during clinical assessment of scapula dyskinesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:202-209. [PMID: 32152691 DOI: 10.1007/s00167-020-05916-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Aim of this study is to establish an objective and easily applicable method that will allow clinicians to quantitatively assess scapular dyskinesis during clinical examination using a computer tablet software. Hypothesis is that dyskinetic scapulae present greater motion-deviation from the thoracic wall-compared to the non-dyskinetic ones and that the software will be able to record those differences. METHODS Twenty-five patients and 19 healthy individuals were clinically evaluated for the presence of dyskinesis or not. According to the clinical diagnosis, the observations were divided into three groups; A. Dyskinetic scapulae with symptoms (n = 25), B. Contralateral non-dyskinetic scapulae without symptoms (n = 25), C. Healthy control scapulae (n = 38). Then, all individuals were tested using a tablet with the PIVOT™ image-based analysis software (PIVOT, Impellia, Pittsburgh, PA, USA). The motion produced by the scapula medial border and inferior angle deviation from the thoracic wall was recorded. RESULTS The deviation of the medial border and inferior angle of the scapula from the thoracic wall was 24.6 ± 7.3 mm in Group A, 14.7 ± 4.9 mm in Group B, and 12.4 ± 5.2 mm in Group C. The motion recorded in the dyskinetic scapulae group was significantly greater than both the contralateral non-dyskinetic scapulae group (p < 0.01) and the healthy control scapulae group (p < 0.01). CONCLUSION The PIVOT™ software was efficient to detect significant differences in the motion between dyskinetic and non-dyskinetic scapulae. This system can support the clinical diagnosis of dyskinesis with a numeric value, which not only contributes to scapula dyskinesis grading but also to the evaluation of the progress and efficacy of the applied treatment, thus providing a feedback to the clinician and the patient. LEVEL OF EVIDENCE IV, laboratory study.
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Affiliation(s)
- Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (The-MIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece. .,Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Anastasios Georgoulis
- Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece
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Huang TS, Du WY, Lin JJ. Clinical Factors Related to Improved Scapular Control After a Scapular Conscious Control Program in Symptomatic Overhead Athletes: Secondary Analysis of a Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967120964600. [PMID: 33294472 PMCID: PMC7708709 DOI: 10.1177/2325967120964600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Predictive variables associated with the effects of a scapular conscious
control program should be identified and used to guide rehabilitation
programs. Purpose: To determine whether potential factors are associated with the success of
scapular muscle balance with an early control program in patients with
subacromial pain and scapular dyskinesis. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 38 amateur overhead athletes with subacromial pain and medial
border prominence were recruited. They performed progressive conscious
control of scapular orientation during 45° and 90° of arm elevation.
Stepwise logistic regression and receiver operating characteristic curve
were used to determine the optimal cutoff point of related factors for
success or failure of the program. Potential factors including pain level
during activity, pain duration, anterior/posterior shoulder flexibility,
forward shoulder posture, posterior displacement of root of spine and
inferior angle, scapular kinematics, and muscle activation before conscious
control program were recorded as independent variables. Successful control
defined as decreases of the upper trapezius/serratus anterior ratio in 2
consecutive trials of the 90° program or failure in the program was used as
a dependent variable. Results: Having a posterior displacement of the inferior angle of the scapula of ≤16.4
mm and scapular posterior tipping during arm elevation of ≤3.3° (collected
before the control program) were associated with the success of the program
(R2 = 0.286; P < .05). Additionally,
participants with each or both variables present at baseline had
probabilities of success of 78% and 95%, respectively. Conclusion: The value of scapular posterior displacement and posterior tilt should be
considered before early scapular control program. Other factors related to
the success of the program should be found due to the limited variance
explained in the regression model.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Jamei-Martel O, Palazzuolo M, Gallusser N, Moor BK. Surgical repair of an initially missed traumatic avulsion of the serratus anterior muscle leading to scapular dyskinesis. J Shoulder Elbow Surg 2020; 29:e394-e399. [PMID: 32788042 DOI: 10.1016/j.jse.2020.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Omid Jamei-Martel
- Service of Traumatology and Orthopaedic Surgery, Wallis Hospital Center, Martigny, Switzerland.
| | - Michele Palazzuolo
- Service of Traumatology and Orthopaedic Surgery, Wallis Hospital Center, Martigny, Switzerland
| | - Nicolas Gallusser
- Service of Traumatology and Orthopaedic Surgery, Wallis Hospital Center, Martigny, Switzerland
| | - Beat Kaspar Moor
- Service of Traumatology and Orthopaedic Surgery, Wallis Hospital Center, Martigny, Switzerland
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Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment. PLoS One 2020; 15:e0238424. [PMID: 32903259 PMCID: PMC7480840 DOI: 10.1371/journal.pone.0238424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury. Materials and methods The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS). Results Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X2(4) = 551.59, p = 0.0005; LB ROM X2(4) = 484.58, p = 0.0005; RT ROM X2(4) = 557.14, p = 0.0005; NFHAS X2(4) = 737.41, p = 0.0005. Effect size with ηp2 for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96. Conclusion The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.
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Rabin A, Druckmann I, Chechik O. Shoulder pain and scapular dyskinesis associated with lower trapezius dysplasia - A case report. Phys Ther Sport 2020; 46:104-112. [PMID: 32898828 DOI: 10.1016/j.ptsp.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scapular dyskinesis (SD) has been associated with shoulder soft-tissue tightness as well scapular muscle strength and/or activation deficits. Inadequate development of the trapezius muscle (trapezius dysplasia) is a relatively rare condition inconsistently associated with shoulder dysfunction. CASE DESCRIPTION a 24-year old male complaining of left scapular area pain associated with SD and scapular muscle weakness was noted to present with a smaller ipsilateral lower trapezius (LT). Further inquiry including electromyography, rehabilitative ultrasound imaging (RUSI) and magnetic resonance imaging ruled out nerve palsy and demonstrated a hypoplastic left LT. This led to a greater emphasis on serratus anterior (SA) training along with the addition of neuromuscular electrical stimulation of the LT. OUTCOMES Following 12 sessions over a 5-month period the patient reported no pain or functional deficits, and was able to resume all recreational activities. The patient's subjective shoulder value increased from 55% to 80%, and LT strength was markedly improved. DISCUSSION Scapular muscle dysplasia may represent a less recognized cause of SD. A more thorough inspection of scapular muscle shape and orientation, possibly augmented by RUSI may be indicated in patients presenting with SD. Neuromuscular electrical stimulation is a potentially useful modality for addressing scapular muscle activation and strength deficits and future research into its efficacy under these circumstances may be warranted.
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Affiliation(s)
- Alon Rabin
- Department of Physical Therapy, Ariel University, Ariel, Israel.
| | - Ido Druckmann
- Musculoskeletal Imaging Unit, Department of Radiology, Tel-Aviv Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ofir Chechik
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Shoulder Surgery Unit, Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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Huang TS, Chen WJ, Du WY, Lin JJ. Measurement of scapular prominence in symptomatic dyskinesis using a novel scapulometer: reliability and the relationship to shoulder dysfunction. J Shoulder Elbow Surg 2020; 29:1852-1858. [PMID: 32247722 DOI: 10.1016/j.jse.2020.01.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND No previous studies have investigated whether the extent of scapular dyskinesis is associated with shoulder dysfunction. This study aimed (1) to establish the reliability of a scapulometer in patients with shoulder pain and (2) to investigate the related factors associated with shoulder dysfunction. METHODS One hundred participants with symptomatic scapular dyskinesis were recruited. Twenty-one participants were involved in the reliability study to test the intrarater and inter-rater reliabilities of the scapulometer in patients with shoulder pain. After demographic data and self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) scores were recorded, all participants were measured with a scapulometer to determine the posterior displacement of the root of the spine (ROS) and the inferior angle (IFA) of the scapula from the thorax. Next, the participants performed 5 trials of bilateral scapular plane elevation for scapular kinematics and electromyographic (EMG) data collection. Stepwise multiple linear regressions were used to determine the relationships between self-reported FLEX-SF scores and potential factors. In addition to scapular displacement, pain level, scapular kinematics, and EMG data were included as independent variables. RESULTS The intrarater and inter-rater reliabilities of the scapulometer were excellent (intraclass correlation coefficient [ICC] = 0.93-0.97) and moderate to good (ICC = 0.74-0.81), respectively. The Bland-Altman plots showed no systematic bias between raters in the ROS and IFA measurements. Final stepwise multiple regression models showed that more ROS distance, higher serratus anterior activity, and lower pain level during arm elevation were associated with higher shoulder function (total R2 = 0.253). CONCLUSION The reliability of the scapulometer in patients with shoulder pain is moderate to excellent. Scapular dyskinesis may be a compensatory strategy to avoid shoulder pain and improve shoulder function.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Jou Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Giuseppe LU, Laura RA, Berton A, Candela V, Massaroni C, Carnevale A, Stelitano G, Schena E, Nazarian A, DeAngelis J, Denaro V. Scapular Dyskinesis: From Basic Science to Ultimate Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082974. [PMID: 32344746 PMCID: PMC7215460 DOI: 10.3390/ijerph17082974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023]
Abstract
Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.
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Affiliation(s)
- Longo Umile Giuseppe
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-062-2541-1613; Fax: +39-0622-5411
| | - Risi Ambrogioni Laura
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Carlo Massaroni
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Joseph DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
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Activation Profile of Scapular Stabilizing Muscles in Asymptomatic People: Does Scapular Dyskinesis Have an Impact on It? Am J Phys Med Rehabil 2020; 99:925-931. [PMID: 32304382 DOI: 10.1097/phm.0000000000001446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people. DESIGN This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions. RESULTS A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%-61% and 23%-70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio's in the dyskinetic group. CONCLUSIONS An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.
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Rossi DM, Resende RA, Hotta GH, da Fonseca ST, de Oliveira AS. Altered Scapular Time Series in Individuals With Subacromial Pain Syndrome. J Appl Biomech 2020; 36:113-121. [PMID: 32101790 DOI: 10.1123/jab.2019-0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 10/27/2023]
Abstract
Altered scapular movement in subacromial pain syndrome has been demonstrated using discrete data reduction approach. However, this approach does not consider the data collinearity and variability, and scapular translations are poorly investigated in symptomatic individuals. The purpose of this study was to investigate the scapular rotation and translation of asymptomatic individuals and those with subacromial pain syndrome during arm motions using principal component analysis. Scapulothoracic kinematics were evaluated in 47 participants with subacromial pain syndrome and 50 asymptomatic individuals. The symptomatic group had increased range of scapular anterior/posterior tilt during arm elevation (P = .01, effect size = .59) and arm lowering (P < .01, effect size = .61), and increased range of scapular forward/backward translation during arm lowering (P < .01, effect size = .60) compared with the asymptomatic group. In addition, the symptomatic group had a reduced difference in anterior tilt angular velocities between the early-arm and mid-arm lowering phases and between the mid- and late-arm lowering phases compared with the asymptomatic group (P = .03, effect size = .44). This study demonstrated that scapular anterior/posterior tilt motion and angular velocity and scapular forward/backward translation of symptomatic individuals were different from asymptomatic individuals when considering the entire arm movement.
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Dhein W, Wagner Neto ES, Miranda IF, Pinto AB, Moraes LR, Loss JF. Effects of Kinesio Taping on scapular kinematics and electromyographic activity in subjects with shoulder impingement syndrome. J Bodyw Mov Ther 2020; 24:109-117. [DOI: 10.1016/j.jbmt.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/15/2022]
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Huang TS, Ou HL, Lin JJ. Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis. J Hand Ther 2020; 32:345-352. [PMID: 29196161 DOI: 10.1016/j.jht.2017.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Crossover repeated-measure design. INTRODUCTION Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment. PURPOSE OF THE STUDY The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis. METHODS Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application. RESULTS UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis. DISCUSSION The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated. CONCLUSION Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Nodehi Moghadam A, Rahnama L, Noorizadeh Dehkordi S, Abdollahi S. Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. J Shoulder Elbow Surg 2020; 29:e29-e36. [PMID: 31420226 DOI: 10.1016/j.jse.2019.05.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Therapeutic exercise for scapular muscles is suggested to be effective in reducing shoulder pain in patients with rotator cuff disorders, whereas its effectiveness on scapular position and motion has remained unclear. Therefore, the aim of this systematic review was to investigate whether exercise therapy improves scapular position and motion in individuals with scapular dyskinesis. METHODS This study is a wide systematic review including any type of clinical trial in which the effect of any type of therapeutic exercise, including scapular muscle strengthening, stretching, and scapular stabilization exercise, is investigated in adult participants. RESULTS Twenty studies were included in this systematic review. Studies were categorized on the basis of the techniques they used to measure scapular position and motion and the included participants. Methodologic quality of the studies was assessed by the Cochrane tool of assessing the risk of bias. Eight studies used 3-dimensional techniques for measuring scapular motions. Among them, 5 studies showed significant effects of exercise on scapular motion, of which 3 studies investigated individuals with subacromial impingement syndrome (SIS). The other 12 studies used 2-dimensional measurement techniques, of which 8 studies reported significant effects of exercise on scapular position and motion both in SIS patients and in asymptomatic individuals. However, their methodologic quality was debatable. Therefore, there was conflicting evidence for the effect of exercise on scapular dyskinesis. CONCLUSION There is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis. However, exercise is beneficial in reducing pain and disability in individuals with SIS.
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Affiliation(s)
- Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leila Rahnama
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Yildiz TI, Cools A, Duzgun I. Alterations in the 3-dimensional scapular orientation in patients with non-specific neck pain. Clin Biomech (Bristol, Avon) 2019; 70:97-106. [PMID: 31450180 DOI: 10.1016/j.clinbiomech.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/04/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although it is thought that there is a relationship between neck pain and scapular dysfunction, there are controversial results and no clear information in the literature regarding this issue. This study aimed to investigate the alterations in the 3-Dimensional scapular orientation on patients with non-specific neck pain. METHOD Thirty-four patients with chronic non-specific neck pain [age, 29.1 (5) years; height, 165.3 (6.1) centimeters; weight, 62.1 (9.6) kilogram] and 29 healthy controls [age, 28.2 (3.3) years; height, 166.8 (8.1) centimeters; weight, 60.9 (8.5) kilogram] were included in the study. 3-Dimensional scapular kinematics were obtained during arm elevation and lowering trials in the sagittal, scapular, and frontal planes. FINDINGS Compared to healthy controls, the patients with neck pain demonstrated significantly reduced upward scapular rotation on both the dominant and non-dominant sides in all three planes. Patients with neck pain had increased internal rotation in the sagittal and frontal planes on the dominant side and increased external rotation in the frontal plane on the non-dominant side. No difference was observed between groups considering posterior scapular tilt. INTERPRETATION There are alterations in the 3-Dimensional scapular orientations in patients with chronic non-specific neck pain compared to healthy controls. Therefore, the scapular control may also be examined in patients with neck pain and it can be included in the rehabilitation program if needed.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey.
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital, Ghent, Belgium
| | - Irem Duzgun
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
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Broilo C, Schuster RC, Dhein W. Análise eletromiográfica de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/19004126032019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
RESUMO Na artrocinemática do ombro, o manguito rotador atua estabilizando a cabeça umeral em contato com a cavidade glenoidal, enquanto realiza a translação inferior para contrabalancear a força rotacional promovida principalmente pelo deltoide. Exercícios de rotação externa (RE) vêm sendo utilizados na reabilitação de pacientes com disfunções no complexo do ombro buscando restaurar a artrocinemática. Porém, poucos estudos abordam a utilização da faixa elástica e a avaliação dos músculos da cintura escapular, determinantes para uma cinemática adequada. O objetivo deste estudo é comparar a atividade eletromiográfica (EMG) de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. Participaram 11 sujeitos do sexo masculino que foram avaliados durante os movimentos de (1) RE em ortostase; (2) RE com abdução de ombro; (3) RE em decúbito lateral (DL). Os músculos avaliados pela EMG foram: (1) trapézio superior (TS); (2) deltoide médio (DM); (3) deltoide posterior (DP); e (4) infraespinal (IN). A resistência foi determinada por uma faixa elástica cinza calibrada com carga de 5% do peso corporal. A análise dos dados foi realizada no software Biomec-SAS e as estatísticas foram calculadas por meio da Anova de medidas repetidas no software SPSS v20.0. Pôde-se constatar que os músculos TS e DM obtiveram maior atividade EMG durante o exercício de RE com abdução de ombro, o músculo DP durante a RE com abdução de ombro e RE em decúbito lateral, enquanto o IN a obteve durante a RE em ortostase e RE em decúbito lateral.
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Essers JMN, Peters A, Meijer K, Peters K, Murgia A. Superficial Shoulder Muscle Synergy Analysis in Facioscapulohumeral Dystrophy During Humeral Elevation Tasks. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1556-1565. [PMID: 31295115 DOI: 10.1109/tnsre.2019.2927765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Facioscapulohumeral dystrophy (FSHD) is a progressive muscle-wasting disease which leads to a decline in upper extremity functionality. Although the scapulohumeral joint's stability and functionality are affected, evidence on the synergetic control of the shoulder muscles in FSHD individuals is still lacking. The aim of this paper is to understand the neuromuscular changes in shoulder muscle control in people with FSHD. Upper arm kinematics and electromyograms (EMG) of eight upper extremity muscles were recorded during shoulder abduction-adduction and flexion-extension tasks in eleven participants with FSHD and 11 healthy participants. Normalized muscle activities were extracted from EMG signals. Non-negative matrix factorization was used to compute muscle synergies. Maximum muscle activities were compared using non-parametric analysis of variance. Similarities between synergies were also calculated using correlation. The Biceps Brachii was significantly more active in the FSHD group (25±2%) while Trapezius Ascendens and Serratus Anterior were less active (32±7% and 39±4%, respectively). Muscle synergy weights were altered in FSHD individuals and showed greater diversity while controls mostly used one synergy for both tasks. The decreased activity by selected scapula rotator muscles and muscle synergy weight alterations show that neuromuscular control of the scapulohumeral joint is less consistent in people with FSHD compared to healthy participants. Assessments of muscle coordination strategies can be used to evaluate motor output variability and assist in management of the disease.
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Comparison of scapular position and upper extremity muscle strength in patients with and without lateral epicondylalgia: a case-control study. J Shoulder Elbow Surg 2019; 28:1111-1119. [PMID: 30926184 DOI: 10.1016/j.jse.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The symptoms of lateral epicondylalgia (LE) can be persistent, and recurrence is frequent. Recurrence can be related to proximal segment impairment of the kinetic chain. Knowledge of any relation in the kinetic chain in LE may help treatment. We aimed to investigate scapular position and upper extremity muscle strength in patients with LE and to compare them with controls. METHODS The study enrolled 51 patients with LE and 51 age-matched controls. We assessed scapular position asymmetry using the lateral scapular slide test and measured the strength of the upper trapezius (UT), middle trapezius (MT), lower trapezius, and serratus anterior muscles in addition to shoulder abduction, external rotation, and internal rotation and grip strength. RESULTS The percentage of participants with scapular asymmetry was greater in the patients than in the controls (P = .005). The involved side regarding shoulder external rotation among the patients was significantly weaker than in the controls (P = .016, P = .009). The involved side of the LE patients was significantly weaker than the uninvolved side in terms of shoulder abduction, external rotation, and internal rotation (P = .013, P = .048, P = .013). The UT/MT ratio on the nondominant side of the controls was significantly greater than that on the involved side of the LE patients (P = .016). CONCLUSION Upper extremity muscle strength, grip strength, UT/MT ratio, and scapular position are affected in patients with LE. In addition to the elbow, focusing on the upper segments is essential in the management of LE.
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Scapulothoracic kinematic pattern in the shoulder pain and scapular dyskinesis: A principal component analysis approach. J Biomech 2018; 77:138-145. [DOI: 10.1016/j.jbiomech.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022]
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Huang TS, Du WY, Wang TG, Tsai YS, Yang JL, Huang CY, Lin JJ. Progressive conscious control of scapular orientation with video feedback has improvement in muscle balance ratio in patients with scapular dyskinesis: a randomized controlled trial. J Shoulder Elbow Surg 2018; 27:1407-1414. [PMID: 29886062 DOI: 10.1016/j.jse.2018.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Video feedback (VF) can guide patients to consciously control scapular orientation without inappropriate substitution. This study investigated whether progressive conscious control with VF improves scapular muscle activation and movements during arm elevation in patients with subacromial impingement and scapular dyskinesis. METHODS The study recruited 38 amateur overhead athletes with subacromial impingement and scapular medial border prominence who were randomly assigned to the VF or control group. The participants in both groups controlled the scapular position and progressively practiced from 0° to 45° and from 0° to 90° of arm elevation. Participants in the VF group also controlled the scapular position with a video presentation of the scapula on a screen. We investigated the scapular kinematics, muscle activation, and balance ratio for outcome collection in the preintervention and postintervention conditions with and without VF conditions. RESULTS Decreased upper trapezius (UT) activation (3%-13%, P < .0083), increased lower trapezius (LT) activation (3%-17%, P < .0083), restored UT/LT ratios (0.67-3.13, P < .0083), and decreased scapular internal rotation (1.8°-6.1°, P < .003) relative to the preintervention condition were demonstrated in the 2 postintervention conditions in both groups. The VF group also demonstrated decreased UT/serratus anterior ratios (0.21-0.30, P < .0083) in 2 postintervention conditions relative to the preintervention condition. CONCLUSIONS The progressive control of scapular orientation with or without VF can be used to reduce the UT/LT ratio and improve scapular internal rotation during arm elevation. Control training with VF can further decrease the UT/serratus anterior ratio.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Shen Tsai
- Graduate Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Jing-Lan Yang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Ya Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Karagiannakis D, Athanasopoulos S, Mandalidis D. Scapular muscles’ activity in female volleyball players with scapular asymmetry in the resting position. J Bodyw Mov Ther 2018; 22:580-585. [DOI: 10.1016/j.jbmt.2017.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 01/14/2023]
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Chen K, Deng S, Ma Y, Yao Y, Chen J, Zhang Y. A preliminary exploration of plain-film radiography in scapular dyskinesis evaluation. J Shoulder Elbow Surg 2018; 27:e210-e218. [PMID: 29456056 DOI: 10.1016/j.jse.2017.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluation of scapular dyskinesis is of clinical interest because it is believed to be associated with pathologies of the shoulder. This study investigated the feasibility of plain-film radiography in evaluating scapular dyskinesis. METHODS Subjects with unilateral disorders of the shoulder (n = 186) who underwent plain-film radiography of bilateral scapulae were divided into 4 categories of scapular dyskinesis patterns according to the Kibler classification and analyzed. Coracoid upward shift distance (CUSD), length of the scapular spine line (LSS), and scapular upward rotation angle (SURA) were measured on the radiographs. Intrarater and inter-rater reliability were tested, and the characteristics of these parameters in each type were analyzed. The differences (d) between bilateral scapulae (d-CUSD, d-LSS, and d-SURA) among the 4 categories were compared. RESULTS Intrarater and inter-rater reliability were excellent for all parameters. Significant differences between the scapulae were observed in CUSD in type I and in LSS in type II categories. No significant difference in any of the parameters was found in type III. Compared with the other categories, d-CUSD in type I and d-LSS in type II were significantly larger. The cutoff values of d-CUSD and d-LSS were 1.1 mm and 1.2 mm, respectively. No significant difference in d-SURA was found among the 4 categories. CONCLUSIONS The measurement of CUSD, LSS, and SURA on plain-film radiography had excellent reliability. d-CUSD and d-LSS were characteristic parameters of type I and type II, respectively; however, type III had no distinguishing characteristics among the parameters.
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Affiliation(s)
- Kang Chen
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Simin Deng
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yanhong Ma
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Yelin Yao
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juan Chen
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Zhang
- Department of Rehabiliation Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Umehara J, Kusano K, Nakamura M, Morishita K, Nishishita S, Tanaka H, Shimizu I, Ichihashi N. Scapular kinematic and shoulder muscle activity alterations after serratus anterior muscle fatigue. J Shoulder Elbow Surg 2018; 27:1205-1213. [PMID: 29478944 DOI: 10.1016/j.jse.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/24/2017] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the serratus anterior muscle has an important role in scapular movement, no study to date has investigated the effect of serratus anterior fatigue on scapular kinematics and shoulder muscle activity. The purpose of this study was to clarify the effect of serratus anterior fatigue on scapular movement and shoulder muscle activity. METHODS The study participants were 16 healthy men. Electrical muscle stimulation was used to fatigue the serratus anterior muscle. Shoulder muscle strength and endurance, scapular movement, and muscle activity were measured before and after the fatigue task. The muscle activity of the serratus anterior, upper and lower trapezius, anterior and middle deltoid, and infraspinatus muscles was recorded, and the median power frequency of these muscles was calculated to examine the degree of muscle fatigue. RESULTS The muscle endurance and median power frequency of the serratus anterior muscle decreased after the fatigue tasks, whereas the muscle activities of the serratus anterior, upper trapezius, and infraspinatus muscles increased. External rotation of the scapula at the shoulder elevated position increased after the fatigue task. CONCLUSION Selective serratus anterior fatigue due to electric muscle stimulation decreased the serratus anterior endurance at the flexed shoulder position. Furthermore, the muscle activities of the serratus anterior, upper trapezius, and infraspinatus increased and the scapular external rotation was greater after serratus anterior fatigue. These results suggest that the rotator cuff and scapular muscle compensated to avoid the increase in internal rotation of the scapula caused by the dysfunction of the serratus anterior muscle.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Ken Kusano
- ASICS Corporation, Institution of Sport Science, Kobe, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niitaga University of Health and Welfare, Niigata, Japan
| | - Katsuyuki Morishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Nishishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Itsuroh Shimizu
- Department of Physical Therapy, Fukui General Clinic, Fukui, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Pires ED, Camargo PR. Analysis of the kinetic chain in asymptomatic individuals with and without scapular dyskinesis. Clin Biomech (Bristol, Avon) 2018; 54:8-15. [PMID: 29501915 DOI: 10.1016/j.clinbiomech.2018.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study measured strength of the trunk and hip, and compared Y Balance Test and Upper Quarter Y Balance Test in individuals without and with scapular dyskinesis. Strength and endurance of the scapulothoracic muscles were also assessed. METHODS Forty-four individuals without shoulder pain were divided in 2 groups: without scapular dyskinesis (age 26.00, SD 4.10 years) and scapular dyskinesis (age 23.68, SD 4.20 years). Scapular dyskinesis was assessed by clinical observation of the scapular motion during arm elevation, and was classified as present or absent. A handheld dynamometer was used to measure the isometric strength of the trunk flexors and lateral flexors, hip extensors and abductors, lower trapezius, serratus anterior, and latissimus dorsi. Y and Upper Quarter Y Balance Tests were performed with the individual in single-limb and 3-point plank position, respectively. Endurance of the scapulothoracic muscles was assessed with the individuals in prone with the arm at 135° abduction. Independent t-test and Mann-Witney test were used for comparison between groups. A P < 0.05 was considered significant. Effect sizes between groups were also calculated. FINDINGS No differences (P > 0.05) were demonstrated between groups for all variables. Moderate effect size (d ~ 0.40) was found for the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles, whereas the scapular dyskinesis group showed less strength and endurance in relation to the group without dyskinesis. INTERPRETATION Strength of the trunk flexors and hip extensors, and endurance of the scapulothoracic muscles seem to have influence in scapular dyskinesis in non-athletes without shoulder pain.
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Affiliation(s)
- Elisa Doria Pires
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Brazil.
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Scapular muscle dysfunction associated with subacromial pain syndrome. J Hand Ther 2018; 30:136-146. [PMID: 28576347 DOI: 10.1016/j.jht.2017.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Narrative Review. INTRODUCTION One of the shoulder pain disorders in which the function of the scapula is comprised is the subacromial pain syndrome. Several rehabilitation guidelines and exercises have been proposed to improve scapulothoracic muscle dysfunction. Consideration of muscle activation patterns may help to select the most appropriate rehabilitation exercise in these patients. To date, suggesting rehabilitation exercises is often based upon the knowledge of the superficial lying scapulothoracic muscles' activity. In the assumption that the deeper lying scapulothoracic muscles' activity may hinder normal scapular movement in case of tightness or hyperactivity, exercise protocols for patients with altered pattern in scapulothoracic muscles should also integrate knowledge on the deeper lying scapulothoracic muscle activity. PURPOSE OF THE STUDY To help clinicians choosing the most appropriate exercise in patients with subacromial pain syndrome related to scapulothoracic muscle dysfunction. METHODS First, a summary of key alterations in scapulothoracic (muscle) function in patients with subacromial pain was accomplished. Second, promising practical rehabilitation strategies toward restoring scapulothoracic muscle dysfunction (with a focus on scapulothoracic exercises) were developed, integrating current new research evidence (including information about the deeper lying scapulothoracic muscles) with clinical practice. CONCLUSION This review details clinical exercises and their muscular activity to guide clinicians to optimize individualized scapulothoracic training and treatment programs by selecting the most appropriate exercise, based on knowledge from the clinical examination. LEVEL OF EVIDENCE Level 5.
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Abstract
Scapular kinematics are important indicators of dyskinesis, often suggesting underlying shoulder pathology, but the influence of sex is unknown. This study's objective was to examine scapular kinematics in healthy males and females. Positions of surface-mounted reflective markers were tracked during arm elevation movements in 0°/30°/40°/60°/90°/120° planes. Scapulothoracic rotations (protraction/retraction, medial/lateral rotation, posterior/anterior tilt) were calculated. ANOVA analysis evaluated main and interaction effects of sex, plane, phase, and elevation angle. Males and females had similar protraction/retraction and medial/lateral rotation kinematics; mean sex-related peak angle differences were 2.5°, 1.8° (raise [concentric]), respectively, and 2.9°, 2.7° (lower [eccentric]), respectively. Largest sex differences for mean peak angle occurred for posterior/anterior tilt at higher elevation angles (raise, 8.4°; lower, 8.5°). Elevation, plane, and phase were main effects for all scapular rotations (P < .001). Sex was not a main effect for any rotations. Sex × elevation interactions influenced protraction/retraction (P < .001) and posterior/anterior tilt (P < .001). Sex × plane (P ≤ .01) and sex × phase (P ≤ .002) interactions influenced all rotations. Lower posterior tilt for females compared to males at higher elevation angles could relate to higher female shoulder pathology incidence. Sex, plane, and phase are necessary components of uninjured scapular kinematics. Sex-specific differences provide insight into potential shoulder pathology etiology. These data provide a benchmark to assess pathological populations.
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Biomechanical analysis of the shoulder of swimmers after a maximal effort test. Phys Ther Sport 2017; 30:14-21. [PMID: 29274455 DOI: 10.1016/j.ptsp.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/25/2017] [Accepted: 11/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare the kinematics and electromyography of the periscapular muscles in swimmers before and after a 3-min maximal effort test. PARTICIPANTS 16 competitive swimmers. MAIN OUTCOME MEASUREMENTS Infrared cameras were used to record kinematics in the scapular plane in synchronization with the electromyography system. RESULTS There was an increase in internal rotation in all angles (p < 0.05), an increase of the anterior tilt, with 120° of elevation (p = 0.04). The serratus anterior showed a decrease in the intervals of 120-90° and 60-30° (p = 0.04; p = 0.02). There was a linear relationship between the variation before and after the maximal effort of the anterior tilt in relation to the variation of muscular activation of the transverse trapezius (p = 0.01) and the lower trapezius (42%, p = 0.01); an internal rotation in 120° and 90° of elevation in relation to the transverse trapezius (p = 0.01); and an internal rotation in 60° and 30° of elevation in relation to the serratus anterior (p = 0.04, p = 0.03). CONCLUSION A maximal 3-min effort test resulted in altered scapular biomechanics. More studies are needed to verify if the changes correspond to a risk factor for injuries.
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Wochatz M, Rabe S, Wolter M, Engel T, Mueller S, Mayer F. Muscle activity of upper and lower trapezius and serratus anterior during unloaded and maximal loaded shoulder flexion and extension. Int Biomech 2017. [PMCID: PMC7857459 DOI: 10.1080/23335432.2017.1364668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Altered scapular muscle activity is mostly described under unloaded and submaximal loaded conditions in impingement patients. However, there is no clear evidence on muscle activity with respect to movement phases under maximum load in healthy subjects. Therefore, this study aimed to investigate scapular muscle activity under unloaded and maximum loaded isokinetic shoulder flexion and extension in regard to the movement phase. Fourteen adults performed unloaded (continuous passive motion [CPM]) as well as maximum loaded (concentric [CON], eccentric [ECC]) isokinetic shoulder flexion (Flex) and extension (Ext). Simultaneously, scapular muscle activity was measured by EMG. Root mean square was calculated for the whole ROM and four movement phases. Data were analyzed descriptively and by two-way repeated measures ANOVA. CPMFlex resulted in a linear increase of muscle activity for all muscles. Muscle activity during CONFlex and ECCFlex resulted in either constant activity levels or in an initial increase followed by a plateau in the second half of movement. CPMExt decreased with the progression of movement, whereas CONExt and ECCExt initially decreased and either levelled off or increased in the second half of movement. Scapular muscle activity of unloaded shoulder flexion and extension changed under maximum load showing increased activity levels and an altered pattern over the course of movement.
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Affiliation(s)
- Monique Wochatz
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Sophie Rabe
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Martin Wolter
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Steffen Mueller
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
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Nodehi Moghadam A, Abdi K, Shati M, Noorizadeh Dehkordi S, Keshtkar AA, Mosallanezhad Z. The Effectiveness of Exercise Therapy on Scapular Position and Motion in Individuals With Scapular Dyskinesis: Systematic Review Protocol. JMIR Res Protoc 2017; 6:e240. [PMID: 29237578 PMCID: PMC5745349 DOI: 10.2196/resprot.8011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapular stabilizing muscles contributes to impingement syndrome. Scapular muscle exercises are included in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis because the muscular system is one of the major contributors of scapular positioning both at rest and during shoulder movement, but there is considerable uncertainty relating to the relative effectiveness of such approaches on changing scapular position and motion. Objective The aim of this systematic review protocol is to evaluate the effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis. Methods A systematic review will be conducted using PubMed, Scopus, Web of Science, Elsevier, Ovid, ProQuest, Physiotherapy Evidence Database, and Cochrane Library. The reference lists of articles, other reviews, gray literature, and key journals will be searched for relevant articles. Clinical trials reporting the effect of therapeutic exercises (scapular strengthening exercise, scapular stabilization exercise, scapular muscle stretching) with the aims of changing scapular position and motion in individuals with scapular dyskinesis will be included. Two independent reviewers will select studies, extract data, and assess the quality of primary studies. Any disagreement during the selection of studies will be discussed and decided by the whole team. Results This systematic review began in December 2016 and is currently in progress. The findings will be synthesized to determine the effectiveness of recommended therapeutic exercise on scapular position and motion in individuals with scapular dyskinesis. Conclusions This is the first systematic review protocol aiming to assess the effectiveness of exercise therapy in individuals with scapular dyskinesis. The systematic review doesn’t require ethics approval because all data used will be provided from published documents. The results of this study will be published in a peer-reviewed journal. Trial Registration PROSPERO CRD42017053923; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53923 (Archived by WebCite at http://www.webcitation.org/6uzq32T02)
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Affiliation(s)
- Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Mohsen Shati
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran
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Du WY, Huang TS, Hsu KC, Lin JJ. Measurement of scapular medial border and inferior angle prominence using a novel scapulometer: A reliability and validity study. Musculoskelet Sci Pract 2017; 32:120-126. [PMID: 28827031 DOI: 10.1016/j.msksp.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Previous studies have proposed various ways to assess scapular dyskinesis. In clinic, assessment tools designed to measure the posterior displacement of the inferior angle of the scapula with reference to the posterior thoracic cage are needed. OBJECTIVES A novel scapulometer was developed to measure scapular medial border and inferior angle prominence. METHODS A novel scapulometer was designed to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall in 29 participants with scapular dyskinesis bilaterally. Two raters measured the ROS and INF distance of the scapula 3 times bilaterally. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to determine the inter-rater and intra-rater reliability. Validity was based on correlations (convergent: ROS and internal/external rotation, and INF and tilt; divergent: ROS/INF and upward rotation of the scapula) using a FASTRAK Polhemus 3-D motion tracking system assessing scapular tilt, internal/external rotation, and upward/downward rotation. RESULTS The average ROS and INF displacements were 13.7 ± 5.0 mm and 12.5 ± 6.3 mm, respectively. The results showed excellent intra-rater and inter-rater reliability, with ICC = 0.88-0.99 and 0.95-0.99 (SEM = 0.7-0.8 mm), respectively. Correlations were 0.35/0.19 (convergent validity) and 0.07/0.09 (divergent validity). CONCLUSIONS The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended.
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Affiliation(s)
- Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan
| | - Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan
| | - Kai-Chieh Hsu
- Department of Mechanical Engineering, College of Engineering, National Taiwan University, 100 Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.
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The Effect of Shoulder Muscle Fatigue on Acromiohumeral Distance and Scapular Dyskinesis in Women With Generalized Joint Hypermobility. J Appl Biomech 2017; 33:424-430. [DOI: 10.1123/jab.2016-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Muscle fatigue is considered to be one cause of shoulder pain, and subjects with generalized joint hypermobility (GJH) are affected more by shoulder pain. The purpose of this study was to examine the effects of muscle fatigue on acromiohumeral distance (AHD) and scapular dyskinesis in women with GJH. Thirty-six asymptomatic participants were assigned to either a GJH (n = 20) or control group (n = 16) using the Beighton scale. Before and after elevation fatigue trials, AHD was measured with ultrasonography at rest and when the arm was in 90° active elevation. A scapular dyskinesis test was used to visually observe alterations in scapular movement. Our results showed that in both groups, the fatigue reduced AHD in the 90° elevation position and increased the presence of scapular dyskinesis; however, no differences were found between the two groups. Although GJH has been identified as a factor for developing musculoskeletal disorders, generalized joint hypermobility did not result in changes to scapular dyskinesis or AHD, even after an elevation fatigue task. More studies are needed to evaluate the effects of muscle fatigue in subjects with GJH and a history of shoulder instability.
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Rossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS One 2017; 12:e0181518. [PMID: 28749966 PMCID: PMC5531566 DOI: 10.1371/journal.pone.0181518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8-10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.
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Affiliation(s)
- Denise Martineli Rossi
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristiane Rodrigues Pedroni
- Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, São Paulo, Brazil
| | - Jaqueline Martins
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Movement Pattern of Scapular Dyskinesis in Symptomatic Overhead Athletes. Sci Rep 2017; 7:6621. [PMID: 28747702 PMCID: PMC5529546 DOI: 10.1038/s41598-017-06779-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/16/2017] [Indexed: 01/01/2023] Open
Abstract
This study investigated the characteristics of arm elevation via principal component analysis in symptomatic overhead athletes with scapular dyskinesis. One hundred-thirty-four overhead athletes with scapular dyskinesis [24: inferior angle prominence (pattern I); 46: medial border prominence (pattern II), 64: pattern I + II] were evaluated by three-dimensional electromagnetic motion and electromyography to record the scapular kinematics (upward rotation/posterior tipping/exterior rotation) and muscle activation (upper trapezius: UT; middle trapezius: MT; lower trapezius: LT; serratus anterior: SA) during lowering phase of arm elevation. The results showed: (1) for pattern I and II, the first 3 principal component (PCs) explained 41.4% and 42.6% of total variance of movement; (2) the first PCs were correlated with MT, LT activity (r = 0.41~0.61) and upward rotation, posterior tipping (r = −0.59~−0.33) in pattern I, and UT, MT, SA (r = 0.30~0.70) activity in pattern II; (3) contour plots of muscle activity demonstrated that muscle activities varied with dyskinesis patterns. In summary, for the pattern I, the major characteristics are coactivation of MT and LT and corresponding scapular posterior tipping and upward rotation. For the pattern II, the major characteristics are coactivation of UT, MT and SA without corresponding scapular external rotation.
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The scapula backward tipping test: An inter-rater reliability study. J Bodyw Mov Ther 2017; 21:69-73. [PMID: 28167193 DOI: 10.1016/j.jbmt.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/04/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND & PURPOSE The purpose of this study was to determine the reliability of the scapula backward tipping test (SBTT) in detecting the presence of pectoralis minor (PM) tightness and subsequently scapula forward tipping, in a symptomatic population. PM tightness with scapula forward tipping has been described to cause pain and dysfunction in the shoulder region. METHODS 30 patients with a diagnosis of shoulder pain were randomly assigned and examined by 2 musculoskeletal physical therapists at a time. The procedure consisted of having the individual lay on the stomach in a neutral head position with palms in the anatomical position. The examiner firmly stabilized the inferior angle of the scapula with one hand and the fingers of the other hand hooked the under surface of the coracoid process. A gentle yet firm pull was imparted in an upward direction to sense tightness and to observe movement of the acromion up to the tragus of the ear. A comparison was made with the other side to sense restriction. Inter-rater reliability was determined using the kappa statistic. RESULTS The SBTT was found to be reproducible between examiners (Kappa = 0.735, SE of kappa = 0.123, 95% confidence interval), with a percentage agreement of 86.67%. CONCLUSION The SBTT may be incorporated as a simple yet effective test to determine the presence of PM tightness and subsequently scapula forward tipping.
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