Reliability, agreement, and diagnostic accuracy of the Modified Lateral Scapular Slide test

The effect of muscle-biased manual therapy on shoulder kinematics, muscle performance, functional impairment, and pain in patients with frozen shoulder

BACKGROUND

Frozen shoulder (FS) is characterized by restricted active and passive shoulder mobility and pain.

PURPOSE

Compare the effect of muscle-biased manual therapy (MM) and regular physical therapy (RPT) in patients with FS.

STUDY DESIGN

Pretest-post-test control group study design.

METHODS

We recruited 34 patients with FS and compared the effect of 12-session MM and RPT. The outcome measures were scapular kinematics and muscle activation, scapular alignment, shoulder range of motion, and pain intensity. Two-way analysis of variance was used to examine the intervention effect with α = 0.05.

RESULTS

Both programs resulted in similar improvements in pain and shoulder function. Compared to the RPT, MM resulted in increased posterior tilt (MM: 7.04°-16.09°, RPT: -2.50° to -4.37°; p = 0.002; ES = 0.261) and lower trapezius activation (MM: 260.61%-470.90%, RPT: 322.64%-313.33%; p = 0.033; ES = 0.134) during scaption, and increased posterior tilt (MM: 0.70°-15.16°, RPT: -9.66° to -6.44°; p = 0.007; ES = 0.205) during the hand-to-neck task. The MM group also showed increased GH backward elevation (MM: 37.18°-42.79°, RPT: 43.64°-40.83°; p = 0.004, ES = 0.237) and scapular downward rotation (MM: -2.48° to 6.80°, RPT: 1.93°-1.44°; p < 0.001; ES = 0.404) during the thumb-to-waist task, enhanced shoulder abduction (MM: 84.6°-102.3°, RPT: 85.1°-92.9°; p = 0.02; ES = 0.153), and improved scapular alignment (MM: 10.4-9.65 cm, RPT: 9.41-9.56 cm; p = 0.02; ES = 0.114).

CONCLUSIONS

MM was superior to the RPT regarding scapular neuromuscular performance. Clinicians should consider adding muscle-biased treatment when treating FS.

The Correlation Between Cervical Proprioception and Scapular Dyskinesis in Patients With Neck Pain: A Case-Control Study

Introduction Neck pain is common among office workers, and the assessment of cervical proprioception and scapular dyskinesis is key in the management of patients with neck pain. While some studies have shown the relevance of both factors in neck pain patients, the correlation between the two parameters has not yet been investigated. Hence, this study aimed to determine the correlation between cervical proprioception and scapular dyskinesis in workplace computer users without neck pain (control group) versus those with neck pain (case group). Methodology A case-control, correlational study was performed within office settings; based on the selection criteria, 88 participants were included and categorized into two groups consisting of 44 workplace computer users without neck pain in the control group (Group A) and 44 workplace computer users with neck pain in the case group (Group B). Cervical proprioception was evaluated by using the joint position error (JPE) test and scapular dyskinesis was assessed using the modified lateral scapular slide test (MLSST). Results There was a statistically significant difference in cervical proprioception and scapular dyskinesis between the case and control groups (p<0.001). Workplace computer users with neck pain showed greater JPE compared to those without neck pain, and scapular dyskinesis was observed in the case group. Moreover, Spearman's correlation coefficient showed a significant correlation between cervical proprioception and scapular dyskinesis in workplace computer users with neck pain. Conclusions The present study provides guidance on the assessment as well as management of JPE with different positions of scapular dyskinesia. The evaluation of scapular dyskinesis is frequent clinically; given its positive correlation, managing JPE in neck pain patients is feasible.

A randomized controlled trial of scapular exercises with electromyography biofeedback in oral cancer patients with accessory nerve dysfunction

PURPOSE

This study aims to investigate the effects of electromyography (EMG) biofeedback on scapular positions and muscle activities during scapular-focused exercises in oral cancer patients with accessory nerve dysfunction.

METHODS

Twenty-four participants were randomly allocated to the motor-control with biofeedback group (N = 12) or the motor-control group (N = 12) immediately after neck dissection. Each group performed scapular-focused exercises with conscious control of scapular orientation for 3 months. EMG biofeedback of upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) was provided in the motor-control with biofeedback group. Scapular symmetry measured by modified lateral scapular slide test; shoulder pain; active range of motion (AROM) of shoulder abduction; upper extremity function; maximal isometric muscle strength of UT, MT, and LT; and muscle activities during arm elevation/lowering in the scapular plane were evaluated at baseline and the end of the intervention.

RESULTS

After the 3-month intervention, only the motor-control with biofeedback group showed improving scapular symmetry. Although both groups did not show significant improvement in shoulder pain, increased AROM of shoulder abduction and muscle strength of the UT and MT were observed in both groups. In addition, only the motor-control with biofeedback group had improved LT muscle strength, upper extremity function, and reduced UT and MT muscle activations during arm elevation/lowering.

CONCLUSIONS

Early interventions for scapular control training significantly improved shoulder mobility and trapezius muscle strength. Furthermore, by adding EMG biofeedback to motor-control training, oral cancer patients demonstrated greater effectiveness in stabilizing scapular position, muscle efficiency, and upper extremity function than motor-control training alone.

TRIAL REGISTRATION

Institutional Review Board: This study was approved by the Chang Gung Medical Foundation Institutional Review Board (Approval No: 201901788A3. Approval Date: 2 January, 2020).

CLINICAL TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT04476004. Initial released Date: 16 July, 2020).

Diagnosis and Treatment of Snapping Scapula Syndrome: A Scoping Review

CONTEXT

Snapping scapula syndrome (SSS) is commonly misdiagnosed and underreported due to lack of awareness.

OBJECTIVE

This scoping review aims to summarize the current evidence related to SSS diagnosis and treatment to aid clinicians in managing the condition more effectively.

DATA SOURCES

PubMed, Medline, and Embase databases were searched for studies related to the etiology, diagnosis, or treatment of SSS (database inception to March 2020).

STUDY SELECTION

Databases were searched for available studies related to the etiology, diagnosis, or treatment of SSS.

STUDY DESIGN

A scoping review study design was selected to explore the breadth of knowledge in the literature regarding SSS diagnosis and treatment.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Primary outcomes abstraction included accuracy of diagnostic tests, functional outcomes, and pain relief associated with various nonoperative and operative treatment options for SSS.

RESULTS

A total of 1442 references were screened and 40 met the inclusion criteria. Studies commonly reported SSS as a clinical diagnosis and relied heavily on a focused history and physical examination. The most common signs reported were medial scapular border tenderness, crepitus, and audible snapping. Three-dimensional computed tomography had high interrater reliability of 0.972, with a 100% success rate in identifying symptomatic incongruity of the scapular articular surface. Initial nonoperative treatment was reported as successful in most symptomatic patients, with improved visual analogue scale (VAS) scores (7.7 ± 0.5 pretreatment, to 2.4 ± 0.6). Persistently symptomatic patients underwent surgical intervention most commonly involving bursectomy, superomedial angle resection, or partial scapulectomy. High satisfaction rates of surgery were reported in VAS (6.9 ± 0.7 to 1.9 ± 0.9), American Shoulder and Elbow Surgeons scores (50.3 ± 12.2 to 80.6 ± 14.9), and mean simple shoulder test scores (5.6 ± 1.0 to 10.2 ± 1.1).

CONCLUSION

Focused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.

Relationship between scapular initial position and scapular movement during dynamic motions

Optimal scapular position and movement are necessary for normal function of the shoulder joint and it is essential to focus on scapula in the rehabilitation for shoulder disorders. The aim of this study was to discover the relationship between the scapular initial position and scapular movement during dynamic motions in healthy young men. Thirty-four men participated in this study. The scapular angles at initial position and in elevation and lowering during flexion and abduction were measured using an electromagnetic tracking device. The scapular movements from 30° to 120° during flexion and abduction were calculated. Spearman's rank correlation coefficients were used to analyze the relationship between the scapular initial position and scapular movements. For upward rotation and posterior tilt of the scapula, there were significant positive correlations between the scapular initial position and scapular movement during flexion and abduction. For internal rotation, there were significant positive correlations, except 90° in lowering phase and 120° in both phases. While the humeral elevation increased, the correlation coefficients tended to decrease. Except for the internal rotation our results clarified the interactions between the scapular initial position and scapular movement during dynamic motions in healthy young men. The tendency of the decrease in correlation coefficient with elevation angle was shown.

Clinical assessment methods for scapular position and function. An inter-rater reliability study

Introduction: The aim of this study was to assess the inter-rater reliability of selected static, semi-dynamic, and dynamic test assessment methods for evaluation of scapular positioning and function. Methods: A standardized three-phase (i.e. training, overall agreement, and actual study) protocol for reliability studies was applied on 41 overhead sports participants, aged 18-56 (22 with obvious scapular winging, classified as visibility of the medial or inferior angle border of scapula). Ten scapular test assessment methods (two static, three semi-dynamic, and five dynamic) were evaluated. Results: Bland-Altman plots showed no funnel effects, although systematic bias and significant differences between raters were present in three of the methods. ICC values ranged from 0.71 to 0.80 for the static test assessment methods and from 0.25-0.92 for the semi-dynamic test assessment methods. Three of the five dynamic test assessment methods had ICCs of 0.47-0.68. For the two remaining dynamic test assessment methods, kappa varied between -0.034 and 0.71. Using PABAK, kappa increased to 0.54-0.86. Conclusion: Four scapular test assessment methods (Upper horizontal distance, Lower horizontal distance at max shoulder flexion, Acromial distance, and Winging scapula) showed satisfactory inter-rater reliability. Simple visual observational methods and quantitative distance measurements have better reliability between clinicians than more complex measurements and may be better suited for use in clinical practice.

A positive scapular assistance test is equally present in various shoulder disorders but more commonly found among patients with scapular dyskinesis

OBJECTIVE

Assess the frequency of a positive scapular assistance test (SAT) in different shoulder disorders and establish its association with scapular dyskinesis.

DESIGN

Cross-sectional.

SETTING

Shoulder clinic.

PARTICIPANTS

Seventy-four patients.

MAIN OUTCOME MEASURES

The SAT and visual assessment of scapular movement were performed by a physical therapist. An orthopaedic surgeon classified participants into 4 diagnostic categories: rotator cuff disease, superior labrum anterior posterior lesion (SLAP), shoulder instability, and other.

RESULTS

Twenty-seven (36.5%) participants presented with a positive SAT. The SAT was positive among 9 of 28 participants (32.1%) with rotator cuff disease, 7 of 23 participants (30.4%) with SLAP lesions, 9 of 21 participants (42.9%) with shoulder instability, and 2 of 2 participants (100.0%) with other pathologies. The frequency of a positive SAT did not differ between the various diagnostic categories (P = 0.64). The SAT was more frequently positive among participants with scapular dyskinesis (48.5% versus 26.8%, P = 0.05).

CONCLUSIONS

The SAT is found similarly positive among patients with various common shoulder disorders. Although associated with scapular dyskinesis, the SAT was positive in less than half of those demonstrating scapular dyskinesis suggesting the SAT may help identify patients in whom altered scapular movement is contributing to shoulder pain.

POSTURAL ALTERATIONS IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME

Background

An aberrant upper body posture has been proposed as one of the etiological factors contributing to the development of subacromial impingement syndrome (SAIS). Clinicians have translated this supposition into assessment and rehabilitation programs despite insufficient and conflicting evidence to support this approach.

Purpose

The purpose of this study was to compare several postural variables between the SAIS patients and asymptomatic healthy controls.

Study Design

Case-Control Study.

Methods

A total of 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated several postural variables including forward head posture (FHP), forward shoulder posture (FSP), thoracic kyphosis index (TKI), scapular index (SI), normalized scapular protraction (NSP), and the lateral scapular slide test (LSST). The variables were compared between patient and control groups according to sex.

Results

Significant differences were observed in the female patients compared to asymptomatic controls for the FHP (49.38 + 9.6o vs 55.5o+8.38, p=0.03), FSP (45.58 + 10.1o vs 53.68 + 7.08, p=0.02), and LSST in third position (10.2 + 2.1cm vs 11.5 + 0.7cm, p=0.01). Male patients showed a significant difference only in the FSP compared to controls (61.9o+9.4o vs 49.78 + 9.28, p<0.001).

Conclusions

While inadequate data on the relationship between dysfunctional posture and SAIS has led to broad variations in current rehabilitation strategies, the results of the present study revealed different patterns of postural aberrations in female and male patients with SAIS. This clarifies the need to develop individualized or sex-specific approaches for assessing posture in men and women with SAIS and rehabilitation programs based on the assessment results.

Level of Evidence

3b.