Clinical Assessment of Scapula Motion: Scapula Upward Rotation and Relationship with Injury in Swimmers

Clinically Feasible Quantitative Assessments of Dynamic Scapular Motion: A Scoping Review

Background

Scapular kinematics and stabilization are crucial for optimal upper extremity function. Disruptions in normal scapular motion, also rereferred to as dyskinesis, are associated with injuries like subacromial impingement and glenohumeral instability. Clinically feasible methods to assess dynamic scapular motion are essential for accurate diagnosis and rehabilitation but remain limited in both reliability and functionality.

Purpose

The purpose of this scoping review was to systematically identify and summarize the existing literature on clinically feasible quantitative methods that assess active dynamic scapular motion in at least one plane. It seeks to identify tools, technologies, and protocols used in clinical settings, highlighting gaps in current research.

Study Design

Scoping Review.

Methods

A systematic search was conducted in PubMed, CINAHL, and SPORTDiscus databases. Studies that utilized clinically feasible methods to assess scapular motion in at least one plane, and with continuous motion or at least two actively achieved and maintained positions (dynamic), were included. Data were extracted regarding instrument types, measurement methods, dynamic motions assessed, and reliability/validity results.

Results

Of the 62 studies meeting inclusion criteria, digital inclinometers were the most frequently used tools, followed by gravity inclinometers and measuring tapes. Scapular upward rotation was the most commonly assessed motion, with a majority of studies focusing on static or basic dynamic tasks rather than functional or sport-specific activities. Validity results varied, with moderate to strong correlations in some tools, but reliability was inconsistent, particularly in dynamic settings.

Conclusions

Clinically feasible methods for assessing dynamic scapular motion exist, but their reliability and ability to capture continuous motion during functional movements are limited. Further research is needed to develop tools that can assess scapular motion during dynamic, multi-planar, and functional tasks, enhancing clinical decision-making for injury prevention and rehabilitation.

Level of Evidence

2b.

Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review

BACKGROUND

Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level.

PURPOSE

The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests.

DESIGN

Systematic review.

METHODS

PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified.

RESULTS

Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies.

CONCLUSION

Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures.

Key level of evidence

3, Systematic review of mostly Level 3 studies.

Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence

BACKGROUND

Current literature highlights the difficulty in identifying an optimal educational technique for maintaining continence during cough.

OBJECTIVE

To characterize the effects of an educational intervention focusing on neutral posture during cough in women with cough-induced urinary incontinence (UI).

METHODS

This interventional study design included women with cough-induced UI. We recorded PFMs surface electromyographic (sEMG) peak activity, and assessed symptoms and quality of life (QoL) 6 weeks after the intervention. The effect of the experimental situation was estimated using a linear mixed model, sEMG measurements during coughing were indexed to each situation and adjusted to the resting value at, and a moderation analysis was used.

RESULTS/FINDINGS

Eighteen participants were included. The measurement situations (control versus experimental) did not have a statistically significant impact on sEMG peak activity during coughing: mean effect [95% CI] 3.42 [-1.28; 7.66]. Six weeks post-intervention, participants reported statistically significant decrease in urinary symptoms (P=0.0246) and significant improvement in QoL (P=0.00776). This was also particularly marked on the dimension related to effort activities (P=0.00162).

CONCLUSION

This study suggests that a brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks. These improvements seem to be independent of electromyographic PFMs peak activity recorded during cough. As such, our preliminary results pave the way for future research.

LEVEL OF EVIDENCE

NP4.

Scapulohumeral kinematics and neuromuscular control during scaption are associated with passive stiffness and strength of periscapular muscles in competitive adolescent swimmers

The passive stiffness and strength of periscapular muscles may affect scapulohumeral control, especially in overhead athletes due to sports-specific training. This study tried to assess the relationship between the passive stiffness and strength of periscapular muscles, scapulohumeral kinematics and neuromuscular control during scaption in swimmers. Ten male adolescent competitive front-crawl swimmers were recruited. The passive stiffness and strength of periscapular muscles were measured in standard postures by a hand-held myotonometer and dynamometer, respectively. Surface electromyography and electromagnetic tracking systems were synchronized to record the muscle activities and scapulohumeral kinematics during scaption. Correlations between the passive stiffness or strength of periscapular muscles and the kinematics or muscle activity were examined by Spearman's rank correlation coefficient. The maximal strength of periscapular muscles correlated positively with the ranges of upward and external rotation of the scapula and negatively with muscle activity during scaption. Passive stiffness of periscapular muscles was associated with the downward rotation of the scapula and triggered an increase in muscle activity. Increased passive stiffness or decreased strength in the periscapular muscles may affect their role in controlling the scapular rotation and contribute to compensation from adjacent muscles. Our findings suggest that when attempting to evaluate scapular behavior, it may be beneficial to examine muscle strength and passive stiffness of periscapular muscles.

The effect of axillary crutch length on upper limb kinematics during swing-through gait

BACKGROUND

Axillary crutches are commonly used in rehabilitation. Inappropriately fit crutches may result in upper limb pain or injury.

OBJECTIVE

To investigate the effects of axillary crutch length on upper limb kinematics to better understand potential injury mechanisms. It was hypothesized that crutches that were longer or shorter than standard-fit crutches would alter upper limb kinematics.

DESIGN

Cross-sectional.

SETTING

Gait laboratory.

PARTICIPANTS

Fifteen healthy males with no prior crutch experience.

INTERVENTIONS

Participants were fit with axillary crutches using standardized methods, as well as with crutches that were 5 cm longer and 5 cm shorter. Participants performed swing-through gait (1.20 ± 0.07 ms^-1 ) with all crutch lengths in randomized order. Kinematics were recorded using an optical motion-tracking system and joint angles for the scapula, shoulder, elbow, and wrist were computed.

MAIN OUTCOME MEASURES

The effects of crutch length on joint range of motion (ROM) and joint angles at initial crutch contact were analyzed using multivariate analysis (Hotelling's T² ; α = .025) and simultaneous confidence intervals (CI).

RESULTS

The long-standard crutch fit comparison showed effects across all joints (ROM p = .009; initial contact p < .001). Longer crutches resulted in greater scapular upward rotation (mean difference [95% CI] ROM: 1.0 [-0.2 to 2.2]; initial contact: -2.7 [-4.4, -1.1]) and shoulder abduction (ROM: 0.8 [-0.1 to 1.8]; initial contact: -1.9 [-4.1 to 0.3]). Crutch length also had effects across all joints for the short-standard fit comparison (ROM p = .004; initial contact p = .016). Shorter crutches resulted in greater scapula downward rotation (2.2 [-0.4 to 4.8]) and greater shoulder adduction (2.5 [-0.6 to 5.6]) at initial contact. Shorter crutches also reduced shoulder flexion/extension ROM (-2.5 [-4.4 to -0.6]).

CONCLUSIONS

Altered crutch length results in scapular and shoulder kinematic deviations that may present risk factors for upper limb injury with crutch-walking. This may underline the importance of appropriate device fitting to reduce injury risk in crutch users.

Scapular upward rotation position is symmetrical in swimmers without current shoulder pain

OBJECTIVES

A history of shoulder pain is common in swimmers and may influence scapular position, possibly increasing the risk of shoulder pain recurring. The aim of this study was to establish and compare bilateral static measures of scapular upward rotation in swimmers (14-20 years), some with a history of shoulder pain but all currently pain free, in two different elevated positions of shoulder abduction.

DESIGN

Cross-sectional, observational study.

PARTICIPANTS

Eighty-five swimmers without current shoulder pain.

METHODS

Scapular upward rotation position was measured on both shoulders using a digital inclinometer in 90° and 140° shoulder abduction. Descriptive statistics were calculated for degrees of scapular upward rotation in both shoulder positions. Differences between shoulders (dominant, non-dominant, history and no history of pain) were explored using one-way ANOVA and paired t tests.

RESULTS

A large range of values for scapular upward rotation was found at both positions of shoulder abduction but there were no significant differences between the shoulders: with and without a history of shoulder pain for the dominant and non-dominant sides.

CONCLUSIONS

A history of shoulder pain and arm dominance did not influence scapular upward rotation position when measured in shoulder abduction in swimmers without current shoulder pain.