Rhomboideus Research Articles

Effect of INIT in Treatment of Myofascial Trigger Points in Rhomboid muscle: A Case Report

Effect of INIT in Treatment of Myofascial Trigger Points in Rhomboid muscle: A Case Report

The value of T2-weighted MRI contrast ratio combined with DWI in evaluating the pathological grade of solid lung adenocarcinoma

To assess the predictive value of T2-weighted (T2W) magnetic resonance imaging (MRI) in combination with diffusion-weighted imaging (DWI) for determining the pathological grading of solid lung adenocarcinoma. The clinical and imaging data from 153 cases of solid lung adenocarcinoma (82 men, 71 women, mean age 63.2 years) confirmed at histopathology in The First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to May 2022 were analysed retrospectively. Adenocarcinomas were classified into low-grade (G1 and G2) and high-grade (G3) groups following the 2020 pathological grading system proposed by the International Association for the Study of Lung Cancer. The T2-weighted contrast ratio (T2CR), calculated as the T2 signal intensity of the lung mass/nodule divided by the T2 signal intensity of the right rhomboid muscle was utilised. Two experienced radiologists reviewed the MRI images independently, measured the T2CR, and obtained apparent diffusion coefficient (ADC) values. The Mann-Whitney U-test was used to compare general characteristics (sex, age, maximum diameter), T2CR, and ADC values between the low-grade and high-grade groups. The non-parametric Kruskal-Wallis test determined differences in T2CR and ADC values among the five adenocarcinoma subtypes. Receiver characteristic curve (ROC) analysis, along with area under the curve (AUC) calculation, assessed the effectiveness of each parameter in distinguishing the pathological grade of lung adenocarcinoma. A Z-test was used to compare the AUC values. Among the 153 patients with adenocarcinoma, 103 had low-grade adenocarcinoma, and 50 had high-grade adenocarcinoma. The agreement between T2CR and ADC observers was good (0.948 and 0.929, respectively). None of the parameters followed a normal distribution (p<0.05). The ADC value was lower in the high-grade adenocarcinoma group compared to the low-grade adenocarcinoma group (p=0.004), while the T2CR value was higher in the high-grade group (p=0.011). Statistically significant differences were observed in maximum diameter and gender between the two groups (p<0.001 and p=0.005, respectively), while no significant differences were noted in age (p=0.980). Among the five adenocarcinoma subtypes, only the lepidic and micropapillary subtypes displayed statistical differences in ADC values (p=0.047), with the remaining subtypes showing no statistical differences (p>0.05). The AUC values for distinguishing high-grade adenocarcinoma from low-grade adenocarcinoma were 0.645 for ADC and 0.627 for T2CR. Combining T2CR, ADC, sex, and maximum diameter resulted in an AUC of 0.778, sensitivity of 70%, and specificity of 75%. This combination significantly improved diagnostic efficiency compared to T2CR and ADC alone (p=0.008, z=2.624; p=0.007, z=2.679). The MRI quantitative parameters are useful for distinguishing the pathological grades of solid lung adenocarcinoma, offering valuable insights for precise lung cancer treatment.

Effect of Ultrasound-Guided Rhomboid Interfascial Plane Block on Pain Severity, Disability, and Quality of Life in Myofascial Pain Syndrome – A Case Series With One-Year Follow-Up

BACKGROUND: Myofascial pain syndrome (MPS) is a condition characterized by trigger points in the taut bands of skeletal muscles, commonly affecting the trapezius, rhomboid, and supraspinatus muscles. Rhomboid intercostal block (RIB), an interfascial plane block used to assist perioperative analgesia might be a potential treatment option in MPS. OBJECTIVES: To investigate the short and long-term effects of ultrasound-guided RIB in reducing the severity of pain, disability, and improving quality of life in MPS patients with trigger points in the rhomboid muscle. STUDY DESIGN: Retrospective study. SETTING: Physical medicine and rehabilitation outpatient clinic in a university hospital. METHODS: Patients with a diagnosis of MPS who received ultrasound (US)-guided RIB between November 2021 and January 2022 were enrolled in this study. All patients reported pain lasting &gt;= 3 months and severity &gt;= 4/10 on numeric rating scale (NRS), without any comorbidities affecting the neuromuscular system. Trigger points in the rhomboid muscle were treated with US-guided RIB. Pain intensity was evaluated using a NRS at pre-treatment and one week, one month and one year after the injection. At pre-treatment, one month, and one year after treatment, self-administered neck pain and disability scale and Nottingham Health Profile were evaluated. RESULTS: A total of 23 patients were included in this study (5 men and 18 women, with an average age of 45). Pain severity was statistically significantly reduced in approximately 90%, 60-70%, and 50% of the chronic MPS patients at the first week, first month, and first year following injection, respectively. Disability scores improved significantly in 70% and 56% of those patients at the first month and first-year follow-up. Improvement in the quality of life was observed at the first month and maintained at the first-year follow-up. LIMITATIONS: The retrospective design of this study is a limitation. Due to the lack of a control group, this treatment option could not be compared with other treatments. CONCLUSIONS: Our study demonstrated that RIB might be an effective long-term treatment option for MPS in the reduction of pain and disability, improvement of quality of life and overall patient satisfaction. KEY WORDS: Myofascial pain syndrome, trigger point, pain, pain management, interventional ultrasound

Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis

BackgroundObstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity.This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years.Materials and methodsOBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study.ResultsFour Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting.ConclusionsRSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements.Level of evidence: Level IV, Case series.

OA01 Tennis shoulder? A rare case of brachial neuritis

OA01 Tennis shoulder? A rare case of brachial neuritis

Supine counterstrain technique for rhomboid tender point.

Because poor posture is a common instigating factor in back, shoulder, and neck pain, the rhomboid muscles should be considered in a complete physical evaluation. Previous techniques for treating a rhomboid tender point have addressed only one of the two main actions of the muscle, specifically retraction of the scapula utilizing shoulder abduction. This modified supine counterstrain technique forthe rhomboid tender point incorporates both scapular retraction as well as superior, medial rotation of the inferior border of the scapula without abduction, providing a comprehensive treatment to accommodate patients with shoulder movement restrictions. This article discusses indications, contraindications, treatment, and a list of problem-solving strategies for the rhomboid tender point.

Stripping Massage and Literature Review in Post-Thoracoscopic Chest Pain Management.

The aim of this randomized study was to investigate whether stripping massage (SM) of myofascial trigger points in the lower rhomboid muscle could alleviate chest pain in patients following thoracoscopic surgery. In addition, a literature review was conducted to assess the effectiveness of various pain management techniques. Sixty adult patients who reported a visual analog scale (VAS) score of 4 or higher were randomly assigned to receive conventional analgesics alone (conventional group) or combined with SM twice daily for 2 weeks (SM group). VAS scores and the use of additional analgesics were evaluated on postoperative days 1, 3, 7, 14, and 30. Using the PubMed and Cochrane Library databases, a review of current pain management techniques was carried out up to January 31, 2022. A subgroup analysis was also performed to examine the treatment effect during different surgical periods and techniques. Results showed that the SM group had significantly lower VAS scores on postoperative days 3, 7, 14, and 30 (p < 0.001), as well as a shorter hospitalization duration and reduced need for additional analgesics (p < 0.001). The literature review included a total of 20 studies (2,342 cases of chest pain relief after thoracoscopic surgery), which indicated that serratus anterior plane (SAP) blocks were commonly used as a perioperative approach to reduce pain and opioid consumption. SM and SAP can both serve as adjuvant treatments for chest pain in patients following thoracoscopic surgery, with SM being a safe and noninvasive pain control option after hospital discharge.

Analysis of abnormal muscle activities in patients with loss of cervical lordosis: a cross-sectional study

BackgroundThis study aimed to detect the differences in cervical muscle activation patterns in people with versus without cervical lordosis and explore the possible mechanism of cervical pain originating therein.MethodsThis cross-sectional design included 39 participants without and 18 with normal cervical lordosis. Muscular activation was measured for 5 s in both groups using surface electromyography. Subsequently, the root mean square (RMS) of muscle amplitude was obtained at the bilateral splenius capitis, upper and lower parts of the splenius cervicis, upper and lower parts of the semispinalis cervicis, sternocleidomastoid, upper trapezius, and rhomboid muscles in five cervical positions: 0° (resting), 30° of flexion, 30° of extension, 60° of extension, and upon a 1-kg load on the head in a resting posture.ResultsThe RMS values of the upper trapezius muscle at all postures and the rhomboid muscles at 60° of extension were significantly lower in the loss of lordosis than control group. Comparing the RMS ratio of each posture to the resting position, the ratio of the upper trapezius at flexion was significantly higher and that of the rhomboids at 60° of extension and upon loading was significantly lower in the loss of lordosis than control group. Moreover, the pattern changes in the RMS values according to posture showed a similar shape in these two muscles, and lower in the loss of lordosis than the normal group.ConclusionsThe loss of normal cervical alignment may correlate with predisposed conditions such as reduced muscle activation of the trapezius and rhomboid muscle, and may also provoke over-firing of the upper trapezius muscle, possibly increasing neck musculoskeletal pain.Trial registration.Clinicaltrials.gov, registration number: NCT03710785.

Rhomboid muscle spasms among the population of Saudi Arabia

Rhomboid muscle spasms among the population of Saudi Arabia

Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain.

Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with aretrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Синдром крыловидной лопатки

Since A. Velpeau [1] first described a case of isolated paralysis of the anterior serratus muscle leading to the development of winged scapula syndrome, it has been shown that this lesion leads to shoulder joint dysfunction and the development of pain syndrome. Correct movement and positioning of the scapula relative to the rib cage is essential for proper shoulder joint function and positioning of the upper extremity in space. Weakness and loss of biomechanics of scapula motion leads to difficulty in lifting the upper extremity as well as lifting weights. According to the literature, the most common causes of winged scapula syndrome are injuries of the long thoracic nerve (paralysis of the anterior serratus muscle) and the spinal accessory nerve (paralysis of the trapezius muscle). The number of cases of anterior serratus muscle paralysis ranges from 0.0026 to 0.21% [2]. Most authors focus on nerve damage leading to paralysis of the anterior dentate and trapezius muscles. However, in 1930, S. Fichet described the development of winged scapula syndrome as a result of traumatic detachment of the muscles surrounding the scapula [3]. Traumatic detachment of the anterior serratus, trapezius, and rhomboid muscles is an important and understudied problem leading to shoulder joint dysfunction and development of winged scapula. The aim of the review is to study the main injuries leading to the development of wing-shaped scapula syndrome, as well as the main methods of diagnosis and treatment of this pathology.

Effects of low-protein diet and feed restriction on mRNA expression of cationic amino acid transporters in porcine skeletal muscles.

We investigated the effects of a low-protein diet and feed restriction on the mRNA expression of cationic amino acid transporters (CATs) in the longissimus dorsi (LD), rhomboideus (RH), and biceps femoris (BF) muscles of pigs. Eighteen piglets were divided into three groups: a control (CP21%), low-protein diet (LP, CP16%), and feed-restricted diet (FR, CP21%, 76% feed intake of control pigs) groups. The expression levels of CAT-1 in the LD and BF muscles of LP pigs were higher than that of control pigs, whereas that of FR pigs showed no difference. The CAT-2A expression levels in the RH muscle of FR pigs were higher than that of control pigs. The free lysine concentrations in all muscles of LP and FR pigs were lower than that of control pigs. To examine the factors that affect CATs mRNA expression, we evaluated the effects of lysine, arginine, insulin-like growth factor-I, and dexamethasone on the expression of CATs in C2C12 myotubes. CAT-1 expression levels increased in lysine and/or arginine deprivation. We show that CAT-1 and CAT-2A expression levels in skeletal muscles differ in response to dietary treatments and CAT-1 expression in skeletal muscles appears to increase in response to low free lysine concentrations.

Dynamic Muscle Stimulation for Pain, Tenderness, and Stiffness on Upper Back Muscles: A Novel Approach and Analysis on Shear-wave Elastography

Abstract Upper back myalgia is a complaint of pain, stiffness, and tightness in the upper back muscles. It is characterized by acute or persistent neck–shoulder pain. We report the case of a 24-year-old male who presented with pain and swelling in the neck and upper back region, along with gradual restriction in cervical range of motion (ROM) for 2 months. The pretreatment assessment revealed severe tightness of the middle fibers of the trapezius and upper fibers of the rhomboid major muscle. Pretreatment elastography revealed high elasticity contrast index (ECI) values of 8.59 and 9.01, respectively, and a red region indicative of increased stiffness of the muscle fibers. The patient was treated with Naqvi’s-Dynamic Electrical Therapy Approach (Naqvi’s DELTA) which is a novel method of using interferential current with a dynamic stimulation probe for 15 min using ultrasound gel on the affected area and examining the patient for the effect of the DELTA on muscle elongation by shear wave elastography which is a unique variation in ultrasound imaging. The pre- and posttreatment findings revealed a significant reduction in stiffness of the muscle fibers, indicated by decreased ECI values of 2.14 and 0.94, respectively, in the blue region. In addition, posttreatment also had an impact on pain reduction and a significant increment in the overall cervical ROM.

Scapular winging due to rhomboid muscle paralysis: clinical assessment of 4 cases and anatomic study of the dorsal scapular nerve.

A rare cause of scapular winging is rhomboid muscle paralysis secondary to dorsal scapular nerve (DSN) neuropathy. This paralysis causes winging of the medial border of the scapula with lateral rotation of its inferior angle. We report a series of 4 clinical cases of isolated DSN compression and the results of a specific rehabilitation protocol. A continuous clinical series of 4 patients with isolated rhomboid muscle deficiency was analyzed. Two patients were men and 2 were women, with a mean age of 40years (range, 33-51years). Three patients were right-handed and 1 was left-handed. Scapular winging always affected the dominant side. Two patients had occupations involving heavy physical work. The sports practiced involved exertion of the arms (dancing, boxing, gymnastics, muscle strengthening). A specific rehabilitation protocol was offered to the patients. In addition, 6 fresh cadaver dissections were performed to reveal possible DSN compression. Potential areas of compression were identified, in particular when the arm was raised. The 4 patients presented with isolated DSN neuropathy were confirmed by electroneuromyographic testing. Total correction of scapular winging was not obtained in any patient. Three patients experienced residual pain with a neuropathic pain by the questionnaire for a Diagnosis of Neuropathic Pain (DN4) score of 2. The mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score after treatment was 31.8 of 100. The mean ASES score was 56.2. Only 1 patient agreed to rehabilitation in a specialized center and underwent follow-up electroneuromyography. Signs of rhomboid muscle denervation were no longer present and distal motor latencies had become normal. In all cadaver dissections, the DSN originated from the C5 nerve root and did not pass through the middle scalene muscle. We identified a site of dynamic compression of the DSN by the upper part of the medial border of the scapula when the arm was raised. DSN compression is conventionally attributed to the middle scalene muscle, but it is noteworthy that our study reveals the possibility of dynamic compression of the nerve by the proximal part of the medial border of the scapula, which occurs when the arm elevation is above 90°. Our study reveals the possibility of dynamic compression of the DSN by the proximal part of the medial border of the scapula, which occurs when the arm is raised above 90°. In the absence of a surgical solution, conservative treatment is fundamental and requires management in a rehabilitation center with intervention by a multidisciplinary team.

Clavicle lengthening, a novel operation technique to reduce pain in brachial plexus birth injury patients

Brachial plexus birth injury (BPBI) can lead to an imbalance of shoulder musculature that can lead to glenohumeral contractures, and joint and osseous deformities. Glenoid hypoplasia, lengthening of coracoid and acromion, protraction, lateral rotation and elevation of the scapula, and shortening of the clavicle can be observed. As a consequence, the trapezius, levator scapulae, rhomboid, and supraspinatus muscles are overloaded in daily activities causing pain, which can be difficult to treat conservatively. It is hypothesized that operative lengthening of the clavicle may lead to a more anatomic position of the scapula and periscapular muscles, which, as a consequence, may lead to less overloading pain. This study presents the results of this new technique in patients with BPBI. Seven patients (median age 20 years) were included and underwent a lengthening osteotomy of the clavicle at the affective side. Preoperatively, the osseous deformities were confirmed with a computed tomography scan. Patient-reported outcome measures, Disabilities of Arm, Shoulder and Hand score, and Mallet score were evaluated pre- and postoperatively. After a median of 42 (interquartile range [IQR]: 8.0) months' follow-up, all patients were satisfied with the result. The median numeric rating scale for satisfaction was 8.0 (IQR: 2). Pain decreased from a median numeric rating scale of 7.0 (IQR: 2) preoperatively to 2.0 (IQR: 3) at the final follow-up. The median Mallet score was 14.5 (IQR: 1) preoperatively and 14 (IQR: 0) at the final follow-up. The median Disabilities of Arm, Shoulder and Hand score was 36.7 (IQR: 24.1) at the final follow-up. All patients returned to their normal work without changes in working conditions. Short-term follow-up shows that in patients with BPBI with a short clavicle at the affected side and malposition of the scapula, a lengthening osteotomy of the clavicle is a safe and promising technique to reduce pain based on overloading, without deterioration of shoulder function.

P.207 Muscle magnetic resonance imaging in Myotonic dystrophy type 1: Longitudinal study for 5 years

Myotonic dystrophy type 1 is the most common genetic muscle disease in adults, caused by increased expansion of CTG repeats in the DMPK gene. It is characterized by progressive distal dominant muscle weakness and myotonia. The aim of this study was to evaluate objective longitudinal changes in the muscle magnetic resonance imaging in DM1 patients over five years. Eighteen genetically diagnosed DM1 patients were enrolled at baseline. The mean age was 44.86±9.83, mean CTG repeat length was 465±328.86 and a disease duration of 18.29±9.43 years. The baseline motor function such as medical research council sum score, Muscular impairment rating scale and 6-minute walk test were evaluated at the baseline and after 5 years of follow up. The pulmonary function and serum creatine kinase levels were also evaluated. The muscle magnetic resonance imaging was performed at baseline and after 5 years. The individual muscles were semi-quantitatively graded using five-point Mercuri scores. The thirteen upper muscle groups and twenty one lower limb muscles were evaluated. The lower muscle groups including gluteus muscles. The fatty infiltrative changes progressed after 5 years of follow up, with significant score changes were most prominently observed in lower limb muscles including gastrocnemius, soleus, tibialis anterior, gastrocnemius and tensor fascia latae muscles. Among upper limb muscles, latissimus dorsi showed most significant fatty infiltrative changes, followed by serratus and rhomboid muscles. Bases on the longitudinal follow up of the muscle MRI, DM1 showed significant deterioration in the lower limb muscles, with prominent changes in the crural muscles. This is the first longitudinal muscle MRI study and more studies are warranted to understand muscle degeneration in DM1.

A Cadaveric Study of a Safe and Accurate Electromyographic Needle Approach to the Rhomboid Major.

This study aimed to investigate a safe and accurate electromyographic needle insertion site of the rhomboid major (RM) muscle using cadaver dissection. Dissection of the trapezius and rhomboid major muscles around the scapula was performed in 18 scapulae from nine fresh cadavers. The point (point A) at which the lateral margin of the lower trapezius muscle crossed the medial border of the scapula and the distal insertion point (point DI) of the rhomboid major muscle to the medial scapula were determined. The midpoint (point M) between points A and DI was also determined. The distance from the inferior angle of the scapula to each point was measured. The length of the medial scapula was 12.9 ± 1.2 cm from the root of the scapular spine to the inferior angle of the scapula. Points A, DI, and M were located at a mean distance of 8.4 ± 0.7, 1.8 ± 0.4, and 5.1 ± 0.5 cm proximal to the inferior angle of the scapula, respectively. Needle electromyographic examination of the rhomboid major muscle can be performed safely and accurately using the lower part of the rhomboid major muscle, as investigated in this anatomical study.

Effect of Eight Weeks of Corrective Exercises on Scapulohumeral Rhythm, Isometric Strength of Shoulder Girdle Muscles and Functional Stability in Volleyball Players With Scapular Downward Rotation Syndrome

Background and Aims Movement impairment is common among overhead athletes and can make them susceptible to shoulder injuries. This study aims to invesigate the effect of an eight-week corrective exercise program based on Sahrmann’s approach on scapulohumeral rhythm, isometric strength of shoulder girdle muscles, and functional stability in volleyball players with scapular downward rotation syndrome (SDRS). Methods The is a quasi-experimental study with a pre-test/post-test design. Participants were 34 volleyball players with SDRS who were randomly divided into two equal groups of training (n=17) and control (n=17). Participants were selected based on observance of SDRS under the scapular dyskinesis test (SDT) in both flexion and abduction states, Kibler’s lateral scapula slide test (LSST), and scapulohumeral rhythm assessment. Before exercises, range of motion (ROM), isometric strength of shoulder girdle muscles, scapulohumeral rhythm, and functional stability were evaluated in both groups. Then, the training group performed the corrective exercises for eight weeks, three sessions per week. The control group performed no exercise and had their daily activities. At the end of training, post-test assessments were codncuetd in both groups. For the evaluation of isometric strength and ROM, a manual dynamometer and a goniometer were used, respectively. Scapulohumeral rhythm was measured at 4 positions (0, 45°, 90°, and 135°) with two inclinometers, and the Y-Balance Test Upper Quarter was used to measure the functional stability of the upper extremity. Paired sample t-test was used to compare the pretest and posttest means, and independent t-test was used to compare the differences between the two groups. The significance level was set at 0.05. Results After 8 weeks of training program, there were significant increase in the strength of the isometric strength of shoulder external rotaion (P=0.003), upper trapezius (P=0.001), middle trapezius (P=0.027), lower trapezius (P=0.001), and serratus anterior (P=0.002) as well as scapulohumeral rhythm at 0-45° (P=0.012), 45-90° (P= 0.025), and 90-135° (P= 0.037) abduction; the ROM of the shoulder flexion (P=0.002), abduction (P= 0.001), internal rortation (P= 0.001) and external rotaion(P= 0.004); and pectoralis minor muscle length (P= 0.001) compared to pre-test scores in the training group. Moroever, the functional stability of the upper extremity after training program increased significantly in the training group (P=0.001), but the training program had no significant effect on the strength of shoulder internal rotaion (P=0.165), rhomboid muscule strength (P=0.283) and supraspinatus muscule strength (P=0.214). In the post-test phase, between group comparison showed a significant difference in scapularhumeral rhythm, functional stability, ROM, pectoralis minor length, and strength of trapezius, serratus anterior, and strength of shoulder external rotation between the control and training groups (P&lt;0.05), but no significant difference was observed in the strength of supraspinatus and rhomboid muscles and strength of shoulder internal rotation (P&gt;0.05). Conclusion Eight weeks of corrective exercise program based on Sahrmann’s approach can improve the functional stability of the upper etermity, the scapulohumeral rhythm, and isometric strength of shoulder girdle muscles in volleyball players. This exercise protocol is recommended as an effective method to improve alignment and performance in athletes with SDRS.

Chronic Effects of Pitching on Muscle Thickness and Strength of the Scapular Stabilizers in Professional Baseball Players.

The posterior scapular muscles eccentrically contract to disperse the high forces observed in the deceleration phase of pitching. Muscular adaptations often occur following chronic eccentric loading, however, no study has evaluated the adaptations of the posterior scapular muscles with regard to throwing and their relationship with humeral retroversion (HR) in professional pitchers. Significant chronic adaptations in muscle thickness (MT) and strength of the trapezius and rhomboids would be observed in healthy professional baseball pitchers, and there would be a significant relationship between humeral adaptations (ie, HR) and posterior scapular muscle adaptations (ie, strength and MT). Cross-sectional; Level 3. A total of 28 healthy male professional baseball pitchers (age, 22 ± 2 years; mass, 95 ± 17 kg; height, 190 ± 7 cm) were included in the study. Bilateral isometric muscle strength of the upper trapezius (UT), middle trapezius, lower trapezius (LT), and rhomboids was measured during a maximum voluntary isometric contraction. Diagnostic ultrasound images of the UT, middle trapezius, LT, rhomboid major, and rhomboid minor muscles were collected bilaterally to measure MT. HR was also quantified bilaterally with ultrasound. Paired sample t tests were used to compare dominant and nondominant strength and MT. Pearson correlation coefficients were used to assess the relationship between HR, isometric strength, and MT. A significantly increased MT of the LT was found on the dominant arm compared with the nondominant arm (5.4 ± 1.1 mm vs 4.4 ± 1.5 mm; P = 0.00). The Pearson correlation coefficient demonstrated a significant weak negative relationship between HR and rhomboid major MT (P = 0.03; R = -0.36), and a significant weak negative correlation between HR and middle trapezius isometric strength (P = 0.03; R = -0.37). LT thickness was greater in the throwing arm compared with the nonthrowing arm of pitchers, suggesting a positive adaptation of the LT. Interestingly, there was a weak negative relationship between HR and both rhomboid major MT and middle trapezius isometric strength. This negative relationship suggests that since increased HR leads to decreased internal rotation range of motion during deceleration, the scapula may be forced into anterior tilt and protraction, which can place excessive eccentric load on the rhomboid major and middle trapezius.

Levator scapulae and rhomboid minor are united

Pain over the superior angle of the scapula is a common musculoskeletal symptom. It is often accompanied by radiating pain to the neck, head, and shoulder. The aetiologies can be varied but may also be idiopathic in nature. To explore the fascial connections of this region, we studied 26 unembalmed, -two Thiel and one alcohol body-donors of science, by dissection, histological probes, and plastinations. When removing the descending and transverse fibres of the trapezius, a large prominent triangular area of white connectives is revealed, varying in mass. A subdivision of these connectives can be further dissected to prove that the rhomboid minor and levator scapulae muscles are interconnected and enclosed by connectives. Between these two muscles a bridge of connective tissue, containing fat, is observed. These connectives end cranially at the surface of the splenius capitis, and at the midline, containing vessels and nerves, as supported by histology and plastinations. This unification is separate from the rhomboid major muscle but overlaps with the latter dorsally. It connects to the superior angle of scapula and its upper medial borders, respectively, and cranially to the root of the spine of the scapula. Beneath the united levator scapulae and rhomboid minor, described here, the serratus posterior superior and possibly serratus anterior form a hypomochlion or fulcrum at the superior angle of the scapula. Any tension on this unified entity can unbalance this fulcrum. Investigating the connections between these two unified muscles may help explain the often idiopathic nature of superior scapular pain, and the success or failure of surgery, and other treatments.