Scapular Upward Rotation Research Articles

Effect of elastic scapular taping on shoulder and spine kinematics in adolescents with idiopathic scoliosis.

The aim of this study was to investigate the short-term effects of scapular repositioning using an elastic taping technique on the three-dimensional (3-D) shoulder and thoracic kinematics during various activities of daily living (ADLs) in adolescents with idiopathic scoliosis (IS). Shoulder and spine kinematics during five ADL movement tasks were assessed in 24 adolescents with IS (3 males and 21 females; mean age: 15.8 years; age range: 14-17 years) before and 15 min after elastic scapular taping. All the participants had a moderate curve magnitude (Cobb angle: 20°-45°), with a primary thoracic curve. A 3-D electromagnetic tracking system (Ascension Technology Corporation, Shelburne, VT, USA) was used to record 3-D shoulder and thoracic kinematics. ADL movement tasks included touching the mouth/drinking, touching the back, touching the contralateral shoulder, reaching upward, and bilateral 4-kg weight lifting. Two separate strips of elastic tape were applied using the same correction technique for each shoulder and scapular region to control scapular alterations in the resting position. Elastic scapular taping significantly improved scapular external rotation and scapular upward rotation. Similarly, humeral horizontal adduction, external rotation, thoracic flexion, and lateral bending significantly increased in the taped condition depending on the specific task (p<0.05). Elastic scapular taping can change scapular orientations on the convex and concave sides, thereby affecting upper extremity and trunk kinematics. Thus, the dynamic stability of the scapula increases to produce larger movements during functional activities. Level IV, Therapeutic study.

Between-Day Reliability of Scapular Locator for Measuring Scapular Position During Arm Elevation in Asymptomatic Participants

ObjectiveThe aim of this study was to assess the between-day reliability of the scapular locator for measuring scapular rotations during arm elevation in patients without shoulder pain/conditions/disorders. MethodsTwenty-three asymptomatic individuals were measured during 2 sessions separated by 24 hours. One observer measured scapular position with a scapular locator while participants held their arms at 30°, 60°, 90°, and 120° elevation in the scapular plane. Three trials were performed for each arm position. ResultsAt 30°, between-day intraclass correlation coefficients (ICCs) for all scapular rotations were poor (ICC 0.10-0.40). At higher arm elevations (60°, 90°, and 120°), ICCs ranged from 0.73 to 0.93 for scapular upward rotation, 0.80 to 0.87 for posterior tilt, and 0.37 to 0.62 for scapular internal rotation. For all scapular rotations, the standard error of measurement was less than 6°, and the smallest detectable difference ranged from 11° to 18°. ConclusionThe findings indicate good to excellent reliability for measuring scapular upward/downward rotation and anterior/posterior tilt between 60° and 120° of shoulder elevation in the scapular plane. However, low reliability was found for all scapular rotations at 30° elevation, and for scapular internal rotation at higher arm elevation.

Kinematic Differences between Two Types of Forward Elevations of the Shoulder Joint: Flexion and Reaching Elevation

Background: Extension of the elbow joint is maintained during shoulder flexion. In contrast, the arm starts from the flexed position of the elbow joint and the joint gradually extends during reaching elevation. Objectives: This study aimed to compare the kinematic elements and electromyographic (EMG) activities of the rotator cuff muscles between flexion and reaching elevation. Methods: The study included 10 healthy young men. (average age, 21.5 ± 3.4 years), and measurements were performed on their dominant arms. A three-dimensional motion analyzer was used to record the following elements during shoulder flexion and reaching elevation: the angles of glenohumeral joint elevation and scapular upward rotation, scapulohumeral rhythm, external rotation of the humerus, and glenohumeral plane shifting from the coronal plane. The EMG activities in the supraspinatus, infraspinatus, subscapularis, and teres minor were recorded simultaneously. Results: The plane of reaching elevation was retained at 60° from the coronal plane. The glenohumeral planes (P &lt; 0 .01) and the external rotation angles of the humerus below 90° of elevation (P &lt; 0.05) were significantly different between both the motions. The EMG activities in the supraspinatus (P &lt; .01), infraspinatus (P &lt; 0.05), and teres minor (P &lt; 0.01) were significantly lower while reaching elevation than those during flexion. Conclusion: The motion plane at 60° from the coronal plane, movement of the humeral external rotation, and EMG activities of the rotator cuff muscles were different during reaching elevation and shoulder flexion.

Three-dimensional in vivo comparative analysis of the kinematics of normal shoulders and shoulders with massive rotator cuff tears with successful conservative treatment

BackgroundThis study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders. MethodsTen patients (age, 67.4 ± 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders. FindingsThere was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p < .05). This difference disappeared in the range from 40° to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9° at rest (p < .05) and by 11.6° at terminal elevation (p < .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups. InterpretationKinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.

To Evaluate Scapulohumeral Rhythm in Scapular Dyskinesia in Software Professionals with Neck Pain

Neck Pain a musculoskeletal condition which is increasing commonly throughout the World havingconsiderable impact on individuals that affects their social, physical and psychological aspects. Neck Pain ismore prevalent in office workers than in general community. Computers have become an epitome of modernlife, being used in every aspect of life. Work related Neck pain is leading cause of disability and absenteeism.Evaluation, treatment planning for Neck Pain rehabilitation often fails to include an objective assessment ofscapular motion. Methodology: A cross-sectional study,120 subjects with Neck Pain. Convenient samplingmethod was done. Subjects were screened for Scapular Dyskinesia using Lateral Scapular Slide Test(LSST)those fulfilling the inclusion criteria, further Scapular Upward Rotation(SUR) assessed by DigitalInclinometer at 00,450,900,1200 of Gleno-Humeral abduction and assessed for Scapulohumeral rhythm(SHrhythm). NDI questionnaire was asked to fill. Results: The results showed statistically significant correlationbetween all the variables. SUR is more in dominance hand and SH rhythm is more in non-dominance handand is altered in all the angles and none were closely related to the clinically accepted ratio. SH rhythm ismore in starting angles of humeral elevation and is less when reaching to full range

Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test

BackgroundThe Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test. MethodsFifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively. FindingsThere were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups. InterpretationIndividuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Randomized controlled clinical trial. Research laboratory. Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Three-dimensional kinematics and EMG were recorded before and after feedback training. Lower trapezius muscle activity increased (4.2%-18%, P < .011) and UT/LT decreased (0.56-1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. ClinicalTrials.gov: NCT03252444.

Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks

BackgroundBreast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group. MethodsFifty women (aged 35–65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05). FindingsBreast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80–1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54–0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development. InterpretationImpingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.

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

BackgroundAlthough 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. MethodThirty-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. FindingsCompared 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. InterpretationThere 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.

Effect of different trunk postures on scapular muscle activities and kinematics during shoulder external rotation

Shoulder external rotation at abduction (ER) is a notable motion in overhead sports because it could cause strong stress to the elbow and shoulder joint. However, no study has comprehensively investigated the effect of different trunk postures during ER. This study aimed to investigate the effect of different trunk postures on scapular kinematics and muscle activities during ER. Fourteen healthy men performed active shoulder external rotation at 90° of abduction with the dominant arm in 15 trunk postures. At maximum shoulder external rotation in 15 trunk postures, including 4 flexion-extension, 6 trunk rotation, and 4 trunk side-bending postures, as well as upright posture as a control, scapular muscle activities and kinematics were recorded using surface electromyography and an electromagnetic tracking device, respectively. The data obtained in the flexion-extension, trunk rotation, and trunk side-bending postures were compared with those obtained in the upright posture. In the flexion-extension condition, scapular posterior tilt and external rotation significantly decreased, but the muscle activities of the lower trapezius and infraspinatus significantly increased in maximum trunk flexion. Moreover, scapular upward rotation and the activity of the serratus anterior significantly increased in maximum trunk extension. In the rotation condition, scapular posterior tilt and external rotation significantly decreased, but the activity of the serratus anterior significantly increased in the maximum contralateral trunk rotation posture. In the trunk side-bending condition, scapular posterior tilt and the external rotation angle significantly decreased. Trunk postures affected scapular kinematics and muscle activities during ER. Our results suggestthat different trunk postures activate the lower trapezius and serratus anterior, which induce scapular posterior tilt.

Reliability of Clinical Assessment Methods to Measure Scapular Upward Rotation: A Critically Appraised Topic.

Clinical Scenario: Assessing movement of the scapula is an important component in the evaluation and treatment of the shoulder complex. Currently, gold-standard methods to quantify scapular movement include invasive technique, radiation, and 3D motion systems. This critically appraised topic focuses on several clinical assessment methods of quantifying scapular upward rotation with respect to their reliability and clinical utility. Clinical Question: Is there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Key Findings: Four studies were selected to be critically appraised. The quality appraisal of diagnostic reliability checklist was used to score the articles on methodology and consistency. Three of the 4 studies demonstrated support for the clinical question. Clinical Bottom Line: There is moderate evidence to support reliable clinical methods for measuring scapular upward rotation in subjects with or without shoulder pathology. Strength of Recommendation: There is moderate evidence to suggest there are reliable clinical measures to quantify scapular upward rotation in patients with or without shoulder pathology.

Lower Trapezius Weakness and Shoulder Complex Biomechanics during the Tennis Serve.

This study aimed to assess the effect of lower trapezius (LT) weakness on humeral and scapular kinematics and shoulder muscle activity during the tennis serve. Fifteen competitive male tennis players (age, 23.8 ± 3.4 yr; height, 182.8 ± 6.7 cm; mass: 76.6 ± 8.7 kg; tennis experience: 15.6 ± 4.9 yr) performed two tennis serves before and after selective fatigue of the LT (25-min electric muscle stimulation). During each tennis serve, racket, humeral and scapular kinematics and the activity of 13 shoulder muscles were recorded using an optoelectronic system synchronized with indwelling and surface electromyography. The serve was split into five phases, that is, early and late cocking, acceleration, early and late follow-through. Selective fatigue led to a 22.5% ± 10.4% strength decrease but did not alter maximum racket speed and humerothoracic joint kinematics. However, increased scapular upward rotation was observed in the acceleration (P = 0.02) and early follow-through (P = 0.01) phases. Decreased muscular activity was observed during the early cocking phase for the LT (P = 0.01), during the acceleration phase for the LT (P = 0.01), anterior deltoid (P = 0.03), pectoralis major (P = 0.04), and subscapularis (P = 0.03), and during the early follow-through phase for the anterior deltoid (P = 0.03) and LT (P = 0.04). The LT weakness altered neither serve velocity nor humerothoracic joint kinematics, but impaired scapulothoracic kinematics and anterior shoulder muscle activation. Such alterations may reduce the subacromial space and jeopardize humeral head stability. These findings shed new light on the consequences of LT weakness, highlighting the importance of monitoring and strengthening this muscle in overhead athletes.

Dynamic scapular recognition exercise improves scapular upward rotation and shoulder pain and disability in patients with adhesive capsulitis: a randomized controlled trial

ABSTRACT Background Examine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis of the shoulder. Methods A test-retest randomized controlled study design was used. A total of sixty-six patients with unilateral adhesive capsulitis were equally divided into two groups. The study group received a dynamic scapular recognition exercise using a wireless biofeedback system, while the control group received placebo treatment in the form of active range-of-motion (ROM) exercises of the sound upper limb. A digital inclinometer was used to measure the scapular upward rotation and ROM of the shoulder joint, and the Shoulder Pain and Disability Index (SPADI) was used to measure the shoulder pain and disability. Results Study results showed that after two weeks, there were statistically significant differences between the study and control groups in scapular upward rotation and shoulder flexion and abduction (P < .05) and nonsignificant differences in shoulder external rotation and SPADI (P > .05). After two and six months, there were statistically significant differences between study and control groups in scapular upward rotation; shoulder flexion, abduction and external rotation; and SPADI scores (P < .05). Conclusion This study showed that a dynamic scapular recognition exercise significantly improves scapular upward rotation and the ROM of shoulder flexion and abduction after two weeks. At two and six months, this exercise improves scapular upward rotation; ROM of shoulder flexion, abduction, and external rotation; and SPADI scores. These improvements persisted for six months after the performance of this exercise

Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting

ObjectiveTo determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared...

Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke.

ObjectiveTo describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects.MethodsTwenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer.ResultsIn both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°.ConclusionPassive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.

Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review

Study DesignThis is a systematic review. IntroductionScapular 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 StudyThe 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. MethodMEDLINE 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. ResultsEleven 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. DiscussionScapular 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. ConclusionThe 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.

Comparison of Scapular Muscles Activation with Shoulder Retraction and Shoulder Elevations in Individuals with Scapular Dyskinesia

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;&lt;br /&gt; Scapular dyskinesis is a condition that is commonly associated with shoulder pathology but is also present in asymptomatic individuals, and it is believed to be a risk factor for further injury. Evidence suggests that patients with rotator cuff–related shoulder pain present scapular kinematic abnormalities such as decreased scapular upward rotation, decreased scapular posterior tipping, and external rotation. It has been proposed that abnormal scapular kinematics may be linked to weakness of scapular muscle. &lt;br /&gt; Muscle Activation is a very specific, non-medical, mechanically based process of evaluating and treating muscular imbalance and dysfunction. Its main goal is to increase the contractile capability of your muscles, resulting in increased strength, stability, range of motion, and reduced muscle and joint pain. &lt;br /&gt; The study was conducted to determine whether shoulder elevations and retractions showed any difference in the interscapular distance in indivudals with scapular dyskinesia.&lt;br /&gt;&lt;strong&gt;Objectives:&lt;/strong&gt;&lt;/p&gt; &lt;ol&gt; &lt;li&gt;To assess Interscapular distance post shoulder retraction exercise.&lt;/li&gt; &lt;li&gt;To assess Interscapular distance post shoulder shrugging exercise.&lt;/li&gt; &lt;li&gt;To assess Interscapular distance post shoulder retraction + shrugging exercise.&lt;/li&gt; &lt;li&gt;To compare the effectiveness of these exercises on scapular dyskinesia.&lt;/li&gt; &lt;/ol&gt; &lt;p&gt;&lt;strong&gt;Materials and Methodology:&lt;/strong&gt;&lt;br /&gt; An intervention based study comprising of 30 female individuals. The subjects were randomly divided into 3 groups, Group A was given combined exercises of shoulder retraction and elevations. Group B was given shoulder retraction and Group C was given shoulder elevations.The samples were assessed pre and post with the help of Interscapular distance.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;br /&gt; Shoulder retractions when given along with shoulder elevations was clinically significant pre and post . Likewise, Shoulder retractions and elevations when given separately were also clinically significant pre and post. The comparison of all the three groups showed that all were equally effective in treating scapular dyskinesia. &lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;br /&gt; The study concludes that all three forms of exercise showed similar results in reducing the Inter scapular distance in individuals with scapular dyskinesia.&lt;/p&gt;

Comparison of scapular upward rotation during arm elevation in the scapular plane in healthy volunteers and patients with rotator cuff tears pre- and post-surgery

BackgroundFunction loss caused by rotator cuff tears alters the scapular orientation, however, few prior studies have reported on scapular movements after rotator cuff repair. The purpose was to determine the scapular orientations before and after rotator cuff repair. MethodsWe recruited 14 healthy controls, 10 small and six massive rotator cuff tear in patients. The scapular upward rotation during arm elevation was analyzed using fluoroscopic imaging. FindingsBefore surgery, both rotator cuff groups demonstrated greater scapular upward rotation compared to healthy controls. Two months postoperation, the analyses showed significant differences between the patients with small rotator cuff tears and healthy controls at arm elevations of 90°, and between patients with both rotator cuff tear groups and healthy controls at arm elevations of 120°. At five months post-operation, significant differences still existed between the healthy controls and both rotator cuff groups. In regard to the temporal effects in the patients with small rotator cuff tears, the scapular upward rotation decreased significantly over time (2–5 months postoperation) at arm elevations of 120°. We did not identify a main effect owing to time in the patients with massive rotator cuff tears. InterpretationIn patients with small rotator cuff tears, scapular upward rotation was reduced over the period of 2–5 months postoperation, however, the patients with massive rotator cuff tears showed greater scapular upward rotation throughout the experimental period. The results suggested that the execution of the rehabilitation program should consider that the tear size could affect scapular motion.

Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review.

Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = -0.04; 95% CI = -0.31, 0.22), posterior tilt (mean difference = -0.09; 95% CI = -0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = -0.19, 0.31). The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.

Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators

BackgroundModifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine–shoulder and spine–pelvis relationships suggest that the pelvis may influence shoulder posture. ObjectiveTo investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm. MethodsThirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed. ResultsPaired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=−2.79 to −1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=−0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=−2.79 to −0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=−3.36 to 9.87). ConclusionThe influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.