Unilateral Shoulder Impingement Research Articles

Does COVID-19 vaccine exacerbate rotator cuff symptoms? A prospective study

BackgroundShoulder injury related to vaccine administration (SIRVA) is a rare but increasing complication after vaccination. The aim of this study was to increase awareness of post-vaccination shoulder pain and to investigate the effect of the clinical condition of the shoulder before vaccination on the loss of function that may occur after vaccination.MethodsThis prospective study included 65 patients aged > 18 years who were diagnosed with unilateral shoulder impingement and/or bursitis. The first vaccination was performed on the shoulders with rotator cuff symptoms, then the second vaccination was performed on healthy shoulders of same patients as soon as the health system allowed. Pre-vaccination MRI of the symptomatic shoulders of the patients was performed and VAS, ASES and Constant scores were evaluated. At 2 weeks after vaccination of the symptomatic shoulder, scores were reassessed. For the patients with changes in the scores, MRI was performed again and the treatment of all patients was started. A second vaccination was given to asymptomatic shoulders and the patients were recalled two weeks later and their scores were evaluated.ResultsAfter vaccination, the symptomatic shoulder of 14 patients was affected. No clinical changes were observed in the asymptomatic shoulders after vaccination. The VAS scores of the symptomatic shoulders evaluated after vaccination were significantly higher than the scores evaluated before vaccination (p = 0.001). The ASES and Constant scores of symptomatic shoulders evaluated after vaccination were significantly decreased compared to the scores evaluated before vaccination (p = 0.001).ConclusionsExacerbation of symptoms may occur if symptomatic shoulders are vaccinated. Before vaccination, a detailed anamnesis should be taken from the patients and vaccination should be performed to the asymptomatic side.

Outcomes with Additional Mirror Theraphy to Rehabilitation Protocol in Patients with Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study

Mirror therapy is a method that increases the functionality of the affected extremity and is effective in the treatment of chronic pain. In this study, we aimed to investigate the effect of mirror therapy on shoulder impingement syndrome. The study included 62 participants, including 31 in the intervention group (IG) and 31 in the control group (CG) who met the inclusion criteria. IG received mirror therapy with conventional physiotherapy while CG received only conventional physiotherapy. The patients were evaluated before treatment and immediately after treatment with Visual Analog Scale (VAS) score for pain, goniometric measurement for shoulder range of motion, modified Constant-Murley score for functionality, and Tampa Kinesiophobia Scale (TSK) for kinesiophobia. After treatment, the change in the VAS score was 5.51 ± 1.89 for IG, 2.80 ± 2.61 for CG, and the significance was p<0.01. The change in the TSK score was 10.83 ± 9.53 for IG and 1.66 ± 4.85 for CG (p<0.01). The change in the total Constant-Murley score was 23.77 ± 11.41 for IG and 9.60 ± 9.70 for CG, and the significance was calculated as p<0.01. This study showed that the addition of mirror therapy to conventional treatment can improve pain severity, functionality, and levels of kinesiophobia in patients with unilateral shoulder impingement syndrome. The decrease in fear of movement along with pain in impingement syndrome has shown that mirror theraphy can be used in the treatment of different diseases for which it has not been used before.

Combined Use of Diadynamic Currents and Manual Therapy on Myofascial Trigger Points in Patients With Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to evaluate the effect of combined manual therapy (MT) and diadynamic (DD) currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome. MethodsA randomized clinical trial was conducted involving 60 individuals with shoulder impingement syndrome who were allocated to the following 3 groups: (1) MT and DD currents (MTDD), (2) MT alone, and (3) DD currents alone. The participants were submitted to 16 treatment sessions over an 8-week period and were evaluated using the Numerical Rating Pain Scale as well as the pain and disability subscales of the Shoulder Pain and Disability Index. ResultsDifferences in Numerical Rating Pain Scale scores (secondary outcome) between MTDD and MT groups (mean difference 2.25 points, 95% confidence interval 1.07-3.42) and between MTDD and DD groups (mean difference 2.30 points, 95% confidence interval 1.42-3.17) were clinically relevant. No clinical gains were observed in the comparisons between groups of Shoulder Pain and Disability Index scores. ConclusionThe combination of MT and DD currents on myofascial trigger points was more effective at reducing pain intensity but not disability than each therapy performed individually for patients with unilateral shoulder impingement syndrome.

Effect of Adding Interferential Current in an Exercise and Manual Therapy Program for Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Clinical Trial

ObjectiveThe purpose of this study was to measure the additional effect of adding interferential current (IFC) to an exercise and manual therapy program for patients with unilateral shoulder impingement syndrome. MethodsForty-five participants were randomly assigned to group 1 (exercise and manual therapy), group 2 (exercise and manual therapy + IFC), or group 3 (exercise and manual therapy + placebo ultrasound). Individuals participated in 16 treatment sessions, twice a week for 8 weeks. The primary outcome of the study was total score of the Shoulder Pain and Disability Index (SPADI). The secondary outcomes were the pain and disability subscales of SPADI, Numeric Rating Scale, and Pain-Related Self-Statement Scale. Adjusted between-group mean differences (MDs) and 95% confidence intervals (CIs) were calculated using linear mixed models. ResultsAfter 16 treatment sessions, statistically significant but not clinically important differences were identified in favor of the exercise and manual therapy program alone in the SPADI-total (group 1 vs group 2, MD 11.12 points, 95% CI 5.90-16.35; group 1 vs group 3, MD 13.43 points, 95% CI 8.21-18.65). Similar results were identified for secondary outcomes. ConclusionThe addition of IFC does not generate greater clinical effects in an exercise and manual therapy program for individuals with unilateral shoulder impingement syndrome.

Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome.

Chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points (MTrPs), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe postneedle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. The authors hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. Single-blind randomized clinical trial. Sports medicine physical therapy clinic. A total of 40 overhead athletes (age = 36 [16]y; 20 females and 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n = 21) and ISP DN (n = 19) groups. An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in 3 sessions (2-day interval between each sessions) for each group. Pain intensity (visual analog scale), pain pressure threshold, and disability in the arm, shoulder, and hand were assessed before and after the interventions. Pain and disability decreased significantly in both groups (P < .001) and pain pressure threshold increased significantly only in the ISP group (P = .02). However, none of the outcome measures showed a significant intergroup difference after treatments (P > .05). Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

ObjectiveThe purpose of this study was to investigate changes in pain, disability, and range of movement after cervicothoracic manipulation plus exercise therapy in individuals with unilateral shoulder impingement syndrome. MethodsForty-one patients (30 men, 11 women; aged 47 ± 9) diagnosed with unilateral shoulder impingement syndrome attended 10 sessions for 5 weeks (2 sessions/wk). Eligible patients were randomly allocated to 2 study groups: cervicothoracic manipulation plus exercise therapy (n = 21) or home exercise program (n = 20). The outcomes measures included the visual analog scale (VAS); the Disabilities of the Arm, Shoulder, and Hand score; Shoulder Disability Questionnaire; subacromial impingement syndrome (Hawkins-Kennedy Test and Neer Test); and shoulder active range of motion (movements of flexion, extension, rotation, adduction, and abduction). Assessments were applied at baseline and 24 hours after completing 5 weeks of related interventions. ResultsAfter 5 weeks of treatment significant between-group differences were observed in the Disabilities of the Arm, Shoulder, and Hand score (P = .012); however, no statistically significant differences were achieved for Shoulder Disability Questionnaire (P = .061) and pain intensity (P = .859). Both groups improved with regard to disability and clinical tests for detecting subacromial impingement syndrome. ConclusionsThis clinical trial suggests that cervicothoracic manipulative treatment with mobilization plus exercise therapy may improve intensity of pain and range of motion compared with the home exercise group alone; the home exercise group had significant changes for flexion, extension, adduction, and abduction, but not for external and internal rotation movement in patients with shoulder impingement.

One-year outcome of subacromial corticosteroid injection versus manual physical therapy for unilateral shoulder impingement syndrome: a pragmatic randomized clinical trial

Background: Corticosteroid injections (CSI) and physical therapy are often used to treat shoulder impingement syndrome, but their effectiveness has never been directly compared out to one year. Purpose:Theprimarypurposeof this studywas to directly compare the effectiveness of 2 common nonsurgical treatment approaches for shoulder impingement syndrome. The secondary purpose was to compare 1year healthcare utilization between the two groups. Methods: Patients referred to physical therapy received random assignment into 2 groups: 40mg triamcinalone acetonide subacromial CSI versus 6 sessions of manual physical therapy (MPT). Follow-up occurred at 1, 3, 6, and 12months. TheShoulder Pain andDisability Index (SPADI) served as the primary outcome. Secondary outcomes included the Global Rating of Change (GRC), the Numeric Pain Rating Scale (NPRS), and 1-year healthcare utilization based off electronic medical records review. Results:Over an 18-month period, 104 consecutive adults between 18 and 65 years of age with unilateral shoulder impingement were enrolled. Both groups demonstrated ∼50% improvement in SPADI at all 4 follow-ups maintained through 1 year, howevermean difference between groupswas not significant (1.5 [95% CI: 6.3, 9.4]). Both groups showed improvements in GRC and NPRS, but between group differences for the GRC (0 [95% CI: 2, +1]) and NPRS (0.4 [95% CI: 0.5, 1.2]) were not significant. During the 1-year followup, patients receiving CSI hadmore SIS-related visits to their primary care provider (60% vs. 37%), required additional steroid injections (38% vs. 20%), and 19% needed physical therapy (compared to 9% in the MPT group). Conclusion(s): Patients randomized to the MPT group experienced similar outcomes in terms of function, pain and patient perceived improvement as patients receiving CSI. However they utilized significantly less additional healthcare resources than the CSI patients for the following year after initial treatment. Implications: CSI and MPT are two common conservative treatment options offered to patients with shoulder impingement. Understanding their long-term impact and the comparative effectiveness of each can help guide best evidence care decisions. Disclaimer:The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army or Defense.

Effects of Mobilization With Movement on Pain and Range of Motion in Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to compare the immediate effects of mobilization with movement (MWM) to a sham technique in patients with shoulder impingement syndrome. MethodsA randomized controlled trial was performed. Forty-two patients (mean ± SD age, 55 ± 9 years; 81% female) satisfied eligibility criteria, agreed to participate, and were randomized into an MWM group (n = 21) or sham manual contact (n = 21). The primary outcome measures including pain intensity, pain during active range of motion, and maximal active range of motion were assessed by a clinician blinded to group allocation. Outcomes were captured at baseline and after 2 weeks of MWM treatment or sham intervention. The primary analysis was the group×time interaction. ResultsThe 2×2 analysis of variance revealed a significant group×time interaction for pain intensity during shoulder flexion (F = 7.054; P = .011), pain-free shoulder flexion (F = 32.853; P < .001), maximum shoulder flexion (F = 18.791; P < .01), and shoulder external rotation (F = 7.950; P < .01) in favor of the MWM group. No other significant differences were found. ConclusionsPatients with shoulder impingement syndrome who received 4 sessions of MWM exhibited significantly better outcomes for pain during shoulder flexion, pain-free range of shoulder flexion, maximal shoulder flexion, and maximal external rotation than those patients who were in the sham group.

Isokinetic studies for detection of functional disorders in patients with unilateral shoulder impingement syndrome

Introduction. The isokinetic assessment allows objective evaluation of muscle strength in patients considered for surgery in cases of rotator cuff injury. Aim. The goal of this study was to define functional disorders of shoulder joint in patients with rotator cuff injury. Material and methods. The examination was conducted in two groups, ten patients each. One group consisted of subjects with rotator cuff injury while the other was a healthy control group. Isokinetic test was performed with use of Biodex System 4 Pro Device. The following parameters were evaluated: peak torque, peak torque/body weight (peak TQ/BW), total work, average power, range of movement (ROM) and peak torque ratio of external to internal rotators (ERPT/IRPT ratio). Studies of Shoulder Pain and Disability Index (SPADI) scale supplemented clinical evaluation. Results. Examination indicated a significant deficit of muscle strength during external rotation and ROM limitation only on symptomatic side in shoulder impingement group. Alteration between agonistic and antagonistic muscles strength for 2400/s was found. Significant differences between involved and uninvolved shoulders during pain and disability tests were detected. There was no correlation between result of isokinetic and SPADI tests. Conclusions. Patients after injury of rotator cuff present functional disorders that occur mainly during external rotation in isokinetic evaluation.

Bilateral Myofascial Trigger Points and Pressure Pain Thresholds in the Shoulder Muscles in Patients With Unilateral Shoulder Impingement Syndrome

To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS). Twenty-seven patients with SIS and 20 matched control patients participated in this study. TrPs of 10 shoulder muscles and 8 PPTs, including tibialis anterior PPT, were assessed. SIS group showed a greater number of TrPs (t=-2.697; P=0.010) than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs. PPTs showed small differences between involved and uninvolved sides of patients with SIS and higher differences between both sides of the SIS group and dominant side of controls although with significant difference only in the supraspinatus PPT (F=3.239; P=0.045). The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences. The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain.

Changes in pain and pressure pain sensitivity after manual treatment of active trigger points in patients with unilateral shoulder impingement: A case series

The aim of this case series was to investigate changes in pain and pressure pain sensitivity after manual treatment of active trigger points (TrPs) in the shoulder muscles in individuals with unilateral shoulder impingement. Twelve patients (7 men, 5 women, age: 25±9 years) diagnosed with unilateral shoulder impingement attended 4 sessions for 2 weeks (2 sessions/week). They received TrP pressure release and neuromuscular interventions over each active TrP that was found. The outcome measures were pain during arm elevation (visual analogue scale, VAS) and pressure pain thresholds (PPT) over levator scapulae, supraspinatus infraspinatus, pectoralis major, and tibialis anterior muscles. Pain was captured pre-intervention and at a 1-month follow-up, whereas PPT were assessed pre- and post-treatment, and at a 1-month follow-up. Patients experienced a significant (P<0.001) reduction in pain after treatment (mean±SD: 1.3±0.5) with a large effect size (d>1). In addition, patients also experienced a significant increase in PPT immediate after the treatment (P<0.05) and one month after discharge (P<0.01), with effect sizes ranging from moderate (d=0.4) to large (d>1).A significant negative association (r(s)=-0.525; P=0.049) between the increase in PPT over the supraspinatus muscle and the decrease in pain was found: the greater the decrease in pain, the greater the increase in PPT. This case series has shown that manual treatment of active muscle TrPs can help to reduce shoulder pain and pressure sensitivity in shoulder impingement. Current findings suggest that active TrPs in the shoulder musculature may contribute directly to shoulder complaint and sensitization in patients with shoulder impingement syndrome, although future randomized controlled trials are required.

The Shoulder Gradient in Patients with Unilateral Shoulder Impingement Syndrome

ObjectiveTo investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome.MethodUsing the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula.ResultsIn patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03±1.28 mm, compared with 10.46±1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31±3.73 degrees, compared with 3.85±4.42 degrees for the higher shoulder.ConclusionThe frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder.

Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study

Our aim was to describe the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects' condition. Patients with shoulder impingement have a greater number of active (mean +/- SD: 2.5 +/- 1; P < 0.001) and latent (mean +/- SD: 2 +/- 1; P = 0.003) TrPs when compared to controls (only latent TrPs, mean +/- SD: 1 +/- 1). Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group. Patients showed a significant lower PPT in all muscles when compared to controls (P < 0.001). Within the patient group a significant positive correlation between the number of TrPs and pain intensity (r (s) = 0.578; P = 0.045) was found. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles (P < 0.05). Significant negative correlations between pain intensity and PPT levels were found. Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.

Does Scapula Taping Facilitate Recovery for Shoulder Impingement Symptoms? A Pilot Randomized Controlled Trial

Scapula taping is a commonly used adjunctive treatment for shoulder im- pingement pathology. However, this intervention has not previously been subject to formal investigation. A pilot single-blind randomized controlled trial was conducted to evaluate facilitatory taping as an adjunct to routine physiotherapy management. Twenty-two sub- jects with unilateral shoulder impingement symptoms were randomized into a taping with routine physiotherapy or a routine physiotherapy only group. The intervention group had scapula taping applied three times per week for the first two weeks of their treatment. All subjects were assessed at baseline, then at 2 and 6 weeks after the commencement of treat- ment. Pain and functional ability were assessed using the Shoulder Pain and Disability In- dex, range of shoulder elevation, and self-reported pain on elevation. At 2 weeks, the taping group demonstrated a strong trend toward reduced pain both on self-reported activity (SPADI pain subscale mean for taping 27.0 versus 41.5 for control) and pain during mea- sured abduction (mean VAS 22.8 for taped, 46.8 for control), statistical power being limited by small sample size. No similar trend was evident in the SPADI disability subscale. The magnitude of the differences was reduced at 6-week follow-up. This study provides prelimi- nary evidence for a short-term role for scapula taping as an adjunct to routine physiother- apy in the management of shoulder impingement symptoms but also highlights the need for consideration on a case basis relating to risk factors for skin reaction.

Acromiohumeral distance in a seated position in persons with impingement syndrome.

To compare the acromiohumeral distance (AHD) of both shoulders in subjects with a unilateral shoulder impingement syndrome (SIS) and healthy subjects in a seated position during free shoulder movements of large amplitude. Using a 0.5-Tesla SIGNA-SP/i trade mark open-configuration magnetic resonance imaging (MRI) system, the AHD was measured at several arm positions, in a standardized seated position. In flexion (rest to 130 degrees ), the mean AHD of SIS varied from 8.3 to 2.8 mm, as compared to from 8.7 to 4.1 mm for asymptomatic contralateral shoulders. In abduction (rest to 110 degrees ), the AHD varied from 8.1 to 3.4 mm and from 8.8 to 4.6 mm for SIS and asymptomatic shoulders, respectively. The smallest AHD (P <.01) was observed at 110 degrees. From 80 degrees of arm elevation, the AHD was significantly smaller in impingement than in asymptomatic shoulders (P <.05). The AHD of asymptomatic shoulders did not differ from that of healthy subjects. In SIS, the AHD at rest was correlated with its reduction at all shoulder positions (r(p) = 0.62-0.88), but was a poor predictor of the smallest AHD observed at 110 degrees (flexion, R(2) = 0.09; abduction, R(2) = 0.08). In the critical arm elevation positions for impingement, AHD is discriminative for SIS, compared to asymptomatic shoulders and healthy ones. AHD at rest is a good indicator of the magnitude of its reduction in elevation, but not of the smallest AHD in arm elevation.

Scapular behavior in shoulder impingement syndrome

Hébert LJ, Moffet H, McFadyen BJ, Dionne CE. Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil 2002;83;60-9. Objective: To quantify the contribution of each scapular rotation to the scapular total range of motion (ROM) in both shoulders of persons with a unilateral shoulder impingement syndrome (SIS), to compare 3-dimensional (3D) scapular attitudes of their symptomatic and asymptomatic shoulders in flexion and in abduction, and to characterize the scapular behavior of these subjects by classifying them into subgroups based on scapular tilting differences between their symptomatic and asymptomatic shoulders. Design: Comparisons of 3D scapular attitudes, scapular total ROM, and percentage of contributions of each scapular rotation to the scapular total ROM. Setting: A motricity laboratory. Participants: Fifty-one subjects, including 41 with a SIS (29 had an asymptomatic contralateral shoulder) and 10 healthy subjects. Interventions: The 3D scapular attitudes were calculated with the subjects in a standardized seated position; with the arm at rest; or at 70°, 90°, and 110° of shoulder flexion and abduction. Axial rotation angles were calculated using a fixed set of Cardanic angles. Main Outcome Measures: At 90° of arm elevation, data from 10 shoulders of healthy subjects were used to set up normative values (99% confidence interval of mean 3D scapular attitudes) to compare with 3D scapular attitudes of symptomatic and asymptomatic shoulders of SIS subjects. We analyzed the scapula behavior of subjects with SIS and classified them into subgroups based on scapular anterior tilting asymmetry. Results: In flexion, almost half of the scapular total ROM was provided by anterior tilting (48.2%-51.3%), whereas in abduction, external rotation (40.3%-42.4%) was the main contributor. Scapular total ROM was higher in abduction than in flexion in all arm positions for both shoulder groups (P <.01). Also, 3D scapular attitude patterns of both shoulders of SIS subjects were different from those of healthy subjects. At 90°, scapular asymmetry in anterior tilting allowed us to classify SIS subjects with respect to more (lead) or less (lag) scapular tilting in the affected side (P <.0001) or no difference (P =.11) between the sides (symmetrical). No significant differences (P >.05), except for a small 2° difference in transverse rotation during arm flexion at 110° (P =.002), were observed in 3D scapular attitudes and scapular total ROM between both shoulders of SIS subjects. Patterns of 3D scapular attitudes and scapular total ROM were significantly different between flexion and abduction arm positions (P <.05). Conclusions: The contribution of rotations and scapular total ROM differed according to the plane of arm elevation in SIS subjects. Group analyses revealed no differences in 3D scapular attitudes between symptomatic and asymptomatic shoulders of subjects with unilateral SIS. This could be caused by the use, in SIS subjects, of inappropriate neuromuscular strategies affecting both shoulders. However, individual analyses revealed scapular asymmetry in the sagittal plane, which suggests that SIS subjects with less anterior tilting in the symptomatic shoulder, as compared with the asymptomatic contralateral one, may be at high risk of developing chronic SIS. This last finding provides scientific evidence to focus rehabilitation protocols toward a restoration of anterior tilting. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation