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Melo AS, Moreira JS, Afreixo V, Moreira-Gonçalves D, Donato H, Cruz EB, Vilas-Boas JP, Sousa AS. Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:161-174. [PMID: 38706660 PMCID: PMC11065746 DOI: 10.1016/j.xrrt.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Methods Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. Results From the 8318 records identified, 8 (high to low risk of bias- scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: -0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Conclusions Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
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Affiliation(s)
- Ana S.C. Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Juliana S. Moreira
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| | - Vera Afreixo
- Department of Mathematics, Center for Research and Development in Mathematics and Applications – CIDMA, University of Aveiro, Portugal
| | - Daniel Moreira-Gonçalves
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Helena Donato
- Documentation and Scientific Information Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo B. Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J. Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia S.P. Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
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Melo AS, Montóia B, Cruz EB, Vilas-Boas JP, Sousa AS. Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions. Proc Inst Mech Eng H 2024; 238:288-300. [PMID: 38403635 DOI: 10.1177/09544119241228082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.
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Affiliation(s)
- Ana Sc Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Bárbara Montóia
- Escola Superior de Saúde, Politécnico do Porto, Porto, Portugal
| | - Eduardo B Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia Sp Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
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Melo ASC, Taylor JL, Ferreira R, Cunha B, Ascenção M, Fernandes M, Sousa V, Cruz EB, Vilas-Boas JP, Sousa ASP. Differences in Trapezius Muscle H-Reflex between Asymptomatic Subjects and Symptomatic Shoulder Pain Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094217. [PMID: 37177422 PMCID: PMC10180810 DOI: 10.3390/s23094217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.
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Affiliation(s)
- Ana S C Melo
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Center for Interdisciplinary Applied Research in Health, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal
| | - Janet L Taylor
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Ricardo Ferreira
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Bruno Cunha
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Manuel Ascenção
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Mathieu Fernandes
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Vítor Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do IPS Estefanilha, 2914-503 Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Andreia S P Sousa
- Center for Rehabilitation Research, ESS (Escola Superior de Saúde), Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
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Melo ASC, Vilas-Boas JP, Cruz EB, Macedo RM, E Ferreira SB, Sousa AS. The influence of shoulder position during multi-joint exercises in the relative scapular muscles activity in symptomatic and asymptomatic conditions. J Back Musculoskelet Rehabil 2023:BMR220056. [PMID: 36776036 DOI: 10.3233/bmr-220056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain. OBJECTIVE To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze. METHODS Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0∘ and 90∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles.
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Affiliation(s)
- Ana S C Melo
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal.,Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory, Porto, Portugal.,Center for Interdisciplinary Applied Research in Health, Health School of the Setubal Polytechnic Institute, Campus do IPS Estefanilha, Setúbal, Portugal
| | - João P Vilas-Boas
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Campus do IPS Estefanilha, Setúbal, Portugal.,Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rui M Macedo
- Department of Physiotherapy, Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, School of Health, Polytechnic of Porto, Porto, Portugal
| | | | - Andreia S Sousa
- Department of Physiotherapy, Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, School of Health, Polytechnic of Porto, Porto, Portugal
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Watson L, Pizzari T, Balster S, Lenssen R, Warby SA. Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint. J Clin Med 2022; 11:5140. [PMID: 36079068 PMCID: PMC9456769 DOI: 10.3390/jcm11175140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, VIC 3752, Australia
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
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Rehabilitation for atraumatic shoulder instability in circus arts performers: delivery via telehealth. J Shoulder Elbow Surg 2022; 31:e246-e257. [PMID: 34861406 DOI: 10.1016/j.jse.2021.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Watson Instability Program (WIP1) is current best evidence for conservative management of atraumatic shoulder instability, but it is unknown if this program can be effectively delivered via tele-consultation. The purpose of this longitudinal pre-post intervention study was to determine the effects of the WIP1 on patient-reported outcome measures, scapular position, shoulder strength, and handstand stability in student circus performers with atraumatic shoulder instability when delivered via tele-consultation. METHODS Student circus performers aged between 15 and 35 years from the National Institute of Circus Arts were recruited. A 12-week shoulder exercise program was delivered via tele-consultation during the Melbourne, Australia COVID-19 (coronavirus disease 2019) lockdown. The primary outcome measures were the Western Ontario Shoulder Instability Index score and the Melbourne Instability Shoulder Scale score. Secondary outcomes measures included the Orebro Musculoskeletal Pain Questionnaire, the Tampa Scale for Kinesiophobia, and physical assessment measures including strength via handheld dynamometry, scapular position using an inclinometer, and handstand stability via center-of-pressure fluctuation. Patient-reported outcomes were collected at baseline and 6-week, 12-week, 6-month, and 9-month time points, and physical outcomes were measured at baseline and 9-month time points. A repeated-measures mixed model (with effect sizes [ESs] and 95% confidence intervals [CIs]) was used to analyze patient-reported outcomes, handstand data, strength, and scapular measures. Significance was set at P < .05. RESULTS Twenty-three student circus arts performers completed the study. Significant improvements were found in both Western Ontario Shoulder Instability Index scores (effect size [ES], 0.79 [95% CI, 0.31-1.33] at 6 weeks; ES, 1.08 [95% CI, 0.55-1.6] at 12 weeks; ES, 1.17 [95% CI, 0.62-1.78] at 6 months; and ES, 1.31 [95% CI, 0.74-1.95] at 9 months; P < .001) and Melbourne Instability Shoulder Scale scores (ES, 0.70 [95% CI, 0.22-1.22] at 6 weeks; ES, 0.83 [95% CI, 0.34-1.37] at 3 months; ES, 0.98 [95% CI, 0.46-1.54] at 6 months; and ES, 0.98 [95% CI, 0.43-1.50] at 9 months; P < .001), as well as Orebro Musculoskeletal Pain Questionnaire scores at all follow-up time points. The Tampa Scale for Kinesiophobia scores reached significance at 6 weeks and 12 weeks. Following rehabilitation, we found statistically significant increases in shoulder strength in all positions tested and increased scapular upward rotation measured at end-of-range abduction, as well as during loaded external rotation. The affected arm showed greater instability than the unaffected arm with a significant intervention effect on the affected arm showing a greater consistent anterior-posterior movement pattern. CONCLUSION In a group of circus performers with atraumatic shoulder instability, treatment with the WIP1 via telehealth resulted in clinically and statistically significant improvements in shoulder symptoms and function.
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Melo ASC, Cruz EB, Vilas-Boas JP, Sousa ASP. Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review. SENSORS 2022; 22:s22072565. [PMID: 35408180 PMCID: PMC9002787 DOI: 10.3390/s22072565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
Several tools have been used to assess muscular stiffness. Myotonometry stands out as an accessible, handheld, and easy to use tool. The purpose of this review was to summarize the psychometric properties and methodological considerations of myotonometry and its applicability in assessing scapular muscles. Myotonometry seems to be a reliable method to assess several muscles stiffness, as trapezius. This method has been demonstrated fair to moderate correlation with passive stiffness measured by shear wave elastography for several muscles, as well as with level of muscle contraction, pinch and muscle strength, Action Research Arm Test score and muscle or subcutaneous thickness. Myotonometry can detect scapular muscles stiffness differences between pre- and post-intervention in painful conditions and, sometimes, between symptomatic and asymptomatic subjects.
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Affiliation(s)
- Ana S. C. Melo
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
- Center for Interdisciplinary Applied Research in Health, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal
| | - Eduardo B. Cruz
- Department of Physiotherapy, School of Health, Setubal Polytechnic Institute, Campus do IPS Estefanilha, 2914-503 Setubal, Portugal;
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - João Paulo Vilas-Boas
- Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
- Correspondence: or
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Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals. JSES Int 2020; 5:238-246. [PMID: 33681843 PMCID: PMC7910733 DOI: 10.1016/j.jseint.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Altered scapular motion is thought to be one of the factors associated with the development of symptomatic rotator cuff tears. However, the differences in kinematics and muscle activities of scapular upward/downward rotation between patients with symptomatic and asymptomatic tears are unclear. The purpose of this study was to compare the differences in kinematics and muscle activities of scapular rotation among patients with symptomatic and asymptomatic tears, and healthy individuals. Methods Twenty-three patients with rotator cuff tears and 9 healthy individuals (healthy group) participated in this study. Based on a visual analog scale (VAS, 0-100 mm), the patients were divided into symptomatic (13 patients; VAS ≥20 mm) and asymptomatic (10 patients; VAS <20 mm) groups. Scapular upward rotation was measured with a digital inclinometer. Elasticities of the upper trapezius, levator scapulae, and rhomboid major were assessed by using ultrasound real-time tissue elastography to quantify their muscle activities. All measurements were performed at 0°, 60°, 90°, and 120° of active arm elevation in the scapular plane. Results Scapular upward rotation was significantly less in the symptomatic group (9.4° ± 5.6°) compared with the asymptomatic group (15.7° ± 6.0°; P = .022) at 90° of arm elevation. The activity of the levator scapulae was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups (P = .013 and P = .005, respectively) at 90° of arm elevation. The activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group (P = .015) at 120° of arm elevation. Conclusion Patients with symptomatic rotator cuff tears showed less scapular upward rotation and higher activity of the levator scapulae at 90° of arm elevation compared to patients with asymptomatic rotator cuff tears.
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Yukata K, Doi K, Okabayashi T, Hattori Y, Sakamoto S. Shrug radiographs for the diagnosis of long thoracic nerve palsy in traumatic brachial plexus injury. J Shoulder Elbow Surg 2020; 29:2595-2600. [PMID: 33190758 DOI: 10.1016/j.jse.2020.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/25/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative diagnosis of long thoracic nerve (LTN) palsy is important for shoulder reconstruction after a traumatic brachial plexus injury (BPI). In the present study, we developed an objective diagnostic method for LTN palsy for patients with traumatic BPI. METHODS This is a retrospective review of 56 patients with traumatic BPI who had been receiving treatment at a single institution for over 8 years. The patients were divided into 2 groups: an LTN palsy group (n = 30) and a no palsy control group (n = 26). The LTN palsy group had 21 different palsy types with 4 and 5 C5-7 and C5-8, whereas the no palsy group had 18 different palsy types with 5 and 3 C5-6 and C5-8, respectively. Preoperative plain anteroposterior radiographs were taken in shoulder adduction and shrug positions. Scapulothoracic (ST) upward rotation and clavicle lateral (CL) rotation angles were measured on X-rays. The differences between the adduction and shrug positions for the respective angles were calculated and defined as ΦST and ΦCL, respectively. The differences in the ΦST and ΦCL values due to the presence or absence of LTN palsy were examined, the cutoff values of ΦST and ΦCL for the diagnosis of LTN palsy were determined, and further sensitivity and specificity were calculated. RESULTS Both ΦST and ΦCL were significantly decreased in the LTN palsy group compared with the no palsy control group. The sensitivity and specificity for LTN palsy were 0.833 and 1.000 for ΦST and 0.833 and 0.840 for ΦCL, respectively, when the cutoff value was set as ΦST = 15° and ΦCL ≤ 24°. CONCLUSION Dynamic shrug radiographs provide a useful objective diagnosis of LTN palsy after traumatic BPI.
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Affiliation(s)
- Kiminori Yukata
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan.
| | - Toshitaka Okabayashi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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Spanhove V, Van Daele M, Van den Abeele A, Rombaut L, Castelein B, Calders P, Malfait F, Cools A, De Wandele I. Muscle activity and scapular kinematics in individuals with multidirectional shoulder instability: A systematic review. Ann Phys Rehabil Med 2020; 64:101457. [PMID: 33221471 DOI: 10.1016/j.rehab.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking. OBJECTIVE This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls. METHOD The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration. RESULTS After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface. CONCLUSION There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
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Affiliation(s)
- Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Matthias Van Daele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Aäron Van den Abeele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Lies Rombaut
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Birgit Castelein
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Fransiska Malfait
- Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium
| | - Inge De Wandele
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Giuseppe LU, Laura RA, Berton A, Candela V, Massaroni C, Carnevale A, Stelitano G, Schena E, Nazarian A, DeAngelis J, Denaro V. Scapular Dyskinesis: From Basic Science to Ultimate Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082974. [PMID: 32344746 PMCID: PMC7215460 DOI: 10.3390/ijerph17082974] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023]
Abstract
Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.
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Affiliation(s)
- Longo Umile Giuseppe
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-062-2541-1613; Fax: +39-0622-5411
| | - Risi Ambrogioni Laura
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Carlo Massaroni
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Joseph DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
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12
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Borms D, Maenhout A, Cools AM. Incorporation of the Kinetic Chain Into Shoulder-Elevation Exercises: Does It Affect Scapular Muscle Activity? J Athl Train 2020; 55:343-349. [PMID: 32160060 DOI: 10.4085/1062-6050-136-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. OBJECTIVE To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-one asymptomatic participants (15 men, 16 women). MAIN OUTCOME MEASURE(S) The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). RESULTS A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference = 3.44% MVIC) and LT (mean difference = 7.76% MVIC) activity. Incorporating the lower limb (exercises 3-5) increased UT activity when compared with exercise 1 (mean differences = 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT : MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). CONCLUSIONS Incorporating the kinetic chain during shoulder-elevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity.
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Affiliation(s)
- Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Annelies Maenhout
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
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Shoulder muscle onset timing during clinical assessment movements is the same in elite handball players as non-athletes: Implications for clinical assessment. Phys Ther Sport 2019; 37:64-68. [PMID: 30878904 DOI: 10.1016/j.ptsp.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study examines neuromuscular firing patterns in overhead athletes and non-athletes of the periscapular, prime-moving, and rotator cuff muscles during "clinical" cardinal plane physiological movements. DESIGN Cohort prospective study. SETTING EMG recordings were taken of the periscapular, prime-moving, and rotator cuff muscles during flexion, scaption, and abduction performed at fast, medium, and slow speeds with a loaded (3 kg) and unloaded arm. PARTICIPANTS 14 Handball players and 20 non-athletes. Differences in firing patterns between groups were analyzed by fitting mixed linear models with random intercepts per subject, and fixed factors for group, muscle, movement type, speed, and load. MAIN OUTCOME MEASURES No difference in timing of activation was seen between the professional athletes and non-athletes. RESULTS Speed and load appear to independently vary muscle activation timing in a non-intuitive manner in both athletes and non-athletes. Onset timing of periscapular, prime movers and rotator cuff muscles are prior to movement in all scenarios studied, with rotator cuff muscles firing last. CONCLUSIONS Onset activation patterns in overhead athletes are not different to non-athletes during cardinal plane movements.
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14
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Derakhshani A, Letafatkar A, Abbasi A. Comparison of the effects of sensorimotor training programs on pain, electromyography and kinematics in patients with scapular downward rotation syndrome. Phys Ther Sport 2018; 34:66-75. [PMID: 30223235 DOI: 10.1016/j.ptsp.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Comparison of the effects of six weeks sensorimotor and sensorimotor with passive interventions programs on pain, electromyography (EMG) and kinematics in patients with scapular downward rotation syndrome (SDRS). DESIGN Randomized Controlled Trial. SETTING Institutional practice. PARTICIPANTS 140 active subjects with unilateral SDRS were randomized to three groups. Group one received sensorimotor (n = 46), group two received sensorimotor with passive interventions (n = 48), and group three received active self-exercise as a control group (n = 46). Pain, EMG of the levator scapula (LS), upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA), as well as kinematics were measured at the baseline and after the interventions. MAIN OUTCOME MEASURES Primary outcome: Pain - Secondary outcomes: EMG and kinematics. RESULTS There were significant between-group differences between intervention groups one and two in pain, LS and SA onset activation favoring group two and LS muscle activity favoring group one. There were significant within-group changes in almost all dependent variables except LT muscle onset activation in both groups one and two. CONCLUSIONS The addition of passive interventions on the scapula and neck may be superior to conservative training alone on the scapula and neck for improving neck pain, EMG and kinematics in participants with SDRS.
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Affiliation(s)
- Alireza Derakhshani
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Mirdamad Blvd, Tehran, Islamic Republic of Iran.
| | - Amir Letafatkar
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Mirdamad Blvd, Tehran, Islamic Republic of Iran
| | - Ali Abbasi
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Mirdamad Blvd, Tehran, Islamic Republic of Iran
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15
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Bleichert S, Renaud G, MacDermid J, Watson L, Faber K, Lenssen R, Saulnier M, Phillips P, Evans T, Sadi J. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. J Hand Ther 2018. [PMID: 28641732 DOI: 10.1016/j.jht.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical Commentary. INTRODUCTION Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sarah Bleichert
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Genevieve Renaud
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Ken Faber
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Marie Saulnier
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paul Phillips
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Tyler Evans
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
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Watson L, Balster S, Warby SA, Sadi J, Hoy G, Pizzari T. A comprehensive rehabilitation program for posterior instability of the shoulder. J Hand Ther 2018. [PMID: 28641736 DOI: 10.1016/j.jht.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Posterior shoulder instability is recognised as being less prevalent than anterior instability, however the diagnosis of this pathology is easily overlooked or missed and this may contribute to an underestimation of prevalence. Recently, there has been increasing recognition of this condition and consequently a greater requirement for knowledge of diagnostic procedures and treatment directions. Currently there is limited research into the conservative management of posterior instability, although it is recommended as first-line treatment prior to surgical review, particularly in those with an atraumatic instability mechanism. The aim of this paper is to outline a comprehensive rehabilitation program for the conservative management of posterior instability with a focus on scapular and humeral head control. The information provided includes extensive written information, flowcharts, figures and a table of management parameters that will provide therapists with adequate detail to replicate the program in the clinical setting.
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Affiliation(s)
- Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Sarah Ann Warby
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | | | - Greg Hoy
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
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17
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Scapular muscle dysfunction associated with subacromial pain syndrome. J Hand Ther 2018; 30:136-146. [PMID: 28576347 DOI: 10.1016/j.jht.2017.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Narrative Review. INTRODUCTION One of the shoulder pain disorders in which the function of the scapula is comprised is the subacromial pain syndrome. Several rehabilitation guidelines and exercises have been proposed to improve scapulothoracic muscle dysfunction. Consideration of muscle activation patterns may help to select the most appropriate rehabilitation exercise in these patients. To date, suggesting rehabilitation exercises is often based upon the knowledge of the superficial lying scapulothoracic muscles' activity. In the assumption that the deeper lying scapulothoracic muscles' activity may hinder normal scapular movement in case of tightness or hyperactivity, exercise protocols for patients with altered pattern in scapulothoracic muscles should also integrate knowledge on the deeper lying scapulothoracic muscle activity. PURPOSE OF THE STUDY To help clinicians choosing the most appropriate exercise in patients with subacromial pain syndrome related to scapulothoracic muscle dysfunction. METHODS First, a summary of key alterations in scapulothoracic (muscle) function in patients with subacromial pain was accomplished. Second, promising practical rehabilitation strategies toward restoring scapulothoracic muscle dysfunction (with a focus on scapulothoracic exercises) were developed, integrating current new research evidence (including information about the deeper lying scapulothoracic muscles) with clinical practice. CONCLUSION This review details clinical exercises and their muscular activity to guide clinicians to optimize individualized scapulothoracic training and treatment programs by selecting the most appropriate exercise, based on knowledge from the clinical examination. LEVEL OF EVIDENCE Level 5.
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Lefèvre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V, Poiraudeau S, Roby-Brami A, Roren A. Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications. Ann Phys Rehabil Med 2018; 61:46-53. [PMID: 28987866 DOI: 10.1016/j.rehab.2017.09.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints. METHODS This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. RESULTS For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation. CONCLUSION The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
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Affiliation(s)
- Marie-Martine Lefèvre-Colau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Christelle Nguyen
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Clemence Palazzo
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Srour
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Guillaume Paris
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Valerie Vuillemin
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Poiraudeau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Agnes Roby-Brami
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandra Roren
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Kinsella R, Cowan SM, Watson L, Pizzari T. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2017; 3:45. [PMID: 29163981 PMCID: PMC5684744 DOI: 10.1186/s40814-017-0190-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 09/26/2017] [Indexed: 01/10/2023] Open
Abstract
Background Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Methods Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening—isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1–6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6–12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an evaluation of key study parameters including (a) ease of recruitment (rate and number as well as suitability of the assessment algorithm), (b) adherence to all phases of the exercise intervention including home program compliance and logbook completion, (c) participant non-completion (drop out number and rate) and (d) adverse events (nature and number) will be undertaken. Secondary outcomes will measure immediate effects: (i) within-treatment changes in pain perception (verbal rating scale (VRS) and shoulder muscle strength (hand-held dynamometer) as well as longer-term changes: (ii) shoulder-related symptoms and disability (Western Ontario Rotator Cuff Index (WORC) and Shoulder Pain and Disability Index (SPADI)), (iii) perception of pain (11-point numerical rating scale (NRS), (iv) shoulder muscle strength (hand-held dynamometer) and (v) perceived global rating of change score. The immediate within-treatment assessment of pain and muscle strength will be undertaken in treatments 2 and 3, and the longer term measures will be collected at the primary (conclusion of Phase 1 at 6 weeks) and secondary (conclusion of Phase 2 at 12 weeks) end-points of the study. Discussion The findings of this pilot study will permit evaluation of this study design for a full-scale RCT. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001676404 Electronic supplementary material The online version of this article (10.1186/s40814-017-0190-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rita Kinsella
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Physiotherapy Department, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, Australia
| | - Sallie M Cowan
- Clifton Hill Physiotherapy, 111 Queens Parade, Clifton Hill, Melbourne, Australia.,University of Melbourne, School of Physiotherapy, Melbourne, Australia
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
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Jaggi A, Alexander S. Rehabilitation for Shoulder Instability - Current Approaches. Open Orthop J 2017; 11:957-971. [PMID: 28979601 PMCID: PMC5611703 DOI: 10.2174/1874325001711010957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Background: The shoulder relies predominantly on dynamic muscular control to provide stability. Successful treatment is highly dependent upon the correct clinical diagnosis, identification of anatomical structural defects and abnormal movement patterns so that rehabilitation programs can be designed accordingly and individualised to the patient. Method: A systematic outline is provided to guide the clinician on how to identify muscular insufficiencies both local to the shoulder joint and global muscles that can influence shoulder instability. Management is based on expert experience and current literature. Results: The Stanmore classification helps to correctly diagnose the type of instability and prioritise management. Symptom modification tests can help to guide management, however assessing individual muscle groups local to glenohumeral control is also recommended. Conclusion: Physical and psychosocial factors can influence motor control in the presence of pain and injury. A multi-disciplinary approach is required to avoid recurrence of symptoms with rehabilitation focusing on kinetic chain, scapular and gleno-humeral control.
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Affiliation(s)
- Anju Jaggi
- RNOHT - Therapies Dept Brockley Hill Stanmore Middlesex Stanmore HA7 4LP United Kingdom
| | - Susan Alexander
- RNOHT - Therapies Dept Brockley Hill Stanmore Middlesex Stanmore HA7 4LP United Kingdom
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21
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Watson L, Warby S, Balster S, Lenssen R, Pizzari T. The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1. Shoulder Elbow 2016; 8:271-8. [PMID: 27660660 PMCID: PMC5023053 DOI: 10.1177/1758573216652086] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The most commonly recommended initial treatment for multidirectional instability is a rehabilitation program. Although there is evidence to support the effect of conservative management on this condition, the published literature provides little information on the exercise parameters of such programs. In addition, current published rehabilitation programs for multidirectional instability do not focus on scapula stability or exercise drills into functional and sports-specific positions, which are often important aspects to consider in this patient population. METHODS The aim of this paper (Part 1) is to outline the first two stages of a six-stage rehabilitation program for the conservative management of multidirectional instability with a focus on scapula control and exercise drills into functional positions. RESULTS AND CONCLUSIONS This clinical protocol is currently being tested for efficacy as part of a randomized controlled trial (Australian New Zealand Clinical Trials Registry #ACTRN12613001240730). The information in this paper and additional online supplementary files will provide therapists with adequate detail to replicate the rehabilitation program in the clinical setting.
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Affiliation(s)
- Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Department of Rehabilitation, Nutrition and Sport, Bundoora, Victoria 3086, Australia
| | - Sarah Warby
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Department of Rehabilitation, Nutrition and Sport, Bundoora, Victoria 3086, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Department of Rehabilitation, Nutrition and Sport, Bundoora, Victoria 3086, Australia
| | - Tania Pizzari
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Department of Rehabilitation, Nutrition and Sport, Bundoora, Victoria 3086, Australia
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22
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Superficial and Deep Scapulothoracic Muscle Electromyographic Activity During Elevation Exercises in the Scapular Plane. J Orthop Sports Phys Ther 2016; 46:184-93. [PMID: 26868896 DOI: 10.2519/jospt.2016.5927] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. BACKGROUND In scapular rehabilitation training, exercises that include a humeral elevation component in the scapular plane are commonly implemented. While performing humeral elevation, the scapula plays an important role, as it has to create a stable basis for the glenohumeral joint. However, a comparison of both deep and superficial muscle activity of the scapula between different types of elevation exercises is lacking and would be helpful for the clinician in choosing exercises. OBJECTIVES To evaluate scapulothoracic muscle activity during different types of elevation exercises in the scapular plane. METHODS Scapulothoracic muscle activity was measured in 21 healthy subjects, using fine-wire electromyography in the levator scapulae, pectoralis minor, and rhomboid major muscles and surface electromyography in the upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. Measurements were conducted while the participants performed the following elevation tasks in the scapular plane: scaption (elevation in the scapular plane), towel wall slide, and elevation with external rotation (Thera-Band). The exercises were performed without and with additional load. Possible differences between the exercises and the load were studied with a linear mixed model. RESULTS Performing elevation in the scapular plane with an external-rotation component resulted in higher middle trapezius and lower trapezius activity compared to the scaption and wall slide exercises. The upper trapezius was maximally activated during scaption. The pectoralis minor and serratus anterior showed the highest activity during the towel wall slide. The towel wall slide activated the retractors to a lesser degree (middle trapezius, lower trapezius, levator scapulae, rhomboid major). Adding load resulted in higher muscle activity in all muscles, with some muscles showing a different activation pattern between the elevation exercises, depending on the load condition. CONCLUSION Scaption maximally activated the upper trapezius. The addition of an extra external-rotation component may be used when the goal is to activate the lower trapezius and middle trapezius. The towel wall slide exercise was found to increase pectoralis minor activity. Adding load resulted in higher muscle activity. Some muscles showed a different activation pattern between the elevation exercises, depending on the loading condition. The findings of this study give information about which elevation exercises a clinician can choose when the aim is to facilitate specific muscle scapulothoracic activity.
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23
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Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A Systematic Review. Orthop J Sports Med 2016; 4:2325967115627608. [PMID: 26962539 PMCID: PMC4765819 DOI: 10.1177/2325967115627608] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Scapular dyskinesis, or abnormal dynamic scapular control, is a condition that is commonly associated with shoulder pathology but is also present in asymptomatic individuals. Literature varies on whether it represents a cause or symptom of shoulder pathology, but it is believed to be a risk factor for further injury. Clinical identification focuses on visual observation and examination maneuvers. Treatment of altered scapular motion has been shown to improve shoulder symptoms. It is thought to be more common in overhead athletes due to their reliance on unilateral upper extremity function but the incidence within nonoverhead athletes is unknown. Hypothesis: Overhead athletes will have a greater prevalence of scapular dyskinesis when compared with nonoverhead athletes. Study Design: Systematic review; Level of evidence, 3. Methods: After PROSPERO registration, a systematic review was performed using PRISMA guidelines through the PubMed database looking for studies published before October 2014. All studies containing the search terms scapular, scapulothoracic, dyskinesis, dyskinesia, shoulder athlete, or overhead athlete were included. Studies that did not include prevalence data for scapular dyskinesis were excluded. Study methodological quality was evaluated using the modified Coleman methodology score. Descriptive statistics and 2-proportion 2-tailed z-tests were used to compare the reported prevalence of scapular dyskinesis between overhead and nonoverhead athletes. Results: Twelve studies were analyzed including 1401 athletes (1257 overhead and 144 nonoverhead; mean age, 24.4 ± 7.1 years; 78% men). All the studies were evidence level 2 (33%) or level 3 (67%). The reported prevalence of scapular dyskinesis was significantly (P < .0001) higher in overhead athletes (61%) compared with nonoverhead athletes (33%). Conclusion: Scapular dyskinesis was found to have a greater reported prevalence (61%) in overhead athletes compared with nonoverhead athletes (33%). Clinical Relevance: Prevalence data for scapular dyskinesis are scarce within the literature. Information on the reported prevalence, laterality, and association with the dominant extremity will allow for better allocation of diagnostic and therapeutic interventions. Recognition and treatment will help athletes to optimize functional performance and decrease the risk of further shoulder injury.
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Affiliation(s)
- Matthew B Burn
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Patrick C McCulloch
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - David M Lintner
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Shari R Liberman
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Joshua D Harris
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
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24
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Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR. Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:382-9. [PMID: 26704789 DOI: 10.1007/s00167-015-3940-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/09/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. METHODS This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. RESULTS Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. CONCLUSIONS This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. LEVEL OF EVIDENCE Expert opinion, Level V.
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Affiliation(s)
- Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Birgit Castelein
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Fran Vanderstukken
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Fredrik R Johansson
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.,Department of Environmental Medicine, Musculoskeletal and Sports Injury Epidemiology Center (MUSIEC), Karolinska Institute, Stockholm, Sweden
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25
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Castelein B, Cools A, Parlevliet T, Cagnie B. Modifying the shoulder joint position during shrugging and retraction exercises alters the activation of the medial scapular muscles. ACTA ACUST UNITED AC 2016; 21:250-5. [DOI: 10.1016/j.math.2015.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
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26
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Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Hum Mov Sci 2015; 45:119-29. [PMID: 26625348 DOI: 10.1016/j.humov.2015.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 11/27/2022]
Abstract
Scapular dyskinesis, characterized by scapular downward rotation syndrome (SDRS) affects scapula-humeral rhythm and results in shoulder dysfunction. Previous study has led to the recommendation of standard shrug exercise to contend with SDRS and strengthen the upper trapezius (UT) muscle. However, few researchers have examined which shrug exercise is most effective. The aim of this research was to compare scapular kinematic changes and scapular rotator muscles activity across three different shrug exercises in SDRS. The amounts of scapular downward rotation were measured by a caliper and the scapular upward rotation angle was measured using two digital inclinometers. Surface electromyography was used to measure EMG amplitude from the UT, lower trapezius (LT), serratus anterior (SA), and levator scapula (LS). Seventeen subjects with SDRS were recruited for this study. The subjects performed three shrug exercises with 30° shoulder abduction (preferred shrug, frontal shrug, and stabilization shrug). The stabilization shrug showed a significantly greater scapular upward rotation angle compared with the preferred shrug (P=0.004) and frontal shrug (P=0.006). The UT activity was significantly greater in the frontal shrug than in the preferred shrug (P=0.002). The UT/LS muscle activity ratio was also significantly greater in the frontal shrug than in the preferred shrug (P=0.004). The stabilization shrug should be preferred to enhance the upward rotation angle. In addition, the frontal shrug can be used as an effective method to increase UT activity and to decrease LS activity in SDRS.
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27
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Huang TS, Ou HL, Huang CY, Lin JJ. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elbow Surg 2015; 24:1227-34. [PMID: 25704212 DOI: 10.1016/j.jse.2014.12.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of the kinematics and associated muscular activity in individuals with scapular dyskinesis may provide insight into the injury mechanism and inform the planning of treatment strategies. We investigated scapular kinematics and associated muscular activation during arm movements in individuals with scapular dyskinesis. METHODS A visual-based palpation method was used to evaluate 82 participants with unilateral shoulder pain. Scapular movements during arm raising/lowering movements were classified as abnormal single pattern (inferior angle prominence, pattern I; medial border prominence, pattern II; excessive/inadequate scapular elevation or upward rotation, pattern III), abnormal mixed patterns, or normal pattern (pattern IV). Scapular kinematics and associated muscular activation were assessed with an electromagnetic motion-capturing system and surface electromyography. RESULTS More scapular internal rotation was found in pattern II subjects (4°, P = .009) and mixed pattern I and II subjects (4°, P = .023) than in control subjects during arm lowering. Scapular posterior tipping (3°, P = .028) was less in pattern I subjects during arm lowering. Higher upper trapezius activity (14%, P = .01) was found in pattern II subjects during arm lowering. In addition, lower trapezius (5%, P = .025) and serratus anterior activity (10%, P = .004) were less in mixed pattern I and II subjects during arm lowering. CONCLUSIONS Specific alterations of scapular muscular activation and kinematics were found in different patterns of scapular dyskinesis. The findings also validated the use of a comprehensive classification test to assess scapular dyskinesis, especially in the lowering phase of arm elevation.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ying Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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28
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Choi WJ, Cynn HS, Lee CH, Jeon HS, Lee JH, Jeong HJ, Yoon TL. Shrug exercises combined with shoulder abduction improve scapular upward rotator activity and scapular alignment in subjects with scapular downward rotation impairment. J Electromyogr Kinesiol 2015; 25:363-70. [DOI: 10.1016/j.jelekin.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 12/01/2022] Open
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Barrett C. The clinical physiotherapy assessment of non-traumatic shoulder instability. Shoulder Elbow 2015; 7:60-71. [PMID: 27582958 PMCID: PMC4935096 DOI: 10.1177/1758573214548934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
Non-traumatic shoulder instability is frequently associated with chronic disabling pain, altered patterns of motion, dysfunctional muscle strategies and hyperlaxity. Identifying the relationship between potential aetiologies can be challenging. An expanded assessment may be useful to estimate the contribution of each component and offer a framework for targeted rehabilitation.
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Affiliation(s)
- Catherine Barrett
- Catherine Barrett, Specialist Physiotherapist Shoulder Academy, Central Health Physiotherapy, Central Health Ltd, 53–64 Chancery Lane, London WC2A 1QS, UK. Tel: +44 (0)20 7404 6343. Fax: +(44) (0) 207 404 6345.
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