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Low KY, Chong LR, Lim HY, Lim I, Tan AKV. Scapular dyskinesia with focal impingement of the hypertrophied serratus anterior muscle in a competitive swimmer. Singapore Med J 2024:00077293-990000000-00142. [PMID: 39229743 DOI: 10.4103/singaporemedj.smj-2024-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/11/2024] [Indexed: 09/05/2024]
Affiliation(s)
- Kay Yi Low
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Le Roy Chong
- Department of Radiology, Changi General Hospital, Singapore
| | - Hui Yin Lim
- Department of Rehabilitative Services, Changi General Hospital, Singapore
| | - Ivy Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
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Martens G, Gofflot A, Tooth C, Schwartz C, Bornheim S, Croisier JL, Kaux JF, Forthomme B. Differences in Strength and Fatigue Resistance of Scapular Protractors and Retractors Between Symptomatic and Asymptomatic Dyskinesis. J Athl Train 2024; 59:814-821. [PMID: 37734729 PMCID: PMC11340672 DOI: 10.4085/1062-6050-0092.23] [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: 09/23/2023]
Abstract
CONTEXT Scapular dyskinesis is a shoulder dysfunction that can be asymptomatic or associated with pain or weakness. Reduced strength and fatigue resistance of the scapular protractor and retractor muscles that stabilize the scapula might contribute to dyskinesis. OBJECTIVES To determine the strength and fatigue resistance profiles of participants with symptomatic or asymptomatic scapular dyskinesis and compare them with healthy control (HC) individuals using isokinetic assessment. DESIGN Cross-sectional study. SETTING University hospital. PATIENTS OR OTHER PARTICIPANTS Twenty HC individuals and 21 overhead athletes with symptomatic (n = 10) or asymptomatic (n = 11) scapular dyskinesis. MAIN OUTCOME MEASURE(S) Strength (peak torque, maximum work), fatigue resistance (total work), and protraction:retraction ratios measured during a closed chain isokinetic protocol (40 repetitions in concentric mode at 24.4 cm/s). RESULTS The scapular protractors' strength and fatigue resistance were higher (P < .01) in HC individuals (peak torque = 5.0 ± 0.9 N/kg, maximum work = 2.4 ± 0.5 J/kg, total work = 72.4 ± 0.6 J/kg) than in asymptomatic (peak torque = 3.4 ± 0.7 N/kg, maximum work = 1.7 ± 0.4 J/kg, total work = 50.0 ± 13.7 J/kg) or symptomatic (peak torque = 3.8 ± 0.6 N/kg, maximum work = 1.8 ± 0.3 J/kg, total work = 58.1 ± 12.9 J/kg) dyskinetic participants. The symptomatic dyskinetic group presented the highest retractor strength and fatigue resistance (P < .01) values (peak torque = 5.2 ± 0.6 N/kg, maximum work = 2.9 ± 0.8 J/kg, total work = 87.7 ± 22.7 J/kg), followed by the HC individuals (peak torque = 4.7 ± 1.0 N/kg, maximum work = 2.1 ± 0.5 J/kg, total work = 65.3 ± 17.9 J/kg) and the asymptomatic dyskinetic participants (peak torque = 3.9 ± 1.0 N/kg, maximum work = 1.9 ± 0.6 J/kg, total work = 58.6 ± 18.5 J/kg). The protraction:retraction ratios showed a gradual decrease (P < .001) from the HC individuals (1.1) to the asymptomatic (0.9) and symptomatic (0.7) dyskinetic participants. CONCLUSIONS Scapular dyskinesis is characterized by weaker scapular protractors and reduced agonist:antagonist ratios, especially when patients are symptomatic. Targeting the scapular protractors to achieve a better balance of scapular musculature in rehabilitation and strengthening programs may improve shoulder symptoms and function, but more interventional studies are required.
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Affiliation(s)
- Géraldine Martens
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health University Hospital of Liege, Belgium
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
| | - Amandine Gofflot
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
- Laboratory of Human Motion Analysis, University of Liege, Belgium
| | - Camille Tooth
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
- Laboratory of Human Motion Analysis, University of Liege, Belgium
| | - Cédric Schwartz
- Laboratory of Human Motion Analysis, University of Liege, Belgium
| | - Stephen Bornheim
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
| | - Jean-Louis Croisier
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health University Hospital of Liege, Belgium
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
- Laboratory of Human Motion Analysis, University of Liege, Belgium
| | - Jean-François Kaux
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health University Hospital of Liege, Belgium
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
| | - Bénédicte Forthomme
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health University Hospital of Liege, Belgium
- Physical Medicine and Sport Traumatology Department, SportS, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Belgium
- Laboratory of Human Motion Analysis, University of Liege, Belgium
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Sciascia AD. Rehabilitation of the painful shoulder. J Shoulder Elbow Surg 2024; 33:494-506. [PMID: 37573929 DOI: 10.1016/j.jse.2023.07.013] [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: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.
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Affiliation(s)
- Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
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Skoumal C, Dewald M. Clinical Diagnosis of Scapular Dyskinesis in a Youth Softball Pitcher: A Case Report. Int J Sports Phys Ther 2024; 19:238-244. [PMID: 38313669 PMCID: PMC10837815 DOI: 10.26603/001c.91642] [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: 08/30/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Effective rehabilitation strategies for upper extremity injuries in softball pitchers are scarce in current literature, especially among youth athletes. Additionally, there continues to be ambiguity regarding the interpretation and clinical practicality when treating an overhead athlete with scapular dyskinesis. The purpose of this case report is to highlight the examination and treatment of a youth softball pitcher referred to physical therapy with the diagnosis of scapular dyskinesis. Case Description This case report presents data and outcomes for a 14-year-old female who experienced chronic right shoulder discomfort related to performing the windmill softball pitch (WSP). The subject was clinically diagnosed with scapular dyskinesis by her referring physician and demonstrated abnormal scapular movement when elevating and lowering her upper extremity. Internal and external rotator isokinetic strength testing and the Athletic Shoulder Test (ASH) were used as primary objective measures. Both were performed six days after the initial evaluation and again six weeks later. Initial testing demonstrated decreased peak torque and total work. Initial treatment involved periscapular and shoulder strengthening with progression to overhead loading. Later rehabilitation strategies focused on neuromuscular control, functional training, and sport-specific activities. Outcomes The subject initially demonstrated improved peak torque and total work of the shoulder with isokinetic strength testing but continued to have symptoms with pitching, even though the Scapular Dyskinesis Test had become negative. After changing the focus to neuromuscular and functional training the subject had fewer symptoms and became comfortable with self-management. Discussion This case matches previous research that endorses scapular dyskinesis being a normal finding in overhead athletes with and without shoulder pain. Neuromuscular control and functional training after a period of scapular strengthening were beneficial in improving symptoms in this athlete. Level of Evidence 5.
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5
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Mantovani M, Sciascia A, Varini A, Muraccini M, Nardini F, Tonino P, Kibler BW. Accuracy of measuring scapular position and motion with a novel motion capture system. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:303-311. [PMID: 37588505 PMCID: PMC10426632 DOI: 10.1016/j.xrrt.2023.03.007] [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: 08/18/2023]
Abstract
Background Scapula kinematics is recognized to be a crucial variable in shoulder dysfunction. Nevertheless, quantitative scapula tracking and measurement are not part of the current clinical evaluation. The main concern is measurement accuracy. Methods To assess the accuracy of the wearable sensor technology Showmotion a cadaver experiment was designed, allowing a direct comparison between sensors directly pinned to the scapula and superficial sensors. A measurement protocol was adopted to evaluate errors in measurement, mimicking the suggested in vivo evaluation. Sensors were simultaneously placed above (supraspinal) and below (infraspinal) the scapular spine to determine if one placement resulted in fewer errors compared to the other. Results Mean and standard deviations of the supraspinal sensor root mean square error (RMSE) in flexion-extension movements resulted in 3.59° ± 2.36°, 4.73° ± 2.98°, and 6.26° ± 3.62° for upward-downward rotation (up-down), anterior-posterior tilt and internal-external (intra-extra) rotation, respectively, while 2.16° ± 1.21°, 2.20° ± 1.02°, and 4.46° ± 2.16° for the infraspinal sensor. In abduction-adduction movements, mean and standard deviations of the supraspinal sensor RMSE resulted in 4.26° ± 2.98°, 5.68° ± 4.22°, and 7.04° ± 4.36° for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.38° ± 1.63°, 2.47° ± 1.77°, and 4.92° ± 3.14° for the infraspinal sensor. The same behavior was confirmed in shrug movements, where 4.35° ± 3.24°, 4.63° ± 3.09°, and 5.34° ± 6.67° are mean and standard deviations of the supraspinal sensor RMSE for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.76° ± 1.87°, 2.83° ± 2.53°, and 4.68° ± 5.22° for the infraspinal sensor. Conclusion This method of quantitative assessment of scapular motion is shown to have good accuracy and low error between the sensor measurements and actual bone movement in multiple planes of scapular motion, both over the entire range of motion and in its individual segment intervals. The decreased amount of error with the infraspinal sensor placement suggests that placement is ideal for clinical quantitative assessment of scapular motion.
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Affiliation(s)
| | - Aaron Sciascia
- Institute of Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA
| | | | - Marco Muraccini
- NCS Lab Srl, Medical Device Research Lab, Carpi (Modena), Italy
| | | | - Pietro Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Salamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, Kolber MJ. Is it Time to Normalize Scapular Dyskinesis? The Incidence of Scapular Dyskinesis in Those With and Without Symptoms: a Systematic Review of the Literature. Int J Sports Phys Ther 2023; V18:558-576. [PMID: 37425102 PMCID: PMC10324350 DOI: 10.26603/001c.74388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Up to 67% of adults experience shoulder pain in their lifetime. Numerous factors are related to the etiology of shoulder pain, one of which is thought to be scapular dyskinesis (SD). Given the prevalence of SD among the asymptomatic population a concern is that the condition is being medicalized (clinical findings suggested to require treatment but is ultimately a normal finding). Therefore, the purpose of this systematic review was to investigate the prevalence of SD among both symptomatic and asymptomatic populations. Methods A systematic review of the literature up to July of 2021. Relevant studies identified from PubMed, EMBASE, Cochrane and CINAHL were screened utilizing the following inclusion and exclusion criteria; inclusion: (a) individuals being assessed as having SD, including reliability and validity studies (b) subjects aged 18 or older; (c) sport and non-sport participants; (d) no date restriction; (e) symptomatic, asymptomatic, or both populations; (f) all study designs except case reports. Studies were excluded if: (a) they were not published in the English language; (b) they were a case report design; (c) the presence of SD was part of the studies inclusion criteria; (d) data were not present distinguishing the number of subjects with or without SD; (e) they did not define participants as having or not having SD. Methodological quality of the studies was assessed utilizing the Joanna Briggs Institute checklist. Results The search resulted in 11,619 after duplicates were removed with 34 studies ultimately retained for analysis after three were removed due to low quality. A total of 2,365 individuals were studied. Within the studies for the symptomatic athletic and general orthopedic population there were 81% and 57% individuals with SD, respectively, and a total of 60% among both symptomatic groups (sport and general orthopedic population). Within the studies for the asymptomatic athletic and general population there were 42% and 59% individuals with SD, respectively, and a total of 48% among both asymptomatic groups (sport and general orthopedic population). Limitation A strict inclusion and exclusion criteria was used to identify studies that provided the appropriate data for the purpose of this study. There was a lack of consistency for measuring SD across studies. Conclusion A considerable number of individuals with shoulder symptoms do not present with SD. More revealing is the number of asymptomatic individuals who do present with SD, suggesting that SD may be a normal finding among nearly half of the asymptomatic population. Level of Evidence 2a.
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Ben Kibler W, Lockhart JW, Cromwell R, Sciascia A. Managing Scapular Dyskinesis. Phys Med Rehabil Clin N Am 2023; 34:427-451. [PMID: 37003662 DOI: 10.1016/j.pmr.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.
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Sonnier JH, Ciccotti MC, Darius D, Hall AT, Freedman KB, Tjoumakaris F. Scapular Dyskinesis in the Athletic Patient: A Sport-Specific Review. JBJS Rev 2023; 11:01874474-202302000-00001. [PMID: 36745713 DOI: 10.2106/jbjs.rvw.22.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
» Scapular dyskinesis is an alteration of normal scapular kinematics. It is essential that each patient be evaluated holistically and that sport-related factors be taken into account. » The presentation of scapular dyskinesis may be highly variable depending on the underlying etiology or associated pathology, but the onset of symptoms is often gradual. » Sport-specific literature on scapular dyskinesis is most commonly reported in the context of baseball, swimming, and tennis. Treatment is most often conservative and involves physical therapy directed at the scapular stabilizers.
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Affiliation(s)
| | | | - Danielle Darius
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anya T Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Chen PT, Wang PK, Chen TT, Tuan-Mu HY, Chiu CH, Liu KL. Scapulohumeral kinematics and neuromuscular control during scaption are associated with passive stiffness and strength of periscapular muscles in competitive adolescent swimmers. Sci Rep 2023; 13:725. [PMID: 36639696 PMCID: PMC9839700 DOI: 10.1038/s41598-023-27920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
The passive stiffness and strength of periscapular muscles may affect scapulohumeral control, especially in overhead athletes due to sports-specific training. This study tried to assess the relationship between the passive stiffness and strength of periscapular muscles, scapulohumeral kinematics and neuromuscular control during scaption in swimmers. Ten male adolescent competitive front-crawl swimmers were recruited. The passive stiffness and strength of periscapular muscles were measured in standard postures by a hand-held myotonometer and dynamometer, respectively. Surface electromyography and electromagnetic tracking systems were synchronized to record the muscle activities and scapulohumeral kinematics during scaption. Correlations between the passive stiffness or strength of periscapular muscles and the kinematics or muscle activity were examined by Spearman's rank correlation coefficient. The maximal strength of periscapular muscles correlated positively with the ranges of upward and external rotation of the scapula and negatively with muscle activity during scaption. Passive stiffness of periscapular muscles was associated with the downward rotation of the scapula and triggered an increase in muscle activity. Increased passive stiffness or decreased strength in the periscapular muscles may affect their role in controlling the scapular rotation and contribute to compensation from adjacent muscles. Our findings suggest that when attempting to evaluate scapular behavior, it may be beneficial to examine muscle strength and passive stiffness of periscapular muscles.
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Affiliation(s)
- Po-Tsun Chen
- School of Physical Therapy, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Sports Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Ting Chen
- Department of Leisure Industry and Health Promotion, National Ilan University, Yilan, Taiwan
| | - Ho-Yi Tuan-Mu
- Sports Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Physical Therapy, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Lin Liu
- Sports Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
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Hadjisavvas S, Efstathiou MA, Malliou V, Giannaki CD, Stefanakis M. Risk factors for shoulder injuries in handball: systematic review. BMC Sports Sci Med Rehabil 2022; 14:204. [PMID: 36461053 PMCID: PMC9717475 DOI: 10.1186/s13102-022-00588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION PROSPERO ID: CRD42020138233.
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Affiliation(s)
- Stelios Hadjisavvas
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.
| | | | - Vivian Malliou
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Is Scapular Dyskinesis effective on Shoulder Strength Profiles in Asymptomatic Young Swimmers? JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1071136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sattasuk W, Sitilertpisan P, Joseph L, Paungmali A, Pirunsan U. A Clinical Evaluation of Scapular Dyskinesis Among Professional Bus Drivers With Unilateral Upper Quadrant Musculoskeletal Pain. Workplace Health Saf 2021; 69:460-466. [PMID: 33966565 DOI: 10.1177/21650799211003562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Professional bus drivers report a high prevalence of upper quadrant musculoskeletal pain which could be associated with scapular dyskinesis (SD). However, the evidence for valid and reliable screening methods for this condition is limited as SD among bus drivers is an emerging area of research. Therefore, the main aim of the study was to investigate the reliability of dynamic scapular motion test (DSMT) using video analysis as an accurate method to evaluate SD and to identify patterns of SD among bus drivers. METHODS In total, 32 bus drivers from a private bus company with unilateral upper quadrant musculoskeletal pain participated in the study. The DSMT was conducted and the SD was captured in the video during shoulder flexion-abduction movements. Two investigators analyzed the video recordings and identified the patterns of SD. The intra- and interrater reliability were determined using the percentage of agreement and weighted Kappa coefficients (Kw). Descriptive analysis was used to examine the patterns of SD. FINDINGS The intra- and interrater reliability of DSMT using video analysis were excellent (Kw coefficient: 0.762-0.878 and 0.87-1.00, respectively). About 56.2% and 53.1% of bus drivers presented SD with the shoulder flexion and abduction movements during DSMT. Medial border prominence (Type II pattern of SD) was identified as the common pattern of SD. CONCLUSION/APPLICATION TO PRACTICE The DSMT using video analysis showed excellent intra- and interrater reliability to evaluate SD. Occupational health practitioners can consider DSMT using video analysis to identify SD among people with upper quadrant musculoskeletal pain at the workplace.
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Affiliation(s)
- Wipawee Sattasuk
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | | | - Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University
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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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Activation Profile of Scapular Stabilizing Muscles in Asymptomatic People: Does Scapular Dyskinesis Have an Impact on It? Am J Phys Med Rehabil 2020; 99:925-931. [PMID: 32304382 DOI: 10.1097/phm.0000000000001446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the activation profile of scapular stabilizing muscles in dyskinetic asymptomatic people. DESIGN This is a noninterventional observational study. Two groups of 20 people were included in the study. The first group involved asymptomatic athletes with scapular dyskinesis. The second one included athletes without scapular dysfunction. Muscle activation of upper trapezius, lower trapezius, and serratus anterior were recorded by a surface electromyography during shoulder flexion and shoulder abduction, in unloaded and loaded conditions. RESULTS A significant increase of the activity of the upper trapezius (between 23% and 31%) and a significant decrease of the activity of the lower trapezius (between 32% and 65%) were observed in the dyskinetic group in comparison with the nondyskinetic group in asymptomatic athletes. A significant increase between 17% and 31% of the activity of the serratus anterior was also observed in dyskinetic people. Likewise, a significant increase approximately 24%-61% and 23%-70% was noted respectively in upper trapezius/lower trapezius and upper trapezius/serratus anterior ratio's in the dyskinetic group. CONCLUSIONS An alteration of periscapular muscular activation exists in dyskinetic asymptomatic people. Future studies will be needed to know whether those alterations increase the risk of shoulder injuries.
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Examining the link between thoracic rotation and scapular dyskinesis and shoulder pain amongst college swimmers. Phys Ther Sport 2019; 40:78-84. [PMID: 31499399 DOI: 10.1016/j.ptsp.2019.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES In National Collegiate Athletic Association Division I swimmers, we examined the differences in thoracic spine rotation in swimmers with and without scapular dyskinesis and the relationship between thoracic spine rotation and shoulder pain/dysfunction according to the Kerlan-Jobe Orthopaedic Clinic (KJOC) score. DESIGN Cross-sectional. SETTING Laboratory-based. PARTICIPANTS 34 NCAA Division I swimmers (13 males, 21 females). MAIN OUTCOME MEASURES Self-reported upper extremity function and pain assessed with the KJOC questionnaire, thoracic spine range of motion, presence of scapular dyskinesis. RESULTS Dyskinesis was present in 15 of 34 (44%) subjects. Thoracic rotation averaged 136.7° and KJOC averaged 87.7 with no differences between swimmers with or without dyskinesis. We observed no correlation between KJOC-identified shoulder pain/dysfunction and thoracic rotation. CONCLUSIONS In our cohort of NCAA Division 1 swimmers, no differences were found between swimmers with or without scapular dyskinesis and extent of thoracic rotation. We found no correlation between thoracic rotation and the amount of self-reported pain and dysfunction experienced in the upper extremity. The presence of scapular dyskinesis in nearly half of our subjects indicates that swimmers need to be assessed for this abnormality. If observed, rehabilitation should address the dyskinesis and improve thoracic rotation in an attempt to alleviate further upper extremity pain and dysfunction.
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Gaudet S, Tremblay J, Dal Maso F. Evolution of muscular fatigue in periscapular and rotator cuff muscles during isokinetic shoulder rotations. J Sports Sci 2018; 36:2121-2128. [PMID: 29447092 DOI: 10.1080/02640414.2018.1440513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To this day, how shoulder muscles react to a strong fatigue stimulus during dynamic shoulder rotations remains unknown. The aims of this study were to assess the effect of repeated maximal internal-external isokinetic shoulder rotations on shoulder strength and muscle activity. Twenty-four individuals completed a 50-repetition fatiguing isokinetic protocol while electromyography was recorded on eleven muscles of the shoulder girdle. Time-frequency transformation and an ANOVA model using statistical parametric mapping methods were used to analyze shifts in instantaneous median frequency (MDF) between each 10-repetition Blocks. Peak torques decreased in both internal and external rotation (P < 0.01) by 24.8% on average which indicated the presence of fatigue. Significant decrease in MDF (P < 0.01) was observed for pectoralis, middle deltoid, upper, middle and lower trapezius, infraspinatus and subscapularis muscles. The observed fatigue to the periscapular and rotator cuff muscles suggests that shoulder stability could be compromised during repeated shoulder rotations, which could underlie the increased risk of scapular dyskinesis and shoulder impingement during fatiguing tasks. The present study provides a deeper understanding on the manifestations of fatigue within muscles of the shoulder girdle and the results could be applied toward improvements in athlete shoulder injury prevention and rehabilitation programs.
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Affiliation(s)
- Sylvain Gaudet
- a Département de Kinésiologie , Université de Montréal , Montréal , Canada
| | - Jonathan Tremblay
- a Département de Kinésiologie , Université de Montréal , Montréal , Canada
| | - Fabien Dal Maso
- a Département de Kinésiologie , Université de Montréal , Montréal , Canada
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