Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?

Risk Factors for Shoulder Injuries in Female Athletes Playing Overhead Sports: A Systematic Review

CONTEXT

Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries.

OBJECTIVE

To determine risk factors (RFs) for shoulder injuries in female athletes who play overhead sports and evaluate strategies to reduce shoulder injuries in these athletes.

DATA SOURCES

A systematic electronic search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Databases included were PubMed, Tulane Matas Library Search Engine, and Google Scholar, with search terms: "Overhead injuries/Shoulder AND female athletes AND Risk Factors."

STUDY SELECTION

Of the initial 1574 studies identified, 314 were evaluated for eligibility by full-text review and 291 studies were excluded. Overall, 23 studies were included in this study. Studies were published from 2000 to 2021, subject age range was 15 to 35 years, with documented prevalence of shoulder injuries in female athletes playing overhead sports.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Two independent researchers completed abstract and full-text review. Data extraction used the Covidence and Cochrane Consumer guide template.

RESULTS

Volleyball was the most common sport with shoulder injuries (6/23; 26%) followed by softball 5/23 (22%), swimming 5/23 (22%), gymnastics 4/23 (17%), tennis 3/23 (13%), water polo 2/23 (8%), and basketball 1/23 (4%). Six RFs (dominant shoulder, volume/overuse, time in sport, older age at time of injury, past injury, and multidirectional instability) were described. Of the 23 studies, 9 (39%) identified the dominant shoulder as a RF for sustaining injury (mean risk ratio [RR], 2.04), while 6 (26%) cited volume of repetition and overuse as a prominent RF (RR, 1.45).

CONCLUSION

This systematic review demonstrates important RFs for shoulder injuries in female athletes associated with playing overhead sports. Multiple prevention strategies are described. Prevention programs are helpful in reducing the risk of reinjury.

Clinical and ultrasound findings of 'swimmer's shoulder' and its association with training history in elite Portuguese swimmers: a cross-sectional study

OBJECTIVES

To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors.

METHODS

This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination.

RESULTS

A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006).

CONCLUSIONS

A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.

Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review

BACKGROUND

Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level.

PURPOSE

The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests.

DESIGN

Systematic review.

METHODS

PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified.

RESULTS

Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies.

CONCLUSION

Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures.

Key level of evidence

3, Systematic review of mostly Level 3 studies.

Comparison of Muscle Coordination During Front Crawl and Backstroke With and Without Swimmer's Shoulder Pain

BACKGROUND

Shoulder pain, known as swimmer's shoulder, is the most common injury for swimmers. Studies that have analyzed muscle activity have focused on the shoulder joint. However, the whole-body muscle coordination of swimmers with swimmer's shoulder is not clear, although swimming requires movements of the upper limbs, trunk, and lower limbs to obtain propulsive force. This study investigated differences in muscle coordination between swimmers with and without swimmer's shoulder during the front crawl and backstroke using muscle synergy analysis.

HYPOTHESIS

Swimmers with swimmer's shoulder have muscle synergies differing from those without it.

STUDY DESIGN

Case-control study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 20 elite swimmers who regularly swam front crawl and backstroke were included (swimmer's shoulder, n = 8; control, n = 12). Muscle synergy data were analyzed using the nonnegative matrix factorization method and compared between groups.

RESULTS

For both front crawl and backstroke, there were 2 synergies in the control group and 3 synergies in the swimmer's shoulder group. During recovery, the control group showed coordinated triceps brachii, serratus anterior, upper trapezius, lower trapezius, internal oblique, and external oblique muscles activities; however, in the swimmer's shoulder group, the contribution of the upper limbs decreased and only that of the trunk muscles increased.

CONCLUSION

A comparison of muscle coordination during the front crawl and backstroke performed by swimmers with and without swimmer's shoulder revealed that coordination differed during the recovery phase. During both front crawl and backstroke, the swimmer's shoulder group could not maintain coordination with the upper limb when the trunk rolled, and split synergy was formed between the upper limbs and trunk.

CLINICAL RELEVANCE

Because coordination of the upper limbs and trunk is important during the recovery phase of front crawl and backstroke, swimmer's shoulder rehabilitation should introduce exercises to improve their coordination between the upper limbs and the trunk.

Preseason shoulder screening in volleyball players: is there any change during season?

Background

Volleyball players sollicit their shoulder with high velocity and high ranges of motion. Musculoskeletal adaptations have been described after some years of practice but have not been explored after some months of practice. The objective of this study was to analyze the short-term evolution of shoulder clinical measures and functional performance in youth competitive volleyball players.

Methods

Sixty-one volleyball players were assessed twice, at preseason and at midseason. Shoulder internal and external rotation range of motion as well as forward shoulder posture and scapular upward rotation were measured in all players. Two functional tests were also performed: the upper quarter Y-balance test and the Single-arm medicine ball throw. The results obtained at midseason were compared to those measured at preseason.

Results

Compared to preseason, an increase in absolute value of shoulder external rotation, total rotation range of motion and forward shoulder posture were observed at midseason (P < .001). An increase in side-to-side difference for shoulder internal rotation range of motion was also observed during the season. As for scapular kinematics, scapular upward rotation was significantly decreased at 45° and increased at 120° of abduction at midseason. Concerning functional tests, an increase in throwing distance in the single-arm medicine ball throw was observed at midseason while no change was noted for the upper quarter Y-balance test.

Conclusion

Significant changes in clinical measures and functional performance were observed after some months of practice. Since some variables have been suggested to be correlated to a higher risk of shoulder injuries, the current study emphasizes the importance of regular screening in order to highlight injury risk profiles throughout the season.

Narrative review of the prevalence and distribution of acute pain in children in the self-care setting

Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.

The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review

CONTEXT

Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions.

OBJECTIVES

The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice.

EVIDENCE ACQUISITION

A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist.

EVIDENCE SYNTHESIS

From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12 weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance.

CONCLUSIONS

Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.

Scapular Dyskinesis Is Not an Isolated Risk Factor for Shoulder Injury in Athletes: A Systematic Review and Meta-analysis

BACKGROUND

Scapular dyskinesis has been considered a risk factor for athletic shoulder injury; however, findings in the prospective literature have demonstrated mixed results.

PURPOSE

To determine if scapular dyskinesis increases the risk of shoulder injury in athletes.

STUDY DESIGN

Meta-analysis.

METHODS

A systematic search was conducted on the MEDLINE, CINAHL Plus, SPORTDiscus, and Embase databases to identify prospective studies examining scapular dyskinesis and shoulder injury risk in athletes. Studies were included if they assessed participants using a dynamic scapular assessment at baseline and monitored for the development of shoulder injury. Data from the studies were subject to meta-analysis using the Mantel-Haenszel method to produce a pooled risk ratio.

RESULTS

Seven studies were eligible for inclusion, resulting in 212 shoulder injuries observed across 923 athletes. Scapular dyskinesis was present in 46% of participants, and these athletes had an injury rate of 25%. The presence of scapular dyskinesis displayed a trend to increase the risk of shoulder injury, but this was not statistically significant (risk ratio, 1.07; 95% CI, 0.85-1.34; P = .59).

CONCLUSION

Scapular dyskinesis was not significantly associated with the development of shoulder injury in athletes.

REGISTRATION

CRD42019133089 (PROSPERO).

Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

CONTEXT

Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.

OBJECTIVES

To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.

DATA SOURCES

A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.

STUDY SELECTION

Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.

RESULTS

Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.

CONCLUSION

Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

Clinical Evaluation Techniques for Injury Risk Assessment in Elite Swimmers: A Systematic Review

CONTEXT

Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce.

OBJECTIVE

To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers.

DATA SOURCES

PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018.

STUDY SELECTION

Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology.

STUDY DESIGN

Systematic review and qualitative analysis.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool.

RESULTS

A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region.

CONCLUSION

Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.

Scapular muscle dysfunction associated with subacromial pain syndrome

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.

Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Background

It is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.

Objectives

To determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.

Methods

A systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.

Results

Five studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).

Conclusions

Athletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.

Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain

OBJECTIVES

To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging.

DESIGN

A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers.

METHODS

Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm.

RESULTS

There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group.

CONCLUSIONS

There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.

Differences in Scapular Orientation Between Standing and Sitting Postures at Rest and in 120° Scaption: A Cross-Sectional Study

BACKGROUND

Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore, a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning.

OBJECTIVE

To determine whether there are differences in scapular orientation between standing, neutral sitting, and habitual sitting, while adjusting for spinal posture.

DESIGN

A single group randomized repeated measures study.

SETTING

University laboratory.

PARTICIPANTS

Twenty-eight participants with shoulder pain were recruited from the community.

METHODS

Scapular orientation between standing and seated positions was compared, with the arm by the side and at 120° of glenohumeral scaption. Thoracic kyphosis and lumbar lordosis angles were used as covariates.

MAIN OUTCOME MEASUREMENTS

Scapular elevation, lateral translation, upward rotation, and posterior tilt.

RESULTS

Scapular orientation was marginally but significantly different between sitting postures for lateral translation (mean 0.5 cm; 95% confidence interval [95% CI] 0.2-0.7 cm); P < .001), upward rotation (mean 3°; 95% CI 1.1-5.0°; P < .001), and posterior tilt (mean 2.3°; 95% CI 0.2-4.3°; P = .009) in the arm by side position. A small-but-significant difference between standing and neutral sitting was found for upward rotation (mean 1.8°; 95% CI 0-3.7°; P = .02), and between standing and habitual sitting for lateral translation (mean 0.6 cm; 95% CI 0-1.1 cm; P =.02) in the arm by side position.

CONCLUSIONS

The results of this study suggest that scapular orientation can be slightly affected by body posture, although the clinical relevance is uncertain. To enhance scapular upward rotation or posterior tilt, it may be preferable to place the patient in neutral sitting.

LEVEL OF EVIDENCE

Not applicable.

Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method

BACKGROUND

The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression.

OBJECTIVE

The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position.

DESIGN

An interrater and intratester reliability and validity study was conducted.

METHODS

Testing was conducted on the same day by 2 physical therapists who were blinded to each other's results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity.

RESULTS

For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were <0.9 mm, <2.5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method.

LIMITATION

The results of this study are limited to static measurement of the scapula in one plane.

CONCLUSION

Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.

The pectoralis minor muscle and shoulder movement-related impairments and pain: Rationale, assessment and management

The adaptive shortening or tightness of the pectoralis minor muscle (PMm) is one of the potential biomechanical mechanisms associated with altered scapular alignment at rest and scapular motion during arm elevation (scapular dyskinesis) in patients with shoulder complaints. This masterclass briefly reviews the role of the PMm in shoulder movement-related impairments and provides a critical overview of the assessment of PMm tightness and the conventional approaches to increase its resting length and extensibility. A rehabilitation approach focused on PMm stretching and simultaneous optimization of the kinematic chain of arm elevation is also discussed, hoping to improve the management of shoulder movement-related impairments and pain.