Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis

Where do archers hurt? Epidemiology of injuries during archery practice

BACKGROUND

The risk of injury in archery is supposedly low. However, relations between pain, shooting phases and types of bow have not been studied.

OBJECTIVE

Understanding the biomechanical mechanisms of archery-related injuries.

METHODS

Online survey for archers from all types of bow. Variables were analyzed using contingency tables and chi-squared tests.

RESULTS

396 surveys were completed. 36.9% of the archers had practiced archery for more than 10 years, 23.3% between 5 and 10 years. Olympic recurve bow was the most commonly used (38.2%), followed by traditional (23.3%) and compound (22.0%). 57.3% of the archers suffered some kind of injury during archery practice. Drawing shoulder (28.2%) and neck/back injuries (19.9%) were the most prevalent, preventing 50.3% of those who suffered them from continuing archery practice. There was a moderate association between drawing arm injuries and symptomatology in the drawing phase, especially in the shoulder region (0.55), elbow (0.20), and hand (0.13), and to a lesser extent in the neck/back (0.28).

CONCLUSIONS

Our results show that injury chronicity is frequent on archery. Correlations between types of bow, phases of the shoot and areas of pain could be a starting point for future studies on the repercussions of different types of injuries in archery practice.

Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis

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.

Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey

The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.

Normal values of scapular muscle activity ratio during arm elevation and the relationship to muscle strength and sex difference

BACKGROUND

The normal value of the scapular muscle activity ratio during arm elevation is not clear.

OBJECTIVE

To obtain normal values of the scapular muscle activity ratio during arm elevation in healthy individuals.

METHODS

This cross-sectional study enrolled 47 healthy people. The participants performed shoulder flexion and lowered task with 90-degree movements every 2 seconds. Muscle activities of scapular muscles were measured. For normalization, the maximum isometric contraction of the shoulder flexion was measured at 90∘ (reference contraction). The integrated electromyographic value (IEMG) obtained during the task was normalized by IEMG during the reference contraction and the relative IEMG value was calculated. Then, the scapular muscle activity ratio was computed. The relationship between muscle strength and other factors was also investigated.

RESULTS

The median values for upper trapezius/serratus anterior and upper trapezius/lower trapezius were often approximately 1, and that for upper trapezius/middle trapezius was often between 1 and 2. The shoulder flexion isometric strength and scapular muscle activity ratio showed significant negative correlations in multiple phases.

CONCLUSION

Normal values for upper trapezius/serratus anterior and upper trapezius/lower trapezius during arm elevation and lowering were generally 1. Low muscle strength may contribute to an abnormal scapular muscle activity balance.

Shoulder pain: Is the outcome of manual therapy, acupuncture and electrotherapy different for people with high compared to low pain self-efficacy? An analysis of effect moderation

Background

High baseline pain self-efficacy (PSE) predicts a better outcome for people attending physiotherapy for musculoskeletal shoulder pain. A potential contributing factor is that PSE moderates the relationship between some treatment modalities and outcome. Our aim was to investigate whether there is a difference in outcome between participants with high compared to low PSE receiving manual therapy, acupuncture, and electrotherapy.

Methods

Participants were stratified into high or low baseline (i) PSE, (ii) shoulder pain and disability index (SPADI), and (iii) did or did not receive the treatment. Whether the effect of treatment differs for people with high compared to low PSE was assessed using the 95% confidence interval of the difference of difference (DoD) at a 5% significance level (p < 0.05).

Results

Six-month SPADI scores were consistently lower (less pain and disability) for those who did not receive passive treatments compared to those who did (statistically significant less pain and disability in 7 of 24 models). However, DoD was statistically insignificant.

Conclusion

PSE did not moderate the relationship between treatment and outcome. However, participants who received passive treatment experienced equal or more pain and disability at 6 months compared to those who did not. Results are subject to confounding by indication but do indicate the need for further appropriately designed research.

Level of Evidence

Level of evidence II-b.

Comparing the effect of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome: a randomized controlled trial

PURPOSE

To compare the short and medium-term effects of physiotherapy plus corticosteroid injection (combined) with physiotherapy alone on pain intensity, disability, Quality of Life (QoL), and treatment effectiveness in patients with Subacromial Pain Syndrome (SAPS).

METHODS

In this double-blind, parallel Randomized Controlled Trial (RCT), 50 patients with SAPS were randomly assigned into combined (N = 25, a single injection 3-6 days before physiotherapy) and physiotherapy alone group (N = 25). Pain, disability, QoL, and treatment-effectiveness were measured at pre-intervention, post-intervention, and 3 and 6-month follow-up with Visual Analog Scale (VAS), Shortened Disability of the Arm, Shoulder, and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI) (primary outcome measure), Western Ontario Rotator Cuff (WORC), and Global Rating of Change (GRC) respectively. A 2 × 4 (group × time) mixed model analysis of variance (ANOVA) was applied for analysis.

RESULTS

The ANOVA revealed statistically significant group-in-time interaction for all outcome measures (p-value < 0.05). The independent t-test showed more effectiveness in the combined group at medium-term, as the mean scores of almost all outcome measures were substantially lesser (p < 0.01). Moreover, in short-time, despite a greater number of patients stating "completely recovered" in the combined group, there was no statistically significant difference between groups.

CONCLUSIONS

Effects of physiotherapy plus corticosteroid injection could be more long-lasting than physiotherapy alone in improving pain intensity, disability, QoL, and treatment effectiveness in patients with SAPS.

TRIAL REGISTRATION NUMBER

IRCT20201010048980N1.IMPLICATIONS FOR REHABILITATIONShoulder pain is common, persistent, and predominantly results from subacromial pain syndrome (SAPS).Physiotherapy and corticosteroid injections are effective interventions for this condition.Comprehensive physiotherapy alone can be as effective as corticosteroid injection combined with physiotherapy in the short term.A combined approach versus physiotherapy alone may have more medium-term effects on SAPS patients' pain, disability, quality of life, and treatment effectiveness.

Comparison of the physiotherapy with and without focus on the scapulothoracic joint on pain, range of motion, functional disability, quality of life, and treatment effectiveness of patients after arthroscopic shoulder rotator cuff tendon repair: A randomized controlled trial with short-term follow-up

BACKGROUND

Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence.

PURPOSE

This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR).

STUDY DESIGN

Two arms, parallel-group, randomized controlled trial, with concealed allocation METHODS: This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used.

RESULTS

Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: -17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: -19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = -25.4 to 0.56; active ROM: confidence interval = -20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported.

CONCLUSIONS

Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR.

Scapular movement training is not superior to standardized exercises in the treatment of individuals with chronic shoulder pain and scapular dyskinesis: randomized controlled trial

PURPOSE

To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.

METHODS AND METHODS

A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks.

RESULTS

SMT significantly (p < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks.

CONCLUSIONS

SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03528499Implications for rehabilitationScapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises.SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks.The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity.Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain.

Effectiveness of Combined Program of Manual Therapy and Exercise Vs Exercise Only in Patients With Rotator Cuff-related Shoulder Pain: A Systematic Review and Meta-analysis

CONTEXT

Therapeutic exercise is considered the mainstay in the management of rotator cuff-related shoulder pain (RCRSP). Manual therapy (MT) interventions have also shown to be effective in RCRSP. However, the benefits of adding MT along with exercise interventions for the management of RCRSP remain unknown.

OBJECTIVE

To evaluate the additional benefits of MT with exercise compared with exercise in isolation for the management of RCRSP.

DATA SOURCES

A search of PubMed, Scopus, PEDro, and EBSCO from the inception date of each database through April 20, 2022, was conducted for randomized trials comparing the additional effects of MT in exercise interventions compared with exercise alone for pain management and function in patients with RCRSP. Standardized mean differences (SMDs) and 95% CIs were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the grading of recommendations assessment, development and evaluation approach.

STUDY DESIGN

Meta-analysis of randomized controlled trials.

LEVEL OF EVIDENCE

Level 2.

RESULTS

Twelve articles were found eligible and 8 of them demonstrated high methodological quality. Eleven articles were included for quantitative analysis. Pain with movement was not significantly different between MT and exercise versus exercise alone (SMD [95% CI] = -0.15 [-0.41 to 0.12]; I2 = 0%), whereas pain at rest was significantly improved in the groups that used exercise only with a moderate effect size (SMD [95% CI] = 0.47 [0.04 to 0.89]; I2 = 75%). Furthermore, shoulder function was not significantly different between MT and exercise versus exercise alone in the short term (SMD [95% CI] = 0.23 [-0.22 to 0.69]; I2 = 88%) or the long term (SMD [95% CI] = -0.02 [-0.21 to 0.16]; I2 = 2%).

CONCLUSION

Adding MT to exercise interventions for the management of RCRSP is not more effective than exercise alone for pain and function in adult patients.

Etiology and Prevention of Common Injuries in Golf

ABSTRACT

Golf is a popular sport played by individuals of varying age and skillsets. The golf swing is unique and complex, creating potential for various musculoskeletal injuries in both amateur and professional golfers. Understanding the basic biomechanics of the golf swing and its relation to injury etiology can assist the health care provider in recognizing and preventing musculoskeletal injuries secondary to golf. Most injuries occur in the upper limb and the lumbar spine. This review describes musculoskeletal pathologies seen in golfers with respect to anatomic area and golf swing biomechanics, while summarizing effective prevention strategies and swing modifications to address these potential injuries.

Effectiveness of scapular mobilization in people with subacromial impingement syndrome: A randomized controlled trial

BACKGROUND

Scapular mobilization is a manual therapy technique widely used in the management of musculoskeletal disorders of the shoulder.

OBJECTIVE

To determine the effects of scapular mobilization in addition to an exercise program in people with subacromial impingement syndrome (SIS).

METHODS

Seventy-two adults with SIS were randomly allocated to 1 of 2 groups. The control group (n=36) participated in a 6-week exercise program, and the intervention group (n = 36) participated in the same exercise program plus passive manual scapular mobilization. Both groups were assessed at baseline and 6 weeks (end of treatment). The primary outcome measure was upper limb function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcome measures were the Constant-Murley questionnaire, pain (visual analog scale [VAS]), and scapular upward rotation.

RESULTS

All participants completed the trial. The between-group difference in DASH was -1.1 points (Cohen d = 0.05; p = 0.911), Constant-Murley 2.1 points (Cohen d = 0.08; p = 0.841), VAS rating of pain at rest -0.1 cm (Cohen d = 0.05; p = 0.684), and VAS rating of pain during movement -0.2 cm (Cohen d = 0.09; p = 0.764); scapular upward rotation at rest (arm by the side) was 0.6° (Cohen d = 0.09; p = 0.237), at 45° shoulder abduction was 0.8° (Cohen d = 0.13; p = 0.096), at 90° was 0.1° (Cohen d = 0.04; p = 0.783), and at 135° was 0.1° (Cohen d = 0.07; p = 0.886). Most differences were in favor of the intervention group; however, the effect sizes were weak and not statistically significant.

CONCLUSIONS

In the short-term, the addition of scapular mobilization did not provide significant clinical benefits in terms of function, pain or scapular motion in participants with SIS.

TRIAL REGISTRATION

Brazilian registry of clinical trials UTN number U1111-1226-2081. Registered February 25, 2019.

Optimal Blood Flow Restriction Occlusion Pressure for Shoulder Muscle Recruitment With Upper Extremity Exercise

BACKGROUND

As blood flow restriction (BFR) utilization continues to rise, it is crucial to define optimal parameters for use. Currently unknown are the effects of occlusion level during BFR on muscle activity in the proximal shoulder.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare electromyographic amplitude (EMGa) of shoulder musculature during exercise using limb occlusion percentages (LOPs). The authors hypothesized that EMGa would increase concurrently with occlusion.

STUDY DESIGN

Controlled laboratory study.

METHODS

α Fifteen healthy adults were recruited and underwent 4 experimental sessions, performing 3 common rotator cuff exercises at low intensity (20% maximal strength) to failure in the following order: cable external rotation (ER), cable internal rotation (IR), and dumbbell scaption. Exercises were completed at a different occlusion pressure (0%, 25%, 50%, and 75% LOP- order randomized) applied at the proximal arm. EMGa was recorded from shoulder musculature proximal to the occlusion site and averaged across 5-repetition intervals and overall for the first 30 repetitions. An analysis of variance repeated on occlusion pressure followed by a Bonferroni post hoc test was used to compare EMGa, repetitions to fatigue, and ratings of discomfort (visual analog scale [VAS], 0-10) between occlusion pressures. The type 1 error was set at α = .05 for all analyses.

RESULTS

Significant effects of the occlusion level on shoulder muscle EMGa were observed for all exercises (P < .05) with diminishing returns above 50% LOP (overall). For ER, elevations in EMGa were observed at ≥50% LOP for the anterior deltoid, middle deltoid, infraspinatus, and trapezius compared with 0% LOP (P < .05). For IR, elevations in EMGa were observed at ≥25% LOP for the anterior deltoid and trapezius compared with 0% LOP (P < .05). For the teres minor, a significant elevation in EMGa occurred at 75% LOP compared with 0%, 25%, and 50% LOP (P < .05). A decrease in EMGa was observed at ≥50% LOP compared with 0% LOP for the posterior deltoid (P < .05). For scaption, an increase in EMGa was observed at ≥25% LOP for the infraspinatus and teres minor muscles, at 75% LOP for the posterior deltoid, and at ≥50% LOP for the trapezius compared with 0% LOP (P < .05). Decreases in repetitions to failure relative to 0% LOP were observed at 75% LOP for ER (0%: 47 ± 5; 75%: 40 ± 2; P = .034), IR (0%: 82 ± 10; 75%: 64 ± 5; P = .017), and scaption (0%: 85 ± 9; 75%: 64 ± 6; P < .001). A significant linear increase in discomfort was observed for all exercises with increasing occlusion pressures (VAS: 0-10, 0% → 75% LOP; ER: 2.2 ± 0.4 → 7.2 ± 0.3; IR: 1.3 ± 0.2 → 6.1 ± 0.6; scaption: 1.3 ± 0.4 → 6.1 ± 0.4; P < .01).

CONCLUSION

There are several differences in muscle activation about the shoulder based on exercise and occlusion when utilizing BFR. Increasing the percentage of limb occlusion leads to heightened EMGa with diminished returns past 50% LOP when considering muscle activation, discomfort, and achievable exercise volume.

CLINICAL RELEVANCE

These findings may be used to refine upper extremity BFR guidelines.

The effect of EMG biofeedback training on muscle activation in an impingement population

Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.

Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool

Introduction

Although the negative effects of kinesiophobia on functional status in subacromial pain syndrome (SAPS) patients are clearly demonstrated, no study examines the risk factors of kinesiophobia in individuals with SAPS from a biopsychosocial perspective. The present study aims to determine the risk factors of kinesiophobia in individuals with SAPS using a biopsychosocial approach. This study also aims to explore the compounding effects of multiple associative risk factors by developing a clinical prediction tool to identify SAPS patients at higher risk for kinesiophobia.

Materials and methods

This cross-sectional study included 549 patients who were diagnosed with SAPS. The Tampa-Scale of Kinesiophobia (TSK) was used to assess kinesiophobia. Visual analog scale (VAS), The Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the presence of metabolic syndrome, using any non-steroidal anti-inflammatory drugs, Pain Catastrophizing Scale (PCS), Illness Perception Questionnaire-revised (IPQ-R), Hospital Anxiety and Depression Scale (HADS), behavioral pattern of the patient, sociodemographic characteristics, and treatment expectancy were outcome measures.

Results

Thirteen significant risk factors of having kinesiophobia were: VASat rest (≥ 5.2), VASduring activity (≥ 7.1), DASH (≥ 72.1), presence of metabolic syndrome, PCShelplessness (≥ 16.1), IPQ-Rpersonal control (≤ 17.1), IPQ-Rtreatment control (≤ 16.3), HADSdepression (≥ 7.9), avoidance behavior type, being female, educational level (≤ high school), average hours of sleep (≤ 6.8), and treatment expectancy (≤ 6.6). The presence of seven or more risk factors increased the probability of having high level of kinesiophobia from 34.3 to 51%.

Conclusions

It seems necessary to address these factors, increase awareness of health practitioners and individuals.

Level of evidence

Level IV.

Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study

BACKGROUND

Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature.

OBJECTIVE

To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS.

METHODS

The study was conducted with 60 outpatients diagnosed with SIS, aged 40-65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied along the inferior-medial edge of the scapula, starting from the processus coracoids), n= 30] and control [conventional physiotherapy program, n= 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being.

RESULTS

The interaction effect of Group*Time was not statistically significant in all outcome measures (p> 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p< 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p< 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81.

CONCLUSION

Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate.

Shoulder vibratory exercises improves shoulder external rotation muscle strength and shoulder function: Randomized comparison trial

BACKGROUND

Based on electromyography measurements, shoulder vibratory exercises efficiently stimulate shoulder muscles activity. Yet very few studies have supported that shoulder vibratory exercises increased shoulder muscles strength and function, and the noninferiority compared with conventional elastic resistance exercises remains unknown.

OBJECTIVE

This study investigated the effect of vibratory exercises versus conventional elastic resistance exercises with elastic bands on shoulder external rotation muscles strength and functional performance in young adults.

METHODS

26 young adults (7 males and 19 females, with age 23.89 ± 3.02) were recruited and randomly allocated to shoulder vibratory exercises with FLEXI-BAR (FLEXI-BAR group) or conventional resistance exercises with elastic band (TheraBand group) for 3 times/week, 4 weeks totally. Shoulder external rotator muscles strength test and Underkofler softball distance throw test (USDTT) were performed before and after the training period.

RESULTS

After 4 weeks training, shoulder external rotator muscles strength increased 22.25 ± 15.06 N (P= 0.004, effect size = 1.48) within FLEXI-BAR group and 22.81 ± 14.94 N (P= 0.007, effect size = 1.53) within TheraBand group. There were no statistically significant differences between groups in the three muscle strength tests (P> 0.65). Regarding shoulder function, FLEXI-BAR exercises increased the throw distance 0.81 ± 0.92 meters in USDTT (P= 0.041, effect size = 0.88) while TheraBand exercise did not (P= 0.284), yet there was no statistically significant between group effects (P= 0.608).

CONCLUSIONS

These findings suggest that shoulder vibratory exercises can improve shoulder muscles strength in young adults and can be a useful alternative to the conventional elastic resistance exercises to improve the shoulder muscles strength and function. This provides therapists with more options in terms of choosing training equipment for rehabilitation programs.

Assessment of Bilateral Shoulder Range of Motion in Firefighter Trainees Using a Markerless Motion Capture System

The unpredictable environments firefighters face paired with biomechanically compromising shoulder movements, such as overhead and lifting movements, place this population at an increased risk for shoulder injury. The purpose of this study was to assess firefighter trainees’ bilateral shoulder range of motion (ROM) using the Dynamic Athletic Research Institute Motion system. Retrospective anthropometric and ROM data for 31 male firefighter trainees were analyzed. Firefighter trainees’ mean shoulder ROM for bilateral external rotation, internal rotation, and extension were lower than previously published values. External rotation demonstrated the lowest percentage of trainees within normal ROM (left—6.67%, right—16.67%). Noting the susceptibility of upper extremity injuries among firefighters, establishing baseline ROM measurements for reference may improve musculoskeletal evaluations, training interventions, and injury rehabilitation.

Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.

Association between changes in pain or function scores and changes in scapular rotations in patients with subacromial shoulder pain: a prospective cohort study

Background

Scapular dyskinesis is reported as one of the potential factors contributing to the presentation of pain in subacromial shoulder pain. In clinical practice, the evaluation and control of scapular dyskinesis is considered important for managing the subacromial shoulder pain. The aim is to determine the association between changes in pain or function and changes in scapular rotations in participants with subacromial shoulder pain.

Method

Pain, function and scapular rotations were measured in 25 participants with subacromial shoulder pain at baseline and after 8 weeks. Pain was measured with Numeric Pain Rating Scale (NPRS) and function was measured with Patient Specific Functional Scale (PSFS). Scapular rotations were measured with a scapular locator at 60°, 90° and 120° of scapular arm elevation. Spearman rank correlations (r_s) were used to assess the association between variables.

Findings

No association was observed between changes in pain or function scores with changes in scapular upward/downward rotations (r_s = 0.03 to 0.27 for pain and − 0.13 to 0.23 for function) and scapular anterior/posterior tilt (r_s = − 0.01 to 0.23 for pain and − 0.13 to 0.08 for function) of arm at 60°, 90° and 120° elevation. Data associated with scapular internal/external rotation was not reported due to low reliability.

Conclusion

These findings reject associations between changes in pain or function scores and scapular rotations. Future observational study is warranted using a multifactorial approach to understand potential factors that contribute to the presentation of subacromial shoulder pain.

Weakness in patients with subacromial pain syndrome is local and more pronounced in females

BACKGROUND

Subacromial pain syndrome is the predominant cause of shoulder pain, accounting for approximately half of all shoulder complaints. This population presents with weakness of the involved shoulder. However, there is a gap in our understanding of how pain contributes to this weakness, and whether there are sex related differences.

METHODS

Regional and global isometric strength was tested at the involved shoulder joint and remote joints (uninvolved shoulder and both knees) in patients with subacromial pain syndrome. Data were collected before and after acute pain reduction with a subacromial injection.

FINDINGS

Patients demonstrated weakness at the involved shoulder while remote joints demonstrated normal strength. When compared to healthy controls, male patients were shown to exhibit greater levels of weakness than female patients at the involved shoulder, based on comparisons with sex-matched controls using z-scores. Pain reduction (through an anesthetic injection) had no influence on strength in the short-term.

INTERPRETATION

Weakness in patients appears to be sex dependent and is not resolved with reduction of pain. This calls into question the assumptions of the physiological causes of this weakness.

Shoulder muscle activation during scapular protraction exercise with arm rotation

BACKGROUND

The role of the serratus anterior is to maintain scapular stability. To strengthen this muscle, scapular protraction exercises are typically performed. Although the angle of arm rotation leads to changes in shoulder muscle activation, the arm rotation position is not normally determined.

OBJECTIVE

To investigate if scapular muscle activations were changed by combining arm external rotation during scapular protraction exercises.

METHODS

Thirty-four healthy men were enrolled in this study. Participants were instructed to perform scapular protraction exercises at 90∘ and 120∘ of shoulder flexion while in the standing and supine positions. Two different arm rotation angles were used: the thumb-up position (neutral position) and the maximum arm external rotation (ER) position. The percentages of maximum voluntary contractions (%MVCs) were measured, and %MVCs in the neutral and arm ER positions were compared.

RESULTS

Muscle activities of the middle serratus anterior (MSA) and lower serratus anterior (LSA) in the arm ER position were significantly higher than those in the neutral position during all tasks. The highest MSA and LSA positions were observed with the arm ER position of 120∘ while standing.

CONCLUSIONS

Scapular protraction exercises with arm ER resulted in a higher serratus anterior activity.

The role of scapular dyskinesis on rotator cuff tears: a narrative review of the current knowledge

Scapular dyskinesis can be present in healthy individuals as in patients with shoulder pathology.Altered patterns of scapular kinematics can cause or exacerbate rotator cuff tear pathology. However, more research is needed.Regardless of the cause or the consequence of rotator cuff tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and compromises the success of clinical intervention.The available literature suggests physical therapy as the first treatment for degenerative cuff tears, and scapular dyskinesis should be addressed if present. Non-responsive cases or traumatic tears may require surgery.Postsurgical physical therapy protocols after rotator cuff repair must consider scapular dyskinesia to improve the outcomes. Cite this article: EFORT Open Rev 2021;6:932-940. DOI: 10.1302/2058-5241.6.210043.

Scapular Retraction under Adduction Load: An Alternative to Overhead Exercises to Activate Infraspinatus, Upper, and Lower Trapezius in Subjects with and without Shoulder Pain

Exercises for lower trapezius (LT) often use overhead positions, causing compressive forces to the subacromial space. Scapular retraction would be an alternative to activate LT muscle. The present study aimed to assess the excitation levels of infraspinatus, upper trapezius, and lower trapezius muscles during a scapular retraction exercise under progressive adduction loads in subjects with and without painful shoulder. Electromyography of infraspinatus (IS), upper trapezius (UT), and LT was recorded during scapular retraction under progressive adduction loads of 42 participants, divided into two groups: with (SP, n = 26) and without shoulder pain (nSP, n = 16). The adduction loads of 20%, 30%, 40%, and 50% of the maximal voluntary contraction (MVC) were applied using a load cell. Normalized electromyography and the ratio between UT and LT (UT:LT) were used for statistical analysis. No differences were observed between groups, but a condition effect occurred for all muscles: UT showed higher values at 50% vs. 20% of MVC (p = 0.004); LT showed higher values on 40% and 50% of MVC (p = 0.001; 0.006). Higher values for IS were noted at 40% of MVC (vs. 20% of MVC; p = 0.04) and at 50% of MVC (vs. 20% of MVC; p = 0.001, vs. 30% of MVC, p = 0.001; vs. 40% of MVC; p = 0.001). UT:LT showed lower values at 50% of MVC (vs. 20% of MVC; p = 0.001 and vs. 30% of MVC; p = 0.016). Scapular retraction with adduction loads at 40-50% is an alternative to overhead exercises aiming to activate the LT and the IS muscles. The exercise ensures higher levels of LT and IS excitation without increasing UT excitation.

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

STUDY DESIGN

This is a systematic review.

INTRODUCTION

Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear.

PURPOSE OF THE STUDY

The purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics.

METHOD

MEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment.

RESULTS

Eleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles.

DISCUSSION

Scapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial.

CONCLUSION

The results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.

Current concepts in the rehabilitation of rotator cuff related disorders

Rotator cuff related disorders (RCRD) are common. Exercise-based rehabilitation can improve outcomes, yet uncertainty exists regarding the characteristics of these exercises. This scoping review paper summarises the key characteristics of the exercise-based rehabilitation of rotator cuff related disorders (RCRD). An iterative search process was used to capture the breadth of current evidence and a narrative summary of the data was produced. 57 papers were included. Disagreement around terminology, diagnostic standards, and outcome measures limits the comparison of the data. Rehabilitation should utilise a biopsychosocial approach, be person-centred and foster self-efficacy. Biomedically framed beliefs can create barriers to rehabilitation. Pain drivers in RCRSD are unclear, as is the influence of pain during exercise on outcomes. Expectations and preferences around pain levels should be discussed to allow the co-creation of a programme that is tolerated and therefore engaged with. The optimal parameters of exercise-based rehabilitation remain unclear; however, programmes should be individualised and progressive, with a minimum duration of 12 weeks. Supervised or home-based exercises are equally effective. Following rotator cuff repair, rehabilitation should be milestone-driven and individualised; communication across the MDT is essential. For individuals with massive rotator cuff tears, the anterior deltoid programme is a useful starting point and should be supplemented by functional rehabilitation, exercises to optimise any remaining cuff and the rest of the kinetic chain. In conclusion, exercise-based rehabilitation improves outcomes for individuals with a range of RCRD. The optimal parameters of these exercises remain unclear. Variation exists across current physiotherapy practice and post-operative rehabilitation protocols, reflecting the wide-ranging spectrum of individuals presenting with RCRD. Clinicians should use their communication and rehabilitation expertise to plan an exercise-based program in conjunction with the individual with RCRSD, which is regularly reviewed and adjusted.

The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function

The purpose of this study was to examine the association of breast cancer-related lymphedema on shoulder girdle kinematics and upper extremity function. The study included 67 breast cancer survivors with and without unilateral lymphedema. Individuals were divided into non-lymphedema, moderate and severe lymphedema groups according to the volumetric measurement difference between the affected and unaffected upper extremities. A three-dimensional motion monitor-electromagnetic system was used to analyze scapular movements during the elevation and depression phases of the upper extremity elevation in the scapular plane. Shoulder range of motion was assessed with a digital inclinometer. Upper extremity function was assessed with the 'Disabilities of the Arm, Shoulder, and Hand Questionnaire-Short Form (Quick-DASH)'. The scapular upward rotation was lower for the severe lymphedema group than for the non-lymphedema group in the 90-60-30° depression phases of arm elevation (p < .05). The scapular anterior tilt was higher for the severe lymphedema group than for the non-lymphedema group in the 30° depression phase of arm elevation (p < .05). Shoulder abduction range of motion was the lowest in the severe lymphedema group (p < .05). The non-lymphedema group had the lowest quick-DASH score and the severe lymphedema group had the highest score (p < .05). There were statistically significant moderate associations between the quick-DASH scores and scapular movements in all groups (p < .05). The development, presence and/or severity of lymphedema were associated with impaired shoulder-girdle kinematics and decreased upper extremity function. However, a need exists for longitudinal studies comparing individuals with and without lymphedema and healthy controls.

No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis

To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. To investigate whether there is a correlation between subacromial space and pain or disability in adults with SAPS and whether temporal changes in pain or disability are accompanied by changes in subacromial space. Systematic review and meta-analysis. Fifteen studies with a total of 775 participants were included. Twelve studies were of high quality and three studies were of moderate quality using the modified Black and Downs checklist. There was no between group difference in AHD in neutral shoulder position (mean difference [95% CI] 0.28 [−0.13 to 0.69] mm), shoulder abduction at 45° (−0.02 [−0.99 to 0.96] mm) or 60° (−0.20 [−0.61 to 0.20] mm). Compared to the control group, a greater occupation ratio in neutral shoulder position was demonstrated in participants with SAPS (5.14 [1.87 to 8.4] %). There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. The results suggest that surgical (e.g. sub-acromial decompression) and non-surgical (e.g. manual therapy, taping, stretching and strengthening) management of subacromial pain syndrome should not focus solely on addressing a potential decrease in subacromial space, but also on the importance of other biopsychosocial factors.

Is there an association between changes in pain or function with changes in scapular dyskinesis: A prospective cohort study

OBJECTIVE

To assess the association between changes in pain or function with changes in scapular dyskinesis in participants with subacromial shoulder pain.

METHOD

Forty-four participants with subacromial shoulder pain were assessed at baseline and 8 weeks later. The outcome measures included 'pain at rest' and 'pain during movement' using Numeric Pain Rating Scale (NPRS), shoulder function using Patient Specific Functional Scale (PSFS), and observation of scapular movement pattern using the scapular dyskinesis test. Robust paired t-tests were used to compare scores between baseline and follow-up. Repeated measures correlation coefficient was used to assess the association between changes in pain or function with changes in scapular dyskinesis scores.

RESULTS

A fair association was found between improvement in function and improvement in scapular dyskinesis (correlation coefficient = -0.4, 95% CI: -0.6 to -0.1). No associations were found between changes in 'pain at rest' (correlation coefficient = -0.1, 95% CI: -0.2 to 0.2) or 'pain during movement' (correlation coefficient = 0.28, 95% CI: 0.0 to 0.5) with changes in scapular dyskinesis.

CONCLUSION

Our findings showed improvement in function is associated with improvement in scapular dyskinesis scores. Future studies should explore whether there is causal effect between improvement in scapular dyskinesis and function.

Scapular Kinematics in Athletes With and Without Rotator Cuff Tendinopathy: A Systematic Review

Context: Rotator cuff tendinopathy is one of the most frequently reported shoulder injuries in athletes of overhead sports. Abnormal scapular kinematics has been proposed as one of the contributing factors of rotator cuff tendinopathy in overhead athletes. Objectives: To review the literature on 3-dimensional scapular kinematics in overhead athletes with and without rotator cuff tendinopathy. Evidence Acquisition: Electronic databases (Cochrane Library, MEDLINE, Embase, and PubMed) were searched from inception to September 2017. In addition, the reference lists of the articles that met the inclusion criteria were also searched. We included studies that compared the changes in 3-dimensional scapular kinematics in athletes with and without rotator cuff tendinopathy. Two reviewers independently examined the quality of studies by using the modified Downs and Black checklist. Evidence Synthesis: A total of 9 studies (a total of 332 athletes, mean age 23.41 [2.62] y) were included in the final analysis. The methodological quality was low (modified Downs and Black checklist = 9/15). Our findings showed a consistent pattern of increased scapular anterior tilting and internal rotation in the dominant shoulders than the nondominant shoulders of athletes who participated in overhead sports. Athletes of overhead sports seem to demonstrate an increase in scapular upward rotation during arm elevation when compared with nonathlete individuals. However, there is no consensus on the scapular kinematics pattern in athletes with rotator cuff tendinopathy when compared with healthy controls. Conclusion: Findings demonstrated that changes in scapular kinematics were observed in overhead athletes. However, all the included studies were cross-sectional studies with small sample size and diverse sports participation, whether changes in scapular kinematics may contribute to rotator cuff tendinopathy in overhead athletes warrants more high-quality prospective studies.

An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain

OBJECTIVE

To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain.

DESIGN

Umbrella review.

LITERATURE SEARCH

An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews.

STUDY SELECTION CRITERIA

Nonsurgical treatments for subacromial shoulder pain.

DATA SYNTHESIS

Sixteen systematic reviews were retrieved. Results were summarized qualitatively.

RESULTS

A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.

CONCLUSION

There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.

Comparative study of the differences in shoulder muscle activation according to arm rotation angle

BACKGROUND

Scapular muscle exercise is important for patients with shoulder disorders. Distal variance leads to changes in shoulder muscle activation. Here, we aimed to determine whether scapular muscle activation is affected by different arm rotation angles.

METHODS

Overall, 30 healthy men participated in this study. The subjects were asked to keep their arms at 120 degrees of shoulder flexion while holding a 1.0-kg dumbbell in palms down (pronation) and palms up (supination) positions. Electromyography was used to measure anterior, middle, posterior deltoid, serratus anterior, upper, and lower trapezius muscle activation during the task. The muscle activations of each shoulder were compared between the pronation and supination positions.

RESULTS

Anterior deltoid and serratus anterior activations were significantly higher in supination than in pronation (p < .05). Alternatively, posterior deltoid and lower trapezius muscles were significantly more activated in pronation than in supination (p < .05).

CONCLUSION

Scapular muscle activation changed with arm rotation angle. Arm rotation angle should be assessed to estimate scapular muscle activation during exercise and motion analysis in clinical practice.

Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome - A randomised controlled trial

BACKGROUND

The aim was to investigate the effect of Electromyography (EMG)-biofeedback guided exercises (BIONEX) on shoulder pain and function in participants with subacromial pain syndrome (SPS).

METHODS

Twenty-five women and 24 men (19-67 years), diagnosed with SPS, were randomised to BIONEX or the same exercises without EMG-biofeedback (NEX). Primary outcome was shoulder pain during the past 7 days (Numeric Pain Rating Scale (NPRS)). Secondary outcomes included self-reported (Disability of Arm Shoulder and Hand (DASH), Oxford Shoulder Score (OSS)), and measured shoulder function (surface EMG from upper trapezius, lower trapezius and serratus anterior) in mean and ratios of % of maximum voluntary EMG (%MVE) and onset time (msec), during arm tasks with 0, 1 and 3 kg.

RESULTS

There was no group difference (BIONEX versus NEX) in changed shoulder pain (NPRS, mean difference 0.18 (95% CI. -1.56; 1.19)), self-reported or measured shoulder function. Both groups, however, showed significant within-group improvements on self-reported outcomes (NPRS, DASH, OSS), only clinically relevant on NPRS (BIONEX 2.23 (SD 2.47); NEX 2.04 (SD 2.29)).

CONCLUSION

BIONEX and NEX were both effective in reducing pain to a clinically relevant level, while EMG-biofeedback did not make a difference. The current neuromuscular shoulder exercise protocol is recommended.

Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer - A case control study

BACKGROUND

There are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery.

OBJECTIVE

To compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed.

METHODS

Forty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36).

RESULTS

The surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p < .05; d = -0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls.

CONCLUSION

Scapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.