Clinical assessment of scapular positioning in musicians: an intertester reliability study

Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study

BACKGROUND

the pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS.

OBJECTIVES

to compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals.

DESIGN

cross-sectional study.

METHOD

Thirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level.

RESULTS

Patients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups.

CONCLUSION

A clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.

Mismatch between fixed classroom furniture and anthropometric measurements among university students: Relationships to ergonomic risk

BACKGROUND

Appropriate arrangement of classroom ergonomics is necessary for maintaining health and improving academic performance, learning, and motivation.

OBJECTIVE

We aimed to determine the anthropometric measurements and ergonomic risk levels of students during a handwriting activity on a fixed desk and chair and to analyze the mismatch and relationships between these factors.

METHODS

This study included 149 university students (female:73, male:76). Anthropometric measurements (lower and upper extremity length, shoulder height, elbow-rest height, hip-popliteal length, popliteal height, knee height, the distance between tragus and wall, and between acromion and wall) were done with a tape measure. The Rapid Upper Limb Assessment (RULA) tool was conducted to determine the ergonomic risk level while students wrote a standard text on a fixed desk and chair as if they were taking notes in the classroom. The mismatch was evaluated between backrest height and sitting shoulder height, seat height, and popliteal height. The Pearson Chi-Square and the Spearman Correlation test were used for statistical analysis.

RESULTS

The median values of the participants' age, height, weight, and BMI were 22 years, 1.70 m, 68 kg, and 23.18 kg/cm2, respectively. Most students had inadequate ergonomic posture while writing on fixed furniture at the university (Median RULA grand score: 4). More mismatches for seat height (54.4%) were found in high ergonomic risk levels but mismatches for backrest height did not follow a similar result.

CONCLUSIONS

More investigation should be conducted with prospective studies including interventions like adjustable furniture.

Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability

Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.

Prevalence of disabled throwing shoulder and its shoulder function among youth football goalkeepers

Aim

Although the football goalkeepers are overhead athletes, no studies have reported the prevalence of disabled throwing shoulder (DTS) and the shoulder function. Thus, this study aimed to investigate the prevalence of DTS among youth football goalkeepers and to determine the relationship among their shoulder functions.

Methods

Youth football goalkeepers, who participated in a pre-participation medical examination were included in the study. The questionnaire was handed out before the examination to determine the players' age, dominant hand, and shoulder pain history. If the player had a history of shoulder pain during ball throwing motion in the past, they were defined as goalkeepers with DTS. Physical examination of scapular positioning, scapular retraction and rotator cuff muscle strength, and ultrasonographic evaluation were performed.

Results

Six goalkeepers (16%) had a history of DTS among the 38 male youth football goalkeepers. The presence of scapular malpositioning, limitation of scapular retraction, and decrease in rotator cuff strength was significantly higher in goalkeepers with DTS than in those without DTS (p = 0.03, p < 0.001, p < 0.001, respectively). Three goalkeepers with DTS revealed ultrasonographic findings.

Conclusion

The prevalence of DTS among youth football goalkeepers was 16%. All these players had scapular malpositioning and limitation of scapular retraction. Scapular malpositioning and limitation of scapular retraction may be related to the DTS in youth football goalkeepers.

Level of evidence

Level IV.

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.

Acute effects of doorway stretch on the glenohumeral rotational range of motion and scapular position in high-school baseball players

Background

Pectoralis minor tightness has been thought to affect the scapular position. Despite the wide implementation of doorway stretch in clinical practice owing to its apparent effectiveness in stretching the pectoralis minor, limited studies have investigated its influence on the glenohumeral rotational range of motion (ROM). This study aimed to examine the acute effects of doorway stretch on the glenohumeral rotational ROM and the correlation between the scapular position and ROM.

Materials and Methods

In total, 34 male high-school baseball players participated in this study. Outcomes included the pectoralis minor muscle length, glenohumeral rotational ROM, and scapular position. The distance between the sternocostal joint of rib 4 and the coracoid process was measured as the pectoralis minor length. Internal and external rotation ROM with the shoulder abducted at 90° were measured. The scapular position was defined by the following two measurements: the distance between the surface and the posterolateral corner of the acromion as well as the scapular index. The participants performed doorway stretch by abducting and externally rotating the shoulder at 90° and flexing the elbow at 90°. The outcomes were compared before and after stretching. Furthermore, the correlation between these changes was investigated.

Results

Pectoralis minor muscle length and glenohumeral internal rotation ROM was significantly higher after stretching than before, and the scapular position also significantly changed (P < .01 for both). A moderate correlation was found between the degree of change in the glenohumeral internal rotational ROM and scapular position (r = 0.44, P < .01).

Discussion

Our results indicated that doorway stretch significantly increased the pectoralis minor muscle length and glenohumeral internal rotation ROM and significantly altered the scapular position. Furthermore, a significant correlation between the degree of change in the scapular position and glenohumeral internal rotation ROM was observed. These results suggest that doorway stretch could be beneficial for improving the scapular position and glenohumeral internal rotation ROM, which are considered the cause of throwing injuries. Furthermore, the glenohumeral ROM may be affected by the scapular position.

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.

Prediction of Shoulder Pain in Youth Competitive Swimmers: The Development and Internal Validation of a Prognostic Prediction Model

BACKGROUND

Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain.

PURPOSE

To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism.

RESULTS

A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94).

CONCLUSION

Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.

Reliability of assessment methods for scapular dyskinesis in asymptomatic subjects: A systematic review

OBJECTIVE

The aim of this systematic review was to evaluate the available published evidence on the intra- and inter-rater reliabilities of assessment methods used for identifying and measuring scapular dyskinesis (SD) in asymptomatic subjects.

METHODS

A systematic electronic literature search was performed in PubMed, Physiotherapy Evidence Database, Scopus, and the Cochrane Library, and studies on the intra- and inter-rater reliabilities of physical examination tests used for identifying SD in asymptomatic people were identified. Methodological quality of the studies meeting the inclusion criteria was assessed using the Quality Appraisal of Reliability Studies (QAREL) checklist by two reviewers. The overall level of evidence of this systematic review was determined by the Modified Cochrane Back Pain Criteria based on previous research which was modified for reliability studies of the shoulder complex.

RESULTS

The literature search generated 388 results, and only 14 articles met the inclusion criteria. In these studies, reliabilities of two qualitative and five quantitative methods for the assessment of SD were analyzed. The QAREL checklist revealed that 12 studies had moderate risk of bias and 2 had high risk of bias. Additionally, none of the studies were of high quality. On the basis of the Modified Cochrane Back Pain Criteria, the overall level of evidence was moderate. Most of the studies including quantitative measurement methods found good to excellent inter- and intra-rater reliability values. Most of the studies including qualitative methods found low-to-moderate intra- and inter-rater reliability values.

CONCLUSION

Considering the available published evidence, there is lack of high-quality studies evaluating the inter- and intra-rater reliabilities of qualitative or quantitative methods used for the assessment of SD. There are no qualitative methods with high reliability that are fit for clinical applications. Some quantitative methods with higher reliability are present, but clinicians should be aware of the methodological flaws that studies evaluating these methods suffer from.

LEVEL OF EVIDENCE

Level II, Diagnostic study.

Measurement of scapular prominence in symptomatic dyskinesis using a novel scapulometer: reliability and the relationship to shoulder dysfunction

BACKGROUND

No previous studies have investigated whether the extent of scapular dyskinesis is associated with shoulder dysfunction. This study aimed (1) to establish the reliability of a scapulometer in patients with shoulder pain and (2) to investigate the related factors associated with shoulder dysfunction.

METHODS

One hundred participants with symptomatic scapular dyskinesis were recruited. Twenty-one participants were involved in the reliability study to test the intrarater and inter-rater reliabilities of the scapulometer in patients with shoulder pain. After demographic data and self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) scores were recorded, all participants were measured with a scapulometer to determine the posterior displacement of the root of the spine (ROS) and the inferior angle (IFA) of the scapula from the thorax. Next, the participants performed 5 trials of bilateral scapular plane elevation for scapular kinematics and electromyographic (EMG) data collection. Stepwise multiple linear regressions were used to determine the relationships between self-reported FLEX-SF scores and potential factors. In addition to scapular displacement, pain level, scapular kinematics, and EMG data were included as independent variables.

RESULTS

The intrarater and inter-rater reliabilities of the scapulometer were excellent (intraclass correlation coefficient [ICC] = 0.93-0.97) and moderate to good (ICC = 0.74-0.81), respectively. The Bland-Altman plots showed no systematic bias between raters in the ROS and IFA measurements. Final stepwise multiple regression models showed that more ROS distance, higher serratus anterior activity, and lower pain level during arm elevation were associated with higher shoulder function (total R² = 0.253).

CONCLUSION

The reliability of the scapulometer in patients with shoulder pain is moderate to excellent. Scapular dyskinesis may be a compensatory strategy to avoid shoulder pain and improve shoulder function.

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.

Intertester reliability of a movement impairment-based classification system for individuals with shoulder pain

Background:

Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature.

Objective:

This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain.

Methods:

The patients with shoulder pain, between the ages 18–60 years, were recruited if he or she had pain between 30 and 70 on the 100 mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated/anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined.

Results:

The results showed that agreement levels in identifying subgroup syndromes was fair (71.11% agreement, kappa coefficient = 0.34) and classifying subcategories syndromes were poor to substantial (73.33–91.11% agreement, kappa coefficient = 0.20–0.66). The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient = 0.11; 95% CI 0.05–0.18). The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners.

Conclusion:

The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

Relationship between scapular initial position and scapular movement during dynamic motions

Optimal scapular position and movement are necessary for normal function of the shoulder joint and it is essential to focus on scapula in the rehabilitation for shoulder disorders. The aim of this study was to discover the relationship between the scapular initial position and scapular movement during dynamic motions in healthy young men. Thirty-four men participated in this study. The scapular angles at initial position and in elevation and lowering during flexion and abduction were measured using an electromagnetic tracking device. The scapular movements from 30° to 120° during flexion and abduction were calculated. Spearman's rank correlation coefficients were used to analyze the relationship between the scapular initial position and scapular movements. For upward rotation and posterior tilt of the scapula, there were significant positive correlations between the scapular initial position and scapular movement during flexion and abduction. For internal rotation, there were significant positive correlations, except 90° in lowering phase and 120° in both phases. While the humeral elevation increased, the correlation coefficients tended to decrease. Except for the internal rotation our results clarified the interactions between the scapular initial position and scapular movement during dynamic motions in healthy young men. The tendency of the decrease in correlation coefficient with elevation angle was shown.

Quantifying cervical and axioscapular muscle stiffness using shear wave elastography

This study aimed to assess intra-rater (intra-session and inter-day) reliability and influence of side dominance and the scapular resting position on the shear modulus (an index of stiffness) of resting cervical and axioscapular muscles. Sixteen healthy participants were recruited. On day one, ultrasound shear wave elastography was used to measure the shear modulus of superficial and deep cervical extensor and axioscapular muscles bilaterally. Clinical assessments of scapular resting position were performed bilaterally. On day two, testing was repeated on the dominant side. Both intra-session and inter-day reliability were good to excellent for shear modulus of superficial muscles, and poor to excellent for deep muscles. Side differences of shear modulus for posterior upper trapezius were statistically significant but clinically irrelevant. The shear modulus of posterior upper trapezius and middle trapezius were significantly correlated with scapular depression. Ultrasound shear wave elastography is a reliable tool for quantitatively assessing stiffness of superficial cervical and axioscapular muscles. The influence of scapular position should be considered in future comparative studies of healthy controls and patients with neck/shoulder pain. This study provides the necessary first step for future studies on assessing and interpreting the stiffness of cervical and axioscapular muscles for neck and shoulder musculoskeletal disorders.

Clinical assessment methods for scapular position and function. An inter-rater reliability study

Introduction: The aim of this study was to assess the inter-rater reliability of selected static, semi-dynamic, and dynamic test assessment methods for evaluation of scapular positioning and function. Methods: A standardized three-phase (i.e. training, overall agreement, and actual study) protocol for reliability studies was applied on 41 overhead sports participants, aged 18-56 (22 with obvious scapular winging, classified as visibility of the medial or inferior angle border of scapula). Ten scapular test assessment methods (two static, three semi-dynamic, and five dynamic) were evaluated. Results: Bland-Altman plots showed no funnel effects, although systematic bias and significant differences between raters were present in three of the methods. ICC values ranged from 0.71 to 0.80 for the static test assessment methods and from 0.25-0.92 for the semi-dynamic test assessment methods. Three of the five dynamic test assessment methods had ICCs of 0.47-0.68. For the two remaining dynamic test assessment methods, kappa varied between -0.034 and 0.71. Using PABAK, kappa increased to 0.54-0.86. Conclusion: Four scapular test assessment methods (Upper horizontal distance, Lower horizontal distance at max shoulder flexion, Acromial distance, and Winging scapula) showed satisfactory inter-rater reliability. Simple visual observational methods and quantitative distance measurements have better reliability between clinicians than more complex measurements and may be better suited for use in clinical practice.

Clarifying acromial distance: Standardisation and association between supine and sitting positions

OBJECTIVES

To define a standardised acromial distance (AD) in relaxed, supine position and its cut-point with sensitivity and specificity for classifying pectoralis minor (PMI) shortness. To clarify a predictive value of AD while relaxed, supine (AD2) from AD while sitting (AD1), adjusted by the effect of body mass index (BMI).

DESIGN

Cross-sectional; SETTING: Laboratory of Physical Therapy Faculties.

PARTICIPANTS

Eighty-five participants aged 18-38 years.

MAIN OUTCOME MEASURES

A standardised-AD was proportionate of AD at scapular retraction (AD3) to AD2. AD1 was clarified as a predictive variable for AD2 in circumstances of adjusted BMI.

RESULTS

The cut-point of standardised-AD for PMI shortness was equal to or above 0.61. The sensitivity and specificity were 75.64% and 85.71%. AD2 was 0.355 time of AD1 when adjusted for effect of BMI. This cumulative effect may be able to explain AD2 for 41.4% of the variation in the AD1 and BMI around its mean.

CONCLUSIONS

Standardised-AD may be suitable to reflect PMI shortness while supine. Application for clinical practise may estimate AD2 from AD1 by summation of the effect of BMI. When designing postural education for correcting PMI shortness while lying, efficacy may be a concern in transfer to upright or functional position.

Review of scapular movement disorders among office workers having ergonomic risk

BACKGROUND

Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers.

OBJECTIVE

The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus).

METHODS

183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed.

RESULTS

The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p< 0.05). No significant difference has been found statistically among the postural angle values of individuals (p> 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p< 0.05).

CONCLUSIONS

Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.

Measurement of scapular medial border and inferior angle prominence using a novel scapulometer: A reliability and validity study

BACKGROUND

Previous studies have proposed various ways to assess scapular dyskinesis. In clinic, assessment tools designed to measure the posterior displacement of the inferior angle of the scapula with reference to the posterior thoracic cage are needed.

OBJECTIVES

A novel scapulometer was developed to measure scapular medial border and inferior angle prominence.

METHODS

A novel scapulometer was designed to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall in 29 participants with scapular dyskinesis bilaterally. Two raters measured the ROS and INF distance of the scapula 3 times bilaterally. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to determine the inter-rater and intra-rater reliability. Validity was based on correlations (convergent: ROS and internal/external rotation, and INF and tilt; divergent: ROS/INF and upward rotation of the scapula) using a FASTRAK Polhemus 3-D motion tracking system assessing scapular tilt, internal/external rotation, and upward/downward rotation.

RESULTS

The average ROS and INF displacements were 13.7 ± 5.0 mm and 12.5 ± 6.3 mm, respectively. The results showed excellent intra-rater and inter-rater reliability, with ICC = 0.88-0.99 and 0.95-0.99 (SEM = 0.7-0.8 mm), respectively. Correlations were 0.35/0.19 (convergent validity) and 0.07/0.09 (divergent validity).

CONCLUSIONS

The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended.

Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes

Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8-10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.

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.

Change of pectoralis minor length, and acromial distance, during scapular retraction at 60° shoulder elevation

As the pectoralis minor muscle is inserted into the coracoid process, an improper length of this muscle would affect scapular and shoulder motions. Therefore, this study is proposed to assess the effects on pectoralis minor's length and acromial distance after active scapular retraction in scaption at 60° elevation. Sixty right-hand-dominant participants (11 males, 49 females) were randomized into an intervention group and a control group. The intervention group performed pectoralis minor muscle stretching by active scapular retraction, while the control group were asked to sit in an upright position. The result shows that, the mean lengths of pectoralis minor in the intervention group were significantly increased when compared with those of the control group (p = 0.004 and p = 0.014 respectively). Simultaneously, the reduction in acromial distance of this intervention group was substantially greater than the control group's (p < 0.001 and p = 0.001 respectively). However, it should be noted that the results reported only relate to the period immediately following muscle stretching.

Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review

BACKGROUND

Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies.

PURPOSE

The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain.

DATA SOURCES

The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015.

STUDY SELECTION

Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest.

DATA EXTRACTION

Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties.

DATA SYNTHESIS

Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property.

LIMITATIONS

All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor.

CONCLUSIONS

High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar tests was present, and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently, these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinically meaningful context of movement into clinical tests is warranted.

The Influence of Test Positions on Clinical Assessment for Scapular Dyskinesis

BACKGROUND

Appropriate evaluation of scapular dyskinesis is essential for therapeutic strategies. Although the current visual-based assessment is rapid and practical, the reliability of this method is unsatisfactory. It is necessary to adequately understand the conditions of assessment to maximize the benefit of therapeutic interventions.

OBJECTIVE

To explore the influence of different test positions on clinical assessment for scapular dyskinesis.

DESIGN

Observational study.

SETTING

University rehabilitation department.

PATIENTS

A total of 102 subjects diagnosed with unilateral shoulder disorder were recruited from among rehabilitation outpatients from November 2015 to February 2016.

METHODS

Two experienced raters categorized the subjects' scapular movement pattern according to Kibler et al classification by the vision-palpation method at 4 test positions (at rest, and the end range of elevation in the sagittal, scapular, and coronal planes).

MAIN OUTCOME MEASUREMENTS

The overall prevalence of scapular dyskinesis, the distribution of types, and the reproducibility of types at the 4 test positions were analyzed.

RESULTS

The overall prevalence of scapular dyskinesis was 90.08%, and the highest frequency was found at the resting position. Type III was the most common type in our sample. In reproducibility analysis, 21.57% of subjects presented with the same type at any position, and 75.49% of subjects presented with 2 types.

CONCLUSIONS

Scapular dyskinesis in individuals with shoulder disorder showed a high prevalence, especially at the resting position. More than 1 type of scapular pattern would be present if assessed at different positions. This study indicates that test positions can affect the results of scapular dyskinesis assessment, and that the resting position should primarily be applied.

LEVEL OF EVIDENCE

III.

Inter-rater reliability of shoulder measurements in middle-aged women

OBJECTIVES

To investigate inter-rater reliability of a set of shoulder measurements including inclinometry [shoulder range of motion (ROM)], acromion-table distance and pectoralis minor muscle length (static scapular positioning), upward rotation with two inclinometers (scapular kinematics) and pain pressure thresholds (muscle tenderness) in middle-aged women.

DESIGN

Observational study.

PARTICIPANTS

Thirty symptom-free middle-aged women (first cohort) were measured by two raters. All measurements with an intraclass correlation coefficient (ICC) below 0.75 were retested after an additional training period in a second cohort of 30 symptom-free middle-aged women.

MAIN OUTCOME MEASURES

Inter-rater reliability of all variables was measured with the ICC (95% confidence interval) and standard error of measurement (SEM).

RESULTS

Acromion-table distance (ICC=0.91, SEM 0.22 to 0.28% of body length), pectoralis minor muscle length (ICC=0.91, SEM 0.16% of body length), pain pressure thresholds (ICC=0.78 to 0.85, SEM 0.39 to 0.70kg) and abduction ROM (ICC=0.77, SEM 5°) showed good to excellent inter-rater reliability in the first cohort. After an additional training period, forward flexion ROM showed good inter-rater reliability (ICC=0.83, SEM 5°), scapular upward rotation in resting position showed moderate reliability (ICC=0.52, SEM 2°), and other scaption angles showed weak reliability (ICC=0.26 to 0.43, SEM 3 to 8°).

CONCLUSIONS

In a battery of clinical tools to evaluate factors contributing to shoulder pain, static scapular positioning and pressure pain thresholds were found to have good to excellent inter-rater reliability in middle-aged women. Additional training is recommended for measurements with a gravity inclinometer.

Scapulohumeral control after stroke: A preliminary study of the test-retest reliability and discriminative validity of a clinical scapular protocol (ClinScaP)

BACKGROUND

Clinical scapulohumeral tests are lacking post-stroke.

OBJECTIVE

To test reliability and discriminant validity of clinical scapulohumeral assessments post-stroke.

METHODS

Following tests were assessed in 57 individuals with stroke (IwS) (subdivided in a low, moderate, high proximal arm function (PAF) group) and 15 healthy controls: (1) Observation of tilting/winging; (2) shoulder girdle position tests (pectoralis minor index, acromial index, scapular distance test); (3) scapular lateral rotation measurement; (4) maximal humeral elevation and (5) medial rotation test were executed. 15 IwS were measured twice by the same assessor to determine test-retest reliability. Differences between controls and IwS and between IwS with different levels of PAF were assessed.

RESULTS

ICCs were very high for all tests (>0.80), except the pectoralis minor index (0.66). Weighted Kappas were high for observation and the medial rotation test (>0.70). Group differences were found for observation, lateral rotation and humeral elevation. IwS compared to controls, and IwS with lower compared to higher PAF generally showed increased lateral rotation (p < .01); decreased maximal active humeral elevation (p < .001); and more often tilting and winging (p < .05).

CONCLUSIONS

The use of these tests in clinical settings will allow for identification of altered scapular characteristics, which will enhance treatment planning for PAF post-stroke.

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.

CLINICAL RELIABILITY AND DIAGNOSTIC ACCURACY OF VISUAL SCAPULOHUMERAL MOVEMENT EVALUATION IN DETECTING PATIENTS WITH SHOULDER IMPAIRMENT

BACKGROUND

Clinical investigation of shoulder injuries commonly utilizes visual evaluation of scapular movement to determine if abnormal or asymmetrical movements are related to the injury. To date, the intrarater reliability and diagnostic accuracy of visual evaluation of scapular movement among physical therapists are not known.

PURPOSE

The aims of this study were to determine the clinical reliability and diagnostic accuracy of physical therapists visual evaluation of scapulohumeral movements when used to diagnose shoulder impairment.

STUDY DESIGN

University based laboratory and an internet based survey.

METHODS

Thirty-three physical therapists and 12 patient participants participated in this study. Reliability was measured as percent agreement and using the free marginal kappa statistic (κ) and Cronbach's alpha (α) for interrater and intrarater reliability respectively. Diagnostic accuracy variables such as sensitivity, specificity, likelihood ratios were calculated from contingency table analysis.

RESULTS

Visual evaluation yielded the following (95% CI): diagnostic accuracy 49.5%, specificity 60% (56 - 64), and sensitivity 35% (29 - 41), positive and negative likelihood ratios were 0.87 (0.66 - 1.14) and 1.09 (0.92 - 1.27) respectively. Percent agreements of evaluation findings between sessions for static and dynamic symmetry were 69% and 68%, respectively. The alpha statistics for static and dynamic symmetry were both 0.51. Percentage agreement in determining the injured shoulder was 59%, with an alpha statistic of 0.35.

CONCLUSION

Visual evaluation of scapular movements, without additional clinical information, demonstrated a poor to fair reliability and poor to fair diagnostic accuracy.

CLINICAL RELEVANCE

The clinical utility of the use of isolated visual scapular evaluation is cautioned. More reliable and valid objective measures are needed for diagnosing shoulder impairment.

LEVEL OF EVIDENCE

2b, Exploratory cohort study.

The relevance of scapular dysfunction in neck pain: a brief commentary

Synopsis Though our understanding of motor disorders and mechanical neck pain has advanced, the role of scapular dysfunction in mechanical neck pain remains enigmatic. The biomechanical interdependence between the neck and scapula and the potentially deleterious consequences of scapular dysfunction in the cervical region are biomechanically plausible. Yet the relevance of observed scapular dysfunction in patients with neck pain is still inadequately explained by research. However, studies investigating the association between scapular function and neck pain are beginning to emerge. The purpose of this paper was to review the current knowledge of this topic and consider the implications for clinical practice. Level of Evidence Therapy, level 5.

Inter- and intrarater reliability of modified lateral scapular slide test in healthy athletic men

OBJECTIVE

The reliability of lateral scapular slide test (LSST) at 90 degrees of abduction is controversial; therefore, in order to achieve more reliability it may be necessary to make changes in this particular position.

METHODS

Modified lateral scapular slide test (MLSST) was done on thirty male basketball players with two examiners in one session and for the retest with one examiner in the next week. The test was done in 7 positions: arm relaxed at the side (P1), 90 degrees of abduction (P2), 90 degrees of scaption without having a weight in hands (P3), 90 degrees of scaption with having 3 different weights (1, 2, and 4 kg) in hands (P4, P5, and P6, resp.), and 180 degrees of scaption without having a weight in hands (P7).

RESULTS

In P1 and P6, the ICC scores indicated the highest level of intrarater reliability. In P2, the ICC scores showed a fair level of intrarater reliability, as the minimum reliability. The maximum and minimum interrater reliability were P1 and P4, respectively.

CONCLUSION

Scaption with loading, as a functional position in the overhead athletes, is a reliable positioning and may be replaced with the third position of the traditional LSST.

Predictor variables for forward scapular posture including posterior shoulder tightness

The purpose of this study was (1) to determine the relationships between the degree of forward scapular posture and the pectoralis minor index, the strength of the serratus anterior, the thoracic spine angle, and posterior shoulder tightness, and (2) to identify predictors of forward scapular posture, including posterior shoulder tightness. The study recruited eighteen subjects with forward scapular posture and objectively measured the acromion distance, the pectoralis minor index, and the strength of the serratus anterior muscle of each participant. The amount of glenohumeral horizontal adduction and internal rotation were evaluated to measure posterior shoulder tightness. There were high intra-rater reliabilities in all measurements. The measurement results showed a statistically strong negative correlation between the degree of forward scapular posture and the pectoralis minor index. They also revealed a moderate positive correlation between the degree of forward scapular posture and the thoracic spine angle and a moderate negative relationship between the degree of forward scapular posture and the amount of the glenohumeral horizontal adduction. A multiple regression analysis indicated that a total multiple regression model explained 93% of the amount of forward scapular posture. All predictor variables, including posterior shoulder tightness, should be considered while assessing, managing, and preventing forward scapular posture.

Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. From 50 articles, 54 method names were identified and categorized into three groups: (1) Static positioning assessment (n = 19); (2) Semi-dynamic (n = 13); and (3) Dynamic functional assessment (n = 22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was "fair" (57%) to "poor" (43%), with only one study rated as "good". The reliability domain was most often investigated. Few of the assessment methods in the included studies that had "fair" or "good" measurement property ratings demonstrated acceptable results for both reliability and validity. We found a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general "fair" to "poor". None were examined for all three domains: (1) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase utility for clinical practice.

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

BACKGROUND

Scapula alata (SA) is a known complication of breast surgery associated with palsy of the serratus anterior, but it is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT).

METHODS

The trial randomized women with completely resected stage I-II breast cancer to short-course image-guided RT, versus conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at one to three months post-RT. Shoulder/arm morbidities were computed as a post-RT percentage change relative to pre-RT measurements.

RESULTS

Of 119 evaluable patients, 13 (= 10.9%) had pre-RT SA. Age younger than 50 years old, a body mass index less than 25 kg/m2, and axillary lymph node dissection were significant risk factors, with odds ratios of 4.8 (P = 0.009), 6.1 (P = 0.016), and 6.1 (P = 0.005), respectively. Randomization group was not significant. At one to three months' post-RT, mean arm volume increased by 4.1% (P = 0.036) and abduction decreased by 8.6% (P = 0.046) among SA patients, but not among non-SA patients. SA resolved in eight, persisted in five, and appeared in one patient.

CONCLUSION

The relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.

Lateral scapular slide test and scapular mobility in volleyball players

CONTEXT

The stability of the scapula in relation to the entire moving upper extremity is the key in the throwing sequence. The importance of scapular positioning in volleyball players has been well documented in the literature, but no one has compared scapular positioning between volleyball players and sedentary people.

OBJECTIVE

To compare measurements of scapular mobility obtained using the lateral scapular slide test between volleyball players and sedentary participants without shoulder impairments and to compare changes in scapular mobility in players according to the number of years of sport participation.

DESIGN

Randomized controlled clinical trial.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 121 people at a single university volunteered. Of these, 67 were sedentary (age = 24.3 ± 2.34 years, height = 1.69 ± 0.09 m, mass = 65.1 ± 11.91 kg); 54 were volleyball players from 4 professional teams and were separated into 2 groups according to their years of sport participation. The first group was named young players (n = 31; age = 17.7 ± 2.58 years, height = 1.83 ± 0.10 m, mass = 68.3 ± 12.21 kg, sport participation ≤ 9 years), and the second group was named old players (n = 23; age = 26.9 ± 3.39 years, height = 1.95 ± 4.38 m, mass = 90.7 ± 5.75 kg, sport participation ≥ 10 years).

MAIN OUTCOME MEASURE(S)

Study participants completed a rating scale for pain and a questionnaire about demographic and shoulder problems. One assessor performed the lateral scapular slide test and additional flexibility measurements around the shoulder girdle. Flexibility (external rotation, internal rotation) and scapular position (1, 2, 3) were compared among groups (young players, old players, sedentary people) and between sides (dominant, nondominant).

RESULTS

In sedentary participants, we found differences for position 1 (t(66) = 3.327, P = .002), position 2 (t(66) = 2.491, P = .004), position 3 (t(66) = 2.512, P = .006), and internal rotation (t(66) = 2.592, P = .001) between the dominant and nondominant sides. In old players, we found differences for position 2 between the dominant and nondominant sides (t(22) = 2.956, P = .004). For position 2 (F(2,118) = 4.265, P = .02) and position 3 (F(2,118) = 4.702, P = .01), we found differences between young and old players. For internal rotation, we found differences between sedentary and old players (F(2,118) = 6.578, P = .002) and between young and old players (F(2,118) = 3.723, P = .01).

CONCLUSIONS

Clinicians evaluating overhead athletes need to remember that asymmetric scapular posture between the dominant and nondominant sides in unilateral overhead athletes might be normal and not necessarily related to injury.

Scapular dyskinesis in trapezius myalgia and intraexaminer reproducibility of clinical tests

The aims were to test the intraexaminer reproducibility and report the presence of specific clinical variables of scapular dyskinesis in cases with trapezius myalgia and healthy controls, along with general health and work ability. A total of 38 cases and 23 controls were tested for scapular dyskinesis, general health, and work ability, and 19 cases and 14 controls participated in the reproducibility study. Intraexaminer reproducibility was good to excellent for 6 of 10 clinical variables (Intraclass Correlation Coefficient [ICC] 0.76-0.91; kappa 0.84-1.00), and fair to good for four variables (ICC 0.42-0.74), test for muscular weakness having the lowest ICC (0.42). Cases showed significantly larger medial border misalignment, larger lower horizontal distance of the inferior scapular angle and larger passive shoulder internal rotation, by 110% (1.02 cm), 15% (1.38 cm), and 8% (5.5°), respectively. Cases with the highest degree of scapular dyskinesis showed reduced work ability and general health. The present specific clinical variables on scapular dyskinesis showed satisfactory intraexaminer reproducibility. An increased standardization must be implemented to increase reproducibility of tests for muscular weakness, and the interexaminer reproducibility must be tested for all variables. Finally, scapular dyskinesis in cases with trapezius myalgia must be followed longitudinally for clinical importance.