Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review (original) (raw)
Purpose: Altered kinematics of the scapula or scapular dyskinesis (downward rotation, anterior tilt, and protraction) contribute to impingement syndrome by decreasing the subacromial space. Given the critical role of scapular position and movement in the function of the shoulder, the aim of this study was to compare scapular position and dyskinesis in individuals with and without rounded shoulder posture. Methods: By employing the convenience sampling method, 21 individuals with rounded shoulder posture (11 females and 10 males; average age: 22.95 years) and 23 individuals without rounded shoulder posture (13 females and 10 males; average age: 22.43 years) were enrolled in this study through a case-control design.The scapular dyskinesis test was used to observe alterations in scapulohumeral rhythm in the sagittal and frontal planes of the arm. Also, the scapular position was examined according to the Kibler test. Data were analyzed using SPSS 21. We used the Independent t-test and Mann-Whitney test to compare the differences between the two groups. Results: There were no differences in scapular dyskinesis between the two groups (P>0.05). The prevalence of subtle or obvious scapular dyskinesis in individuals with rounded shoulder posture was greater than those without rounded shoulder posture, but the difference was not statistically significant. Furthermore, no significant difference was found in static scapular position (Kibler test) of the dominant and non-dominant sides between the two groups (P>0.05). Conclusion: There were no significant differences in scapular position and scapular movement pattern between the individuals with and without rounded shoulder posture.
Manual Therapy, 2011
Introduction: The scapular muscular system is the major determinant of scapular positioning. In addition, strength and muscular endurance develops from childhood through adolescence. It is not known whether differences in scapular positioning and motor control between adults and children may exist. Methods: Ninety-two shoulders of 46 adults (mean ¼ 39.4; 18e86 years; SD ¼ 22.5), and 116 shoulders of 59 children (mean ¼ 11.6; 6e17 years; SD ¼ 3.5), were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic Medial Rotation Test (KMRT). Results: The observation protocol for scapular winging and tilting did not show significant differences between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm (0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward rotation (18.6 ; SD 9.6 ) than adults (14.5 ; SD 10.9 ) at 90 shoulder abduction. No significant differences were seen between children (19% positive test) and adults (24% positive test) using the KMRT. Conclusion: Children and adults show significant but small differences in scapular upward rotation and forward shoulder posture. These data provide useful reference values using a clinical protocol.
Clinical assessment of the scapula: a review of the literature
British Journal of Sports Medicine, 2012
Scientific evidence supporting a role for faulty scapular positioning in patients with various shoulder disorders is cumulating. Clinicians who manage patients with shoulder pain and athletes at risk of developing shoulder pain need to have the skills to assess static and dynamic scapular positioning and dynamic control. Several methods for the assessment of scapular positioning are described in scientific literature. However, the majority uses expensive and specialised equipment (laboratory methods), making their use in clinical practice nearly impossible. On the basis of biometric and kinematic studies, guidelines for interpreting the observation of static and dynamic scapular positioning pattern in patients with shoulder pain are provided. At this point, clinicians can use reliable clinical tests for the assessment of both static and dynamic scapular positioning in patients with shoulder pain. However, this review also provides clinicians several possible pitfalls when performing clinical scapular evaluation. On the basis of its clinical relevance, its proven reliability, its relation to body length and its applicability in a clinical setting, this review recommends to assess the scapula both static (visual observation and acromial distance or Baylor/double square method for shoulder protraction) and semidynamic (visual observation and inclinometry for scapular upward rotation). In addition, when the patient demonstrates with shoulder impingement symptoms, the scapular repositioning test and scapular assistant test are recommended for relating the patients' symptoms to the position or movement of the scapula.
Medical Journal of the Islamic Republic of Iran, 2014
Background: Dysfunction in the kinetic chain caused by poor scapula stabilization can contribute to shoulder injuries and Shoulder Impingement Syndrome (SIS). The purpose of this study was to compare the effectiveness of two treatment approaches scapular stabilization based exercise therapy and physical therapy in patients with SIS. Methods: The study is a randomized clinical trial in which 68 patients with SIS were randomly assigned in two groups of exercise therapy (ET) and physical therapy (PT) and received 18 sessions of treatment. Pain, shoulders' range of abduction and external rotation, shoulder protraction, scapular rotation and symmetry as well as postural assessment and Pectoralis minor length were evaluated pre and post intervention. The paired-sample t test and the independent sample t test were applied respectively to determine the differences in each group and between two groups. Results: Our findings indicated significant differences in abduction and external rotation range, improvement of forward shoulder translation and increase in the flexibility of the involved shoulder between the two groups (respectively ; p=0.024, p=0.001, p<0/0001, p<0/0001). No significant difference was detected in pain reduction between the groups (p=0.576). Protraction of the shoulder (p<0.0001), forward head posture (p<0/0001) and mid thoracic curvature (p<0.0001) revealed a significant improvement in the ET group. Apparent changes occurred in scapular rotation and symmetry in both groups but no significant differences were observed between the two groups (respectively; p=0.183, p=0.578). Conclusion: The scapular stabilization based exercise intervention was successful in increasing shoulder range, decreasing forward head and shoulder postures and Pectoralis minor flexibility.
Journal of Orthopaedic & Sports Physical Therapy, 2020
T he etiology of shoulder complaints is multifactorial. 56 Scapular dyskinesis is one factor frequently suggested to mechanically contribute to the onset and persistence of shoulder complaints. 3,16 Although debated, scapular dyskinesis generally encompasses a concept of scapular dysfunction that is reflected by aberrant scapular posture and movement patterns, such as scapular winging and asymmetry. 22 Such scapular movement and posture are believed to evoke circumstances where soft tissue structures in and around the shoulder joint are exposed to detrimental mechanical stress. 26,53 Assessing scapular movement and posture is therefore often part of the clinical-reasoning process of clinicians who manage shoulder pain. Assessments of scapular upward rotation and visual evaluation systems to assess scapular dyskinesis have been advocated as reliable and valid for clinical use. 12,24 However, we recently studied the reliability of these measures and found that the evidence was insufficient to recommend their use. 8 There is also growing evidence that common treatment programs that target scapular dyskinesis may have limited clinical U OBJECTIVE: To determine the construct validity, criterion validity, and responsiveness of measurement instruments evaluating scapular function. U DESIGN: Systematic review of measurement properties.
Archives of Physical Medicine and Rehabilitation, 2017
To investigate the effects of 2 different exercise programs on 3-dimensional scapular kinematics, disability, and pain in participants with subacromial impingement syndrome (SIS). Design: Randomized controlled trial. Setting: Outpatient clinic and research laboratory. Participants: Participants who were diagnosed with SIS and who also exhibited scapular dyskinesis (NZ30). Interventions: The participants were randomized in 2 different exercise groups: (1) shoulder girdle stretching and strengthening with additional scapular stabilization exercises based on a kinetic chain approach (intervention group), and (2) shoulder girdle stretching and strengthening exercises only (control group). Main Outcome Measures: Three-dimensional scapular kinematics, self-reported shoulder pain, and disability were evaluated at baseline, after 6 weeks of training, and after 12 weeks of training. Results: Significant differences were observed between the control and intervention groups in external rotation and posterior tilt after 6 weeks of training and in external rotation, posterior tilt, and upward rotation after 12 weeks of training. All groups showed improvement in self-reported pain and disability scores; however, there were no significant differences between the groups. Conclusions: Progressive exercise training independent from specific scapular stabilization exercises provides decreased disability and pain severity in impingement syndrome.
Measurement of scapula upward rotation: a reliable clinical procedure
British Journal of Sports Medicine, 2005
Background: It is important to deal with the scapula when developing rehabilitation strategies for the shoulder complex. This requires clinical measurement tools that are readily available and easy to apply and which provide a reliable evaluation of scapula motion. Aim: To determine the reliability of the Plurimeter-V gravity inclinometer for the measurement of scapular upward rotation positions during humeral elevation in coronal abduction in a group of patients with shoulder pathology. Method: Twenty six patients were assessed in two repeat tests within a single testing session. Patients exhibiting a wide spectrum of shoulder pathology were selected. The angle of scapular upward rotation was measured during total shoulder abduction. The measurement protocol was performed twice during a single testing session by a single tester. Results of the two tests were compared and the reliability assessed by intraclass correlation coefficients (ICCs). Results: There was no significant difference in the scapula measurements taken during the two tests at each testing position. Overall, there was very good intrarater reliability (ICC = 0.88). The ICC ranged from 0.81 (at 135˚) to 0.94 (at both resting and end of total shoulder abduction range). Conclusion: The Plurimeter-V gravity inclinometer can be used effectively and reliably for measuring upward rotation of the scapula in all ranges of shoulder abduction in the coronal plane.
Middle East Journal of Rehabilitation and Health Studies
Context: With a key role in normal shoulder function, scapular kinematics have been investigated in shoulder impingement syndrome (SIS). Objectives: This systematic review aimed at determining scapular kinematic patterns in patients with SIS compared to in asymptomatic individuals. Data Sources: Databases such as PubMed, Scopus, Web of Science, Ovid, Embase and PEDRO were searched from January 1995 to June 2021. Study Selection: Articles in English published in peer-reviewed journals and using motion analysis systems to compare scapular kinematics between patients with SIS and asymptomatic subjects during arm elevation were included. Data Extraction: A modified Downs and Black checklist was used to assess the risk of bias of the included studies. A random-effects model was employed to perform a meta-analysis. Results: Nine out of 1650 screened abstracts were included for data extraction. Scapular upward rotation significantly decreased during arm elevation in SIS (SMD = -0.13, 95% C...
Journal of Exercise Rehabilitation
Scapular stabilization approaches have been a mainstay of therapeutic training programs in the recent past for patients with subacromial impingement syndrome, whereas its contributions solely in the clinical outcome of reducing shoulder pain and disability are largely unclear. This systematic review aims to evaluate and summarize the best evidence regarding the role of scapular stabilization interventions in alleviating shoulder dysfunction among subjects with subacromial impingement syndrome. Six reviewers involved in this systematic review. Literature was retrieved systematically through searching 5 electronic databases (PubMed, MEDLINE, CINAHL, Cochrane, and Google Scholar). Articles published from the year 2010 up to and including 2019 were included. The literature search included clinical trials those intervened subjects with scapular exercises or scapular stabilization exercises or scapular rehabilitation, as an intervention for subacromial impingement syndrome. Seven studies, totaling 228 participants were included in this systematic review. Articles included in this review were graded ac-cording to Lloyd-Smith hierarchy of evidence scale and critically appraised with a tool developed by National, Heart, Lung and Blood Institute (United States), named as quality assessment of controlled intervention studies tool. There was a significant effect on the scapular stabilization exercise program on improving pain and disability among subjects with subacromial impingement syndrome. This systematic review provides sufficient evidence to suggest that scapular stabilization exercises offers effectiveness in reducing pain and disability among subjects with subacromial impingement syndrome. However, more trials with larger sample are needed to provide a more definitive evidence on the clinical outcomes of scapular stabilization exercises among patients with impingement.