Scapular Muscle Tests in Subjects With Shoulder Pain and Functional Loss: Reliability and Construct Validity (original) (raw)
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Intrarater and interrater reliability of three isometric dynamometers in assessing shoulder strength
Journal of Shoulder and Elbow Surgery, 1996
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.
Shoulder Dysfunction Assessment: Self-report and Impaired Scapular Movements
Physical therapy, 2006
Background and Purpose. Shoulder dysfunction is common in various patient populations. This investigation was performed to assess shoulder dysfunction with self-report and performance-based functional measures. Subjects. Fifty men (25 with shoulder dysfunction and 25 without shoulder dysfunction) participated in this study. Methods. Self-report functional disabilities were assessed with the Flexilevel Scale of Shoulder Function (FLEX-SF), and electromagnetic tracking sensors were used to monitor 3-dimensional scapular movements during 4 functional tasks. Results. Relative to the control group, the group with shoulder dysfunction showed significant alterations in scapular movements (averages of 6.9°less posterior tipping, 5.7°less upward rotation, and 2.3 cm more elevation). Scapular kinematics correlated significantly (r) with the Self-report FLEX-SF measure during functional tasks (posterior tippingϭ.454 to .712, upward rotationϭ.296 and .317, and elevationϭϪ.310). Discussion and Conclusion. Functional disabilities were identified with self-report and performance-based functional measures. The inadequate scapular posterior tipping and scapular upward rotation as well as the excessive elevation may have implications in planning intervention strategies for people with shoulder dysfunction. [Lin J, Hanten WP, Olson SL, et al. Shoulder dysfunction assessment: self-report and impaired scapular movements.
Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength
Manual Therapy, 2011
Acceptable reliability is a prerequisite for inclusion of physical examination tests in clinical examinations of the painful shoulder. The aim of this study was to establish the intraexaminer and interexaminer reliability of measures of shoulder range of motion (ROM) and muscle force using a new hand-held dynamometer with the ability to standardize overpressure force during passive ROM tests. Forty consecutive subjects with shoulder pain were recruited, and tests were performed by two physiotherapists. Tests included active ROM elevation, passive ROM glenohumeral abduction and external rotation and resisted abduction and external rotation. All tests demonstrated high levels of intraexaminer reliability (ICC 0.85e0.99; LOA 6e24 and 1.1e7.0 kg). Highest levels of interexaminer reliability reliability were observed for measures of active ROM flexion (ICC 0.88e0.95; LOA 14e22 ). Passive ROM tests demonstrated 'moderate e substantial' interexaminer reliability (ICC 0.45e0.62; LOA 25e34 ). The ICCs for resisted tests ranged from 0.68 to 0.84, and LOA ranged from 3.2 to 8.5 kg. Active ROM flexion demonstrated high levels of both intra-and interexaminer reliability. Measures of passive ROM and peak isometric force demonstrated acceptable levels of intraexaminer reliability.
The Prediction of Disability to Scapular Training in Patients with Shoulder Impingement Syndrome
Egyptian Journal of Applied Science, 2021
Study design: prospective clinical trial study Background: People with shoulder impingement syndrome (SIS) present alterations in the scapular kinematics 'scapular dyskinesis' when compared with asymptomatic individuals. Those patients consistently report disability, especially during overhead activities, which might hinder activities of daily living and for some sports movements. Objectives: To investigate if the disability can predict patient's response to scapular training. Methods: Forty-five patients between 18-45 years old, their mean age (32.56±2.85) years and their mean body mass index (BMI) (29±6) kg/m², suffering from subacromial impingement syndrome assessed by Shoulder Pain and Disability Index (SPADI) before and after exercise program of scapular muscle training (Cools exercises), serratus anterior strength (supine punch) and scapular stabilization exercises for one month. Results: The Area under curve (AUC) showed excellent results with disability percent 0.94(sensitivity 0.956, specificity 0.156). Conclusion: disability is a predictor of treatment success in patients suffering from subacromial impingement syndrome treated with scapular training.
Journal of athletic training
Alterations in scapular muscle activation, which are common with glenohumeral (GH) injuries, affect stability and function. Rehabilitation aims to reestablish activation between muscles for stability by progressing to whole-body movements. To determine scapular muscle-activation ratios and individual muscle activity (upper trapezius [UT], middle trapezius [MT], lower trapezius [LT], serratus anterior [SA]) differences between participants with GH injuries and healthy control participants during functional rehabilitation exercises. Cross-sectional study. Laboratory. Thirty-nine participants who had GH injuries (n = 20; age = 23.6 ± 3.2 years, height = 170.7 ± 11.5 cm, mass = 74.7 ± 13.1 kg) or were healthy (n = 19; age = 24.4 ± 3.3 years, height = 173.6 ± 8.6 cm, mass = 74.7 ± 14.8 kg) were tested. Clinical examination confirmed each participant's classification as GH injury or healthy control. Participants performed 4 exercises (bow and arrow, external rotation with scapular squ...
Assessment of scapular position in patients suffering from shoulder dysfunction
Journal of Physical Activity and Health, 2016
Shoulder dysfunction inhibits 80% of competitive swimmers from performing optimally. The most common contributing factor to shoulder dysfunction is an altered scapula position. A standard for the distance between T4 and the medial border of the scapula is lacking. Measurements of the distance between T4 and the root of the scapula were made and the relationship of the distance and the function of trapezius middle fibres at resting length was tested. A Vernier caliper ® (ICC 0.94) was used to measure the distance from T4 to the medial border of the scapula. Exercises and stretches to retrain and strengthen the middle fibres of the trapezius specifically were performed twice a week, scheduled around the swimmers’ regular training and strengthening sessions, for six weeks. The results showed that palpation of the scapula to measure the distance between T4 and the spinal root is reliable and valid. A normalisation index should be used to adjust for body build and posture. Furthermore, ...
Archives of Physical Medicine and Rehabilitation, 2010
Scapular muscle activity in overhead athletes with symptoms of secondary shoulder impingement during closed chain exercises. Arch Phys Med Rehabil 2010;91: 550-6. Objective: To determine the amount of muscle activation in 4 scapular muscles in overhead athletes with and without a history of secondary shoulder impingement, during 3 upper extremity closed chain exercises. Design: One-between (group), one-within (exercise) repeated measures. Setting: Controlled laboratory study. Participants: Overhead athletes (nϭ15; mean age Ϯ SD, 21.0Ϯ2.5y; mean height Ϯ SD, 176.0Ϯ7.8cm; mean weight Ϯ SD, 76.1Ϯ13.4kg) demonstrating with symptoms of shoulder impingement and overhead athletes (nϭ15; mean age Ϯ SD, 20.4Ϯ3.8y; mean height Ϯ SD, 174.1Ϯ9.7cm; mean weight Ϯ SD, 73.3Ϯ11.7kg) with no shoulder pathologies. Interventions: Subjects completed 5 individual trials of a standard push-up, a push-up on an unstable surface, and a revolution on a shoulder rehabilitation device while electromyography (EMG) recorded muscle activity of the serratus anterior, upper trapezius, middle trapezius, and lower trapezius. Main Outcome Measures: The mean EMG data for the 4 muscles from the standard push-up, push-up on an unstable surface, and shoulder rehabilitation device trials were normalized as a percentage of a maximum voluntary isometric contraction for each muscle. Results: There was a statistically significant interaction for the middle trapezius (F 2,56 ϭ3.856; Pϭ.027). The shoulder impingement push-up on an unstable surface (33.76%Ϯ26.45%) had significantly greater activation compared with the shoulder impingement standard push-up (25.88%Ϯ13.76%), the shoulder impingement shoulder rehabilitation device (9.40%Ϯ5.86%), and the nonpathology push-up on an unstable surface (19.49%Ϯ 7.73%). The shoulder impingement standard push-up had significantly greater activation compared with the shoulder impingement shoulder rehabilitation device and nonpathology standard push-up (17.99%Ϯ7.31%). The nonpathology standard push-up and nonpathology push-up on an unstable surface had significantly greater activation compared with the nonpathology shoulder rehabilitation device (7.95%Ϯ4.30%). Conclusions: These results suggest that the muscle activation of the middle trapezius differs in overhead athletes with a history of secondary shoulder impingement compared with those who lack this history during closed chain exercise, as well as within the 3 closed chain exercises. The levels of muscle activation of the serratus anterior and upper trapezius during these closed chain exercises were similar between the 2 groups. These results support the use of closed chain exercises in the rehabilitation process of overhead athletes with secondary shoulder impingement. However, clinicians should consider the muscle(s) of interest when selecting an exercise.
Scapular Muscle Activity from Selected Strengthening Exercises Performed at Low and High Intensities
Journal of Strength and Conditioning Research, 2012
Andersen, CH, Zebis, MK, Saervoll, C, Sundstrup, E, Jakobsen, MD, Sjøgaard, G, and Andersen, LL. Scapular muscle activity from selected strengthening exercises performed at low and high intensity. J Strength Cond Res 26(9): 2408-2416, 2012-A balanced level of muscle strength between the different parts of the scapular muscles is important in optimizing performance and preventing injuries in athletes. Emerging evidence suggests that many athletes lack balanced strength in the scapular muscles. Evidence-based recommendations are important for proper exercise prescription. This study determines scapular muscle activity during strengthening exercises for scapular muscles performed at low and high intensities (Borg CR10 levels 3 and 8). Surface electromyography (EMG) from selected scapular muscles was recorded during 7 strengthening exercises and expressed as a percentage of the maximal EMG. Seventeen women (aged 24-55 years) without serious disorders participated. Several of the investigated exercisespress-up, prone flexion, one-arm row, and prone abduction at Borg 3 and press-up, push-up plus, and one-arm row at Borg 8-predominantly activated the lower trapezius over the upper trapezius (activation difference [D] 13-30%). Likewise, several of the exercises-push-up plus, shoulder press, and press-up at Borg 3 and 8-predominantly activated the serratus anterior over the upper trapezius (D18-45%). The middle trapezius was activated over the upper trapezius by one-arm row and prone abduction (D21-30%). Although shoulder press and push-up plus activated the serratus anterior over the lower trapezius (D22-33%), the opposite was true for prone flexion, one-arm row, and prone abduction (D16-54%). Only the press-up and push-up plus activated both the lower trapezius and the serratus anterior over the upper trapezius. In conclusion, several of the investigated exercises both at low and high intensities predominantly activated the serratus anterior and lower and middle trapezius, respectively, over the upper trapezius. These findings have important practical implications for exercise prescription for optimal shoulder function. For example, both workers with neck pain and athletes at risk of shoulder impingement (e.g., overhead sports) should perform push-up plus and press-ups to specifically strengthen the serratus anterior and lower trapezius. *MT = middle trapezius; UT = upper trapezius; LT = lower trapezius. †Values are expressed as mean (95% confidence interval). Significance levels are indicated in bold.