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Introduction: In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. Materials and methods: A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. Results: The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). Conclusions: NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement. [ABSTRACT FROM AUTHOR]

Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement units (M-IMUs) represent a valid alternative for applications in unstructured environments. The aim of this systematic literature review is to report and describe the existing methods to estimate 3D scapular movements through wearable systems integrating M-IMUs. A comprehensive search of PubMed, IEEE Xplore, and Web of Science was performed, and results were included up to May 2023. A total of 14 articles was included. The results showed high heterogeneity among studies regarding calibration procedures, tasks executed, and the population. Two different techniques were described, i.e., with the x-axis aligned with the cranial edge of the scapular spine or positioned on the flat surface of the acromion with the x-axis perpendicular to the scapular spine. Sensor placement affected the scapular motion and, also, the kinematic output. Further studies should be conducted to establish a universal protocol that reduces the variability among studies. Establishing a protocol that can be carried out without difficulty or pain by patients with shoulder musculoskeletal disorders could be of great clinical relevance for patients and clinicians to monitor 3D scapular kinematics in unstructured settings or during common clinical practice. [ABSTRACT FROM AUTHOR]

Shoulder pain is one the most common musculoskeletal complaints. The most common pathological causes of shoulder pain in the general population are subacromial impingement syndrome and adhesive capsulitis, commonly referred to as "frozen shoulder". The purpose of this study was to evaluate the role of the scapulo-thoracic complex, particularly in scapular kinematic functions, in rehabilitative interventions for shoulder pain in patients suffering from these two common conditions. This systematic review was performed using the scientific search engines PubMed, PEDro and Cochrane Library, considering only randomized controlled clinical trials. Selected articles were evaluated according to the level of evidence and methodological quality. Thirteen randomized clinical trials were selected. Interventions have been divided into three macro-categories: (1) manual therapy in patients with subacromial impingement, (2) therapeutic exercise programs including interventions on the scapulothoracic complex in patients with subacromial impingement syndrome, and (3) therapeutic exercise programs including interventions on the scapulothoracic complex in patients with frozen shoulder. Following this, a qualitative analysis was performed according to outcomes such as pain, shoulder function, and scapular kinematics. Physiotherapy exercise programs that included scapular motor control training and scapular mobilizations, in particular, those of the scapulo-thoracic complex in scapular kinematic function, represent valid alternatives in the management of patients with subacromial impingement syndrome. [ABSTRACT FROM AUTHOR]

Understanding scapular motion during everyday tasks is essential for adequate return-to-work and intervention programming, yet most scapular assessments involve restricted motion analysis within a laboratory setting. Inertial measurement units (IMUs) have been used to track scapular motion, but their validity compared to "gold standard" optical motion capture is not well defined. Further, it is unclear how different IMU sensor placements could affect scapular kinematic outcomes during a functional task protocol. To assess the reliability of scapular motion measurements with the use of the "gold standard" optical motion capture and IMUs, and to compare scapular IMU placement to assess which location (acromion or spine) was best for reliability of scapular motion, participants completed two testing sessions. During each lab visit, participant torso, humeri, and scapulae motion was tracked during 3 trials of 8 dynamic tasks and two elevation movements. Scapular angles were extracted during each task. To assess intra-session reliability, intra-class correlation coefficients (ICCs), and root mean square errors (RMSEs) were calculated. Results showed ICCs and RMSEs were acceptable. Although there appeared offsets between the two motion capture system scapular kinematics outcomes based on the plotted waveforms, the movement patterns appeared consistent between both motion capture methods. Data also showed that acromion IMU placement produced slightly more reliable outcomes than placement on the spine. Two placements of scapular tracking IMUs were tested with identical procedures. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the effects of scapular stabilization exercise with and without cognitive functional therapy (CFT) on disability and scapular kinematics in people suffering from chronic neck pain. Methods: A total of 72 patients with chronic non-specific neck pain were randomized into scapular stabilization exercise alone, n = 24, combined (scapular stabilization exercise + CFT), n = 24, and a control group, n = 24. Scapular kinematic and disability were measured at baseline and after the intervention. Results: Statistically significant differences in neck pain and disability scale (NPAD) were found when the multimodal physiotherapy group including a cognitive functional approach was compared with stabilization exercises group at 6 weeks (effect size (95%CI) = –1.63 (–2.55, –.71); P = 0.019)). Regarding the neck disability index (NDI), a significant between-group difference was observed at six-week (effect size (95%CI) = –2.69 (–3.80, –1.58); P = 0.007), with the superiority of effect in multimodal physiotherapy group. A significant between-group difference was observed in the scapular upward rotation and scapular osterior tilt at 30°, 60°, 90° and 120° of shoulder adduction. Conclusions: A group-based multimodal rehabilitation program including scapular stabilization exercise plus cognitive functional therapy was superior to group-based stabilization exercises alone for decreasing disability and, improving scapular kinematic in patients with chronic neck pain. [ABSTRACT FROM AUTHOR]

Postural asymmetry due to the alterations in scapular posture is typically considered to be associated with injury. Pectoralis minor (PM) has played a crucial role in scapular posture, but limited knowledge exists that shows the possible effect of PM length on static scapular positioning in adolescents. The aim of this study was to investigate the association between static scapular positioning and two different PM length measurements in adolescents. Pearson rank test demonstrated that direct measurements of the PM length significantly and strongly inversely correlated to scapular anterior tilting (p =.01; r = −.592)and significantly and moderately inversely correlated to scapular internal rotation (p =.013; r = −.465) and scapular downward rotation (p =.028; r = −.416). However, indirect measurement of the PM length was not related to scapular posture. No significant correlation was found between direct and indirect PM length measurements. Direct measurement of PM length presents more information regarding alterations of the static scapular positioning. [ABSTRACT FROM AUTHOR]

To characterize the scapular pitching biomechanics in symptomatic GIRD pitchers (SG) compared to asymptomatic GIRD (ASG) and healthy pitchers. The scapular kinematics and associated muscle activities during pitching were recorded in 33 high school pitchers. Compared to healthy, GIRD pitchers had less scapular posterior tilt in each pitching event (average difference, AD=14.4°, p<0.01) and ASG demonstrated less scapular upward rotation at ball release (AD=12.8°, p<0.01) and greater muscle activity in the triceps brachii in the early-cocking phase (AD=9.9%, p=0.015) and in the serratus anterior in the late-cocking phase (AD=30.8%, p<0.01). Additionally, SG had less muscular activity on triceps brachii in the acceleration phase and serratus anterior in the cocking phase (AD=37.8%, p=0.016; AD=15.5%, p<0.01, respectively) compared to ASG. GIRD pitchers exhibited less scapular posterior tilt during pitching, which may cause impingement. Since tightness of the anterior shoulder is a common cause of inadequacy of posterior tilt during arm elevation, stretching exercise of the anterior shoulder is recommended. Given the inadequate recruitment during pitching in the GIRD pitchers, symptoms may develop following potential impingement. [ABSTRACT FROM AUTHOR]

Videogrammetry is commonly used to record upper limb motions. However, it cannot track the glenohumeral joint center (GH). GH is required to reconstruct upper limb motions. Therefore, it is often estimated by separately measuring scapular motions using scapular kinematics measurements devices (SKMD). Applications of SKMD are neither straightforward nor always noninvasive. Therefore, this work investigates the feasibility of an alternative method to estimate GH from videogrammetry using a CT/MRI image of subject's glenohumeral joint and without requiring SKMD. In order to evaluate the method's accuracy, its GH estimations were compared to reference GH trajectories. The method was also applied to estimate scapular configurations and reconstruct an abduction motion measured by videogrammetry. The accuracy of GH estimations were within 5 mm, and the reconstructed motion was in good agreement with reported in vivo measurements. [ABSTRACT FROM AUTHOR]

Background and Objectives: One of the abnormal forms of scapular malalignment is the scapular downward rotation defect, which includes depression, protraction, and anterior scapula tilt, which potentially reduces the upper rotation and posterior tilting of the scapula. Therefore, the aim of this study was to determine the effect of six weeks of corrective exercises on the kinematics of the scapula in males with scapular downward rotation defect. Materials and Methods: This randomized clinical trial was performed in the Faculty of Physical Education of Kharazmi University in 2019, Iran. Twenty-four eligible patients were selected and randomly divided into two equal groups of 12, corrective exercises and control group. The control group did not receive any specific treatment during the study. The scapular upward rotation and scapular posterior tilt were measured in the same way before and after the corrective exercises in the intervention group by Noraaxon's MyoMotion 3D device. Data were analyzed using twoway repeated measures ANOVA and paired t-test. Results: A significant increase was observed in scapular upward rotation in the angles of 30º (p=0.038), 60º (p<0.001), 90º (p<0.001) and 120º (p<0.001), and in scapular posterior tilt in the angles of 30º (p<0.001), 60º (p< 0.001), 90º (p<0.001) and 120º (p<0.001) after applying the exercise intervention in the intervention group compared to the control group. Conclusion: The results showed that the intervention of scapular correction exercises improves the angles of scapular upward rotation and scapular posterior tilt in people with scapular downward rotation defect. [ABSTRACT FROM AUTHOR]

Background: During nonoperative or postoperative rehabilitation after sports injuries, exercise selection is often based on minimal load on the injured/repaired glenohumeral structures, while optimally activating scapulothoracic muscles. Previous research explored scapular muscle activity during rehabilitation exercises using surface electromyography (EMG). However, limited information exists about the deeper lying muscle activity, measured with fine-wire electrodes, even more in combination with 3-dimensional scapular kinematics. Purpose: To report scapular kinematics synchronously with surface and fine-wire EMG during specific shoulder exercises for early rehabilitation. Study Design: Descriptive laboratory study. Methods: A total of 23 healthy male patients were recruited. Three-dimensional scapular kinematics were measured combined with EMG recording of 8 muscles during 4 commonly used shoulder exercises (inferior glide, low row, lawnmower, and robbery). Upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior muscle activities were measured with bipolar surface electrodes. Intramuscular electrodes were placed in the levator scapulae (LS), rhomboid major (RM), pectoralis minor (Pm), and infraspinatus (IS) muscles. All data were normalized as a percentage of maximal voluntary isometric contraction (%MVIC). A linear mixed model with Bonferroni correction was applied for statistical analysis. Results: Scapular kinematics revealed an anterior tilt position during the inferior glide, low row, and robbery (P <.05). An upward rotation position between 20° and 30° was reached in all exercises except low row. Inferior glide (31°) and low row (42°) represented a significantly increased internal rotation position compared with lawnmower and robbery. Lawnmower and robbery showed significantly (P <.05) more MT (lawnmower, 36% MVIC; robbery, 39% MVIC) and RM (lawnmower, 59% MVIC; robbery, 66% MVIC) activation compared with inferior glide and low row. Lawnmower and robbery showed significantly (P <.05) less Pm activation (9.5%-12% MVIC). LS was significantly more active during robbery (58% MVIC) compared with inferior glide and low row (27%-36% MVIC) (P <.05). IS showed moderate activity (24%-37% MVIC) for all exercises, except low row (13% MVIC). Conclusion/Clinical Relevance: This study provides new insights about scapular positions and activation of the deeper layer muscles during 4 commonly used shoulder rehabilitation exercises. The lawnmower showed a favorable position of the scapula with less Pm activity in contrast to the low row. The inferior glide, lawnmower, and robbery should not be implemented in early phases of shoulder rehabilitation because of their moderate muscle activity. [ABSTRACT FROM AUTHOR]

Context: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. Objective: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Design: Randomized controlled clinical trial. Setting: Research laboratory. Patients or Other Participants: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Main Outcome Measure(s): Three-dimensional kinematics and EMG were recorded before and after feedback training. Results: Lower trapezius muscle activity increased (4.2%- 18%, P, .011) and UT/LT decreased (0.56-1.17, P, .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.38, P = .024). Conclusions: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. Trial Registration Number: ClinicalTrials.gov: NCT03252444. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of a scapular exercise programme in addition to a physical therapy treatment in patients with distal radius fracture. Design: A single-blinded randomized controlled trial was conducted. Setting: Clinical Hospital San Borja Arriaran, Santiago, Chile. Participants: A total of 102 patients above 60 years of age with extra-articular distal radius fracture were randomly divided into two groups. Interventions: The control group (n = 51) received a six-week physical therapy treatment; the intervention group (n = 51) received the same treatment plus a scapular exercise programme. Outcome measures: The two groups were assessed at baseline and after the six-week treatment. The arm function was assessed with the disabilities of the arm, shoulder and hand (DASH) questionnaire; secondary outcomes were measured by the patient-rated wrist evaluation (PRWE) questionnaire and visual analogue scale (VAS). Results: A total of 102 patients, 51 in the control group (40 women; mean age of 65.3 ± 4.8 years) and 51 in the intervention group (42 women; mean age of 67.2 ± 5.4 years), were analysed. At the end of the treatment, the difference between groups for the DASH was 16.7 points (P < 0.001), 1.5 points (P = 0.541) for the PRWE, 0.2 cm (P = 0.484) for the VAS at rest, and 1.7 cm (P < 0.001) for the VAS at movement. All differences were in favour of the intervention group. Conclusion: In the short term, adding a scapular exercise programme provides a significant clinical benefit in arm function and pain relief with movement in patients above 60 years of age with extra-articular distal radius fracture treated conservatively. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the effects of scapular taping on scapular kinematics by three-dimensional electromagnetic system during shoulder elevation in facioscapulohumeral muscular dystrophy patients. A total of 11 patients with facioscapulohumeral muscular dystrophy were included in the study. Scapular anterior-posterior tilt, upward-downward rotation, and internal-external rotations were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane before and after kinesio taping. For maximum humerothoracic elevation, there were no differences between the patients before and after taping on both dominant (p = 0.72) and non-dominant sides (p = 0.64). For scapular internal rotation, upward rotation, and posterior tilt, there were no differences between patients before and after taping during humerothoracic elevation on both dominant and non-dominant sides (p > 0.05). These results showed us that the excessive and abnormal movements of the scapula observed during the humeral elevation in facioscapulohumeral muscular dystrophy patients cannot be supported with flexible methods like kinesio taping. Therefore, we recommend to evaluate the scapula position by applying flexible and rigid taping to the patients who can reach over 90o in humerothoracic elevation in future studies. [ABSTRACT FROM AUTHOR]

Purpose: Acromioclavicular-coracoclavicular ligament injury occurs frequently, and the clavicle hook plate technique is an easy-to-use treatment method. However, complications such as subacromial impingement syndrome, synovitis, erosion, osteolysis, post-operative pain, and post-operative limitations in range of motion have been reported. We aimed to evaluate the use of the clavicle hook plate in the shoulder joints and to compare in vivo three-dimensional (3D) scapular kinematics and scapulohumeral rhythm between the shoulders with a clavicle hook plate and contralateral normal shoulder joints.Methods: Ten male patients (aged 40.5 ± 14.4 years) who underwent clavicle hook plate fixation for an acromioclavicular-coracoclavicular ligament injury were selected. Computed tomography and fluoroscopy were conducted on both the shoulder joints, and 3D models were created. Using a 3D-2D model-image registration technique, we determined the 3D coordinates of the scapula, and we measured the scapular kinematics and scapulohumeral rhythm.Results: The values for upward rotation, posterior tilt, and external rotation in the two groups increased in proportion with humeral elevation, showing significant differences between the two groups (p < 0.05). Overall, the value in the clavicle hook plate group (group H) was smaller than that in the control group (group C) by 23.5% (6.7°) of upward rotation and 64.8% (18.9°) of posterior tilt. However, the external rotation in group H was greater than that in group C by 32.3% (2.3°). In overall value, there was a significant difference not in upward rotation and external rotation, but in posterior tilt. During humeral elevation, the overall changes in scapulohumeral rhythm were 4.65 ± 2.45 in group H and 3.8 ± 0.8 in group C, and statistical differences were not detected between the two groups.Conclusions: Clavicle hook plate fixation changes the scapular kinematics and scapulohumeral rhythm; thus, when clavicle hook plate fixation is complete, the implant should be promptly removed. [ABSTRACT FROM AUTHOR]

Context: Empirical data for treating forward shoulder posture supports stretching the anterior shoulder musculature. Although muscle-energy techniques (METs) have been hypothesized to lengthen muscle, no data have described the usefulness of this technique among swimmers. Objective: To determine if an MET provides improvements in resting pectoralis minor length (PML), forward scapular position, and scapular upward rotation in female collegiate swimmers. Design: Controlled laboratory study. Setting: Athletic training room. Patients or Other Participants: Thirty-nine asymptomatic National Collegiate Athletic Association Division I women's swimmers (19 experimental, 20 control). Intervention(s): The experimental group received 2 treatment sessions per week for 6 weeks. The control group received no intervention during this 6-week period. Main Outcome Measure(s): We administered pretest and posttest measurements for PML, forward scapular position, and scapular upward rotation in positions of rest and 60°, 90°, and 120° of humeral elevation. The MET consisted of a 3-second stretch in the direction of the pectoralis minor fibers, followed by a 5-second isometric horizontal adduction contraction at 25% of maximum force. Immediately after this contraction, the entire sequence was repeated with the muscle being stretched to the new endpoint. A total of 4 cycles of MET were continuously applied per treatment session twice per week for 6 weeks. We conducted 1-way analyses of covariance to determine any between-groups postintervention test differences. Results: The MET group had a greater increase in PML postintervention (P = .001, effect size = 1.6) and a greater decrease in forward scapular position postintervention (P=.001, effect size = 1.07) compared with the control group. No differences were found for scapular upward rotation (P > .10). Conclusions: Our results indicate that 6 weeks of MET treatments applied to the pectoralis minor of asymptomatic female swimmers provided improvements in PML and forward scapular position compared with a control group. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses the accuracy of single calibration (SC) and double calibration (DC) comparing to the skinmarker-based methods to a scapula palpation procedure. The study used acromion marker method, two-way analysis of variance, and infrared cameras. Results showed that on the two-way analysis of variance, DC measurements were not different from palpation for five axes of rotation, while SC showed differences for five axes.