Abstract
Study Design
Narrative Review.
Introduction
One of the shoulder pain disorders in which the function of the scapula is comprised
is the subacromial pain syndrome. Several rehabilitation guidelines and exercises
have been proposed to improve scapulothoracic muscle dysfunction. Consideration of
muscle activation patterns may help to select the most appropriate rehabilitation
exercise in these patients. To date, suggesting rehabilitation exercises is often
based upon the knowledge of the superficial lying scapulothoracic muscles’ activity.
In the assumption that the deeper lying scapulothoracic muscles’ activity may hinder
normal scapular movement in case of tightness or hyperactivity, exercise protocols
for patients with altered pattern in scapulothoracic muscles should also integrate
knowledge on the deeper lying scapulothoracic muscle activity.
Purpose of the Study
To help clinicians choosing the most appropriate exercise in patients with subacromial
pain syndrome related to scapulothoracic muscle dysfunction.
Methods
First, a summary of key alterations in scapulothoracic (muscle) function in patients
with subacromial pain was accomplished. Second, promising practical rehabilitation
strategies toward restoring scapulothoracic muscle dysfunction (with a focus on scapulothoracic
exercises) were developed, integrating current new research evidence (including information
about the deeper lying scapulothoracic muscles) with clinical practice.
Conclusion
This review details clinical exercises and their muscular activity to guide clinicians
to optimize individualized scapulothoracic training and treatment programs by selecting
the most appropriate exercise, based on knowledge from the clinical examination.
Level of Evidence
Level 5.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and correlates of shoulder pain and stiffness in a population-based study: the North West Adelaide Health Study.Int J Rheum Dis. 2010; 13: 215-222
- Motion of the shoulder complex during multiplanar humeral elevation.J Bone Joint Surg Am. 2009; 91: 378-389
- Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability.Scand J Med Sci Sports. 2011; 21: 352-358
- The association of scapular kinematics and glenohumeral joint pathologies.J Orthop Sports Phys Ther. 2009; 39: 90-104
- Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review.Br J Sports Med. 2014; 48: 1251-1256
- In vivo assessment of scapulohumeral rhythm during unconstrained overhead reaching in asymptomatic subjects.J Shoulder Elbow Surg. 2009; 18: 960-967
- Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo.J Shoulder Elbow Surg. 2001; 10: 269-277
- Comparative electromyographic analysis of shoulder muscles during planar motions: anterior glenohumeral instability versus normal.J Shoulder Elbow Surg. 1996; 5: 118-123
- Observations of the function of the shoulder joint. 1944.Clin Orthop Relat Res. 1996; : 3-12
- Scapular dyskinesis and its relation to shoulder pain.J Am Acad Orthop Surg. 2003; 11: 142-151
- Dynamic stability of the scapula.Man Ther. 1997; 2: 123-131
- Anatomy and actions of the trapezius muscle.Clin Biomech (Bristol, Avon). 1994; 9: 44-50
- Comparing the function of the upper and lower parts of the serratus anterior muscle using surface electromyography.J Orthop Sports Phys Ther. 2004; 34: 235-243
- Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement.Rev Bras Fisioter. 2009; 13: 1-9
- Kinesiology: The Mechanics and Pathomechanics of Human Movement.Lippincott Williams & Wilkins, Philadelphia, PA2004
- Shoulder muscle activity and function in common shoulder rehabilitation exercises.Sports Med. 2009; 39: 663-685
- Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?.Br J Sports Med. 2009; 43: 259-264
- Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology.Br J Sports Med. 2008; 42: 628-635
- Scapular kinematics and subacromial-impingement syndrome: a meta-analysis.J Sport Rehabil. 2012; 21: 354-370
- Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?.J Sports Sci. 2012; 30: 1767-1776
- Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study.Br J Sports Med. 2014; 48: 1327-1333
- Does scapular dyskinesis affect top rugby players during a game season?.J Shoulder Elbow Surg. 2012; 21: 709-714
- Scapular dysfunction in high school baseball players sustaining throwing-related upper extremity injury: a prospective study.J Shoulder Elbow Surg. 2013; 22: 1154-1159
- Does scapular positioning predict shoulder pain in recreational overhead athletes?.Int J Sports Med. 2014; 35: 75-82
- Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms.Br J Sports Med. 2004; 38: 64-68
- Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms.J Athl Train. 2005; 40: 104-110
- The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies.BMC Musculoskelet Disord. 2010; 11: 45
- Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability.J Electromyogr Kinesiol. 2014; 24: 277-284
- Scapulothoracic muscle activity during elevation exercises measured with surface and fine wire EMG: a comparative study between patients with subacromial impingement syndrome and healthy controls.Man Ther. 2016; 23: 33-39
- Scapular behavior in shoulder impingement syndrome.Arch Phys Med Rehabil. 2002; 83: 60-69
- Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement.J Orthop Sports Phys Ther. 1999; 29 (discussion 584–586): 574-583
- A cross-sectional study examining shoulder pain and disability in Division I female swimmers.J Sport Rehabil. 2014; 23: 65-75
- Risk factors for volleyball-related shoulder pain and dysfunction.PM R. 2010; 2: 27-36
- Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers.J Athl Train. 2012; 47: 149-158
- Changes in pain and pressure pain sensitivity after manual treatment of active trigger points in patients with unilateral shoulder impingement: a case series.J Bodyw Mov Ther. 2011; 15: 399-404
- Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles.Scand J Med Sci Sports. 2013; 23: 66-73
- Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study.Exp Brain Res. 2010; 202: 915-925
- Clinical assessment of the scapula: a review of the literature.Br J Sports Med. 2014; 48: 883-890
- Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’.Br J Sports Med. 2013; 47: 877-885
- A clinical method for identifying scapular dyskinesis, part 2: validity.J Athl Training. 2009; 44: 165-173
- Evaluation of clinical assessment methods for scapular dyskinesis.Arthroscopy. 2009; 25: 1240-1248
- The role of the scapula in athletic shoulder function.Am J Sports Med. 1998; 23: 325-337
- Current concepts: scapular dyskinesis.Br J Sports Med. 2010; 44: 300-305
- Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes.J Orthop Sports Phys Ther. 2008; 38: 4-11
- Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.Am J Sports Med. 2006; 34: 1643-1647
- The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome.J Back Musculoskeletal Rehabil. 2011; 24: 173-179
- Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome.Am J Sports Med. 2012; 40: 1906-1915
- The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial.Med J Islam Repub Iran. 2014; 28: 87
- The effect of axioscapular and rotator cuff exercise training sequence in patients with subacromial impingement syndrome: a randomized crossover trial.Int J Sports Phys Ther. 2016; 11: 94-107
- Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial.Clin Rheumatol. 2013; 32: 73-85
- Resting position variables at the shoulder: evidence to support a posture-impairment association.Phys Ther. 2006; 86: 549-557
- The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals.J Orthop Sports Phys Ther. 2005; 35: 227-238
- Lengthening of the pectoralis minor muscle during passive shoulder motions and stretching techniques: a cadaveric biomechanical study.Phys Ther. 2009; 89: 333-341
- Motion analysis study of a scapular orientation exercise and subjects' ability to learn the exercise.Man Ther. 2009; 14: 13-18
- Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula.Clin Biomech (Bristol, Avon). 2014; 29: 201-205
- Diagnosis and Treatment of Movement Impairment Syndromes.Elsevier Health Sciences, St. Louis, MO2002
- Thoracic outlet syndrome part 2: conservative management of thoracic outlet.Man Ther. 2010; 15: 305-314
- Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms.Scand J Med Sci Sports. 2007; 17: 25-33
- Rehabilitation of scapular muscle balance: which exercises to prescribe?.Am J Sports Med. 2007; 35: 1744-1751
- Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.Phys Ther. 2000; 80: 276-291
- Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review.Br J Sports Med. 2010; 44: 319-327
- Electromyographic study of the scapular rotators during arm abduction in the scapular plane.Am J Phys Med. 1986; 65: 111-124
- Electromyographic activity of selected shoulder muscles in commonly used therapeutic exercises.Phys Ther. 1993; 73 (discussion 677–682): 668-677
- An electromyographic analysis of the shoulder during a medicine ball rehabilitation program.Am J Sports Med. 1996; 24: 386-392
- Serratus anterior muscle activity during selected rehabilitation exercises.Am J Sports Med. 1999; 27: 784-791
- Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles.J Orthop Sports Phys Ther. 2003; 33: 247-258
- EMG analysis of the scapular muscles during a shoulder rehabilitation program.Am J Sports Med. 1992; 20: 128-134
- On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis.J Athl Train. 2005; 40: 15-22
- Electromyographic activity in the immobilized shoulder girdle musculature during scapulothoracic exercises.Arch Phys Med Rehabil. 2006; 87: 923-927
- A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises.J Orthop Sports Phys Ther. 2006; 36: 903-910
- EMG analysis of shoulder positioning in testing and strengthening the supraspinatus.Med Sci Sports Exerc. 1996; 28: 661-664
- Superficial and deep scapulothoracic muscle EMG activity during different types of elevation exercises in the scapular plane.J Orthop Sports Phys Ther. 2016; 46: 184-193
- Serratus anterior or pectoralis minor: which muscle has the upper hand during protraction exercises?.Man Ther. 2016; 22: 158-164
- Modifying the shoulder joint position during shrugging and retraction exercises alters the activation of the medial scapular muscles.Man Ther. 2016; 21: 250-255
- Specific kinematics and associated muscle activation in individuals with scapular dyskinesis.J Shoulder Elbow Surg. 2015; 24: 1227-1234
- Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises.Am J Sports Med. 2004; 32: 484-493
- Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete.Br J Sports Med. 2014; 48: 692-697
JHT Read for Credit
Quiz: #478
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The authors advocate giving more attention to the ________________ than currently seen in most clinics
- a.posterior portion of the rotator cuff
- b.anterior portion of the rotator cuff
- c.deeper lying scapulothoracic musculature
- d.more superficial scapulothoracic musculature
- a.
- #2.A component of normal elevation of the shoulder is
- a.posterior tilt of the scapula
- b.anterior tilt of the scapula
- c.gapping between the scapula and the thoracic cage
- d.gapping between the glenoid and the humeral head
- a.
- #3.It can correctly be said that
- a.the scapula is a bridge between the spine and the shoulder
- b.there are limited ligamentous connections between the spine and the scapula
- c.the scapula articulates with both the proximal humerus and the lateral aspect of the clavicle
- d.all of the above
- a.
- #4.The article draws attention to the relationship of _____________in the performance of complex functional motions
- a.muscle strength and velocity
- b.muscle strength and peak forces
- c.peak forces and velocity
- d.fatigue and power
- a.
- #5.The authors suggest that one major cause of subacromial pain is scapulothoracic motor dysfunction
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: May 30, 2017
Accepted:
March 27,
2017
Received in revised form:
March 27,
2017
Received:
December 8,
2016
Footnotes
Conflicts of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
