Skip to main content

Advertisement

SpringerLink
Log in

A computer tablet software can quantify the deviation of scapula medial border from the thoracic wall during clinical assessment of scapula dyskinesis

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Aim of this study is to establish an objective and easily applicable method that will allow clinicians to quantitatively assess scapular dyskinesis during clinical examination using a computer tablet software. Hypothesis is that dyskinetic scapulae present greater motion—deviation from the thoracic wall—compared to the non-dyskinetic ones and that the software will be able to record those differences.

Methods

Twenty-five patients and 19 healthy individuals were clinically evaluated for the presence of dyskinesis or not. According to the clinical diagnosis, the observations were divided into three groups; A. Dyskinetic scapulae with symptoms (n = 25), B. Contralateral non-dyskinetic scapulae without symptoms (n = 25), C. Healthy control scapulae (n = 38). Then, all individuals were tested using a tablet with the PIVOT™ image-based analysis software (PIVOT, Impellia, Pittsburgh, PA, USA). The motion produced by the scapula medial border and inferior angle deviation from the thoracic wall was recorded.

Results

The deviation of the medial border and inferior angle of the scapula from the thoracic wall was 24.6 ± 7.3 mm in Group A, 14.7 ± 4.9 mm in Group B, and 12.4 ± 5.2 mm in Group C. The motion recorded in the dyskinetic scapulae group was significantly greater than both the contralateral non-dyskinetic scapulae group (p < 0.01) and the healthy control scapulae group (p < 0.01).

Conclusion

The PIVOT™ software was efficient to detect significant differences in the motion between dyskinetic and non-dyskinetic scapulae. This system can support the clinical diagnosis of dyskinesis with a numeric value, which not only contributes to scapula dyskinesis grading but also to the evaluation of the progress and efficacy of the applied treatment, thus providing a feedback to the clinician and the patient.

Level of evidence

IV, laboratory study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kibler WB, Sciascia A (2016) The shoulder at risk: scapular dyskinesis and altered glenohumeral rotation. Oper Tech Sports Med 24:162–169

    Article  Google Scholar 

  2. Ben KW, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD (2013) Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “scapular summit”. Br J Sports Med 47:877–885

    Article  Google Scholar 

  3. Lawrence RL, Braman JP, Ludewig PM (2019) Shoulder kinematics impact subacromial proximities: a review of the literature. Braz J Phys Ther. https://doi.org/10.1016/j.bjpt.2019.07.009

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nodehi Moghadam A, Rahnama L, Noorizadeh Dehkordi S, Abdollahi S (2020) Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. J Should Elbow Surg 29:e29–e36

    Article  Google Scholar 

  5. Sambandam SN (2015) Rotator cuff tears: an evidence based approach. World J Orthop 6:902. https://doi.org/10.5312/wjo.v6.i11.902

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ben KW, Sciascia A (2016) The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc 24:390–397

    Article  Google Scholar 

  7. Panagiotopoulos AC, Crowther IM (2019) Scapular dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT-J 5:29

    Article  Google Scholar 

  8. Shitara H, Kobayashi T, Yamamoto A, Shimoyama D, Ichinose T, Tajika T, Osawa T, Iizuka H, Takagishi K (2017) Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers. Knee Surg Sports Traumatol Arthrosc 25:3303–3310

    Article  Google Scholar 

  9. Fernandez-Matias R, Gallardo-Zamora P, Sanchez-Aguilera CL, Mardones-Varela H, Gallego-Izquierdo T, Pecos-Martin D (2019) Reliability of the scapula reposition test in subjects with rotator cuff tendinopathy and scapular dyskinesis. J Clin Med 9:80

    Article  Google Scholar 

  10. Johnson MP, McClure PW, Karduna AR (2001) New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop Sports Phys Ther 31:81–89

    Article  CAS  Google Scholar 

  11. Odom CJ, Taylor AB, Hurd CE, Denegar CR (2001) Measurement of scapular asymmetry and assessment of shoulder dysfunction using the lateral scapular slide test: a reliability and validity study. Phys Ther 81:799–809

    Article  CAS  Google Scholar 

  12. McClure P, Tate AR, Kareha S, Irwin D, Zlupko E (2009) A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athl Train 44:160–164

    Article  Google Scholar 

  13. Tate AR, McClure P, Kareha S, Irwin D, Barbe MF (2009) A clinical method for identifying scapular dyskinesis, part 2: validity. J Athl Train 44:165–173

    Article  Google Scholar 

  14. Uhl TL, Ben KW, Gecewich B, Tripp BL, Ph D (2009) Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 25:1240–1248

    Article  Google Scholar 

  15. Christiansen DH, Møller AD, Vestergaard JM, Mose S, Maribo T (2017) The scapular dyskinesis test: reliability, agreement, and predictive value in patients with subacromial impingement syndrome. J Hand Ther 30:208–213

    Article  Google Scholar 

  16. Huang TS, Ou HL, Huang CY, Lin JJ (2015) Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elbow Surg 24:1227–1234

    Article  Google Scholar 

  17. Park J-Y, Kim J, Seo BH, Yu HD, Sim JH, Lee JH, Oh KS, Chung SW (2019) Three-dimensional analysis of scapular kinematics during arm elevation in baseball players with scapular dyskinesis: comparison of dominant and nondominant arms. J Sport Rehabil 16:1–9

    Google Scholar 

  18. Xu X, Dickerson CR, Lin JH, McGorry RW (2016) Evaluation of regression-based 3-D shoulder rhythms. J Electromyogr Kinesiol 29:28–33

    Article  Google Scholar 

  19. Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V (2016) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Eng 19:217–228

    Article  Google Scholar 

  20. Musahl V, Burnham J, Lian J, Popchak A, Svantesson E, Kuroda R, Zaffagnini S, Samuelsson K, PIVOT Study Group (2018) High-grade rotatory knee laxity may be predictable in ACL injuries. Knee Surg Sports Traumatol Arthrosc 26:3762–3769

    Article  Google Scholar 

  21. Pfeiffer TR, Kanakamedala AC, Herbst E, Nagai K, Murphy C, Burnham JM, Popchak A, Debski RE, Musahl V (2018) Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 26:1319–1325

    Article  Google Scholar 

  22. Araujo PH, Ahlden M, Hoshino Y, Muller B, Moloney G, Fu FH, Musahl V (2012) Comparison of three non-invasive quantitative measurement systems for the pivot shift test. Knee Surg Sports Traumatol Arthrosc 20:692–697

    Article  Google Scholar 

  23. Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 20:732–736

    Article  Google Scholar 

  24. Hoshino Y, Araujo P, Ahldén M, Samuelsson K, Muller B, Hofbauer M, Wolf MR, Irrgang JJ, Fu FH, Musahl V (2013) Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc 21:975–980

    Article  Google Scholar 

  25. Hoshino Y, Araujo P, Irrgang JJ, Fu FH, Musahl V (2012) An image analysis method to quantify the lateral pivot shift test. Knee Surg Sports Traumatol Arthrosc 20:703–707

    Article  Google Scholar 

  26. Karduna AR, McClure PW, Michener LA, Sennett B (2001) Dynamic measurements of three-dimensional scapular kinematics: a validation study. J Biomech Eng 123:184

    Article  CAS  Google Scholar 

  27. Dupont WD, Plummer WDJ (1990) Power and sample size calculations. A review and computer program. Control Clin Trials 11:116–128

    Article  CAS  Google Scholar 

  28. Kibler WB, Uhl TL, Maddux JWQ, Brooks PV, Zeller B, McMullen J (2002) Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Should Elbow Surg 11:550–556

    Article  Google Scholar 

  29. Ben KW, Sciascia A (2010) Current concepts: scapular dyskinesis. Br J Sports Med 44:300–305

    Article  Google Scholar 

  30. de Oliveira VMA, da Silva HA, Pitangui ACR, dos Passos MHP, de Araújo RC (2018) Scapular dyskinesis was not associated with pain and function in male adolescent athletes. Rev Dor 19:40–45

    Article  Google Scholar 

  31. Preziosi Standoli J, Fratalocchi F, Candela V, Preziosi Standoli T, Giannicola G, Bonifazi M, Gumina S (2018) Scapular dyskinesis in young, asymptomatic elite swimmers. Orthop J Sport Med 6:1–7. https://doi.org/10.1177/2325967117750814

    Article  Google Scholar 

  32. Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR (2016) Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 24:382–389

    Article  Google Scholar 

  33. Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, Cagnie B, Witvrouw EE (2007) Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med 35:1744–1751

    Article  Google Scholar 

  34. Ben KW, Sciascia A (2019) Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med. https://doi.org/10.1007/s12178-019-09591-1

    Article  Google Scholar 

  35. Nowotny J, Kasten P, Kopkow C, Biewener A, Mauch F (2018) Evaluation of a new exercise program in the treatment of scapular dyskinesis. Int J Sports Med 39:782–790

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Dr. Volker Musahl, Professor of Orthopaedic Surgery, University of Pittsburgh, USA and Mrs. Norma Nieto, Impellia Co, USA, for their valuable consultation during the execution of the present study. They offered solutions to any difficulty we faced with the Pivot App use and function.

Author information

Authors and Affiliations

  1. Thessaloniki Minimally Invasive Surgery (The-MIS) Orthopaedic Center, St. Luke’s Hospital, 55236, Thessaloniki, Greece

    Trifon Totlis

  2. Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Trifon Totlis

  3. 1st Orthopaedic Department, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios Kitridis

  4. 2nd Orthopaedic Department, Papageorgiou University Hospital, Thessaloniki, Greece

    Konstantinos Tsikopoulos

  5. Department of Orthopaedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece

    Anastasios Georgoulis

Authors
  1. Trifon Totlis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Kitridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konstantinos Tsikopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anastasios Georgoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TT conceived the study and participated in its design, co-ordination, data collection and manuscript preparation. DK carried out the literature search, wrote the initial manuscript draft, and participated in data interpretation and figures preparation. KT performed the statistical analysis, participated in data interpretation and edited the manuscript. AG participated in the study design, data collection, had the supervision of the study and performed the final critical revision of the manuscript.

Corresponding author

Correspondence to Trifon Totlis.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest related to this study.

Funding

Aided by a Grant from the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine and the Orthopaedic Research and Education Foundation.

Ethical approval

Approval was obtained from the scientific committee of the St. Luke’s Hospital, Thessaloniki (24 Oct 2017).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Totlis, T., Kitridis, D., Tsikopoulos, K. et al. A computer tablet software can quantify the deviation of scapula medial border from the thoracic wall during clinical assessment of scapula dyskinesis. Knee Surg Sports Traumatol Arthrosc 29, 202–209 (2021). https://doi.org/10.1007/s00167-020-05916-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05916-7

Keywords

Search

Navigation