Abstract
A disturbance in scapulohumeral rhythm may cause negative biomechanic effects on rotator cuff (RC). Alteration in scapular motion and shoulder pain can influence RC strength. Purpose of this study was to assess supraspinatus and infraspinatus strength in 29 overhead athletes with scapular dyskinesis, before and after 3 and 6 months of rehabilitation aimed to restore scapular musculature balance. A passive posterior soft tissues stretching was prescribed to balance shoulder mobility. Scapular dyskinesis patterns were evaluated according to Kibler et al. Clinical assessment was performed with the empty can (EC) test and infraspinatus strength test (IST). Strength values were recorded by a dynamometer; scores for pain were assessed with VAS scale. Changes of shoulder IR were measured. The force values increased at 3 months (P < 0.01) and at 6 months (P < 0.01). Changes of glenohumeral IR and decrease in pain scores were found at both follow-up. Outcomes registered on pain and strength confirm the role of a proper scapular position for an optimal length–tension relationship of the RC muscles. These data should encourage those caring for athletes to consider restoring of scapular musculature balance as essential part of the athletic training.
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References
Morrey BF, Itoi E, An KA (1998) Biomechanics of the shoulder. In: Rockwood CA, Matsen FA (eds) The shoulder. WB Saunders, Philadelphia, pp 233–276
Bassett RW, Browne AO, Morrey BF, An KN (1990) Glenohumeral muscle force and movement mechanics in a position of shoulder instability. J Biomech 23:405–415
De Duca CJ, Forrest WJ (1973) Force analysis of individual muscles acting simultaneously on the shoulder joint during isometric abduction. J Biomech 6:385–393
Jobe FW, Pink M (1993) Classification treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther 18:427–432
Meiker K (2000) Injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med 28:265–275
Kibler WB (1991) Role of the scapula in the overhead throwing motion. Contemp Orthop 22:525–532
Kibler WB, Sciascia A, Dome D (2006) Evaluation of apparent, absolute supraspinatus strength in patients with shoulder injury using the scapula retraction test. Am J Sports Med 34:1643–1647
Smith J, Kotajarvi BR, Padgett DJ, Eischen JJ (2002) Effect of scapular protraction and retraction on isometric shoulder elevation strength. Arch Phys Med Rehabil 83:367–370
Tate AR, McClure PW, Kareha S, Irwin D (2008) Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes. J Orthop Sports Phys Ther 38:4–11
Ludewig PM, Phadkev V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF (2009) Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 91:378–389
Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J (2002) Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg 11:550–556
Chipchase LS, O’Connor DA, Costi JJ, Krishnan J (2000) Shoulder impingement syndrome: preoperative health status. J Shoulder Elbow Surg 9:12–15
Jobe FW, Moynes DR (1982) Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med 10:336–339
Hawkins RJ, Kennedy JC (1980) Impingement syndrome in athletes. Am J Sports Med 8:151–158
Leroux JL, Thomas E, Bonnel F, Blotman F (1995) Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed 62:423–428
Rubin BD, Kibler WB (2002) Fundamental principles of shoulder rehabilitation: conservative to postoperative management. Arthroscopy 18:29–39
Cools AM, Witvrouw E, Declercq G, Vanderstraeten G, Cambier D (2004) 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 38:64–68
Johansen RL, Callis M, Potts J, Shall LM (1995) A modified internal rotation stretching technique for overhand and throwing athletes. J Orthop Sports Phys Ther 21:216–219
Laudner KG, Sipes RC, Wilson JT (2008) The acute effects of sleeper stretches on shoulder range of motion. J Athl Train 43:359–363
Norkin CC, White DJ (1985) Introduction to goniometry. In: Measurement of joint motion: a guide to goniometry. F.A. Davis Company, Philadelphia, pp 1–7
Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352
Laudner KG, Stanek JM, Meister K (2006) Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athl Train 41:375–380
Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthroscopy 19:404–412
Pappas AM, Zawacki RM, McCarthy CF (1985) Rehabilitation of the pitching shoulder. Am J Sports Med 13:223–235
Kibler WB, Sciascia A (2009) Scapular dyskinesis: current concepts. Br J Sports Med. doi:10.1136/bjsm.2009.058834
Kebaetse M, McClure PM, Pratt NA (1999) Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Arch Phys Med Rehab 80:945–950
Poppen NK, Walker PS (1976) Normal and abnormal motion of the shoulder. J Bone Joint Surg Am 58:195–201
DiGiovine NM, Jobe FW, Pink M, Perry J (1992) An electromyographic analysis of the upper extremity in pitching. J Shoulder Elbow Surg 1:15–25
Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26:325–337
Elliott BC, Marshall R, Noffal G (1995) Contributions of upper limb segment rotations during the power serve in tennis. J Appl Biomech 11:433–442
Kennedy K (1993) Rehabilitation of the unstable shoulder. Oper Techniq Sports Med 1:311–324
Karduna AR, McClure PW, Michener LA, Sennett B (2001) Dynamic measurements of three-dimensional scapular kinematics: a validation study. J Biomech Eng 123:184–190
McClure PW, Michener LA, Sennett BJ, Karduna AR (2001) Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg 10:269–277
Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B et al (2007) Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med 35:1744–1751
Bagg SD, Forrest WJ (1988) A biomechanical analysis of scapula rotation during arm abduction in the scapular plane. Am J Phys Med Rehab 67:238–245
Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ (1999) Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med 27:784–791
Escamilla RF, Yamashiro K, Paulos L, Andrews JR (2009) Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med 39:663–685
Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR (2006) The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. J Shoulder Elbow Surg 15:339–343
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Merolla, G., De Santis, E., Campi, F. et al. Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskelet Surg 94, 119–125 (2010). https://doi.org/10.1007/s12306-010-0082-7
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DOI: https://doi.org/10.1007/s12306-010-0082-7