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Sports Medicine

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01-05-2008 | Review Article

Scapular Positioning in Athlete’s Shoulder

Particularities, Clinical Measurements and Implications

Authors: Dr Bénédicte Forthomme, Jean-Michel Crielaard, Jean-Louis Croisier

Published in: Sports Medicine | Issue 5/2008

Abstract

Despite the essential role played by the scapula in shoulder function, current concepts in shoulder training and treatment regularly neglect its contribution. The ‘scapular dyskinesis’ is an alteration of the normal scapular kinematics as part of scapulohumeral rhythm, which has been shown to be a nonspecific response to a host of proximal and distal shoulder injuries. The dyskinesis can react in many ways with shoulder motion and function to increase the dysfunction. Thoracic kyphosis, acromio-clavicular joint disorders, subacromial or internal impingement, instability or labral pathology can alter scapular kinematics. Indeed, alteration of scapular stabilizing muscle activation, inflexibility of the muscles and capsule-ligamentous complex around the shoulder may affect the resting position and motion of the scapula. Given the interest in the scapular positioning and patterns of motion, this article aims to give a detailed overview of the literature focusing on the role of the scapula within the shoulder complex through the sports context. Such an examination of the role of the scapula requires the description of the normal pattern of scapula motion during shoulder movement; this also implies the study of possible scapular adaptations with sports practice and scapular dyskinesis concomitant to fatigue, impingement and instability. Different methods of scapular positioning evaluation are gathered from the literature in order to offer to the therapist the possibility of detecting scapular asymmetries through clinical examinations. Furthermore, current concepts of rehabilitation dealing with relieving symptoms associated with inflexibility, weakness or activation imbalance of the muscles are described. Repeating clinical assessments throughout the rehabilitation process highlights improvements and allows the therapist to actualize rationally his or her intervention. The return to the field must be accompanied by a transitory phase, which is conducive to integrating new instructions during sports gestures. On the basis of the possible scapular disturbance entailed in sports practice, a preventive approach that could be incorporated into training management is encouraged.

¹ The use of trade names is for product identification purposes only and does not imply endorsement

Weiser WM, Lee TQ, Mc Master WC, et al. Effects of simulated scapular protraction on anterior glenohumeral stability. Am J Sports Med 1999; 27: 801–5PubMed

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003; 19: 641–61PubMedCrossRef

Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes: the ‘dead arm’ revisited. Clin Sports Med 2000; 19: 125–58PubMedCrossRef

Myers JB, Laudner KG, Pasquale MR, et al. Scapular position and orientation in throwing athletes. Am J Sports Med 2005; 33: 263–71PubMedCrossRef

Rubin BD, Kibler WB. Fundamental principles of shoulder rehabilitation: conservative to postoperative management. Arthroscopy 2002; 18: 29–39PubMedCrossRef

Fleisig GS, Barrentine SW, Escamilla RF, et al. Biomechanics of overhand throwing with implications for injuries. Sports Med 1996; 21: 421–37PubMedCrossRef

Forthomme B, Croisier JL, Ciccarone G, et al. Factors correlated with volleyball spike velocity. Am J Sports Med 2005; 33: 1513–9PubMedCrossRef

Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998; 26: 325–37PubMed

Kibler WB, Uhl TL, Maddux JWQ, et al. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg 2002; 11: 550–6PubMedCrossRef

10.

Kibler WB, Mc Mullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 2003; 11: 142–51PubMed

11.

Poppen NK, Walker PS. Normal and abnormal motion of the shoulder. J Bone Joint Surg 1976; 58: 195–201PubMed

12.

Ellen MI, Gilhool JJ, Rogers DP. Scapular instability: the scapulothoracic joint. Phys Med Rehab Clin North Am 2000; 11: 755–70

13.

Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 2000; 80: 276–91PubMed

14.

Codman EA. The shoulder. Boston (MA): G. Miller and Company, 1934

15.

Mc Quade KJ, Smidt G. Dynamic scapulohumeral rhythm: the effects of external resistance during elevation of the arm in the scapular plane. J Orthop Sports Phys Ther 1998; 27: 125–33

16.

Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med 2006; 34: 1643–7PubMedCrossRef

17.

Warner JJP, Micheli LJ, Arslanian LE, et al. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability: a study using Moiré topographic analysis. Clin Orthop Rel Res 1992; 285: 191–9

18.

Su KPE, Johnson MP, Gracely EJ, et al. Scapular rotation in swimmers with and without impingement syndrome: practice effects. Med Sci Sports Exerc 2004; 36: 1117–23PubMedCrossRef

19.

Schmitt L, Snyder-Mackler L. Role of scapular stabilizers in etiology and treatment of impingement syndrome. J Orthop Sports Phys Ther 1999; 29: 31–8PubMed

20.

Mc Clure PW, Michener LA, Karduna AR. Shoulder function and 3−dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther 2006; 86: 1075–90

21.

Von Eisenhart-Rothe R, Jäger A, Englmeier K-H, et al. Relevance of arm position and muscle activity on three—dimensional glenohumeral translation in patients with traumatic and atraumatic shoulder instability. Am J Sports Med 2002; 30: 514–22

22.

Von Eisenhart-Rothe R, Matsen FA, Eckstein F, et al. Pathomechanics in atraumatic shoulder instability. Clin Orthop Relat Res 2005; 433: 82–9CrossRef

23.

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthroscopy 2003; 19: 404–20PubMedCrossRef

24.

Laudner KG, Myers JB, Pasquale MR, et al. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther 2006; 36: 485–94PubMed

25.

Cools AM, Witvrouw EE, Declercq GA, et al. 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: 64–8PubMedCrossRef

26.

Borich MR, Bright JM, Lorello DJ, et al. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther 2006; 36: 926–34PubMedCrossRef

27.

Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 2005; 35: 227–38PubMed

28.

Hebert LJ, Moffet H, Mc Fadyen BJ, et al. A method of measuring three—dimensional scapular attitudes using the Optotrak probing system. Clin Biomech 2000; 15: 1–8CrossRef

29.

Karduna AR, Mc Clure PW, Michener LA, et al. Dynamic measurements of three—dimensional scapular kinematics: a validation study. J Biomech Eng 2001; 123: 184–90PubMedCrossRef

30.

Endo K, Ikata T, Katoh S, et al. Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome. J Orthop Sci 2001; 6: 3–10PubMedCrossRef

31.

Berthonnaud E, Herzberg G, Zhao KD, et al. Three—dimensional in vivo displacements of the shoulder complex from biplanar radiography. Surg Radiol Anat 2005; 27: 214–22PubMedCrossRef

32.

Itoi E, Motzkin NE, Morrey BF, et al. Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992; 1: 131–9PubMedCrossRef

33.

Dayanidhi S, Orlin M, Kozin S, et al. Scapular kinematics during humeral elevation in adults and children. Clin Biomech 2005; 20: 600–6CrossRef

34.

Karduna AR, Mc Clure PW, Michener LA. Scapular kinematics: effects of altering the Euler angle sequence of rotations. J Biomech 2000; 33: 1063–8PubMedCrossRef

35.

Mc Clure PW, Michener LA, Sennett BJ, et al. Direct 3−dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg 2001; 10: 269–77CrossRef

36.

Wu G, vand der Helm FCT, Veeger HEJ, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, part II: shoulder, elbow, wrist and hand. J Biomech 2005; 38: 981–92PubMedCrossRef

37.

Borstad JD. Resting position variables at the shoulder: evidence to support a posture—impairment association. Phys Ther 2006; 86: 549–57PubMedCrossRef

38.

Borstad JD, Ludewig PM. Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane. Clin Biomech 2002; 17: 650–9CrossRef

39.

Lukasiewicz AC, Mc Clure P, Michener L, et al. Comaprison of 3−dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther 1990; 29: 574–86

40.

Ludewig PM, Cook TM, Nawoczenski DA. Three—dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther 1996; 24: 57–65PubMed

41.

Meskers CGM, Vermeulen HM, de Groot JH, et al. 3D shoulder position measurements using a six—degree of freedom electromagnetic tracking device. Clin Biomech 1998; 13: 280–92CrossRef

42.

Price CIM, Franklin P, Rodgers H, et al. Active and passive scapulohumeral movement in healthy persons: a comparison. Arch Phys Med Rehabil 2000; 81: 28–31PubMed

43.

Ebaugh DD, Mc Clure PW, Karduna AR. Three—dimensional scapulothoracic motion during active and passive arm elevation. Clin Biomech 2005; 20: 700–9CrossRef

44.

Borsa PA, Timmons MK, Sauers EL. Scapular—positioning patterns during humeral elevation in unimpaired shoulders. J Athlet Train 2003; 38: 12–7

45.

Johnson MP, Mc Clure PW, Karduna AR. New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop Sports Phys Ther 2001; 31: 81–9PubMed

46.

Watson L, Balster SM, Finch C, et al. Measurement of scapula upward rotation: a reliable clinical procedure. Br J Sports Med 2005; 39 (9): 599–603PubMedCrossRef

47.

Nijs J, Roussel N, Vermeulen K, et al. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Arch Phys Med Rehabil 2005; 86: 1349–55PubMedCrossRef

48.

Diveta J, Walker ML, Skibinski B. Relationship between performance of selected scapular muscles and scapular abduction in standing subjects. Phys Ther 1990; 70: 470–7PubMed

49.

Odom CJ, Taylor AB, Hurd CE, et al. Measurement of scapular asymmetry and assessment of shoulder dysfunction using the lateral scapular slide test: a reliability and validity study. Phys Ther 2001; 81: 799–809PubMed

50.

Gibson MH, Goebel GV, Jordan TM, et al. A reliability study of measurement techniques to determine static scapular position. J Orthop Sports Phys Ther 1995; 21: 100–6PubMed

51.

Kibler WB, Uhl TL, Maddux JW, et al. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg 2002; 11: 550–6PubMedCrossRef

52.

Koslow PA, Prosser LA, Strony GA, et al. Specificity of the lateral scapular slide test in asymptomatic competitive athletes. J Orthop Sports Phys Ther 2003; 33: 331–6PubMed

53.

Forthomme B, Crielaard JM, Croisier JL. Rééducation de l’épaule du sportif: proposition d’une fiche d’évaluation fonctionnelle. J Traumatol Sport 2006; 23: 193–202CrossRef

54.

Kendall FP, Mc Creary EK, Provance PG. Muscles: testing and function. 4th ed. Baltimore (MD): Williams and Wilkins, 1993

55.

Downar JM, Sauers EL. Clinical measures of shoulder mobility in the professional base. J Athl Train 2005; 40: 23–9PubMed

56.

Downar JM, Sauers EL, Mourtacos SL. Chronic adaptations in the throwing shoulder of professional baseball players. J Athl Train 2002; 2: S17–8

57.

Mc Quade KJ, Dawson J, Smidt GL. Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. J Orthop Sports Phys Ther 1998; 28: 74–80

58.

Ebaugh D, Mc Clure P, Karduna A. Effects of task intensity on changes in scapular kinematics [abstract]. American Society of Biomechanics Annual Meeting; 2003 Sep 25; Toledo

59.

Tsai N-T, Mc Clure PW, Karduna AR. Effects of muscle fatigue on 3−dimensional scapular kinematics. Arch Phys Med Rehabil 2003; 84: 1000–5PubMedCrossRef

60.

Ebaugh DD, Mc Clure PW, Karduna AR. Scapulothoracic and glenohumeral kinematics following an external rotation fatigue protocol. J Orthop Sports Phys Ther 2006; 36: 557–71PubMedCrossRef

61.

Steindler A. Kinesiology of the human body under normal and pathological conditions. Springfield (IL): Charles C. Thomas, 1955

62.

Hebert LJ, Moffet H, Mc Fadyen BJ, et al. Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil 2002; 83: 60–9PubMedCrossRef

63.

Mathiassen SE, Winkel J. Electromyographic activity in the shoulder: neck region according to shoulder arm position and glenohumeral torque. Eur J Appl Physiol 1990; 61: 370–9CrossRef

64.

Schüldt C, Harms-Ringdahl K. Activity levels during isometric test contractions of neck and shoulder muscles. Scand J Rehabil Med 1988; 20: 117–27PubMed

65.

Host HH. Scapular taping in the treatment of anterior shoulder impingement. Phys Ther 1995; 75: 803–12PubMed

66.

Karduna AR, Kerner PJ, Lazarus MD. Contact forces in the subacromial space: effects of scapular orientation. J Shoulder Elbow Surg 2005; 14: 393–9PubMedCrossRef

67.

Glousman R. Electromyographic analysis and its role in the athletic shoulder. Clin Orthop Relat Res 1993; 288: 27–35PubMed

68.

Harryman DT, Sidles JA, Clark JM, et al. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg 1990; 72-A: 1334–43

69.

Myers JB, Laudner KG, Pasquale MR, et al. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med 2006; 34: 385–91PubMedCrossRef

70.

Huffman GR, Tibone JE, Mc Garry MH, et al. Path of glenohumeral articulation throughout the rotational range of motion in a thrower’s shoulder model. Am J Sports Med 2006; 34: 1662–9PubMedCrossRef

71.

Grossman MG, Tibone JE, Mc Garry MH, et al. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior—to—posterior lesions. J Bone Joint Surg Am 2005; 87: 824–31PubMedCrossRef

72.

Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med 2002; 30: 136–51PubMed

73.

Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther 1993; 18: 365–77PubMed

74.

Kibler WB. Shoulder rehabilitation: principles and practice. Med Sci Sports Exerc 1998; 30: S40–50

75.

Hintermeister RA, Lange GW, Schultheis JM, et al. Electromyographic activity and applied load during shoulder rehabilitation exercises using elastic resistance. Am J Sports Med 1998; 26: 210–20PubMed

76.

Wise MB, Uhl TL, Mattacola CG, et al. The effect of limb support on muscle activation during shoulder exercises. J Shoulder Elbow Surg 2004; 13: 614–20PubMedCrossRef

77.

Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther 2003; 33: 247–58PubMed

78.

Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push—up exercises. Am J Sports Med 2004; 32: 484–93PubMedCrossRef

79.

Moseley JB, Jobe FW, Pink M, et al. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med 1992; 20: 128–43PubMedCrossRef

80.

Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med 1999; 27: 784–91PubMed

81.

Cordasco FA, Wolfe IN, Wootten MA, et al. An electromyographic analysis of the shoulder during a medicine ball rehabilitation program. Am J Sports Med 1996; 24: 386–91PubMedCrossRef

82.

Myers JB, Lephart SM. The role of the sensorimotor system in the athletic shoulder. J Athl Train 2000; 35: 351–63PubMed

83.

Kibler WB. Closed kinetic chain rehabilitation for sports injuries. Phys Med Rehabil Clin N Am 2000; 11: 369–84PubMed

84.

Lewis JS, Wright C, Green A. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther 2005; 35: 72–87PubMed

85.

Ackermann B, Adams R, Marshall E. The effect of scapula taping on electromyographic activity and musical performance in professional violinists. Aust J Physiother 2002; 48: 197–203PubMed

Title: Scapular Positioning in Athlete’s Shoulder
Particularities, Clinical Measurements and Implications
Authors: Dr Bénédicte Forthomme
Jean-Michel Crielaard
Jean-Louis Croisier
Publication date: 01-05-2008
Publisher: Springer International Publishing
Published in: Sports Medicine / Issue 5/2008
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI: https://doi.org/10.2165/00007256-200838050-00002

At a glance: The STEP trials

Springer Medicine

Scapular Positioning in Athlete’s Shoulder

Particularities, Clinical Measurements and Implications

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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