Background: Individuals with scapular winging may have proprioceptive dysfunction which is important for motor control and causes shoulder instability. Reduced serratus anterior (SA) and lower trapezius (LT) muscle activity accompanied by over-active upper trapezius (UT), and pectoralis major (PM) may be contributing factors. Flexi-bar (FB) exercise may be used to increase joint position sense (JPS) and alter the target muscle activities. Objects: This study aimed to investigate the immediate effects of flexi-bar exercise prior to knee push-up plus (FPK) versus knee push-up plus (KPP) on JPS and muscle activity of SA, LT, UT, and PM in subjects with scapular winging. Methods: Eighteen subjects with scapular winging were recruited. JPS was investigated at baseline, after KPP and after FPK. Passive and active JPS errors were calculated by isokinetic equipment. Surface electromyography was used to record muscle activities during KPP and FPK. One-way repeated-measures analysis of variance and post hoc analyses were used to analyze the JPS error measured at baseline, after KPP and after FPK. Paired t-tests were used to compare muscle activities between KPP and FPK. Results: Passive JPS error was significantly decreased after KPP (p = 0.005) and after FPK (p = 0.003) compared to the baseline. Active JPS error was also significantly decreased after KPP (p = 0.016) and after FPK (p = 0.012) compared to the baseline. There was no significant difference in the passive and active JPS errors between KPP and FPK. SA activity during FPK was significantly increased (p = 0.024), and LT activity during FPK was significantly increased (p = 0.006). There were no significant differences in the UT and PM activity. Conclusion: FB might be recommended to immediately improve passive and active JPS and to selectively increase SA and LT muscle activities during KPP in individuals with scapular winging.

Background: The scapulo-thoracic musculatures including serratus anterior (SA), upper trapezius and lower trapezius can provide shoulder stability and functional shoulder movement. Objects: The muscle activities of upper and lower SA were compared during three different scapular protraction exercises in healthy individuals in sitting position. Methods: Twenty-five healthy subjects were participated. Electromyography device was used to measure muscle activity of upper and lower SA and trapezius muscles. Each subject was asked to perform three different scapular protraction exercises (scapular protraction [SP], SP with self-resistance [SPSR], SPSR with hand-exerciser [SPSRH]) in random order. One-way repeated measures analysis of the variance and a Bonferroni post hoc test were used. Results: The muscle activity of lower SA muscle was significantly different among three conditions (SP vs. SPSR vs. SPSRH) (p < 0.01). The lower SA muscle activity was significantly greater during SPSRH compared to SP and SPSR, which required joint stability more than SP and SPSR (p < 0.01). Conclusion: SPSRH exercise can be recommended to facilitate the muscle activity of lower SA. In addition, the intramuscular variation in the upper and lower SA during scapular protraction exercise is required to consider the effective rehabilitation.

Background: Shoulder horizontal abduction in the prone position (SHAP) has been reported as an effective exercise to strengthen the lower trapezius. However, the effects of pre-emptive scapular posterior tilt on scapular muscle activity and scapulohumeral movements during SHAP have not been examined. Objectives: To examine the effect of the addition of scapular posterior tilt on muscle activity of the trapezius and posterior deltoid, and scapular posterior tilt and shoulder horizontal abduction, during SHAP. Design: Cross-sectional study. Methods: Fifteen healthy male subjects performed two types of SHAP: general and modified SHAP (SHAP combined with pre-emptive scapular posterior tilt). To perform modified SHAP, pre-emptive scapular posterior tilt training was performed prior to the modified SHAP. Muscle activity of the middle and lower trapezius and posterior deltoid, and the amount of scapular posterior tilt and shoulder horizontal abduction, were measured during two types of SHAP. Results: Muscle activity of the lower trapezius and scapular posterior tilt was significantly increased during the modified SHAP, while muscle activity of the posterior deltoid and the amount of shoulder horizontal abduction were significantly decreased. However, the middle trapezius muscle activity did not change during the modified SHAP. Conclusion: The SHAP with pre-emptive scapular posterior tilt can be useful to strengthen the lower trapezius.

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, n1=30), a shoulder surgery group (SS, n2=30) and a control group (n3=30). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.

The purpose of this study was to determine the reliability of distance measurements from the medial border of the scapula to the spinous process of the thoracic vertebrae when obtained using tape and photography measurements. The study included 20 healthy subjects (10 males, 10 females); for a total of 40 scapula measurements. The distance measurements made using tape or photography methods were conducted with the subject in a standing position. Repeated tape and photography measurements were conducted in two sessions on different days by two examiners to assess the inter-rater and intra-rater reliability of the two methods. The reliability of scapular distance measured using tape and photography methods was tested using intraclass correlation coefficients (ICC(3,1)) and the standard error of measurement (SEM). The inter-rater reliability of the tape measurement method was excellent (ICC=.77) and the intra-rater reliability was fair to good (ICC=.74). The inter-rater and intra-rater reliabilities of the photography measurement method were excellent (ICC=.76 and .76 respectively). Our results suggest that photography measurement is an objective and qualitative measurement tool for scapular distance measurements.

The purpose of this study was to investigate the most effective and comprehensible method for the assessment of resting scapular position (RSP) and pain level (PL) in unilateral shoulder pain (USP). Fifty volunteers with USP were involved in the study. Resting scapular assessments of the patients' pain sides (PS) and non-pain sides (NPS) were evaluated. The assessment tools for RSP are: 1) sternal notch (SN) to coracoid process (CP) distance 2) 3rd thoracic spinous process (T3S) to posterolateral angle of acromion (PLA) distance 3) scapular index 4) 8th thoracic spinous process (T8S) to inferior angle of scapular (IAS) distance 5) supine measurement of pectoralis minor (PM) distance 6) standing PM distance 7) PM index (PMI) and 8) PM pain. The paired t-test was used to compare PS and NPS in RSP. Pearson correlation analysis was used to confer a relationship between the PL and RSP. The results of this study indicated that: 1) all the variables between the PS and NPS for RSP were statistically significant(p<.05) and 2) the PMI showed the strongest relationship in the correlation analysis between RSP and PL(p<.05, r=.37). Therefore, it can be concluded that there is a relationship between PMI and PL and it is suggested that an assessment tool using PMI to diagnose shoulder pain would be clinically effective.

The purpose of this study was to investigate the effects of serratus anterior strengthening exercises on scapular position and Visual Analog Scale (VAS) pain measurements taken at the resting position in young adults with adducted scapular. The exercise program included stretching of the scapular retractor and strengthening of the serratus anterior muscle. We measured the distance from the midline of the thorax to the vertebral border of the scapular with a tape line (Superior Kibler), and the distance from the 7th cervical spinous process to the acromial angle with 3-dimension motion analysis system, to compare the resting scapular position before and after exercise. Fifteen subjects with adducted scapular were recruited to compare the resting scapular position and VAS. The distance from 7th cervical spine process to acromial angle of the scapular and VAS decreased significantly (p<.01) after exercise, while the distance from the midline of the thorax to vertebral border of the scapular increased (p<.05). The conclusion is that the serratus anterior exercise program altered the resting scapular position and decreased VAS.

Altered scapular kinematics in the scapular joint is commonly believed to be a factor contributing to trunk posture. The purpose of this study was to analyze the muscle activity with several changes of the shoulder angle. Tests were performed on 10 male subjects by repeated measures. Each subject was measured while sitting in both erect and slouched trunk positions. In each sitting posture, a three-dimensional motion analysis measurement was used to measure thoracic angle and shoulder abduction angle. Measurements were taken with the shoulder abdcution angle at , , , , , and . By using surface Electromyography (EMG) electrodes, we recorded the activity of the upper trapezius, middle trapezius, lower trapezius, middle deltoid, and serratus anterior muscle while the subject held a 4 kg weight at each angle. The mean of root mean square (RMS) of EMG activity was calculated. The middle trapezius, lower trapezius, and middle deltoid muscle activity showed significantly higher results but serratus anterior muscle activity showed significantly lower results (p<.05). With the shoulder angle increased, the muscle activity was also significantly increased (p<.05). In conclusion, the thoracic spine posture significantly affects the scapular muscle during scapular plane abduction, and the slouched posture is associated with increased trapezius muscle activity and with decreased serratus anterior muscle activity.