• 국제물리치료학회지
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• 제1권2호
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• pp.143-148
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• 2010

The present study examined the effects of functional electrical stimulus(group 1), proprioceptive neuromuscular facilitation(group 2) and combined training of functional electrical stimulus and proprioceptive neuromuscular facilitation(group 3) with scapula adductor muscles on scapula movement, upper limb function and gait in fifteen subjects stroke patients. The training was thirty minutes a day, five times a week for six weeks, obtained result as follow, upper limb function was significant difference in the group 2(p<.05) but no significant difference in other groups. The change of weight bearing were significant difference in all the groups(p<.05), and increase of gait velocity were significant difference in all the group(p<.05). In conclusion, when applied with functional electrical stimulus, proprioceptive neuromuscular facilitation and combined training to the scapular adductor muscles, it was oberved in the course of the experiment that proprioceptive neuromuscular facilitation was the most effective treatment among the three methods applied to the scapula adductors.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.121-127
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• 2019

Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients' shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear. Methods: We assessed patients' rotator cuff tear humeral head positions based on humeral-scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated. Results: One hundred seventy-five patients (80 males, 95 females; mean age: $59.7{\pm}6.5$ years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (p<0.001, p<0.001, p<0.001). Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

• 한국전문물리치료학회지
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• 제24권4호
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• pp.29-37
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• 2017

Background: The serratus anterior (SA) muscle is one of the important muscles in the upward rotation of the scapula when the arm is raised. Insufficient muscle activity of the SA can cause deformation of the shoulder rhythm resulting in shoulder pathology. Objects: This study intends to compare SA and upper trapezius (UT) activity during the conventional wall-slide and push-up plus exercises for SA muscle strengthening and the scapular upward rotation (SUR) exercise. Methods: A total of 30 subjects participated in this study, and we measured the muscle activity of the SA and UT muscles during the wall-slide, push-up plus and SUR exercises. The one-way repeated ANOVA was used to compare SA and UT muscle activities during the 3 exercises. Results: During the SUR exercise, SA muscle activity was 79.88% maximum voluntary isometric contraction (MVIC), which was significantly higher than its activity during the other 2 exercises. The UT muscle activity was 47.53 %MVIC during the SUR exercise, indicating a significantly higher UT muscle activity than during the other 2 exercises. Conclusion: These findings suggest that the SUR exercise can maximize SA muscle activity to strengthen the SA while keeping UT muscle activity at an appropriate level.

• 대한정형도수물리치료학회지
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• 제11권2호
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• pp.71-82
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• 2005

The couple force of the scapular stabilizers for upward rotation that include the upper and lower trapezius, serratus anterior muscles is essential to maintain the stability of shoulder joint. But if there is an imbalance of these muscles, it would occur many problems of shoulder joint. A push-up plus exercise with an unstable support is used in order to increase the muscle activity and stimulate the proprioception of shoulder joint. The purpose of this study was to compare the muscle activity of upper and lower trapezius, serratus anterior muscles and to determine which exercise is more effective when subjects perform push-up plus exercise in the stable support and unstable support. 15 healthy subjects and 15 painful subjects with injury of shoulder joint participated in this study. Surface electromyography data were collected during plus phase of push-up plus exercise. The types of push-up plus exercise were composed of three conditions. Stable type is subjects performed the push-up plus exercise on the fixed support and unstable type 1 is on the sling without shaking and unstable type 2 is on the sling with shaking by tester's manual. The upper and lower trapezius activities of injured group were higher than uninjured group at three measure conditions, but serratus anterior activities were not. The UT/SA ratio of injured group was higher than uninjured group at three measure conditions. The serratus anterior activities were most high at unstable 2 measure in both groups. The UT/SA ratio was most low at unstable 2 measure condition in injured group only. The present result revealed that push-up plus exercise in the unstable support with shaking which took most high serratus anterior activities and most low of UT/SA ratio is optimal cure method that can improve the imbalance of the scapular stabilizer.

• 한국전문물리치료학회지
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• 제27권2호
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• pp.140-148
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• 2020

Background: Scapular winging (SW) could be caused by tightness or weakness of the periscapular muscles. Although data mining techniques are useful in classifying or predicting risk of musculoskeletal disorder, predictive models for risk of musculoskeletal disorder using the results of clinical test or quantitative data are scarce. Objects: This study aimed to (1) investigate the difference between young women with and without SW, (2) establish a predictive model for presence of SW, and (3) determine the cutoff value of each variable for predicting the risk of SW using the decision tree method. Methods: Fifty young female subjects participated in this study. To classify the presence of SW as the outcome variable, scapular protractor strength, elbow flexor strength, shoulder internal rotation, and whether the scapula is in the dominant or nondominant side were determined. Results: The classification tree selected scapular protractor strength, shoulder internal rotation range of motion, and whether the scapula is in the dominant or nondominant side as predictor variables. The classification tree model correctly classified 78.79% (p = 0.02) of the training data set. The accuracy obtained by the classification tree on the test data set was 82.35% (p = 0.04). Conclusion: The classification tree showed acceptable accuracy (82.35%) and high specificity (95.65%) but low sensitivity (54.55%). Based on the predictive model in this study, we suggested that 20% of body weight in scapular protractor strength is a meaningful cutoff value for presence of SW.

• Clinics in Shoulder and Elbow
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• 제18권3호
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• pp.152-158
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• 2015

Background: Acromioclavicular (AC) stability is maintained through a complex combination of soft-tissue restraints that include coracoclavicular (CC), AC ligament and overlying muscles. Among these structures, the role of the CC ligament has continued to be studied because of its importance on shoulder kinematics, especially after AC injury. This study was designed to determine the geometric change of conoid and trapezoid ligaments and resulting stresses on these ligaments according to various scapular motions. Methods: The scapuloclavicular (SC) complex was isolated from a fresh-frozen cadaver by removing all soft tissues except the AC and CC ligaments. The anatomically aligned SC complex was then scanned with a high-resolution computed tomography scanner into 0.6- mm slices. The Finite element model of the SC complex was obtained and used for calculating the stress on different parts of the CC ligaments with simulated movements of the scapula. Results: Average stress on the conoid ligament during anterior tilt, internal rotation, and scapular protraction was higher, whereas the stress on the trapezoid ligament was more prominent during posterior tilt, external rotation, and retraction. Conclusions: We conclude that CC ligament plays an integral role in regulating horizontal SC motion as well as complex motions indicated by increased stress over the ligament with an incremental scapular position change. The conoid ligament is the key structure restraining scapular protraction that might occur in high-grade AC dislocation. Hence in CC ligament reconstructions involving only single bundle, every attempt must be made to reconstruct conoid part of CC ligament as anatomically as possible.

• 국제물리치료학회지
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• 제11권1호
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• pp.1975-1980
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• 2020

Background: It has been argued that changes in muscle activity in the upper trapezius and serratus anterior may or may not cause shoulder joint pain and dysfunction. Objective: To investigate the effects of active vibration exercise on muscle activity regarding scapular stabilization using a flexi-bar. Design: A randomized controlled trial. Methods: A total of 24 subjects were randomly assigned to a flexi-bar group with active vibration and general stick group with non-active vibration. Both groups performed the same four action programs for 6 weeks, three times a week for 30 minutes at a time. The upper trapezius muscle, middle trapezius muscle, lower trapezius muscle and serratus anterior muscle of the dominant side was measured by electromyography before and after the 6 weeks of exercise. The independent t-test and paired t-test were used to analyze data. Results: There was a significant difference between groups in upper trapezius muscle and serratus anterior muscle activity after exercise (P<.05). Also, there was a significant difference in upper trapezius muscle and serratus anterior muscle activity before and after exercise in the flexi-bar group (P<.05). Conclusion: This study demonstrates that active vibration exercise using a flexi-Bar contribute to reduce the activity of the upper trapezius muscle and promote the activity of the serratus anterior muscle.

• 대한통합의학회지
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• 제12권1호
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• pp.139-150
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• 2024

Purpose : Scapular dyskinesis, it have been shown to be common in overhead athletes and has been associated with RC muscle strength. Posterior shoulder tightness (PST) has been suggested as an important factor causing scapular dyskinesis. Therefore, rehabilitation programs should focus on a posterior shoulder stretch combined with scapular stabilization exercise (PSSE) intervention. Determine the effects of posterior shoulder stretch combined with scapular stabilization exercise on the rotator cuff (RC) muscles strength, functional strength ratio (FSR), range of motion (ROM), and pain. Methods : 30 adolescent baseball players participated and subjects were allocated PSSE group (n=15) or the SSE group (n=15). Both group performed a 6-weeks intervention and measured of isokinetic peak torque/body weight (PT/BW) of concentric external rotator (CER), eccentric external rotator (EER), concentric internal rotator (CIR), eccentric internal rotator (EIR), FSR, ROM, and pain. Results : After 6 weeks PSSE, significant increase CER PT/BW (+6.02±4.76 %), EER PT/BW (+5.39±4.22 %), EER to CIR ratio (+.17±.16), and internal rotation ROM (+15.08±3.57 °). Whereas, significant decrease EIR to CER ratio (-.14±.18), external rotation ROM (-12.00±6.94 °), and GIRD (-17.41±2.84 °) compared with pre-intervention. No significant difference of isokinetic PT/BW of CIR and EER post-intervention. In the SSE group showed no significant difference all measurements for isokinetic PT/BW, FSR, and ROM post-intervention. The pain was significant improve both PSSE group (-3.25±1.60) and SSE group (-2.83±1.85) post-intervention. Conclusion : Both the PSSE and SSE interventions led to more pain relief. However, only the PSSE group showed ROM, CER, EER PT/BW, and FSR improvements. These results might suggest that the PSSE intervention is a more effective program for improving RC muscle strength and balance, in particular, concentric and eccentric ER muscle strength, FSR and can expect to prevent shoulder injuries in adolescent baseball players with scapular dyskinesis.

• 한국전문물리치료학회지
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• 제14권2호
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• pp.44-52
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• 2007

This study was carried out to compare the muscle activities of the shoulder stabilizers between persons with and without winging scapular during push-up plus exercise (adds the scapular protraction to the general push-up exercise). For this study, eleven males with winging scapular and eleven healthy males were recruited. Surface electromyographic (EMG) activity was recorded from the serratus anterior, upper trapezius, lower trapezius, infraspinatus, and pectoralis major while the subjects performed the push-up plus. Each push-up plus was subdivided into three phases according to the elbow position which was measured using the 3-D motion analysis system: elbow flexion (EF), elbow extension (EE), and shoulder protraction phases (SP). Two-way repeated measure ANOVA (phase ${\times}$ group) were used for statistical analysis. There was significant phase by group interaction only on the EMG composition ratio of the serratus anterior (p>.05). The EMG composition ratio of the serratus anterior was significantly higher in SP than in either EF or EE however, it was not different between winging scapular and normal groups. For both groups, the EMG composition ratio of upper trapezius, lower trapezius, and pectoralis major was significantly different across the phases of push-up plus, but the infraspinatus EMG composition ratio was not. For both groups, in EF and EE phases, the EMG composition ratio of both pectoralis major and serratus anterior were relatively higher than that of other muscles. However, in both groups, the EMG composition ratio of the serratus anterior became much more predominant than that of the pectoralis major. In addition, infraspinatus activated greater than pectoralis major. These results showed that the push-up plus exercise is effective to selectively strengthen the serratus anterior for both individuals with and without winging scapular, but not equally effective for other shoulder stabilizers.

• 대한물리의학회지
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• 제10권4호
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• pp.113-121
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• 2015

PURPOSE: The purpose of this study was to determine the effect of shoulder external rotation on muscle activities of the scapular upward rotators during arm elevation. METHODS: Nineteen healthy subjects with no medical history of shoulder pain or upper extremity disorders were recruited for this study. Electromyography (EMG) was used to measure the muscle activities of the serratus anterior (SA), upper trapezius (UP), lower trapezius (LT) and infraspinatus (IS) muscles during arm elevation. The EMG activities were recorded while the subjects performed $90^{\circ}$ arm elevation with three different arm positions; palm down (PD), neutral position (NP), and palm up (PU). While seated in a chair, the subject was asked to raise the upper extremity in the sagittal plane in random order. Subjects performed $90^{\circ}$ arm elevations in three trials at each arm position. The mean EMG activity normalized by the maximal voluntary isometric contraction was analyzed across three arm positions. Repeated measures one-way ANOVA and the post hoc Bonferroni tests were used to determine the differences in muscle activities among the three arm positions. RESULTS: The EMG activities of the SA and IS were significantly greater in the PU condition than in the other conditions during arm elevation. No significant difference was noted between the NP and PD conditions during arm elevation. CONCLUSION: These results suggest that shoulder external rotation (palm up position) can be used to activate the SA. Therefore, we recommend a scapular protraction exercise in the palm up position for strengthening the SA.