• PNF and Movement
• /
• v.20 no.3
• /
• pp.399-408
• /
• 2022

Purpose: This study investigated the differences in winged scapula between the symptomatic side and asymptomatic side, the reliability of the winged scapula test, and the correlation between winged scapula and the stability of the scapula in patients with subacromial impingement syndrome. Methods: Twenty-four patients with unilateral subacromial impingement syndrome participated in this study. Winged scapula was compared between the symptomatic and asymptomatic sides using a scapulometer. The reliability of the scapulometer was assessed by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). The correlation between winged scapula and the results of the upper quarter Y-balance test were also obtained. Conclusion: Winged scapula was significantly greater on the symptomatic side compared with the asymptomatic side (p < 0.05). High to excellent ICCs were obtained for the winged scapula test, and SEM and MCID values were obtained for winged scapula (SEM: 0.2-0.3 cm, MCID: 0.6-0.8 cm); however, winged scapula and the results of the upper quarter Y-balance test were not correlated. Conclusion: The scapulometer is useful for measuring winged scapula in patients with subacromial impingement syndrome.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.24 no.2
• /
• pp.29-36
• /
• 2018

Background: The purpose of this study was to investigate the effect of leg lift difference on serratus and upper trapezius when exercising in a scapula in a prone position, a typical waist stabilization exercise for subjects with a winged scapula. Method: Twenty normal adults and 20 subjects with winged scapula participated in the experiment. The surface EMG recordings were obtained from external oblique muscle and internal oblique muscle during scapula protraction exercise. The presence or absence of winging of the shoulder bone was measured using an electronic digital caliper for the distance the medial border of the scapula is lifted to the rear. In prostrate pier movement posture in both groups, both legs supporting, dominant leg lifting, and non-dominant leg lifting including the scapula protraction were conducted respectively. Results: In the results of comparison between the two groups, the dominant external oblique muscle and the non-dominant internal oblique muscle tended to increase according to the difference of the leg lifting of normal people. In the winged scapula group, internal oblique muscle showed increased muscle activity more than external oblique muscle. Conclusion: It was most effective to exercise with lifting the same position leg for strengthening the same external oblique muscle, and the opposite internal oblique muscle. Also, it is effective to exercise in prone pier movement posture for trunk stability. In addition, internal oblique muscle shows increased muscle activity in subjects with winged scapula. Therefore, appropriate adjustment of external oblique muscle and internal oblique muscle may have a positive effect on scapula dysfunction for trunk stability.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.25 no.1
• /
• pp.29-36
• /
• 2019

Background: This study was conducted to investigate the effect of leg lift difference on the serratus anterior muscle and the upper trapezius muscle when a subject with winged scapula performs a scapula protraction exercise in a four-leg crawling posture. Method: Twenty normal adults and 20 subjects with winged scapula participated in the experiment. Surface EMG recordings were collected from serratus anterior muscle and back trapezius muscle during scapula protraction exercises. Scapular winging is measured with the lifting distance of scapula retraction to the back using an electronic digital caliper. In two groups of four-leg crawling posture, the two legs support, the dominant leg lifting, and the non-dominant leg lifting, including the scapula protraction, were performed. To examine the difference between groups in the variance analysis, the Bonferroni correction was used (significance level ${\alpha}=.017$). Statistical significance level ${\alpha}$ was .05. Results: There was a significant difference in serratus anterior muscle and upper trapezius muscle during push-up plus exercise in leg lifting in four-leg crawling posture, but there were no significant differences in muscle activity between serratus anterior muscle and upper trapezius muscle, and there was no significant difference according to the presence or absence of scapular winging. Conclusion: For the shoulder stability of the ipsilateral side with the serratus anterior muscle, the leg-lifting posture is effective in the four-leg crawling, and also when a subject with winged scapula chooses an exercise, lifting the ipsilateral side of leg with scapula protraction exercises at the same time may have a positive effect on scapula dysfunction.

• Clinics in Shoulder and Elbow
• /
• v.12 no.2
• /
• pp.236-239
• /
• 2009

Purpose: We wanted to evalulate the clinical results of pectoris major tendon transfer for a neglected winged scapula that was caused by paralysis of the serratus anterior due to injury to the long thoracic nerve. Materials and Methods: A patient had neglected winged scapula that followed an arthroscopic operation for multi-directional instability of the shoulder joint, which was caused by traumatic dislocation. The patient was treated with pectoralis major tendon transfer using the modified Eden-Lange procedure. The range of a motion was improved from forward flexion $90^{\circ}$ and external rotation $70^{\circ}$ to $170^{\circ}$ and $150^{\circ}$ respectively. Results and Conclusion: There were no complications or recurrence and the patient's psychological satisfaction was also high. If the shoulder girdle muscles are intact, except for the serratus anterior, then pectoralis tendon transfer is a satisfactory method that can provide normal scapulo-thoracic motion.

• Physical Therapy Korea
• /
• v.26 no.4
• /
• pp.29-34
• /
• 2019

Background: The serratus anterior is one of the most important muscle for maintaining good scapular alignment in the shoulder joint. The pectoralis major and upper trapezius may also compensate for weak serratus anterior muscles. The push-up plus exercise has been identified as the optimal exercise for maximum activation of the serratus anterior. Objects: The purpose of this study was to examine differences in surface electromyography (EMG) activity of upper trapezius, pectoralis major, and serratus anterior muscles during push-up plus exercises on variously angled surfaces in subjects with winged scapula. Methods: Sixteen subjects with winged scapula (male=5, female=11) volunteered for this study. The subjects performed push-up plus exercise on four different tilt angles, namely $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$. EMG activities in the serratus anterior, upper trapezius, and pectoralis major muscles during performance of push-up plus exercise were measured in all subjects. Data were processed from repeated measures one-way analysis of variance. Results: There was significant difference in the muscle activity of the serratus anterior on the different surface angles (p<.05). The results of the post-hoc analysis showed significantly greater serratus anterior muscle activity on a surface at a $0^{\circ}$ angle than at others tilt angles (p<.05). There was also significant difference in the ratio of serratus anterior to upper trapezius and serratus anterior to pectoralis major across the four surfaces (p<.05), and post-hoc analysis showed significantly greater values on the $0^{\circ}$ surface than on other tilts (p<.05). Conclusion: This study found that performing push-up plus exercises on a flat surface with $0^{\circ}$ and $30^{\circ}$ tilt angle achieves high activation of the serratus anterior muscle for selective strengthening. It can also take into account the sequential application, which is first performed at a $30^{\circ}$ and at a $0^{\circ}$ tilt angle for and effective but not excessive muscle activation.

• Physical Therapy Korea
• /
• v.30 no.1
• /
• pp.41-49
• /
• 2023

Background: Scapular dyskinesis may cause not only rotator cuff (RC) tear but also weakness of the upper extremity, studies on scapular dyskinesis that may occur after RC repair is still lacking. Objects: To determine whether scapular dsykinesis was present in patients after arthroscopic RC repair and to investigate the influence of passive scapular stabilization on upper extremity strength. Methods: A total of 30 patients after RC repair participated in this study. To compare the scapula of the arthroscopic RC repair shoulder and the contralateral shoulder, the winged scapula (WS) was measured using a scapulometer and scapular dyskinesis was also classified by type. Fixed instruments for muscle strength measurements were used to measure upper extremity muscle strength differences depending on passive scapular stabilization position or natural scapular position. A chi-square test, an independent t-test and a 2-way mixed measures analysis of variance (ANOVA) was used as statistical analysis. In analyses, p < 0.05 was deemed to be statistically significant. Results: Postoperative shoulder had a significant association with scapular dyskinesis and the WS compared to the contralateral shoulder (F = 0.052, p < 0.01). Postoperative shoulder, muscle strength in the shoulder abduction (p < 0.01), elbow flexion (p < 0.01) and forearm supination (p < 0.05) were significantly greater in the scapular stabilization position than in the scapular natural position. Conclusion: Patients underwent arthroscopic RC repair had a significant association with scapular dyskinesis and muscle strength was improved by a passive scapular stabilization position, therefore scapular stabilization is important in rehabilitation program.

• Journal of the Korean Society of Physical Medicine
• /
• v.8 no.3
• /
• pp.369-378
• /
• 2013

PURPOSE: The purpose of present study was to ascertain how the activity of the serratus anterior muscle, the upper trapezius muscle and the pectoral major muscle was affected while the upper arm was being flexed at 70, 90 and 110 degrees respectively in a closed kinetic chain exercise (wall push up plus) and an open kinetic chain exercise (static hug). METHODS: Sixteen healthy young men subjects participated in the study. Surface electromyography (EMG) data were collected from the dominant-side muscles during a closed kinetic chain exercise and an open kinetic chain exercise. The activity of each muscle was measured quantitatively, and by the use of the two-way repeated ANOVA, the data were compared with each other according to exercises and shoulder flexion angles. RESULTS: Results indicated that the closed kinetic chain exercise did not interact with the open kinetic chain exercise (p>.05). In both the closed kinetic chain exercise and the open kinetic chain exercise, the activity of the serratus anterior muscle became different significantly according to angles (p<.05). Its activity increased in order of 70, 90 and 110 degrees (p<.05). In both exercises and all angles, muscle activity was significantly higher in the serratus anterior muscle than in the upper trapezius muscle and the pectoral major muscle (p<.05). CONCLUSION: The above results show that there is a need to selectively control the exercise stress of the serratus anterior muscle in the case of the patients with the shoulder impingement syndrome characterized by the winged scapula, insufficient scapular protraction and upward rotation.

• The Journal of the Korean bone and joint tumor society
• /
• v.12 no.2
• /
• pp.118-125
• /
• 2006

Purpose: We report elastofibroma which is a rare fibrous lesion that most commonly occurs in the between subscapularis and thoracic cage. Materials and Methods: Four patients include one man and three women, the average age was 70 years and the average follow up period was six months. Two patients had on left side, two patients had on both sides. Main symptom was palpable mass. One patient complained mild pain, two complained scapular snapping. Results: All four masses removed with marginal or wide margin. Average mass size was 9.7${\times}$7.2${\times}$3.8 cm. Preoperative symptoms disappeared after surgery. All of the patients have returned to their daily living and showed no recurrence. There was no serious complication such as limitation of shoulder motion and winged scapula. Conclusion: Elastofibroma scapulae can be diagnosed through patient's age, tumor location and radiological finding without preoperative biopsy. When patient is symptomless, observation is enough without surgical operation. Surgical operation considered for relieve of symptoms of pain and snapping.