Skip to main content
SpringerLink
Log in
Book cover

Rotator Cuff Across the Life Span pp 113–121Cite as

Scapulothoracic Disorders and Nonsurgical Management of the Impingement

  • Chapter

Abstract

Patients with shoulder impingement often show abnormal scapulothoracic motions known as scapular dyskinesis. In those patients, pain relief with scapular assistant maneuver is a good indication for exercises correcting the scapular dyskinesis and strengthening periscapular muscles. Several clinical studies have demonstrated the effect of scapular exercise programs on reducing pain in patients with impingement. Based on the classification of scapular dyskinesis, optimal scapulothoracic exercises are prescribed. Types 1 and 2 of scapular dyskinesis are observed in patients with subacromial impingement, whereas type 3 dyskinesis is seen in patients with posterosuperior impingement. For type 1 dyskinesis characterized by scapular anterior tilt, stretching of the pectoralis minor and strengthening the lower trapezius and serratus anterior are recommended. For type 2 dyskinesis characterized by scapular internal rotation, strengthening the entire serratus anterior is advocated. For type 3 dyskinesis characterized by scapular elevation and upward rotation, relaxation of the upper trapezius can be an effective intervention. Factors affecting scapular kinematics, such as poor posture and glenohumeral internal rotation deficit, also need to be treated.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

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

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  3. Lin J, Hsieh SC, Cheng WC, Chen WC, Lai Y. Adaptive patterns of movement during arm elevation test in patients with shoulder impingement syndrome. J Orthop Res. 2011;29:653–7. https://doi.org/10.1002/jor.21300.

    Article  PubMed  Google Scholar 

  4. Su KP, Johnson MP, Gracely EJ, Karduna AR. Scapular rotation in swimmers with and without impingement syndrome: practice effects. Med Sci Sports Exerc. 2004;36:1117–23.

    Article  Google Scholar 

  5. McClure 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.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  7. Hebert LJ, Moffet H, McFadyen BJ, Dionne CE. Scapular behaviour in shoulder impingement syndrome. Arch Phys Med Rehabil. 2002;83:60–9.

    Article  Google Scholar 

  8. Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29:574–83.

    Article  CAS  Google Scholar 

  9. Finley MA, McQuade KJ, Rodgers MM. Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement. Clin Biomech. 2005;20:32–40.

    Article  Google Scholar 

  10. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using moire topographic analysis. Clin Orthop Relat Res. 1992;285:191–9.

    Google Scholar 

  11. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39:90–104. https://doi.org/10.2519/jospt.2009.2808.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Timmons MK, Thigpen CA, Seitz AL, Karduna AR, Arnold BL, Michener LA. Scapular kinematics and subacromial-impingement syndrome: a meta-analysis. J Sport Rehabil. 2012;21:354–70.

    Article  Google Scholar 

  13. Laudner KG, Myers JB, Pasquale MR, Bradley JP, Lephart SM. Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 2006;36:485–94.

    Article  Google Scholar 

  14. Seitz AL, Reinold M, Schneider RA, Gill TJ, Thigpen CA. No effect of scapular position on 3-dimensional scapular motion in the throwing shoulder of healthy professional pitchers. J Sport Rehabil. 2012;21:186–93.

    Article  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  16. Oyama S, Myers JB, Wassinger CA, Daniel Ricci R, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008;43:565–70. https://doi.org/10.4085/1062-6050-43.6.565.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ratcliffe E, Pickering S, McLean S, Lewis J. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Br J Sports Med. 2014;48:1251–6. https://doi.org/10.1136/bjsports-2013-092389.

    Article  PubMed  Google Scholar 

  18. Castelein B, Cools A, Parlevliet T, Cagnie B. The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm. J Shoulder Elbow Surg. 2017;26:497–505. https://doi.org/10.1016/j.jse.2016.09.005.

    Article  PubMed  Google Scholar 

  19. Ettinger L, Shapiro M, Karduna A. Subacromial injection results in further scapular dyskinesis. Orthop J Sports Med. 2014;2:232596711454410. https://doi.org/10.1177/2325967114544104.

    Article  Google Scholar 

  20. Kolk A, Henseler JF, de Witte PB, van Arkel ER, Visser CP, Nagels J, et al. Subacromial anaesthetics increase asymmetry of scapular kinematics in patients with subacromial pain syndrome. Man Ther. 2016;26:31–7. https://doi.org/10.1016/j.math.2016.07.002.

    Article  PubMed  Google Scholar 

  21. Scibek JS, Mell AG, Downie BK, Carpenter JE, Hughes RE. Shoulder kinematics in patients with full-thickness rotator cuff tears after a subacromial injection. J Shoulder Elbow Surg. 2008;17:172–81.

    Article  Google Scholar 

  22. Sole G, Osborne H, Wassinger C. Electromyographic response of shoulder muscles to acute experimental subacromial pain. Man Ther. 2014;19:343–8. https://doi.org/10.1016/j.math.2014.03.001.

    Article  PubMed  Google Scholar 

  23. Wassinger CA, Sole G, Osborne H. Clinical measurement of scapular upward rotation in response to acute subacromial pain. J Orthop Sports Phys Ther. 2013;43:199–203. https://doi.org/10.2519/jospt.2013.4276.

    Article  PubMed  Google Scholar 

  24. Muraki T, Yamamoto N, Sperling JW, Steinmann SP, Cofield RH, An KN. The effect of scapular position on subacromial contact behavior: a cadaver study. J Shoulder Elbow Surg. 2017;26:861–9. https://doi.org/10.1016/j.jse.2016.10.009.

    Article  PubMed  Google Scholar 

  25. Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, et al. Association between kyphosis and subacromial impingement syndrome: LOHAS study. J Shoulder Elbow Surg. 2014;23:e300–7. https://doi.org/10.1016/j.jse.2014.04.010.

    Article  PubMed  Google Scholar 

  26. Gumina S, Di Giorgio G, Postacchini F, Postacchini R. Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers. Chir Organi Mov. 2008;91:93–6. https://doi.org/10.1007/s12306-007-0016-1.

    Article  PubMed  Google Scholar 

  27. Alizadehkhaiyat O, Roebuck MM, Makki AT, Frostick SP. Postural alterations in patients with subacromial impingement syndrome. Int J Sports Phys Ther. 2017;12:1111–20.

    Article  Google Scholar 

  28. Borich MR, Bright JM, Lorello DJ, Cieminski CJ, Buisman T, Ludewig PM. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther. 2006;36:926–34.

    Article  Google Scholar 

  29. Thomas SJ, Swanik KA, Swanik CB, Kelly JD 4th. Internal rotation deficits affect scapular positioning in baseball players. Clin Orthop Relat Res. 2010;468:1551–7. https://doi.org/10.1007/s11999-009-1124-z.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  32. Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? Br J Sports Med. 2009;43:259–64.

    Article  CAS  Google Scholar 

  33. Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2016;23:57–68. https://doi.org/10.1016/j.math.2016.03.009.

    Article  PubMed  Google Scholar 

  34. Barrett E, O’Keeffe M, O’Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016;26:38–46. https://doi.org/10.1016/j.math.2016.07.008.

    Article  PubMed  Google Scholar 

  35. Culham E, Peat M. Functional anatomy of the shoulder complex. J Orthop Sports Phys Ther. 1993;18:342–50.

    Article  CAS  Google Scholar 

  36. Kebaetse M, McClure P, Pratt NA. Thoracic position effect on shoulder range of motion, strength, and three dimensional scapular kinematics. Arch Phys Med Rehabil. 1999;80:94–50.

    Article  Google Scholar 

  37. Lewis JS, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. J Shoulder Elbow Surg. 2005;14:385–92.

    Article  Google Scholar 

  38. Kado DM, Christianson L, Palermo L, Smith-Bindman R, Cummings SR, Greendale GA. Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the fracture intervention trial. Spine. 2006;31:463–7.

    Article  Google Scholar 

  39. Ripani M, Di Cesare A, Giombini A, Agnello L, Fagnani F, Pigozzi F. Spinal curvature: comparison of frontal measurements with the spinal mouse and radiographic assessment. J Sports Med Phys Fitness. 2008;48:488–94.

    CAS  PubMed  Google Scholar 

  40. 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;19:641–61.

    Article  Google Scholar 

  41. Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT 3rd. Glenohumeral internal rotation deficit and injuries: a systematic review and meta-analysis. Orthop J Sports Med. 2018;6:232596711877332. https://doi.org/10.1177/2325967118773322.

    Article  Google Scholar 

  42. Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg. 2006;15:324–30.

    Article  Google Scholar 

  43. Muraki T, Aoki M, Izumi T, Fujii M, Hidaka E, Miyamoto S. Lengthening of the pectoralis minor muscle during passive shoulder motions and stretching techniques: a cadaveric biomechanical study. Phys Ther. 2009;89:333–41. https://doi.org/10.2522/ptj.20080248.

    Article  PubMed  Google Scholar 

  44. Andersen CH, Zebis MK, Saervoll C, Sundstrup E, Jakobsen MD, Sjøgaard G, et al. Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res. 2012;26:2408–16. https://doi.org/10.1519/JSC.0b013e31823f8d24.

    Article  PubMed  Google Scholar 

  45. Maenhout A, Benzoor M, Werin M, Cools A. Scapular muscle activity in a variety of plyometric exercises. J Electromyogr Kinesiol. 2016;27:39–45. https://doi.org/10.1016/j.jelekin.2016.01.003.

    Article  PubMed  Google Scholar 

  46. Tsuruike M, Ellenbecker TS. Serratus anterior and lower trapezius muscle activities during multi-joint isotonic scapular exercises and isometric contractions. J Athl Train. 2015;50:199–210. https://doi.org/10.4085/1062-6050-49.3.80.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Alizadehkhaiyat O, Hawkes DH, Kemp GJ, Frostick SP. Electromyographic analysis of the shoulder girdle musculature during external rotation exercises. Orthop J Sports Med. 2015;3:2325967115613988. https://doi.org/10.1177/2325967115613988.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Moseley JB, Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20:128–34.

    Article  Google Scholar 

  49. Ludewig PM, Hoff MS, Osowski EE, Meschke SA, Rundquist PJ. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32:484–93.

    Article  Google Scholar 

  50. Pirauá AL, Pitangui AC, Silva JP, Pereira dos Passos MH, Alves de Oliveira VM, Batista Lda S, Cappato de Araújo R. J Electromyogr Kinesiol. 2014;24:675–81. https://doi.org/10.1016/j.jelekin.2014.05.009.

    Article  PubMed  Google Scholar 

  51. Khademi Kalantari K, Berenji Ardestani S. The effect of base of support stability on shoulder muscle activity during closed kinematic chain exercises. J Bodyw Mov Ther. 2014;18:233–8. https://doi.org/10.1016/j.jbmt.2013.08.005.

    Article  PubMed  Google Scholar 

  52. Batbayar Y, Uga D, Nakazawa R, Sakamoto M. Effect of various hand position widths on scapular stabilizing muscles during the push-up plus exercise in healthy people. J Phys Ther Sci. 2015;27:2573–6. https://doi.org/10.1589/jpts.27.2573.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Castelein B, Cagnie B, Parlevliet T, Cools A. Serratus anterior or pectoralis minor: which muscle has the upper hand during protraction exercises? Man Ther. 2016;22:158–64. https://doi.org/10.1016/j.math.2015.12.002.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  55. Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744–51.

    Article  Google Scholar 

  56. 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;35:72–87.

    Article  Google Scholar 

  57. Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008;43:359–63. https://doi.org/10.4085/1062-6050-43.4.359.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lintner D, Mayol M, Uzodinma O, Jones R, Labossiere D. Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program. Am J Sports Med. 2007;35:617–21. https://doi.org/10.1177/0363546506296736.

    Article  PubMed  Google Scholar 

  59. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37:108–14. https://doi.org/10.2519/jospt.2007.2337.

    Article  PubMed  Google Scholar 

  60. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44:300–5. https://doi.org/10.1136/bjsm.2009.058834.

    Article  PubMed  Google Scholar 

  61. Kibler WB, Sciascia A. Rehabilitation of the athlete’s shoulder. Clin Sports Med. 2008;27:821–31. https://doi.org/10.1016/j.csm.2008.07.001.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan

    Takayuki Muraki & Eiji Itoi

Authors
  1. Takayuki Muraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eiji Itoi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Itoi .

Editor information

Editors and Affiliations

  1. Orthopaedic Sportsmedicine, University of Munich (TUM), Orthopaedic Sportsmedicine, Munich, Bayern, Germany

    Andreas B. Imhoff

  2. Department of Orthopaedics, Tulane University School of Medicine, Department of Orthopaedics, New Orleans, LA, USA

    Felix H. Savoie III

1 Electronic Supplementary Materials

Scapular assistance test. For elevation of the right shoulder, the examiner puts his right thumb on the medial aspect of the patient’s scapular inferior angle and puts his left palm on top of the shoulder. To assist scapular upward rotation and posterior tilt, the examiner pushes the inferior angle laterally and anteriorly and pulls the top of the shoulder posteriorly during arm elevation. (MP4 3873 kb)

Scapular correction in SSMP: elevation, retraction, and posterior tilt. The examiner sequentially corrects the patient’s scapular position during shoulder abduction. First, the examiner elevates the patient’s scapula. Second, the examiner retracts the scapula. Third, the examiner tilts the scapula posteriorly. Then, the examiner asks the patient which scapular correction reduced the symptom most. (MP4 9700 kb)

Thoracic correction in SSMP. The patient pushes his sternum supero-posteriorly to extend his thoracic spine during arm elevation. Then, the examiner asks the patient if there was any change in shoulder symptom during arm elevation before and after thoracic correction. (MP4 2719 kb)

Pectoralis minor stretching. The patient lies in supine position. The therapist flexes the patient’s elbow maximally and flexes the shoulder by 30°. Then, the therapist pushes the elbow supero-posteriorly so that the origin and insertion of the pectoralis minor would be separated maximally. (MP4 5556 kb)

Antigravity flexion in the quadruped position. The patient flexes the shoulder with a light dumbbell in the quadruped position. Simultaneously, the patient needs to keep the positions of the trunk and lower extremities. (MP4 4543 kb)

Serratus punch. The patient flexes both shoulders up to 90° with the elbows extended in standing position. While the patient is grasping a rubber band with the involved hand (left hand) and the therapist pulling the rubber band from behind, the patient retracts the scapulae bilaterally and then protracts them maximally. To keep the neutral rotation of the trunk, the patient needs to perform symmetric motion of bilateral scapulae. (MP4 1297 kb)

Lawn mower exercise. The patient begins this exercise with a contralateral leg stepped forward and with a flexed and rotated trunk toward the contralateral side with the hand in front of the stepped leg. Then the patient rotates and extends the trunk while retracting the scapula. (MP4 4284 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 ISAKOS

About this chapter

Cite this chapter

Muraki, T., Itoi, E. (2019). Scapulothoracic Disorders and Nonsurgical Management of the Impingement. In: Imhoff, A.B., Savoie, F.H. (eds) Rotator Cuff Across the Life Span. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58729-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-58729-4_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-58728-7

  • Online ISBN: 978-3-662-58729-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation