• The Journal of Korean Physical Therapy
• /
• v.14 no.3
• /
• pp.92-105
• /
• 2002

This research described dynamic scapulohumeral rhythm though the measurement of inter relationship between humorous and scapular movement during elevation of the arm in the scapular plane. In the previous studies static plane film X-ray has usually been used, but the limitation of such method was that it did not show the real· movement. In this study, we investigated real movement of humorous and scapular bones by Digital fluoroscopy system. 1. In resting position, humorous was taken to lie at the average $5.97^{\circ}$ in abduction, and scapular at the average $3.66^{\circ}$ in internal rotation. 2. At the maximal abduction, humorous was abducted to the average of 181.25", and scapular was rotated externally to $51.43^{\circ}$. 3. This research has shown that there is a variety of scapulohumeral rhythm from resting position to $60^{\circ}$ abduction in elevation of humorous. This case study demonstrated that the ratio n of scapulohumeral rhythm is 3.46 to 1, but there was individual difference.

• Archives of Reconstructive Microsurgery
• /
• v.7 no.1
• /
• pp.41-46
• /
• 1998

Microvascular free tissue transfer technique is widely accepted for reconstruction of extensive soft tissue defects on the extremities. The system of flap based on the subscapular artery and vein provides the widest ways of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flaps, the serratus anterior and latissimus dorsi muscular flaps, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available to mutiple tissue defects or complex defects because it can incorporated with skin, muscle and bone flaps. A strikig advantage is the independent vascular pedicles of each components, which allow freedom in orientation of each components. So, it can be freely applied to any forms of three demensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in seven patients to reconstruct massive deefcts on the extremities. There was no flap failure and little complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed.

• Clinics in Shoulder and Elbow
• /
• v.24 no.3
• /
• pp.141-146
• /
• 2021

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

• The Korean Journal of Pain
• /
• v.25 no.3
• /
• pp.168-172
• /
• 2012

Background: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). Methods: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. Results: The average NRS was decreased from $4.8{\pm}0.6$ to $0.6{\pm}0.5$ after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of $15.1{\pm}2.2$ ($11-19^{\circ}$) and a caudal angle of $15.4{\pm}1.7^{\circ}$ ($12-18^{\circ}$). The average distance from the skin to the scapular notch was $5.8{\pm}0.6$ cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. Conclusions: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

• The Journal of Korean Physical Therapy
• /
• v.30 no.4
• /
• pp.141-145
• /
• 2018

Purpose: Changes in the curvature of the vertebral columns of elderly women with increasing age causes various side effects and disorders. Therefore, this study was conducted to evaluate the effectiveness of the 8-figure scapular brace to improve pulmonary function and balance ability based on lung capacity and foot pressure by increasing the vertebral curvature. Methods: Seventeen elderly women with a forward head posture were selected. Women were asked to wear the 8-figure scapular brace and the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured, as were changes in foot pressure. Measurements were conducted three times each and the mean values were used for subsequent analyses. For static evaluation, we used the paired t-test to identify differences between pre and post values. Results: There was no significant difference in FEV1 and FVC before and after use of the brace (p>0.05); however, there was a significant decrease in forefoot pressure and an increase in rearfoot pressure following application of the brace (p<0.05). Conclusion: Application of the 8-figure scapular brace to correct vertebral curvature in elderly women influenced pressure distribution change from immediate effect body arrange of cervical and thoracic. However, wearing the 8-figure scapular brace may interfere with expansion of the chest and therefore respiratory muscle activity. Accordingly, it is necessary to apply appropriate treatment when wearing a scapular brace and to allow a sufficient intervention period while also providing therapeutic interventions such as posture correction or respiration training.

• Korean Journal of Applied Biomechanics
• /
• v.22 no.2
• /
• pp.193-199
• /
• 2012

The purpose of this study was to investigate the activities of the serratus anterior (SA) and upper trapezius (UT) muscles during scapular protraction exercise with a dumbbell. Twenty-one healthy subjects with no medial history of shoulder pain or upper extremity disorders were recruited for this study. Subjects performed scapular protraction at $90^{\circ}$ and $130^{\circ}$ shoulder flexion with a dumbbell in supine and standing positions. The activities of the SA and UT were measured via surface electromyography (EMG) during 4 scapular protraction exercises. A 2 (angle) ${\times}$ 2 (position) repeated-measures analysis of variance (ANOVA) was used to compare the normalized activities of the SA and UT and the UT/SA ratio. The results showed that activities of both the SA and UT were the highest for the scapular protraction exercise at $130^{\circ}$ shoulder flexion in the standing position. However, the UT/SA ratio was the lowest for the exercise at $90^{\circ}$ shoulder flexion in supine position. Therefore, for selective activation of the SA muscle, we recommend performing the scapular protraction exercise with a dumbbell in the supine position at $90^{\circ}$ shoulder flexion.

• Physical Therapy Korea
• /
• v.23 no.4
• /
• pp.38-46
• /
• 2016

Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE. Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain. Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention. Results: GSE resulted in significantly better shoulder stability (p=.046, from $8.67{\pm}7.54$ score to $13.93{\pm}9.40$) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472). Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.22 no.1
• /
• pp.51-58
• /
• 2016

Background: Evidence for effective management of scapular downward rotation syndrome is limited. The present study was performed to compare the scapular muscle activation through 4weeks wall slide exercise and sling slide exercise in subjects with scapular downward rotation syndrome. Methods: Twenty-two subjects with scapular downward rotation syndrome participated in the study. Surface electromyography data were collected from the upper and lower trapezius, serratus anterior and pectoralis major during shoulder flexion of $60^{\circ}$, $90^{\circ}$ and $120^{\circ}$ in the sagittal plane. The alignment of the scapula was measured using radiographic analysis. Subjects were assessed pre and post a 4 weeks exercise (wall slide, sling slide). The significance of the difference in pre- and post-exercise within each groups was assessed using a paired t-test. The significant difference between wall- and sling-exercise was used a independent t-test. Results: In the wall slide group, the muscle activity of upper trapezius decreased significantly during shoulder flexion at $60^{\circ}$, $90^{\circ}$ and $120^{\circ}$ after 4 weeks, and the muscle activity of serratus anterior increased significantly at all angles. Also, the muscle activity of pectoralis major decreased significantly at $90^{\circ}$ and $120^{\circ}$. Conclusions: Based on such results, it can be said that wall slide exercise is effective than sling slide exercise for the subjects with scapular downward rotation syndrome.

• Physical Therapy Korea
• /
• v.21 no.3
• /
• pp.73-79
• /
• 2014

The purposes of the current study were to (1) estimate the inter-rater agreement for visual assessment of scapular downward rotation (SDR), (2) develop the scapular downward rotation index (SDRI) as a method to measure SDR objectively and quantitatively, and (3) analyze the intra- and inter-rater reliability of the SDRI. Twenty subjects with scapular downward rotation syndrome (SDRS) were recruited for this study. The visual assessment and the measurement for the SDRI were conducted by two examiners in two sessions each. The SDRI [$(a-b){\div}a{\times}100$] is calculated with the measurement of two linear distances: One is a perpendicular distance from the root of the scapular spine to the thoracic mid-line (a), and the other is a perpendicular distance from the inferior angle of the scapula to the thoracic mid-line (b). Cohen's kappa coefficient was calculated to estimate the inter-rater agreement for visual assessment. Intra-class correlation coefficients (ICCs) with a 95% confidence interval (CI), the standard error of measurement, and minimal detectable differences were calculated to assess intra- and inter-rater reliability of SDR measurement using the SDRI. The results indicated that the kappa coefficient of inter-rater agreement for visual assessment was fair (${\kappa}=.21$). The intra-rater reliability of SDR measurement using the SDRI was excellent for examiner 1 (ICC=.92, 95% CI=.78~.97) and good for examiner 2 (ICC=.82, 95% CI=.55~.93). The inter-rater reliability was moderate (ICC=.73, 95% CI=.32~.89). These findings showed that SDR measurement using the SDRI for subjects with SDRS may be considered reliable and better than the visual assessment.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.15 no.1
• /
• pp.32-40
• /
• 2009

Purpose: The purposes of this study were to determine the intertester and intratester reliabilities of the Lateral Scapular Slide Test (LSST) method, and to examine if significant differences existed in scapular positions among the pain groups (right-shoulder pain group, left-shoulder, pain group and both-shoulders pain group). 27 female subjects (mean age = 51.6, mean height = 157.7 cm, mean weight = 57.5 kg) with shoulder pain were recruited for this study. Methods: The bilateral distances between the root of the scapular spine and T3/4 (RSS), and between the inferior scapular angle and T7/8 (IA), were recorded. Subjects were tested at three positions: the with arms with abducted at 0, 45 and 90 degrees in the coronal plane. The LSST measurements were performed by two testers, selected randomly. Results: The results were as follows: Intraclass correlation coefficients (ICCs) for the intertester reliability were excellent (ICC 0.78-0.94). And the ICCs for the intratester reliability were excellent (ICC 0.83-0.99). In the right-shoulder and both-shoulders pain groups, the right-side RSS and IA values of right side were significantly greater than of the left-side RSS values left side for the arms abducted at 0 degrees of right shoulder pain group and both shoulder pain group (p<.05). However, the side-to-side difference was less than 1.5 cm. Conclusion: Our results suggest that the LSST is highly reliable in identifying the abnormal scapular position of patients with shoulder problems. Future research should be continued to clarify the clinical usefulness of this method.