• Clinics in Shoulder and Elbow
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• 제12권2호
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• pp.271-277
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• 2009

목적: 그동안 견관절과 견봉하 관절에 대한 연구는 전세계적으로 매우 많은 연구가 이루어져 왔고 많은 의사들의 관심분야로 각광받아왔다. 그러나 그에 비해서 견갑골과 그 주위근육들은 상대적으로 관심의 대상이 되어오지 못한 것이 사실이다. 이에 저자들은 견갑골의 운동장애에 대하여 기술해 보고자 하는 것이 목적이다. 대상 및 방법: 기본적으로 견관절의 움직임은 언제나 견갑골의 운동을 동반하게 되어있고, 견관절의 운동에 이상이 발생하면 이는 직접적으로 견관절 움직임에도 영향을 미칠 수 밖에 없다는 것은 이미 널리 알려진 사실이다. 결과 및 결론: 특히 운동선수에 있어서는 견갑골의 움직임과 견고한 고정이 매우 중요한 역할을 차지하게 된다. 이에 저자들은 견갑골의 움직임과 중요성에 대해서 조명해보고자 한다.

• PNF and Movement
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• 제4권1호
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• pp.1-7
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• 2006

Objective : The purpose of this study was conducted to find scapular movement instability related with shoulder complex and provide strengthening the scapular muscles with proprioceptive neuromuscular facilitation(PNF). Methods : This is a literature study with books and articles, seminar note and book for PNF international course. Results : The scapular serve as the platform for humeral motions. The scapulothoracic articulation is stabilized and controlled, in part, by the scapular muscles. Therefore, if scapular muscle function is altered, then dysfunctional scapulothoracic kinematics may result. Strengthening exercise for scapular muscles are a common part of rehabilitation programs designed for patients with scapular instability. Conclusion : Treatment of the scapular instability is provided. It is that treatment with combination of isotonic, stabilize reversal on different patient's positions.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.248-253
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• 2015

Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

• 대한물리의학회지
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• 제8권1호
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• pp.41-48
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• 2013

PURPOSE: This study was to determine the effect of the plane of movement (sagittal plane vs. scapular plane) and shoulder flexion angle ($90^{\circ}$ vs. $130^{circ}$) during scapular protraction exercises in healthy subjects by investigating the elecromyographic (EMG) activities of the serratus anterior (SA), upper trapezius (UT), and pectoralis major (PM). METHODS: Twenty-one healthy subjects participated in this study. Subjects performed maximal scapular protraction at the $90^{\circ}$ or $130^{\circ}$ shoulder flexion angles in the sagittal or scapular planes. Surface EMG was recorded from the SA and UT, and PM muscles. Dependent variables were examined by 2 (plane) ${\times}$ 2 (angle) repeated measures of analysis of variance (ANOVA). RESULTS: Significantly increased EMG activities in the SA and UT were found during scapular protraction exercise at the $130^{\circ}$ shoulder flexion angle in the sagittal and scapular plane. Also, EMG activity of the PM significantly decreased at the $130^{\circ}$ shoulder flexion angle in the sagittal plane and the $90^{\circ}$ and $130^{\circ}$ shoulder flexion in the scapular plane. CONCLUSION: we recommend scapular protraction exercise at the $90^{\circ}$ shoulder flexion in the sagittal plane to selectively strengthen the SA muscle with limitation of upper trapezius activity and at the $130^{\circ}$ shoulder flexion in the scapular plane to selectively strengthen the SA muscle with limitation of pectoralis major activity.

• PNF and Movement
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• 제14권2호
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• pp.113-120
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• 2016

Purpose: The purpose of this study was to compare the intramuscular activation of the scapular stabilizing muscles and the upper trapezius/middle serratus anterior (UT/MSA) ratios during shrug exercise and proprioceptive neuromuscular facilitation (PNF) scapular pattern exercise. Methods: The participants of this study were 13 young adult men who voluntarily consented to participate in this experiment after listening to its purpose and methods. All participants were instructed on maximal voluntary isometric contraction and scapular exercises. The intramuscular activation of the upper trapezius (UT), lower trapezius (LT), middle serratus anterior (MSA), and lower serratus anterior (LSA) muscles while performing scapular exercises in a side-lying position were measured using surface electromyography. To analyze the muscle activation and UT/MSA ratio between the two exercises, a one-way repeated ANOVA was performed. Post-hoc analyses were conducted using Tukey's multiple comparison and analysis. Hamstring flexibility for each group was measured by a passive straight leg raising test. Results: The shrug exercise showed significantly higher UT activation compared to PNF anterior elevation and posterior elevation scapular patterns. The PNF scapular anterior elevation pattern showed significantly higher serratus anterior activation than the shrug exercise. Additionally, the UT/MSA ratios were significantly lower in the PNF scapular anterior elevation pattern than in the two exercises. Conclusion: Although shrug exercise was effective for strengthening UT, the PNF scapular anterior elevation pattern may be effective for strengthening MSA and improving the UT/MSA ratio.

• PNF and Movement
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• 제19권1호
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• pp.19-29
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• 2021

Purpose: This study aimed to compare the effects of a four-week scapular stabilization exercise program using the PNF technique on scapular symmetry and range of flexion motion (ROM), pain, function, and quality of life (QOL) in post-mastectomy women with breast cancer. Methods: This study included 20 women divided into an experimental group (n = 10) and a control group (n = 10). All patients performed complex decongestive physiotherapy for 40 min daily, five times per week for four weeks. The experimental group performed the extra scapular stabilizing exercise program using the PNF technique for 50 min daily, five times per week for four weeks. Scapular symmetry, shoulder flexion ROM, pain and function, and QOL were subsequently assessed. For ROM measurement, the range of shoulder flexion was measured using a clinometer smart phone application; the pain of the shoulder was measured using the visual analogue scale (VAS); the scapular position was measured using a lateral scapular slide test (LSST); the level of pain and functional activity was measured using the Shoulder Pain and Disability Index (SPADI); and the QOL was measured using Functional Assessment of Cancer Therapy-Breast. Results: There were significant differences in shoulder flexion ROM, VAS, SPADI, and LSST 0˚ and 45˚ when the experimental group was compared with the control group (p < 0.05). After the intervention, there was an improved within-group change in the ROM, SPADI, LSST, and QOL in both the experimental and control groups. Conclusion: These findings suggest that a scapular stabilization exercise program using the PNF technique may be used as a possible treatment option for post-mastectomy women with breast cancer that aims to improve scapular position, shoulder ROM and function, and QOL.

• 한국전문물리치료학회지
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• 제17권2호
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• pp.10-16
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• 2010

This study was undertaken to develop the scapulometer, a measuring tool for scapular winging, and to determine the reliability of scapulometer. Thirty subjects with scapular winging greater than 2 cm participated in this study. Two examiners measured scapular winging using the scapulometer. Standardized measurement position of each subject was as follows: neutral position of shoulder and wrist, $90^{\circ}$ flexion of elbow, and cuff weight of 5% and 10% of body weight (BW) to neutral wrist. The interrater and intrarater reliability were calculated with an intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and standard error of measurement (SEM) at 5% BW and 10% BW. The level of scapular winging was tested between 5% BW and 10% BW with a paired t-test. The interrater reliability was shown to be high at 5% BW (ICC(2,k)=.955, 95% CI=.900~.979, SEM=.07) and at 10% BW (ICC(2,k)=.968, 95% CI=.930~.985, SEM=.06). The intrarater reliability was shown to be high at 5% BW (ICC(2,k)=.921, 95% CI=.842~.961, SEM=.09) and at 10% BW (ICC(2,k)=.906, 95% CI=.813~.954, SEM=.10). The level of scapular winging was significantly different between 5% BW and 10% BW. Conclusively, it is demonstrated that the scapulometer is an objective and qualitative measurement tool for scapular winging.

• 한국전문물리치료학회지
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• 제26권4호
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• pp.53-62
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• 2019

Background: Shoulder function is achieved by the coordinated movements of the scapula, humerus, and thoracic spine, and shoulder disorders can be associated with altered scapular kinematics. The trunk plays an important role as the kinematic chain during arm elevation. Objects: The purpose of this study was to determine the effects of thoracic hyperkyphosis on scapular orientation and trunk motion. Methods: Thirty-one subjects (15 in the ideal thorax group and 16 in the thoracic hyperkyphosis group) performed right-arm abduction and adduction movements in an unconstrained plane. The scapular orientation and trunk motion were recorded using a motion analysis system. Results: Those subjects with thoracic hyperkyphosis displayed greater scapular posterior tilting at a $120^{\circ}$ shoulder elevation, greater scapular internal rotation throughout the arm raising phase, and greater trunk axial rotation at the upper ranges of the shoulder elevation, compared to those subjects with an ideal thorax (p<.05). Conclusion: Thoracic hyperkyphosis can cause scapular instability, greater trunk rotation and greater scapular posterior tilting, and may contribute to preventing the achievement of a full range of humeral abductions in an unconstrained plane.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.113-119
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• 2018

Background: This study was undertaken to evaluate the positional relationship between planes of the glenoid component (the scapular plane and the perpendicular plane to the glenoid) and its surrounding structures. Methods: Computed tomography (CT) images of both shoulders of 100 patients were evaluated using the 3-dimensional CT reconstruction program ($Aquarius^{(R)}$; TeraRecon). We determined the most lateral scapular bony structure of the scapular plane and measured the shortest distance between the anterolateral corner of the acromion and the scapular plane. The distance between the scapular plane and the midpoint of the line connecting the posterolateral corner of acromion and the anterior tip of the coracoid process (fulcrum axis) was also evaluated. The perpendicular plane was then adjusted to the glenoid and the same values were re-assessed. Results: The acromion was the most lateral scapular structure of scapular plane and perpendicular plane to the glenoid. The average distance from the anterolateral corner of the acromion to the scapular plane was $10.44{\pm}5.11mm$, and to the plane perpendicular to the glenoid was $9.55{\pm}5.13mm$. The midpoint of fulcrum axis was positioned towards the acromion and was measured at $3.90{\pm}3.21mm$ from the scapular plane and at $3.84{\pm}3.17mm$ from the perpendicular plane to the glenoid. Conclusions: Our data indicates that the relationship between the perpendicular plane to the glenoid plane and its surrounding structures is reliable and can be used as guidelines during glenoid component insertion (level of evidence: Level IV, case series, treatment study).

• 한국전문물리치료학회지
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• 제23권3호
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• pp.68-75
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• 2016

Background: Shoulder horizontal adduction (HA) is performed in many activities of daily living. The limited range of motion (LROM) of HA is affected by the tightness of the posterior deltoid, infraspinatus, teres major, and posterior capsule of glenohumeral joint. The LROM of shoulder HA contributes to excessive scapular abduction. Objects: The aim of this study is to compare the scapular abduction distance and three-dimensional displacement of the scapula during shoulder horizontal adduction between subjects with and without the LROM of shoulder HA. Methods: 24 subjects (12 people in LROM group and 12 people in normal ROM group) participated. Subjects with less than $115^{\circ}$ of HA ROM were included in LROM group. Shoulder HA was performed 3 times for measuring scapular abduction distance and three-dimensional displacement of the scapula. Tape measure was used for measuring scapular abduction distance. Scapular abduction distance was normalized by dividing the scapular size. Polhemus Liberty was used for measuring the three-dimensional displacement of the scapula. Results: Normalized scapular abduction distance was significantly greater in LROM group than normal ROM group (p<.001). Three-dimensional displacement of the scapula during shoulder HA was greater in LROM group than normal ROM group (p<.05). Conclusion: LROM group had a greater scapular abduction and three-dimensional displacement of the scapula during shoulder HA compared to normal ROM group.