• Physical Therapy Korea
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• v.14 no.4
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• pp.58-65
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• 2007

The purpose of this study was to investigate the effects of serratus anterior strengthening exercises on scapular position and Visual Analog Scale (VAS) pain measurements taken at the resting position in young adults with adducted scapular. The exercise program included stretching of the scapular retractor and strengthening of the serratus anterior muscle. We measured the distance from the midline of the thorax to the vertebral border of the scapular with a tape line (Superior Kibler), and the distance from the 7th cervical spinous process to the acromial angle with 3-dimension motion analysis system, to compare the resting scapular position before and after exercise. Fifteen subjects with adducted scapular were recruited to compare the resting scapular position and VAS. The distance from 7th cervical spine process to acromial angle of the scapular and VAS decreased significantly (p<.01) after exercise, while the distance from the midline of the thorax to vertebral border of the scapular increased (p<.05). The conclusion is that the serratus anterior exercise program altered the resting scapular position and decreased VAS.

• Physical Therapy Korea
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• v.24 no.3
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• pp.30-39
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• 2017

Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.

• The Korean Journal of Pain
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• v.32 no.4
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• pp.307-312
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• 2019

Background: The aim of this study was to clarify the topographical relationships between the dorsal scapular nerve (DSN) and the dorsal scapular artery (DSA) in the interscapular region to identify safe and convenient injection points related to DSN blockade. Methods: Thirty shoulders of embalmed Korean cadavers and 50 live subjects were used for dissection and ultrasound (US) analysis. Results: The running patterns of the DSA and DSN in the interscapular region were classified into 3 types. Type I was defined as nerves that were medial to the artery and parallel without changing location (80.0% of specimens). In type II (13.3%), the nerve and artery traversed one another only one time over their entire length. In type III (6.7%), the nerve and artery traversed one another, resembling a twist. Above the level of the scapular spine, the nerve was always medial to the artery. Below the scapular spine, the number of arteries was obviously decreased. Most of the arteries were lateral to the medial border of the scapula, except at the level of the superior angle of the scapula artery (SA). The positional tendency of the DSN toward the medial or lateral sides from the medial border of the scapula was similar. In US imaging of live subjects, the DSA was most observed at the level of the SA (94.0%). Conclusions: Results of this study enhance the current knowledge regarding the pathway of the DSN and DSA and provide helpful information for selective diagnostic nerve blocks in the interscapular region.

• The Journal of Korean Medicine
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• v.21 no.4
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• pp.148-158
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• 2000

Objective : The purpose of this study was to investigate the back shape of school children using the phase-shifting scanning grating projection moire interferometer, which was developed by the Korea Advanced Institute of Science and Technology and is useful in evaluating three dimensional back shape. Methods : In this study the subjects consisted of 1,358 pupils [711 boys(52.36%), 647 girls(47.64%)] attending elementary and middle schools in Seoul. Their ages ranged from nine to fifteen and the average age was 12.2. With the phase-shifting scanning grating projection moire interferometer, the posterior view of the body were taken to see if there are correlations of moire fringe number, width difference between left and right, and correlation between differences in moire fringe number and width on both sides in the scapular, lumbar and gluteal regions. Results : The results were as follows : I. More frequent findings of fringe were observed on the right in all regions : in the scapular region, 309 boys(43.4%) and 156 girls(24.2%) had more fringe numbers on the right side; in the lumbar region, 68 boys(9.5%) and 11 girls(1.7%); and in the gluteal region, 160 boys(22.4%) and 63 girls(9.8%). Such tendency was striking especially in the scapular and lumbar regions, and in boys rather than in girls. In the scapula, 661 subjects(48.7%) with one moire fringe on either side need further attention and 110 subjects(8.I %) with two or more are required to do follow-up radiography for scoliosis. 2. In an analysis of width difference in the trunk, the left side is wider in all regions except for the gluteal region in boys : in the scapular region 21 boys(3.0%) and 103 girls(15.9%); in the lumbar region, 87 boys(12.2%) and 250 girls(38.6%); and in the gluteal region 197 girls(30.4%) had a wider left side and 45 boys(6.3%) showed a wider right side. 3. In correlation analysis of the number of moire fringe and width difference in each region, the side where more moire fringes were observed was significantly wider in the lumbar and gluteal regions, but not in the scapular region.(p<0.01) Conclusions : From these results, it is concluded that the back shape of elementary and middle school students in Seoul shows that the right side had more moire fringes; the left side was wider; and especially in the lumbar and gluteal regions the side where more moire fringes were observed was wider.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.20-27
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• 1998

Among many kinds of introduced free flaps, scapular freeflap is one of the most popularly using modalities in fasciocutaneous defect coverage with minimal donor defect and easier procedure and constant vascular patterns of the donor. Many surgeons who had experience of this flap pointed out deficit of the reliable sensation of the transplanted flap is the main shortcoming of the scapular free flap. If we can subjugate that point, scapular free flap is the most excellent procedure in such a cases as heel pad reconstruction and hand reconstruction which are relatively important to have skin with protective sensation. Author performed anatomical literature review, 10 cadaveric dissections and 12 clinical dissections. In surgical anatomical aspect, the upper six dorsal rami of the thoracic nerves have medial branches which pierce Longissimus thoracis and Multifidus muscle with small cutaneous twigs which pierce Latissimus dorsi and Trapezius muscle. Among that cutaneous twigs, several twigs distribute to the skin of the back from midline to lateral aspect which territory is identical to scapular free flap. We analysed clinical experiences of that sensory bearing scapular free flap surgical anatomy and one year follow-up studies with several results. 1) Two to three cutaneous twigs which pierced from the Trapezius muscle over the scapular free flap region. 2) Each twigs has two to four nerve fascicles with small artery. 3) The nerve distributed to the ordinary scapular free flap and large enough size and pedicle length to neurorrhapy with various recipient site nerves. 4) The inconvenience of this procedure is the vascular pedicle and nerve pedicle have opposite directions, vascular pedicle of that comes from lateral direction from subscapular vessels, but nerve pedicle comes from medial direction from trapezius muscle. Author can found constant cutaneous nerve branches which come from piercing the Trapezius. This nerves are helpful for protective sensation in transplanted scapular free flap. We can't had enough follow-up and evaluation of the nerve function of this procedure, we need continuous research works to application of this procedure. The in conveniences come from directional differences of pedicle can solve with longer harvest neural pedicle and change direction of the neural pedicle.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.14 no.2
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• pp.1-15
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• 2008

Purpose : This survey was to investigate on the effect of each region changed in trunk through sagittal plane after Trunk Flexion-Extension Exercise. Methods : 18 students of Gimcheon College participated in this study for the period of July 9-30, 2007. Analyzed factor were 1) degree of pain 2) presence of Gillet test and 3) difference of right-left for 7 landmark region in trunk applying I.B.S.-2000 after Trunk Flexion - Extension Exercise. We used the SPSS $PC^+$ program for classifying into analysis of frequency, $x^2$-test, t-test and Simple Linear Regression analysis test. Results: Followings are concluded For degree of pain, 13(72.2%) of students answered "No pain" after Trunk Flexion-Extension Exercise and in the result 4 more students decreased the pain. In the Gillet test, 14(77.8%) of students answered "positive" after Trunk Flexion-Extension Exercise and in the result 4 more students increased mobility of Sacroiliac joint. In the differences of right-left for 7 landmark region in trunk by B.M.I. scale, Slim type was decreased both Acromion(0.45mm), both Iliac crest(0.44mm), and both ASIS(0.31mm) to anterior plane, Normal type was decreased both inferior angle of Scapular(0.02mm), both L4-5(0.07mm), and both PSIS(0.09mm) to posterior plane Fatness type was decrease both Acromion(0.05mm), both ASIS(0.05mm) to anterior plane. In the differences of right-left for 7 landmark region in trunk for degree of pain No pain group was decreased both Acromion(0.17mm), both Nipple(0.25mm) to anterior plane and both PSIS(0.13mm) to posterior plane Pain group was decreased both Acromion(0.04mm), both Iliac creast(0.03mm) to anterior plane and both inferior angle of Scapular(0.18mm) both PSIS(0.13mm) to posterior plane. In the difference of right-left for 7 landmark region in trunk for each of the exercises, Both iliac crest(0.1mm), both ASIS(0.12mm) to anterior plane were decreased after Flexion Trunk Exercise. Both acromion(0.27mm) to anterior plane, both inferior angle of scapular(0.14mm) and both PSIS(0.12mm) to posterior plane were decreased after Extension Trunk Exercise. Each of the exercises, The both inferior angle of Scapular showed high scores($0.65{\pm}0.23$) at Trunk Extension Exercise group and there was statistical significance between Trunk Flexion Exercise group and Extension exercise group(t :-2.502, p < 0.05). 7. At Pre-exercise group, Both inferior angle of Scapular showed low scores($0.23{\pm}8.27$) at Trunk Extension Exercise group and there was statistical significance between Pre- Exercise group and Trunk Extension Exercise group(t :-2.5430, p<0.05). Conclusion : The simple linear regression analysis was presented at Acromion(-0.243), L4-5(-0.753), PSIS(0.576) and there was statistical significance in BMI scale(p<0.01).

• The Journal of Korean Physical Therapy
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• v.26 no.3
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• pp.140-146
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• 2014

Purpose: Differences in scapular kinematics and muscle activity appear in the forward head and rounded shoulder posture (FHRSP). Thus, the aim of this study was to investigate the following effects according to different postures on scapular kinematics and muscle activity around scapular region in individuals with and without FHRSP during overhead reaching task. Methods: Thirty pain-free subjects with/without FHRSP participated in this study. All subjects were positioned into three positions: habitual head posture (HHP), self-perceived ideal head posture (SIHP) and therapist-perceived neutral head posture (TNHP). Muscle activities of upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) were measured during overhead reaching task. Results: Muscle activity of trapezius muscle (UT and LT) during HHP was significantly higher than SIHP and TNHP in FHRSP group (p<0.05), but there was no difference between SIHP and TNHP. SA also significantly increased muscle activity in HHP more than SIHP and TNHP in FHRSP group (p<0.05), but there was no significant difference between SIHP and TNHP. In Non-FHRSP group, although there was a tendency of different muscle activities among three postures, it was not statistically significant. Conclusion: This result demonstrates that muscle activity associated with overhead reaching task is increased in HHP which affects the scapular kinematics and SIHP contributes changed scapular kinematics and proper recruitment of muscle activity in FHRSP similarly to TNHP.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.9 no.2
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• pp.69-77
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• 2003

Objective: The purpose of this study is to describe the effect of the serratus anterior muscle exercise in a patient with winging of the scapular. Background and Purpose: The patient was a 33-year-old man with an 3 years history of the left deltoid region. He had not responded to previous treatments of rest, TENS and medicine. Materials and Methods: After Surgical operation of the shoulder, the patient was treated for 6 months in 144 visits. treatment consisted of push-up with plus in the standing position with his hands against the wall and unique push-up with quadruped position at mat. Also, Sling exercise therapy was utilized to control scapular stabilization and reduce stress on the scapulohumeral joint. Result: Following 104 physical therapy visits, the patient was able to full range of motion of the shoulder without shrug motion. Conclusion and Discussion: Scapular winging and serratus anterior muscle function are important consider in the rehabilitation of the shoulder dysfunction. Therefore, specific exercise program for people with the winging scapular should be considered.

• The Journal of Pediatrics of Korean Medicine
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• v.17 no.2
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• pp.55-74
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• 2003

Objective : The purpose of this study was to investigate the back shape and self-conscious symptoms of the students in S High school using the phase-shifting scanning grating projection Moire interferometer and Questionnaire investigations. Methods : In this study the subjects consisted of 317 pupils[168 boys(53%), 149girls(47%)] attending S high school in Sungnamsi, Kyoungkido in 2002. Their ages ranged from sixteen to eighteen. With the phase-shifting scanning grating projection moire interferometer, the posterior views of the body were taken to see if there are correlation of remainder value of the height spot of left & right shoulder blade and gluteal region in Moire topography. And using questionnaire investigation, we investigated the self-conscious symptoms. Results : 1. In questionnaire investigation, we observed that the ratios of self-conscious symptoms of girls are more than that of boys. The ratios of headache, neck pain, lower back pain, digestive symptom were more than 70% in boys and girls. 2. In Moire topography, more frequent findings of scapular region were observed that left scapular area were higher than right(in boys 69.3%, 60%, 100%, aged 16,17,18, in girls 66.8%, 40.5%, 58.8% aged 16,17,18). 3. More frequent findings of gluteal region were observed that left scapular area were higher than right(in boys 75.2%, 60%, 36.4% aged 16,17,18, in girls 61.1%, 46.8%, 64.7% aged 16,17,18) 4. More frequent findings of reminder value of the vertical lines of cervical and buttock region in Moire topography were observed that the vertical lines of cervical region were inclined to left than the vertical lines of buttock(in boys 73.3%, 92.2%, 100% aged 16,17,18, in girls 72.2%, 77.2%, 73.5% aged 16,17,18) Conclusion : From these results, we found that the self-conscious symptoms were more than in girls than boys; the ratio of headache, neck pain, Lower back pain, digestive symptom was more than the others; the back shape of high school students were not balanced in scapular and buttock region; necks were inclined to left than buttock.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.307-311
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• 1979

Bronchogenic carcinoma with subcutaneous metastasis is rare, and the incidence ranged from 1.0 to 3.0 %. Therefore metastatic nodules are incidental findings in some instances. The distribution in order of frequency Is as follows: chest wall, scapular region, abdominal wall, course of spine, upper extremities and scalp etc, and mos. of nodules are between 0.5-2.0 cm in diameter. In this report, we present one case of a 54 year old male having bronchogenic carcinoma (squamous cell type) with multiple subcutaneous metastases. The metastatic nodules were located in subcutaneous tissue of right posterior chest wall ($4{\times}5$ cm), frontal scalp area (two; $2{\times}3$ cm, $0.5{\times}0.5$ cm), left scapular region ($1{\times}1$ cm) and left iliac crest ara ($1{\times}11$ cm).