• 산업융합연구
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• 제19권3호
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• pp.83-90
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• 2021

본 연구는 어깨뼈 기능이상이 있는 사무직원에 대해 어깨뼈 안정화 운동과 등뼈관절가동술을 시행한 후 어깨뼈의 위치와 움직임 및 어깨기능장애지수에 미치는 영향을 분석하기 위한 목적으로 실행되었다. 연구 대상자는 충남의 N대학에서 근무하는 사무직원 중에서 어깨뼈 기능이상 검사(Scapular Dyskinesis Test, SDT)를 하여 이에 해당되는 42명을 연구 대상자로, A그룹은 어깨뼈 안정화운동 적용군(N=14), B그룹은 등뼈관절가동술 적용군(N=14), 그리고 C그룹은 어깨뼈 안정화운동과 등뼈관절가동술을 결합한 실험군(N=14)으로 나누었다. 각 중재는 4주간 주 3회, 회당 25분씩 총 12회 실시하였다. 연구 결과, 어깨뼈 위치 변화의 그룹 간 비교에서는 C그룹이 다른 그룹에 비해 유의한 차이가 있었다(p<.05). 어깨뼈 움직임의 변화에서 위팔뼈 벌림 45°에서는 C그룹이 다른 그룹과 비교하여 그룹 내 및 그룹 간 비교에서 유의한 차이를 보였다(p<.001). 벌림 90°에서도 C그룹이 그룹 내 및 그룹 간 비교에서 유의한 차이를 보였다. 어깨기능장애지수(Shoulder pain and disability index, SPADI)에서는 C그룹이 다른 그룹에 비해 유의한 차이를 보였다(p<.05). 본 연구의 결과, 어꺠뼈 안정화운동과 등뼈관절가동술의 결합은 어깨뼈 기능이상이 있는 사무직원의 어깨뼈 위치와 움직임 그리고, 상지기능장애지수의 향상에 유의한 효과가 있었다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2009년도 제17차 학술대회
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• pp.208-208
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• 2009

Eleven shoulders (9 patients) with refractory scapulothoracic dysfunction were treated with scapulothoracic arthrodesis between 2000 and 2006. Refractory shoulder dysfunction included facioscapulohumeral muscular dystrophy in five shoulders (3 patients), refractory scapular winging with long thoracic nerve palsy in one shoulder, scapular winging caused by serratus anterior palsy with trapezius dysfunction in one shoulder, post-surgical thoracic outlet syndrome due to medial clavicle resection in two shoulders, refractory scapular winging with spinal accessory nerve injury in one shoulder, and chronic trapezius rupture caused by cervical spine surgery in one shoulder. The mean active flexion was improved from 82 degrees preoperatively to 112 degrees postoperatively. The mean Constant score was improved from 27.2 points to 68.0 points. Two shoulders (1 patient) that had facioscapulohumeral muscular dystrophy had broken wires due to nonunion, and one patient had a reactive pulmonary effusion. In ten of the eleven shoulders, the patients were satisfied with their results. The scapulothoracic arthrodesis can cause significant pain relief and functional improvement in refractory scapulothoracic and/or shoulder dysfunction. By selecting patients that present with appropriate indications, and using experienced surgical technique through complete preoperative evaluation, we can diminish the complication rate and make good clinical outcomes.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.229-236
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• 2015

Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range, $20^{\circ}-165^{\circ}$) preoperatively to $151^{\circ}$ (range, $125^{\circ}-170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.

• 대한임상전기생리학회지
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• 제10권2호
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• pp.23-29
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• 2012

Purpose : Purpose of this study was to investigate whether cervicothoracic posture was associated with scapula orientation and muscle activity during shoulder abduction. Methods : Cervicothoracic junction angle and thoracic kyphosis angle were measured in health twenty subjects. Then, scapular resting orientation and range of motion (upward/downward rotation, internal/external rotation) and muscle activity (upper trapezius, lower trapezius, serratus anterior) was determined using motion capture system and surface electromyography while subjects performed shoulder abduction. Results : Cervicothoracic junction angle was significantly associated with range of motion of scapular internal/external rotation during shoulder abduction. Thoracic kyphosis angle was significantly associated with scapular resting orientation of upward/downward rotation and average IEMG of lower trapezius. Conclusion : The result of this study shows that poor cervicothoracic posture is relationship with altered scapular kinematics cause of shoulder dysfunction. These findings suggested that cervicothoracic posture may be considered in occupation and exercise including arm elevation over head as well as used as predict factor to estimate shoulder dysfunction.

• 한국전문물리치료학회지
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• 제22권1호
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• pp.9-18
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• 2015

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, $n_1=30$), a shoulder surgery group (SS, $n_2=30$) and a control group ($n_3=30$). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.

• 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.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.53-53
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• 2008

Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed with split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Twenty-five patients had positive results for long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range 12~120 months). Four patients had non-traumatic etiologies and twenty-two patients had traumatic etiologies. At the final follow-up assessment for functional improvement, a Constant-Murley score was used. 21 patients were completely evaluated, while 5 patients who had less than 12 months follow-up were excluded. Pain relief was achieved in 19 of the 21 patients, with twenty patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range $20^{\circ}\sim165^{\circ}$) preoperatively to $151^{\circ}$ (range $125^{\circ}\sim170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range 21~86) preoperatively to 86.9 (range 42~98) postoperatively. A recurrence developed in one patient. Of the twenty-one patients, eight had excellent results, nine had good results, three had fair results, and one had poor results. Most patients with severe symptomatic scapular winging had functional improvement and pain relief with resolution of scapular winging.

• 대한정형도수물리치료학회지
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• 제9권2호
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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.

• 한국운동역학회지
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• 제21권2호
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• pp.243-252
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• 2011

The purpose of this study was to determine the effect of trunk posture on muscle activity and motion of scapular and scapulohumeral rhythm. Thirty-one healthy subjects performed right-arm abduction and adduction along the frontal plane while standing in both upright and flexed posture of trunk. Scapular upward rotation, anterior tilting and internal rotation ware recorded using a motion analysis system and muscle activity of upper trapezius, lower trapezius and serratus anterior ware recorded using surface electromyography during abduction and adduction in both trunk postures. then, scapulohumeral rhythm was calculated. Scapulohumeral rhythm and scapular posterior tilting in flexed posture was significantly decreased than in upright posture. Also, muscle activity of lower trapezius in flexed posture was significantly increased and serratus anterior was significantly decreased than in general posture. The result of this study revealed that flexed posture of trunk altered the muscle activity and kinematic of scapular. Measurement of trunk posture should be included the evaluation of dysfunction and disorder of shoulder girdle since rehabilitation of trunk posture is important to restore of upper limbs function.

• 한국전문물리치료학회지
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• 제28권4호
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• pp.256-265
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• 2021

Background: Individuals with scapular winging may have proprioceptive dysfunction which is important for motor control and causes shoulder instability. Reduced serratus anterior (SA) and lower trapezius (LT) muscle activity accompanied by over-active upper trapezius (UT), and pectoralis major (PM) may be contributing factors. Flexi-bar (FB) exercise may be used to increase joint position sense (JPS) and alter the target muscle activities. Objects: This study aimed to investigate the immediate effects of flexi-bar exercise prior to knee push-up plus (FPK) versus knee push-up plus (KPP) on JPS and muscle activity of SA, LT, UT, and PM in subjects with scapular winging. Methods: Eighteen subjects with scapular winging were recruited. JPS was investigated at baseline, after KPP and after FPK. Passive and active JPS errors were calculated by isokinetic equipment. Surface electromyography was used to record muscle activities during KPP and FPK. One-way repeated-measures analysis of variance and post hoc analyses were used to analyze the JPS error measured at baseline, after KPP and after FPK. Paired t-tests were used to compare muscle activities between KPP and FPK. Results: Passive JPS error was significantly decreased after KPP (p = 0.005) and after FPK (p = 0.003) compared to the baseline. Active JPS error was also significantly decreased after KPP (p = 0.016) and after FPK (p = 0.012) compared to the baseline. There was no significant difference in the passive and active JPS errors between KPP and FPK. SA activity during FPK was significantly increased (p = 0.024), and LT activity during FPK was significantly increased (p = 0.006). There were no significant differences in the UT and PM activity. Conclusion: FB might be recommended to immediately improve passive and active JPS and to selectively increase SA and LT muscle activities during KPP in individuals with scapular winging.