• Korean Journal of Applied Biomechanics
• /
• v.31 no.3
• /
• pp.155-161
• /
• 2021

Objective: There is a lack of studies using the 3D-2D image registration techniques on the mechanism of a shoulder injury for ice hockey players. This study aimed to analyze in vivo 3D glenohumeral joint arthrokinematics in collegiate ice hockey athletes and compare shoulder scaption with or without a hockey stick using the 3D-2D image registration technique. Method: We recruited 12 male elite ice hockey players (age, 19.88 ± 0.65 years). For arthrokinematic analysis of the common shoulder abduction movements of the injury pathogenesis of ice hockey players, participants abducted their dominant arm along the scapular plane and then grabbed a stick using the same motion under C-arm fluoroscopy with 16 frames per second. Computed tomography (CT) scans of the shoulder complex were obtained with a 0.6-mm slice pitch. Data from the humerus translation distances, scapula upward rotation, anterior-posterior tilt, internal to external rotation angles, and scapulohumeral rhythm (SHR) ratio on glenohumeral (GH) joint kinematics were outputted using a MATLAB customized code. Results: The humeral translation in the stick hand compared to the bare hand moved more anterior and more superior until the abduction angle reached 40°. When the GH joint in the stick hand was at the maximal abduction of the scapula, the scapula was externally rotated 2~5° relative to 0°. The SHR ratio relative to the abduction along the scapular plane at 40° indicated a statistically significant difference between the two groups (p < 0.05). Conclusion: With arm loading with the stick, the humeral and scapular kinematics showed a significant correlation in the initial section of the SHR. Although these correlations might be difficult in clinical settings, ice hockey athletes can lead to the movement difference of the scapulohumeral joints with inherent instability.

• Physical Therapy Korea
• /
• v.18 no.2
• /
• pp.76-83
• /
• 2011

The aim of this study was to determine the immediate effects of single treatment of strain-counter strain (SCS) on pressure pain threshold (PPT) and muscle activity during scapular plane abduction with 3% body weight load. Fifteen asymptomatic male adults with upper trapezius latent trigger point (LTrP) (PPT<2.9 $kg/cm^2$) participated in this study. Pressure algometer was used to measure PPT and surface electromyography was used to record upper, middle arid lower trapezius, serratus anterior, infraspinatus and middle deltoid muscle activity and relative ratio during scapular plane abduction between pre- and post-intervention. There was a significant increase in upper trapezius PPT after a 90-second SCS (p<.05). The activity of the upper trapezius and middle deltoid was significantly decreased (p=.014, p=.001), coupled with a decreased muscle activity ratio between the upper and lower trapezius (p<.05). These results indicate that the SCS may effectively deactivate upper trapezius activity, thereby alleviating muscle balance and reducing pain sensitivity.

• Archives of Reconstructive Microsurgery
• /
• v.5 no.1
• /
• pp.24-34
• /
• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Journal of the Korean Society of Physical Medicine
• /
• v.10 no.4
• /
• pp.113-121
• /
• 2015

PURPOSE: The purpose of this study was to determine the effect of shoulder external rotation on muscle activities of the scapular upward rotators during arm elevation. METHODS: Nineteen healthy subjects with no medical history of shoulder pain or upper extremity disorders were recruited for this study. Electromyography (EMG) was used to measure the muscle activities of the serratus anterior (SA), upper trapezius (UP), lower trapezius (LT) and infraspinatus (IS) muscles during arm elevation. The EMG activities were recorded while the subjects performed $90^{\circ}$ arm elevation with three different arm positions; palm down (PD), neutral position (NP), and palm up (PU). While seated in a chair, the subject was asked to raise the upper extremity in the sagittal plane in random order. Subjects performed $90^{\circ}$ arm elevations in three trials at each arm position. The mean EMG activity normalized by the maximal voluntary isometric contraction was analyzed across three arm positions. Repeated measures one-way ANOVA and the post hoc Bonferroni tests were used to determine the differences in muscle activities among the three arm positions. RESULTS: The EMG activities of the SA and IS were significantly greater in the PU condition than in the other conditions during arm elevation. No significant difference was noted between the NP and PD conditions during arm elevation. CONCLUSION: These results suggest that shoulder external rotation (palm up position) can be used to activate the SA. Therefore, we recommend a scapular protraction exercise in the palm up position for strengthening the SA.

• The Journal of Korean Physical Therapy
• /
• v.10 no.1
• /
• pp.213-221
• /
• 1998

The purpose of this study was a motion analysis of proprioceptive neuromuscular facilitation patterns which is scapular and pelvis patterns, upper extremity patterns, lower extremity patterns, trunk patterns. The patterns combine motion in sagittal plane for flextion and extension, coronal or frontal plane for abduction and adduction, transverse plane for rotation. The patterns composed of mass movement pattern of the limbs and trunk muscles. Every pattern can change by changing the activity of the middle joint in the extremity patterns and changing the patient's positions.

• Clinics in Shoulder and Elbow
• /
• v.15 no.2
• /
• pp.73-78
• /
• 2012

Purpose: Understanding exactly detailed anatomy and morphology of scapula is very important for further surgical procedures. This study was intended to provide accurate anatomic and morphologic information of scapula by exactly measuring scapular thickness using computed tomography and reconstructing its geometric model. Materials and Methods: Eight average lengths and two angles of 102 scapular structures obtained from 51 cadavers were generally measured by computed tomography. Also, to measure the scapular thickness, sagittal planes of each scapula were divided almost equally and the thicknesses of each sagittal plane was measured by computed tomography. After measuring every thickness, average results were calculated and the gender difference was compared by Student t-test. Results: Average results of the thickness of glenoid fossa, lateral border, medial border, and the middle 1/3 portion of the scapular body were 22.4 mm, 13.83 mm, 4.44 mm and 2.06 mm, respectively. Also, male scapulars were found to be significantly thicker than female. Based on these measured thicknesses, we reconstructed the 3-dimensional geometric model of scapula. Conclusion: From these results, glenoid fossa and lateral border were the thickest part of scapula, while the middle 1/3 portion of the scapular was the thinnest.

• Physical Therapy Korea
• /
• v.25 no.1
• /
• pp.62-70
• /
• 2018

Background: Sitting posture influences movements of scapulothoracic and glenohumeral joints and changes the shoulder muscle activities. The development and maintenance of correct sitting posture is important for the fundamental treatment of shoulder pain during rehabilitation. Objects: The purpose of this study was to investigate the effects of the sitting postures and the shoulder movements on shoulder muscle activities for both male and female. Methods: Twenty-eight subjects without shoulder-related diseases participated in this experiment. The subjects had randomly adopted three different sitting postures (upright posture, preferred posture, maximum slouched posture) and shoulder flexion angles in scapular plane ($30^{\circ}$, $90^{\circ}$, $120^{\circ}$). Surface electrodes were collected from upper trapezius (UT), anterior deltoid (AD), and posterior deltoid (PD) and the active shoulder range of motion was measured in each sitting posture and shoulder flexion angle. Results: The active range of motions of the shoulder external rotation and the flexion in the scapular plane decreased from the upright posture to the maximum slouched posture (p<.05, mixed-effect linear regression with random intercept, Tukey post-hoc analysis). All muscles showed the highest EMG activities at $120^{\circ}$ shoulder flexion with the maximum slouched posture and did not show the gender differences. Conclusion: Increased shoulder muscle activities may become the potential risk factor for the shoulder impairment and pain if people continuously maintain the maximum slouched posture. Therefore, an upright position is necessary during shoulder exercises, as well as in activities of daily living, including motions involving lifting the arms.

• Clinics in Shoulder and Elbow
• /
• v.1 no.2
• /
• pp.221-229
• /
• 1998

We measured, with manual goniometer, the active and passive arc of motion of the shoulder in 31 healthy male subjects who were right-hand dominant and who ranged in age from twenty to thirty-one years. Among ten directions through the four motion plane, the range of motion on the dominant side were significantly smaller than those on the non-dominant side in the motion of six directions. We also measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement(θGH/θST) was 1.6 for the full range of motion in scapular plane. At the lower angles of abduction, scapulothoracic movement was slight compared with glenohumeral movement. The motion fraction of scapulothoracic joint was increased from 60-degree to 150 degree of arm angle especially between 120 to 150 degree. During arm elevation, scapula was also extended from 42 degrees to 20 degrees tilting as well as internal rotation. The measuring technique of glenohumeral to scapulothoracic movement(θGH/θST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment.

• Physical Therapy Rehabilitation Science
• /
• v.6 no.4
• /
• pp.208-213
• /
• 2017

Objective: Despite reliable evidence of abnormal scapular motions increases, there is not yet sufficient evidence of abnormal humeral translations. This study aims to analyze the motion of the humeral head toward the scapula when the shoulder is actively abducted using the C-arm. Design: A case report. Methods: The participant was a healthy man without any limitation and pain during shoulder movement. The participant's shoulder was abducted; this movement in the frontal plane was measured using a C-arm (anterior-posterior view) and was analyzed with computer-aided design. The starting posture was $15^{\circ}$, and as the participant abducted his shoulder measurements were taken and analyzed at $30^{\circ}$, $60^{\circ}$, $90^{\circ}$, $120^{\circ}$, $150^{\circ}$, and ending at $165^{\circ}$. A line was drawn perpendicularly to the line connecting the humeral head axis to the glenoid, and another line was drawn perpendiculary to the line connecting the scapular axis to the glenoid. The distance between the two lines measured is defined as the e value. Results: At the starting posture ($15^{\circ}$), the central axis of the humeral head was located 1.92 mm inferior to the central axis of the scapula. The humeral head was superiorly translated from the starting posture to $120^{\circ}$, and then, showed an inferior translation to the ending posture ($165^{\circ}$). Conclusions: The results of this study showed that the humeral head moved upward from the starting posture ($15^{\circ}$) up to $120^{\circ}$ indicating, superior translation, and it moved downward when the posture was past $120^{\circ}$, indicating inferior translation.

• Physical Therapy Korea
• /
• v.27 no.2
• /
• pp.93-101
• /
• 2020

Background: For performing various movements well, cooperation between the muscles around the scapula and shoulder has been emphasized. Taping has been widely used clinically as a helpful adjunct to other physiotherapy methods for shoulder pathology and dysfunction treatment. Previous studies have evaluated the effect of taping techniques using dynamic tapes on shoulder function and pain. However, no study investigated the electromyographic (EMG) changes in the shoulder muscles. Objects: This study aimed to investigate the effect of the upper limb offload taping technique using a dynamic tape on EMG activities of the upper trapezius (UT), lower trapezius, serratus anterior (SA), and middle deltoid (MD) muscles during scaption plane elevation. Methods: A total of 26 healthy subjects (19.85 ± 6.40 years, male = 20) volunteered to participate in this study. The subjects were instructed to perform scaption elevation with and without dynamic taping on the shoulder. Shoulder elevation strength tests were performed at 100%, 75%, 50%, and 25%, for the maximal isometric contraction force. Results: There were statistically significant interaction effects between the taping application and shoulder scaption elevation force in EMG activities in the UT (p < 0.05) and MD (p < 0.05). EMG activities in the UT showed significant increases in 50%RVC (reference voluntary contraction, p < 0.05) and 25%RVC (p < 0.01). Furthermore, the EMG activity of the SA significantly increased in 50%RVC (p < 0.01) and 25%RVC (p < 0.01) after dynamic taping. For the MD, the EMG activity level significantly decreased in 100%RVC (p < 0.05). Conclusion: These results indicated that upper limb offload dynamic taping application affects the muscle activities of some shoulder muscles depending on different scaption elevation strength levels. Therefore, we suggest that the upper limb offload dynamic taping can be applied to the shoulders when patients need middle deltoid inhibition or upper trapezius facilitation, such as patients with shoulder impingement syndrome.