• PNF and Movement
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• v.3 no.1
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• pp.47-53
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• 2005

Purpose : To describes the important aspects of scapular movement and function used when applying PNF technique to the upper limb and scapular. Method : The scapular was a very important roles in the upper limb movement. This study summarizes the physiologic movement of scapular to the PNF upper extremity patterns or scapular patterns. Result : The shoulder joint has the most freedom of range of motion in the human body, composed of the glenohumeral joint, the subacromial joint, the acromioclavical joint, the sternoclavicular joint, the scapulothoracic joint, the costosternal joint, and the costovertebral joint. During upper limb movement, the scapular position change at the sternoclavicular joint and the acromioclavical joint. This concerted motion was characterized by scapulohumeral rhythm. In clinical situations, it is import to understand factors affect the scapulohumeral rhythm so that optimal evaluation and therapeutic intervention can be devised. Conclusions : The scapular movement depend on the proper and coordinated contraction of muscles. Physical therapists need to understand the normal scapular movement relationships of the scapulohumeral rhythm under different interventions for PNF techniques application.

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

• Korean Journal of Applied Biomechanics
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• v.21 no.2
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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.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2002.03a
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• pp.54-59
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• 2002

$\bullet$ Rehabilitation should be based on an understanding pathology and abnormal arthrokinematics and biomechanics. $\bullet$ Rehabilitation should be kept in mind to play a vital role in the successful outcome after shoulder injuries or surgeries. $\bullet$ Program should emphasize treating the cause and not just the symptoms. $\bullet$ Maintenance of the normal scapulohumeral and scapulothoracic rhythm and optimal strength should be re-established with rehabilitation. $\bullet$ Program modification and appropriate progression must be peformed on an individual basis.

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

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.148-155
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• 2023

Background: Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. Methods: The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. Results: At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°-120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. Conclusions: Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions.

• Journal of Korean Physical Therapy Science
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• v.3 no.4
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• pp.121-138
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• 1996

Impingement syndrome is mechanical impingement between the greater tubercle of the humerus and the under surface of the coracoacromial arch, is a common source of shoulder pain in the athletes as well as non-athletes. Several factors contribute to shoulder impingement syndrome, including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. The purpose of this article is to review current concepts of anatomy and biomechanics and the underlying pathomechanics as it relates to evaluation and treatment of shoulder impingement syndrome.

• Physical Therapy Rehabilitation Science
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• v.10 no.4
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• pp.463-469
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• 2021

Objective: If non-surgical treatment fails, arthroscopic rotator cuff repair (ARCR) is recommended, and ARCR considers graft augmentation in consideration of size, direction, and re-tear. It is reported to have potential benefits by improving the healing rate as it can fill the gaps that have been left behind. The purpose of this study is to investigate the effect of structural changes observed after ARCR on muscle action through magnetic resonance imaging and to investigate the effect of appropriate physical therapy required for graft augmentation in the general ARCR rehabilitation protocol. Case presentation: A 47-year-old male hospitalized for postoperative rehabilitation following ARCR participated in a 5-week physical therapy intervention. The postoperative day was 6 months, but due to shooting pain and shoulder dysfunction,and the movement of the shoulder was compensatory motion, not normal motion. Physical agents, manual therapy, and supervised exercise for 110 minutes per session were performed 3 times a week, and pain intensity, range of motion, function, and strength were evaluated. Results: As a result of the study, the patient showed positive improvement in pain intensity, range of motion, function, and strength. In addition, normal scapulohumeral rhythm movement was observed. Conclusions: According to the results of this case, appropriate physical therapy according to the compensatory motion shown in the structural changes after ARCR can positively improve the pain intensity, range of motion, function, and strength of ARCR patients.

• Physical Therapy Korea
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• v.23 no.4
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• pp.55-62
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• 2016

Background: The functioning of the serratus anterior (SA) muscle is essential to normal scapulohumeral rhythm during forward flexion (FF) of the shoulder. Also, SA weakness and overuse of the upper trapezius (UT) is observed in patients with shoulder dysfunction and trapezius myalgia. We designed a combination exercise involving FF and scapular protraction with resistance (CFFSP) to activate the SA muscle and to deactivate the UT muscle. Objects: The purpose of this study was to determine whether or not CFFSP would be more effective in activating the SA muscle than FF alone and FF with scapular protraction (FFP). Methods: Nineteen subjects (12 men and 7 women) participated in this study and performed FF, FFP, and CFFSP at $120^{\circ}$. Surface electromyography was applied to the SA, UT, and pectoralis major (PM) muscles, as was one-way analysis of variance (ANOVA) with repeated measures. Statistical significance was set at .05. Bonferroni adjustment was used to counteract the problem of multiple comparisons, with a statistical level of significance of .017 (.05/3). Results: A statistically significant difference was found in relation to the three positions for the SA muscle (p<.001) and the SA/UT ratio (p=.005) using ANOVA. Significantly different results, depending on the position, were also demonstrated using the Bonferroni post-hoc test for the SA muscle ($FF=28.27{\pm}16.20$, $FFP=45.66{\pm}15.81$, and $CFFSP=62.4{\pm}27.21$) and for the SA/UT ratio ($FF=3.04{\pm}2.14$, $FFP=3.61{\pm}2.38$, and $CFFSP=5.95{\pm}3.01$). Significant differences between the three positions was not found regarding the average amplitude of SA/PM muscle ratio (SA/PM: p=.060). Conclusion: We recommend the use of CFFSP to strengthen the SA muscle at $120^{\circ}$.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.2
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• pp.67-75
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• 2022

Background: Scapular winging is a rare disorder that is commonly caused by nerve damage of the dorsal scapular nerve, spinal accessory nerve, or the long thoracic nerve. This affects the scapulohumeral rhythm which may cause abnormal kinetic motion of the shoulder. The purpose of this case report is to describe a self-exercise oriented management incorporating shoulder strengthening to reduce symptoms in a shoulder pain patient with winging scapular. Methods: A 45 year old male patient complained of pain in his both shoulders without any trauma. Shoulders were treated with steroid injections for supraspinatus tendonitis, but although pain improved to some extent, pain and disability continued for 3 months. Both shoulders had pain, decreased active range of motions, muscles weakness, and scapular winging. The patient underwent 9 interventional sessions over 3 months and was managed mainly by self-exercise. The intervention method involved push up plus, sling, muscle strengthening, and stabilization exercises. Loads were increased as symptoms improved. Results: Clinical outcomes were measured at every session. Pain in both shoulders reduced to 0 on a numerical pain rate scale by the 4th session, and the active range of motion was fully recovered. During the 9th session, the strength of the serratus anterior had improved from grade P to G on the right side and grade G to N grade on the left. Conclusion: In this case study, the self-exercise program was effective in reducing pain, increasing active range of motion, and improving muscle strength in subjects with scapular winging.