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Jafarian Tangrood Z1, Sole G1, Cury Ribeiro D1
1University of Otago, Physiotherapy, Dunedin, New Zealand
Background: Coordination between scapula and humerus during arm movements is important to centre the humeral head with the glenoid fossa and provide a stable support for arm motions during daily tasks. Changes in scapular rotations during arm motions might increase the risk of shoulder pain.
There is some evidence that patients with subacromial shoulder pain are more likely to present with dyskinesis when compared to individuals without shoulder pain. However, within patients with shoulder pain, there is conflicting findings regarding scapular rotation during arm elevation. This may be linked with the association of pain levels with scapular movement patterns.
Purpose: To assess the association between changes in pain or disability levels with scapular rotations in patients with subacromial shoulder pain.
Methods: Twenty-two participants with shoulder pain participated in this study (46.5 ± 13.6 years). Participants were assessed in two sessions: baseline (session 1) and at 8 weeks following baseline (session 2). Participants' demographic data were collected during session 1. The primary outcome measures were collected in both sessions, and consisted of:
(1) pain during progressive positions of arm elevation - assessed with the Numeric Pain Rating Scale (NPRS);
(2) participants' level of disability - assessed with the Patient Specific Functional Scale (PSFS); and
(3) scapular rotations, measured with inertial sensors.
For assessing scapular rotations, three wireless inertial sensors were used, one fixed to the thorax, one fixed to the upper arm and one fixed to the scapula locator. During assessments, participants remained seated. One assessor measured scapular orientations while participants maintained their arms at 60°, 90° and 120° arm elevation in scapular plane. Three trials were performed for each position. In each degree of arm elevation, participants were asked to rate their shoulder pain. Changes from session 1 to session 2 were calculated for pain, PSFS scores and scapular rotations. This was done for each arm position. We used a Spearman rank correlation coefficient (rs) to assess the association between changes in scores (pain or disability) and scapular rotations.
Results: The highest recorded correlation was rs= -0.35 at 60°, and rs= -0.34 at 90° between changes in pain and scapular internal rotation. This magnitude of correlation was close to significant (with 22 participants, rs should be equal or above 0.36 to be significant). For scapular upward/downward rotation and scapular anterior/posterior tilt, no significant correlations were observed associated with changes in pain. Furthermore, no correlations were observed between changes in PSFS and any scapular rotations.
Conclusion(s): Findings from this study may suggest a close to significant correlation between decreased pain scores and increased scapular internal rotation. However, because of no significant changes in pain and disability over the 8-week period, further investigation is needed to better understand the role of pain and its duration on scapular movement pattern in patients with shoulder subacromial pain.
Implications: It is possible that scapular rotations adaptation occurs in association to changes in pain intensity. Such information may help to understand the role of pain intensity and scapular rotations in patients with shoulder subacromial pain.
Keywords: Scapular rotations, Pain, Correlation
Funding acknowledgements: This study was a part of PhD project of Zohreh Jafarian who is supported by University of Otago PhD Scholarship.
There is some evidence that patients with subacromial shoulder pain are more likely to present with dyskinesis when compared to individuals without shoulder pain. However, within patients with shoulder pain, there is conflicting findings regarding scapular rotation during arm elevation. This may be linked with the association of pain levels with scapular movement patterns.
Purpose: To assess the association between changes in pain or disability levels with scapular rotations in patients with subacromial shoulder pain.
Methods: Twenty-two participants with shoulder pain participated in this study (46.5 ± 13.6 years). Participants were assessed in two sessions: baseline (session 1) and at 8 weeks following baseline (session 2). Participants' demographic data were collected during session 1. The primary outcome measures were collected in both sessions, and consisted of:
(1) pain during progressive positions of arm elevation - assessed with the Numeric Pain Rating Scale (NPRS);
(2) participants' level of disability - assessed with the Patient Specific Functional Scale (PSFS); and
(3) scapular rotations, measured with inertial sensors.
For assessing scapular rotations, three wireless inertial sensors were used, one fixed to the thorax, one fixed to the upper arm and one fixed to the scapula locator. During assessments, participants remained seated. One assessor measured scapular orientations while participants maintained their arms at 60°, 90° and 120° arm elevation in scapular plane. Three trials were performed for each position. In each degree of arm elevation, participants were asked to rate their shoulder pain. Changes from session 1 to session 2 were calculated for pain, PSFS scores and scapular rotations. This was done for each arm position. We used a Spearman rank correlation coefficient (rs) to assess the association between changes in scores (pain or disability) and scapular rotations.
Results: The highest recorded correlation was rs= -0.35 at 60°, and rs= -0.34 at 90° between changes in pain and scapular internal rotation. This magnitude of correlation was close to significant (with 22 participants, rs should be equal or above 0.36 to be significant). For scapular upward/downward rotation and scapular anterior/posterior tilt, no significant correlations were observed associated with changes in pain. Furthermore, no correlations were observed between changes in PSFS and any scapular rotations.
Conclusion(s): Findings from this study may suggest a close to significant correlation between decreased pain scores and increased scapular internal rotation. However, because of no significant changes in pain and disability over the 8-week period, further investigation is needed to better understand the role of pain and its duration on scapular movement pattern in patients with shoulder subacromial pain.
Implications: It is possible that scapular rotations adaptation occurs in association to changes in pain intensity. Such information may help to understand the role of pain intensity and scapular rotations in patients with shoulder subacromial pain.
Keywords: Scapular rotations, Pain, Correlation
Funding acknowledgements: This study was a part of PhD project of Zohreh Jafarian who is supported by University of Otago PhD Scholarship.
Topic: Musculoskeletal: upper limb; Human movement analysis
Ethics approval required: Yes
Institution: University of Otago
Ethics committee: The Human Ethics Committee (Health)
Ethics number: H17/079
All authors, affiliations and abstracts have been published as submitted.
