Thursday, November 29, 2018

How is the motion of the scapula on the chest wall affected in common shoulder conditions?

The contribution of the scapula to active shoulder motion and self-assessed function in three hundred and fifty two patients prior to elective shoulder surgery

These authors determined the contribution of the scapula to active shoulder motion in control subjects and patients with loss of shoulder function.

They used the Kinect motion capture system to assess active scapulothoracic (ST) and humerothoracic (HT) abduction in 12 controls and in 352 patients before elective shoulder surgery.

For the controls, ST abduction averaged 26 ± 7° or 19% of the active HT abduction (135 ± 5°). 

For the 352 patients prior to elective surgery, active ST abduction averaged 12 ± 10°, or 17% of the active HT abduction (72 ± 38). 

For 10 of the 12 Simple Shoulder Test functions, patients unable to perform the function had significantly less scapulothoracic abduction, e.g., shoulders unable to lift one pound to shoulder level had 9 ± 8° of ST abduction in contrast to 17 ± 10 for those able to perform this function (p < .001). 

They concluded that scapulothoracic motion is an important component of active shoulder motion and function in both healthy shoulders and in those compromised by common pathologies. 

They suggested that rehabilitation directed at improving active scapulothoracic motion may improve the function of shoulders with loss of glenohumeral motion.

Comment: This study shows that in common conditions that involve the glenohumeral joint, such as osteoarthritis, rotator cuff tear, and cuff tear arthropathy, motion at both the glenohumeral and the scapular articulations are compromised. After surgery to address the glenohumeral pathology, rehabilitation directed at the scapulothoracic joint may enhance the outcome.


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