Clinical Assessment of Scapula Motion: Scapula Upward Rotation and Relationship with Injury in Swimmers

Abstract

Abnormal scapulothoracic mechanics and scapulohumeral rhythm are implicated in shoulder pathologies, including glenohumeral impingement and rotator cuff tears. Upward scapula rotation, specifically asymmetry of scapula motion and associations of patterns through range with injury, was investigated in dominant and non-dominant limbs of nationally ranked junior and Paralympic swimmers during competition season. The static and throughout phases measures of upward scapula rotation were: Phase I (start position, 45°), Phase II (45° to 90°), Phase III (90° to 135°) and Phase IV (135° to max). Injury was assessed with a validated questionnaire. Differences between side (dominant and non-dominant), group (junior and Paralympic), and phase were examined. Significant differences (P < 0.05) between groups were identified for dominant side at rest, 45° and 135°, and in phases II and IV (including range). Scapulohumeral rhythm was higher in the non-dominant limb of Paralympic swimmers but in the dominant limb of junior swimmers. Greatest differences in upward rotation between injured and non-injured swimmers were found in Phase 1: 43.6% (3.3°) Paralympic; 73.1% (8°) junior. Results suggest asymmetry of movement in both limbs, through all phases, and at single points in range, should be investigated for assessing injury and developing preventive strategies and rehabilitation protocols.

The effect of axillary crutch length on upper limb kinematics during swing‐through gait

“…The scapula performs an essential role in facilitating glenohumeral stability and optimizing activation of the rotator cuff muscles 23 . There are inconsistencies in the literature on whether increased upward scapular rotation presents a risk factor for upper limb injury 24 . However, increased scapular upward rotation may increase strain on the suprascapular nerve, 25 and there has been a case report of suprascapular neuropathy in a 41‐year‐old man using axillary crutches for 2 weeks 26 .…”

“…23 There are inconsistencies in the literature on whether increased upward scapular rotation presents a risk factor for upper limb injury. 24 However, increased scapular upward rotation may increase strain on the suprascapular nerve, 25 and there has been a case report of suprascapular neuropathy in a 41-year-old man using axillary crutches for 2 weeks. 26 Repetitive shoulder abduction with longer crutches may also be a risk factor for the development of supraspinatus tendinopathy, which has been reported in crutch users with paraplegia.…”

Scapulohumeral kinematics and neuromuscular control during scaption are associated with passive stiffness and strength of periscapular muscles in competitive adolescent swimmers

“…The scapula provides a stable support for arm movements during swimming. Once scapula dyskinesis (SD) appears in athletes, the risk of developing shoulder pain is increased by 43% 3 SD is commonly seen in the non-breathing side 4 or the injured shoulder 5 of competitive front-crawl swimmers. During scaption, internal rotation and anterior tilting of the scapula are more pronounced in young competitive swimmers than in nonpractitioners 6 Since SD is connected to abnormalities in neuromuscular control related to weakness or stiffness of periscapular muscles [7][8][9][10] muscle activity should be comprehensively evaluated within training programs.…”