The Scapular Assistance Test Results in Changes in Scapular Position and Subacromial Space but Not Rotator Cuff Strength in Subacromial Impingement

Abstract

Study Design Controlled laboratory study. Objectives To determine the effect of the modified scapular assistance test (SAT) on 3-dimensional shoulder kinematics, strength, and linear measures of subacromial space in patients with subacromial impingement syndrome (SAIS). Background Abnormal scapular kinematics have been identified in patients with SAIS. Increased scapular upward rotation and posterior tilt, as induced with manual assistance using the SAT, have been theorized to increase subacromial space and may alter shoulder strength. Methods Forty-two subjects (21 with SAIS and 21 controls) participated in this study. The anterior outlet of the subacromial space, measured via the acromiohumeral distance on ultrasound images, and 3-dimensional scapular kinematics, measured using motion analysis, were determined with the arm at rest, and at 45° and 90° of active elevation with and without the SAT. A dynamometer was used to measure isometric shoulder strength. Full factorial mixed-model analyses of variance evaluated the effects of the SAT on variables between groups. Results There was an increase in scapular posterior tilt at all angles, upward rotation at rest and 45° of elevation, and acromiohumeral distance at 45° and at 90° with the SAT. The SAT did not alter normalized isometric strength. There were no differences in response to the SAT between the SAIS and control groups. Conclusion Manual scapular assistance using the SAT influences factors associated with SAIS, such as subacromial space and potentially scapular orientation during static arm elevation, but not more so in individuals with SAIS than in healthy individuals. The SAT performed statically may be a way to identify potential subgroups of individuals with SAIS for whom subacromial space narrowing may be a contributing factor. J Orthop Sports Phys Ther 2012;42(5):400–412, Epub 27 January 2012. doi:10.2519/jospt.2012.3579

Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review

“…The testers undertaking the ultrasound scanning were physiotherapists in seven of the studies,7–9 24 26 31 32 variously described as having training ranging from 1 hour to 3 months, and radiologists in two of the studies,23 30 with one study not providing details of the raters 25. One study reported similar degrees of reliability between an experienced radiologist (ICC=0.94) and a novice in ultrasound (ICC=0.92),30 while in two studies by the same authors, one using a physiotherapist trained in shoulder ultrasound, and the other using student physiotherapists with limited training or experience, slightly better reliability was reported with the experienced examiner (ICC=0.96–0.99)26 compared with the novices (ICC=0.88–0.91) 27…”

“…There was variation in transducer placement, with two studies placing it on the anterior part of the acromion,23 31 while others used the posterior or mid-acromion25 or did not give adequate details of the testing protocol. There were also differences in how AHD was measured between studies.…”

The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach

“…↓PT and ER at 90° abduction. (9) ICC ( (12) ICC ( CG Mell et al (2005) (13) SD for phases 1, Group Group Group FSG compared to CG Rundquist et al (2003) (15) ------↓ Maximum ROM of arm elevation from flexion to scapular plane abduction to coronal plane abduction. ↑ ER ROM with the abducted arm than with the arm at the side.…”

“…Manual therapy, 13(6), 544-551. Yoshizaki, K., Hamada, J., Tamai (15) Ogston & Ludewig (2008) ( (19) -------3 ASI, 2 MDI 1 SI -------37 ± 8.5 ------ (21) recent upper extremity pathology Arias (22) 25 40 (1) Static 90˚ Seitz & Michener (2012) (9) Static Sc Emag Acromial receiver -Skin fixed Pro/lat/tilt AA?? 90˚…”

Ultrasonographic measurement of the acromiohumeral distance in spinal cord injury: Reliability and effects of shoulder positioning

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