Study Design: Two-group comparison. Objective: To compare scapular kinematics during arm elevation between groups distinguished by pectoralis minor resting length. Background: Studies have demonstrated that individuals with subacromial impingement have altered scapular kinematics, such as loss of posterior tipping and increased internal rotation. One proposed mechanism for these alterations is an adaptively short pectoralis minor. This anterior scapulothoracic muscle may impact normal scapular kinematics if adaptively short. Methods and Measures: Fifty volunteers without shoulder pain were divided into long or short groups according to normalized pectoralis minor resting length. An electromagnetic motion capture system determined the angular orientation of the scapula, humerus, and trunk during arm elevation in 3 separate planes. Groups were compared for 3-dimensional scapular orientation relative to the trunk at arm elevation angles of 30°, 60°, 90°, and 120°, using a mixed-model analysis of variance (ANOVA). Results: There were statistically significant interaction effects between group and arm elevation angle for scapular tipping in all planes of arm elevation, with the scapula for the short group staying anteriorly tipped at higher angles. There was also a significant interaction for scapular internal rotation at lower arm elevation angles in the coronal plane only, with individuals with a shorter pectoralis minor demonstrating a more internally rotated scapula. Conclusions:The group distinguished by a short pectoralis minor demonstrated scapular kinematics similar to the kinematics exhibited in earlier studies by subjects with shoulder impingement. These results support the theory that an adaptively short pectoralis minor may influence scapular kinematics and is therefore a potential mechanism for subacromial impingement. J Orthop Sports Phys Ther 2005;35:227-238.

Background: Repetitive or sustained elevated shoulder postures have been identified as a significant risk factor for occupationally related shoulder musculoskeletal disorders. Construction workers exposed to routine overhead work have high rates of shoulder pain that frequently progresses to functional loss and disability. Exercise interventions have potential for slowing this progression. Aims: To evaluate a therapeutic exercise programme intended to reduce pain and improve shoulder function. Methods: Construction worker volunteers were screened by history and clinical examination to test for inclusion/exclusion criteria consistent with shoulder pain and impingement syndrome. Sixty seven male symptomatic workers (mean age 49) were randomised into a treatment intervention group (n = 34) and a control group (n = 33); asymptomatic subjects (n = 25) participated as an additional control group. Subjects in the intervention group were instructed in a standardised eight week home exercise programme of five shoulder stretching and strengthening exercises. Subjects in the control groups received no intervention. Subjects returned after 8-12 weeks for follow up testing. Results: The intervention group showed significantly greater improvements in the Shoulder Rating Questionnaire (SRQ) score and shoulder satisfaction score than the control groups. Average post-test SRQ scores for the exercise group remained below levels for asymptomatic workers. Intervention subjects also reported significantly greater reductions in pain and disability than controls. Conclusions: Results suggest a home exercise programme can be effective in reducing symptoms and improving function in construction workers with shoulder pain.

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