Altered Alignment of the Shoulder Girdle and Cervical Spine in Patients With Insidious Onset Neck Pain and Whiplash-Associated Disorder

Abstract

Clinical theory suggests that altered alignment of the shoulder girdle has the potential to create or sustain symptomatic mechanical dysfunction in the cervical and thoracic spine. The alignment of the shoulder girdle is described by two clavicle rotations, i.e, elevation and retraction, and by three scapular rotations, i.e., upward rotation, internal rotation, and anterior tilt. Elevation and retraction have until now been assessed only in patients with neck pain. The aim of the study was to determine whether there is a pattern of altered alignment of the shoulder girdle and the cervical and thoracic spine in patients with neck pain. A three-dimensional device measured clavicle and scapular orientation, and cervical and thoracic alignment in patients with insidious onset neck pain (IONP) and whiplash-associated disorder (WAD). An asymptomatic control group was selected for baseline measurements. The symptomatic groups revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle. A difference was found between the symptomatic groups on the left side, whereas the WAD group revealed an increased scapular anterior tilt and the IONP group a decreased clavicle elevation. These changes may be an important mechanism for maintenance and recurrence or exacerbation of symptoms in patients with neck pain.

Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders

“…The presence of neck pain is known to alter the activity of the upper and lower trapezius during upper limb tasks (Szeto et al, 2005a;Falla et al, 2007;Wegner et al, 2010) and alter scapular orientation (Szeto et al, 2002(Szeto et al, , 2005bYip et al, 2008;Helgadottir et al, 2010Helgadottir et al, , 2011. Biomechanical reasoning indicates that altered activity in the axioscapular muscles associated with altered scapular orientation may induce detrimental load on the cervical spine (Behrsin and Maguire, 1986;Janda, 1994;Jull et al, 2004).…”

Intratherapist Reliability in the Rating of Scapula Posture in Multiple Planes of Reference

“…Changes in scapular posture and motion (often referred to as scapular dyskinesis) [3] are proposed to detrimentally alter the distribution of mechanical forces within the upper quadrant during upper limb activities due to their extensive muscle attachments to the axial skeleton [4,5] and impact on glenohumeral joint biomechanics [6]. In support of this are studies showing scapular dyskinesis in upper quadrant disorders such as subacromial impingement [6][7][8] and chronic neck pain [9,10] that may also be associated with altered axioscapular muscle function [6,7,11,12]. However, as highlighted in a review paper, there are inconsistencies between 2 ISRN Rehabilitation studies as to the most common pattern of scapular dyskinesis present in painful shoulder girdle disorders [13].…”

The Relevance of Scapular Dysfunction in Neck Pain: A Brief Commentary

“…46 These studies also suggest that alterations in scapular position/motion may differ between the dominant and nondominant scapula, and may be dependent on the type of neck disorder (traumatic or nontraumatic). 22,23,46 While these studies offer preliminary evidence of an association between altered scapular posture/motion and neck pain, their limited sample size makes it difficult to draw any firm conclusions regarding specific patterns of impairment in neck pain that would inform clinical practice, and further investigation is T T SYNOPSIS: Though our understanding of motor disorders and mechanical neck pain has advanced, the role of scapular dysfunction in mechanical neck pain remains enigmatic. The biomechanical interdependence between the neck and scapula and the potentially deleterious consequences of scapular dysfunction in the cervical region are biomechanically plausible.…”

“…There is some initial evidence that scapular position at rest and scapular motion during elevation of the upper limb may be altered in some individuals with neck pain when compared to a healthy population. 22,23,46 For example, symptomatic office workers were observed to have slightly more scapular protraction than asymptomatic office workers during their computer work. 46 These studies also suggest that alterations in scapular position/motion may differ between the dominant and nondominant scapula, and may be dependent on the type of neck disorder (traumatic or nontraumatic).…”