Effect of the Scapula Reposition Test on Shoulder Impingement Symptoms and Elevation Strength in Overhead Athletes

Abstract

[ research report ] t Study deSign: Two-group, repeatedmeasures design.t ObjectiveS: To determine whether manually repositioning the scapula using the Scapula Reposition Test (SRT) reduces pain and increases shoulder elevation strength in athletes with and without positive signs of shoulder impingement.t backgrOund: Symptom alteration tests may be useful in determining a subset of those with shoulder pathology who may benefit from interventions aimed at improving scapular motion abnormalities.t MethOdS and MeaSureS: One hundred forty-two college athletes underwent testing for clinical signs of shoulder impingement. Tests provoking symptoms were repeated with the scapula manually repositioned into greater retraction and posterior tilt. A numeric rating scale was used to measure symptom intensity under both conditions. Isometric shoulder elevation strength was measured using a mounted dynamometer with the scapula in its natural position and with manual repositioning. A paired t test was used to compare the strength between positions. The frequency of a significant increase in strength with scapular repositioning, defined as the minimal detectable change (90% confidence interval), was also assessed.t reSultS: Of the 98 athletes with a positive impingement test, 46 had reduced pain with scapular repositioning. Although repositioning produced an increase in strength in both the impingement (P = .001) and nonimpingement groups (P = .012), a significant increase in strength was found with repositioning in only 26% of athletes with, and 29% of athletes without, positive signs for shoulder impingement. 27,51 In addition to the variability of findings in these studies, the magnitude of differences between those with healthy shoulders and those with pathology is typically small (in the 3° to 5° range), and it is unclear whether these differences, although statistically significant, are really of clinical significance. Because of the variability of findings in symptomatic subjects and the generally small kinematic differences found compared to asymptomatic subjects, correctly identifying patients with relevant scapular dysfunction is difficult.An alternative approach in attempting to identify those with scapular motion abnormalities is the use of symptom altering tests. The premise of these tests is to assess the magnitude of symptoms during provocation tests or shoulder movements when the scapula is in its natural position and then to repeat the provocative tests and shoulder movements with the examiner manually altering scapular motion or position. Two symptom alteration tests have been reported in the literature. The Modified Scapular Assistance test involves application of both an upward rotary and retraction force to the scapula by a single examiner in an effort to reduce pain during arm elevation. Rabin et al 40 reported satisfactory interrater reliability of this test for clinical use. The Scapula Retraction Test has been described as 1 Physical Therapist, H/S Therapy Associates, Inc, Lower Gwynedd, PA; Associate Fac...

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

“…Both the scapular retraction 29 and reposition tests 48 have been shown to influence muscle strength, but the influence of these on scapular position has not been studied. Another maneuver performed by an examiner to alter the orientation of the scapula is the scapular assistance test (SAT).…”

“…4,5 Shoulder strength was defined as maximum isometric force production measured with a dynamometer (micro-FET; Hoggan Health Industries, Draper, UT) that was fixed to a rigid metal bar and clamped to a doorframe to reduce measurement variation attributed to differences in examiner force and stabilization. 10,48 Excellent interrater and intrarater reliability has been reported using a handheld dynamometer for assessment of shoulder strength in both symptomatic and healthy subjects.…”

“…These results differ from prior studies that found increases in elevation strength with passive alterations of the scapula using the scapular retraction or reposition test. 29,48 In performing the scapular retraction test, the examiner assists the scapula into adduction, 29 as compared to the reposition test, in which the examiner attempts to manually induce scapular posterior tilt and external rotation without retraction. 48 The scapular reposition test has been shown to increase peak shoulder elevation torque 48 ; however, only 26% of subjects with SAIS and 29% without SAIS had an increase that exceeded the MDC 90 , which casts doubt on the meaningfulness of this change.…”

Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders

“…Some patients will contract their muscles with reduced force due to fear of injury. Likewise, poor posture can place rotator cuff and scapular muscles in an altered length tension relationship that could reduce the ability to produce force during muscle strength testing (Tate et al 2008). However, it is difficult to either identify the amount to which pain or posture affects the results of muscle strength tests or to exclude any pain or posture effect.…”

“…However, it is difficult to either identify the amount to which pain or posture affects the results of muscle strength tests or to exclude any pain or posture effect. Concerning posture, scapular positioning may be abnormal in patients with shoulder pain (Struyf et al 2011a, b), and manual scapular repositioning tests can increase shoulder muscle strength (Tate et al 2008).…”