Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review

Abstract

Context Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. Objective To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. Data Sources We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. Study Selection Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. Data Extraction Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. Data Synthesis Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = −0.04; 95% CI = −0.31, 0.22), posterior tilt (mean difference = −0.09; 95% CI = −0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = −0.19, 0.31). Conclusions The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.

Effect of scapular stabilization exercise program in patients with subacromial impingement syndrome: a systematic review

“…Improper movement of the scapula is often forgotten cause of pain and dysfunction (Panagiotopoulos and Crowther, 2019). Though alteration in scapular kinematics in people with impingement is evident, yet the prevalence and type of alterations vary substantially (Takeno et al, 2019). The majority of previously published literature reports a decreased scapular external rotation, decreased scapular upward rotation, and a decreased posterior scapular tilting in patients with subacromial impingement syndrome (Struyf et al, 2011).…”

Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial

“…Current evidence suggests that scapular control is an important component of scapular rehabilitation and scapular stabilization exercise is effective in reducing pain and improving function [ 44 ]. Scapular stabilization exercise that includes stretching and strengthening emphasis scapular position and kinematics, allowing the scapula to perform the role of energy transfer, serving as the basis for muscle activation and as a link in the kinetic chain [ 45 ]. However, there is a lack of targeted scapular stabilization exercise based on the type of SD.…”

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

“…The scientific literature suggests that an adequate scapular motion may be crucial to shoulder function [ 4 , 5 ]. Subjects with SAPS present less scapular upward rotation and increased scapular internal rotation [ 6 , 7 ] and anterior tilt [ 8 ] than asymptomatic subjects.…”

“…Principal Component Analysis) showed differences in scapular anterior/posterior tilt and forward/backward translation in subjects with SAPS [ 9 ]. Despite the lack of high-quality evidence to support a causal association between these biomechanical changes with pain and disability in people with SAPS, it is believed that scapular motion impairments contribute to the development and maintenance of shoulder pain [ 4 ], as highlighted by a consensus statement from 2013 [ 10 ] and by the Movement System Diagnosis framework [ 10 , 11 ]. Therefore, interventions for subjects with shoulder pain commonly focus on improving scapular movement [ 10 , 11 ].…”