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Manual scapular stabilization: Its effect on shoulder rotational range of motion,☆☆,

https://doi.org/10.1053/apmr.2000.5617Get rights and content

Abstract

Boon AJ, Smith J. Manual scapular stabilization: its effect on shoulder rotational range of motion. Arch Phys Med Rehabil 2000;81:978-83. Objectives: To study the effect of a recently described method of measuring shoulder rotational range of motion in which the scapula is manually stabilized, and to determine the reliability of that technique compared with measurements taken with the scapula unstabilized. Design: Fifty high school athletes underwent measurement of shoulder rotational range of motion with and without the scapula manually stabilized. Measurements were performed by two groups of physical therapists blinded to the movement results, with repeat measurements performed 5 days later. Results: Rotational motion measured with the scapula stabilized was significantly less than when it was measured with the scapula unstabilized. Reliability was comparable for the two techniques when measuring external rotation, but the new technique was more reliable for measuring internal rotation. Conclusion: Scapular stabilization should be used when measuring internal rotation of the shoulder to obtain more accurate measurement of pure glenohumeral rotation. The technique described is promising, but warrants further refinement before it can be recommended for widespread clinical use. With practice, in experienced clinicians' hands, this technique may be the most reliable method for measuring outcome in clinical trials and for following clinically significant rotational motion deficits. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Subjects

Three hundred twenty-five high school athletes attending the annual preparticipation examinations were given the opportunity to participate in the study. Of these, 50 athletes (age 12 to 18yrs) volunteered, including 18 boys and 32 girls. Inclusion criteria included willingness to participate in day 2 of the study; no previous history of neurologic disease, arthritis, connective tissue disease, or shoulder/neck injury or surgery; and parental informed consent. Demographic data were collected,

Results

The mean values for goniometrically measured shoulder internal, external, and total rotations (table 2) showed that scapular stabilization significantly affected shoulder rotation: rotation measurements with the scapula stabilized were significantly smaller (p <.001) than rotation measurements with no stabilization for all 3 end points.Differences in ROM with respect to arm dominance and gender were detected, independent of scapular stabilization (table 2). The dominant arm had a larger

Discussion

The present study has attempted to demonstrate the reliability of a recently described technique of manually stabilizing the scapula in order to isolate glenohumeral RROM more reliably. Loss of glenohumeral internal rotation may be a pathologic finding in an overhead athlete, predisposing to impingement, overuse injuries, and impaired performance.4, 5, 6, 7, 8 It is now becoming accepted practice in the rehabilitation as well as preventative conditioning of overhead athletes to incorporate a

Conclusion

A recently described technique for measuring shoulder RROM in which the scapula is manually stabilized was studied and found to be more reliable and reproducible than a currently used technique, particularly for measurement of internal rotation. External rotation was less affected by manual stabilization than internal rotation, presumably because of biomechanical factors. Manual scapular stabilization, with the arm abducted to 90°, is recommended when measuring internal rotation.

Acknowledgements

The authors thank Dirk Larson, MS, and Terry M. Therneau, PhD, of the Department of Biostatistics, Mayo Clinic, for their statistical contribution to this study, and Dave Kraus, PT, Pete Lommen, PT, Tim McLean, PT, and Jeff Brault, DO, PT, from the Mayo Clinic Sports Medicine Center, for their technical assistance.

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    No commerical party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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    Reprint requests to Jay Smith, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

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