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Phys. Ther. Korea 2023; 30(1): 41-49

Published online February 20, 2023

https://doi.org/10.12674/ptk.2023.30.1.41

© Korean Research Society of Physical Therapy

Effects of Passive Scapular Stabilization on Upper Extremity Muscle Strength in Patients With Rotator Cuff Repair

Won-jeong Jeong1 , PT, MSc, Duk-hyun An2 , PT, PhD, Jae-seop Oh2 , PT, PhD

1Department of Rehabilitation Science, The Graduate School, Inje University, 2Department of Physical Therapy, College of Healthcare Medical Science and Engineering, Inje University, Gimhae, Korea

Correspondence to: Jae-seop Oh
E-mail: ysrehab@inje.ac.kr
https://orcid.org/0000-0003-1907-0423

Received: January 17, 2023; Revised: February 3, 2023; Accepted: February 3, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background: Scapular dyskinesis may cause not only rotator cuff (RC) tear but also weakness of the upper extremity, studies on scapular dyskinesis that may occur after RC repair is still lacking. Objects: To determine whether scapular dsykinesis was present in patients after arthroscopic RC repair and to investigate the influence of passive scapular stabilization on upper extremity strength.
Methods: A total of 30 patients after RC repair participated in this study. To compare the scapula of the arthroscopic RC repair shoulder and the contralateral shoulder, the winged scapula (WS) was measured using a scapulometer and scapular dyskinesis was also classified by type. Fixed instruments for muscle strength measurements were used to measure upper extremity muscle strength differences depending on passive scapular stabilization position or natural scapular position. A chi-square test, an independent t-test and a 2-way mixed measures analysis of variance (ANOVA) was used as statistical analysis. In analyses, p < 0.05 was deemed to be statistically significant.
Results: Postoperative shoulder had a significant association with scapular dyskinesis and the WS compared to the contralateral shoulder (F = 0.052, p < 0.01). Postoperative shoulder, muscle strength in the shoulder abduction (p < 0.01), elbow flexion (p < 0.01) and forearm supination (p < 0.05) were significantly greater in the scapular stabilization position than in the scapular natural position.
Conclusion: Patients underwent arthroscopic RC repair had a significant association with scapular dyskinesis and muscle strength was improved by a passive scapular stabilization position, therefore scapular stabilization is important in rehabilitation program.

Keywords: Muscle strength, Passive scapular stabilization, Rehabilitation, Scapular dyskinesis

Article

Original Article

Phys. Ther. Korea 2023; 30(1): 41-49

Published online February 20, 2023 https://doi.org/10.12674/ptk.2023.30.1.41

Copyright © Korean Research Society of Physical Therapy.

Effects of Passive Scapular Stabilization on Upper Extremity Muscle Strength in Patients With Rotator Cuff Repair

Won-jeong Jeong1 , PT, MSc, Duk-hyun An2 , PT, PhD, Jae-seop Oh2 , PT, PhD

1Department of Rehabilitation Science, The Graduate School, Inje University, 2Department of Physical Therapy, College of Healthcare Medical Science and Engineering, Inje University, Gimhae, Korea

Correspondence to:Jae-seop Oh
E-mail: ysrehab@inje.ac.kr
https://orcid.org/0000-0003-1907-0423

Received: January 17, 2023; Revised: February 3, 2023; Accepted: February 3, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Scapular dyskinesis may cause not only rotator cuff (RC) tear but also weakness of the upper extremity, studies on scapular dyskinesis that may occur after RC repair is still lacking. Objects: To determine whether scapular dsykinesis was present in patients after arthroscopic RC repair and to investigate the influence of passive scapular stabilization on upper extremity strength.
Methods: A total of 30 patients after RC repair participated in this study. To compare the scapula of the arthroscopic RC repair shoulder and the contralateral shoulder, the winged scapula (WS) was measured using a scapulometer and scapular dyskinesis was also classified by type. Fixed instruments for muscle strength measurements were used to measure upper extremity muscle strength differences depending on passive scapular stabilization position or natural scapular position. A chi-square test, an independent t-test and a 2-way mixed measures analysis of variance (ANOVA) was used as statistical analysis. In analyses, p < 0.05 was deemed to be statistically significant.
Results: Postoperative shoulder had a significant association with scapular dyskinesis and the WS compared to the contralateral shoulder (F = 0.052, p < 0.01). Postoperative shoulder, muscle strength in the shoulder abduction (p < 0.01), elbow flexion (p < 0.01) and forearm supination (p < 0.05) were significantly greater in the scapular stabilization position than in the scapular natural position.
Conclusion: Patients underwent arthroscopic RC repair had a significant association with scapular dyskinesis and muscle strength was improved by a passive scapular stabilization position, therefore scapular stabilization is important in rehabilitation program.

Keywords: Muscle strength, Passive scapular stabilization, Rehabilitation, Scapular dyskinesis

Fig 1.

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Figure 1.Measurement of winged scapula using a scapulometer.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 2.

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Figure 2.Three upper extremity strength in sitting position. (A) Shoulder abduction, (B) elbow flexion, and (C) elbow supination.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 3.

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Figure 3.The graph shows significant difference the type of scapular dyskinesis between RC repair and non-RC repair. Type 1: Abnormal dyskinesis patterns with the prominence of an inferior medial scapular angle, excessive anterior tilting of the scapula. Type 2: Abnormal dyskinesis patterns with the excessive internal rotation of the scapula and prominent of the entire medial border. Type 3: Abnormal dyskinesis patterns with the prominence of the superior border and excessive upward translation of the scapula. Type 4: A pattern classified as “normal” and no asymmetry in bilateral scapular motion. RC, rotator cuff.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 4.

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Figure 4.The graph shows significant difference for the winged scapula between RC repair and non-RC repair. RC, rotator cuff. **p < 0.01.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 5.

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Figure 5.Comparison of shoulder abduction strength during SNP and SSP between RC repair and non-RC repair. SNP, scapular natural position; SSP, scapular stabilization position; RC, rotator cuff. **p < 0.01.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 6.

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Figure 6.Comparison of elbow flexion strength during SNP and SSP between RC repair and non-RC repair. SNP, scapular natural position; SSP, scapular stabilization position; RC, rotator cuff. **p < 0.01.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Fig 7.

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Figure 7.Comparison of forearm supination strength during SNP and SSP between RC repair and non-RC repair. SNP, scapular natural position; SSP, scapular stabilization position; RC, rotator cuff. **p < 0.01.
Physical Therapy Korea 2023; 30: 41-49https://doi.org/10.12674/ptk.2023.30.1.41

Table 1 . Demographic data for patients.

VariableTotal (N = 30)
Age (y)51.81 ± 9.10
Sex
Male14 (62.5)
Female16 (71.4)
Height (cm)167.10 ± 8.38
Weight (kg)73.09 ± 13.67
VAS for shoulder pain5.40 ± 1.00
Repaired side
Dominant18 (60.0)
Non-dominant12 (40.0)
Arthroscopic finding
Size of rotator cuff rear
Small9 (30.0)
Medium21 (70.0)

Values are presented as mean ± standard deviation or number (%). VAS, visual analog scale..

Table 2 . Statistical difference between two different variables for comparison of scapula type (N = 30).

GroupType 1Type 2Type 3Type 4X2
RC repair9 (30.0)14 (46.0)5 (17.0)2 (7.0)10.957
Non-RC repair5 (17.0)8 (27.0)4 (13.0)13 (43.0)0.012*

Values are presented as number (%). Type 1: Abnormal dyskinesis patterns with the prominence of an inferior medial scapular angle, excessive anterior tilting of the scapula. Type 2: Abnormal dyskinesis patterns with the excessive internal rotation of the scapula and prominent of the entire medial border. Type 3: Abnormal dyskinesis patterns with the prominence of the superior border and excessive upward translation of the scapula. Type 4: A pattern classified as “normal” and no asymmetry in bilateral scapular motion. RC, rotator cuff. *p < 0.05..

Table 3 . Comparison of rotator cuff repair shoulder and contralateral shoulder in the winged scapula.

VariableSubject shoulderp-value
RC repairnon-RC repair
Scapular winging (cm)1.98 ± 0.531.11 ± 0.54< 0.01**

Values are presented as mean ± standard deviation. RC, rotator cuff. **p < 0.01..

Table 4 . Comparison of muscle strength with and without scapular stabilization in RC repair and non-RC repair shoulder.

VariableGroupSNPSSPWithin-group changeBetween-group change
Shoulder abductionRC repair2.78 ± 1.563.45 ± 1.690.66 (–0.85 to –0.47)**3.90 (–4.86 to –2.94)**
Non-RC repair7.10 ± 3.406.94 ± 3.080.16 (–0.21 to 0.54)*
Elbow flexionRC repair5.66 ± 2.537.17 ± 3.501.51 (–1.97 to –1.04)**4.13 (–5.55 to 2.70)**
Non-RC repair9.66 ± 4.2010.86 ± 5.570.61 (–0.94 to –0.28)**
Forearm supinationRC repair2.43 ± 1.262.80 ± 1.510.37 (–0.56 to –0.18)**0.73 (–2.23 to –1.23)
Non-RC repair4.20 ± 0.994.56 ± 1.040.30 (–0.51 to –0.91)**

Values are presented as mean ± standard deviation or mean difference (95% CI). RC, rotator cuff; SNP, scapular natural position; SSP, scapular stabilization position. *p < 0.05, **p < 0.01..